DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
QUALITY SERVICE REVIEWS OVERVIEW
The Arc of Virginia 2013 State Convention
Charline Davidson
Department of Behavioral Health and
Developmental Services
August 9, 2013
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
DOJ Settlement Agreement Requirements
for Quality Service Reviews (QSRs)
Section V.1 “Quality Service Reviews”
–
The Commonwealth shall use Quality Service Reviews to evaluate the quality of services
at the individual, provider, and system-wide level and the extent to which services are
provided in the most integrated setting appropriate to the individuals’ needs and choice
QSRs shall evaluate whether:
–
Individuals’ needs are being identified and met through person-centered planning;
–
Services are being provided in the most integrated setting appropriate to the individuals’
needs and consistent with their informed choice; and
–
Individuals are having opportunities for integration in living arrangements, work and other
day activities; access to community services and activities; and opportunities for
relationships with non-paid individuals
Information from QSRs is intended to be used to improve practice and the
quality of services on the provider, CSB, and system-wide levels
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Quality Service Review Surveys
QSRs shall collect information annually through:
•
Face-to-face interviews of a statistically significant random sample of
individuals receiving services under the Agreement, to include:
– Individuals receiving ID/DS and DD waiver services and supports
– Individuals receiving services in community ICFs/ID
– Individuals receiving services in state training centers
– Individuals with ID/DD diagnoses in nursing facilities
•
Face-to-face surveys of all individuals who have been discharged
from a state training center on or after October 13, 2011
• Surveys of family members
• Surveys of providers/professionals
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
National Core Indicator (NCI) Survey
Instruments
•
Will use the National Core Indicators (NCI) survey instruments to meet
QSR requirements - http://nationalcoreindicators.org/indicators/
•
NCI indicator domains align with information required for QSR surveys:
– Individual Outcomes:
• Work (finding and maintaining community integrated employment)
• Community inclusion (participating in everyday community activities)
• Choice and decision-making (making choices about their lives and are actively
engaged in service planning)
• Self-determination (having the authority and support to direct and manage their
own services)
• Relationships (having friends and relationships)
• Satisfaction (receiving adequate and satisfactory supports)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
NCI Surveys’ Domains - continued
– Family Outcomes:
• Information and planning (having information and support necessary to plan for
their services and supports)
• Choice and control (determining services and supports they receive and
individuals/agencies providing them)
• Access and support delivery (getting the services and supports they need)
• Community connections (using integrated community services and participating
in everyday community activities)
• Family involvement (maintaining connections with family members not living at
home)
• Satisfaction (receiving adequate and satisfactory supports)
• Family outcomes (having individual and family supports make a positive difference
in the lives of families)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
NCI Surveys’ Domains - continued
– Health, Welfare, and Rights:
• Safety (being safe from abuse, neglect, and injury)
• Health (securing needed health services)
• Medications (having medications effectively and appropriately managed)
• Wellness (being supported to maintain healthy habits)
• Restraints (system is making limited use of restraints/other restrictive practices)
• Respect/rights (receiving the same respects/protections as others)
– Direct Care Staff Stability and Competence
• Turnover (low enough to maintain support continuity and resource efficiency)
• Competence (staff are competent to provide services and supports)
– System Performance:
• Service coordination (accessible, responsive, and support participation)
• Access (services are readily available to those who need and qualify for them)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
•
Why Use NCI Surveys for QSRs?
The NCI Project is a collaborative effort between the National Association
of State Directors of Developmental Disabilities Services (NASDDDS) and
the Human Services Research Institute (HSRI)
– Gathers a standard set of performance and outcome measures states can
use to track performance over time, compare results across states, and
establish benchmarks
– National goal is to have all state participate in NCI
•
Virginia has experience implementing the NCI adult survey in selected
regions to individuals receiving ID waiver services and the child family
survey
•
NCI participation provides Virginia access to NASDDS/HSRI staff support
and resources, including interviewer training and ODESA database
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Project 15 QSR Team Charge and
Membership
•
Project team is advising DBHDS on survey instrument content, survey
administration, and use of survey results to improve practice and service
quality
•
Team members include:
– CSB staff representing the VACSB ID Council and Data Management Committee
– Private provider
– The Arc of Virginia
– Department of Medical Assistance Services
– Partnership for People with Disabilities
– DBHDS executive leadership and Developmental Services, Licensing, Human Rights, and
Case Management staff
•
The team has been meeting once or twice a month since its inception in
December 2012
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
•
Project 15 QSR Team Accomplishments
The focus of DBHDS and QSR Team’s work has been on:
– Adding a small number of questions to the NCI adult and family surveys
– Developing two provider surveys for alternate year administration
– Defining QSR first year implementation requirements
– Communicating with and seeking input from stakeholders:
• TACIDD
• CSB ID directors and service coordinators
• Developmental services providers
•
DBHDS has contracted with the Partnership for People with Disabilities at
VCU to conduct individual, family, and provider surveys
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
•
Individual Survey
NCI Individual Survey
– Statewide random sample of 800 surveys
– Sample will be proportional to individuals that reside in each region
– DBHDS is working with the Partnership to develop a target number of
surveys for each region
– Surveys will be conducted by the Partnership between November
2013 to May 2014
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
•
Family Surveys
NCI Family Surveys
– Three mailed NCI family surveys –
• Adult Family Survey (family members of people living in the family’s home
who are 18 and older),
• Family/Guardian Survey (family members of people living in residential
settings who are 18 and older), and
• Child Family Survey (families with a child living at home)
– Surveys will be mailed and results compiled by the Partnership in
the Spring 2014
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
•
Provider Surveys
NCI Provider Survey
– Goal is to make the provider survey a useful tool for identifying issues
and opportunities to improve practice and service quality from a
provider perspective
– QSR Team is recommending two surveys:
• Service Access Survey – First Year
• Staff Turnover Survey – Residential and Day Services Direct
Support Staff and Case Managers/Support Coordinators – Second
Year
– Web-based surveys will be conducted by the Partnership in the Spring
2014
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
CASE MANAGEMENT OVERVIEW
The Arc of Virginia 2013 State Convention
Dee Keenan, LCSW
Department of Behavioral Health and
Developmental Services
August 9, 2013
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
DOJ Settlement Agreement
Case Management Requirements
For the purposes of this agreement, case
management shall mean:
1. Assembling professionals and nonprofessionals who
provide individualized supports, as well as the individual
being served and other persons important to the
individual being served, who, through their combined
expertise and involvement, develop Individual Support
Plans ("ISP") that are individualized, person-centered,
and meet the individual's needs;
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
DOJ Settlement Agreement
Case Management Requirements
2. Assisting the individual to gain access to needed
medical, social, education, transportation, housing,
nutritional, therapeutic, behavioral, psychiatric, nursing,
personal care, respite, and other services identified in
the ISP;
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
DOJ Settlement Agreement
Case Management Requirements
3. Monitoring the ISP to make timely additional referrals,
service changes, and amendments to the plans as
needed.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
DOJ Settlement Agreement
Case Management Requirements
The DOJ Settlement Agreement views the case
manager or service coordinator as the hub of the
service delivery system and the person responsible
for ensuring the principles and practices of a person
centered integrated system are implemented.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Overview of Measures
Enhanced Case Management:
…the individual’s case manager shall meet with
the individual face-to-face at least every 30
days, and at least one such visit every two
months must be in the individual’s place of
residence (V.F.3)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Enhanced Case Management Target
Population Criteria
…for any individual who:
a. Receive services from providers having conditional
or provisional licenses;
b. Have more intensive behavioral or medical needs
as defined by the Support Intensity Scale (“SIS”)
category representing the highest level of risk to
individuals;
c. Have an interruption of service greater than 30
days;
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Enhanced Case Management
Target Population Criteria
d. Encounter the crisis system for a serious crisis or
for multiple less serious crises within a threemonth period;
e. Have transitioned from a Training Center within
the previous 12 months; or
f. Reside in a congregate settings of 5 or more
individuals.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
“The Commonwealth shall establish a
mechanism to monitor compliance with
performance standards” (III.C.5.d.)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Project Team 9 –Case Management
– Initially met in 2012
– Developed Phase I measures
– Developed mechanism for collecting
measures
– Developed Operational Guidelines and FAQs
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Phase I Measures
In March 2013, CSBs began collecting type, frequency
and duration of ID Case Management Services
Some boards provided enhanced case management to all
of the individuals who had Medicaid
Other boards provided enhanced case management to only
those individuals who met at least one of the 6 DOJ criteria
for the “target population”
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DBHDS
Phase I Measures
Virginia Department of
Behavioral Health and
Developmental Services
Current
Proximity to
Target
Periods DENOM. NUMER.
%
Prior
↓↑
Target
0
7
Percent receiving face- C: Apr
to-face Developmental 2013
Case Management
P: May
services
2013
13,534
9,915
73%
71%
2%
70%
8
Percent receiving inhome Developmental
Case Management
services
8,005
5,742
72%
68%
3%
70%
C: Apr
2013
P: May
2013
50
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100
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
What’s Next – Phase II
Phase II
…key indicators from the case manager’s face to face visits
with the individual, and the case manager’s
observations and assessments, shall be reported to
the Commonwealth for its review and assessment of
data (V.F.5.)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Phase II - continued
“Reported key indicators shall capture
information regarding both positive and negative
outcomes for both health and safety and
community integration….”
Page 26
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Phase II - continued
Project Team 9 was reconvened in March
2013
Team Membership includes
CSB staff representing the VACSB ID Council and Data
Management Committees
Private Provider
Department of Medicaid Services
DD Case Managers
Vocal Virginia
DBHDS executive leadership and Developmental Services,
Licensing and Community Contracting
Page 27
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Proposal for DOJ Quality Measures –
Case Management
Five new data elements will be established in CCS 3 to
collect this information starting March 6, 2014. Each data
element would use a three-point scale to respond to the
measure for the domain:
○ the measure was met,
○ the measure was partially met, or
○ the measure was not met.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Proposal for DOJ Quality Measures –
Case Management
Domain
Physical, Mental, and
Behavioral Health and Well
Being
1
2
Measure
Data Source
Meeting health goals in the
individual’s ISP
New CCS 3
Data Element
Community Inclusion
Meeting community inclusion goals in
the individual’s ISP
New CCS 3
Data Element
Choice and Self
Determination
The extent to which the individual’s
life choices1 have been implemented
New CCS 3
Data Element
Stability
The degree to which the individual
maintained his or her chosen living
arrangement
New CCS 3
Data Element
Stability
The degree to which the individual
maintained his or her chosen day
activities2
New CCS 3
Data Element
Examples: choice of clothing, decorating living area, what church to attend, what activities to attend
Examples: full- or part-time integrated employment, integrated supported employment, other day program
Page 29
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Licensing Overview
The Arc of Virginia 2013 State Convention
Les Saltzberg, Ph.D.
Department of Behavioral Health and
Developmental Services
August 9, 2013
Page 30
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Overall Providers
 814 Provider Organizations
 1948 Services
 6507 Locations
 315 New Applications in Process
 31 Licensure Specialists
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
ID Providers (as of April 2013)
 586 Provider Organizations
 951 Services
 4780 Locations
 132 New Applications in Process (104 group
homes)
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
This Includes:
 1100 Group Homes
 42 Intermediate Care Facilities/Institutions
for Intellectually Disabled
 1085 Sponsored Residential Providers
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Licensing High Risk Factors
More frequent visits for the following providers:
a) Providers who have a conditional license;
b) Providers who serve individuals with intensive
medical and behavioral needs as defined by the SIS
category representing the highest level of risk to
individuals;
c) Providers who serve individuals who have an
interruption of service greater that 30 days;
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Licensing High Risk Factors
d) Providers who serve individuals who encounter the
crisis system for a serious crisis or for multiple
less serious crises within a three-month period;
e) Providers who serve individuals who have
transitioned from a Training Center within the
previous 12 months;
f) Providers who serve individuals in congregate
setting of 5 or more individuals
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Enhanced Licensing Visit Protocol
Visit Schedule
A. Unexpected Deaths and Serious Injuries/Incidents
resulting in significant injuries/risks – Investigations
started within two weeks of notification.
B. Significant Health and Safety CAP’s resulting from
several sources (deaths, serious injuries, case
management concerns CRC and CIM concerns,
complaints, unannounced visits) – Individualized
schedule but no less than monthly until issues are
resolved.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Enhanced Licensing Visit Protocol
C. Training Center Discharges – 45 days after
admission. Further visits depending on status.
D. Provisional License – Individual based on issues but
no less than monthly while on Provisional license
E. Conditional License – After initial admission visit and
within thirty days.
F. ICF/ID and All ID Group Homes – Every six months;
Once a year for triennial
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Enhanced Licensing Visit Protocol
G. Sponsored Residential
i.
ii.
iii.
iv.
Agency – Every six months
All new homes before opening
25%of homes each year with a minimum based on size
Once a year for triennial
H. Case Management – Every six months with greater
sample of cases. Once a year for triennial providers with
greater sample of cases
I. ID Day Support – Every six months, once a year for
triennial.
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DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Licensing Program Overview
“The licensure process will assess the adequacy
of the individualized supports and services…” in
the following domains:
•safety and freedom from harm
• physical, mental and behavioral health and well being
• choice and self determination
• community inclusion
• stability
• avoiding crisis
• access to services
• provider capacity
Page 39
DBHDS
Virginia Department of
Behavioral Health and
Developmental Services
Questions?
Page 40