2005 community practice review statewide findings draft 2005 community practice review statewide...

2005 Community Practice Review2005 Community Practice Review

Statewide FindingsStatewide FindingsDRAFTDRAFT

Presented: March 20, 2006Quarterly Meeting

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2005 Community Practice Review DRAFT Statewide Findings

Class Members: 395Class Members: 395

Total Number in Sample: 101 (26%)Total Number in Sample: 101 (26%)

Number of Agencies in the Sample:Number of Agencies in the Sample:

Independent Case Management: 21Independent Case Management: 21

Employment/Day Agencies: Employment/Day Agencies: 3939

Residential Agencies: Residential Agencies: 4141

Class Member and Sample Information

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Individuals Needing Immediate Attention: 9 People 9% of sample

Individuals Needing Special Attention: 27 People 27% 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, effect the person’s health, safety and/or welfare.

In 2004, 24 people required Immediate Attention (25%) and 18 people required Special Attention (19%).

(96 people in the 2004 sample)

Class Members with Immediate or Special Needs

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Fourteen people are active swimmers.

People are active in their communities

Twenty people are members of and visit their local libraries – one person reads with the children during story hour!

Four people are involved in other types of sports, such as Tennis, Walkathons, Baseball, and Putt-Putt golf.

Twenty people are active bowlers.

Seven people are zoo members – and two participate in prairie dog rescue.

Specific Examples of Good PracticeSpecific Examples of Good Practice

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People play valued roles in their communities

Two people are part of the special orchestra

Seven people are members or volunteers at local clubs or shelters.

Thirteen people are involved with national awareness groups, including Special Olympics, People First!, Habitat for Humanity, and Meals on Wheels.

Forty-two people attend church – and one volunteers in the nursery.

One person does presentations for non-disabled people.


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Forty-four people are going more places or participating/interacting more while in the community.

Thirty-one people have increased their communication ability and/or their interactions with others --One person has learned to spell her name, and is beginning to learn letters and numbers.


People are interacting more and have friends

Forty-three people have non-paid friends with whom they meet and interact with in the community – one person regularly exchanges e-mail with two friends, and four have “significant others”.

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People have shown evidence of progress

During the past year, eight people have shown a decrease in behaviors that have been identified as dysfunctional.

687 assistive technology and adaptive equipment devices are needed by the members of the sample; 600 are in good repair, available, and used when needed. (87%).

Thirty-one people are becoming more independent in their homes: cooking/meal prep, cleaning, personal hygiene, dressing and other daily tasks.

Nineteen people are becoming more physically active or have increased their mobility.


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Findings: Person-Centered OutcomesFindings: Person-Centered OutcomesService planning and program intensity are not adequate.

• 71% did not have a program of the level of intensity adequate to meet their needs.

• 65% received services and supports recommended in the ISP (47% in 2004).

• 21% had ISPs adequate to meet their needs.

• 64% of the people achieved progress in the last year (56% in 2004).

Question 2000 2001 2002 2004 2005

Overall, is the ISP adequate to meet the person’s needs?

33% 34% 29% 5% 21%

Is the program of the level of intensity adequate to meet this person’s needs?

42% 53% 36% 18% 29%

Summary – Historical Scoring

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Findings: Person-Centered OutcomesFindings: Person-Centered Outcomes

More individuals are being provided with choices.

• 74% of persons have daily choices/appropriate autonomy over his/her life (57% in 2004).

• 87% of persons (70% in 2004) were provided the assistance and support needed to participate meaningfully in the planning process.

• 69% have the opportunity to make informed choices. (46 CND)

o 85% (55% in 2004) had choices about where and with whom to live. (47 CND)

o 78% (60% in 2004) had choices about where and with whom to work/spend his/her day. (46 CND)

o 83% (63% in 2004) had choices about where and with whom to socialize/spend leisure time. (41 CND)

• For persons who are retired, 70% have adequate opportunities to engage in activities of interest during the day (47% in 2004). (80 N/A)

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Integration improving, more opportunities needed.

• 65% of persons have adequate access to and use of generic services and natural supports (44% in 2004).

• 53% of persons were found to be adequately integrated into the community. (32% in 2004)

Daily lives are improving.

• 92% of individuals’ cultural preferences are being accomodated. (82% in 2004)

• 75% of people are treated with dignity and respect.

• 98% of the sample have adequate food and drink available. (12 CND)

• 90% of persons have adequate transportation to meet their needs.

• 88% were found to have sufficient personal money. (16 CND)

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The health and wellness needs of many class members are not being adequately addressed.

• 69% of the persons’ health supports/needs are not being adequately addressed. (81% in 2004)

• 67% of Teams did not arrange for and obtain the needed, relevant assessments (82% in 2004).

• There was evidence/documentation of physical regression in the last year for 28% of the sample (29% in 2004).

• There was evidence or documentation of behavioral or functional regression in the last year for 18% of the sample (32% in 2004).

• 67% of the Teams are adequately addressing this regression. (19% in 2004)

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Generally, people are safe at home and work.

• 89% have day/employment environments that are generally clean, free of safety hazards and conducive to the work/activity intended. (71% in 2004)

• 90% of residences are safe for individuals (void of hazards), (88% in 2004).

• For 84% of the sample, the person’s residential environment offered a minimal level of quality of life. (82% in 2004)

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When a determination could be made, individuals were found to get along with their staff.

• 100% of persons get along with their case manager (74 CND) and find them helpful (87 CND).

• 96% get along with their day program/employment staff. (31 CND)

• 99% get along with their residential provider staff. (16 CND)

• 82% of guardians determined the case manger was helpful. (23 CND)

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Guardianship remains a key issue statewide• The level of participation for the guardians in the sample is:

Active: 40% (43% in 2004) 3 or + x monthModerate: 35% (28% in 2004) 1 or + x monthLimited: 24% (27% in 2004) - than 12 x yrNone: 1% ( 2% in 2004)

• 100% of the individuals for whom a determination could be made know his/her guardian (54 CND).

• 75% of individuals (80 CND) believe their guardian is helpful (89% in 2004).

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Question 2000 2001 2002 2004 2005

Does the person need behavioral services? 64% 71% 76% 64% 60%

Have adequate behavioral assessments been completed?

89% 100% 85% 64% 76%

Does the person have behavior support plan developed out of the behavior assessments that meet the person’s needs?

89% 90% 92% 62% 76%

Have the staff been trained on the behavior support plan?

67% 78% 92% 54% 73%

Does the person receive behavioral services consistent with his/her needs?

89% 100% 92% 62% 71%

Are behavioral support services integrated into the ISP? 89% 67% 38% 31% 58%

Behavioral Supports and Services Are Improving

Behavior Services – Historical Scoring

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Question 2000 2001 2002 2004 2005

Has the person received all adaptive equipment? 50% 60% 88% 59% 75%

Has the person received all assistive technology needed?

50% 63% 100% 52% 44%

Has the person received all communication assessments and services needed?

56% 73% 50% 36% 46%

More class members (CM) are receiving needed adaptive equipment, more are used and more work as intended. For many, assistive technology continues to be either unavailable, not used or not working. Communication assessments and services continue to be inadequate for more than half of the class members in the review.

Historical Scoring

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Question 2000 2001 2002 2004 2005

Need an employment assessment? 64% 100% 88% 82% 58%

Need supported employment? 57% 29% 59% 53% 51%

Receive supported employment assessment? 100% 100% 100% 86% 83%

Assessment conforms to DOH Regulations? 89% 71% 87% 15% 39%

Has a Career Development Plan? 38% 100% 30% 14% 25%

Is supported employment provided in line with requirements?

38% 75% 30% 25% 21%

Supported Employment - Historical Scoring

There are fewer CM recommended for SE, fewer CM in SE as recommended and fewer CM having access to jobs that meet minimal standards for quality employment.

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The IDT Planning and Implementation Process is not adequate for most class members.

• For 83% of the class members reviewed, the IDT process was not adequate for assessing, planning, implementing and monitoring of services (up from 81% last year).

• Of the ISP documents that were found to be adequate (21), 33% were not being adequately implemented.

• For individuals who had less than adequate ISP documents, 24% were receiving current services that met their needs.

Findings: Team and Planning ProcessFindings: Team and Planning Process

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Many IDTs are not using and following up on health assessments as needed.

• 73% of individuals have teams that discussed their health-related needs (up from 49% in 2004).

• 54% of teams considered what assessments were needed and relevant to the team’s planning efforts (42% last year).

• Although an increase from 22% least year, only 54% of teams adequately used recommendations from assessments in planning.

Findings: Team and Planning ProcessFindings: Team and Planning Process

Direct Support Staff need adequate input in the ISP.

• 65% of day/employment direct service staff (up from 46% in 2004) have adequate input in to the person’s ISP.

• 78% of residential direct service staff (up from 67% in 2004) have adequate input in to the person’s ISP.

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More staff know their daily care responsibilities.

• Overall, 77% of individuals had direct service staff able to describe their responsibilities in providing daily care/support to the person (up from 67% last year).

• 84% of case managers understand his/her role/job (72% in 2004).

• 86% of day/employment direct service staff were able to describe his/her responsibilities in providing daily care/supports to the person (76% last year).

• 88% of residential direct service staff were able to describe his/her responsibilities in providing daily care/supports to the person (79% last year).

Findings: Staff Competency/KnowledgeFindings: Staff Competency/Knowledge

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More staff “know” the person whom they support

• 84% of case managers “know” the person (up from 70% last year).

• 78% of day/employment direct services staff “know” the person (74% in 2004).

• 89% of residential direct service staff “know” the person (up from 83%).

Staff need more health related information

• 69% of team members interviewed were not able to describe the person’s health related needs (31% could, up from 29% last year).

• For 50% of those in the sample, the case manger could describe the person’s health related needs (up from 44% in 2004).

• Employment/Day staff could describe the person’s health-related needs 60% of the time, Residential staff could do so 63% of the time (up from 46% and 55%).


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Staff have received more training

• 81% of residential staff received training on the ISP Process (60% in 2004).

• 80% of employment/day staff received training on the ISP Process (60% in 2004).

• 75% of the day/employment direct service staff received training on implementing this person’s ISP (58% last year).

• 84% of residential staff received training on implementing this person’s ISP (up from 73% last year).

• Overall, 67% of all direct service staff were found to have received training on the implementation of the ISP (51% in 2004).

• For 90% of the sample, the case manager received training on the topics needed to assist in meeting the needs of the person. (68% in 04)

• 73% of staff were trained on the behavior support plan (54% last year).

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Team performance and follow up has improved, but needs further improvement.

• 34% of IDT members are following up on their responsibilities. (25% in 04)

• In 55% of the instances of team conflict, there was evidence that the team made efforts to build consensus.

• 71% of teams were found to have adequate communication between meetings to ensure the person’s program is being implemented (51% in 2004)

• Teams convened meetings as needed due to changed circumstances or needs 76% of the time (up from 51% last year).

Findings: Performance ExpectationsFindings: Performance Expectations

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Teams have low expectations of growth for individuals

• Less than half (47%) of IDTs have an appropriate expectation of growth for the person they support (25% last year).

• 60% of case managers have appropriate expectation of growth for the person they support (36% in 2004).

• 68% of residential direct service staff have an appropriate expectation of growth for the individuals (up from 49%).

• 67% of employment/day direct service staff have an appropriate expectation of growth for the individuals (52% in 2004).

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Case Management services are improving, knowledge of health related needs requires more attention.

• 54% of case managers are not providing case management services at the level needed by the person (46% are, 34% were in 2004).

• 83% of the individuals in the sample have case managers who are adequately available to them (78% were available last year).

• 84% of the case managers know those whom they support. (70% in 2004)

• 50% of the case managers were able to describe the health related needs of those whom they support. (44% in 2004)

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Findings: Documents/Record keepingFindings: Documents/Record keepingIndividual Service Plans are not adequate to meet the needs of class members.

• 21% of ISPs were found to be adequate to meet the person’s needs.

• Overall, 62% of FSAs gave adequate guidance to achieving the person’s long-term vision (up from 31% last year).

• ISP goals in 61% of the sample were related to achieving the person’s long-term vision (31% last year).

• 52% of ISP goals address the person’s major needs (24% in 2004)

• Less than half (43%) of the objectives are specific and relevant to assisting the person in achieving his/her goals (18% last year).

• 45% of the strategies were found to be sufficient to ensure consistent implementation of the services planned (up from 21%).

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Findings: Documents/Record KeepingFindings: Documents/Record KeepingIndividual Service Plans are not adequate

• 44% of the recommendations and/or objectives/strategies of ancillary providers were integrated into the goals, objectives and strategies of the ISP (12% in 2004).

• 62% of applicable ISPs contain a specific crisis plan that meets the person’s needs (up from 28% last year).

• 74% of ISPs contain specific arrangements for primary health (medical) care (48% in 2004).

• For 60% of the applicable class members, the ISP reflects how the person will obtain prescribed medications (42% last year).

• 47% of the case manager’s records contain progress notes or other documentation that reflect the status of the goals and services of the key life areas stated in the ISP (up from 28% last year)

• 53% of assessments were found to be adequate for planning (24% in 2004)

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Findings: Documents/Record KeepingFindings: Documents/Record Keeping

Individual Service Planning – Historical Scoring

Question 2000 2001 2002 2004 2005

Does the person have an ISP that addresses living, learning/working and social/leisure…

79% 79% 82% 57% 68%

Does the ISP contain a functional supports assessment based on a long-term view?

100% 93% 82% 59% 77%

Does the person receive services and supports recommended in the ISP?

71% 79% 88% 47% 58%

Does the person have adequate access to and use of generic services and natural supports?

57% 79% 88% 44% 65%

Is the person adequately integrated into the community?

64% 79% 82% 32% 53%

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Lyn RuckerLyn RuckerCommunity MonitorCommunity Monitor

[email protected]@aol.comOffice: 785-258-2214Office: 785-258-2214Cell: 785-366-6468Cell: 785-366-6468

Thank you!Thank you!