Essential Elements of Self-Determination In Wisconsin Excerpts from: SDS Stakeholders Seminar October, 24, 2006 Wisconsin Dells Updated for: SDS Network July 11, 2011 Wisconsin Dells

Key Elements of a Service System based upon Self-Determination 2006

Clarity of Purpose To help people Receive the support they need, To craft meaningful lives for themselves in their communities, In the company of those they care about, in the company of those who care about them.

INDIVIDUAL Individual Self and Consciousness Subjective Personal Can best be known by self, and for some people by those who best know and care about the person ( Family often play that role) COMMUNITY & CULTURE Place Culture/Values/Beliefs Voluntary Associations SERVICE SYSTEM Public Bureaucracies (DHFS,DWD,DPI) Counties and CMOs (No IRIS Yet) Provider and Health Care Agencies Professionals/Paraprofessionals Political Systems Integrating Support & Services to People with Disabilities

Principles of Self-Determination Authority over dollars needed for support Freedom to live a meaningful life in the community Support to organize resources in ways that are life enhancing and meaningful, promote valued social roles, enable and enhance connections to others Responsibility for the wise use of public dollars Confirmation of the important leadership that self-advocates and families must hold within the system they rely upon

High Expectations for: Regular Lives Employment, Careers, Retirement Contribution and Meaning A Home That is One’s Own Community Inclusion

Systems Tools: An Individual Budget What is it? A certain amount of funding for support and services, Allocated for an individual or family, Which cannot be spent without authorization by that individual or family.

Within An Individual Budget Needed support can be directly purchased & managed by an individual or family (Employer Authority) Or, all supports and services can be chosen, developed, and subject to change through the authority of the individual or family & allies. (Budget Authority)

Budget Authority Includes Choosing where to live, who to live with and what to do during the day; Selecting and, if desired, changing agencies; Hiring, training, dismissing support workers; Proposing and negotiating new ways of obtaining support.

Independent Support Coordination Also called support broker or personal agent, Ideally,works for the person, not a service provider, county or managed care organization Provides independent advice and support May help a person…. … plan … imagine what is possible … find and organize resources … evaluate how things are working

Financial Management Services Can … Write checks to pay bills; Take care of tax withholding,pay worker’s comp, health insurance, other benefits Some can also Assist person to recruit, screen, hire and train his or her support workers Act as employer of record if needed

Individualized Services Home … work … community

Community Connections Valued Social Roles Presence Participation Contribution Support

Safeguarding – Addressing Vulnerability Personal Intentional Thoughtful

Information & Support Peer to PeerFamily to Family From the System --- Simply

Imagining Better …. Innovation

Self-Directed Supports in Wisconsin 2011 How are we doing?

Our Laboratories Dane County Family Care IRIS

Dane County Darn Good 1915(c) Waiver DD Only # People June 1, Family Care Managed LTC 1915(b)(c) Waiver DD Phys Dis IRIS 1915(c) “SDS” Waiver 1915(j) PC DD Phys Dis Elderly 4000

Dane County Self Directed Support Flow Chart Providers Fiscal Intermediaries Co-Employment Other goods or services Agreements Individual and Support Broker develop person centered and financial plan Vouchers Individual chooses Support Broker Dane County Adult Community Services Fiscal Management (Direct Support Funds) Payments Individual & Financial Plan submitted Individual & Financial Plan Approved Transfer of Individual Funds Rate set & given to individual Specialized Transportation Training Events Community Organizing Housing Counseling Public Services Personal Counseling Personal Counseling Augmentative Communication Assistance with Self Employment Behavior Interventions Support Brokers Community Nursing Sound Response Sound Response Legal & Self Advocacy

Living arrangements Number Served Number of Providers Number Waiting Live with roommate (s)670 Living alone, in cluster59 Living alone, come-in support97 Living alone with behavioral support51 AFH Corporate AFH Private4232 Out of County42 Total Day Support Number Served Number of Providers Number Waiting Supported Employment/Self-Employed90913 Facility-Based (Sheltered/Adult Day Care)3053 Total Dane County How People are Supported 14

Merging Managed Care with Self-Directed Supports

SDS within Family Care Each Family Care member may meet with their Inter- Disciplinary Team (IDT) to identify the outcomes they would like to meet use SDS The MCO will develop a “budget allocation” for the member based upon the outcomes identified and the typical costs to meet those services through the MCO provider network The IDT will assist the member in developing a plan and obtaining and monitoring support for SDS A member may use SDS to manage some or nearly all of their Family Care benefit

CMS required alternative to Family Care Available where Family Care is offered –Began 7/1/2008 Comprehensive, creative “SDS” waiver State-Administered with two primary contracts –IRIS Independent Consultant Agency –Fiscal Services Agency Self-Directed PC (1915 j) added 10/09 Design Overview

Begins with an Individual Budget Allocation (obtained though ADRC, using Wisconsin LTC Functional Screen) Plan developed and approved with the assistance of an IRIS Consultant and the IRIS Consultant Agency Ongoing support through an IRIS Consultant “Bills paid” by Financial Services Agency Using IRIS

26 Overall SDS Learning There are differences among the three laboratories that would benefit from further exploration. For example: Dane County has by far the highest proportion of participants in supported living and integrated employment. Why? Family Care’s IDTs offer a strong system of support. Can that system enhance creativity and flexibility over time? IRIS has a high proportion of people employing support directly. What are the strengths and concerns about that over time?

27 Overall SDS Learning All three laboratories, in general, have: maintained or increased quality; increased choice, empowerment and inclusion through SDS; been cost-effective; grown rapidly and become a popular choice seen less creativity and innovation than might have been expected. Challenges remain... And there is no reason they cannot be successfully addressed.