Using State-Level Performance Data: an Update on the National CIP

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Using State-Level Performance Data an Update on
the National CIP
Val Bradley and Sarah Taub Human Services
Research Institute
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How Did We Get Here?

• Initial concentration on rudiments of custodial
  care
• Evolution of programmatic standards that
  reflected growth in our understanding of peoples
  needs and our own expertise
• Increased concern about the efficacy of our
  interventions
• Attention to the outcomes of services and
  supports from the perspective of the customer

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Signs of Change in Performance Management

• No longer just better than the institution
• Rooted in outcomes
• Emphasis on enhancement
• Changing role of the state
• Changes in experiences and expectations of
  families and consumers
• Changes in accreditation approaches

Outcomes
Expectations
Inclusion
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More Signs of Change

• Movement away from prescriptive standards
• Emphasis on CQI
• Collaborative development of standards
• Inclusion of customer satisfaction

Satisfaction
Consensus
CQI
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Changing Quality Landscape

• Exposure of fault-lines in the system (e.g., HCFA
  and the press)
• Expansion of supports to individuals on the
  waiting list
• Emergence of self-determination
• Olmstead decision
• Struggles with MIS applications
• Direct support staff shortages

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Emergence of Performance Indicators

• First appeared in behavioral and acute care
• Provide some cues for managing these complex
  systems
• Highlight impact of cost containment
• Illuminate whats working
• Provide early warning signs

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Characteristics of Performance Indicators

• Reflect major organizational or system goals.
• Address issues that can be influenced by the
  organization or system
• Have face validity

• Point a direction
• Reflect rates or major events
• Related to associated standards

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Consumer Involvementin Assuring Quality

• Choice among providers/ purchasing decisions
• Designing and refining QA mechanisms
• Grievance/appeals process
• Consumer satisfaction surveys
• Membership on policy-making board
• Consumer Reports

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Continuous Quality Improvement

• Leadership at the senior level
• Engagement of multipleconstituencies
• Development of benchmarks
• Identification of change strategies
• Measurement of progress

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Project Beginnings

• NASDDDS and HSRI collaboration
• Launched in 1997
• Seven field test states steering committee
• 60 candidate performance indicators
• Development of data collection instruments

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Current Participating States

WA
VT
WA
VT
MT
MT
MA
MA
SD
RI
WY
RI
WY
PA
CT
PA
CT
IA
IA
NE
NE
IN
IN
UT
IL
UT
IL
WV
DE
WV
DE
KY
KY
NC
NC
AZ
OK
AZ
OK
Orange
Orange
SC
County
County
AL
HI
HI
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What will CIP accomplish?

• Nationally recognized set of performance and
  outcome indicators for developmental disabilities
  service systems
• Benchmarks of performance
• Trend data at the state national level
• Reliable data collection methods tools

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What are the Core Indicators?

• Consumer Outcomes
• Satisfaction, choice, employment
• Provider Agency/Workforce Stability
• Staff turnover
• System Performance
• Protection of Health and Safety

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Data Sources

• Consumer Survey
• Family Surveys
• Family Support Survey (adult lives at home)
• Children/Family Survey (child lives at home)
• Guardian/Family Survey (adult lives out-of-home)
• Provider Survey
• DD System MIS (state-level)

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Selected Findings

• 1999 and 2000 Data

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Family Survey (2000)
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Family/Guardian Survey (2000)
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Children/Family Survey (2000)

• 84.7 of respondents choose the agencies or
  providers that work with their family some or
  most of the time
• 73.1 of families choose the support staff that
  work directly with their family (some or most of
  the time)
• 87.3 of respondents would like at least some
  control over the hiring and management of their
  support workers, yet only 67.2 feel they have
  some or more control over this hiring and
  management

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Community Inclusion
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Choice and Decision-Making
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Consumer employment data (1999)

• Where people work
• Duplicated counts
• Aggregate N 3900 (11 states)
• 27.7 -- supported employment
• 21.7 -- group employment (enclave/crew)
• 40.4 -- facility-based employment
• 36.8 -- non-vocational day supports

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Employment by state (1999)
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Health Safety Outcomes

• Knowing how to file a grievance
• Feeling safe in your neighborhood
• Having checkups with doctor and dentist

• Being free from major/serious injuries
• Not taking psychotropic medications if you dont
  need to
• Being safe from crime

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Health Outcomes (2000)
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Health Outcomes (2000)
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Health Outcomes (2000)
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Consumer Outcomes (2000)

• Access
• 79 of respondents reported that they almost
  always have a way to get where they want to go
• Safety
• 94 of respondents report feeling safe in their
  neighborhoods
• 96 report feeling safe at home

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Staff Stability

• Rate of direct supportturnover
• Average length of time on the job
• Vacancy rate
• Staff qualifications and competency considered
  but postponed considered a staff survey

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Staff Stability (1999)

• Day support providers report
• Lower turnover
• Current staff have been employed longer
• About half as many vacant positions(both FT and
  PT)
• Both types of agencies report
• Staff who left within the last year were employed
  on average about 19 months
• Part-time position vacancies are much higher than
  full-time position vacancies

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Staff Turnover (1999)

• Day Support Agencies
• 31.2 turnover (n294)
• Separated staff employed average of 19.4 months
  (n242)
• Current staff employed average of 40.3 months
  (n290)

• Residential Support Agencies
• 35.2 turnover (n283)
• Separated staff employed average of 19.5 months
  (n259)
• Current staff employed average of 37.8 months
  (n272)

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Staff Vacancies (1999)

• Day Support Agencies
• 5.9 of full-time positions are vacant (n222)
• 8.7 of part-time positions are vacant (n167)

• Residential Support Agencies
• 9.9 of full-time positions are vacant (n217)
• 18.9 of part-time positions are vacant (n199)

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Representation on Boards (1999)

• Across all providers reporting (N 302)
• 3.2 of board members are consumers
• 19.0 of board members are family

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Board membership across states (1999)
Consumer Family Representation on Boards
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For more information

• Visit HSRIs website
• www.hsri.org/cip/core.html

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What Do You Do With the Information?

• Include at your web site
• Prepare annual reports
• Develop provider profiles
• Use with sister agencies
• Use in allocation decisions
• Use to spot red flags

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Final Words

• Beware the Continuous Improvement of Things
  Not Worth Improving
• W. Edward Deming

CAUTION