1. Chester County Independent Monitoring for Quality (IM4Q) I M 4 Q Independent Monitoring Corporation 331 Gordon Drive Exton, PA 19341 610-594-0290

2. Intent & Purpose of Independent Monitoring (IM4Q) IM4Q adds a perspective on quality that does not focus on regulation, process or compliance issues. IM4Q often reinforces what human service professionals already know about the person or raises issues that they would want to know. The purpose of IM4Q is to provide information obtained from interviewing people receiving services and supports in the ID System to: Improve their Quality of Life Improve the Quality of PA’s Intellectual Disability System Offer an additional safeguard for the health and wellbeing of individuals receiving services

3. Some Guiding Principles of IM4Q  Independence: Local IM4Q Programs have no conflict of interest with providers of service and the County MH/IDD Program.  Community Participation: Family members, people with disabilities and concerned citizens monitor services and supports.  Accountability: The agencies who receive reports on this information are responsible to use it for quality improvement purposes. IM4Q Chester County and State3

4. 4 The Where and Why of IM4Q  Several years ago, Pennsylvania determined that they needed to look at the quality of services and subsequent improvement and options of these services provided to individuals with developmental disabilities. As a result, the Office of Developmental Programs (ODP) convened a workgroup to develop a Multi-Year Plan in 1997 to address these needs.  One of the outcomes and recommendations was that local monitoring groups, independent of the service system, could best measure individual and family satisfaction with the services and supports being provided to them.  As a result, in 2001, IM4Q programs were established in PA counties.

5. How IM4Q Works  ODP selects a representative sample of people receiving services and families each year to be interviewed.  Local IM4Q Teams interview people receiving services and families in the sample, and share their considerations after the interview with the AE, providers, the individuals and their families as applicable.  The AE addresses IM4Q Team considerations and uses survey results to improve the person’s services.  The IM4Q Program enters the results of interviews in HCSIS (Home and Community Services Information System) where aggregate results are accessed by providers, County Programs and ODP for improving the quality of the service system. IM4Q Chester County and State5

6. How IM4Q Improves the Services System  Provides independently-gathered information on service quality, satisfaction and outcomes.  Serves as a safeguard by identifying “Major Concerns” affecting health and safety.  Helps to identify “promising practices” as well as areas needing improvement.  Provides a consistent source of information to measure the effect of program practices and quality improvement actions.  IM4Q data results feed information into performance system measurements. IM4Q Chester County and State6

7. What IM4Q Is and Is Not  IM4Q is one aspect of quality measurement within the ID system quality framework.  IM4Q is a measurement of quality, consumer satisfaction and outcomes.  IM4Q is a SNAPSHOT of quality to be used for quality improvement purposes.  IM4Q is not the only measurement of quality. Others, like incident management and licensing also need to be considered.  IM4Q is not a measurement of compliance with standards. IM4Q Chester County and State7

8. IM4Q Role of Supports Coordinators  Explain IM4Q purpose and operations to consumers, families and support professionals.  May obtain and organize some demographics information.  Coordinate quality improvement with providers of service, families and individuals.  Champion quality improvement. IM4Q Chester County and State8

9. Service Provider Roles  Provide demographic information needed by the IM4Q Program.  Assist in answering IM4Q interview questions that the person can’t answer.  Use aggregate IM4Q information to improve services by reviewing reports made available in HCSIS and reports generated by the Chester County IM4Q program. IM4Q Chester County and State9

10. IM4Q Chester Count and State 2010-2015 10 WHO PARTICIPATES IN IM4Q SURVEYS? (Fiscal Years 2010 through 2015) Statewide – Over 6,690 individuals are interviewed yearly, including people living in State Centers. Chester County – Yearly -168 individuals living in a residential setting, with their families, or independently. (151 were visited in 2012-13, 2013-14 & 2014-15) Demographics of Chester County individuals interviewed during the period 2010 through 2015: 407 Living in a residential setting (Community Homes) 95 Living in a residential setting (Private ICF) 50 Living in a shared living setting 205 Living independently or with family 32 Living in other settings (PCH, Dom Care, Nursing Facilities, Children’s Facilities) 789 TOTAL

11. IM4Q Chester County and State 2010-2015 11 HCSIS drawn sample of interviews 5 SAMPLE GROUPS are interviewed in Chester County. ODP provides HCSIS Sample: 1.25 PFDS Waiver 2.96 IM Sample 3.30 National Core Indicators (NCI) 4.30 NCI Family Guardian Surveys mailed out by County to families whose relative lives in a residential program 5.30 NCI Adult Family Surveys mailed out by County to families whose relative lives at home with the family

12. IM4Q Reports Available to the Public  2014-15 Chester County IM4Q Reports, FAQ’s and Background & Information on the Chester County Website at www.chesco.org/mhidd www.chesco.org/mhidd  Institute on Disabilities Statewide Summary at the Office of Developmental Programs (ODP)’s Website at www.odpconsulting.net www.o IM4Q Chester County and State12

13. Terms and Abbreviations  National Core Indicators (NCI): A survey used to compare Pennsylvania’s performance with other participating states.  Essential Data Elements (EDE): The standard Pennsylvania survey tool developed by Temple University’s Institute on Disabilities.  Family, Friend, Guardian (FFG): That portion of the EDE survey used to obtain satisfaction information from family, friends and guardians. IM4Q Chester County and State13

14. Terms and Abbreviations (cont.)  Closing the Loop: Follow-up actions taken in the community intellectual disability system to address IM4Q findings and team considerations. Actions can occur on an individual, provider, county and/or statewide level.  NCI Family Surveys: Two surveys, one for families living with the person receiving services and the other for families living apart from the person, are included in the National Core Indicators portion of IM4Q. IM4Q Chester County and State14

15. IM4Q Chester County and State15 The Interview Questionnaire: Essential Data Elements (EDE)  The EDE is the interview instrument used by monitoring teams to ask 105 questions. It is a combination of the NCI project questions and IM4Q questions.  The IM4Q Monitoring Team also completes 15 additional questions in the EDE after the visit with the individual.  A Family/Friend/Guardian Survey is also completed which consists of 33 questions.  HSRI (Human Services Research Institute) publishes NCI reports to individual Counties and Temple University’s Institute on Disabilities publishes reports for all projects within IM4Q.

16. IM4Q Chester County and State16 Employment and Habilitation Pilot  Chester County participated with five other counties in the ODP Habilitation Pilot.  40 individuals who attend day programs and/or work in the community and their families were surveyed each year during a six year period (2005-2011).  The purpose of the pilot was to ascertain satisfaction with day activities/services and the individual and families understanding of availability of habilitation services.

17. Transition Pilot  In 2011-12 Chester County was selected to participate in the ODP Transition Pilot.  72 individuals between the ages of 14 and 22 and their families were surveyed in 2014-15.  The purpose of the pilot is to gather information about how the transition process is conducted in the school system and to see if it is preparing individuals for employment and/or further education after school. IM4Q Chester County and State 17

18. IM4Q Chester County and State 2010-2015 18 SATISFACTION – EDE Responses 2010-2015  The first two sections of the EDE ask questions related to the individual’s satisfaction with their home, work, happiness, privacy and their people with whom they live and work.  Only the individual being interviewed can respond to the questions in the Satisfaction section of the EDE.

19. IM4Q Chester County and State 2010-2015 19 Satisfaction Scale with Day/Work Activity

20. IM4Q Chester County and State 2010-2015 20 Satisfaction Scale With Living Arrangement

21. IM4Q Chester County and State 2010-2015 21 Other Satisfaction Data Have friends that are not staff or family members State:73.4% Chester County:75.2% Report they always have privacy State:95.4% Chester County:96.8%

22. IM4Q Chester County and State 2010-2015 22 Other Satisfaction Data (cont.) Report that staff always knock on bedroom door before entering State:85.0% Chester County:83.6% Report that people knock/ring bell before entering their home State:90.6% Chester County:89.8% Report that housemates are nice or very nice State:88.6% Chester County:88.6% Report that they usually feel happy State:83.2% Chester County:85.0%

23. IM4Q Chester County and State 2010-2015 23 Other Satisfaction Data (cont.) Report that staff who work with them in their home are very nice or nice: State:94.8% Chester County:94.6% Report that staff who work with them at their day activity are nice or very nice: State:95.2% Chester County:93.0%

24. IM4Q Chester County and State 2010-2015 24 Dignity/Respect and Rights – EDE Responses 2010-2015  Only the individual being interviewed may respond to the questions in this section of the EDE.

25. IM4Q Chester County and State 2010-2015 25 Dignity, Respect & Rights Do you vote? If not, would you like to vote?

26. IM4Q Chester County and State 2010-2015 26 Other Dignity, Respect & Rights Data  Report that they always carry some type of ID State:60.4% Chester County:56.2%  Report that they never carry some type of ID State:18.2% Chester County:16.8%  Always have someone in their life to help them State:92.2% Chester County:90.2%

27. IM4Q Chester County and State 2010-2015 27 Dignity/Respect and Rights Supports Coordination Services  Report that Supports Coordinator helps them get what they need if they ask: State: 91.4%Chester County: 95.2%  Individuals are told how much money was in their annual budget: State: 68.2%Chester County: 49.6%

28. IM4Q Chester County and State 2010-2015 28 Choice and Control EDE Responses 2010-2015

29. IM4Q Chester County and State 2010-2015 29 Choice & Control Do you have a key to your home?

30. IM4Q Chester County and State 2010-2015 30 Choice & Control Other  Met their housemates before they began living together State: 83.8% Chester County:90.4%  Individuals did not choose their housemates State: 66.8% Chester County: 55.6%  Have their own bedroom State: 72.6% Chester County: 74.2%  Personal mail is never opened without permission State: 80% Chester County: 69.8%

31. IM4Q Chester County and State 2010-2015 31 Choice and Control Other (cont.)  Individuals always chose what to buy with their spending money State: 58.8%Chester County: 49.8%  Individuals are always able to get in touch with family when they wish to State: 89.4% Chester County: 85.4%  Individuals are always able to see friends whenever they wish to State: 80.8% Chester County: 74.4%

32. IM4Q Chester County and State 2010-2015 32 Choice and Control - Communication

33. IM4Q Chester County and State33 Employment In 2014-15, 17 individuals were interviewed that were employed in a community integrated setting.  Average hours worked per week: State: 16 hours Chester County: 10 hours  Average hourly wage: State: $8.41 Chester County: $7.60

34. IM4Q Chester County and State34 Employment

35. IM4Q Chester County and State 2010-2015 35 INCLUSION EDE 2010-2015 Responses

36. IM4Q Chester County and State 2010-2015 36 Inclusion – Community Participation  Visit with friends, neighbors, families at least weekly State: 53.2% Chester County: 43.0%  Go to a supermarket at least weekly State: 45% Chester County: 45.4%  Go to a restaurant at least weekly State: 43.2% Chester County: 42.8%  Go shopping at least weekly (mall or department store) State: 41.2% Chester County: 41.6%

37. IM4Q Chester County and State 2010-2015 37 Inclusion – Community Participation (cont.)  Go to a place of worship at least weekly State: 28.2% Chester County:25.6%  Go to a bank at least weekly State:13.4% Chester County:15%  Go to coffee houses/bars/taverns at least weekly State:7.4% Chester County:6.2%

38. IM4Q Chester County and State 2010-2015 38 Inclusion – Community Activities  Frequently go into the community for entertainment State:55.8% Chester County:50%  Frequently go to social events in community attended by people with and without disabilities State:31.4% Chester County:22.2%  Went on a vacation in the past year State:45.8% Chester County:59.2%

39. IM4Q Chester County and State 2010-2015 39 Inclusion – Adaptive Equipment  Individuals report that they have all the adaptive equipment they need State:89.0% Chester County:89.6%  Individuals report that adaptations have been made to home to make it accessible State:81.4% Chester County:82.8%

40. IM4Q Chester County and State 2010-2015 40 Monitoring Teams and IM4Q Program Impressions

41. IM4Q Chester County and State 2010-2015 41 Monitoring Team Impressions  Caregivers expectations regarding growth reported as high or very high State:58.8% Chester County:46.6%  Staff OBSERVED recognized the individuals in ways that promoted independence State:86.6% Chester County:90.8%  Staff OBSERVED treated individuals with dignity and respect State:95.6% Chester County:97.8%

42. IM4Q Chester County and State 2010-2015 42 Family, Friend, Guardian Survey F/F/G Responses 2010-2015 The IM4Q Program conducts a F/F/G Survey with a family member, friend or guardian if the individual has someone in their life and if they give permission for the interview.

43. IM4Q Chester County and State 2010-2015 43 Family Satisfaction with Relative’s Home and Day Activity

44. IM4Q Chester County and State 2010-2015 44 Family Satisfaction with Home and Day Activity Staff

45. IM4Q Chester County and State 2010-2015 45 Family Survey - Relative’s Happiness  Family feels that their relative is happy or somewhat happy with their living situation: State:94.2% Chester County: 94.4%  Family feels that their relative is happy or somewhat happy with their day program: State:91.2%Chester County: 89.4%  Family feels that their relative is happy or somewhat happy with home staff. State:94.8% Chester County: 95.2%  Family feels that their relative is happy or somewhat happy with day program staff: State:96% Chester County: 95.8%

46. IM4Q Chester County and State 2010-2015 46 Family Satisfaction with Residential Staff  Feel there are enough staff in relative’s home State: 89.2%Chester County: 92.4%  Feel that staff treat individuals’ with dignity and respect State: 94.8%Chester County: 94.8%  Feel that ALL staff APPEAR to have the skills they need to support their relative State: 85.6%Chester County: 86.8%

47. IM4Q Chester County and State 2010-2015 47 Family Satisfaction – Learning and Participating/Communication Feel their relative gets enough opportunities to participate in activities in the community State: 86.8% Chester County:85.2% Feel their relative seems to have the opportunity to learn new things State:88.6% Chester County:86.8% If relative does not communicate verbally, communication system is in place & is being used State:35.2% Chester County:37.2%

48. IM4Q Chester County and State 2010-2015 48 What does it all mean  This presentation reflects an analysis of aggregate data related to IM4Q monitoring over five fiscal periods (2010-11; 2011-12; 2012-13; 2013-14, 2014-15).  The data used by Chester County’s IM4Q program was obtained from reports generated by Temple University’s Institute on Disabilities which provides statewide and countywide statistical reports each year to ODP, Administrative Entities, IM4Q and the community-at- large.  It compares PA data reflecting interviews with over 6,600 individuals yearly to Chester County interviews with 151 individuals yearly.

49. IM4Q Chester County and State 2010-2015 49 What does it all mean (cont.)?  Although the intent is that all IM4Q programs conform to the same interviewing and training methods, we need to bear in mind that data and responses may sometimes be interpreted somewhat differently depending upon the location and demographics of the interview as well as monitoring teams interpretations and impressions gained during the interview.  The EDE offers many options of responses to questions. This presentation focuses on primarily yes or no or always or never responses.

50. IM4Q Chester County and State50 What do we believe we have learned specific to Chester County?  Chester County parallels PA overall results in many areas.  Chester County’s services to individuals with developmental disabilities excel in many areas; however, methods should be explored for improvement in other areas.  IT IS IMPORTANT TO REMEMBER THAT THESE ARE JUST STATISTICS!

51. IM4Q Chester County and State51 CLOSING THE LOOP PROCESS IM4Q encourages everyone involved in the Close the Loop process to be creative in their ideas for Quality Improvement in the individual’s life. Individuals Families Friends Staff Providers IM4Q Monitors Supports Coordinators

52. IM4Q Chester County and State52  Closing the Loop is how the AE uses the IM4Q results to improve the overall service system and the life of the individual receiving services.  The source of the consideration may include the person with a disability, family, staff, friend, advocate or IM4Q team.  Depending on the issues, closing the loop can involve the work of numerous agencies, the supports coordinator, the family and the person receiving services.  The IM4Q program’s role is to bring issues to the attention of the AE, not to implement change.  The AE is expected to notify the IM4Q program regarding actions, based on monitoring team findings and considerations. CLOSE THE LOOP ISP/IM4Q Connection

53. IM4Q Chester County and State53 WHAT IS A CONSIDERATION AND WHY ARE THEY IMPORTANT?  The IM4Q Program submits a report after each visit which may include “Considerations”.  A “Consideration” is a request or perceived request for change or improvement indicated by the person, family, staff or monitor.  Considerations may result in changes or provide an opportunity to improve the quality of life of the person being interviewed!

54. Things to Remember About IM4Q Results  IM4Q Team considerations may need further clarification and follow-up with the individual, a Provider of Service or the IM4Q Program. The IM4Q Program will be glad to clarify any of its findings.  IM4Q Teams appreciate feedback on ways to improve their interviews and information sharing.  Not everyone needs to agree with all IM4Q Team considerations. What’s important is that IM4Q considerations are respectfully considered and acted on in an appropriate and timely manner. IM4Q Chester County and State54

55. Making Everyday Lives a Reality As a result of the IM4Q reports to Chester County’s Supports Coordination Organizations and Providers of Service the following changes occurred during FY 10-11, 11-12, 12-13, 13-14 & 2014-15. These reports often assist to emphasize and validate already recognized needs and supports.  Several individuals whose desire was to move out of their family homes did so and are now living in more independent settings.  Several families became more knowledgeable about waiver funding and their relatives are now receiving services to improve and maintain skills.  Many individuals are attending new vocational programs of their choice or are working with job coaches to find community employment. Others are receiving more appropriate and meaningful day activities.  One family obtained funding to make adaptations to their daughter’s bathroom and interior and exterior improvements were made to several other homes. A few individuals obtained adaptive equipment.  Several individuals expressed interest in learning new skills and are taking classes to achieve these goals.

56. FAQs  Is IM4Q participation voluntary? Yes  How often are people asked to participate? Once every 3-4 years  Can the person choose not to share his/her personal survey information? Yes  Will IM4Q information affect a person’s eligibility for funding or services? No IM4Q Chester County and State56