2018 Performance Contract - San Diego Regional...

East County Office 8760 Cuyamaca St #100 Santee CA 92071 619-596-1000

Imperial County Office 512 W Aten Rd Imperial CA 92251 760-355-8383

North County Office 5931 Priestly Dr #100 Carlsbad CA 92008 760-736-1200

South County Office 2727 Hoover Ave #100 National City CA 91950 619-336-6600

San Diego Regional Center Serving Individuals with Developmental Disabilities in San Diego and Imperial Counties

4355 Ruffin Road, San Diego, California 92123 • (858) 576-2996 • www.sdrc.org

2018 Performance Contract Public Meeting

DATES

TUESDAY 9/12/17

12:15 p.m. – 12:45 p.m.

San Diego Regional Center Board Room, Suite 101

4355 Ruffin Road San Diego CA

THURSDAY 9/14/17

6:00 p.m. to 7:00 p.m.

San Diego Regional Center Imperial Office

512 West Aten Road Imperial CA

Information, including the first draft of the Performance Contract, will be shared at the public meetings and will be available after 8/25/17 through the SDRC Department of Community Services, 858-576-2966, or on the SDRC website at www.sdrc.org. You may submit written comments by 9/29/17 to: Lori K. Sorenson, M.A. Director, Community Services San Diego Regional Center 4355 Ruffin Road, Suite 104 San Diego CA 92123 or by e-mail: [email protected]

http://www.sdrc.org/

mailto:[email protected]

East County Office 8760 Cuyamaca St #100 Santee CA 92071 619-596-1000

Imperial County Office 512 W Aten Rd Imperial CA 92251 760-355-8383

North County Office 5931 Priestly Dr #100 Carlsbad CA 92008 760-736-1200

South County Office 2727 Hoover Ave #100 National City CA 91950 619-336-6600

San Diego Regional Center Serving Individuals with Developmental Disabilities in San Diego and Imperial Counties

4355 Ruffin Road, San Diego, California 92123 • (858) 576-2996 • www.sdrc.org

2018 Performance Contract Public Meeting

A G E N D A

San Diego Regional Center sponsored by San Diego Regional Center and

the State Council on Developmental Disabilities San Diego Imperial Office (SCDD)

I. Introductions

Board

II. Purpose of Meeting

Board

III. SCDD San Diego Imperial Office Statement

SCDD

IV. Budget • Total Clients • Historical Purchase of Service Growth • Fiscal Year 2016-2017 Purchase of

Service Expenditures

SDRC Staff

V. Performance Contract • 2017 Demographic Data Report • Performance Contract Pilot

o SDRC Performance Contract Status Reports o 2018 Performance Contract Activities—Input

17,880 18,858 19,147 19,585

20,513 21,460

22,343

23,731

25,080

26,450

0

5,000

10,000

15,000

20,000

25,000

30,000

Jul 08 Jul 09 Jul 10 Jul 11 Jul 12 Jul 13 Jul 14 Jul 15 Jul 16 Jul 17

Total Clients

$181.5

$201.9 $205.5 $212.1 $217.2

$231.5

$246.8

$267.2

$292.1

$324.1

$0.0

$50.0

$100.0

$150.0

$200.0

$250.0

$300.0

$350.0

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17Estimate

Purchase of Services Growth M

illio

ns

Mill

ions

M

illio

ns

Fiscal Year

Support Services $30,116,977

9% Medical

$5,527,022 2%

Habilitation $17,311,059

5%

Day Activities $102,790,883

32%

Early Start $9,091,203

3%

Other $29,252,855

9%

Transportation $20,495,939

6%

Out of Home $94,898,804

29%

Non-Medical $14,567,043

5%

Fiscal Year 2016-2017 Purchase of Services Expenditures $324,051,785 (estimate)

SAN DIEGO REGIONAL CENTER DEMOGRAPHIC INFORMATION

February 23, 2017

TABLE OF CONTENTS

Section Page

General Demographic Information 1

SDRC Demographic Information 1

Community Living Services 2

Adult Day Services 4

Other Services 4

Glossary of Resource Terms 5

Appendix I General Client Statistics 8

Appendix II SDRC Vendor Category Statistics 12

Appendix III New Vendor Statistics 14

Appendix IV Community Living Situation Statistics 16

Appendix V Licensed Residential Facility/Vacancy Rates 19

Appendix VI Deflection Team Statistics 21

Appendix VII State Developmental Center Client Stat. 22

Appendix VIII Adult Day Services Statistics 23

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February 23, 2017

INTRODUCTION This report contains population demographics and client and service provider statistics for the San Diego Regional Center (SDRC). SDRC provides services to persons who meet the state definition of developmental disabilities or, if younger than the age of three, have a developmental delay, or an established risk of a condition causing a developmental delay, or at high risk for a developmental disability, and who reside in San Diego or Imperial Counties. DEMOGRAPHIC INFORMATION San Diego County is the most southwestern county in the state and covers 4,261 square miles. The population of San Diego County as of July 1, 2015, was estimated to be 3,299,521. It is the second largest county in California after Los Angeles County. It encompasses 18 separate municipalities. San Diego is the eighth largest city in the United States. Imperial County is the most southeastern county in the state and covers 4,597 square miles. The population of Imperial County as of July 1, 2015 was approximately 180,191. It is primarily a rural, agricultural area and is sparsely populated when contrasted with San Diego County. Approximately 82% of the population in Imperial County is Latino. In December 2016 the estimated unemployment rate in Imperial County was 23.0%, compared with the California state estimated unemployment rate for December 2016 of 5.2%. SDRC DEMOGRAPHIC INFORMATION San Diego Regional Center is the second largest of the 21 California regional centers, serving 25,772 clients as of January 3, 2017. The population eligible for SDRC services has increased by approximately 1,395 clients in calendar year 2016. SDRC has a main office located in the city of San Diego, and four satellite offices. Three of the satellite offices are located in San Diego County, in the northern, eastern, and southern geographic portions of the county. Each of these satellite offices serves 17% to 22% of SDRC’s clients. The fourth satellite office is located in Imperial County, and serves 11% of SDRC’s clients.

Sixty-six percent (66%) of the clients served by SDRC who are older than the age of three years have a diagnosis of intellectual disability, sixteen percent (16%) have a diagnosis of epilepsy, fifteen percent (15%) have a diagnosis of cerebral palsy, and thirty-one percent (31%) have a diagnosis of autism (a client may have more than one diagnosis).

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February 25, 2017

The percentage of SDRC clients with a diagnosis of autism has increased dramatically over the past 20 years, from 7% of the clients in 1997 to 31% of the clients in 2017. Sixty-eight percent (68%) of SDRC clients in the three years to thirteen years age group have a diagnosis of autism, while only eighteen percent (18%) of SDRC clients in the 18 years to 55 years age group have a diagnosis of autism. Thirteen percent (13%) of clients older than the age of 22 have a mental health diagnosis in addition to a developmental disability (Appendix I). Fifty-one percent (51%) of the clients served by SDRC are children, and forty-nine percent (49%) are adults. Thirteen percent (13%) of the clients served by SDRC are three years of age or younger, and are receiving early intervention services. English is the primary language spoken by seventy-five percent (75%) of SDRC’s clients, twenty-one percent (21%) of SDRC’s clients speak Spanish as their primary language, and less than one percent (1%) speak Vietnamese, Tagalog, or Arabic. Two percent (2%) of SDRC’s clients speak a variety of other languages. SDRC employs service coordinators who are bilingual in English and other languages. SDRC has more than 4,256 vendored services. This includes a number of large agencies that often provide a number of vendored services, as each service vendorization is for a specific type of service, provided at a specific location. This also includes more than 2,013 family members of clients who are vendored to obtain respite, nursing, day care, transportation, or supported living services (Appendix IIa). Fifty-eight SDRC vendors are located in Imperial County, including one family member of a client (Appendix IIb). In January through December 2016, a total of 311 new services and individuals were vendored in San Diego County (Appendix IIIa). These new services include 40 specialists, ten Adult Day programs, one Tailored Day Service Option, two Independent Living Services Agencies, one Supported Living Service Agency, six Day Care/Out-of-Home Respite programs, five In-Home Respite Agencies, 169 family member vendors, and 11 other services. Ten additional licensed residential homes with a total of 43 additional beds were vendored in 2016. COMMUNITY LIVING SERVICES As of January 2017, a total of 20,544 clients were residing with family members, 1,835 clients were residing in their own homes, 329 clients were residing in foster homes, 2,824 clients were residing in residential facilities, and 62 clients were residing in state developmental centers (Appendix IV). More than 97% of the clients younger than the age of 18 live with family members. There has been a decrease in each of the past twenty years in the percentage of SDRC clients living in licensed residential facilities, and an increase in the percentage of SDRC clients living with family members. There has been a slight decrease in the percentage of SDRC clients living in their own homes over the past twenty years, which may be due to the limited affordable housing in San Diego County.

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February 23, 2017 Appendix V summarizes the number of SDRC residential resources of various types and vacancy rates for each type of residential service. The more specialized homes maintain lower vacancy rates and there are generally very few vacancies in licensed residential facilities which provide behavior management services for children. Vacancy rates for health licensed facilities remain very low. When no residential resources are identified for a client through the standard process, the person is referred to the SDRC Deflection Review Team for review and a determination of whether a statewide search for an appropriate resource is warranted. Deflection Review Team statistics from January 2016 through December 2016 are summarized in Appendix VI. A total of 38 client referrals were reviewed during this 12-month time period. Fifteen(40%) of the clients referred were either identified by their service coordinator as having a mental health diagnosis, or were prescribed psychotropic medications, in addition to having a developmental disability. Ten (26%) clients referred to the Deflection Review Team have a diagnosis of autism, with 54% of clients younger than the age of 18 having a diagnosis of autism. Twenty-six (68%) of the clients identified for deflection are younger than the age of 30. As of July 1, 2012, a person may only be admitted to a State Developmental Center (SDC) when the person is in “acute crisis” and there is a transition plan to return that person to the community within six months. Fourteen (37%) of the clients referred to the Deflection Review Team were deflected from an SDC Placement by the use of a highly specialized residential facility. Sixty-two of SDRC’s clients currently live in an SDC, with 42 clients living at Fairview Developmental Center. Fairview Developmental Center is scheduled for closure by December 31, 2019. SDRC is developing appropriate community services that will meet the needs of the clients currently residing at SDCs. Demographic information on these clients is summarized in Appendix VII. In contrast to the clients identified for deflection, 79% of these clients are older than the age of 30, and 45% of these clients are older than the age of 50. Appropriate community placements have been identified for nine of these clients. SDRC currently has 1,835 clients who live in their own homes (i.e. their own apartments or houses rather than in the houses of family members). Most of these clients use independent or supported living services to support them in their residence (Appendix IV). Independent Living Services may also be provided to clients living in the home of a parent or relative if the client wants to learn skills that will allow them greater independence in the family home. Two hundred and sixty-eight clients receive support through Supported Living Services agencies and 1,662 clients receive services through Independent Living agencies. There are currently 49 Independent Living Services vendors, and 25 agencies that provide Supported Living Services. Increased rental costs in San Diego County, combined with very low vacancy rates have made itvery difficult for SDRC clients to locate affordable housing. Clients who wish to utilize the Section 8 rental assistance program, a federally funded program, are almost always placed on a

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February 23, 2017 waiting list, and often wait for this assistance for more than ten years. SDRC contracts with two different non-profit corporations to assist clients with accessing affordable housing. One of these non-profit housing corporations is working with local affordable housing developers to increase the availability of affordable housing options for people with developmental disabilities. SDRC also contracts with a non-profit agency to assist clients who are interested in pursuing home ownership.

ADULT DAY SERVICES SDRC has 7,528 clients who participate in adult day services (Appendix VIII). SDRC funds adult day services for 5,936 clients. The Department of Rehabilitation funds services for 262 clients. Fourteen percent (1,411) of the SDRC clients who participate in adult day services go to a public school program, community college, or other publically and privately funded educational programs. Approximately 404 clients will turn 22 years old in 2017 who will consequently need regional center funded adult day services. Appendix V provides estimates, based on recent trends, on the types and locations of the adult day services that will be needed by these clients. Currently there are 213 SDRC vendored adult day programs. Providing services for most of the clients graduating from public school programs in 2016 should be within the capacity of current adult day service resources; however, licensed (site-based) programs in the central area of San Diego County and in Imperial County are near capacity.

OTHER SERVICES As of January 4, 2016, SDRC funded respite services for 7,251 clients, which is 38% of the clients who are living with a parent or relative. Most clients authorized for respite services use an In-Home Respite Agency or utilize the Respite Registry Services (Appendix IV). SDRC has one In-Home Respite Agency that acts as employer of record for the respite workers. SDRC funds licensed nursing respite care for 397 clients. SDRC has substantially increased the number of individually vendored Registered and Licensed Vocational Nurses. The current total of 224 vendored nurses and 20 Home Health Agencies is sufficient to meet the respite needs of SDRC clients.

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GLOSSARY OF RESOURCE TERMS Adult Developmental Center (ADC):

A day program that serves adults who are in the process of acquiring self-help skills, need sustained support and direction in developing the ability to interact with others, need support to make their needs known, and need support to respond to instructions. ADC programs focus on the development and maintenance of the functional skills required for self-advocacy, community integration, employment and self-care.

Activity Center (AC):

A day program that serves adults who generally have acquired most basic self-care skills, have some ability to interact with others, and are able to make their needs known and respond to instructions. AC programs focus on the development and maintenance of the functional skills required for self-advocacy, community integration, and employment.

Behavior Management Program:

A day program that serves adults with severe behavior challenges and/or a mental health diagnosis who have not been accepted into any other adult day program because of their behaviors. Behavior Management programs work towards understanding the function of the behavior and assisting clients with communicating their needs effectively so that transition to another program can take place.

Community Based Adult Service (CBAS) Centers: CBAS centers offer a package of health, therapeutic and social services in a community-

based day health care program. Services are provided according to a six-month plan of care developed by the CBAS center’s multidisciplinary team. The services are designed to prevent premature and unnecessary institutionalization and to keep recipients as independent as possible in the community.

Client Development Evaluation Report (CDER):

The CDER is an assessment instrument containing diagnostic and developmental information. Completion of the CDER for clients older than the age of three years is required by DDS.

Community Placement Plan (CPP): The plan developed by the regional center to return clients placed in state developmental

centers to the local community, and to deflect clients who might otherwise be placed in a state developmental center so that they can remain in the local community.

Foster Family Agency:

A non-profit organization which is community care licensed to recruit, train, certify, and support foster families who provide specialized care to 1-2 children in their own homes.

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Family Home Agency A Family Home Agency (FHA) approves family homes which offer the opportunity for

up to two adult individuals with developmental disabilities per home to reside with a family and share in the interaction and responsibilities of being part of a family.

Infant Development Program:

A training and activity program for infants and their families designed to encourage the development and adjustment of the infants in the community and their homes, and to prepare the infants for entrance into the classes of local schools.

Intermediate Care Facility/Developmentally Disabled (ICF/DD)

A health care licensed residential facility that offers special programming in sensory motor skills, self-help skills, behavior management, and close monitoring of medical needs. These facilities are larger, more institutional, more restrictive, and more structured than other levels of care available in the community.

Intermediate Care Facility/Developmentally Disabled-Habilitative (ICF/DD-H): A health care licensed residential facility which provides personal care, habilitation and supported health services to 15 or fewer (usually 6) individuals with developmental disabilities who have intermittent recurring needs for nursing services but have been certified by a physician as not requiring availability of continuous skilled nursing care.

Intermediate Care Facility/Developmentally Disabled-Nursing (ICF/DD-N):

A health care licensed residential facility which provides personal care, habilitation, and nursing staff for 15 or fewer individuals with developmental disabilities who are medically fragile.

Level 2 Home:

A community care licensed residential facility with a staffing level of one staff for up to six residents. These homes offer training, supervision, activities and intervention as needed during the normal activities of the day.

Level 3 Home:

A community care licensed residential facility that serves individuals who need extensive assistance with behavior challenges, self-help skills, and/or who are non-ambulatory. The home provides structured programming, including planned instruction and activities with an average staff to client ratio of 1:3.

Level 4 Home:

A community care licensed residential facility that specializes in behavior management. Objectives and plans are developed to diminish challenging behaviors. High staff/client ratios and a licensed behavioral consultant are provided. Level 4 homes may also be approved to serve clients with special medical needs. High staff/client ratios and a licensed medical consultant are provided in these homes.

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Respite: Temporary or intermittent care and supervision which can be provided in the family home or a licensed facility that relieves family members from the constantly demanding responsibility of caring for a client.

Specialized Residential Facility: A community care licensed residential facility that is designed to meet the needs of clients

that are either exiting a developmental center or who are being deflected from placement in a developmental center. These homes have staff/client ratios that are greater than those in Level 4 homes, and an interdisciplinary team of consultants (behavior management consultants, registered nurses, occupational therapists, etc.)

Tailored Day Service: Tailored Day Services are designed to maximize a client's individualized choices and

needs, with customization of day services through individualized services. Tailored Day Services provide opportunities for increased integration and inclusion, as well as further opportunities for the consumer to develop or maintain employment/volunteer activities, and pursue postsecondary education.

San Diego Information System (SANDIS): SANDIS is a software data base for client information used by the San Diego Regional

Center. Skilled Nursing Facility (SNF):

A health care licensed facility which offers skilled nursing and supportive care. A SNF-Distinct Part is a SNF that has a contract with, and is in close proximity to an acute care hospital.

State Developmental Center:

A large institution owned and operated by the State of California. As of July 1, 2012, a person may be admitted to a State Developmental Center only when the person is in “acute crisis”. Any person admitted to a State Developmental Center must be transitioned back to the community within six months of admission.

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Appendix I

SAN DIEGO REGIONAL CENTER GENERAL CLIENT STATISTICS

(based on CDER data of 1/3/17)

Persons Served by San Diego Regional Center

Intake Case Management Genetics Total

Total Number 595 25,170 7 25,772

Diagram 1 Client Caseload Growth

Persons Served by Each Area Office

San Diego (Main Office)

Santee (East

County Office)

Carlsbad (North

County Office)

National City (Southbay

Office)

Imperial (Imperial

County Office)

8942(33%) 4341 (17%) 5614 (22%) 4525 (18%) 2748 (11%)

0 5000 10000 15000 20000 25000 30000

1997

2002

2007

2012

2016

Number of Clients

Intake Case Management

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Appendix I

SAN DIEGO REGIONAL CENTER GENERAL CLIENT STATISTICS

(based on CDER data of 1/3/17)

Age

0 - 3 3 -18 18 - 22 22 - 55 > 55

3-13 13-18

22-30 30-45 45-55 55-65 >65

7086 2544 3607 3489 1676 1150 505

3565 9660 2121 8772 1655

(change based on CDER data of 1/5/15)

264 615 74 346 60

Diagram 2 Client Age Groups

Primary Language

English Spanish Vietnamese Tagalog Arabic All Other

19,454 (75%) 5,364 (21%) 190 (0.7%) 141(0.5%) 148 (0.6%) 475 (1.8%)

3 to 18 Years old 37.87%

18 to 22 Years Old 8.31%

22 to 55 Years Old 34.39%

Older than 55 Years 6.49%

Younger than Age 3 12.94%

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Appendix I

SAN DIEGO REGIONAL CENTER GENERAL CLIENT STASTICS (based on CDER data of 1/3/17)

Qualifying Diagnosis of Clients age 3 and older (each person may have more than one diagnosis)

Intellectual Disability

(ID)

Epilepsy (EP)

Cerebral Palsy (CP)

Autism (AU) Other

14,335 (66%) 3,507 (16%) 3,261 (15%) 6,799 (31%) 1,587(7%)

Diagram 3 SDRC Clients – Types of Developmental Disabilities

Additional Client Diagnostic/Service Needs

Ages Psychiatric Diagnosis

G-Tube Feeding

Injections (weekly or more often)

Tracheostomy Care

Under 22 383 (3.3%) 122 (1.0%) 27 (0.2%) 17 (0.1%)

22 and over 1334 (12.8%) 194 (1.9%) 189 (1.8%) 37 (0.4%)

ID Only 41.72%

AU Only 21.13%

ID/AU 11.72%

ID/EP 7.39%

ID/CP/EP 6.14%

ID/CP 5.79%

CP Only 3.00%

EP Only 1.91%

EP/CP 1.11%

Other Only 0.78%

ID/EP/AU 0.93% ID/CP/AU

0.21%

ID/AU/CP/EP 0.09%

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Appendix I

SAN DIEGO REGIONAL CENTER GENERAL CLIENT STASTICS (based on CDER data of 1/5/15)

Diagram 4

Changes in Client Diagnoses

Diagram 5 Current Client Diagnoses by Age Groups

0

10

20

30

40

50

60

70

80

90

Intellectual Disability Cerebral Palsy Epilepsy Autism

Perc

enta

ge w

ith

Dia

gnos

is

Jan-97 Jan-02 Jan-07 Jan-12 Jan-17

0

20

40

60

80

100

Intellectual Disability Cerebral Palsy Epilepsy Autism

Perc

enta

ge w

ith

Dia

gnos

is

Children (3 to 13) Adolescents (13 to 18) Adults (18 to 55) Seniors (Over 55)

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Appendix IIa SAN DIEGO REGIONAL CENTER VENDORS*

by category of vendorization 1/3/17

*includes vendors not currently being used Education Resources

Day Programs Medical Services

Developmental Spec. 1 Sup. Employ. – Ind. 16 Physicians 71

Teacher 10 Sup. Employ. - Group 15 Dentists 63

Ind. or Family Train. 61 Work Activity Prog. 13 Psychiatrists 9

Tutor Services 1 Activity Centers 14 R.N.s 44

ADCs 98 LVNs 180

Psychology Resources B. Mod. Programs 29 Hospitals 19

Clinical Psychologists 64 Community Pharmacies 31

B. Mod. Consultants 24 Integration Training 8 Dietary Services 10

Behavior Analyst 51 Socialization Train. 5 Med. Equipment 25

Counseling Services 2 CBAS Centers 18 Audiology 6

Family Services Comm. Act. Support 2 Speech 12

Respite Voucher 51 Community Living Lab/Radiology 16

Nursing Voucher 4 Licensed Facilities 558 Orthoptic Service 8

Day Care Voucher 158 Ind. Living Agencies 49 Early Start Spec. Ther. 244

Early Start Voucher 49 Sup. Living Agencies 25 Home Health Agency 20

Day Care Facility 40 Parent Coord. SL 3 Other Med. Service 18

Camps 15 Adult Fam. Home Ag. 3 Other Services

In-Home Res. Agency 45 Personal Assist. Serv. 13 Translators/Interpret. 10

Out-of-Home Respite 10 Transportation Mobile Crisis Team 4

Parent Coordinated Trans. Voucher 1751 Legal Services 12

Behavioral Interven. 2 Trans. Company 20 Sports Club 2

Homemaker Program 2 T-Add. Component 20 Housing Service 2

Infant Dev. Programs 57 Public Transit Co. 11 Retail Stores 3

Infant Dev. Specialist 11 Mobility Training 3 Interdisciplin. Assess. 9

Fiscal Management 2 Vehicle Modification 1 Lifeline Emergency 1

Total Vendors 4256 Total Vouchers 2013 Total Vendors w/o Vouchers

2243

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Appendix IIb SAN DIEGO REGIONAL CENTER VENDORS

Located* in Imperial County by category of vendorization

1/3/17 * This list only includes vendors whose office address is in Imperial County. There are some agencies and individuals who provide services in Imperial County with a home office address in San Diego County

Respite/Family Services Community Living Services

Early Start Voucher 1 Licensed Facilities 8

In-Home Respite Agency 1 Independent Living Agencies 3

Infant Development Program

1 Supported Living Agencies 1

Day Care Facility 1 Day Programs

Homemaker Program 1 Supported Employment – Ind. 2

Supported Employment - Group 2

Clinical Services Work Activity Program 1

Dentist 2 Activity Centers 1

Registered Nurse 1 Adult Development Center (1:4) 1

Teacher 1 Adult Development Centers (1:3) 2

Dietary Services 3 Behavior Management Program 2

Pharmacy 2 Socialization Training 2

Audiology 1 Adult Day Health Center 2

Orthoptic Service 1

Medical Equipment 1 Transportation Resources

Physical Therapy 2 Public Transit Company 4

Hospital 1 Transportation-Add. Component 2

Home Health Agency 1

Behavior Analyst 2

Speech Therapist 1

Occupational Therapist 1

Total Vendors 58 Total Vendors w/o Vouchers

57

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Appendix IIIa

SAN DIEGO REGIONAL CENTER NEW VENDORS

by category of vendorization January through December 2016

Specialists Other Services 2 - Dentists 5 – Individual/Family Training Services 9 - Behavior Analysts 4 - Pharmacy 2– Physicians 1 – Transportation Company 1 - Psychiatrist 1 – Public Transit Service 1 - Registered Nurse Total: 11 Other New Services 19 - Licensed Vocational Nurses 2 – Behavior Management Consultant 4- Clinical Psychologists Total: 40 New Specialists Programs 8 – Personal Assistance Service 2 – Creative Art Program 9 – Infant Development Programs 3 - Adult Development Center 2 – Behavior Management Program 3 – Community Integration Training Programs Licensed Residential Facilities 1 –Tailored Day Service Option Level 3 homes for Adults – 2 homes/12 beds 5 - In-Home Respite Agencies Level 4 homes for Adults – 4 homes/15 beds 6 - Day Care/Out-of-Home Respite Programs Specialized Res. for Children 1 home/4beds 1 – Supported Living Agency Specialized Res. for Adults –3 homes/8 beds 2 - Independent Living Agencies Total: 10 New Homes/43 beds 39 – Early Start Specialized Therapeutic Programs Total: 81 New Programs

Parent Directed Services (Vouchers) 135- Transportation/Family Member 34- Day Care/Family Member Total: 169 New Family Member Vendors

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Appendix IIIb

SAN DIEGO REGIONAL CENTER DEVELOPMENT OF NEW OR ENHANCED PROGRAM SERVICES

January 2012 through December 2016 Community Integration Program for Adults designed to serve clients who need intensive staffing in Adult Day Services - 3 Sites Tailored Day Services for Adults

- 17 Programs Behavior Support Module for a CBAS Center Substance Use Disorder (SUD) Treatment services including recovery coaching that assist clients with accessing community SUD treatment and recovery services Specialized Mental Health Counseling and Support Programs

- 2 Programs Cross Systems Support & Treatment Team for individuals with complex/high profile forensic needs

Specialized Residential Facilities with intensive levels of staffing, licensed professional interdisciplinary consultation, and a variety of other services - 14 four bed homes for adults - 2 four bed homes for adolescents Wraparound program developed in collaboration with San Diego Mental Health Services for adolescents with a developmental disability and a mental health diagnosis Non-Profit Housing Organization which purchases and renovates residential homes to be used as Specialized Residential Facilities. These homes are deed restricted to be maintained and used solely for the benefit of SDRC clients in perpetuity.

- 6 homes purchased and renovated before 1/1/17 Specialized Competency Training provided by vendors who are also contractors with San Diego Behavioral Health Services

Appendix IV SAN DIEGO REGIONAL CENTER COMMUNITY LIVING SITUATION STATISTICS (based on SANDIS data of 1/3/17)

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Community Living Situation

Under 18 Years Old

Over 18 Years Old

Totals

Total on

1/3/17

Change

from 1/4/16

Total on

1/3/17

Change

from 1/4/16

Total on

1/3/17

Change

from 1/4/16

Parent or Relative 12865 +900 7679 +424 20544 +1324

Independent/Supported Living 0 0 1835 +22 1835 +22

Foster Home/Family Home Agency 222 -24 107 +6 329 -18

Community Care Facility 60 -13 2013 +53 2073 +40

ICF/DD-H 0 -1 446 -15 446 -16

Health Facility 11 -2 294 -6 305 -8

Developmental Center 0 0 62 -4 62 -4

Other 17 +4 94 +11 111 +11

Total 13175 +864 12530 +491 25705 +1347

INDEPENDENT AND SUPPORTED LIVING

SERVICE AUTHORIZATIONS as of 1/3/17

Service

Number of

Clients

Change from

1/4/16 Supported Living Services 268 +19

Independent Living Services 1662 +107 TOTAL 1930 +126

RESPITE SERVICE AUTHORIZATIONS as of 1/3/17

Service Type Number of Clients Change from 1/4/16

In-Home Respite Agency 6095 (77%) +479

Respite Registry 1014 (13%) +11

Respite Service Family Member (Voucher) 1(0%) -2

Nursing Respite 436 (6%) +39

Out-of-Home Respite (Day/Evening) 254(3%) +7

Out-of-Home Respite (Overnight) 122(2%) +4 TOTAL 7251 +673


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Diagram 6

Client Living Situations Children (under age 18)

Diagram 7

Client Living Situations Adults (Age 18 and older)

Parent or Relative 97.77%

Foster Home 1.69%

Community Care Facility 0.46%

Health Facility 0.08%

Health Facility 2.93%

Community Care Facility 16.19%

Independent or Supported Living

14.76%

ICF/DD-H 3.59%

Developmental Center 0.50%

Parent or Relative 61.75%

Adult Family Home 0.86%


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Diagram 8 Changes in Client Living Situations

Children (Under 18)

Diagram 9 Changes in Client Living Situations

Adults (18 and older)

0 20 40 60 80 100

Parent or Relative

Community Care Facility

Foster Home

Health Facility

Percentage of Clients in Living Situation

Jan-17

Jan-12

Jan-07

Jan-02

Jan-97

0 20 40 60 80

Developmental Center

Health Facility

Community Care Facility

Independent and Supported Living

Parent or Relative

Percentage of Clients in Living Situation

Jan-17

Jan-12

Jan-07

Jan-02

Jan-97

19 | P a g e

Appendix V RESIDENTIAL RESOURCES & VACANCY RATES

January 4, 2016

Level 2O

Level 2S

Homes

Beds

Vac.

Homes

Beds

Vac.

Adults 41 209 23 80 524 45 Children 1 4 2 0 0 0 Totals 42 213 25 80 524 45

Level

3

O

Level

3

S

Level 4

Homes

Beds

Vac.

Homes

Beds

Vac.

Homes

Beds

Vac.

Adults 16 94 12 131 782 61 95 508 30 Children 4 16 2 0 0 0 7 39 2 Children-Spec. Needs 0 0 0 N/A 6 18 1 Totals 20 110 14 131 782 61 108 565 33

Community Care Licensed Homes - Totals Homes Beds Vacancies/% Non-amb. Beds Homes with > 6 beds

Level 2 122 737 60/8% 69 11

Level 3 147 778 75/6% 298 3

Level 4 108 565 33/6% 126 0

Spec.Res. 46 200 2/1% 73 1

TOTAL 423 2280 170/7% 566 15

Health Care Licensed Homes - Totals

Homes

Beds

Vacancies/%

Non-amb. Beds

Homes with > 6 beds

ICF/DD-H 81 485 7/1% 196 0 ICF/DD-N 23 147 6/4% 147 1 ICF/DD 1 57 0 57 1 SNF-Distinct Part 1 59 5/9% 59 1

TOTAL 106 748 15/2% 459 3

TOTALS - ALL RESIDENTIAL

Homes Beds

Vacancies/% 529 3028 188/6%

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Appendix V RESIDENTIAL RESOURCES & VACANCY RATES

January 4, 2016

Diagram 10 Residential Homes-Licensed Beds

Diagram 11 Residential Homes-Vacancies

Level 3 25.7%

Level 4 18.7%

ICF/DD-H 16.0%

ICF/DD 1.9%

ICF/DD-N 4.9% SNF-Distinct Part

1.9%

Specialized Residential Facility

6.6%

Level 2 24.3%

Level 3 40%

Level 4 18%

Health Licensed Facilities

10%

Level 2 32%

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Appendix VI

SAN DIEGO REGIONAL CENTER REFERRALS TO DEFLECTION TEAM

January 2016 - December 2016

Level of Intellectual Disability

None/Border. Mild Moderate Severe Profound Total 2(5%) 23(61%) 7(18%) 6(16%) 0 38

Age and Gender

0-10 11-17 18-30 31-49 50+ Total Male 0 10 9 4 5 28(74%)

Female 0 3 4 2 1 10(26%)

Other Background Factors

Mental Health Diagnosis 15(40%)

Autism-Under 18 7(54%)

Autism-Over 18 3(12%)

Residence on 12/31/16

Residence at the time of referral Family Level

4

SDC Crisis Center

Special. Resident.

Facilty

ICF-DD/H

Sup. Living SNF Psych

Hosp. Total

Family 7 6 1 14

Level 4 4 2 2 1 9

ICF-DD/H 2 2 Special.

Resident. Facilty 2 4 6

Psych. Hospital 2 2 4 Skilled Nursing

(SNF) 1 1

Jail 1 1 2

Total 7 7 2 14 2 1 1 4 38

22 | P a g e

Appendix VII

SAN DIEGO REGIONAL CENTER Clients living in State Developmental Centers

1/3/7

Age and Gender

0-17 18-30 31-49 50+ Total Male 0 11 15 18 44(71%)

Female 0 2 6 10 18(29%)

Qualifying Diagnosis (each person may have more than one diagnosis)

Intellectual Disability (ID)

Epilepsy (EP)

Cerebral Palsy (CP)

Autism (AU)

58 (94%) 5 (8%) 11 (17%) 4 (6%)

Level of Intellectual Disability

None/Border. Mild Moderate Severe Profound Total 4 30(48%) 6 6 16(26%) 62

Legal Commitment to State Developmental Center

HOP (Gravely Disabled) 25(47%)

6500 (Danger to Self or Others) 31(50%)

1370.1 (Penal Code –Competency Training) 1

Other Important Information

Family Opposed to Community Placement 14(23%)

Specific Community Placement has been identified for the Client 9(15%)

Needs an Adult Residential Facility for People with Special Healthcare Needs

(ARF-PSHN) 17(27%)

23 | P a g e

Appendix VIII

SAN DIEGO REGIONAL CENTER ADULT DAY SERVICES STATISTICS

(based on SANDIS data of 1/3/17)

Type of Program/Activity Number of Clients

Competitively Employed (without funded supports) 241

Department of Rehabilitation Funded Services 262

Other Publicly and Privately Funded Programs 285 Educational Programs (Community College, Public

School, Adult Education, etc.) 1045

No Day Services 3066

Regional Center Funded Services 5936

Diagram 12 Adult Client-Day Program/Activity

Competitively Employed

2.2%

No Day Services 28.3%

Department of Rehabilitation

Funded Services 2.4%

Regional Center Funded Services

54.8%

Other Programs 2.6%

Educational Program

9.6%

24 | P a g e

Appendix VIII

SAN DIEGO REGIONAL CENTER REGIONAL CENTER FUNDED ADULT DAY SERVICES STATISTICS

(based on SANDIS data of 1/3/17)

REGIONAL CENTER FUNDED DAY SERVICE

Staff: Client Ratio

Number of Clients

Change from 1/4/16

Supported Employment- Individual Placement 1:1 502 +38

Supported Employment- Group Placement 1:3 685 -41

Work Activity Program 1:12 563 -43

Activity Center 1:8 156 -16

“ “ 1:7 27 -6

“ “ 1:6 304 -2

Adult Development Center 1:4 1067 -10

“ “ 1:3 1762 -370

Behavior Management Program 1:3 814 +77

Tailored Day Services 1:1 810 +192

Intensive Daytime Support Program 1:1 52 N/A

Diagram 13 Clients in SDRC Funded Adult Day Services

Activity Center (1:8) 2.3% Activity Center (1:7)

0.4%

Activity Center (1:6) 4.5%

Adult Development Center (1:4)

15.8%

Adult Development Center (1:3)

26.1% Behavior Management Program (1:3)

12.1%

Intensive Day Support Program

0.8%

Supported Employment-

Individual Placement 7.4%

Supported Employment-Group

Placement 10.2%

Work Activity Program

8.4%

Tailored Day Services 12.0%

25 | P a g e

Appendix VIII

Clients turning 22 years old in 2017 by Geographic Area and Estimated Adult Day Service needs

Geographic Area

# Needing Activity Center

# Needing

ADC

# Needing Behav.

Manage.

# Needing

Hab. Services

# Needing Other

(Tailored Day, Intensive, etc)

Total

Central San Diego 4 36 29 30 20 119

North County 3 26 21 23 15 88

Southbay 3 29 23 25 16 96

East County 2 24 19 21 15 81

Imperial County 1 6 5 5 3 20

Total 13 121 97 104 69 404

Licensed Program Capacities compared to Authorizations (1/3/17)

by Type of Program and Location

Central East County North County Southbay Imperial

County

Cap. Auth. Cap. Auth. Cap. Auth. Cap. Auth. Cap. Auth.

AC 24 24 239 216 125 101 52 28 35 31

ADC 325 288 743 632 491 442 385 354 70 64

Behavior Manage. 57 52 214 193 221 171 93 76 25 24

Intensive Day 0 0 20 6 39 31 0 0 0 0

Seniors 65 58 105 92 24 11 32 31 0 0

Summary Performance Report for San Diego Regional Center, Spring 2017 1

Spring 2017

Performance Report for the San Diego Regional Center Every year, the Department of Developmental Services (DDS) contracts with regional centers in California to serve clients and families. And, every year DDS looks at how well the regional centers are doing. This report will give you information about your regional center. Last year, at San Diego Regional Center (SDRC) we served about 25,000 clients. The charts on page 2 tell you about the clients we serve. You’ll also see how well we are doing in meeting our goals and in fulfilling our contract with DDS. At SDRC, we want to improve every year, do better than the state average, and meet or exceed the DDS standard. As you can see in this report, we did well in 2016. We hope this report helps you learn more about SDRC. If you have any questions or comments, please contact us! This report is a summary. To see the complete report, go to: www.sdrc.org. Or contact the SDRC Community Services Department at 858-576-2966. Carlos Flores Executive Director, San Diego Regional Center

San Diego Regional Center

Carlos Flores, Executive Director 4355 Ruffin Road, Suite 200, San Diego, CA 92123-1648 Phone: (858) 576-2996 • Fax: (858) 576-2873 E-mail: www.sdrc.org



Who uses SDRC? These charts tell you about who SDRC consumers are and where they live.

How well is SDRC performing? This chart tells you about 5 areas where DDS wants each regional center to keep improving. The first column tells you how SDRC was doing at the end of 2015. And, the second column shows how SDRC was doing at the end of 2016. To see how SDRC compares to the other regional centers in the state, compare the numbers to the state averages (in the shaded columns).

Regional Center Goals (based on Lanterman Act)

December 2015 December 2016

State Average SDRC State

Average SDRC

Less clients live in developmental centers 0.36% 0.28% 0.30% 0.25%

More children live with families 99.15% 99.20% 99.24% 99.34%

More adults live in home settings* 78.04% 76.33% 78.89% 76.94%

Less children live in large facilities (more than 6 people) 0.06% 0.18% 0.05% 0.08%

Less adults live in large facilities (more than 6 people) 2.78% 2.60% 2.60% 2.47% * Home settings include: independent living, supported living, Adult Family Home Agency homes, and consumers’ family homes.


Did SDRC meet DDS standards? Read below to see how well SDRC did in meeting DDS compliance standards:

Areas Measured Last Period Current Period

Passes independent audit Yes Yes Passes DDS audit Yes Yes Audits vendors as required Met Met Didn’t overspend operations budget Yes Yes Participates in the federal waiver Yes Yes CDERs and ESRs are updated as required (CDER is the Client Development Evaluation Report and ESR is the Early Start Report. Both contain information about consumers, including diagnosis.)*

94.36% 93.44%

Intake/Assessment timelines for consumers age 3 or older met 97.07% 98.55% IPP (Individual Program Plan) requirements met 98.66% 98.66% IFSP (Individualized Family Service Plan) requirements met 78.69% 83.97%

*CDER and ESR currency percentages were weighted based on the regional center’s Status 1 and Status 2 caseloads, to arrive at a composite score.

How is SDRC doing regarding differences and equity?

*Institutions include developmental centers, state hospitals and correctional facilities.

2015-16 Purchase of Service Expenditures by Residence Type

Ethnicity Home

Independent Living Services/

Supported Living Services

Institutions* Residential Medical/

Rehabilitation/Psychiatric

Other

White 24.8% 62.4% 26.5% 60.2% 65.4% 47.5% Hispanic 30.5% 14.5% 31.2% 19.7% 9.5% 24.8% Black/African American 4.4% 10.5% 4.6% 6.6% 5.8% 4.5%

American Indian or Alaska Native 0.1% 0.3% 0.0% 0.4% 0.0% 0.0%

Asian 6.4% 2.2% 0.0% 3.7% 4.3% 0.4% Native Hawaiian or Other Pacific Islander

0.1% 0.4% 0.0% 0.5% 0.0% 0.0%

Other Ethnicity or Race/Multi-Cultural 33.7% 9.6% 37.6% 8.9% 14.9% 22.8%

TOTAL 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


Want more information? To see the complete report, go to: www.sdrc.org Or contact the SDRC Cultural Specialist at 858-576-2869

Percent of Total Annual Purchase of Service Expenditures by Diagnosis and Ethnicity

Ethnicity/Race Autism Intellectual Disability

Cerebral Palsy Epilepsy Category

5 American Indian or Alaska Native 0.1% 0.3% 0.5% 0.6% 0.4% Asian 6.7% 4.8% 4.4% 4.4% 4.3% Black/African American 4.7% 7.3% 5.5% 5.6% 6.6% Hispanic 22.1% 25.9% 24.7% 25.0% 15.3% Native Hawaiian or Other Pacific Islander 0.6% 0.4% 0.2% 0.4% 0.4% Other Ethnicity or Race 32.9% 12.0% 9.6% 9.2% 8.7% White 32.8% 49.2% 55.2% 54.8% 64.4% TOTAL 100.0% 100.0% 100.0% 100.0% 100.0%


SDRC PERFORMANCE CONTRACT STATUS REPORT January 1, 2017 through June 30, 2017

OUTCOMES INITIAL

BASELINE Jan 2002

STATUS as of

Dec 2014

STATUS as of

Dec 2015

STATUS as of

Dec 2016

STATUS as of

June 2017 Decrease percentage of Regional Center caseload in Developmental Centers.

1.48% .34% .28% .25% .23%

Increase percentage of minors residing with families.

96.61% 99.18% 99.20% 99.34% 99.37%

Increase percentage of adults residing in own homes.

66.41% 75.74% 76.33% 76.94% 77.03%

Decrease percentage of adults living in housing facilities for 7 or more people.

8.60% 2.85% 2.60% 2.47% 2.47%

Decrease percentage of children living in housing facilities for 7 or more people.

.84% .18% .18% .08% .08%

Unqualified Independent Audit.

Unqualified Audit

Unqualified Audit

Unqualified Audit In Process In Process

Substantial compliance in the DDS Fiscal Audit.

Substantial Compliance





Operate within OPS budget. Yes Yes Yes Yes Yes

Certified to participate in Waiver. Certified Certified Certified Certified Certified

Compliance with vendor audit requirements.

In Compliance

In Compliance

In Compliance

In Compliance

In Compliance

Intake/Assessment timelines (0-3).

To Be Determined

To Be Determined

To Be Determined

To Be Determined

To Be Determined

Intake/Assessment timelines (over age 3). 72.36% 97.68% 97.07% 98.55% 100%

CDER Currency 83.47% 91.17% 94.36% 97.14% 96.95%

SDRC PERFORMANCE CONTRACT STATUS REPORT January 1, 2017 through June 30, 2017

Page 2 of 2

State-wide processes for tracking the following outcomes have not been developed: Increase percentage of adults in supported employment; Increase percentage of adults in competitive employment; Access to medical and dental services; Reduce number of people with developmental disabilities who are abused; Accurate fiscal projection; Timely Individual Program Plans (IPP) (96% as a result of 2002 DDS audit); and, Timely Individual Family Service Plans (IFSP) (95.45% as a result of 2002 DDS audit). T:\Community_Services\Sdcau\Reports\Performance Contract\2018\SDRC PERFORMANCE CONTRACT STATUS REPORT 063017.Docx

DRAFT #1

San Diego-Imperial Counties Developmental Services, Inc. 2018 Performance Contract Plan Outcomes and Activities

1. Outcome: Decrease percentage of Regional Center caseload in Developmental

Centers.

Activity A: Implement the Community Placement Plan (CPP). Activity B: Complete comprehensive assessments for persons residing in the

developmental centers; develop community resources to transition 20 clients into the community.

2. Outcome: Increase percentage of minors residing with families.

Activity A: Maximize the use of community resources that provide supports to families to assist them in maintaining their children at home.

Activity B: Provide information and training to community service providers on the

special needs of families with children with developmental disabilities. Activity C: Provide training to service coordinators on how to assist families to be

effective advocates for their child related to the IEP process and/or navigating other service systems (e.g. Child Welfare, Mental Health, IHSS, SSI, etc.).

Activity D: Continue crisis intervention and wrap-around services.

3. Outcome: Increase percentage of adults residing in own homes.

Activity A: Contract with a nonprofit organization to develop and help people access safe and affordable housing.

Activity B: Review living options, including related supports, with clients at the time

of the annual review. Activity C: Assist clients and families to access assistive technology. Activity D: Provide services and supports to families of clients who are elderly and

live with their family.

San Diego-Imperial Counties Developmental Services, Inc. DRAFT #1 2018 Performance Contract Plan Outcomes and Activities Page 2 of 3 4. Outcome: Increase the percentage of adults living in housing facilities for less than

7 people.

Activity A: Increase individual bedrooms for clients in residential facilities.

Activity B: Advocate for adequate reimbursement rates for services provided to clients.

5. Outcome: Increase the percentage of children living in housing facilities for less

than 7 people. Activity A: Increase individual bedrooms for clients in residential facilities. Activity B: Advocate for adequate reimbursement rates for services provided to

clients. 6. Outcome: Unqualified Independent Audit. 7. Outcome: Substantial compliance in the Department of Developmental Services

Fiscal Audit. 8. Outcome: Accurate fiscal projection. 9. Outcome: Operate within Operations (OPS) budget. 10. Outcome: Certified to participate in waiver. 11. Outcome: Compliance with vendor audit requirements. 12. Outcome: CDER/ESR Currency. 13. Outcome: Intake/Assessment time lines (ages 0 to 3). 14. Outcome: Intake assessment time lines (ages 3 and older). 15. Outcome: Individual Program Plan (IPP) Development. 16. Outcome: Individual Family Service Plan (IFSP) Development.

San Diego-Imperial Counties Developmental Services, Inc. DRAFT #1 2018 Performance Contract Plan Outcomes and Activities Page 3 of 3 17. Outcome: Measure the number and percent of individuals receiving only case

management services by age and ethnicity.

Activity A: San Diego Regional Center will generate data to measure progress in reducing disparities and improving equity in purchase of service expenditures.

18. Outcome: Measure the percent of total annual purchase of service expenditures by

individual’s ethnicity and age.

Activity A: San Diego Regional Center will generate data to measure progress in reducing disparities and improving equity in purchase of service expenditures.

19. Outcome: Measure the number of adults who were placed in competitive, integrated

employment following participation in a Paid Internship Program.

Activity A: Provide information and training to service providers on development and use of Paid Internship Program.

20. Outcome: Measure the total of $1,000, $1,250 and $1,500 incentive payments made

for the fiscal year.

Activity A: SDRC will generate data to measure the number and amount of incentive payments.

T:\Community_Services\Sdcau\Reports\Performance Contract\2018\2018 PC DRAFT #1 PUBLIC HANDOUT.Docx

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