(a) Application.  This Section describes Office of Client Advocacy (OCA) advocacy services for Hissom class members who reside in Oklahoma.  Advocacy services are provided to Hissom class members consistent with OAC 340:2-3-71.  Orders of the United States District Court for the Northern District of Oklahoma in Homeward Bound, Inc., et al. vs. Hissom Memorial Center, et al., Case No. 85-C-437-TCK-SAJ, require the Oklahoma Department of Human Services (OKDHS) and OCA to provide independent advocacy services to individuals certified by the court as members of the plaintiff class, known as Hissom class members.  This includes but is not limited to:

• (1) independently advocating for class members rights and interests regarding: their daily lives, proposed movements, medical and behavioral emergencies including hospitalizations, appropriate consents, financial interests, and meetings held on their behalf;
• (2) challenging adverse service authorization actions through the OKDHS administrative appeal and/or grievance procedures; and
• (3) referral to protection and advocacy agencies in Oklahoma to obtain legal counsel and legal advocacy services.

(b) Assignment of advocate.  OCA assigns an advocate to each Hissom class member living in Oklahoma.  Clients are provided choices with regard to the advocate assigned to represent them to the extent feasible, taking into consideration the geographic location of the client's residence and the caseloads of OCA advocates.  Requests for a change in the advocate representing an individual are made to the advocate general or designee.  • 1 & 2

(c) Team membership.  As a representative of a Hissom class member living in a community residential placement, an OCA advocate is a member of the client's personal support team.  As a team member, the advocate receives from the client's Developmental Disabilities Services Division (DDSD) case manager timely notice of all team meetings, including emergency team meetings.  Within the team context, the advocate assists the client and represents the client's interests without relinquishing priority to client safety and rights.

(d) Guardianship issues.  The OCA advocate ensures the client has a current capacity assessment and attends capacity assessment meetings.  If a client with a full guardianship has sufficient capacity to require no guardian or only a limited guardian, the advocate promotes the filing of a petition with the guardianship court to limit or terminate the guardianship.  If the current capacity assessment of a client who does not have a guardian recommends a guardian or volunteer advocate, the OCA advocate participates with the team in identifying persons who might serve as guardian or advocate for the client.  This includes encouraging the development of friends in the community who might become a guardian or volunteer advocate for the client.  The OCA advocate monitors the implementation of the recommendations in the capacity assessment and advocates for their timely achievement.  When a guardian is needed and a suitable guardian has been identified, the advocate promotes the filing of a petition with the guardianship court to appoint a guardian.

(e) Advocacy and monitoring services for class members in residential community settings.  OCA advocates provide advocacy and monitoring to class members living in community residential settings, including group homes, to ensure compliance with policies, rules, and regulations applicable to the health, safety, and well-being of clients.  In addition to the activities described in OAC 340:2-3-71(h), advocacy and monitoring activities on behalf of each client include:

• (1) verifying a Form 06CB034E, Residential Pre-service Checklist, is completed prior to any change in residence, and making a home visit with the client within 30 calendar days after the client moves into a new residence;
• (2) a face-to-face visit with the client at least quarterly and more frequently as indicated, including:
• (A) site visits to a client's residence at least bi-annually, every five to seven months, at a time when the client is at home; and
• (B) visits with the client outside the home setting at least twice a year, every five to seven months; • 3
• (3) visits with the client at the request of the client, the client's legal guardian, or other person concerned about the well-being of the client;
• (4) completion of a service review twice a year, every five to seven months; • 4
• (5) in connection with each service review, verifying that direct contact staff have completed required training;
• (6) participating as a member of a client's personal support team;
• (7) attending annual individual plan (IP) meetings, interim meetings, and follow-up planning meetings;
• (8) attending emergency team meetings;
• (9) attending other team meetings when significant issues are addressed, including when a rights restriction or an intrusive behavior intervention strategy is contemplated or recommended;
• (10) attending guardianship assessment meetings of the client's team;
• (11) attending other team meetings at the request of the client, guardian, or involved family or friend;
• (12) requesting DDSD Quality Assurance to conduct an administrative inquiry of suspected provider contract violations in accordance with OAC 340:100-3-27;
• (13) assisting the client and the client's guardian or representative with the review of proposed financial agreements and contracts between the client and the provider;
• (14) prior to and during a hospitalization, advocating for the provision of adequate staff to be present in the hospital with the client as circumstances warrant;
• (15) review of documents, including, but not limited to:  assessments, IP and interim IP documents; incident reports; behavior data collection forms; and Adult Protective Services (APS) and OCA investigation findings;
• (16) attending mortality reviews conducted in accordance with OAC 340:100-3-35;
• (17) communicating to the client, the client's guardian, and the client's family as appropriate the final finding of an OCA investigation in which the client was named as an alleged victim;
• (18) attending legal proceedings involving the client, including guardianship proceedings, as warranted by the circumstances;
• (19) monitoring semi-annually the hot water in homes, using a thermometer to ensure the water does not exceed 114 degrees;
• (20) at least bi-annually, every five to seven months, verify that appropriate records are being kept with regard to an individual's personal finances; and
• (21) annually provide each client or guardian a copy of Form 15GR007E, Notice of Grievance Rights:  Hissom Class Members.

(f) Advocacy services for Hissom class members in a private intermediate care facility for the mentally retarded (ICF/MR).  Advocacy and monitoring services for class members who reside in a private ICF/MR in Oklahoma are contained in this subsection.

• (1) The assigned OCA advocate personally visits a client living in a private ICF/MR at least quarterly, and more frequently as warranted.
• (2) The OCA advocate maintains a helping relationship with the client, assessing the realization of desired and targeted outcomes, and initiating change through referral or grievance as needed.  During contacts with the client, the advocate inquires about individual satisfaction with current supports and provides information regarding options available to clients for community supports.
• (3) The OCA advocate, at least bi-annually, contacts the guardian of the client if one has been appointed.  The OCA advocate also contacts the guardian in response to an expression by the client of dissatisfaction with the current residential arrangements.  These contacts reaffirm the availability of service options to clients for support in community settings.  Contacts with the guardian occur in person, by phone, or by mail as the circumstances warrant.
• (4) The OCA advocate contacts the private ICF/MR case manager, generally a Qualified Mental Retardation Professional, responsible for yearly care planning for the client.  The advocate informs the facility case manager of the advocate's intent to attend yearly planning meetings.  The advocate asks to be notified in advance of yearly planning meetings and emergency meetings.  The advocate checks periodically to ensure meetings have not been held without notice to the advocate.
• (5) The OCA advocate participates in annual planning meetings at the private ICF/MR.  The advocate provides advocacy assistance regarding expressed desires of the individual.  The advocate brings to the attention of the team concerns expressed by the client, guardian, or other family members.  The advocate participates in interim meetings addressing any significant change in residence, work, health, or important relationships.
• (6) The OCA advocate develops a working knowledge of the facility's grievance procedure as well as other problem resolution processes and resources for change, for example, the Long-Term Care Ombudsman Program and licensing agencies.  The advocate uses these services, either directly or through referral, as needed for the benefit of the individual.
• (7) The OCA advocate assesses the welfare of the client and determines if advocacy assistance is needed which OCA can provide. The advocate provides assistance, either directly or through referral, with resolving concerns identified by the client or by others on behalf of the client.  This includes contacting the OKDHS Aging Services Division, long-term care ombudsman. The advocate also informs the Long-Term Care Ombudsman Office of concerns involving other individuals living in an ICF/MR which come to the attention of the OCA advocate.
• (8) Service reviews are not completed.
• (9)  The OCA advocate requests a capacity assessment on behalf of the client when there has been a substantial change in circumstances regarding the individual's need for a guardian.
• (10) The OCA advocate provides information and encouragement to consider community residential settings.

(g) Advocacy services for Hissom class members who are in custody.  Advocacy and monitoring services for class members who are in custody of the Department of Corrections or a county sheriff, except those who are detained pre-trial in a facility, are contained in this subsection.  The assigned OCA advocate contacts the client at least semi-annually.  • 5  The advocate assesses the welfare of the client and determines if advocacy assistance is needed that the advocate can provide. The advocate provides assistance, either directly or through referral, with resolving concerns identified by the client or by others on behalf of the client.  • 6  Advocacy assistance is provided with regard to enforcing the rights of clients under the Americans with Disabilities Act and other state and federal laws to the extent they are applicable to persons who are in custody.  • 7  When the client has less than a year remaining to serve in custody, the OCA advocate provides advocacy assistance with the DDSD case manager to commence transition planning.  The advocate participates in and monitors transition planning, representing the client's interests. • 8

(h) Services for Hissom class members who decline DDSD services.  Pursuant to OAC 340:100-3-11, class members and their legal representatives have the right to refuse services from OKDHS.  • 9 The OCA advocate for a class member who has declined DDSD services, contacts the individual bi-annually and remains available to assist with advocacy regarding non-specialized assistance when desired by the individual.  At least one of the contacts is face-to-face when feasible.