Staley Implementation Group Meeting                 Previous Meeting Next Meeting
Official Minutes
April 11, 2001


Representatives: Cindy Helvington, Joe Carroll, Marsha Clark, Mario Bolivar, Kathryn Weit, Cynthia Owens, Judy Cunio, Kristin Ahrens, Bev Herrin, Dianne Deurschiedt, Tim Kral, Mike Maley, Diane Drummond, Fred Renter, Jessica Leitner, Kent Layden (facilitator),
Alternates and Observers: Tom Giles, Tara Asai, Pam Ring, Janna Starr, Don Meyers, Frank Quan, Sherrie Quan, Dana Davis, Anne Coffey, Laurie Powers, James Toews, Howard Klink, Roger Stanton, JoAnna Furhman, Nancy Hazelett, Bill Lynch, Sarah Jane Owens

Division Updates: The waiver application needs further review. Those interested in working with Division staff to do final editing should let Mike Maley know. The group asked for a copy of the final product so that everyone will have the information about what went in the application. The minimum time for the Waiver to be approved is 90 days but we can expect it to take longer.

RFP Review: The core group will travel to at least 5 regions within the State. How the local input will be sought has not yet been determined. There was some discussion about what constitutes "conflict of interest".Some specific situations that may arise that would constitute conflict of interests are:
. You are an applicant or a member of a group (board, council, etc.) that is an applicant
. You or your group gives a letter of support to any applicant (even if given to all applicants equally)
. You are a major contributor to the writing of the response (even if not named as an applicant)

Communication Subcommittee Report:
. The group suggested the development of "Fast Facts" one-page fact sheets targeting one specific question or subject.
. We also need to make more use of technology. We could use the website.
. We could also develop some Frequently Asked Questions (FAQ's) which could also be posted on the website.
. We could develop a brochure modeled after the Oregon Health Plan brochure regarding universal access to Self-Directed Supports. A brochure might include:
1 What is universal access to Self-Directed Supports? Or what is new about services to adults with developmental disabilities in Oregon?
2 Who is eligible?
3 What am I eligible for?
4 When is it available in my area?
5 How do I apply?
6 Who can I contact for more information?
The subcommittee will develop a draft brochure and distribute at our next meeting. The brochure will not include any information about funding limits but focus on the process for thinking about supports. The Communication subcommittee raised the question about what we are calling the program that is going to provide supports to children and families.
Recommendation: FAMILY SUPPORT
The Communication also raised the question of why there is no 1-800 Information and Referral number?  This has been something that has been identified as a need for years.
Recommendation: The group recommends that the Division fund this project.

Kids:
Kids Planning Group will start in April.  Mary Lee is heading this up.

50 Individuals Selection Process:
. The group recommended we look at age of caregiver and then develop criteria to prioritize families.
. James indicated that the State feels the pool of eligible individuals will change throughout the settlement period because people will enter the pool as they become eligible and may transition
out because they are selected for service, experience crisis and receive services immediately, or for some reason no longer need or desire services. (A fluid pool). The State would need to identify 100 individuals who will be offered services at the beginning of each biennium. They would then begin the planning process with the intent to have those identified in
services by the end of the biennium.
. The question was asked about those individuals who are pushing against the $20K support services limit have access to comprehensive services? The answer is only if they are one of the 300 individuals selected because they are eligible for the non-crisis comprehensive
services (age of caregiver) or through crisis diversion.
. If an individual moves to comprehensive services because they exceed $20K annually through crisis they are not counted against the 300 obligations as defined in the settlement agreement.
. Counties may need time to collect data about the age of caregivers and develop referrals to the new non-crisis comprehensive services.
. James reminded the group that the settlement also indicates that these individuals will be identified through the planning process with their broker. It is at this time that a referral gets made because a) they meet eligibility criteria and b) they want the services.

Quality Assurance: The Division met with the DD Coalition and plan to use a subcommittee of the DD Coalition as a Quality Assurance/ Quality Improvement group. Anyone interested in joining the subcommittee of the DD Coalition that is working on this should let James know. Many of the people on the DD Coalition subcommittee are also on this UA group so there is a lot of cross representation to help assure that all issues related to UA are
included.

Small Group activities:
(This information has not been summarized but included as full notes.)
We split up into small groups to discuss how to gauge customer satisfaction. Specifically the groups discussed:
How do you define quality? (from the County, provider, family perspective)

The families, self-advocates and advocates reported that Quality means to them:
. informed consumer satisfaction
. accountability to consumer input (QI)
. must have specific plan (a QA/ QI plan) within an organization
. individual defines what is important to them and there is a quality improvement plan that responds to the individual's input.
. With regards to individual serviceshealth and safety including:
. no abuse
. no second hand smoke exposure
. personal care needs addressed
. adequate training/personnel ratios
. support healthy lifestyle
. transportation available
. safe environment
. non-aversive
. What is quality IN individual services?. Choose from a variety of services - meaningful choice
. Satisfaction with services
. Has this improved your life?
. Services follow person centered plan
. You are being listened to
. Supports value individual
. Health and safety
. Flexibility/change
. Feedback on services requested and there is response to that feedback
. Feel empowered- have information to bring to the table
. People I need to contact are available
. When I have question people are available to answer it
. Respect
. Honest
What is quality in Staff?
. value based - client driven
. listen to person's needs
. honesty
. trained
. understand self determination
. skills to implement plan
. must be trained by individual
. respect for individual decisions
. continuity
. creativity
. positive attitude
. responsiveness
. dependable
What is quality in organizations?
. information dissemination continually - communication open/often
. listens and responds to my concerns
. values individual choice
. "walks the talk" - self determination
. individuals must be involved in governance - participate in decision making
. There must be intentional policies, practices or procedures to involve individuals in governance.  Training support/mentoring must be available
. training components for self advocates and families as well as staff
. 24/7 accessibility and availability
. organization problems should not impact on consumers and services
. must be a continuous quality improvement plan

The providers reported that Consumer driven/person centered QA must be seen in context of HCFA driven quantitative requirements and guidelines:
Ind. Broker     (
Family Demands
Provider
Middle
(   Funded State/Federal Demands: BOLI OSEA
I'm most important
Provider must address both successfully
I'm most important # of people supported
Show outcomes +
Organizational stability
How do I have input? Person served/listening well converts to outcomes
Track record - population
People Person-valuing relationships
Testimony of customers
How do providers address needs
Walk the talk - do what we say we will do
Quality staff to offer those served
Affordable supports - only provide what is needed
First impressions
Take time to know the persons
Do people stay?
Shared vision/values

The County/Government group formed the following statement:
We need to deliver the Right services at the Right time, by the Right provider, at the Right level, at the Right Price. We focus on flexibility, accountability, effectiveness, efficiency and consumer
satisfaction
Individual:
. Does plan reflect goals / needs?
. Can they make changes in the plan? Is it flexible?
. Did staff respond to changes (accountability)?
. Timely response to needs/issues
. Were resources effective / efficient?
. Alternatives were offered to meet needs?
. Did staff respond in respectful/open ways?
Government Structure:
. Cost effectiveness / analysis of costs (generic resources, county resources, other services)
. Are providers of services meeting the standards?(contracts, response, tune, cultural competence)
. Did response meet the needs of consumers?
. Does system give data in appropriate time to make decision and review and give a constant feedback loop?
. Opportunity for input from external partners?
. Does the system have standards that it holds itself accountable to?
. Monitoring the providers system - are outcomes being met?
Provider System:
. Assure minimum adverse selection of consumers-balance needs across system
. System responds to provider needs
. Provider system provides data in a timely manner (outcome, fiscal, consumer satisfaction, etc.)
. Assure health and safety
. Cultural competency
. Flexibility, accountability, effectiveness, efficiency, consumer satisfaction

The "other" group formed questions to consider regarding quality. They are:
. Quality of the Plan: Were your choice honored? Did you have choices? Was the plan what you wanted and did you get what you needed and wanted? Was your plan changed in response to your changing needs? Was it flexible? Were services individualized and delivered in a
timely fashion?
. Quality of Consultant / Broker Services: Were many options explored to discover your long-term vision and does your plan move you closer toward it? Was your consultant responsive, respectful and knowledgeable? Community/system/ resources/ services/funding/needs
assessment? Person centered planning?Do you know what to do if you are unhappy with your services or your consultant? Were changes in services explained in a way you could
understand?
. Quality of Agency: Did you have a choice of brokers, providers, fiscal intermediary services? Does the agency have a system to address quality issues? How does the agency use data to make agency changes? How does the agency systematically share information about changes in
the environment/system? Note: All quality assurance elements need to be weighed/evaluated for
meaningfulness as part of the "whole" picture e.g. isolated pieces of information may seem less desirable until they are reflected in relationship to other outcomes.

Small Group Discussion on Training:
(This information has not been summarized but included as full notes.)

There has been a lot of discussion about training needs. We know that training will be key to the success of universal access to Self-Directed Supports. We split up into small groups to discuss how to address our training needs. Specifically the groups are to discuss:What kind of Training do you need? (from the County, provider, family perspective)

The County/Government group identified the following training needs:
Training for individuals & Families:
. advocacy/choice/communication/decision making/self-determination
. Person Centered Planning
. Systems navigation - selection of services available/alternatives
. Management of in-home supports - fiscal intermediary
. Opportunities in system change - Consumer is in control
. Core training to deal with specific issues (medical, behavior, OIS, Universal Precautions)
. Selection of Qualified Providers/Consultants
. Board involvement / Participation in brokerages
Training for Providers / Brokerages Consultants/ Kids Family Support
Workers:
. Cultural competency
. Person Centered Planning / Facilitation / Mediation
. System navigation (AFS, SDSD, new DHS, Housing, SSI, County, OHP etc)
. Core Training (medical, behavior, OIS, Universal Precautions, etc.)
. Diversion and Crisis Services, eligibility
. Self-determination
. FI Services
. Mandatory Abuse Reporting
. State/Federal Regulations (OAR, HCFA, Service Eligibility)
. Quality Assurance
Training for Counties:
. cultural competency
. Person Centered Planning/Facilitation/Mediation
. Core Training (medical, behavior, OIS, Universal Precautions, etc.)
. State/Federal Regulations (OAR's, HCFA, service eligibility
. Systems navigation/systems change
. Quality Assurance

Consumers and Family Members  motto is Learn It.Live It..Give it! The group suggested these strategies for increasing the knowledge and skills of self advocates and families:
. observation - opportunity to watch how others do it
. informal mentoring
. model - demonstrations
. "get togethers" /formal and informal sharing
. make video tapes available
. use different media
. constant communication
. booklets/tapes/pictures
. web
. training/workshops
. Quarterlies
. share information with other groups/network
. families and self advocates do training (and get PAID)
. joint training with professionals and consumers
. use different avenues for getting information out
. look at generational variations
. program in schools
What information and skills should be offered?
. How do I choose a provider?
. How do I keep that provider?
. Self advocacy = in addition to self-advocacy training for individuals, help families understand the importance of self-advocacy and self determination for their children
. Learn to advocate for services
. Change process
. Learn to distinguish between needs of individual and family
. Specific skills like conflict management, budget management, negotiation, conversation, active listening, assertiveness, safety, street smarts
. Person Centered Planning
. Complaint procedure (QA process)
. How to judge quality of services
. What is self determination - how to direct your life
. How do you train your provider
. Training individual family to share information and train others
. Basic 101 - how does the system work
. What resources are available
. Teaching parents to let go
. Fiscal Intermediary responsibilities
. How to write plans that do not endanger benefits
. Waivers and rules. Provide information to consumers
. Training for transition
. Employment

Other  (Zealot) Group suggested trainings be offered to both professionals and customers...It was also suggested that training be offered across disciplines possibly as part of the DHS reorganization.
. Person Centered Planning (awareness and facilitator training)
. Employee/employer interviewing, hiring, firing, reviewing, job descriptions, responsibilities ( both professionals and customers)
. Inclusion  (professional and customers)
. Empowerment / "shopping"/ Rights - for customers
. Individual budgeting/database use - for professionals
. UA and family support / new roles and interfacing with them brokers/CM's
. Board trainings
. Determining and monitoring quality - professionals and customers

Provider Group identified the following needs:
. Business practices may need to change to reflect
. SDS values from planning to service provision
. How to negotiate days/hours of service
. Marketing - how to and who to?
. Working as brokers
. Procuring information on individual needs
. Information on guidelines regarding fees which are in place
. Training around what's what in the waiver
. Orientation to SDS concepts - how to build this into organizations
. Staff working in different environments like in individual's homes. use of natural supports
. pay for non traditional staff
. Employment law and again, non traditional employees, volunteers etc.
. Training around pricing to provide specific services
. Cost of staff
. Cost of pay-rolling
. Cost of overhead
. How to move decision making to the consumer or to the direct service staff
. Training for Direct Service Staff on Core Competencies, Self Determination and the key elements of that (values)
. Conflict of Interest
. The customer is in control!

There was significant feedback from the group that we cannot lose site of the independent contractors out there who do not have regular access to the core training elements that larger providers offer to direct care staff. Ballot Measure 99 may also affect the minimum
requirements for in home care providers.

Summary and Wrap Up: Between now and our next meeting representatives will combine our lists from the small group exercises on Quality Assurance and Training Needs to reflect common areas. This group recommends that there be a coordinated training effort initiated by the Division. There is a sense of urgency about this given that the Statewide in-service is coming in June.

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