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Essential Elements of Self-Determination In Wisconsin

Essential Elements of Self-Determination In Wisconsin. Updated for: SDS Network July 11, 2011 Wisconsin Dells. Excerpts from: SDS Stakeholders Seminar October, 24, 2006 Wisconsin Dells. Key Elements of a Service System based upon Self-Determination 2006.

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Essential Elements of Self-Determination In Wisconsin

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

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

  3. Clarity of Purpose To help people • Receive the supportthey need, • To craftmeaningful lives for themselves in their communities, • In the company of those they care about, in the company of those who care about them.

  4. Integrating Support & Services to People with Disabilities

  5. Principles of Self-Determination Authorityover 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 Responsibilityfor the wise use of public dollars Confirmationof the important leadership that self-advocates and families must hold within the system they rely upon

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

  7. 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.

  8. 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)

  9. 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.

  10. IndependentSupport 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

  11. 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

  12. Individualized Services Home … work … community

  13. Community Connections Valued Social Roles Presence Participation Contribution Support

  14. Safeguarding – Addressing Vulnerability Personal Intentional Thoughtful

  15. Information & Support Peer to Peer Family to Family From the System --- Simply

  16. Imagining Better …. Innovation

  17. Self-Directed Supports in Wisconsin2011 How are we doing?

  18. Our Laboratories Dane County Family Care IRIS

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

  20. Dane County How People are Supported Number Number of Number Living arrangements Served Providers Waiting Live with roommate (s) 670 Living alone, in cluster 59 14 Living alone, come-in support 97 Living alone with behavioral support 51 AFH Corporate 3-4 42 3 AFH Private 42 32 Out of County 4 2 Total 965 16 350 Number Number of Number Day Support Served Providers Waiting Supported Employment/Self-Employed 909 13 Facility-Based (Sheltered/Adult Day Care) 305 3 Total 1214 14 88

  21. Merging Managed Care with Self-Directed Supports

  22. 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

  23. Design Overview • 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

  24. Using IRIS • 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

  25. Overall SDSLearning 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?

  26. Overall SDSLearning • 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.

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