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Basic Assurances Overview ® : Introduction to a Guided Self Assessment.

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1 Basic Assurances Overview ® : Introduction to a Guided Self Assessment

2 CQL | The Council on Quality and Leadership Who we are…… International not-for-profit organization dedicated to the definition, measurement, and improvement of personal and community quality of life for people with disabilities and people with mental illness.

3 CQL | The Council on Quality and Leadership Vision – A world of dignity, opportunity and community inclusion for all people. Mission – To provide leadership for greater world-wide inclusion and quality of life for people with disabilities

4 CQL | The Council on Quality and Leadership Partners in Excellence; Leadership for the Journey. CQL is at the forefront of improving the quality of services and supports for people with disabilities and people with mental illness. We have been leading this effort for more than three decades. Everyone has a right to a life of dignity, opportunity and community inclusion. Our journey continues with the daily work of establishing real connections between disabilities’ theory and practice

5 CQL | The Council on Quality and Leadership 1970s and 1980s: Basic Assurances ® and Compliance in Services CQL (then the Accreditation Council) developed national consensus standards for organizations providing services to people with intellectual disabilities. The standards reflected the principles and values of professionals, families, provider organizations and government agencies. These standards (1971, 1973, 1978, 1981, 1985, 1987 and 1990) were incorporated into federal court rulings, the Health Care Financing Administration’s (now CMS) Medicaid standards and numerous state licensing requirements.

6 1990s: Personal Outcome Measures ® CQL developed the Personal Outcome Measures ® by holding focus groups with people with disabilities and their families. The Personal Outcome Measures ® were piloted in two states and ten field tests occurred in the United States and Canada. CQL’s initiative in redefining quality in terms of personal outcomes influenced subsequent development of person-directed approaches in numerous states, at CMS and within intellectual disabilities and mental health communities. CQL | The Council on Quality and Leadership

7 2000s: Social Capital and Community Life ® CQL is now focusing on the social and community context for the attainment of personal quality of life. Strong social capital enables all of us to live healthier and happier lives, increase our community affiliations, and exercise choice and self-determination. The challenge of organizations and support groups is not only to engage in person-directed processes; rather it is to use the person-directed orientation to build social capital and Community Life ® for all people.

8 CQL | The Council on Quality and Leadership Personal Outcome Measures

9 CQL | The Council on Quality and Leadership My Self My World My Dreams

10 CQL | The Council on Quality and Leadership My Self 1. People are connected to natural supports. 2.People have intimate relationships. 3.People are safe. 4.People have the best possible health. 5.People exercise rights. 6.People are treated fairly. 7.People are free from abuse and neglect. 8.People experience continuity and security. 9.People decide when to share personal information.

11 CQL | The Council on Quality and Leadership My World 1.People choose where and with whom they live. 2.People choose where they work. 3.People use their environments. 4.People live in integrated environments. 5.People interact with other members of the community. 6.People perform different social roles. 7.People choose services.

12 CQL | The Council on Quality and Leadership My Dreams 1. People choose personal goals. 2. People realize goals. 3. People participate in the life of the community. 4. People have friends. 5. People are respected.

13 CQL | The Council on Quality and Leadership My World My Focus: What is most important to me now. My Self My Dreams My Focus

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15 FAA Level of Safety “The FAA has one level of safety, and there’s no compromise. The airlines that meet it can fly. Those that can’t become part of a business- school case study.” Marion Blakey, Administrator Federal Aviation Administration

16 Basic Assurances ® Basic Assurances ® Essential, fundamental and non-negotiable requirements for all service and support providers Includes the areas of Health, Safety, Human Security Viewed from the person’s perspective

17 Basic Assurances® The Basic Assurances ® use three terms to distinguish levels within the measures: Factor refers to the main topic area. Indicators are the specific expectations for that factor. Probes are designed to assist in determining the presence of the indicator within the organization or system.

18 Rights Protection and Promotion Rights Protection and Promotion The organization implements policies and procedures that promote people’s rights. The organization supports people to exercise their rights and responsibilities. Staff recognize and honor people’s rights. The organization upholds due process requirements. Decision-making supports are provided to people as needed.

19 Dignity and Respect People are treated as people first. The organization respects people’s concerns and responds accordingly. People have privacy. Supports and services enhance dignity and respect. People have meaningful work and activity choices.

20 Natural Support Networks Natural Support Networks Policies and practices facilitate continuity of natural support systems. The organization recognizes emerging support networks. Communication occurs among people, their support staff and their families. The organization facilitates each person’s desire for natural supports.

21 Protection from Abuse, Neglect, Mistreatment and Exploitation Protection from Abuse, Neglect, Mistreatment and Exploitation The organization implements policies and procedures that define, prohibit and prevent abuse, neglect, mistreatment and exploitation. People are free from abuse, neglect, mistreatment and exploitation. The organization implements systems for reviewing and analyzing trends, potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation, and injuries of unknown origin and deaths.

22 Protection from Abuse, Neglect, Mistreatment and Exploitation Protection from Abuse, Neglect, Mistreatment and Exploitation Support staff know how to prevent, detect and report allegations of abuse, neglect, mistreatment and exploitation. The organization ensures objective, prompt and thorough investigations of each allegation of abuse, neglect, mistreatment and exploitation, and of each injury, particularly injuries of unknown origin. The organization ensures thorough, appropriate and prompt responses to substantiated cases of abuse, neglect, mistreatment and exploitation, and to other associated issues identified in the investigation.

23 Best Possible Health People have supports to manage their own health care. People access quality health care. Data and documentation support evaluation of health care objectives and promote continuity of services and supports. Acute health needs are addressed in a timely manner. People receive medications and treatments safely and effectively. Staff immediately recognize and respond to medical emergencies.

24 Safe Environments Safe Environments The organization provides individualized safety supports. The physical environment promotes people’s health, safety and independence. The organization has individualized emergency plans. Routine inspections ensure that environments are sanitary and hazard free.

25 Staff Resources and Supports Staff Resources and Supports The organization implements a system for staff recruitment and retention. The organization implements an ongoing staff development program. The support needs of individuals shape the hiring, training and assignment of all staff. The organization implements systems that promote continuity and consistency of direct support professionals. The organization treats its employees with dignity, respect and fairness.

26 Positive Services and Supports Positive Services and Supports People’s individual plans lead to person-centered and person-directed services and supports. The organization provides continuous and consistent services and supports for each person. The organization provides positive behavioral supports to people. The organization treats people with psychoactive medications for mental health needs consistent with national standards of care. People are free from unnecessary, intrusive interventions.

27 Continuity and Personal Security Continuity and Personal Security The organization’s mission, vision and values promote attainment of personal outcomes. The organization implements sound fiscal practices. Business, administrative and support functions promote personal outcomes. The cumulative record of personal information promotes continuity of services.

28 Basic Assurances ® System Basic Assurances ® System The organization monitors Basic Assurances ®. A comprehensive plan describes the methods and procedures for monitoring Basic Assurances ®.

29 Exercise: Are you on B.A.S.E? Exercise: Are you on B.A.S.E? Basic Assurances ® Short Evaluation

30 Field Experiences 2 Basic Assurances ® Certifications in 2 states (RI, LA) National Network Basic Assurances ® Certification –Mosaic (2 times) –Bethesda Lutheran Communities Over 300 accreditation reviews using Quality Measures 2005 ® since May 2005 Predictors of Success –23 key indicators Implemented Basic Assurances ® Monitoring System (Factor 10)

31 Field Experiences: Key Indicators Top 7 strongest predictors: The organization upholds due process requirements. People have supports to manage their own health care. The organization monitors Basic Assurances ®. Staff recognize and honor people’s rights. Policies and practices facilitate continuity of natural support systems. The cumulative record of personal information promotes continuity of services. The organization has individualized emergency plans.

32 Field Experiences: Key Indicators Predictors 8 – 12: The organization implements systems for reviewing and analyzing trends potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation and injuries of unknown origin and deaths. The organization provides individualized safety supports. People are free from unnecessary intrusive interventions. People receive medications and treatments safely and effectively. The physical environment promotes people’s health safety and independence.

33 Field Experiences: Key Indicators Predictors 13 – 17: Decision-making supports are provided to people as needed. The organization implements systems that promote continuity and consistency of direct support professionals. People have meaningful work and activity choices. The organization provides positive behavioral supports to people. The organization ensures objective prompt and thorough investigations of each allegation of abuse, neglect, mistreatment and exploitation and of each injury, particularly injuries of unknown origin.

34 Field Experiences: Key Indicators Field Experiences: Key Indicators Predictors 18 – 23: The organization respects people’s concerns and responds accordingly. People’s individual plans lead to person-centered and person- directed services and supports. The organization implements an ongoing staff development program. The support needs of individuals shape the hiring training and assignment of all staff. A comprehensive plan describes the procedures for monitoring Basic Assurances ®. People access quality health care

35 Field Experiences: Challenges Rights Protection and Promotion Indicator B: The organization supports people to exercise their rights and responsibilities Indicator D: The organization upholds due process requirements Indicator E: Decision-making supports are provided to people as needed

36 Field Experiences: Challenges Field Experiences: Challenges Dignity and Respect Indicator E: People have meaningful work and activity choices Natural Support Networks Indicator A: Policies and practices facilitate continuity of natural support networks Indicator B: The organization recognizes emerging support networks

37 Field Experiences: Challenges Protection from Abuse, Neglect, Mistreatment and Exploitation Indicator B: People are free from abuse, neglect, mistreatment and exploitation Indicator C: The organization implements systems for reviewing and analyzing trends, potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation, and injuries of unknown origin and deaths

38 Field Experiences: Challenges Best Possible Health Indicator A: People have supports to manage their own health care Safe Environments Indicator A: The organization provides individualized safety supports Indicator C: The organization has individualized emergency plans

39 Field Experiences: Challenges Field Experiences: Challenges Staff Resources and Supports Positive Services and Supports Indicator A: People’s individual plans lead to person-centered and person-directed services and supports Indicator C: The organization provides positive behavioral supports to people Indicator D: The organization treats people with psychotropic medications for mental health needs consistent with national standards of care Indicator E: People are free from unnecessary, intrusive interventions

40 Field Experiences: Challenges Continuity and Personal Security Basic Assurances ® Systems Indicator A: The organization monitors Basic Assurances ® Indicator B: A comprehensive plan describes the methods and procedures for monitoring Basic Assurances ®

41 Basic Assurances ® Factor One Rights Protection and Promotion Check if yes Supporting Information A. The organization implements policies and procedures that promote people’s rights. Probes: 1. Does the policy define the organization’s commitment to protect and promote people’s rights? 2. Does the policy contain a listing of rights afforded all citizens as indicated by the United Nation’s Declaration of Rights and by the constitution and laws of the country in which people reside? SystemPractice

42 Definitions and Decision Making Definitions and Decision Making Systems – organizational supports that provide the structure for organizational practice. These can be policies and procedures, staff training, or other types of systems – ensure sustainability Practice – what is observed in daily operations. This demonstrates how an organization’s supports are put into action

43 Exercise instructions Exercise instructions Read narrative for your assigned Factor in the manual For each indicator, list examples of systems that support For one indicator, list three suggestions to validate practice

44 What about Personal Outcome Measures ® ? Strong Systems + Good Practice = RESULTS!!

45 Self Assessment Tips Self Assessment Tips Start NOW Involve multiple stakeholders Assume learning will cause change –Expect a “messy” self assessment document Remember – these are person focused assurances Avoid overly complex design Communicate, communicate, communicate!

46 Self Assessment Process Self Assessment Process Thoroughly review each factor and its indicators in “teams” –List organizational systems that support each indicator Describe how systems work (independently and together) and identify gaps or need to revise –Consider data in particular Dig deeper – review each indicator and the probes –Cross reference with systems list

47 Self Assessment Process (continued) Self Assessment Process (continued) Develop tools (assessments, data collection formats) and revise policy as needed. Eliminate redundant or unnecessary tools Develop flow chart for each factor including person(s) responsible, time frames, method for analysis Identify reporting mechanism and time frames for summarizing to the larger organization (Factor 10)

48 Suggested Strategies to Validate Practice Suggested Strategies to Validate Practice Talk with people (Personal Outcome Measures ® interviews, targeted interviews, focus groups) Talk to families and staff Spend time with people informally Document review Analyze for gaps between identified systems and practice

49 A world of dignity, opportunity and community for all people www.c-q-l.org


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