2005 Community Practice Review Southeast Region DRAFT Findings Presented: September 20, 2005 SE Revi

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2005 Community Practice ReviewSoutheast
RegionDRAFT FindingsPresented September 20,
2005SE Review held August 22-26, 2005
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• Class Members 43
• Number in Sample 15 (35)
• Five Independent Case Management
• Agencies Represented in the Sample
• DSLM 8 in sample
• PRMC 3 in sample
• JJ Home Care 2 in sample
• Laurel Ridge 1 in sample
• Sun Country 1 in sample

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• Number Reviewed by Day and Residential Provider
• 
  Day Residential
• ResCare 4 3
• ENMRSH 2 2
• Leaders 2
  2
• Tobosa 2 2
• Alliance 1
  1
• CARC 1
  1
• Casa Alegre 1 1
• Door of Opportunity 1 1
• High Desert 1
• Peak 1 1

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Class Members with Immediate or Special Needs
Individuals Needing Immediate Attention 2
People 13 of sample
Individuals for whom health, safety, environment
and/or abuse or neglect issues were identified
during the review.
Individuals Needing Special Attention 7 People

47 of sample
Issues were identified that may, if not
addressed, effect the persons health safety and
welfare.
In 2004, four people required Immediate Attention
(27) and two people required Special Attention
(13). (15 people in the 2004 sample)
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Identified Indicators of Good Practice
People play valued roles in their community

• Nine people are regulars at their local libraries.

• Three people are active swimmers.

• Five people regularly attend church and one
  volunteers
• in the nursery.

• Three people go bowling frequently.

• Three people attend the annual Piñata Fest one
  of whom
• is on the volunteer board.

• Four people are involved with national awareness
  groups
• Special Olympics, People First!, Boys Girls
  Club, Good Samaritans.

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Identified Indicators of Good Practice
People are a part of and integrated into their
communities

• Ten people (67) were seen as adequately
  integrated into the
• community.

• Five people are increasing the number of times
  they are in
• the community and are improving how they
  interact with others.

People have friends

• Seven people have friends that they meet and
  interact with in the
• community one person regularly exchanges
  e-mail with two friends!

People are employed

• Three people are engaged in supported employed
  and work at least 10 hours per week.

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Identified Indicators of Good Practice
People benefit from long term, caring and
respectful staff

• Five people have residential staff that have
  been with them
• for at least five years. One for 10 years!

• Twelve people have case managers who know
  them and
• can describe their preferences, wants and
  needs.

• Nine people have shown progress in their
  activities and/or
• interactions with their day providers.

• Thirteen people are treated with dignity and
  respect.

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Identified Indicators of Good Practice
People have proactive advocates Case
Manager/Guardian

• Eleven Guardians found the Case Manager
  helpful.

• Six people were identified as having actively
  involved
• guardians. (Seen at least 3 times a month)

• Nine people were determined to know their
  guardians.

• Twelve people have case managers who are
  available
• to them.

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Identified Indicators of Good Practice
People have shown evidence of progress

• Four people are increasing their communication
  abilities.

• Seven people are more physically able walking
  more,
• engaging in more activities and tasks in
  their homes
• and in the community.

• Six people are becoming more independent in
  their homes
• cooking, cleaning, dressing and other daily
  tasks.

• 102 assistive technology and adaptive equipment
  
• devices are needed by the members of the
  sample 84 of
• which are available and used at all needed
  times (82).

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• What We Learned Other Findings

A. Expectations for Growth and Quality of Life

• Noteworthy Practice
• 87 were provided the assistance and support
  needed to participate meaningfully in the
  planning process
• 80 (up from 40 in 2004) were offered a range of
  opportunities for participation in each life
  area.
• 90 (up from 67 in 2004) had the opportunity to
  make informed choices about where and with whom
  to live, and 73 about where and with whom to
  work/spend his/her day.
• 100 know their guardian and believe their
  guardian is helpful.
• 100 (up from 33) of retired persons have
  adequate opportunities to engage in activities of
  interest during the day.
• 13 of 15 persons (87) were found to be treated
  with dignity and respect (47 in 2004).

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Other Findings
A. Expectations for Growth and Quality of Life

• Practice Challenges
• 53 had achieved clear progress in the past year.
  13 (an increase from none last year) have
  achieved no progress.
• While there has been some improvement since last
  year, in less than half (47) of the sample was
  the IDT found to have an appropriate expectation
  of growth for the person. Of support persons,
  case managers were least likely to have an
  appropriate expectation of growth, while
  approximately 2/3 of day and residential staff
  had an appropriate expectation.
• 60 (67 last year) of persons were found to have
  the opportunity to make informed choices.
• While the individuals know and believe their
  guardians to be helpful, only 67 have guardians
  who could be described as actively or moderately
  involved in the persons life and service
  planning.

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Other Findings
A. Expectations for Growth and Quality of Life
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Other Findings
A. Expectations for Growth and Quality of Life
(continued)
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Other Findings
B. Satisfaction

• Noteworthy Practice
• For persons for whom it could be determined, 100
  were identified as getting along with their case
  manager (9 CND) and finding them helpful (11
  CND).
• 100 had adequate food and drink available.
• 100 get along with their residential provider
  staff.
• 87 (up from 73) were determined to have
  adequate transportation to meet their needs.

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Other Findings
B. Satisfaction
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Other Findings
C. Assessments
Noteworthy Practice Improvements were realized
in scoring for each of these questions, with the
2004 results ranging from 20 to 27 compliance
and the 2005 scoring ranging from 40 to 67.

• Practice Challenges
• In 47 of instances, the team did not or did not
  fully consider what assessments the person needs
  and would be relevant to the teams planning
  efforts.
• In 60 of instances the team did not arrange for
  and obtain all of the needed, relevant
  assessments.
• In one instance assessments were not considered
  by the team or used in planning.

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Other Findings
C. Assessments
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Other Findings
D. Adequacy of Planning and Adequacy of Services

• Noteworthy Practice
• The ISP was developed by an appropriately
  constituted Team in 64 of instances, up from 33
  in 2004.
• The functional supports assessment gave adequate
  guidance to achieving the persons long-term
  vision in 71 of those reviewed. (33 in 2004)
• A major increase is noted (13 to 64) on
  question 67 the goals in the ISP include
  criteria by which the team can determine when the
  goals have been achieved.
• The strategies in the ISP were found to be
  sufficient to ensure consistent implementation of
  the services planned in 71 of instances, up from
  33 in 2004.
• Crisis pans that meet the persons needs were
  included in 92 of ISPs, up from 23 in 2004.
• Specific arrangements for primary health care are
  identified in 86 of ISPs, up from 40.
• 86 of ISPs identify how the person will obtain
  prescribed medication, up from 20.

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Other Findings
D. Adequacy of Planning and Adequacy of Services

• Practice Challenges
• Half of all ISPs contain an adequate long term
  vision.
• While a significant increase was realized, only
  half of all ISPs contain goals that address the
  persons major needs.
• Similarly, while a significant increase was
  realized, in 50 of the instances recommendations
  and/or objectives/strategies of ancillary
  providers were integrated into the goals,
  objectives and strategies of the ISP.
• In 36 of instances the ISP was found to be
  adequate to meet the persons needs.
• Regarding those instances (10) in which the ISP
  was found to not be fully adequate, only one
  person was found to have services adequate to
  meet the persons needs.

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Other Findings
D. Adequacy of Planning and Adequacy of Services
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Other Findings
D. Adequacy of Planning and Adequacy of Services
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Other Findings
E. Individual Service Planning

• Noteworthy Practice
• With regard to every protocol question there was
  at least some increased compliance.
• More than twice as many people (40 to 87) were
  found to have adequate access to and use of
  generic services and natural supports.
• Also twice as many people (1/3 of sample to 2/3
  of sample) were found to be adequately integrated
  into the community.
• Practice Challenges
• More than half of persons were found to not fully
  receive services and supports as recommended in
  the ISP.
• One third of persons remain not adequately
  integrated into the community.

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Other Findings

• Individual Service Planning

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Other Findings
E. Individual Service Planning
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Other Findings
F. Team Process

• Noteworthy Practice
• 100 of ISPs were found to have been reviewed by
  the IDT within the last 6 months.
• 87 (up from 40) have records or facts to
  indicate that the team convened meetings as
  needed due to changed circumstances and/or needs.
• Similarly in 80 of the sample there was adequate
  communication among team members between meetings
  to ensure the persons program can be/is being
  implemented.
• It appears that in the past year the occurrence
  of physical, behavioral and functional regression
  is down (27 and 33 in 2004 to 7 and 14 in
  2005).
• 86 of the day staff knew the person well.
• 87 of the residential staff knew the person
  well, 80 had adequate input into the persons
  ISP. (Q 44 45)

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Other Findings
F. Team Process

• Practice Challenges
• Individual members of the IDT were found to be
  following up on their responsibilities in 27 of
  the sample (same as 2004).
• Of the day staff who knew the person well, 64
  had adequate input into the persons ISP.
• 9 People had an appropriately constituted IDT.
  For 4 people, their missing team members
  participated in the development of the ISP, but
  5 people did not have input from all IDT members.

• Missing Members were noted as the class
  member, nutritionist, nurse, therapy providers
  and guardians

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Other Findings
F. Team Process
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Other Findings
G. Health Related Needs

• Practice Challenges
• Team members interviewed were able to describe
  the persons health related needs in 27 of
  instances (same as 2004).
• In 20 of instances (down from 27 in 2004) did
  the reviewer find the persons health
  supports/needs to be adequately addressed.

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Other Findings
H. Supported Employment

• Practice Challenges
• For those persons identified as needing a
  supported employment assessment, 88 (down from
  100) actually received such an assessment.
• In 3 of 8 instances the supported employment
  assessment conform to the DOH regulations.
• One person (of 8) had a career development plan
  that meets the persons needs.
• Of the six persons who would be expected to be
  involved in supported employment 50 (down from
  60 last year) were found to be so engaged.

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Other Findings
H. Supported Employment Disengagement Table
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Other Findings
I. Day Services Note 1 class member does not
receive Day services

• Noteworthy Practice
• 79 of Day direct services staff received
  training on implementing the persons ISP (up
  from 47 in 2004).
• 93 of Day direct services staff were able to
  describe his/her responsibilities in providing
  daily care/supports to the person (up from 73).
• The day/employment environment was found to be
  generally clean, free of safety hazards and
  conducive to the work/activity intended for 91
  of the sample (up from 45).
• Practice Challenges
• More than one quarter of the Day direct services
  staff cannot describe the persons health related
  needs.
• More than one quarter of the Day direct services
  staff do not have an appropriate expectation of
  growth for the individual.

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Other Findings
I. Day Services Note 1 class member does not
receive Day services
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Other Findings
J. Behavioral Support Services

• Noteworthy Practice
• 2/3 of those sampled were identified as needing
  behavior services. In 60 of those needing such
  services a behavioral assessment had been
  completed (up from 30).
• Of those with behavioral support plans, 78 of
  the staff reported having been trained on the
  plan (up from 50).
• Practice Challenges
• 40 of people needing a behavior assessment had
  not received one.
• Only 20 of the persons receiving behavioral
  services were found to be receiving those
  services consistent with his/her needs (down from
  40 in 2004).
• Regarding the ten individuals identified as
  needing behavior services, half were found to
  have behavior support services integrated into
  the ISP.

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Other Findings
J. Behavioral Support Services
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Other Findings
K. Adaptive Equipment/Augmentative Communication

• Practice Challenges
• Half of the persons needing adaptive equipment
  received all of it (down from 67 in 2004).
• Half of the persons needing assistive technology
  had received all of it (up from 29 in 2004).
• 46 of persons needing communications
  assessments had completed such assessments (up
  from 36 in 2004).

Adaptive Equipment/Augmentative Communication
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Other Findings
L. Case Management

• Noteworthy Practice
• 80 of case managers were identified as knowing
  the person (53 in 2004).
• 87 of case managers had received training on the
  topics needed to meet the needs of the sample
  class member (53 in 2004).
• 80 of case management records contained
  documentation that the case manager is monitoring
  and tracking the delivery of services as outlined
  in the ISP (up from 27 in 2004).
• Practice Challenges
• Slightly over half of CM (53) were able to
  describe the individuals health related needs
  (up from 40 in 2004).
• The same number (53) had an appropriate
  expectation of growth for the person (up from 20
  in 2004).
• Less than half of case managers were found to
  provide case management services at the level
  needed by the person (47, up from 13 in 2004).

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Other Findings
L. Case Management
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Other Findings
M. Home/Residential

• Noteworthy Practice
• All homes were found to be safe.
• 93 of the homes were found to offer a minimal
  level of quality of life (up from 73 in 2004).
• Practice Challenges
• 60 of residential direct services staff were
  found to have an appropriate expectation of
  growth for the individual. Same as in 2004.
• 53 (down from 60 in 2004) of residential direct
  services staff were able to describe the persons
  health related needs.

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Other Findings
M. Home/Residential
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Thank you!

• Lyn Rucker
• Community Monitor
• rpaltd_at_aol.com
• Office 785-258-2214
• Cell 785-366-6468