Reinventing Quality 2021: Lessons Learned from 2020: Managing and Leveraging Disruptions. Baltimore, MD, August 8-10, 2021

2016 Reinventing Quality Conference
Conference Materials

View/Download the Conference Programpdf (20.9 MB)

Index of Available Presentations
(Addtional Presentations will be added as we receive them)



Opening Plenary Session

HCBS Regulations: Potential for Change
Alison Barkoff, Center for Public Representation; Dan Lusk, South Dakota Division of Developmental Disabilitiespdf; and Myrta Rosa, Community Access Unlimited

Breakout 1


Reinventing Our Services: Providers Responding to the HCBS Community Setting Rule
Susan Sorrentino, Family Residences and Essential Enterprises, Inc.pdf, Gail Brown, New England Village, Deanna Ferguson, Volunteers of America Southeast, Carla Stallworth, Volunteers of America Southeast

As CMS and states negotiate the details of state transition plans to comply with the requirements of the Home and Community Based Services Community Settings Rule, forward-looking providers are moving quickly to transition to person-centered, integrated services consistent with new rule. Participants in this session to learned how three agencies, Volunteers of America Southeast (AL), New England Village (MA), and Family Residences and Essential Enterprises, Inc (Long Island & NYC), are approaching the process, what they have accomplished, and how it’s working.

Managed Care

Managed Care and Stakeholder Partnerships
Barbara Brent, National Association of State Directors of Developmental Disabilities Services, Diane McComb, Delmarva Foundationpdf

States moving to managed long term services and supports (MLTSS) for people with disabilities are pioneering a funding vehicle no one has built or driven before. While states, CMS, and managed care entities know something about managed care for medical services, seniors and behavioral health, few know how to create and implement community based, long term services and supports for people with disabilities under a managed care rubric. State IDD Directors, Providers of LTSS, people with disabilities and families hold the key to creating successful, accountable, and visionary efforts in states implementing managed care. States are compelled to re-design the way they support Medicaid beneficiaries to provide the right, person centered services, while also providing service in the amount and duration needed, for the lowest cost. IDD stakeholders understand person centeredness, self-direction, support coordination and meaningful outcomes in ways others don’t. Participants in this session joined the dialogue to increase collaboration potential in their states and improve the likelihood of fewer bumps along the way.

Behavioral Supports

Building Capacity to Implement Positive Behavior Support with Long-Term Sustainability
Donald Jackson, University of Nevada-Renopdf, Elaine Brown, Nevada Aging and Disability Services Division/Developmental Servicespdf

Mr. Jackon’s presentation (a) reviewed the status of the research knowledge on building and sustaining capacity in prevention-based behavioral health supports, and (b) described the prolonged implementation process undertaken in one state to build capacity at the local and state level. This 20-year perspective is examined to highlight areas in which the State’s original long-term vision was achieved, and to look at some of the gaps in research and applied strategies necessary for successful maintenance of a multi-tiered behavior support framework across multiple locales and service delivery systems.

Ms. Brown’s presentation provided an overview of the progress and challenges associated with the implementation of positive behavior support within the State’s community-based service delivery system. Drawing upon the State’s 20-year history of addressing the need for positive behavioral health supports, this presentation highlighted considerations for the ongoing need for advocacy, research and policy to build long-term services and supports consistent with maintaining rights and promoting enhanced quality of life.


LifeCourse in Action: Providing Person Centered Supports within the Context of Family
Lynn Smith, Progressive Community Services, Jamie Stoner, The Arc of North Chesapeake- Marylandpdf, Sharon Spurlock, The Arc of St. Louis-Missouri

The LifeCourse framework and tools provide a structure for supporting individuals with disabilities and their families to envision what it looks like to have a “good life” and how to look at “today’s” issues and supports in the context of planning for a future. The tools are also used for organizational and systematic change. This session provided concrete examples of how this national framework and tools are being used by three different support provider organizations to guide and practice policy change.

Breakout 2

Person-Centered Practice

Bringing Person-Centered Practice to Scale Statewide: Two Different Approaches
Moderator: Angela Amado, University of Minnesota
Alex Bartolic, Minnesota Department of Human Services, Carol Anthony, Minnesota Department of Human Services, Patt Killingsworth, Bureau of TennCare, Wanda Willis, State of Tennesseepdf

Minnesota has a county based system. Tennessee is in process of developing a new integrated managed long term services and supports system for people with intellectual and developmental disabilities, while also bringing existing HCBS waivers into compliance with new federal requirements. Both are seeking to move to a more person centered system and have taken approaches that reflect their differences. Minnesota has a long history of successful small person-centered projects, but is now engaged in systematic efforts to bring these principles “to scale.” They are implementing training in person-centered thinking and organizational change across state-operated systems, private providers, and within state government, across all disability and aging groups. They are addressing what it takes for services to all groups to be person-centered. Efforts to develop a person centered system have been underway in Tennessee for nearly a decade. Initially done in partnership between the Tennessee Developmental Disabilities Council and the state Department of Intellectual and Developmental Disabilities, a statewide effort developed local capacity and changed state policy based on local learning. The state Medicaid agency, TennCare, is now requiring (and supporting) plans and services that reflect the letter and spirit of the “new” HCBS rule, partnering with both groups and with contracted managed care organizations to build capacity that will transform Tennessee’s service delivery system into one that is a person-centered and that prioritizes integrated employment and community living in a manner consistent with the interests, goals, and preferences of each person supported. Wanda Willis, the Executive Director of the Tennessee Developmental Disabilities Council described the past efforts while Patti Killingsworth, Assistant Commissioner of TennCare, described the efforts that are currently underway.


Quality Employment Services for Individuals with Complex Challenges
Susan Schonfeld, Community Integrated Services, Jeannine Pavlak, New England Business Associatespdf

This session will brought critical information about strategies to support people with significant barriers to employment requiring support. Different perspectives were presented to allow attendees to hear about a wide range of professional and organizational best practices used to facilitate the high quality outcomes. Barriers to implementation and ongoing delivery were also discussed. Time was also be dedicated to allow for attendees to ask specific questions related to the topic.

Housing and Overall Support Strategies

First Step to a Good Life: A Decent, Safe, Affordable, Accessible Place to Live
Bob Laux, Wild River Consulting Group, Derrick Dufresne, Community Resource Alliancepdf

Derrick Dufresne and Bob Laux discussed what they’ve learned about supporting people to live where and with whom they wish and the importance of separating housing from supports. Specific topics included the need for affordable housing, subsidies, the effective use/direction of financial capital resources to create inclusive housing options, ownership options for long term economic stability and community value and the direction of federal housing policy.

Expanding Self-Direction Opportunities

Self-Direction Evolves: Moving from a Special Project to Common Practice
Tyler Oswalt, Business Owner, Bev Oswalt, Parent/Advocate, Lorrie Hetagar, Home Nursing Agency, Jamie Henrypdf, Southern Allegheny Service Management Group, Kristin Ahrens, Temple University, Marian Frattarola-Saulino, Values Into Action

Two stories describe how people can make self-direction real in spite of obstacles. One man, with support from his family, started with a clear and simple person centered plan prior to high school graduation, then worked closely with representatives from a traditional service provider which had developed an agency-with-choice model, to tailor a self-direction option. From interviews, selection of staff, training, supervising and scheduling staff, the family directs the process, while the agency acts as the formal employer. The second man and his family utilize a Support Broker to help them find their way through the maze of rules and requirements, to put together a fabric of support that fits his lifestyle. A UCEDD leads a statewide cross-disability person driven services project aimed at improving state policies and building capacity for Supports Brokering services. Find out how to make it happen in your world.

Behavioral Supports

Positive Behavior Support, Mental Wellness, and Trauma Informed Care: A Unified Framework
Dan Baker, Minnesota Department of Human Services, Karyn Harvey, The Arc Baltimorepdf

Many different interventions methodologies are used in supporting persons with IDD who have problem behaviors. The risk inherent in this is that interventions are managed separately, and may often be working at cross purposes, particularly with psychological and behavioral interventions. A strength of Positive Behavior Support is the ability to offer a means for bringing together different types of support. In these presentations, Drs. Baker and Harvey offered a unified means for bringing together behavior support, mental wellness support, and trauma informed care. The presenters used illustrative case studies to supplement the content.

Breakout 3

Person-Centered Practice

Conflict of Interest and Case Management: State Experiences in System Redesign
Moderator: Robin Cooper, National Association of State Directors of Developmental Disabilities Services
Barbara Ramsey, Colorado Department of Health Care Policy and Financing, Brittani Trujillo, Colorado Department of Health Care Policy and Financingpdf, Valerie Huhn, Missouri Department of Mental Healthpdf, Jeff Richards, Washington County Board for the Handicapped, Dan Lusk, South Dakota Department of Human Servicespdf

The January 2014 Home and Community-based Services rules lay out CMS expectations about conflict of interest (COI) and the provision of case management services under the 1915(c) HCBCS waiver, 1915(i) State plan HCBS and the 1915(k) Community First Choice authorities. The new rules require that states assure the provision of case management services, including eligibility determination, assessment and service planning, be free from COI. The regulations require that states separate case management functions from the provision of direct services. Presenters from Colorado, Missouri, and South Dakota discussed their experiences in redesigning their systems to meet these new requirements.


How States Have Altered Their QA Systems to Embed the Principles in the New Settings Rule
Val Bradley, Human Services Research Institute; Alex Bartolic, Minnesota Department of Human Services; Cathy Robinson, Indiana Bureau of Developmental Disability Services; Patti Killingsworth, TennCare; Wanda Willis, Tennessee Council on Developmental Disabilitiespdf

The recent CMS HCBS settings rule released in early 2014 has necessitated changes at the state level in the way in which developmental disabilities agencies monitor services and supports to people with intellectual and developmental disabilities. State ID/DD agencies had to find ways to assess the extent to which current providers conformed to the requirements, review regulations to ensure that the new expectations were included, and create monitoring techniques that would review compliance over time. This presentation will include information from 3 states, Indiana, Minnesota and Tennessee regarding the steps that have been taken to harmonize state practices with the rule.


Transition and Beyond: Technology For Life
Pat Satterfield, The Center for AT Excellencepdf

As the proud parent of a young adult with Down Syndrome and an Assistive Technology Consultant at a day program for adults with developmental disabilities, Pat has learned firsthand the challenges of creating an excellent quality of life for these individuals after they complete their school years. Technology tools can help individuals with developmental disabilities achieve greater self-determination and independence. Communication and literacy are interconnected and can help them have meaningful interactions in their community. Technology can help individuals with developmental disabilities take in information and understand their world, motivate them by giving greater access to their interests, provide prompting for moving around their world independently, support memory for taking medication or completing tasks. Low tech, light tech and high tech solutions will be discussed as well as ideas for funding. Free and low cost ideas were discussed as applicable.


Conversion Strategies: Changing Business Models, Practices, and Building System Capacity
Rebecca Salon, LEAD Center, Tony Antosh, Rhode Island College, Domenico Cavaiuolo, East Stroudsburg University, Mark Hassemer, Alternative Community Trainingpdf

To scale-up effective employment supports it is critical to build capacity across the system. This session brought different system actors together to discuss effective and emerging strategies for shifting provider practices, shifting provider business/support models, and building wider state capacities. Time was provided for audience engagement and questions.

Housing and Overall Support Strategies

Creative Approaches to Affordable Housing and the Role of CMS in Assuring More Housing Options
Diane Dressler, Community Life Resourcespdf, Martha Egan, Centers for Medicare and Medicaid Services, Deborah Fisher, Jewish Foundation for Group Homes, Tim Wiens, Jubilee Association of Maryland

Debby Fisher, Diane Dressler, Tim Wiens, and Marth Egan discussed ways to develop a pool of affordable housing options that leverage local, state, federal and private (both commercial and philanthropic) funding sources. They discussed the challenges they have encountered, ranging from advocacy and education with affordable housing agencies and local commissions, to state participation, to raising awareness within provider agencies of the opportunities and challenges of separating housing from services and the challenges associated with multiple providers supporting people who choose to live together. They also discussed the impact of the CMS June 2015 Informational Bulletin on using Medicaid funding for housing supports.


Scaling up Progressive Practices: What does NCI tell us about System Readiness, Challenges, and Opportunities?
Valerie Bradley, Human Services Research Institute, Alixe Bonardi, Human Services Research Institute, Dorothy Hiersteiner, Human Services Research Institutepdf

This panel included NCI data on areas of the intellectual and developmental disability (ID/DD) system including self-direction, employment, exercise of choice, and friendships. These areas should form targets for efforts to “scale” up progressive practices. The presentation also included NCI data on DSP turnover rates and alignment with the HCBS settings rule. These data can point to the readiness of the service system to enhance and expand person-centered practices.

Plenary Session

Breakout 4

Managed Care

Federal Perspectives on Managed Long Term Services and Supports
Diane Kayala, Centers for Medicare & Medicaid Services, Aaron Bishop, Administration for Community Living, Sharon Lewis, Health Management Associatespdf

Multiple states are now incorporating individuals with intellectual and developmental disabilities into managed long term services and supports in addition to acute and primary care. This highly knowledgeable panel discussed the latest federal rules, state initiatives, and ways to prepare to the possibility of managed care coming to your state.

Breakout 5

Managed Care

Federal Direction on Housing, Homelessness, and Managed Care
Nancy Mercer, Corporation for Supportive Housingpdf, (Mercer - Handoutpdf), Catherine Anderson, United Health Carepdf

The publicly funded IDD system is among those entities providing residential supports to over 600,000 individuals with IDD across the country, yet thousands are waiting, often due to the lack of affordable housing. We are part of a larger supportive housing universe, yet few of us are aware of the work to end homelessness and lower health care costs through the provision of housing. This dynamic panel of experts from HUD, CSH, and United HealthCare discussed how to learn how the work in the IDD system can interface and benefit by interfacing with these parallel efforts. Housing First initiatives and other supportive housing approaches were shared along with United HealthCare’s creative pilot to lower health care costs through the provision of housing in a community in Texas.

Federal and State Initiatives

State Experiences with HCBS Regulation Implementation: Opportunities and Challenges
Alex Bartolic, Minnesota Department of Human Servicespdf, Nancy Thaler, Pennsylvania Department of Human Services, JoAnn Lamphere, New York State Office for People With Developmental Disabilities

Participants heard from three state officials on their efforts related to compliance with the HCBS regulation. This session highlighted the different strategies in use across the three states, specific considerations and challenges facing the states, and how the state is utilizing the HCBS rule to further community opportunities for individuals with I/DD.

Direct Support Workforce

Families Perspective on Working with DSP’s in the Home– What’s Working and What Needs to Stay the Same
Barbara Kleist, University of Minnesota; Cheryl Dougan, Parentpdf; Cathy Ficker Terrill, Parent & Consultant; Beth Terrill, Self-Advocate

The landscape for where DSPs provide services and supports continues to evolve with more people receiving direct support services in their family’s home or their own home. The focus of this session was hear from families and people who live in their own home about their experiences working with DSPs in their family member’s home. The target audience for this session was family members, caregivers, and anyone who has an interest in learning what is working for families and DSPs and where changes are needed.


Spirituality and Quality of Life: Making the Connections Explicit
Bill Gaventa, Summer Institute on Theology and Disability and Collaborative on Faith and Disabilitypdf, Wendy Quarles, Heritage Christian Services, Tim Wiens, Jubilee Association of Maryland, Deborah Fisher, Consultantpdf

Both research and practice are illustrating the contribution of spiritual supports to quality of life for individuals with intellectual and developmental disabilities and their families. A number of studies in recent years indicate the importance of spirituality and spiritual supports to both individuals and families. Service providers who seek to recognize and honor the preferences of the people they support related to spiritual interests are also noting the ways that spiritual supports contribute to several domains in quality of life measurements. However, most American models for quality of life do not explicitly include spiritual supports. The growing number of initiatives by providers and faith communities alike beg for more research into effective ways of addressing spirituality and accessing the impact of spiritual supports on overall quality of life.

In this session:

  • Bill Gaventa discussed some of the theory, rationale, and strategies for addressing spirituality in quality of life frameworks coming from both research and practice.
  • Staff from Heritage Christian Services in Rochester, New York, who work very intentionally with the people they support and their direct support staff in this area, addressed lessons learned and the ways they have trained and supported their direct support staff.
  • A model agency/congregation partnership: Tim Wiens, Executive Director of the Jubilee Association of Maryland, presented with a self-advocate and family member about a partnership with a Catholic agency, Rosaria Communities, and a Catholic parish.
  • Debby Fisher addressed the need to create opportunities for participation and meaningful inclusion of individuals with disabilities in the spiritual and faith communities of their choice. As both a community services provider and lay leader of her synagogue, Debby will provide strategies for ensuring person-centered, individualized faith-based and spiritual preferences are integrated into individuals’ support plans and life choices.