Self-Determination

1
Self-Determination Individualized Funding

• Can We Trust Consumerism,
• OR
• Is Regulation Necessary?

2
Considerations for External Monitoring

• Public Money is Being Spent
• Basic Health and Safety Responsibilities
• Legal
• Moral
• Vulnerable Population
• Recent Situations CA, DC, etc.
• Short Track Record for SD/IF

3
Monitoring Possibilities

• Federal Rules, Regulations and Inspections (ala
  HCFA)
• Local/Regional Licensing
• Program Process Certification
• External Accreditation
• Accepted Quality Indicators
• Local Ombudsman/Advocate
• Some Combination of the Above

4
Sometimes We Feel A Bit Like This

• I have met the enemy,
• and he is
• US!
• Pogo, Walt Kelly

5
National Accreditation

• Not Regulatory - Not Rules
• External, Impartial Observation
• Standards Quality Indicators
• Focus on Results/Impacts in Life
• Quality Improvement Structure
• May Provide Information for Informed
  Choice/Decision Making/Service Access

6
Implied Information

• A Commitment to
• Consumer Partnership
• Available Service Results Data
• Qualified/Trained Staff
• On-going Quality Improvement
• External Observation
• Efficient, Effective Resource Use

7
Real Information

• Access to 25,000 Services
• Access to 100,000s of Direct Service
  Professionals
• Consumer Information Products
• Consumer and Family Guide to Quality Services
• Using Individual Centered Planning for
  Self-Directed Services
• How to Choose a Provider

8
Possible Combination of Monitoring Activities

• Deemed Status
• Initial Service Licensing Compliance
• Achieve National Accreditation
• Absence of Formal Public Allegations
• Consumer/Family/Funder Satisfaction
• Annual Re-licensing - Waived or Reduced
• Local Hotline, Emergency Response, Technical
  Assistance, Problem Solving, Complaint
  Resolution, etc.

9
There are NO Guarantees!

• Abuse Can Happen in ANY Setting
• There are Good People and Not-So-Good People
• There is always risk in everything
• Information/Experience/Planning Minimize the
  Risks and Danger
• Be Prepared!

10
What Do You Think?

• How do we balance risk and responsibility?
• How do we balance informed choice and concerns of
  well-being?
• How do we stay out of the way and offer some
  protection to all the parties?

11
Audience Comments/Answers

• Can SD and accreditation co-exist?
• What is an appropriate role for accreditation
  (Carf)?
• A Natural tension between SD, Individual Choice,
  and accreditation is healthy - we may need new
  assumptions for a new service delivery system?

12
Audience Comments/Answers

• Some states use a multiple approach to QA - in
  concert with one another.
• Regulations/standards are not necessarily in line
  with consumer preferences - they should be!
• Paper on the wall - certificate - doesnt assure
  safety!

13
Audience Comments/Answers

• Emphasize the local consumer component of any
  accreditation system.
• Consolidate/simplify systems.
• SD is about relationships any system needs a
  focus on people.
• SD will sort out bad supports.

14
Audience Comments/Answers

• Current confusion between funding and regulation
  roles.
• Some regulation, auditing or accountability is
  necessary - the question is how much and what
  kind.

15
For More Information

• Contact CARF
• Employment and Community Services Division, 4891
  East Grant Road, Tucson, AZ 85712 Phone (520)
  325-1044, FAX [phone],
• Dale Dutton, x 133, or Paul Andrew, x112
• Internet addresses http//www.carf.org
• email pandrew_at_carf.org, or ddutton_at_carf.org