Class Members: 52 Number in Sample: 14 (27%) Two Independent Case Management

1. 2005 Community Practice ReviewSouthwest RegionDRAFTFindingsPresented: February 23, 2006Southwest Review held January 9 -13, 2006

2. Class Members: 52 Number in Sample: 14 (27%) Two Independent Case Management Agencies in Sample SCCM 10 in sample DSLM 4 in sample

3. Day and Residential Agencies and number in sample Day Residential Life Quest 1 1 Opportunity Center 1 1 Progressive 1 1 ResCare 3 4 Tresco 7 6 WNG 1 1

4. Class Members with Immediate or Special Needs Individuals Needing Immediate Attention: 3 People 21% of sample Individuals for whom health, safety, environment and/or abuse or neglect issues were identified during the review. Individuals Needing Special Attention: 5 People 36% of sample 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)

5. Identified Indicators of Good Practice People play valued roles in their community • Two people are active swimmers and seven are bowlers. • 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. • Five people attend church. • Five people are members of and visit their local libraries

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

7. Identified Indicators of Good Practice 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. • Four people have day staff that have been with them for at least four years. One for 11 years! • Nine people are treated with dignity and respect.

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

9. Identified Indicators of Good Practice 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 • One person has learned to spell her name, and is beginning to learn letters and numbers.

10. Identified Indicators of Good Practice People have shown evidence of progress • During the past year, three people have shown a decrease in behaviors that have been identified as dysfunctional. • Six people are becoming more independent in their homes: cooking/meal prep, cleaning, personal hygiene, dressing and other daily tasks. • 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%).

11. A. Expectations for Growth and Quality of Life • 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) Findings by Area

12. Findings by Area 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.

13. Findings by Area A. Expectations for Growth and Quality of Life

14. Findings by Area A. Expectations for Growth and Quality of Life

15. Findings by Area B. Satisfaction • 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. Findings by Area B. Satisfaction

17. Findings by Area C. Assessments • Noteworthy Practice • Every score in the Assessments area reflected an increase over 2004 • 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.

18. Findings by Area C. Assessments

19. Findings by Area D. Adequacy of Planning and Adequacy of Services • 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) • 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.

20. Findings by Area D. Adequacy of Planning and Adequacy of Services

21. Findings by Area D. Adequacy of Planning and Adequacy of Services

22. Findings by Area E. Individual Service Planning • 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. Findings by Area • Individual Service Planning – Historical Scoring

24. Findings by Area F. Team Process • 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. Findings by Area F. Team Process

26. Findings by Area F. Team Process (continued)

27. Findings by Area G. Health Related Needs • 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. Findings by Area G. Health Related Needs

29. Findings by Area H. Supported Employment • 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. Findings by Area H. Supported Employment – Historical Scoring

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. Findings by Area I. Day Services

33. Findings by Area J. Behavioral Support Services • 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. Findings by Area J. Behavioral Support Services – Historical Scoring

35. Findings by Area K. Adaptive Equipment/Augmentative Communication • 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%) Adaptive Equipment/Augmentative Communication - Historical Scoring

36. Findings by Area L. Case Management • 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. Findings by Area L. Case Management

38. Findings by Area 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 • 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.

39. Findings by Area 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

40. Thank you! Lyn Rucker Community Monitor rpaltd@aol.com Office: 785-258-2214 Cell: 785-366-6468