On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
D.C.’s Department on Disability Services (DDS) is not continuing its 14-year partnership with Georgetown University. At the center of that partnership is the Developmental Disabilities Administration Health Initiative, a program that serves people with developmental disabilities. DDS will bring some services in-house, while others will be offered through another government contractor.
Public pushback started swiftly after the change was announced. Advocates are concerned that the transition is happening too quickly and that there wasn’t enough time for public input. D.C. has a troubled history when it comes to taking care of individuals with developmental disabilities. Until 2017, the U.S. court supervised the District’s care for people with intellectual and developmental disabilities.
Why is DDS not renewing its contract with Georgetown University, and how is it planning to transition these services? What are the concerns from advocates and stakeholders?
Produced by Cydney Grannan
- Mitch Ryals Loose Lips reporter, Washington City Paper; @mitchryals
- Andy Reese Director, D.C.'s Department on Disability Services (DDS); @DDS_DC
- Morgan Whitlatch Legal Director, Quality Trust for Individuals with Disabilities
- Marisa Brown Former Director, DC Developmental Disabilities Health Initiative at Georgetown University
KOJO NNAMDIWelcome back. D.C.'s Department on Disability Services is ending a partnership with Georgetown University. This partnership has provided medical and social services for people with developmental disabilities for the past 14 years. Advocates are concerned about what this change means for people receiving these services. Joining me to talk about these services is Mitch Ryals. He is the Loose Lips reporter for Washington City Paper. Hi, Mitch. How's it going?
MITCH RYALSGood, Kojo. How are you?
NNAMDII am well. Mitch, D.C. has had a troubled history of caring for people with disabilities. There was a decades-long lawsuit brought against the District over its services and its treatment of people with disabilities. Can you remind us, how did an outside entity -- in this case, Georgetown University -- end up participating in the city's disability services?
RYALSRight. So, the somewhat notorious asylum, Forest Haven, is the source of this litigation, and had the District under federal court supervision for about 40 years. And throughout the course of that court monitoring, Georgetown became a part of this conversation.
NNAMDIHow and when did the lawsuit end? Because, as I remember, the lawsuit started in like 1976, because the District, at that point, used to have people with disabilities housed at Forest Haven. And that facility had become notorious for mistreatment of people. So, how and when did the lawsuit finally end?
RYALSThat's right. The lawsuit finally ended in 2017. And at that hearing, when the judge finally released the District of all the supervision, I think former Mayor Vince Gray, Mayor Bowser were all in attendance. And there was -- I wasn't at the hearing, but I've read the transcript of it, and it was kind of a celebratory occasion, as far as the transcript reads.
NNAMDIAnd that happened when it was finally released in 2017?
NNAMDIOkay. Joining us now by phone is Marissa Brown. Marissa Brown is the former -- now retired -- director of the DC Developmental Disabilities Health Initiative at Georgetown University. Marisa Brown, thank you for joining us.
MARISA BROWNYou're welcome.
NNAMDIAs we start this conversation, there are two terms we need to define: developmental disability and intellectual disability. What do these terms mean?
BROWNYeah, so, developmental disabilities is a group of disabilities that are identified before a person reaches their 18th birthday. And intellectual disability is one of those developmental disabilities. And it's characterized by significant limitations and intellectual functioning -- so reasoning, learning, problem solving and adaptive behavior, which covers a range of everyday social and practical skills. The disability also originates before the age of 18. The Developmental Disabilities Administration in D.C. only serves adults who have been diagnosed with an intellectual disability.
NNAMDIMarisa Brown, how did Georgetown become the city's partner in these services?
BROWNWell, we're part of a network of National University Centers for Excellence and Developmental Disabilities. So, this is work -- there's a group of specialists. They are at that center. And when the District sent out a request for proposals in 2005, it was just a couple of years after the federal surgeon general issued a report called Closing the Gap. And that report, to me, was inspiring. And this project was an opportunity to bring it to life for people in the District of Columbia.
NNAMDIWhat needs were the Georgetown project, known as the Developmental Disabilities Health Initiative, designed to address?
BROWNWell, it was a range of things, because people with intellectual disabilities experience health disparities, which are complex and require, really, a coordinated comprehensive approach. So, we first -- one of the items was health promotion. We have a dedicated health educator, and she worked with people who were experiencing difficulty in maintaining their health, and provided one-on-one education. She also provided sexuality education to some of the most vulnerable people, whose actions really represent years of trauma. And they require specialized and consistent report.
BROWNSecond, we worked on increasing knowledge in the community. We developed evaluation reports to help the District understand the nature of health issues, and if current policies and practices are effective. One study looked at health screening after new policies were in place and showed that people receiving services from DDA were able to have screening rates higher than even for the general population. So, they were finally receiving cancer screenings, high blood pressure, cholesterol screenings.
BROWNAnd this is particularly noteworthy in light of the predominantly African American population of people receiving services, where untreated high blood pressure can lead to stroke, kidney disease and diabetes.
BROWNThird, we were working on improving the quality of healthcare. One of the earliest challenges we identified was that people were staying in the hospital a lot longer than they needed to. So, we started with a medical director, began a dialogue with hospital physicians and primary care physicians. And, ultimately, we hired an experienced nurse who assumed responsibility for hospital visits, making sure that once a person was home, all of their proper treatment regiments were properly in place.
BROWNAnother really successful quality initiative was supports for parents who themselves have intellectual disabilities. And this was more than parent education. Highly skilled home visitors walk with parents in their everyday interactions with schools, physicians, child welfare representatives, and promoted co-parenting if the family was separated.
BROWNOther activities were implementation of dementia screening, development of capacity to better understand end-of-life considerations, and support to community agencies to implement trauma-informed care practices.
NNAMDII wanted to ask about that. What is trauma-informed care practices, and why does the initiative focus on it for people with disability?
BROWNRight. So, trauma-informed care is a means of identifying experiences that people have had from early childhood through adulthood. And there are certain experiences that are known to then produce these long-lasting effects that really impact the person's ability to successfully navigate through life. We knew that this was important for people with disabilities, because there are known higher rates of sexual abuse, physical abuse, separation from family, and many times separation from caregivers because of low-paying wages for direct support professionals that, you know, cause a grief reaction in the person.
BROWNSo, the team at Georgetown worked with other people doing work in this area, trauma-informed care, to develop and test a way of measuring trauma in people's disabilities, and working with providers to make sure that the supports they are giving people recognize trauma, and then are able to address it.
NNAMDIWhen this health initiative started, it was the result of a court order. That court already essentially ended in 2017. But was it the idea that this program would be a permanent fixture, or that DDS or other contractors might, at some point, take it over?
BROWNWell, every year, I used to ask the former director at the department if her intention was to increase capacity within their own employees to do this. Because this could require, possibly, training, certainly an exchange of ideas, like how are we doing our work, specifically. And then really, third, importantly, I mean, the people who are employed now at the Developmental Disability Administration have busy jobs. And so, if they're going to take on new aspects of work, you really have to figure out how is their current work maintained when they're asked to take on new responsibilities.
BROWNBut, at the time, probably because of the court order, they weren't interested in the capacity building. So, I think I had always envisioned that there would be some type of an exchange or transition that, in my opinion, would require at least a year to really kind of talk this through, get the input from the community about what is important to them -- where do we want to go going forward?
BROWNThe project, under my direction for 12 years, was always looking forward to the next things. What are the things that we're learning about the system? What are new ways of supporting people with disabilities? And how can we get that started here in the District?
NNAMDIMarisa Brown is the former, now retired director of the DC Developmental Disabilities Health Initiatives at Georgetown University. Thank you so much for joining us.
BROWNYou are most welcome.
NNAMDIJoining me in studio is Andy Reese, director of the Department on Disability Services in the District of Columbia. Andy Reese, thank you for joining us.
ANDY REESEThank you, Kojo. Good afternoon.
NNAMDIWhy is the Department on Developmental Services not renewing its contract with Georgetown University?
REESEIt isn't really that we're not renewing the contract. The contract was issued five years ago. It was one year, with four option years, and that expires in August. So, what we needed to start doing, as that was expiring, was to look forward to how we would continue to provide those services that were provided under that contract beyond the date that that one expired.
REESEThere are a number of different ways we've done that. I could detail them for you, but some of the services in the contract -- for example, the parenting services that Ms. Brown spoke about, the parenting support for people -- education for people who are parenting, we worked with Georgetown two years ago, so that we could add that as one of our Medicaid waiver services. Also, the health supports that are provided to people, these wellness services, which include sexuality education, nutrition. We've also added those to our Medicaid waiver.
REESEBy providing those services through the waiver, we're allowing people to choose between a number of different providers who can provide that support. And we're providing the support in a way that allows us to receive 70 percent federal support for providing it.
NNAMDIIndeed, if you're going to be receiving 70 percent federal support, is part of this decision financial? Is the District saving money by ending its contract with Georgetown?
REESEThe decision that we made was not based on the finances. The reality is that there is some savings, because we are able to do things that will allow us to capture some federal reimbursement that we were not able to get with the Georgetown contract. But the very first thing that we considered with each service under this was ensuring that every service that any person from Department on Disability Services currently receives would continue, and that we would ensure that the people supported by our agency continue to receive the same high quality services that they have been receiving all along. And we feel very confident that we have a plan in place so that people are transitioning at this time into a different service provider, but maintaining the same services.
NNAMDIJoining me in studio now is Morgan Whitlatch, legal director for Quality Trust for Individuals with Disabilities. That's a nonprofit organization focused on improving the lives of people with disabilities. Morgan Whitlatch, thank you for joining us.
MORGAN WHITLATCHThank you.
NNAMDII know that Quality Trust along with other advocates is concerned about this change. One issue is how the manner in which D.C. has engaged with the public through this process. What has the communication been like?
WHITLATCHSo, I think it's very important to realize that the Georgetown contract, as described by Marisa Brown, is very multimodal in terms of the services that it did. And I do believe that DDS has done outreach with the stakeholder community with respect to the new waiver services that they're discussing, beginning in 2017. But I really think the discussion of the waiver services is a big of red herring in this argument.
WHITLATCHQuality Trust is concerned about the healthcare coordination component associated with the contract, the health promotion piece that we've been discussing here, because of the health and safety of D.C. residents with intellectual and developmental disabilities. And it's that piece that we feel has not received adequate stakeholder input. The community was not informed in a kind of really timely way about the intention to not renew the Georgetown contract, or to seek input into what kinds of services are needed going into the future, now that the lawsuit associated with Forest Haven is closed.
WHITLATCHAnd so we really do believe that there needs to be an extension of the contract to allow time for that conversation. A meaningful discussion with a large group of stakeholders is what needs to inform something that's so critical as healthcare, given that we really are talking about life and death, here. And that's not hyperbole.
NNAMDIAndy Reese, could you quickly walk us through the timeline for the transition of services from Georgetown's contract to DDS and the new contractor? How have you been working to transition services?
REESEYeah, I'd be glad. I'd also like to address the issue that Ms. Whitlatch just raised, which is that, you know, the healthcare that's provided related to this -- a physician and a nurse -- what we've done is change contractors. We still have a contracted physician, and we have a nurse on our staff who is a nurse practitioner. So, we will be providing the same service going forward as is currently being provided, but through a different contractor.
REESESo, in terms of the transition, we actually started speaking with Georgetown regarding this transition back in December when we met with them. And, at that time, we raised questions about part of the development of our system here in the District has been education that's provided to our providers. It's available on the website, all of these materials that were developed through this contract. And we talked with them about after the ending of the contract, how would that continue.
REESEThis summer, we began, then, to identify specifically who were the people currently who are getting services through Georgetown. So, when we talk about parenting, the report that we had when we met with Georgetown is that 20 parents were getting that support. Of those, many of them are actually going to continue with Georgetown through a separate grant that they received from the DC Health Department. So, we're working with all of them to see who will continue and who needs to identify a new provider.
REESEIn the health promotion, the person that provides the wellness services actually had been on leave for a number of months. But we still went in and looked at people who she had been working with over time, identified with all of them who would need a provider, and make sure and connect them. The most important piece in terms of the transition from one physician to another is that this Monday, the new contracted physician will start to receive the referrals of people with complex health needs. The Georgetown physician will remain on until the end of the month, and they'll be conferring about the ongoing cases.
NNAMDIWell, there are a lot of people who would like to address this issue. Some of them are relatives of persons with disabilities who have called. So, if you've called, stay on the line. We do have to take a short break. When we come back, we'll continue the conversation and get to your calls. I'm Kojo Nnamdi.
NNAMDIWelcome back. We're discussing upcoming changes in D.C. disability services with Mitch Ryals, who is the Loose Lips reporter for the Washington City Paper. Mitch, let's talk politics. Mayor Muriel Bowser and D.C. Council Chairman Phil Mendelson received a letter from former directors of disability agencies outside of the District. What did the letter say, and why did these former directors -- who, again, were from other states -- feel compelled to send it?
RYALSThat's right. I can't remember exactly how many of these directors, but they were raising concerns, you know, saying, essentially, the lawsuit that the District had been a part of, the federal court monitoring had an impact and how they provided services in their own states. And that, I guess, they cautioned the District from backing away from the Georgetown contract.
NNAMDIAnd I know that Councilmember Brianne Nadeau has been holding hearings. In fact, she called a roundtable. She heads the Committee on health and human services. She called a roundtable to talk about this change during the D.C. Council's recess. How has the Council responded to what's happened?
RYALSWell, after the hearing -- which was fairly well attended, as far as I could tell -- Councilmember Nadeau sent two letters, one to DDS, requesting, basically, weekly updates on how each of the individuals receiving services under the Georgetown contract would be transitioned to a new provider. And the second letter, which was signed by all 13 Council members, requested Mayor Bowser to, I guess, reexamine DDS's decision to move away from this contract and potentially consider a transition period. I think they suggested maybe nine months to a year, if I recall correctly.
NNAMDIAnd, Andy Reese, quickly before I go to the phones, allow me to read a couple of Tweets and then ask a question. Maria Tweets: this show is important for both the impacted the community in D.C., but also for those of us who asked the courts to protect the rights of vulnerable populations and believe that the judiciary can improve people's lives. Backsliding because the court isn't watching is not right. You have found a contractor for some of this work. DDS did not issue a public request for proposals. You ended up with MOTIR as a contractor.
NNAMDIWe got a Tweet from Bob, who said: why did Bowser refuse to put a competitive request for proposals for this initiative? Was it to squash external oversight? Why MOTIR, and what will this company be doing for the city?
RYALSJust to be clear, MOTIR is a contractor we're using for the physician. For some of the other services, we're using our waiver providers. And, you know, the letter that I got from the former directors really spoke to the issue of their impression at the time that everything was being brought in-house, which was not accurate.
RYALSBut in terms of MOTIR, MOTIR is a D.C. supply schedule provider. They already have a contract with the District. We had another contract end earlier in the year, through which we were providing clinical services. And so we had issued what's called a request for task order proposals, essentially going out to all of the D.C. supply schedule providers who provide professional services, to ask them if they could meet this need for clinical services.
RYALSAnd then when the issue arose with Georgetown, we approached MOTIR -- who had been awarded that contract -- we approached MOTIR to see if they could expand to also provide the services of a physician with experience in providing care to people with intellectual disabilities. And they were able to do so.
NNAMDIMitch Ryals, again, back to the politics: MOTIR is a certified business enterprise in the District. It is also a campaign contributor. Is that an issue?
RYALSWell, it's certainly notable. Its president, Emmanuel Irono, I believe is his name, has donated thousands of dollars to mayoral administrations, including Mayor Bowser. I can't draw a direct connection, but it's worth noting.
NNAMDIOn to the phones, here is Sheoma in Washington, D.C. Sheoma, you're on the air. Go ahead, please.
SHEOMAThank you for having -- taking my call. So, Director Reese and the rest of the panel, I'm Sheoma Woom (sounds like). My parents are involved. My children are very young. They're not very, very young. They're six and eight. And because of the Georgetown impact on DDS, I have been really a student and learned so much. I've drawn really close to DDS through (unintelligible) practice. I sat on a family support council...
NNAMDI(overlapping) Okay. We don't have a lot of time. What are your concerns?
SHEOMASo, yeah, there are processes that we are accustomed to that have been going on for years, where issues of this nature are brought to the families. And we're given the opportunity to participate using the family center practices that Georgetown has taught us all. And I wonder why that hasn't happened, in this case.
NNAMDI(overlapping) Okay. Andy Reese, can you respond to that?
REESEYes, and she raises a good point. The reality is the department does an excellent job of working with stakeholders. And, in this instance, in our work regarding the waiver services, we did that. In the work regarding the other services -- which are really contractual services that are supports to our providers and our agency -- we didn't do that. And our communication in the work that we did really was not in line with what we have typically done.
REESEIt does not mean, however, that we weren't able, through the process that we did have, to put really qualified people in place. We have a very solid transition plan going forward. We are very concerned about the needs of the people. We didn't do the same work. We usually do an exceptional job in gauging our stakeholders.
NNAMDI(overlapping) Morgan Whitlatch, in addition to that, one aspect that your organization, Quality Trust, is concerned with is what we discussed earlier, facilitating hospital care for people with disabilities.
WHITLATCHYes. We are very concerned about that. Right now, that requires really intensive support that's coming from a very qualified, you know, nationally recognized University Center of Excellence for Developmental Disabilities. We're talking about people who have very complicated medical needs. And we are very concerned that with the juxtaposition in the way this has been done without input from the stakeholder community about what's important to them, the safeguards that have been put in place that have been being provided through the Georgetown contract will not be as robust.
WHITLATCHAnd I would just add that I think when we think about the transition plan that was developed by DDS -- really, on the eve of the Council hearing -- that doesn't have stakeholder input into it, we have to be concerned and consider that to be a fatal flaw in that plan.
NNAMDIOn to Seth, in New Jersey. Seth, you're on the air. Go ahead, please.
SETHYeah, hi, Kojo. I'm Seth Keller. I'm the past president of the American Academy of Developmental Medicine and Dentistry National Task Group on Intellectual Disabilities and Dementia Practices. And I work nationally, Kojo, and what we do nationally is to help with the issues of accessing quality of healthcare services for adults with intellectual and developmental disabilities.
SETHAnd I think the key thing, overall, as we can all appreciate, is quality, quality of care, quality of services. And one thing that's really endemic in the United States is that the healthcare providers and others are not really receiving a formalized education training through their practices, through their medical societies or medical schools. And so we work nationally with various states, and I have worked in D.C. I went to George Washington University, and I've been to Georgetown. And we actually are there to kind of help work with different organizations and groups to ensure there's access and quality of DD services for health care.
SETHAnd without that kind of level of, you know, training to go from, you know, a level of services that are expertise in DD care and services is really important as people transition from, you know, one provider to another, because of level -- because these are really complex patients, individuals with IDD, with, you know, various behavioral problems or health issues are very complicated. And, really, to maintain a level of care, Kojo, it's really important to make sure that that access and quality is maintained.
NNAMDIAnd you think that that was happening at Georgetown University, and your fear is that that may not continue if the city takes over?
SETHAbsolutely. I mean, I think that that would be the key thing to ensure quality. You know, how does one measure quality, you know, Kojo, ensure that that level of quality is maintained? And I think, you know, people that receive the services themselves or will access service, Kojo, would want us to ensure that.
NNAMDIThank you very much for your call. Mitch Ryals, the city got into trouble before for poor management of disability services. Obviously, people have questions about whether the city is ready to stand up and provide service on its own, at this point. I know that Councilmember Brianne Nadeau is pursuing this issue. What's she doing?
RYALSAs a I said before, she's asked the Department of Disabilities Services to send, essentially, weekly status reports on how each of these people are transitioned. And she kind of circulated that letter, which all 13 Council members signed asking for some reconsideration from the mayor. It doesn't appear the administration is willing to take any action, as far as I've seen.
NNAMDII got a sense too that the entire Council would like to see the process slowed down, significantly.
RYALSThat's right, yeah.
NNAMDIOkay. We got an email from Robin: The services offered through the health initiative contract provide critical support that helps people with intellectual and developmental disabilities live healthy lives in our community. Ending the contract is taking a step back, and no reason has been provided for ending this long-term, positive relationship.
NNAMDIWell, Andy Reese has provided some of the rationales of the D.C. government. But she says nothing without us is a core value of the disability community. For far too long, decisions have been made for, rather than by people with disabilities. Any changes to this critical program should be considered only after the people served by it and their family members and supporters have had a meaningful opportunity to participate in this conversation. Obviously, Morgan Whitlatch, that's something you feel about very strongly.
WHITLATCHWe really do, you know. And we're really calling upon Mayor Bowser to live up to the commitment that she made at the close of the Evans litigation in January, 2017. She said that they were going to maintain the investments that they reached to do the court milestones and ensure improved services for district residents served by DDA. And we're really concerned that this represents a backslide from that commitment.
NNAMDIAnd, Andy Reese, what assurances can you offer all of the skeptics, all of those people who have seen the District's history on this that, going forward, A. it's going to work well, and B., the people most affected, persons with disabilities and their families, will be a part of this conversation and this transition?
REESEYou know, the statement that Ms. Whitlatch read just now is one that I keep in mind all the time, which is that the mayor is committed to ensuring the quality of our services. After Evans closed out, she contacted our agency and checked in to see what additional support could be provided to ensure the quality of the services that we're providing.
REESEWe have a really sound, quality system. Not only do we have -- we have monitoring by the centers for Medicare and Medicaid services, by the Department of Healthcare Finance, which is the D.C. Medicaid agency. There's monitoring of the people who are in licensed homes by the D.C. Health Department. Through Evans, you had asked before, Ms. Brown, whether there was an intention...
NNAMDI(overlapping) Only have about 30 seconds left.
REESEOkay, sorry -- whether there was an intention to continue the Georgetown contract. And there was not, in Evans. There was, however, an intention that a permanent monitor and advocacy organization would be put in place. The Quality Trust was created for that purpose, and they are here, and I expect to work with them through this process.
NNAMDI(overlapping) Quickly, in the face of all of this pushback, are you reconsidering the decision to not renew the contract with Georgetown?
REESEAs I had said at the beginning, renewing the contract is not an option, in terms of contract law. What you could do is extend the contract, if, through due diligence, you are unable to put those services in place. And as I've said, we have a very sound transition plan, and we're confident that that will go forward and that all the services people currently get, they'll continue.
NNAMDII'm afraid that's all the time we have. Andy Reese, Mitch Ryals, Morgan Whitlatch, thank you all for joining us.
NNAMDIThis conversation about disability services in the District was produced by Cydney Grannan. And our look at human trafficking and what's being done to help stop it was produced by Margaret Barthel. Tomorrow, we remember Toni Morrison's time in D.C., where she studied and taught at Howard University. Plus, the host of WAMU's the Big Broadcast, Murray Horwitz, joins us to talk about his 50-year-long career in show business. There's a reason I call him the most interesting man in the world. And his time as a circus clown is just a tip of the iceberg. That all starts tomorrow, at noon. Until then, thank you for listening. I'm Kojo Nnamdi.
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