Introduction to Oregon ISP (.ppt)


Introduction to

Proposed New

July 22, 2014

This is a work in progress.

Changes are happening based on field test and ongoing feedback.

Why one ISP?

Oregon currently has 11 different ISP models used in various service settings

Consistency for people supported and family members

Assist in transitions across service settings

Improved quality of plans

Advisory Group

Made up of stakeholders representing the array of service settings

Reviewed each existing ISP in Oregon as well as ISPs from other states

Responded to drafts developed by smaller work groups

Partners in conversation

Plan of Care / Billing System

Employment First Implementation Team

Medicaid Waiver Unit and Oregon Health


Licensing Unit

Where are we now?

Started a field test in May

We will continue to learn from what works and what needs improvement

Statewide roll-out is anticipated by

January 1 to coincide with implementation of new OARs






(Jan. 2015)

Field Test




The Plan

Captures what’s important TO and FOR the person from various perspectives

Gather information from the person supported and others who know and care about the person

For Field Test

Gathering Person Centered Info

Our goals are to:

Avoid duplicate or redundant information

Give opportunity to those closest to the person to directly contribute vital information

Build on existing person centered planning tools and plans (e.g. ELP, ELISP,

PFW, Customer Goal Survey)

The Plan

Serious risks are identified and addressed

Maintain instructions for staff to support identified risks (e.g. protocols, BSP, safety plans, etc.)

The Plan

Connects assessed needs to specific chosen services (such as ADL and IADL support needs)

Various goal implementation tools will be offered

How the plan is developed

The person invites people they want to assist them with planning

We are using the field test to identify workflow methods that help teams develop ISPs effectively and efficiently

Coordinated with the Needs Assessment meeting

Highlights of Learning

What Works

Loved the One Page Profile &

Relationships page

Flexibility is apparent; discussion topics, goals, risk management strategies, gathering information

Person’s preferences are clear throughout the plan

CMS reviewed a draft and said we we’re on the right track

Highlights of Learning

What needs more conversation

Asking the right questions when gathering person centered information.

How to best support the person’s choice of who plans with them

“I don’t want my provider present.”

“I don’t want you to talk about the serious risks in my life.”

What’s next?


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This Fall we will announce training schedule for November and December

Thank you!