Revised 7-1-09
1. Office of Client Advocacy (OCA) files. OCA maintains a client file for each Hissom class member and other Developmental Disabilities Services Division (DDSD) service recipient served by OCA who is not a resident of Southern Oklahoma Resource Center (SORC), Northern Oklahoma Resource Center of Enid (NORCE), or the Greer Center Facility (Greer) except for persons provided short-term advocacy services pursuant to OAC 340:2-3-75. Each client file contains documents for the previous two-year period. Documents older than that are purged, with the exception of client histories. Documents which OCA originated and which do not exist in an electronic form are archived. Other purged documents are shredded by OCA.
2. Training of advocates.
(1) Before a new OCA advocate is assigned to represent clients, the advocate attends DDSD Foundations Training or its substantial equivalent, unless the advocate previously completed that training, and receives on-the-job training.
(2) Before an OCA advocate assumes responsibility for a client, the advocate reviews the OCA client file, discusses the case with the previous advocate when possible, and becomes familiar with essential information about the client including specialized supports, rights restrictions and intrusive procedures, and pending informal problem resolution activities and grievances. The advocate also completes individual specific training when the advocate's supervisor or the OCA advocacy programs administrator determines that it is warranted.
3. Client rights. Source of information about a client's rights include but are not limited to: OAC 340:2-5-40, OAC 340:100-3-1.2; OAC 317:35-13-1, and OAC 612:10-1-6; the Developmental Disabilities Assistance and Bill of Rights Act [42 U.S.C. § 6000 et seq.]; Section 504 of the Rehabilitation Act of 1973 [29 U.S.C. § 794]; the Americans with Disabilities Act [42 U.S.C. § 12101 et seq.]; and the Civil Rights of Institutionalized Persons Act [42 U.S.C. § 1997 et seq.].
4. Scope of representation. In assigning advocates to represent clients, OCA avoids actual or perceived conflicts of interest which could prevent an advocate from being objective about the interests and preferences of a client. For example, an OCA advocate is not assigned to represent an individual who is related by blood or marriage to the advocate, or to represent an individual who is receiving services from a person related to the advocate. Advocates comply with OAC 340:2-1-8 the Rules of the Ethics Commission, and Oklahoma Law. [74 O.S. Chapter 62] An advocate represents the client's interests independent of the advocate's own biases, preferences, and belief systems. In advocating for the client's interests and preferences, an advocate does not support any action by the client or others which constitutes criminal activity or places the client at imminent risk of serious harm. An advocate supports providing clients with information necessary for informed and voluntary decision-making with knowledge of the potential consequences of a decision. The advocate explores with the client and the client's team alternatives which minimizes risk of harm to health, safety, or well-being of the client.
5. Transition process when a class member is assigned to a different advocate. In order to ensure OCA advocates are given timely and adequate notice of team meetings, emergency meetings, and similar type meetings, appropriate persons are informed whenever there is a change in the advocate assigned to support a class member or other DDSD client. The procedures when a different OCA advocate is selected for a client are listed in (1) through (7) of this Instruction.
(1) The former OCA advocate sends an e-mail to the case manager for the client and the case manager's supervisor to inform them of the change. The e-mail includes: the name of the new OCA advocate, his or her e-mail address and duty station, the effective date of the change, and a request that notices of meetings and information henceforth be sent to the new advocate. This e-mail is copied to the receiving advocate and his or her supervisor as well as the former advocate's supervisor. To ensure the information in the e-mail has been communicated, the former advocate also mails or sends by FAX a printed copy of the e-mail to the case manager or contacts the case manager by phone.
(2) The supervisor of the former OCA advocate immediately sends an e-mail to OCA transition coordinator to inform him or her of any changes in assignments. The transition coordinator immediately makes the change on the FY 2001 Hissom list.
(3) The former OCA advocate sends an e-mail to the receiving advocate notifying him or her of the dates of any meetings, other events, and deadlines which are pending, with special attention given to scheduled individual plan (IP) meetings. The e-mail also provides information about informal problem resolution activities on behalf of the client which are still pending, any pending grievances, and other pertinent information about the client and the client's team. This e-mail is copied to the receiving advocate's supervisor.
(4) The new OCA advocate contacts the case manager to discuss the status of the case and determine any pressing issues that may need attention.
(5) Within two weeks of the change in assignment, the former OCA advocate and the receiving advocate confer by telephone or in person, at which time the former advocate briefs the receiving advocate about the client and any pending matters of note.
(6) Within two weeks of the change in assignment, the former OCA advocate's supervisor transmits to the receiving advocate's supervisor the client's file, which is organized logically and neatly, and contains all information in the former OCA advocate's possession about the client. A completed "Case File Transition Checklist" is attached. The receiving supervisor notes the date and time of receipt of the client's file, by confirming receipt in an e-mail and noting it in the client file.
(7) When possible, the former OCA advocate has a transition meeting with the client to explain the change and to introduce the client to the receiving advocate. If such a meeting is not possible, the client, guardian(s), and residential and vocational providers are informed of the change by phone, e-mail, or letter.
6. Role of the advocate in resolving problems. The OCA advocate utilizes the client's case manager as a primary resource for resolving a client's support deficiencies. The role of the advocate is to report service deficiencies to those responsible for providing the service. However, an advocate takes immediate action appropriate under the circumstances in situations where the client is at imminent risk of harm, for example, preventing staff from using a defective piece of adaptive equipment. Following an action of this nature, the advocate immediately notifies the DDSD case manager, the case manager's supervisor, or the DDSD on-call administrator to report the circumstances that prompted the advocate's action and to request prompt follow-up to address the situation and to prevent reoccurrence. An OCA advocate does not function as a case manager or a provider of direct contact services for a client.
7. Informal problem resolution. Informal problem resolution activities include but are not limited to:
(1) contact with the case manager, seeking to resolve problems at the lowest possible level of administrative responsibility;
(2) requesting a team meeting;
(3) identifying and articulating client concerns during team meetings;
(4) acting to facilitate resolution of a problem;
(5) representing the preferences of the client in team meetings if known and capacity is not an issue;
(6) facilitating informed-consent decision-making by the client or guardian(s);
(7) identifying acceptable alternatives;
(8) filing an advocate's inquiry in accordance with OAC 340:2-3-51 or 340:2-3-52, whichever is applicable;
(9) advocating for proper implementation of state and federal laws and for changes in Oklahoma Department of Human Services (OKDHS) rules;
(10) facilitating information and referral on the client's behalf either with OKDHS personnel or other persons or entities who can provide problem resolution or support services; and
(11) assisting with making arrangements for mediation.
8. Grievances. When an OCA advocate files a grievance against OKDHS on behalf of a Hissom class member, the grievance format used includes at a minimum: the name of the client, the grievant if other than the client, the client's guardian if there is one, the provider, the case manager, the OCA advocate, and the guardian ad litem (GAL) representative if there is one; the issue being grieved, the facts relevant to the grievance; the grievant's contentions; relevant statutes, policies, and other authorities; the proposed solution; and the advocacy position of OCA. For each subsequent level the grievance is submitted for resolution, the grievance format used also provides the procedural history of the grievance, including a summary of the responses to the grievance at each level it was considered and relevant documentation.
9. Informing clients, guardians, caretakers, and others of OCA investigations. Sections 10-105.1 and 10-110(B)(5) of Title 43A, Oklahoma Statutes require OKDHS to provide notice to guardians, caretakers, custodians, and family members of vulnerable adults when a referral is received about a vulnerable adult, and to provide a summary of the investigation findings. To the extent this applies to referrals to OCA regarding Hissom class members residing in the community, DDSD policy [OAC 340:100-3-34] requires the provider agency to notify the guardian or family member when a referral is made to OCA about a class member. In order to ensure guardians and family members are aware of relevant information regarding their wards and relatives, OCA advocates adhere to the procedures listed in (1) through (6) of this Instruction for each Hissom class member represented by OCA.
(1) The OCA advocate assigned to a client informs the client and the client's guardian or GAL of the results of OCA investigations which involve the client. If an individual does not have a GAL or guardian, a parent or other family member actively involved in the individual's life may be informed. If the guardian or family member is the alleged perpetrator in the investigation, the OCA advocate's responsibility to inform him or her of the results does not change.
(2) The OCA advocate provides this information to the guardian or active family member by telephone, in person, or by sending a letter, using the method of communication suitable for the particular situation.
(3) This information is provided as soon as practicable, but no later than seven working days after an OCA investigation finding has become final. An investigation involving a Hissom class member is considered "final" if the allegation:
(A) is not against a community services worker (CSW), the date the investigation report is approved by the advocate general;
(B) involves a CSW and is ruled out, the date OCA sends the notice to the CSW pursuant to OAC 340:100-3-39(h)(1) informing the CSW that the allegation was ruled out;
(C) involves a CSW and is confirmed, the date OCA sends a letter to the CSW pursuant to OAC 340:100-3-39(h)(B) informing the CSW of the result of the CSW reconsideration request, or the date which is the deadline for the CSW to request reconsideration when none was timely received by OCA. If reconsideration has been denied, a CSW has the right to request a hearing before an administrative law judge to review OCA findings before his or her name is placed on the CSW Registry, in accordance with OAC 340:100-3-39(h)(5). Hence, when informing a client, guardian, or family member of the results of the investigation, the advocate clearly states that OCA finding is provisional subject to further administrative review. OCA advocates are familiar with the CSW Registry and related policies in order to answer questions clients, guardians, and family members have about it.
(4) The advocate only provides a summary of the findings of an OCA investigation. In accordance with OCA statutory obligations to maintain confidentiality, copies of OCA investigation reports are disseminated in accordance with OAC 2-3-32(b).
(5) In providing a summary of the findings, confidentiality of information regarding minors and DDSD clients is maintained. In addition, the identity of persons reporting incidents which are referred to OCA is confidential by statute and is not disclosed.
(6) Briefings of guardians and family members about OCA investigative findings are documented in a contact sheet in OCA computerized database.
10. Guardian's authority to make end-of-life decisions. A guardian does not have authority to consent to a do-not-resuscitate (DNR) order merely because he or she is a guardian of a ward. Oklahoma's Guardianship and Conservatorship Act requires a guardian to obtain a court order which authorizes the guardian to make DNR decisions on behalf of a ward. [30 O.S. § 3-119(1)] In the absence of an order, a guardian can only communicate to a physician facts about the known values and preferences of the ward, on the basis of which the physician can determine whether there is clear and convincing evidence of the client's desires with regard to a DNR order. If a client has never had the ability to communicate, verbally or non-verbally, the client's wishes with regard to end of life issues, clear and convincing evidence does not exist.