Team 1: Support Coordination Enhancement (5-20-14)

Location of Meeting: Services Inc, Joliet IL

Members Present

Members Absent

• Brent Schwartzhoff, Suburban Access
• Lisa Jacino, DayOne
• John Knight, DDD
• Mary Spriggs-Ploessl, Deputy Director, DDD
• Gary Hake, SICCS

Meeting Notes

Agenda Item #1: What have each of us done since our last meeting?

• Mary Lou, Denise, Jennifer, and Lisa met as a subcommittee to discuss the ISSA guidelines to compare the differences between the 2004 ISSA manual and the ISSA manual on the web site.
• Mary Lou gave us an update on the other Life Choices Project teams.
• Vickie mentioned that Pennsylvania has something called "The Gold Book" which serves as a handbook for consumers & families. Vickie will email this to Denise who will then send it out to the rest of the committee to review.

Agenda Item #2 Review of ISSA Manual Subcommittees work

• See attached handout for differences between 2004 guidelines and the guidelines now on the web site
• The team discussed what BQM uses to determine their performance indicators for ISC agencies?  (Attachment A, Waiver Manual) Do they use ISSA guidelines? Most of the BQM survey appears to be developed from Attachment A.
• Our team noted that there are many different places (Attachment A, Waiver Manual, ISSA guidelines from 2004, ISSA guidelines from web site) that we need to look at to see what our job duties are rather than it being in one document.
• Mary Lou noted that Community Services has had some training in changes to the system and their role.
• One of the reasons for the Life Choices Project is the absence of one clear laid out plan of how things should work for consistency and clarity. This easily creates some tension around Community Services and ISC agencies and the process of how things are done. Things work really well in most places, and it is because of the strength of the relationships between PAS/ISSA staff and the Community services staff.  When there is turnover, it is harder to accomplish the tasks.

Agenda Item #3: Review of Waiver Manual Requirements

• The team reviewed the Individual Service Plan information in the Waiver manual We need to enhance the expectations that DHS has when they refer to "monitoring". In the Waiver manual under the Individual Service Plan section, the last sentence states "monitor the implementation of each participant's service plan at least quarterly and undertake follow up activities as appropriate and necessary". The ISSA guidelines say you have to do visits at least once a quarter and a specific form is completed. In order to accomplish a formalization of the responsibility and concurrent authority of ISC agencies the expectations need to be clear, concise, and in one location.

Agenda Item #4: What do we recommend for performance measures? What would be good indicators for the ISC role?

• The team noted that timeliness and accuracy are big issues in the quality world.

Quality by Perception

Customer satisfaction survey is quality by perception. It doesn't matter if we think it's important or not or even accurate, if that person perceives that you did something fantastic, their perception is that you did something fantastic. Customer satisfaction surveys should be sent to families/individuals. Other customer satisfaction survey should go to the providers and ask "how do we do?" How do community services staff at DD think we are doing?

Quality by fact

Quality by fact are things that are in the requirements that are concrete and recognizable. (Think about your bank-the bank needs to get your balance right all the time but you don't also call them up and tell them thanks for getting balance correct-you expect that to happen.) They are minimum standards that you just expect people to do. What are those standards? They are the floor, not the ceiling, in quality. 

If you are really looking at performance standards and look at how ISC agencies are doing, you want it to be variable data. How am I doing compared to the other 18 ISC agencies? How big is the range of scores? You have to be able to measure variation from a set amount of data. It was noted that this is currently on the early intervention model measures itself.

Discussion of ISC performance: How is it currently measured?

• Consumer satisfaction survey
• BQM calling family guardians but not calling individuals who are their own guardians
• How do we measure how families think we are responsive to their needs?
• How do we measure quality?
• Do ISC agencies have a quality management plan? (A plan which discusses the mission/values of the company.) The plan looks at what we do well and comes up with indicators to determine how we will continue to do those things well. The plan also looks at areas that we need improvement in and how we can improve in those areas. You always have to do the basic standard (and if not, that is on your quality improvement plan).
• The system is very dysfunctional right now and there is no easy access to services right now. The needier the person is the longer it takes to find them services

Discussion of Possible ISC Performance Indicators

• How long does it take you to determine eligibility? (from the day your agency receives the referral to the day eligibility is determined)
• Measure through retention rates of staff? For ISC/QIDP, the total number of months of employment with our agency during service coordination.
• The length of time from the day the PUNS invitation letter is received by the family until the day that waiver services are actually started.
• How do we measure how much time we spend with people versus paperwork?
• The average length of time spent during additional monitoring visits per provider?

Discussion of Possible Network Performance Indicators

• Who is responsible for provider capacity building? Whose job is it to build provider capacity? Who in the DD division is responsible for building provider capacity? At the governor's level it appears strides are being made to build capacity (myhome.illinois.gov)
• Some kind of tracking about if a complaint is made regarding a provider and the outcome of that complaint. You don't want to discourage families from making complaints. An increase in complaints may be a strengthening of the system because families feel more secure to complain. Do we listen to the family and were improvements made?
• The Length of time it takes until services start due to issues with provider capacity
• Look at indicators to determine if there is adequate capacity
• The total number of agencies that people volunteer or have membership at (Provider)
• How many people have paying jobs? (Provider)

Potential Recommendation Ideas

• Training Recommendation: Skills section of ISSA guidelines be updated: list of topics that people need training on in the first year and a list of topics on which people will need ongoing training
• Recommendation to have a subcommittee be formed to look at training and training recommendations for initial (1st year) Q's and targeted ongoing training. Laurie, Darlene, Steve, Carol Skrapits (Service Inc), Mary McLaughlin will be on the training subcommittee.
• Annually the Division and all ISC agencies will get together each year to determine training topics for the next year.
• ISSA guidelines manual be updated to be changed to encompass all programming under the ISC and that it be consistent with the contract/amendments and reviewed annually for updates.  There is no person centered process or language in the current guidelines. It doesn't give you the purpose of the guidelines-they are very task orientated rather than infusing the desired outcomes the department has to help families and providers understand what ISC agencies do.
• In the short term, the 2004 ISSA guidelines paper manual and ISSA guidelines on the web will be merged and updated for accuracy by August and removed from draft status and finalized.
• The August version of the ISSA guidelines needs to include the ISP approval process in detail
• Long term a new ISC manual will be completed that incorporates all functions of the ISC agencies (ISSA, Bogard, PAS, PUNS). ISC agencies should be involved in this process to define what needs to be in the manual. Within 1 year of the finished work teams, this ISC manual needs to be completed. It should incorporate all of the approved team recommendations and incorporate a person centered view.
• Consistent state wide handouts on the role of ISC's to have a guide to the families on what ISC's do
• All ISC agencies be financially supported to have a web presence
• BQM recommendations and findings for individual agencies need to be documented in written form and shared with all 18 ISC agencies for consistency, while also protecting identity.
• Anytime policy or procedural changes are made, there be a formal process that vetting and changes are being made, an effective date set, and formal changes made to all documentation.
• In order to accomplish a formalization of the responsibility and concurrent authority of ISC agencies the expectations need to be clear, concise, and in one location.
• The monitoring requirements developed by team 5 need to be formally adopted and made available to the whole DD system as included in the ISC manual and put on the web site. 
• There should be one statewide data base documentation system for the DD system for all of the 18 PAS agencies and the Networks so everyone can interact. We would like a decision to be made to pursue this database within the next year. (One example is FEI Systems in Chicago. It develops IT systems for human services)

Action Items To Be Completed Before Next Meeting

• Sherry is going to look for brochure about the role of ISC's that was developed by the DDD to give to families. The team will then review at the next meeting for suggestions.
• Training subcommittee will meet in June.
• By the next meeting, look at the potential recommendations from 4/30/14 and 5/20/14 meeting notes to try and make some concrete recommendations at our next meeting. Look at which recommendations possibly overlap. Look at ideas/things that would enhance the role of service coordination for ISC agencies. Look at things that have arisen that would be good for the Network region staff, DD Division as a whole, and ISC agencies.
• Think about potential performance indicators for the next meeting. Please come up with 3-4 performance measure that you think would be useful for the system or a particular group. They need to be ISC specific.

Next Meeting

Monday, June 16th, from 10-3 at CISA in Lincoln.

Minutes Prepared By: Denise Oligney-Estill