-ISP QA REVIEWQUALITY FRAMEWORK for CONTINUOUS QUALITY IMPROVEMENT

The Focus of the ISP QA Checklist is to look at how the team created the ISP. By including all participants in the evaluation, the evaluator does not need to determine who was responsible for what. Since State, Federal, & Accreditation Audits do not separate out if only one party completed their portion of the team responsibility, it is believed that evaluating the ISP from this same perspective will only strengthen the final result for all involved. Focus: Support Coordination / Regional PLA Providers I&E Families Quality Management Functions: Design Discovery Remediation Improvement CONTINUOUS QUALITY IMPROVEMENT PROCESS: QAing the ISP using the ISP QA Checklist is the DISCOVERY phase of the Quality Management Function. It uncovers whats working and whats not working. It in turn permits the evaluator to objectively examine the current system process (aka- the current system DESIGN). This discovery of whats working and whats not working leads to REMEDIATION. Recommendations, plans of correction, and tracking follow-ups are completed during this function. IMPROVEMENT is made via implementing the recommendations, plans of correction, and ensuring that any follow-up has occurred on any issue that needs immediate resolution. Through the improvement process, new in-house DESIGN strategies are hypothesized for team members. These new Design Strategies are implemented into the system, creating an overall improved system design, thus permitting better quality ISPs to be created. 8/5/2011 1

THE RESULTS FOR EACH FOCUS GROUP: Support Coordination / Regional PLA: Completes their own 5% Audit and Regional Office HQMs complete a regional 5% Audit. Using a combination of these results, this group uses results to improve training and understanding of their employees. This helps to bring a stronger team player to the table to affect the overall quality of the ISP. Providers: Providers have access to the ISP Checklists in CIS to receive feedback. For any issues in ISPs that need to be resolved immediately, providers are contacted by I&E and/or SC Agency. Providers use the ISP Checklists, outside audits, and training to become stronger team players, which affects the overall quality of the ISP. I&E: Intake & Evaluation Managers receive a copy of the HQM results and use results to improve I & E timeliness and quality measures. As well Regions directly oversee support coordination services within their regions. Families: While families do not receive formal feedback from the QA Checklist, they are directly influenced by all those other team members who are working hard to ensure the health & safety and person-centeredness of services. As the team becomes a strong cohesive unit, families become more engaged in the overall quality of the ISP.

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HOW TO SCORE THE QA CHECKLIST -SCORING CRITERIAIndividuals Name: The individuals name. DOB: Individuals date of birth. Waiver: NOW/COMP/GIA Services Received: The current services being received by the individual. You will need to look at the POC/PA to verify that these services are correct. Date of ISP: The ISP Meeting Date. ISP Start Date: The ISP Start Date. Number of Days Meeting was held before Start Date: Calculate the number of days the meeting was held before the start date. Date ISP Approved: The date the ISP is signed by the Regional Office. ISP Writer: Select the SC/SSC/PLA that completed the ISP. Region: What is the Region where the person is served? Things to think about from the above & make any necessary notes about: - Is the ISP lined up to the birthday? If not, how can it be resolved? - Is the ISP good for 365 days or less? - Was the meeting held 40-50 days before the start date? If not, why? - Was the ISP submitted to RO within 14 days of meeting? If not, why? - Was the ISP approved on time? If not, where was the ISP hung up and why? - If person is new to services, does start date reflect this? DMA-6 Authorization period: Enter the start and end date that the DMA-6 Covers. (These will be the dates written above Box 37 on the DMA-6.) DMA-6 signed by LOC: Enter the date signed by the RO RN. (This will be the date to the right of Box 37 on the DMA-6.) Things to think about & keep in mind from the above: Was the DMA-6 signed by a community/regional physician, Nurse Practitioner, or Physician Assistant? - Was (Were) the medication(s) listed by the community physician, SC/SSC, or regional RN/physician? - If there is a Received Date from the regional office on the DMA-6, was it received by the birthday? - Is the doctors signature within 30 days of start date? - Is the DMA-6 lined up to the birthday? If not, why? - DMA-6s cannot be good for more than a calendar year. Check to ensure that this is the case.

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Does the provider information on the demographic page of the web-based system match the provider information on the POC? Check Individual Information page in CIS against POC/PA. Indicate Yes or No to indicate if the information about the provider(s) on the Individual Information page is accurate. Is the budget present? Check to ensure there is a current budget for the current ISP year. Does the PA match the service(s) and unit rates on the budget? Things to think about & keep in mind from the above: - Is the Personalized Budget Accurate? Does it match the PA? Does it match the ISP? ISP contains a minimum of 3 goals. Review goal section to determine if there are a minimum of 3 goals. ISP contains at least one goal/objective per DD provided service. Review goal section to determine if there is at least one goal/objective per service being received by the person. Are all goals person centered Review goal section to determine if all goals are person centered. At least one goal reflects the persons hopes and dreams? Review goal section to determine if there is at least one goal that reflects the persons hopes and dreams identified in that section. Signature page is complete and signed by participants? Review the signature page of the ISP and ensure the person has signed and if necessary their legal guardian. Review for any other participants signatures. Annual informed consent for psychotropic medications is present. Review if the person is on any psychotropic medications and if so, review the CIS DOC section for this signed annual consent form. Signed Behavior Support Plan/Crisis Plan and/Safety Plan. Review if the person has a behavior support plan/crisis plan and/or safety plan and if so, review the CIS DOC section for this signed annual consent form. The signature page of the ISP identifying that rights have been reviewed with the person is in place. Review the check off list showing whether rights have been reviewed with the person on the signature page of the ISP. All required assessments are completed according to the following guidelines: Nursing assessment completed if the HRST is scored 3 or above and/or if SIS section 3A is scored greater than 5 or there are any ratings of 2 Psychological review completed if the score is a 1 or 2 plus a total of 5 on section B of SIS Physician summary is completed If any of the criteria are met above review the assessment section to determine if they were completed. HRST is completed or updated at least 90-120 days prior to the ISP expiration date. Review the latest HRST to determine if it was completed at least 90 -120 days prior to the ISP expiration date. The Health and Safety section includes a discussion of the HRST training considerations that the team discussed and includes the training staff will receive in the 30 days following the ISP. Review to ensure this information is included in the health and safety section of the ISP. Authorized medical support section is fully completed, including what the team will do to support the person if there is no family or support network authorized to make medical decisions in an emergency. Review this section of the ISP to ensure this information is included.

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As the ISP is written the persons life is reflective of a service life, a good but paid life, or a community life? Service Life A Good but Paid Life Community Life

The scoring for the each of the ISP sections below are scored based upon the number of bulleted areas present in each section. The scoring ranges from zero (0) meaning the section does not include any of the bulleted areas to four (4) where all of the bulleted areas are present. For example, if there are only two bulleted areas present, the score would be a two (2). Relationship Map & discussion on ways to develop relationships Score 0-4 Relationship map contains the name of person along with the relationship. (Ex: cousin, Pam, pastor, Bob, job coach, Anne, etc.) Relationship map includes paid supports. Relationship map includes unpaid supports. If the person does not desire unpaid supports, ensure the area below on building non-paid supports reflects such. Relationship map documentation gives specific details regarding how the person will be supported to build non-paid supports in How will I be supported to develop relationships or identifies if a person does not wish to receive supports in this area. Communication Chart (this includes traditional and non-traditional forms of Score communication) 0-4 Communication chart reflects what is happening in the environment (only). Communication chart incorporates what the person does, refers to behavior (both positive and negative), what others notice, what can be seen and heard by others. Communication chart includes what we think it means, in terms of feelings and emotions of person, what is going on, both positive and negative interactions, verbal and nonverbal. Communication chart includes informative details on what others should or should not do in response to words/action. Person-centered Important To/For Score 0-4 Important to reflects the persons specific interests, and identifies in detail what he/she says is important to have a well lived life. (Persons preferences, likes, dislikes and/or community connections) Important for includes specific supports necessary to address any identified health and safety risks and what others see as important supports and/or needs for the person to be a valued member of their community. What others need to know or do to support the person is present. What new things we have learned about the person is present. (Identify not present if there is nothing identified.)

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Hopes and Dreams: If you could be, do or include anything in your life what would it be? Score (Be specific) 0-4 Hopes and dreams identify in detail opportunities the person wants to develop within his/her home life from the persons perspective. Hopes and dreams identify in detail opportunities the person wants to develop regarding his/her activities during the day from the persons perspective. Hopes and dreams identify in detail opportunities the person wants to develop, regarding friendships and relationships from the persons perspective. Hopes and dreams identify in detail opportunities the person wants to develop regarding his/her community involvement from the persons perspective. Service Summary Score 0-4 Service summary provides a brief overview of the persons living situation, an overview of all services received over the past year. Service summary provides overview on changes in needs/ health and or services this year, what has worked and not worked and continued concerns identified by the individual and team members. Service summary provides a review of what the persons progress or lack of progress for Action Plans delivered in the previous year and identifies supports that worked if applicable. Service summary describes barriers and opportunities to achieving hopes and dreams as described in the current ISP about to end. Rights, Psychotropic Medications, Behavior Supports Section Score 0-4

Rights restrictions are identified by the team in the ISP section titled team concern regarding rights restrictions or suspensions during the year. If rights restrictions are identified in other areas of the ISP or in a Positive Behavior Support Plan (PBSP), it should also be included in this section of the ISP. If a PBSP exists, the ISP includes a description of any concerns around implementation effectiveness and staff training of the positive behavior support plan. If a PBSP does not exist and challenging behaviors exists a discussion related to supports needed is included. If a person is taking an anti-psychotic without a mental health diagnosis or a psychotropic medication for an identified challenging behavior, describe the team discussion around getting a mental health diagnosis, medication reduction plan, positive behavior support plan or effectiveness of these medications and how the provider is documenting this. Score 0-4 Meeting minutes section describes how the person participated in the meeting and their choices of supports and services. Minutes describe the teams discussion regarding increasing and developing opportunities

Meeting Minutes

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for community participation. Minutes describe the teams discussion regarding health and safety recommendations from the HRST, I&E assessments and/or community physician recommendations. Minutes describe the teams discussion of the development of goals and outcomes. If the goal is the same from last year, the reason why should be identified.

SIS completed and support needs are addressed in the ISP. (SIS Information should be Score noted throughout the entire ISP.) 0-4 It is noted in the ISP that the team reviewed the SIS. (Located in the meeting minutes and/or discussion and rational section on Action Plan.) Includes at a minimum one sentence for each domain. (Located in the SIS discussion portion of the service summary.) The Exceptional Medical and Behavioral domains summarize the specific needs and if necessary, identifies if further assessments are warranted. SIS supports section identifies which support needs are going to be developed into Action Plans. Health and Safety Review Section completed accurately and thoroughly. (HRST Score 0-4 information should be noted throughout ISP.) The medication sections of health and safety section of ISP is complete and includes the medication/s name(s), side effects, required follow-up and tracking. If applicable, the Behaviors section identifies whether a PBSP is in place or if needed and describes risks and supports needed that are associated with identified challenging behaviors (such as, such as food seeking, PICA, elopement, unsafe sexual behavior, suicidal ideation, etc.) and any other requirements. If applicable, under the Support section, it includes the identified support needs, protocols and tracking required and description of instructions, plan and/or protocols and where they can be located. The Help section identifies if the person has any specialized personal items, and if necessary, includes whether it is in place, a description, who is responsible for the need and when it will be purchased. Goals are Person Centered. (Include the discussion/rational, desired outcome and goal Score to make this determination.) 0-4 Goals address and build on what is important to and for the person. Goals address persons home life and/or daily contributions. Goals address persons friendships and/or community life. Goals address the changes the person wants to make in his/her life over the next year. Training Goal Action Plan Score 0-4 Desired Outcome that addresses what is important to and for as supported by Personal Profile. Discussion/Rationale: Based on assessment information from SIS, HRST or from the desires 7

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of or what is Important to and for the person (for minors based on needs identified by the team.) Goal is measurable (the person has defined how he/she will know the goal is met.) Goal is directly connected to the desired outcome. Score 0-4

Action Plans/Objectives

All objectives support the desired outcome identified in the Action Plan. All objectives define how the person will know the objective is met. (For example, an objective stating Ann will cook with verbal prompts is not measurable or acceptable. However, an objective stating Ann will bake a cake without any help and that meets her diabetic guidelines sets up a measureable, realistic objective the person has defined but remember that other additional qualifiers can be added based upon the persons preferences.) For each objective it identifies the service to support the objective, the ratio required and the specific supports/strategies provided to help the person meet the objective. For each objective it identifies the frequency of implementation, start date, end date and where the progress and/or lack of progress will be documented. (Each objective does not have to be for a whole year.)

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