Q & A for Service Providers of Brain Injury Program or Developmental Disability Services

BDAP is the Brain Injury and Developmental Disabilities Advocacy Project. This is a pilot program funded by the Department of Disabilities, Aging, and Independent Living (DAIL) to provide independent advocacy regarding BIP or DD services to people who are on Brain Injury Program services or Developmental Disability Services programs. This includes conducting monitoring visits with service recipients at home, taking and investigating complaints, offering know-your-rights training, and making recommendations for changes or improvements to the service systems based on what we learn in providing these other services.

As a pilot project, BDAP will operate only in Franklin and Grand Isle Counties.

During the pilot, we will conduct at least 24 visits to people on the BI or DDS programs in their home setting. We will choose people to visit so that we can meet with people in different housing settings, people with different levels of need for supports, and people both with and without guardians.

Our goal is to get to know the people we meet with, give them a chance to share what they like and don’t like about their home or services privately, and ask for help with any problems or complaints they may have.

No. BDAP will visit at least 24 people during the pilot. We may visit more people if we receive complaints. If we need to visit someone because of a complaint, the access rules described here will apply.

No. While people who receive services have the right to meet privately, they may choose who participates in the visit. We expect some people may not want a private meeting, especially at first. We will work with the person we are visiting, home providers, case managers/service coordinators, and guardians to honor the service recipient’s preferences and support needs.

No. We would prefer to meet people in their homes, but we know some people may not want to meet the BDAP advocate for the first time at home. We can meet the person where they would like. We can also set up follow-up visits as we get to know people.

Yes. BDAP’s job is to advocate for the person who receives services, even if it is against the wishes of the guardian. If there is a conflict between what the service recipient wants and what the guardian wants, BDAP will listen to the service recipient.

The Department of Disabilities, Aging, and Independent Living (DAIL) has authorized BDAP to have access to any home or facility where an individual receives services funded by either BIP or DDS. If the service recipient wants the BDAP advocate to meet them in the home, this cannot be unreasonably denied.

The BDAP advocate is aware that services are being delivered in people’s homes and that there may be times when a visit is inconvenient or otherwise inappropriate. The advocate will take the specific circumstances into account in assessing whether a visit has been denied and will try to resolve the access issue with the Shared Living Provider, group home operator or other residential setting. Any visit that has been unreasonably denied will be reported to the DA/SSA and DAIL.

Yes. If a service recipient lives in a family home or with their guardian (a place that is not contracted by the agency to provide HCBS), they may deny access to the place. However, everyone who receives services has a right to meet with an advocate. If a guardian denies access to their home, they must allow the individual to meet with the advocate in another location.

When the BDAP advocate is  learning about concerns with the home or the services, they will always begin by listening to the person who is receiving services.  BDAP may want to hear from their support person to help us get to know the person getting services, to help them share their feelings or make complaints. We will take the lead from the person who receives services.

We also know some BIP and DDS recipients will not be able to communicate effectively with BDAP. In these cases, we will also talk with their parent or guardian to get direction about who should be included in a monitoring visit, get information about how services are being delivered, and take complaints.

It will be up to BDAP to determine whether a person cannot communicate their preferences for a monitoring visit with us.

DAIL has authorized service providers to share some information related to services, setting, guardianship status and contact information with BDAP. BDAP can request additional records and information with permission from the service recipient or their guardian. Please refer to our access and consent policies for a detailed list of the specific information that is shared with BDAP as a matter of course. 
BDAP does not need to provide a waiver or written authorization to get additional information, but we do need consent from service recipients or their guardians to investigate complaints and share information. BDAP will always request consent for the information we need to investigate complaints and will document it in our internal case records.

If we need to request information that is not controlled by DAIL or the DA/SSA, we may obtain written authorization from the service recipient or their legally responsible person per the organization’s HIPAA policy.

Please refer to our BDAP’s HIPAA policy if you have questions about how we treat Personal Health Information (PHI).

BDAP can only share information about individuals with the consent of the person receiving services or their guardian.

As we conduct monitoring visits and document trends, we can provide general information about what we’ve learned. There may be some issues or trends that we will want to point out as we learn about them; other kinds of information will be shared through reports to DAIL or the legislature.

No. The BDAP advocate is not required to report instances of abuse, neglect or exploitation. Generally, we will only report abuse, neglect or exploitation with the consent of the service recipient. There are times when we may choose to report abuse, neglect or exploitation without the consent of our client: 

1. risk of imminent harm, and 
2. where we are unable to obtain consent from the service recipient, but the legally responsible person has directed us not to.

Any action we take that is against the direction of the client or legally responsible person must first be approved by an ethics committee at Vermont Legal Aid.

No. We are not part of the Designated Agency or DAIL and we do not provide direct services so we will not file CIRs. If we learn of an unreported critical incident, we will investigate the issue and with consent report it to the proper agencies. 
DAIL will provide BDAP with contemporaneous copies of Critical Incident Reports per our Access to Information policy.

BDAP will take complaints that have to do with BIP or DD services and supports. These can be issues of actions, inactions, or decisions by provider agencies, staff, contractors, guardians, or others in the system. These can be issues that may affect the health, safety, welfare, rights, or quality of life of people who are receiving BIP or DD services and supports.

Examples of complaints BDAP can investigate:

• The person is being abused, neglected, or exploited.
• Problems with a home provider or staff in staffed or supervised housing model, such as the provider ignoring a person’s preferences or needs, or is not acting consistent with their rights.
• Problems with a case manager/service coordinator, such as communication, follow through, and other issues.
• Staffing problems, such as training, dignity and respect, and other issues.

When BDAP receives a complaint, we will generally respond in the following way:

1. Confirmation: If possible, BDAP will confirm that the person who receives services agrees there is a problem and wants it to be investigated. 
2. Goal identification: Identify with the person, or their guardian, how they would like the problem to be resolved. 
3. Investigation: Gather more information about the problem from the person, and other people who have information relevant to the complaint. 
4. Resolution: Advocate for their desired outcome through the lowest level of intervention appropriate.  
   • Some complaints may be able to resolved through informal advocacy during conversations, or email.
   • Some complaints may be resolved when BDAP attends a meeting with the person and their team.
   • If the complaint is a legal problem, BDAP may refer the issue to a lawyer.
5. Closure: The service recipient, and their guardian (if appropriate) will receive a letter summarizing the complaint, goal, investigation, and resolution.
   • BDAP cannot make guarantees that it can achieve the identified goal. When advocacy is completed, the complaint may be closed because the goal was achieved, partially achieved, or could not be achieved.
6. Referrals: With permission, if BDAP learns of problems that are outside the scope of the project, BDAP will refer complaints elsewhere.
   • For example, complaints that have to do with Choices for Care, nursing homes, or residential care homes, can be referred to the Vermont Long Term Care Ombudsman (VOP).
   • Similarly, BDAP can refer legal problems that are not about BIP or DDS to other projects within Vermont Legal Aid, to other legal service providers, or to the VBA lawyer referral service as appropriate.