2005 community practice review southwest region draft findings 2005 community practice review...

2005 Community Practice Review2005 Community Practice Review

Southwest RegionSouthwest RegionDRAFTDRAFT FindingsFindings

Presented: February 23, 2006

Southwest Review held January 9 -13, 2006

22

2005 Community Practice Review DRAFT Southwest Region

Class Members: Class Members: 5252

Number in Sample: Number in Sample: 14 (27%)14 (27%)

Two Independent Case Management Two Independent Case Management

Agencies in SampleAgencies in Sample

SCCM SCCM 10 in sample 10 in sample

DSLMDSLM 4 in sample4 in sample

33


Day and Residential Agencies and number in Day and Residential Agencies and number in samplesample

DayDay ResidentialResidential

Life QuestLife Quest 1 1 11Opportunity CenterOpportunity Center 1 1 11Progressive Progressive 1 1 11ResCareResCare 33 4 4 Tresco Tresco 7 7 66WNG WNG 1 1 11

44


Individuals Needing Immediate Attention: 3 People 21% of sample

Individuals Needing Special Attention: 5 People 36% 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, 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)

Class Members with Immediate or Special Needs

55


Identified Indicators of Good Practice

Two people are active swimmers and seven are bowlers.

People play valued roles in their communityPeople play valued roles in their community

Five people attend church.

Five people are members of and visit their local libraries

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.

66


People have friendsPeople have friends Eight 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 People are a part of and integrated into their communitiesintegrated into their communities

Two people are members or volunteers at local clubs or shelters

Three people are engaged in supported employed.

People are employedPeople are employed

Identified Indicators of Good PracticeIdentified Indicators of Good Practice

Two people are “self-employed” – creating their art and selling it in the community

77


People benefit from long term, People benefit from long term, caring and respectful staffcaring 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!

88


People have proactive advocatesPeople have proactive advocatesCase Manager/GuardianCase 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.


99


People have shown evidence of progressPeople 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.

1010


People have shown evidence of progressPeople 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.


1111


A. Expectations for Growth and Quality of LifeFindings by AreaFindings by Area

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)

1212


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.

Findings by AreaFindings by Area

1313


QuestionQuestion ResponseResponse % Yes % Yes

31. Does the case manager have an appropriate expectation of growth for this person?

8 Yes6 Partial

57%

42. Does the [day services] direct service staff have an appropriate expectation of growth for this person?

9 Yes5 Partial

64%

52. Does the residential direct service staff have an appropriate expectation of growth for this person? (1 person not scored)

10 Yes3 Partial

77%

84. Based on all of the evidence, in the opinion of the reviewer, has the person achieved progress in the past year?

6 Yes8 Partial

43%

85. Overall, does the IDT have an appropriate expectation of growth for this person?

7 Yes7 Partial

50%

86. Was the person provided the assistance and support needed to participate meaningfully in the planning process?

10 Yes4 Partial

71%

87. The person is offered a range of opportunities for participation in each of the life areas?

8 Yes4 Partial

57%


A. Expectations for Growth and Quality of Life

1414



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 Partial

70%

91. About where and with whom to socialize/spend leisure time? (4 CND) 9 Yes1 Partial

90%

93. Overall, were the direct service staff interviewed trained on the provider’s complaint process and on abuse, neglect and exploitation?

8 Yes6 Partial

57%

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 Yes 100%

101. Does the person have daily choices/appropriate autonomy over his/her life?

11 Yes3 Partial

79%

102. Have the person’s cultural preferences been accommodated? (2 CND) 12 Yes 100%

103. Is the person treated with dignity and respect? 9 Yes5 Partial

64%

A. Expectations for Growth and Quality of LifeFindings by AreaFindings by Area

1515


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)

1616


B. Satisfaction



104. Overall, is the person satisfied with the current services? (5 CND)

6 Yes3 Partial

67%

105. Does the person get along with the case manager? (9 CND) 5 Yes 100%

106. Does the person find the case manager helpful? (11 CND) 3 Yes 100%

108. Does the person have adequate food and drink available? (1 CND)

12 Yes1 Partial

92%

109. Does the person have adequate transportation to meet his/her needs?

13 Yes1 Partial

93%

110. Does the person have sufficient personal money? (2 CND) 8 Yes4 Partial

67%

1717


C. Assessments


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.

Noteworthy Practice

• Every score in the Assessments area reflected an increase over 2004

1818



C. Assessments


57. Did the team consider what assessments the person needs and would be relevant to the team’s planning efforts?

8 Yes6 Partial

57%

58. Did the team arrange for and obtain the needed, relevant assessments?

6 Yes8 Partial

43%

59. Are the assessments adequate for planning? 9 Yes5 Partial

64%

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

64%

1919


D. Adequacy of Planning and Adequacy of ServicesFindings by AreaFindings by Area

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.

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)

2020


D. Adequacy of Planning and Adequacy of ServicesFindings by AreaFindings by Area


62. Was the ISP developed by an appropriately constituted IDT? 8 Yes6 Partial

57%

64. Overall, is the long-term vision adequate? 6 Yes8 Partial

43%

65. Overall, does the functional supports assessment give adequate guidance to achieving the person’s long-term vision?

9 Yes5 Partial

64%

66. Overall, is the functional supports assessment used as the basis for goal development?

9 Yes4 Partial

1 No

64%

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 Partial

1 No

36%

69. Overall, do the goals in the ISP address the person’s major needs? 6 Yes8 Partial

43%

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 Partial

1 No

64%

2121


D. Adequacy of Planning and Adequacy of Services



74. Does the ISP contain specific arrangements for primary health (medical) care?

12 Yes2 Partial

86%

75. Does the ISP reflect how the person will get to work/day activities, shopping, social activities?

13 Yes 1 No

93%

78. Overall, is the ISP adequate to meet the person’s needs? 14 Partial 0%

80. If there is no ISP, or if #78 is rated “0” or “1”, are current services adequate to meet the person’s needs?

3 Yes11 Partial

21%

82. Overall, were the direct service staff able to describe their responsibilities in providing daily care/support to the person?

13 Yes1 Partial

93%

2222


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.

2323



E.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…

64% 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%

2424


F. Team ProcessFindings by AreaFindings by Area

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. .

2525


F. Team Process



113. Is there evidence that the ISP was reviewed by the IDT within the last six months? (1 N/A)

13 Yes 100%

114. Are the individual members of the IDT following up on their responsibilities?

6 Yes8 Partial

43%

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 No

75%

117. Is there adequate communication among team members between meetings to ensure the person’s program can be/is being implemented?

11 Yes3 Partial

79%

119. Is there evidence or documentation of physical regression in the last year?

5 Yes9 No

36%

120. Is there evidence or documentation of behavioral or functional regression in the last year?

3 Yes11 No

21%

121. If #199 or 120 is Yes, is the IDT adequately addressing the regression? (8 CND)

4 Yes2 Partial

67%

2626


F. Team Process (continued)



122. Has the person changed residential/day services in the last year? If Yes, was the change:

2 Yes12 No

14%

122a. Planned by the IDT? (12 N/A) 2 Yes 100%

122b. Appropriate to meet needs? (12 N/A) 1 Yes1 Partial

50%

123. Has the IDT process been adequate for assessing, planning, implementing and monitoring of services for this person?

2 Yes12 Partial

14%

2727


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.

2828


G. Health Related Needs


QuestionQuestionResponseResponse % Yes % Yes

54. Overall, were the team members interviewed able to describe the person’s health-related needs?

7 Yes7 Partial

50%

55. Is there evidence that the IDT discussed the person’s health-related issues?

11 Yes3 Partial

79%

56. In the opinion of the reviewer, are the person’ health supports/needs being adequately addressed?

6 Yes8 Partial

43%

2929


H. Supported EmploymentFindings by AreaFindings by Area

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.

3030


H. Supported Employment – Historical Scoring


Question 2000 2001 2002 2004 2005

Need 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%

3131



I. 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 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.

3232


I. Day Services



35. Does the day/employment direct services “know” the person? 11 Yes3 Partial

79%

36. Does the direct service staff have adequate input into the person’s ISP? 12 Yes1 Partial

1 No

86%

37. Did the direct service staff receive training on implementing the person’s ISP?

12 Yes2 Partial

86%

38. Was the direct service staff able to describe this person’s health-related needs?

12 Yes2 Partial

86%

41. Did the direct service staff have training on the provider’s complaint process and on abuse, neglect and exploitation?

8 Yes6 Partial

57%

42. Does the direct service staff have an appropriate expectation of growth for this person?

9 Yes5 Partial

64%

3333


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.

3434


J. Behavioral Support Services – Historical Scoring


Question 2000 2001 2002 2004 2005

Does 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 person’s 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%

3535


K. Adaptive Equipment/Augmentative CommunicationFindings by AreaFindings by Area

Question 2000 2001 2002 2004 2005

Has 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%

Adaptive Equipment/Augmentative Communication -

Historical Scoring

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%)

3636


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.

3737


L. Case ManagementFindings by AreaFindings by Area


26. Does the case manager “know” the person? 10 Yes 4 Partial

71%

27. Does the case manager understand his/her role/job? 11 Yes3 Partial

79%

28. Did the case manager receive training on the topics needed to assist him/her in meeting the needs of this person?

13 Yes1 Partial

93%

30. Was the case manager able to describe the person’s health related needs?

7 Yes7 Partial

50%

31. Does the case manager have an appropriate expectation of growth for this person?

8 Yes6 Partial

57%

33. Does the cm provide cm services at the level needed by this person? 3 Yes11 Partial

21%

34. Does the case manager receive the type and level of support needed to do his/her job?

11 Yes3 Partial

79%

3838



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.

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

3939


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



44. Does the residential direct services staff “know” the person? 13 Yes 100%

47. Is the residence safe for individuals? (void of hazards?) 10 Yes3 No

77%

48. Was the residential direct service staff able to describe this person’s health-related needs?

12 Yes1 Partial

92%

49. Was the residential direct service staff able to describe this person’s health-related needs?

12 Yes1 Partial

92%

50. Did the residential direct service staff have training in the ISP process?

13 Yes 100%

51. Did the residential direct service staff have training on the provider’s complaint process and on abuse, neglect and exploitation?

11 Yes2 Partial

85%

52. Does the direct service staff have an appropriate expectation of growth for this person?

10 Yes3 Partial

77%

53. Does the person’s residential environment offer a minimal level of quality of life?

8 Yes5 Partial

62%

4040


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!

2005 community practice review southwest region draft findings 2005 community practice review...

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