2018 Reinventing Quality Conference: Building an Infrastructure that Promotes Equity and Diversity


2004 Reinventing Quality Conference
Conference Materials


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Conference Program (344 K)

Plenary Presentations

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Individual and Family Involvement in Quality- Coccia (586 KB)
Effective state quality management systems ensure families and self-advocates a decisive voice in assessing service performance and shaping systemic responses to the findings. The three panelists discussed how their respective states go about assigning family members and self-advocates pro-active roles in overseeing the quality and appropriateness of publicly funded supports for people with developmental disabilities.
Moderator:
Bob Gettings; NASDDDS
Presenters:
Kenny Capone; Ask Me, Maryland
Dee Coccia Independent Monitoring for Quality (IM4Q), Pennsylvania
Gary Stevens Missouri Alliance for Individuals with Developmental Disabilities (MOAIDD), Missouri
   
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Rising CMS Expectations for HCBS: How Changes in CMS Policy will Affect State Home and Community-Based Waiver Programs- Thaler (572 KB)
The Centers for Medicare and Medicaid Services (CMS) has significantly changed its approach to over-seeing Home and Community Based (HCB) Programs. This change in approach has resulted in altered expectations of states. CMS also is developing a new waiver application format that will communicate CMS expectations for state Quality Management practices and implementation of self-direction within HCBS service system. The presenter provided a context for and an overview of these changes.
Moderator:
Val Bradley; HSRI
Speaker:
Nancy Thaler; Director for Quality Improvement Strategies Centers for Medicare and Medicaid Services (CMS)
Response Facilitator:
Graham Mulholland; Executive Director, Pennsylvania DD Council
   

Breakout Session Presentations

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Parents and Self-Advocates on the Quality Improvement Team- Huwe (574 KB)
Sherri Huwe of the Washington State DD Council (DDC) discussed the Washington State CORE Indicators Project, the process of disseminating the information learned from the survey, and how the review panel used the results of the survey to make recommendations to the DDC and the Division of Developmental Disabilities (DDD), as well the way DDD used the results to act to improve their system. Presenters also shared how Rhode Island merged the National Core Indicators Consumer Survey with PAL's Quality of Life Initiative Questionnaire in order to ask people who receive supports through the Division of Developmental Disabilities (DDD) how they are doing and feel about the supports/services they receive. In addition to participating in the national comparison through HSRI, PAL provides feedback to participants, if desired, through their support agency and their state social worker. Efforts to enhance systems change have included the development of the Quality Consortium work groups, a trends report, follow up process and a comparison of a person's three wishes with three of their goals. The Nevada University Centers for Excellence in Developmental Disabilities (UCEDD) described an evaluation contract with their state regional centers since 1996, the progress and evolution to more self-advocacy, choices and satisfaction and employing people with disabilities as staff members. Participants included three staff members of the project.
Moderator:
Sarah Taub, HSRI
Presenters:
Sheri Huwe; Washington State DD Council
Diana Rovetti; Nevada UCEDD
James Ross; Vista Member/Nevada UCEDD
Doreen McConaghy; PAL, Rhode Island
Barbara McCrae; PAL, Rhode Island
Alvin Tomko; PAL, Rhode Island
   
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Assessing DSP Competencies: The College of Direct Support- Tapp (229 KB)
Each of the presenters has varied experiences and perspectives with regard to the College of Direct Support. Each speaker gave an overview of: (1) The greatest need of your workforce and how the CDS begins to address the need; (2) How the CDS is being incorporated; (3) How the CDS has been accepted by both seasoned and new workers; (4) How you are working to implement quality improvement initiatives for your workforce; and (5) Next steps that your organization envisions for developing a world-class workforce.
Moderator:
Charlie Lakin; RTC/ICI, UMN
Presenters:
Jackie Epstein; OMR, Pennsylvania
Deb Daulton; OMR, Pennsylvania
Judy Dotzman; SPIN of Pennsylvania
Patricia Sastoque; MRDDA, Washington, D.C.
Stacie Brownrigg; MRDDA, Washington, D.C.
Charlie Lakin; College of Direct Support, RTC/ICI, UMN, Minnesota
Bill Tapp; The College of Direct Support
   
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Using National Core Indicators (NCI) to Measure State Performance- Nuss (49 KB)
This session included a panel of presenters from NCI participating states and one Regional Center in California. Panelists discussed the roles of NCI data in performance measurement and quality improvement systems at the state and regional levels. Regional Center of Orange County's (RCOC) participation in the National Core Indicators was also discussed. Information was presented regarding the impact of NCI results in helping RCOC focus on service improvement in areas that are most important to consumers and their families. Moreover, the use of NCI data to initiate policy and procedural changes within the organization was described. Connecticut is designing a new Quality Supports and System Review process as part of broader systems change efforts to enhance the state quality assurance and improvement system, integrating traditional safeguard mechanisms with consumer outcomes and satisfaction measures. The session also detailed how Connecticut has woven the NCI consumer interview into a new provider certification review methodology and process for providers of traditional and self-directed services and supports, and how Maine has used NCI data as a tool to evaluate systems performance and make policy and practice decisions.
Moderator:
Val Bradley; HSRI
Presenters:
Sarah Taub; HSRI, Massachusetts
Val Bradley; HSRI, Massachusetts
LeeAnn Christian; Regional Center of Orange County, California
Laura Nuss; DMR, Connecticut
Jane Gallivan; Adult MR Services, Maine
   
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Aligning State QA Systems with a Quality Framework- Wisser (209 KB)
This session presented the process that has been used to design and develop Ohio's Quality Management System. The CMS Real Choice Systems Change QA/QI grant awarded to the Ohio Department of MRDD has served as the impetus to design a system that creates a common context for the coordination and operation of the Department's multiple and previously disconnected quality assurance activities. CMS's Quality Framework that has been constructed serves as both the foundation of the state's Quality Management System and the aggregation of data elements used for decision-making and public policy direction. This session also described how the Office of Mental Retardation (OMR) in Pennsylvania is integrating CMS's Home and Community Based Services Quality Framework into its Quality Management Program. The presenter discussed how OMR is building structures to embed quality management practices.
Moderator: June Rowe; HSRI

Presenters:
Don Bashaw DMR/DD, Ohio
Kathy Wisser OMR, Pennsylvania
   
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Measuring Risk: Emerging Practices- Anderson/Walker (530 KB)
With the release of the HCBS Quality Framework as well as other initiatives in quality improvement emanating from CMS, states are being encouraged to consider a perspective on quality that differs from historical practice. Instead of the retrospective, look-behind methodology for managing quality, CMS is actively encouraging the states to design quality throughout the system. This session looked at using the Individual Support Planning process as a vehicle to manage risk with the full involvement of the individual. Beginning in fiscal year 2001-2002, the California Department of Developmental Services began developing a data based Risk Management and Mitigation System to enhance individuals' health, safety, and well-being. The system, which applies to all individuals served by California's 21 regional centers, is now fully operational. Presenters provided a description of the overall system, the roles and responsibilities of developmental disability service system structures, supports provided by the independent contractor, and outcomes achieved to date.
Moderator:
Bob Gettings; NASDDDS
Presenters:
Elin Howe; Columbus Group
Rita Walker; DDS, California
Margaret Anderson; DDS, California
Jean Tuller; OTAC, Oregon
   
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Internal Provider QA/QI Systems- Brooks (51 KB)
                            Related Handouts- Brooks (132 KB)
This session discussed the QA/QI initiatives currently being utilized at Community Access Unlimited, OHI, and the Barber Institute to improve supports for adults with developmental disabilities living in the community. The initiatives include the implementation of quality assurance systems focusing on four core elements: performance standards, performance monitoring, feedback, and staff training. Presenters also described the role of the Director of Quality Improvement, the important role of multiple quality improvement teams within the agency, and the vital role of a variety of annual customer satisfaction surveys. The relationship of staff recognition, a pay-for-performance system, and other approaches important to the assurance and improvement of quality was also discussed.
Moderator:
Celia Feinstein; IOD
Presenters:
Laura Williams; Community Access Unlimited, New Jersey
Chris Curcio; Barber Institute, Pennsylvania
Bonnie Jean Brooks; OHI, Maine
   
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Dissemination of Information to Consumers, Families, and Other Stakeholders- Schoolfield (768 KB)

Related Handout - Performance System Needs Assessment- Schoolfield (7 KB)
The Balanced Scorecard is a performance management framework that provides the multidimensional perspectives necessary to evaluate key performance areas required to promote optimal performance of the Human Service System. This interactive session provided a hands-on experience of building a Balanced Scorecard; through an individual assessment, participants evaluated their organization's readiness to begin such an endeavor. In addition, we reviewed some basic challenges and rewards of using this type of performance management system.
Moderator:
Sarah Taub; HSRI
Presenters:
John Jordan Parent, QA Team Trainer, Region X, Minnesota
Donna Garratt Parent, QA Team Member, Region X, Minnesota
Cindy Ostrowski Director, QA Team Trainer, Region X, Minnesota
Susan Schoolfield Creative HealthCare Strategies, Ohio
Joan Baker-Potts Chester County MH/MR, Pennsylvania
   
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CMS: The Emerging Quality Framework- Bach (44 KB)
CMS: The Emerging Quality Framework- Thomas (69 KB) CMS: The Emerging Quality Framework- Ament (667 KB)
The presentation focused on the "Interim Procedural Guidance," the new process used by CMS to review the quality of state HCBS waiver programs. Beginning with the Quality Framework the panel described the changes and what this will mean for CMS as well as for state agencies as they review their current quality management systems and plan for the future.
Moderator:
June Rowe; HSRI
Presenters:
June Rowe; HSRI, Massachusetts
Ronna Bach; CMS, Region III, Philadelphia
Darlynn Thomas; DDSN, South Carolina
Connie Ament; DMR/DD, Ohio
   
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Using Multiple Data Sources to Isolate Systems Problems- Hill (105 KB)
Presenters described how claims data, in combination with other program data, can be used to assess HCBS quality. Through examples developed in other states, Julie Fralich demonstrated how states can generate standardized measures (such as HEDIS and inappropriate drug use) within and across waiver programs. This session also explored the progress of the Delmarva Foundation's Florida Statewide Quality Assurance Program and how data from the Florida Medicaid Management Information System (FMMIS), and the Florida Development Disabilities consumer information system are used in quality assurance/improvement for the state's Developmental Disabilities HCBS Waiver.
Moderator:
Val Bradley; HSRI
Presenters:
Julie Fralich; Muskie School of Public Service, Maine
Marcia Hill; Delmarva, Florida
   
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Quality Improvement for Direct Support Professionals- Oxx (190 KB)
Quality Improvement for Direct Support Professionals- Toth (13 KB)
This session provided an update on the Massachusetts Department of Mental Retardation (DMR) initiative to enhance the quality of healthcare services for people enrolled in its service delivery system. A review of the recently implemented health initiative, implementation challenges and provider reaction and feedback as well as plans to measure outcomes was discussed. This workshop also described the origins and development of the New Jersey Pre-Service Training Program for Direct Support professionals. It included an overview of the curriculum, as well as the ongoing collaborative efforts of public and private agencies to promote quality and continued viability in meeting the need for basic training of Direct Support Professionals (DSPs). The presentation discussed the checks and balances that have assisted in troubleshooting issues and maintaining consistency since the program's inception in 1988.
Moderator:
Charlie Lakin; RTC/ICI, UMN
Presenters:
Sharon Oxx; DMR, Massachusetts
Linda Cobb; Arc of Atlantic County, New Jersey
Donna Toth; Arc of Bergen & Passaic Counties, New Jersey
Mary Ann Basileo; DHS/DDD, New Jersey
   
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Key Information for Person Centered Planning- Tasse (246 KB)
Presenters shared a brief description of the individualized supports provided by Neighbours, Inc. for citizens with disabilities in New Jersey and Pennsylvania; a story was utilized to provide an example. The presenters also discussed the supports planning model contained in AAMR's new Supports Intensity Scale. This approach focuses individualized supports planning on the person. Identifying and planning supports needs starts with the person. Interviewing the person and involving him or her in all steps of support planning are crucial.
Moderator:
Val Bradley; HSRI
Presenters:
Patti Scott; Neighbours Inc., New Jersey
Marc Tasse; University of North Carolina
   
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Using Data for Change to Manage System Improvement- Landauer (26 KB)
Using Data for Change to Manage System Improvement- Walker (510 KB)
This presentation described leading edge technology for managing and monitoring critical case management data that has been successfully implemented at the Regional Center of Orange County with amazing results. The generality of the technology to organizations and/or individuals charged with facilitation of services in the developmental disabilities field, and ways to use it to manage system improvements was discussed. Attendees also had an opportunity to view a demonstration of the capabilities of the "Virtual Chart." Mr. Walker presented information on how the Ohio Department of MR/DD is leveraging business intelligence technology to enhance the quality of services provided to individuals. Data sources include the Incident Tracking System, Accreditation Reviews, Supported Living Quality Assurance, and Licensed Facility Reviews.
Moderator:
Chas Moseley; NASDDDS
Presenters:
Art Walker; Division of Information Systems, DMR/DD, Ohio
Bill Bowman; Regional Center of Orange County, California
   
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Supporting Supervisors- Hewitt (57 KB)
Supporting Supervisors- Taylor (202 KB)
The quality and stability of direct support professionals is highly dependent upon the quality and stability of the support they receive from supervisors and employers. This session reviewed the challenges faced in the field related to frontline supervisors and middle managers and will provide insight into successful intervention strategies and training that can assist in improving the quality and stability of these supervisors. A new on-line training curriculum for frontline supervisors will be previewed: The College of Frontline Supervision. The session also described the voluntary certification utilized in the State of Kansas for Direct Support Professionals.
Moderator:
Marianne Taylor; HSRI
Presenters:
Amy Hewitt; RTC/ICI, UMN, Minnesota
Sheryl Larson; RTC/ICI, UMN, Minnesota
Marianne Taylor; HSRI, Massachusetts
   
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How to Use Information for Local Quality Management- Coles (204 KB)
The presenters discussed quality initiatives at the local (county) level. Presenters discussed how data are received and utilized in a Quality Improvement structure that in some cases includes the development and operation of a county-wide Quality Council.
Moderator:
Celia Feinstein; IOD
Presenters:
Steve Coles; Bucks County MR/MR, Pennsylvania
Joanne Lombardo; Lackawanna-Susquehanna- Wayne County MH/MR, Pennsylvania
   
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Workforce- Taylor (267 KB)
The Everyday Heroes project was initiated in New York City in 2001 in response to the growing need to recognize the contributions of direct support professionals, to support them to develop as leaders and teachers of other direct support workers, and to deepen their commitments and unleash their creativity for community inclusion through application of person-centered principles and practices. Over the past three years, the Everyday Heroes staff and participants have been involved in a continuous series of development activities that has now: (1) spanned three regions in New York State; (2) involved thousands of direct support professionals; (3) promoted the community membership of thousands of people with disabilities; (4) led to the development of numerous teaching and training materials and creative artistic products; and (5) created organizational change in countless agencies and program sites. Participants were provided with an overview of Ohio's voluntary credentialing program for direct support professionals. The discussion focused on the system wide change effort, including the philosophy and strategies that developed this successful statewide effort, followed by a discussion of PATHS organizational and implementation structure. Evaluation results were presented in order to provide participants with an initial evaluation of the impact of PATHS on candidates, individuals with disabilities and the participating organizations. Direct Support Professionals Association of Tennessee (D-SPAT) is a statewide membership association of direct support professionals who work as employees in the full array of supervised, semi-independent and supported residential living arrangements, day service and job training programs, and in-home support services that provide supports to persons with disabilities. In less than two years, D-SPAT has achieved a total membership of 100+, successfully awarded three grants totaling nearly $10,000, designed and implemented four regional training sessions on "Improving Communications in the Workplace," and provided input into the Direct Support Professional Survey developed by the state.
Moderator:
Amy Hewitt; RTC/ICI, UMN
Presenters:
JoAnn Degaglia; Hudson Valley DDSO
JoAnn Civale; Hudson Valley DDSO
Marjorie Robinson; Metro NY DDSO; Bronx Office
Jewel Sancho; Metro NY DDSO; Bronx Office
Sondra Gouldin; Broome DDSO
Florence Williams-Beach; Broome DDSO
Beth Mount; Everyday Heroes Leadership Initiative, OMRDD, New York
Denise Pensky; Everyday Heroes Leadership Initiative, OMRDD, New York
Shelly Okure; Everyday Heroes Leadership Initiative, OMRDD, New York
Don Haughton; D-SPAT, Tennessee
Earl Foxx; D-SPAT, Tennessee
Peggy Cooper; D-SPAT, Tennessee
Amy Gerowitz; PATHS (Outlooks, Ohio)
Marianne Taylor; PATHS (HSRI, Massachusetts)
   
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Quality and Self-Determination- Conroy (77 KB)
Returning to the basics of freedom has led to new insights in measuring quality, especially in light of the self-determination movement. Michigan's DD Council funded the Center for Self-Determination to produce a new instrument to track qualities of life, and the instrument is now ready for testing.
Moderator:
Charlie Lakin; RTC/ICI, UMN
Presenters:
Liz Obermayer; The Council on Quality and Leadership, Maryland
James Conroy; Center for Outcome Analysis, Pennsylvania
   
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Inclusive Communities- Fox (382 KB)
This session discussed the asset-based approach to building an inclusive and accessible community for all residents in Littleton, NH. The overview included the legislative context that gave rise to the Model Community Project concept and the development of a community advisory council governance structure. Presenters included the Model Community Director and a council member who shared their experiences, successes, and future plans.
Moderator:
Chas Moseley; NASDDDS
Presenters:
Sue Fox; Institute on Disabilities, University of New Hampshire
Nicole LaPointe; Institute on Disabilities, University of New Hampshire
Ralph Porfido; Institute on Disabilities, University of New Hampshire