Mind and Body

New noncompliance problems emerge with developmental disability system

Rhode Island may revoke license of a private agency, Community Work Services, run by Fedcap Rehabilitation Services, where Craig Stenning now works as an executive

File photo by Richard Asinof

Craig Stenning, who is the executive vice president of Fedcap Rehabilitation Services for the New England region, was recently named the executive director of Community Work Services, a division of Fedcap. Community Work Services, a private agency operating under a state contract, has come under increased scrutiny because of its failures to meet court-ordered deadlines for developmental disability services, despite intensive state supervision.

By Gina Macris
Posted 10/9/17
The continuing failure of a private agency, Community Work Services, to meet court-imposed deadlines had raised new problems of noncompliance in developmental disabilities for the state of Rhode Island. The license of the private agency may be in jeopardy.
What other problems have emerged in other states with the contractual work on developmental disabilities and human services being done by Fedcap Rehabilitation Services? Are there any potential conflicts of interests regarding the employment relationship of Craig Stenning with Fedcap Rehabilitation Services and his previous work with as director of BHDDH? How much money is being spent by the state to correct the deficiencies in services to the developmental disability population? If the license for Community Work Services is revoked, what happens next?
The health and human services infrastructure in Rhode Island appears to be crumbling, suffering from years of a lack of investment by the state. The Joint Commission recently issued a preliminary denial of accreditation for the Eleanor Slater Hospital, the state’s psychiatric hospital. State officials blamed the problems on an “aging facility.”
The R.I. Department of Children, Youth and Families, despite new leadership, still seems to be operating in a crisis mode, reacting to each new emergency.
The costs of the continuing efforts to correct the deficiencies in the Deloitte software system that under girds the United Health Infrastructure Project, or UHIP, keep mounting, estimating to reach nearly $450 million by next year.
Meanwhile the clock is ticking on how to reconcile some $40 million in interim payments paid to long-term care facilities for Medicaid eligible patients. The likelihood is that the state may face a large loss of funds if and when the numbers do not match up.
Despite efforts to improve the wages for home health workers and those who care for adults with developmental disabilities, agencies are still having difficulty hiring and retaining workers because of the low wages, making it difficult to provide services.
The R.I. Department of Health has had its operating budget cut by some 23 percent in state funds over the past few years.
Now, with the latest news on the developmental disability front, the state may face large penalties for failure to live up to its 2013 and 2014 agreements.

PROVIDENCE – Continuing difficulties at the former sheltered workshop that stood for everything wrong with Rhode Island’s developmental disability system appear to have caused new noncompliance problems for the state in U.S. District Court.

The problems revolve around one private agency, Community Work Services, a program of the New York-based Fedcap Rehabilitation Services. But the state is accountable to the court for the way it manages its service vendors and for ensuring that adults with developmental disabilities receive high-quality supports under provisions of 2013 and 2014 agreements with the U.S. Department of Justice.

In both settlements, Rhode Island agreed to end segregation of adults with developmental disabilities – a violation of the Americans With Disabilities Act – and instead to offer them the choice of supported employment and integrated non-work activities.

Community Work Services was hired in 2013 to correct Americans With Disabilities Act violations at the former sheltered workshop, Training Through Placement, but which itself has operated under one form or another of state supervision for 17 months and nearly lost its license earlier this year.

Missed deadlines
According to the latest report of a federal court monitor, the state has missed two deadlines: one, a July 30, 2017, deadline for improving the quality of individual career plans; and another, a June 30, 2017, deadline for verifying the accuracy of data reported by Community Work Services on its clients’ progress.

Despite the state’s efforts to resolve inconsistencies in the reporting data, “Problems continue to exist with the information provided by [Community Work Services],” according to a Sept. 7 report issued by the court-appointed monitor, Charles Moseley, to U.S. District Court Judge John J. McConnell.

The state, the monitor, and the Department of Justice use that data to determine whether Community Work Services is following the requirements of the Americans With Disabilities Act agreements.

Blueprints, not paperwork
The so-called “career development plans” are not supposed to be just paperwork, but blueprints that allow officials to see in an instant how the services a client currently receives fit into individualized short-term and long-term goals, according to the court agreement.

The plans are supposed to reflect a key principle embodied in the Americans with Disabilities Act: that people with disabilities have choices in how they live their lives.

In Moseley’s Sept. 7 report, the monitor also said 70 percent of the clients’ career plans were “unacceptable” and had not been improved a month after the judge’s July 30 deadline, despite the state’s efforts.

For most of the 64 individuals who are active Community Work Services clients, the daily activities and yearly individual service plans didn’t line up with the long-range career development plans, according to Moseley.

In other cases, the long-range plans were “well done,” but the plans were “not being implemented in a manner which aligns with the participants’ interests,” Moseley said.

Neither the Department of Justice nor Judge McConnell have responded on the record to Moseley’s latest findings, although McConnell has said in the most recent hearing on the so-called “interim settlement agreement” of 2013 that he considers himself personally responsible for defending the rights of some 125 individuals protected by the agreement.

Connection to Craig Stenning
Community Work Services, a Boston-based agency, came to Rhode Island in 2013 as a program of Fedcap, hired by Craig Stenning, then director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to get a jump start on turning around the state’s developmental disability system in the wake of the interim settlement agreement of 2013 and the broader consent decree of 2014.

Between 2013 and 2014, Fedcap was awarded a total of about $1.7 million in state contracts. In 2015, Stenning, following his departure as director at BHDDH, joined the Fedcap senior management team.

As part of the state’s arrangement with Fedcap, Community Work Services took over the Training Through Placement [TTP] program, which had used the Birch Academy at Mount Pleasant High School as a feeder for its sheltered workshop. There, adults with developmental disabilities performed repetitive tasks, sometimes for decades, at sub-minimum wages, even when they expressed a desire to do something else.

License in jeopardy?
At a federal court hearing in May of 2017, the monitor, Moseley, told Judge McConnell that the number of former TTP clients who have found regular jobs in the community has remained “essentially flat” for the last four years. Most of the former TTP clients still received services from Community Work Services.

At that point, Community Work Services itself had been operating under one or another form of state supervision since May of 2016, as a result of both programmatic deficiencies and substandard facilities at the former TTP building in North Providence.

In his most recent Sept. 7 report, Moseley disclosed that state officials had notified Community Work Services in early May – about two weeks before the federal court hearing – that they intended to revoke the private agency’s license. But state officials changed their minds after a conference with Community Work Services’ representatives, the monitor said.

Instead of revoking the license, the R.I. Division of Developmental Disabilities decided to give Community Work Services one last chance by continuing the agency’s probationary status from July 1 to Sept. 30, with the possibility of only one more extension, until Dec. 31. The current status of the license is not clear.

Moseley said Community Work Services has brought on new staff, including a deputy director, a job developer and a new position with responsibilities for data and reporting.

According to the Community Work Services’ website, it also has a new executive director, Craig Stenning, Fedcap’s senior vice president for the New England Region and the former BHDDH director.

Extensive oversight
Less than a year after Stenning’s departure in early 2015 as the director at BHDDH – when Gov. Gina Raimondo declined to reappoint him – the Department of Justice and the court-appointed monitor asked the U.S. District Court for judicial assistance in enforcing the companion agreements of 2013 and 2014, citing a lack of progress by the state.

As a result, McConnell took up the combined cases and held the first hearing in January of 2016. Since then, the judge has held periodic reviews from the bench.

Moseley’s Sept. 7, 2017, report described the extensive state supervision dedicated to Community Work Services. Licensing officials make monthly regulatory reviews of Community Work Services. In addition, there are unannounced monthly visits coordinated with the state’s chief quality improvement officer for developmental disabilities. Supplementary phone calls and emails from state officials to Community Work Services occur at least once a week.

Meanwhile, the state’s chief employment officer for developmental disabilities provides on-site technical assistance to Community Work Services’ job developers, reviewing day-to-day activities and observing so-called “person-centered” planning meetings that are designed to put the needs and preferences of the clients first.

In earlier reports, Moseley has said the state simply does not have enough personnel to provide a fully functioning quality assurance program across the board to verify that some three-dozen service providers are complying with the “person-first” principles and practices of the Americans with Disabilities Act. He has required the R.I. Division of Developmental Disabilities to take steps to create one.

Currently, the R.I. Division of Developmental Disabilities has 24 caseworkers and a handful of supervisory personnel and support staff to manage the needs of a total of about 4,350 individuals. [About 3,700 individuals receive day-to-day services.]

After learning that there had been little change at Community Work Services since 2013, McConnell said he was angered on behalf of those who are “years late in terms of getting the services that the state agreed to,” according to a transcript of the hearing on May 23.

Addressing lawyers and state officials before him, McConnell said: “The truth is that we all [have] these hundred-odd people’s rights in our hands.”

McConnell continued. “I don’t take that lightly. I will use whatever powers that I have available to me to ensure that those individuals aren’t forgotten. Dr. Moseley always reminds me that we’re talking about individuals here and not alphabet soups and programs and whatnot. And this time it’s got to stick.”

Praise for the high school, city
McConnell concluded on what he described as an “optimistic note” for Providence city officials, whom he said had made substantial changes at Mount Pleasant High School during the last few years, enabling special education students who otherwise would have been completely segregated to become part of the broader student body and to have school-to-work experiences in the community.

“Keep up the good work,” the judge told school and city officials. “It doesn’t mean you’re at the finish line, but you’ve showed us that it can be done.”


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