1. 2005 Community Practice Review Southwest Region DRAFT Findings 2005 Community Practice Review Southwest Region DRAFT Findings Presented: February 23, 2006 Southwest Review held January 9 -13, 2006

2. 2005 Community Practice Review DRAFT Southwest Region 2 Class Members: 52 Number in Sample: 14 (27%) Two Independent Case Management Agencies in Sample SCCM 10 in sample SCCM 10 in sample DSLM4 in sample DSLM4 in sample

3. 2005 Community Practice Review DRAFT Southwest Region 3 Day and Residential Agencies and number in sample Day Residential Day Residential Life Quest 1 1 Opportunity Center 1 1 Progressive 1 1 ResCare 3 4 Tresco 7 6 WNG 1 1

4. 2005 Community Practice Review DRAFT Southwest Region 4 Individuals Needing Immediate Attention: 3 People 21% of sample Individuals Needing Special Attention: 5 People 36% of sample Individuals for whom health, safety, environment and/or abuse or neglect issues were identified during the review. Issues were identified that may, if not addressed, may effect the person’s health, safety and/or welfare. In 2004, five people required Immediate Attention (33%) and five people required Special Attention (33%). (15 people in the 2004 sample) Class Members with Immediate or Special Needs

5. 2005 Community Practice Review DRAFT Southwest Region 5 Identified Indicators of Good Practice   Two people are active swimmers and seven are bowlers. People play valued roles in their community   Five people attend church.   Five people are members of and visit their local libraries   Four people are involved in other types of sports, such as Tennis, Walkathons, Baseball, and Putt-Putt golf.   Two people are sports fans – supporting their favorite team.

6. 2005 Community Practice Review DRAFT Southwest Region 6 People have friends   Eight people have non-paid friends that they meet and interact with in the community – one has a “significant other”.   Seven people (50%) were seen as adequately integrated into the community. People are a part of and integrated into their communities   Two people are members or volunteers at local clubs or shelters   Three people are engaged in supported employed. People are employed Identified Indicators of Good Practice   Two people are “self-employed” – creating their art and selling it in the community

7. 2005 Community Practice Review DRAFT Southwest Region 7 People benefit from long term, caring and respectful staff   Four people have residential staff that have been with them for at least four years. One for 11 years!   Ten people have case managers who “know” them and can describe their preferences, wants and needs.   Nine people are treated with dignity and respect. Identified Indicators of Good Practice   Four people have day staff that have been with them for at least four years. One for 11 years!

8. 2005 Community Practice Review DRAFT Southwest Region 8 People have proactive advocates Case Manager/Guardian   Six Guardians found the case manager helpful.   Four people were identified as having actively involved guardians. (Seen at least 3 times a month)   Ten people have case managers who are adequately available to them.   Eleven people have case managers who fully understand their role/job. Identified Indicators of Good Practice

9. 2005 Community Practice Review DRAFT Southwest Region 9 People have shown evidence of progress   Six people are going more places or participating more while in the community.   Nine people have increased their communication ability and/or their interactions with others.   Five people are engaging in more tasks with fewer prompts from Direct Support Staff Identified Indicators of Good Practice   One person has learned to spell her name, and is beginning to learn letters and numbers.

10. 2005 Community Practice Review DRAFT Southwest Region 10 People have shown evidence of progress   During the past year, three people have shown a decrease in behaviors that have been identified as dysfunctional.   92 assistive technology and adaptive equipment devices are needed by the members of the sample; 78 are in good repair, available, and used when needed. (85%).   Six people are becoming more independent in their homes: cooking/meal prep, cleaning, personal hygiene, dressing and other daily tasks. Identified Indicators of Good Practice

11. 2005 Community Practice Review DRAFT Southwest Region 11 A. Expectations for Growth and Quality of Life Findings by Area Noteworthy Practice 9 of 14 individuals have day direct service staff who have an appropriate expectation of growth for them. (64%, 60% in 2004) 10 of 14 individuals have residential direct service staff who have an appropriate expectation of growth for them. (77%, 53% in 2004) For those for whom it could be determined, 90% ( 67% in ‘04) of people made choices about where and with whom to socialize. The one retired person had adequate opportunities to engage in activities of personal interest. 100% of person had their cultural preferences accomodated. (2 CND)

12. 2005 Community Practice Review DRAFT Southwest Region 12 A. Expectations for Growth and Quality of Life Practice Challenges 8 of 14 persons in the sample (57%) had not achieved notable progress in the past year. 7 of 14 IDTs (50%) were found to not have an appropriate expectation of growth for the person they support. 4 of 14 people (29%) were not provided the assistance needed to participate meaningfully in the planning process 36% of the sample (5 of 14 people) were found not to be treated with adequate dignity and respect. 6 people (43%) were supported by people who were not adequately trained on the complaint, abuse, neglect and exploitation process. Findings by Area

13. 2005 Community Practice Review DRAFT Southwest Region 13QuestionResponse % Yes 31. Does the case manager have an appropriate expectation of growth for this person? 8 Yes 6 Partial 57% 42. Does the [day services] direct service staff have an appropriate expectation of growth for this person? 9 Yes 5 Partial 64% 52. Does the residential direct service staff have an appropriate expectation of growth for this person? (1 person not scored) 10 Yes 3 Partial 77% 84. Based on all of the evidence, in the opinion of the reviewer, has the person achieved progress in the past year? 6 Yes 8 Partial 43% 85. Overall, does the IDT have an appropriate expectation of growth for this person? 7 Yes 7 Partial 50% 86. Was the person provided the assistance and support needed to participate meaningfully in the planning process? 10 Yes 4 Partial 71% 87. The person is offered a range of opportunities for participation in each of the life areas? 8 Yes 4 Partial 57% Findings by Area A. Expectations for Growth and Quality of Life

14. 2005 Community Practice Review DRAFT Southwest Region 14QuestionResponse % Yes 88. Does the person have the opportunity to make informed choices? (4 CND)7 Yes 3 Partial 70% 89. About where and with whom to live? (4 CND)7 Yes 3 Partial 70% 91. About where and with whom to socialize/spend leisure time? (4 CND)9 Yes 1 Partial 90% 93. Overall, were the direct service staff interviewed trained on the provider’s complaint process and on abuse, neglect and exploitation? 8 Yes 6 Partial 57% 100. If the person is retired, does he/she have adequate opportunities to engage in activities of interest during the day? (13 N/A) 1 Yes100% 101. Does the person have daily choices/appropriate autonomy over his/her life? 11 Yes 3 Partial 79% 102. Have the person’s cultural preferences been accommodated? (2 CND)12 Yes100% 103. Is the person treated with dignity and respect?9 Yes 5 Partial 64% A. Expectations for Growth and Quality of Life Findings by Area

15. 2005 Community Practice Review DRAFT Southwest Region 15 B. Satisfaction Findings by Area Noteworthy Practice 100% of persons got along with and found their case managers to be helpful (of those for whom determinations could be made). 13 people were found to have adequate transportation to meet their needs (93%). 92% had adequate food and drink available. (1 CND)

16. 2005 Community Practice Review DRAFT Southwest Region 16 B. Satisfaction Findings by Area QuestionResponse % Yes 104. Overall, is the person satisfied with the current services? (5 CND) 6 Yes 3 Partial 67% 105. Does the person get along with the case manager? (9 CND)5 Yes100% 106. Does the person find the case manager helpful? (11 CND)3 Yes100% 108. Does the person have adequate food and drink available? (1 CND) 12 Yes 1 Partial 92% 109. Does the person have adequate transportation to meet his/her needs? 13 Yes 1 Partial 93% 110. Does the person have sufficient personal money? (2 CND)8 Yes 4 Partial 67%

17. 2005 Community Practice Review DRAFT Southwest Region 17 C. Assessments Findings by Area Practice Challenges 6 of 14 people (43%) had IDTs that did not fully consider what assessments the person needs and would be relevant to planning efforts. 57% of IDTs did not adequately arrange for and obtain needed, relevant assessments. Noteworthy Practice Every score in the Assessments area reflected an increase over 2004

18. 2005 Community Practice Review DRAFT Southwest Region 18 Findings by Area C. AssessmentsQuestionResponse % Yes 57. Did the team consider what assessments the person needs and would be relevant to the team’s planning efforts? 8 Yes 6 Partial 57% 58. Did the team arrange for and obtain the needed, relevant assessments? 6 Yes 8 Partial 43% 59. Are the assessments adequate for planning?9 Yes 5 Partial 64% 60. Were the recommendations from assessments used in planning?9 Yes 5 Partial 64%

19. 2005 Community Practice Review DRAFT Southwest Region 19 D. Adequacy of Planning and Adequacy of Services Findings by Area Practice Challenges No ISPs (0%) were found to be adequate to meet the person’s needs. 6 of 14 people (43%) were found to have adequate long-term visions. 8 people (57%) do not have ISP goals that address their major needs. Noteworthy Practice 12 people (86%) have ISP that contain specific arrangements for primary health care (60% in 2004). 93% (13 of 14) of ISPs reflect how the person will get to work/day and social activities. 13 people (93%) have direct service staff that were able to describe their responsibilities in providing daily care. (60% in 2004)

20. 2005 Community Practice Review DRAFT Southwest Region 20 D. Adequacy of Planning and Adequacy of Services Findings by Area QuestionResponse % Yes 62. Was the ISP developed by an appropriately constituted IDT?8 Yes 6 Partial 57% 64. Overall, is the long-term vision adequate?6 Yes 8 Partial 43% 65. Overall, does the functional supports assessment give adequate guidance to achieving the person’s long-term vision? 9 Yes 5 Partial 64% 66. Overall, is the functional supports assessment used as the basis for goal development? 9 Yes 4 Partial 1 No 64% 67. Overall, do the goals in the ISP include criteria by which the team can determine when the goals(s) have been achieved? 5 Yes 8 Partial 1 No 36% 69. Overall, do the goals in the ISP address the person’s major needs?6 Yes 8 Partial 43% 72. Overall, are the recommendations and/or objectives /strategies of ancillary providers integrated in to the goals, objectives and strategies of the ISP? 9 Yes 4 Partial 1 No 64%

21. 2005 Community Practice Review DRAFT Southwest Region 21 D. Adequacy of Planning and Adequacy of Services Findings by Area QuestionResponse % Yes 74. Does the ISP contain specific arrangements for primary health (medical) care? 12 Yes 2 Partial 86% 75. Does the ISP reflect how the person will get to work/day activities, shopping, social activities? 13 Yes 1 No 93% 78. Overall, is the ISP adequate to meet the person’s needs?14 Partial0% 80. If there is no ISP, or if #78 is rated “0” or “1”, are current services adequate to meet the person’s needs? 3 Yes 11 Partial 21% 82. Overall, were the direct service staff able to describe their responsibilities in providing daily care/support to the person? 13 Yes 1 Partial 93%

22. 2005 Community Practice Review DRAFT Southwest Region 22 E. Individual Service Planning Findings by Area Noteworthy Practice: 79% of person in the sample (11 of 14) were found to have an ISP that contains a FSA based on a long-term view. 64% of people received services and supports recommended in the ISP (40% in 2004). Practice Challenges Half of the sample (50%) were found to not have adequate access to and use of generic services and natural supports Half of the sample (50%) are not adequately integrated into the community.

23. 2005 Community Practice Review DRAFT Southwest Region 23 Findings by Area E. E.Individual Service Planning – Historical Scoring Question20002001200220042005 Does the person have an ISP that addresses living, learning/working and social/leisure… 64%79%92%67%71% Does the ISP contain a functional supports assessment based on a long-term view? 100%86%77%67%79% Does the person receive services and supports recommended in the ISP? 57%79%62%40%64% Does the person have adequate access to and use of generic services and natural supports? 64%86%69%27%50% Is the person adequately integrated into the community? 64%79%62%33%50%

24. 2005 Community Practice Review DRAFT Southwest Region 24 F. Team Process Findings by Area Noteworthy Practice In the 6 instances where there was a finding of regression, 67% of IDTs were adequately addressing the regression (0% in 2004). 11 people (79%) have IDTs that are adequately communicating between meetings. Practice Challenges 43% of IDT team members were found to be following up on their responsibilities. For 2 (14%) people, the IDT process was found to be adequate for assessing, planning, implementing and monitoring of services..

25. 2005 Community Practice Review DRAFT Southwest Region 25 F. Team Process Findings by Area QuestionResponse % Yes 113. Is there evidence that the ISP was reviewed by the IDT within the last six months? (1 N/A) 13 Yes100% 114. Are the individual members of the IDT following up on their responsibilities? 6 Yes 8 Partial 43% 116. Do records or facts exist to indicate that the team convened meetings as needed due to changed circumstances and/or needs? (2 N/A) 9 Yes 3 No 75% 117. Is there adequate communication among team members between meetings to ensure the person’s program can be/is being implemented? 11 Yes 3 Partial 79% 119. Is there evidence or documentation of physical regression in the last year? 5 Yes 9 No 36% 120. Is there evidence or documentation of behavioral or functional regression in the last year? 3 Yes 11 No 21% 121. If #199 or 120 is Yes, is the IDT adequately addressing the regression? (8 CND) 4 Yes 2 Partial 67%

26. 2005 Community Practice Review DRAFT Southwest Region 26 F. Team Process (continued) Findings by Area QuestionResponse % Yes 122.Has the person changed residential/day services in the last year? If Yes, was the change: 2 Yes 12 No 14% 122a. Planned by the IDT? (12 N/A)2 Yes100% 122b. Appropriate to meet needs? (12 N/A)1 Yes 1 Partial 50% 123.Has the IDT process been adequate for assessing, planning, implementing and monitoring of services for this person? 2 Yes 12 Partial 14%

27. 2005 Community Practice Review DRAFT Southwest Region 27 G. Health Related Needs Findings by Area Noteworthy Practice 92% of residential support staff could describe the person’s health related needs 86% of day support staff could describe the person’s health related needs. Practice Challenges 8 people (57%) have health supports/needs that are not being adequately addressed. 50% of case managers could describe the person’s health related needs.

28. 2005 Community Practice Review DRAFT Southwest Region 28 G. Health Related Needs Findings by Area QuestionResponse % Yes 54. Overall, were the team members interviewed able to describe the person’s health-related needs? 7 Yes 7 Partial 50% 55. Is there evidence that the IDT discussed the person’s health-related issues? 11 Yes 3 Partial 79% 56. In the opinion of the reviewer, are the person’ health supports/needs being adequately addressed? 6 Yes 8 Partial 43%

29. 2005 Community Practice Review DRAFT Southwest Region 29 H. Supported Employment Findings by Area Practice Challenges 20% of individuals who had a career development plan had a plan that met their needs. 33% of supported employment assessments conformed to DOH Regulations. 30% of individuals identified as needed supported employment services were engaged in supported employment. Of those engaged in supported employment, 20% received those services in line with DOH requirements.

30. 2005 Community Practice Review DRAFT Southwest Region 30 H. Supported Employment – Historical Scoring Findings by Area Question20002001200220042005 Need an employment assessment?86%100%85%100%79% Need supported employment?57%50%69%67%71% Receive supported employment assessment?92%100% 91% Assessment conforms to DOH Regulations?25%100%82%40%36% Has a Career Development Plan?25%43%22%40%20% Is supported employment provided in line with requirements? 25%43%22%20%

31. 2005 Community Practice Review DRAFT Southwest Region 31 Findings by Area I. Day Services Noteworthy Practice 14 (100%) of Day direct service staff could describe their responsibilities in providing daily care/supports. 12 of 14 (86%) direct service staff could describe the person’s health-related needs. 86% (12 of 14) had adequate input into the person’s ISP. 13 (93%) Day direct service staff had adequate training in the ISP process.

32. 2005 Community Practice Review DRAFT Southwest Region 32 I. Day Services Findings by Area QuestionResponse % Yes 35. Does the day/employment direct services “know” the person?11 Yes 3 Partial 79% 36. Does the direct service staff have adequate input into the person’s ISP?12 Yes 1 Partial 1 No 86% 37. Did the direct service staff receive training on implementing the person’s ISP? 12 Yes 2 Partial 86% 38. Was the direct service staff able to describe this person’s health-related needs? 12 Yes 2 Partial 86% 41. Did the direct service staff have training on the provider’s complaint process and on abuse, neglect and exploitation? 8 Yes 6 Partial 57% 42. Does the direct service staff have an appropriate expectation of growth for this person? 9 Yes 5 Partial 64%

33. 2005 Community Practice Review DRAFT Southwest Region 33 J. Behavioral Support Services Findings by Area Noteworthy Practice For those in the sample for whom it was applicable…. 8 (80%) had adequate behavioral assessments completed. 9 (90%) had behavior support plans developed out of behavior assessments that meet the person’s needs. 8 (80%) received behavioral services consistent with his/her needs.

34. 2005 Community Practice Review DRAFT Southwest Region 34 J. Behavioral Support Services – Historical Scoring Findings by Area Question20002001200220042005 Does the person need behavioral services?64%71%69%67%79% Have adequate behavioral assessments been completed? 78%80%78%70%80% Does the person have behavior support plan developed out of the behavior assessments that meet the person’s needs? 100%90%78%80%90% Have the staff been trained on the behavior support plan? 67%80%88%80%100% Does the person receive behavioral services consistent with his/her needs? 33%80%89%80% Are behavioral support services integrated into the ISP? 0%40%22%40%60%

35. 2005 Community Practice Review DRAFT Southwest Region 35 K. Adaptive Equipment/Augmentative Communication Findings by Area Question20002001200220042005 Has the person received all adaptive equipment?67%80%86%38%78% Has the person received all assistive technology needed? 36%38%70%56%57% Has the person received all communication assessments and services needed? 9%11%73%33%80% Adaptive Equipment/Augmentative Communication - Historical Scoring Noteworthy Practice 7 of the 9 people identified as needed adaptive equipment received the devices they needed. (78%) 8 of the 10 people identified to need communication assessments/services adequately received them. (80%)

36. 2005 Community Practice Review DRAFT Southwest Region 36 L. Case Management Findings by Area Noteworthy Practice Increases in scoring have occurred in all but 2 protocol questions in this section. 93% of case mangers received training on the topics needed to assist him/her in meeting the person’s needs. Practice Challenges 21% of case managers provide services at the level needed by the person. 29% of case managers do not adequately “know” the person. Half of the persons in the sample have case managers who cannot adequately describe their health related needs.

37. 2005 Community Practice Review DRAFT Southwest Region 37 L. Case Management Findings by Area QuestionResponse % Yes 26. Does the case manager “know” the person?10 Yes 4 Partial 71% 27. Does the case manager understand his/her role/job?11 Yes 3 Partial 79% 28. Did the case manager receive training on the topics needed to assist him/her in meeting the needs of this person? 13 Yes 1 Partial 93% 30. Was the case manager able to describe the person’s health related needs? 7 Yes 7 Partial 50% 31. Does the case manager have an appropriate expectation of growth for this person? 8 Yes 6 Partial 57% 33. Does the cm provide cm services at the level needed by this person?3 Yes 11 Partial 21% 34. Does the case manager receive the type and level of support needed to do his/her job? 11 Yes 3 Partial 79%

38. 2005 Community Practice Review DRAFT Southwest Region 38 Findings by Area Noteworthy Practice 100% (13) of Residential direct support staff adequately “know” the person, and were trained in the ISP process. 12 of 13 service staff (92%) were able to describe the person’s health-related needs and adequately able to describe his/her responsibilities in providing daily care/supports. Practice Challenges 3 persons in the sample were found to not have a safe residence. 38% of the sample (5 people) had residential environments that did not offer a minimal level of quality of life. M. Residential Services *one person has Assisted Living services provided by the same staff person as supported employment/community membership, so that section was not scored

39. 2005 Community Practice Review DRAFT Southwest Region 39 M. Residential Services *one person has Assisted Living services provided by the same staff person as supported employment/community membership, so that section was not scored Findings by Area QuestionResponse % Yes 44. Does the residential direct services staff “know” the person?13 Yes100% 47. Is the residence safe for individuals? (void of hazards?)10 Yes 3 No 77% 48. Was the residential direct service staff able to describe this person’s health-related needs? 12 Yes 1 Partial 92% 49. Was the residential direct service staff able to describe this person’s health-related needs? 12 Yes 1 Partial 92% 50. Did the residential direct service staff have training in the ISP process? 13 Yes100% 51. Did the residential direct service staff have training on the provider’s complaint process and on abuse, neglect and exploitation? 11 Yes 2 Partial 85% 52. Does the direct service staff have an appropriate expectation of growth for this person? 10 Yes 3 Partial 77% 53. Does the person’s residential environment offer a minimal level of quality of life? 8 Yes 5 Partial 62%

40. 2005 Community Practice Review DRAFT Southwest Region 40 Lyn Rucker Community Monitor rpaltd@aol.com Office: 785-258-2214 Cell: 785-366-6468 Thank you!