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

2005 Community Practice Review

Southwest RegionDRAFT Findings

Presented: February 23, 2006

Southwest Review held January 9 -13, 2006

2005 Community Practice Review DRAFT Southwest Region

Class Members: 52Number in Sample: 14 (27%)

Two Independent Case Management Agencies in Sample

SCCM 10 in sample DSLM4 in sample


Day and Residential Agencies and number in sample

Day Residential

Life Quest 1 1Opportunity Center 1 1Progressive 1 1ResCare 3 4 Tresco 7 6WNG 1 1


Individuals Needing Immediate Attention: 3 People 21% of sampleIndividuals Needing Special Attention: 5 People 36% of sampleIndividuals for whom health, safety, environment and/or abuse or neglect issues were identified during the review.Issues were identified that may, if not addressed, may effect the persons 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)Class Members with Immediate or Special Needs


Identified Indicators of Good PracticeTwo people are active swimmers and seven are bowlers.People play valued roles in their communityFive people attend church.Five people are members of and visit their local librariesFour 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.


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


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


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


Identified Indicators of Good PracticePeople 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 StaffOne person has learned to spell her name, and is beginning to learn letters and numbers.


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


Findings by AreaA. Expectations for Growth and Quality of LifeNoteworthy 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 AreaA. Expectations for Growth and Quality of LifePractice 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.


Findings by AreaA. Expectations for Growth and Quality of Life

QuestionResponse% Yes 31. Does the case manager have an appropriate expectation of growth for this person?8 Yes6 Partial57%42. Does the [day services] direct service staff have an appropriate expectation of growth for this person? 9 Yes5 Partial64%52. Does the residential direct service staff have an appropriate expectation of growth for this person? (1 person not scored)10 Yes3 Partial77%84. Based on all of the evidence, in the opinion of the reviewer, has the person achieved progress in the past year?6 Yes8 Partial43%85. Overall, does the IDT have an appropriate expectation of growth for this person?7 Yes7 Partial50%86. Was the person provided the assistance and support needed to participate meaningfully in the planning process? 10 Yes4 Partial71%87. The person is offered a range of opportunities for participation in each of the life areas?8 Yes4 Partial57%


Findings by AreaA. Expectations for Growth and Quality of Life

QuestionResponse% Yes 88. Does the person have the opportunity to make informed choices? (4 CND)7 Yes3 Partial 70%

89. About where and with whom to live? (4 CND)7 Yes3 Partial70%91. About where and with whom to socialize/spend leisure time? (4 CND)9 Yes1 Partial90%93. Overall, were the direct service staff interviewed trained on the providers complaint process and on abuse, neglect and exploitation?8 Yes6 Partial57%100. If the person is retired, does he/she have adequate opportunities to engage in activities of interest during the day? (13 N/A)1 Yes100%101. Does the person have daily choices/appropriate autonomy over his/her life?11 Yes3 Partial79%102. Have the persons cultural preferences been accommodated? (2 CND)12 Yes100%103. Is the person treated with dignity and respect?9 Yes5 Partial64%


Findings by AreaB. SatisfactionNoteworthy 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)


Findings by AreaB. Satisfaction

QuestionResponse% Yes 104. Overall, is the person satisfied with the current services? (5 CND)6 Yes3 Partial67%105. Does the person get along with the case manager? (9 CND)5 Yes100%106. Does the person find the case manager helpful? (11 CND)3 Yes100%108. Does the person have adequate food and drink available? (1 CND)12 Yes1 Partial92%109. Does the person have adequate transportation to meet his/her needs?13 Yes1 Partial93%110. Does the person have sufficient personal money? (2 CND)8 Yes4 Partial67%


Findings by AreaC. AssessmentsPractice 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.

Noteworthy Practice

Every score in the Assessments area reflected an increase over 2004


Findings by AreaC. Assessments

QuestionResponse% Yes 57. Did the team consider what assessments the person needs and would be relevant to the teams planning efforts?8 Yes6 Partial57%58. Did the team arrange for and obtain the needed, relevant assessments?6 Yes8 Partial43%59. Are the assessments adequate for planning?9 Yes5 Partial64%

60. Were the recommendations from assessments used in planning?9 Yes5 Partial64%


Findings by AreaD. Adequacy of Planning and Adequacy of ServicesPractice Challenges

No ISPs (0%) were found to be adequate to meet the persons 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.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)


Findings by AreaD. Adequacy of Planning and Adequacy of Services

QuestionResponse% Yes 62. Was the ISP developed by an appropriately constituted IDT? 8 Yes6 Partial57%64. Overall, is the long-term vision adequate? 6 Yes8 Partial43%65. Overall, does the functional supports assessment give adequate guidance to achieving the persons long-term vision? 9 Yes5 Partial64%66. Overall, is the functional supports assessment used as the basis for goal development?9 Yes4 Partial1 No64%67. Overall, do the goals in the ISP include criteria by which the team can determine when the goals(s) have been achieved? 5 Yes8 Partial1 No36%69. Overall, do the goals in the ISP address the persons major needs? 6 Yes8 Partial43%72. Overall, are the recommendations and/or objectives /strategies of ancillary providers integrated in to the goals, objectives and strategies of the ISP? 9 Yes4 Partial1 No64%


Findings by AreaD. Adequacy of Planning and Adequacy of Services

QuestionResponse% Yes 74. Does the ISP contain specific arrangements for primary health (medical) care? 12 Yes2 Partial86%75. Does the ISP reflect how the person will get to work/day activities, shopping, social activities? 13 Yes 1 No93%78. Overall, is the ISP adequate to meet the persons needs? 14 Partial0%80. If there is no ISP, or if #78 is rated 0 or 1, are current services adequate to meet the persons needs? 3 Yes11 Partial21%82. Overall, were the direct service staff able to describe their responsibilities in providing daily care/support to the person?13 Yes1 Partial93%


Findings by AreaE. Individual Service PlanningNoteworthy 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.


Findings by AreaIndividual Service Planning Historical Scoring

Question20002001200220042005Does the person have an ISP that addresses living, learning/working and social/leisure64%79%92%67%71%Does the ISP contain a functional supports assessment based on a long-term view?100%86%77%67%79%Does the person receive services and supports recommended in the ISP?57%79%62%40%64%Does the person have adequate access to and use of generic services and natural supports?64%86%69%27%50%Is the person adequately integrated into the community?64%79%62%33%50%


Findings by AreaF. Team ProcessNoteworthy 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. .


Findings by AreaF. Team Process

QuestionResponse% Yes 113. Is there evidence that the ISP was reviewed by the IDT within the last six months? (1 N/A)13 Yes100%114. Are the individual members of the IDT following up on their responsibilities?6 Yes8 Partial43%116. Do records or facts exist to indicate that the team convened meetings as needed due to changed circumstances and/or needs? (2 N/A)9 Yes3 No75%117. Is there adequate communication among team members between meetings to ensure the persons program can be/is being implemented?11 Yes3 Partial79%119. Is there evidence or documentation of physical regression in the last year? 5 Yes9 No36%120. Is there evidence or documentation of behavioral or functional regression in the last year?3 Yes11 No21%121. If #199 or 120 is Yes, is the IDT adequately addressing the regression? (8 CND)4 Yes2 Partial67%


Findings by AreaF. Team Process (continued)

QuestionResponse% Yes Has the person changed residential/day services in the last year? If Yes, was the change:2 Yes12 No14%122a. Planned by the IDT? (12 N/A)2 Yes100%122b. Appropriate to meet needs? (12 N/A)1 Yes1 Partial50%Has the IDT process been adequate for assessing, planning, implementing and monitoring of services for this person?2 Yes12 Partial14%


Findings by AreaG. Health Related NeedsNoteworthy Practice

92% of residential support staff could describe the persons health related needs

86% of day support staff could describe the persons 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 persons health related needs.


Findings by AreaG. Health Related Needs

QuestionResponse% Yes 54. Overall, were the team members interviewed able to describe the persons health-related needs?7 Yes7 Partial50%55. Is there evidence that the IDT discussed the persons health-related issues?11 Yes3 Partial79%56. In the opinion of the reviewer, are the person health supports/needs being adequately addressed?6 Yes8 Partial43%


Findings by AreaH. Supported EmploymentPractice 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.


Findings by AreaH. Supported Employment Historical Scoring

Question20002001200220042005Need an employment assessment?86%100%85%100%79%Need supported employment?57%50%69%67%71%Receive supported employment assessment?92%100%100%100%91%Assessment conforms to DOH Regulations?25%100%82%40%36%Has a Career Development Plan?25%43%22%40%20%Is supported employment provided in line with requirements?25%43%22%20%20%


Findings by AreaI. Day ServicesNoteworthy 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 persons health-related needs.

86% (12 of 14) had adequate input into the persons ISP.

13 (93%) Day direct service staff had adequate training in the ISP process.


Findings by AreaI. Day Services

QuestionResponse% Yes 35. Does the day/employment direct services know the person?11 Yes3 Partial79%36. Does the direct service staff have adequate input into the persons ISP?12 Yes1 Partial1 No86%37. Did the direct service staff receive training on implementing the persons ISP?12 Yes2 Partial86%38. Was the direct service staff able to describe this persons health-related needs? 12 Yes2 Partial86%41. Did the direct service staff have training on the providers complaint process and on abuse, neglect and exploitation?8 Yes6 Partial57%42. Does the direct service staff have an appropriate expectation of growth for this person? 9 Yes5 Partial64%


Findings by AreaJ. Behavioral Support ServicesNoteworthy 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 persons needs.

8 (80%) received behavioral services consistent with his/her needs.


Findings by AreaJ. Behavioral Support Services Historical Scoring

Question20002001200220042005Does the person need behavioral services?64%71%69%67%79%Have adequate behavioral assessments been completed? 78%80%78%70%80%Does the person have behavior support plan developed out of the behavior assessments that meet the persons needs? 100%90%78%80%90%Have the staff been trained on the behavior support plan? 67%80%88%80%100%Does the person receive behavioral services consistent with his/her needs?33%80%89%80%80%Are behavioral support services integrated into the ISP? 0%40%22%40%60%


Findings by AreaK. Adaptive Equipment/Augmentative CommunicationAdaptive Equipment/Augmentative Communication -Historical ScoringNoteworthy 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%)

Question20002001200220042005Has the person received all adaptive equipment?67%80%86%38%78%Has the person received all assistive technology needed?36%38%70%56%57%Has the person received all communication assessments and services needed? 9%11%73%33%80%


Findings by AreaL. Case ManagementNoteworthy 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 persons 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.


Findings by AreaL. Case Management

QuestionResponse% Yes 26. Does the case manager know the person?10 Yes 4 Partial71%27. Does the case manager understand his/her role/job?11 Yes3 Partial79%28. Did the case manager receive training on the topics needed to assist him/her in meeting the needs of this person?13 Yes1 Partial93%30. Was the case manager able to describe the persons health related needs?7 Yes7 Partial50%31. Does the case manager have an appropriate expectation of growth for this person?8 Yes6 Partial57%33. Does the cm provide cm services at the level needed by this person?3 Yes11 Partial21%34. Does the case manager receive the type and level of support needed to do his/her job?11 Yes3 Partial79%


Findings by AreaNoteworthy 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 persons 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.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


Findings by AreaM. 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

QuestionResponse% Yes 44. Does the residential direct services staff know the person?13 Yes100%47. Is the residence safe for individuals? (void of hazards?) 10 Yes3 No77%48. Was the residential direct service staff able to describe this persons health-related needs? 12 Yes1 Partial92%49. Was the residential direct service staff able to describe this persons health-related needs?12 Yes1 Partial92%50. Did the residential direct service staff have training in the ISP process?13 Yes100%51. Did the residential direct service staff have training on the providers complaint process and on abuse, neglect and exploitation?11 Yes2 Partial85%52. Does the direct service staff have an appropriate expectation of growth for this person?10 Yes3 Partial77%53. Does the persons residential environment offer a minimal level of quality of life? 8 Yes5 Partial62%


Thank you!Lyn RuckerCommunity [email protected]: 785-258-2214Cell: 785-366-6468

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

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