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Plaintiff Counsel Outlines Kirk T. Settlement
December 6, 2000

Attorney Ed Tiryak, counsel for the plaintiff, has provided the following information in regard to the settlement of the Kirk T. lawsuit, filed against the Pennsylvania Department of Public Welfare (DPW). Final information will be available following distribution of the written settlement agreement.

Through a series of Mental Health Bulletins, letters, and other mechanisms, the following changes in the behavioral health (BH) system will occur. We expect the bulletins to be issued within 60 days, to be effective in another 60 days.

1. There will be a new standard for the timely delivery of services, which will be 60 days from the date of the request for service.

2. A new data gathering form will be required with packets, which will show how long people waited for services, and what percent of service was provided.

3. For children who are involved with two or less services (i.e. school and BH provider), the Interdisciplinary Team Meeting will be required by DPW only once per year. Packets must still be submitted as before. If they are also involved with Children &Youth, or the mental health system, they will require meetings as before.

4. DPW will relax the Therapeutic Staff Support (TSS) qualification standards as follows: TSS' will now include:

  1. Persons with a Bachelor's Degree in Psychology, Social Work, Education, Criminal Justice, or a related human service field;
  2. Persons with a Bachelor's Degree in any other field who have one year experience in paid work that involved direct contact with children or adolescents;
  3. Persons with an Associate's Degree, or sixty credits toward a degree, who have three years experience in paid work that involved direct contact with children or adolescents;
  4. Licensed registered nurses who have one year experience in paid work that involved direct contact with children or adolescents;
  5. Licensed practical nurses who have three years experience in paid work that involved direct contact with children and adolescents.
  6. All persons who currently qualify as TSS workers will continue to do so.

5. DPW will issue new training requirements for TSS workers. For TSS workers without prior TSS experience:

  1. Prior to working alone with children and adolescents, a worker must receive, and have documented in the agency's files, no fewer than fifteen hours of training.
  2. Within the first six months of working with children and adolescents, a worker must receive, and have documented in the agency's files, no less than an additional twenty-four hours of training.
  3. The overall training curriculum must include at least the following topics:
    1. Professional ethics, conduct, and legal issues including child protective services, mandated reporting, and confidentiality;
    2. Understanding and implementing CASSP principles and the role of the TSS worker in the home, school, and community, including accessing community resources;
    3. Crisis intervention, behavioral management, and safety;
    4. Overview of serious emotional disturbance and other behavioral needs in children and adolescents (with particular emphasis on the specific diagnoses of the children/adolescents with which they may be working);
    5. Collaboration with families;
    6. Supporting CASSP principles in actual clinical practice;
    7. Normal child/adolescent development;
    8. Behavior management skills;
    9. CPR/first aid/universal precautions/safety;
    10. Documentation skills; and
    11. Psychotropic medications/common side effects.

6. Within four months of the effective date of the settlement, the Department will require that all TSS workers receive at least twenty hours of documented training each year after the first year to acquire knowledge and skills related to the required job responsibilities and the population of children and adolescents who will receive services.

7. Within four months of the effective date, the Department will require that all TSS workers receive the following supervision before working alone with children or adolescents:

  1. TSS workers with less than six months TSS experience must receive at least six hours of on-site supervision by a qualified supervisor (while the TSS worker is providing service to the child or adolescent);
  2. TSS workers who are newly hired by a different agency, regardless of the amount of TSS or other experience, must receive a minimum of three hours of on-site supervision by a qualified supervisor (while the TSS worker is providing services to the child or adolescent).

8. Within four months of the effective date, the Department will require that all TSS workers receive the following ongoing supervision:

  1. TSS workers employed twenty hours per week or more must receive at least one hour of supervision per week, which from time to time must include some on-site supervision;
  2. TSS workers employed less than twenty hours per week must receive at least thirty minutes of supervision per week, which from time to time must include some on-site supervision.

9. Within four months of the effective date, the Department will establish a new procedure code, with a rate of $40 per hour, to be billed for:

  1. The initial six hours of on-site TSS service by and supervision of each new TSS worker;
  2. The three hours of on-site TSS service by and supervision of each TSS worker who is newly hired to an agency.

10. DPW will send a letter to all counties, advising them that they cannot grant or deny services, decide that TSSs can be used in schools, and the like.

11. DPW will clarify that psychiatric/psychological evaluations are good if conducted within 60 days of the intended initiation of services.

12. DPW will clarify how providers can use the 1130 process to get waivers of the rate for travel or salaries.

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