[PPT] - Strengthening Community Living disABILITY Services Designing PowerPoint Presentation

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Strengthening Community Living disABILITY Services

Designing Supports Budgets Based

n Assessed Supports Needs

December 2015

John Agosta Jagosta@hsri.org Megan Villwock Mvillwock@hsri.org

Human Services Research Institute 7690 SW Mohawk Street Tualatin, OR 97062 +1 503-924-3783 www.hsri.org

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Note to Reader

The following presentation represents some analysis of the data provided to HSRI as part of their work with CLDS at the Province of Manitoba. This presentation was created to inform the agency, participant and department community of the trends witnessed with how the current system operates. The data illustrated is based on a random selection of participant data in all settings from across Manitoba. Additional data is being collected and added to the overall data set over a period of time lasting to at least 2018. Data is included in this presentation is not meant for distribution outside of the audience it is provided to. Further information can be obtained from CLDS.

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Today’s Agenda

Introductions

Vulnerable Persons Act & driving principles
Project intentions

Data presentation and analysis

General approach
Supports needs assessment
Level assignment
Support needs by level by residence and spending
Focus on people living home with family

Next steps Questions and discussion

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Manitoba Family Services Departmental Vision

Manitobans with developmental disabilities are supported to achieve their fullest potential through inclusion in society, in economy, and in the labor market.

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VPA Philosophical Framework

Individuals with Disabilities should have the opportunity to:
Lead satisfying, productive lives in their communities.
Make their own decisions & direct their own lives, with support if necessary.
Take risks that they & their support network deem appropriate.
Use services that are available to all members of society with adaptation & support

where possible.

maintain family bonds & develop relationships that are a natural part of life.
Supportive & protective services for individuals with disabilities should be individualized,

community based & non-segregated.

When individuals are vulnerable & at risk of suffering harm to themselves or others, their

rights & freedoms must be respected & the least restrictive form of support used.

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Servi Services & & sup uppor

rts th

that peop people le wi with intell llectual l and and de develo lopmental l di disabil ilit itie ies pr prefer

A person- centered & sustainable system

Equitable & personalized funding within limited resources

Ble Blendin ing Together Prin rincip iple les Rela lated to Se Servi vice Deliv livery ry & System Man anagement

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Project Tasks

Phase 1 we’ll take a look at the current services for people with intellectual & other developmental disabilities and decide how they might be changed to make sure everybody’s needs are met.

Phase 1 Phase 2

Phase 2 we’ll build a supports budget system with help from the Supports Intensity Scale (SIS) & a matching provider rate schedule. We’ll focus on those living at home with families first.

15 Tasks Total 8 Tasks 7 Tasks

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Data Presentation

Data presentation and analysis

General approach
Supports needs assessment
Level assignment
Support needs by level by residence and spending
Focus on people living home with family

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General Approach

An assessment assists with establishing supports budgets. The supports budget framework provides policy makers with information necessary to make fiscal choices that are fair & predictable, make the best use of available money, and are consistent with driving system principles. Allocating resources to people based on their assessed level of need means that each person receives what they need, no more no less. The supports budget framework established a best fit solution for most but takes care to accommodate individuals with extraordinary needs.

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Looking Things Over

Assess Needs Level Assignment Supports Budget Person Centered Planning Service Delivery Understanding the Process SIS Interview Sharing Results SIS Results Verification Results (SQs) Level Assigned Assessed need Residence Policy Intentions Supports Budget Control Choice about Services Base & Add-

n Services

Policies TBD

Supporting Policies, Rules & Regulations, and Communication

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Personal Supports Budgets

SIS Assessment Supplemental Questions Verification Level Assignment Personal Supports Budget

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Assess Needs: Supports Intensity Scale

Administration: Interview the person and others who know the

person. Requires solid interviewing skills

Measures general support needs of an individual producing a number of scores Includes basic support need areas like:

A. Home Living Activities,
B. Community Living Activities,
C. Lifelong Learning Activities
D. Employment Activities
E. Health and Safety Activities
F. Social Activities

SIS ABE – refers to the sum of the scores for these 3 areas that have been found useful in helping resource allocation Identifies Medical and Behavior problems which are also significant cost predictors

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Supplemental Questions and Verification

During the SIS assessment, additional questions, called Supplemental Questions, are asked. These pertain to medical and behavioral support needs. Particular responses may indicate that further review of support needs is warranted. If so, additional questions are asked regarding:

Severe medical risk;
Severe community safety risk for people with a related legal conviction;
Severe community safety risk for people with no related legal conviction;
Severe risk of harm to self.

Answers to these questions may trigger a review of individual records review called verification. Verification is a process where CLdS staff review individual records to get a better idea of the individual’s particular needs.

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SIS Assessment Status (11/18/15)

Living Setting Population Percent of Population Total SIS Assessments % Complete Agency Care 1,453 25% 633 44% Foster Home 826 14% 305 37% Independent 1,042 18% 311 30% Family 2,080 36% 421 20% Other 407 7% 110 27% Total 5,808 100% 1,780 31%

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SIS Assessment by Region (11/18/15)

Region Target Number Total Assessments* % Complete Central 255 255 100% Eastman 170 149 88% Interlake 173 171 99% Northern 66 60 91% Parkland 73 73 100% Westman 268 268 100% Winnipeg 1038 804 78% Total 2,043 1,780 87%

* An additional 158 SIS assessments have been completed, but were excluded from further analysis because the individuals did not have full-year financial data

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Number of People by Supports Need Score (low to high)

(11/18/15) The scale shown is the sum of 3 SIS sub-scales regarding Home Living (A), Community Living (B) and Health & Safety (E). The combined scale (Sum A-B-E) can range from 8- 52, low to high.

Findings

People: 1,780 Mean: 24.73 Median: 25 Range: 8 - 48

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Number of Individuals Supports Need Index Sum of Part A, B, and E Medical Need Score Behavioral Need Score SIS Norm 1,306 100.00 30.00 3.23 4.99 Manitoba

1,780 93.17 24.73 1.33 3.20

Alberta 5,061 91.77 24.81 1.86 3.73 Tennessee * 5,765 102.67 30.36 1.45 2.87 Virginia ** 1,275 102.82 30.16 1.96 2.64 Oregon * 5,119 106.33 31.62 1.99 5.06 New Mexico * 3,218 106.31 31.75 3.13 4.82 Utah 4,114 102.15 30.09 2.22 4.09 Rhode Island 3,007 101.75 29.72 2.02 4.19 Kentucky * 3,476 99.76 28.93 1.92 4.28 Georgia 10,574 99.40 28.62 1.39 2.69 Maine * 2,324 98.71 28.35 2.04 4.64 Louisiana * 4,091 98.23 29.95 3.33 3.10 Colorado 6,849 97.49 27.91 2.99 5.55

Comparison of Results in Manitoba with Other Jurisdictions

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* States with partial population for HCBS population **Weighted for entire HCBS population.

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Level Assignment: Seven Levels

Levels must account for a range of support needs, but also categorical needs. Policy makers may adjust the services array, with different expectations about service use.

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Seven Support Level Descriptions 1

Adults in this level have low support need, including some to no support need for medical and behavioral challenges. They can manage many aspects of their lives independently or with little assistance.

2

Individuals in this level need more support than those in Level 1, but their support needs are minimal to modest in a number of life areas. Adults in this level have moderate support needs and little to no support need for medical and behavioral challenges.

3

Adults in this level have low to moderate support needs as in Levels 1 and 2. They also have an increased, though not extraordinary, support need due to behavioral challenges.

4

Adults in this level have moderate to high support needs. They need help with life activities

n a daily basis. They may have behavioral support needs, but these needs are not

extraordinary.

5

Adults in this level have high to maximum support needs. They need help with life activities typically requiring hands on support and/or oversight throughout the day. They may have behavioral support needs, but these needs are not extraordinary.

6

Adults in this level have extraordinary need for medical support Individuals in this level may have behavioral needs, but these needs are not extraordinary.

7

All adults in this level have extraordinary behavioral challenges, regardless of their support need to complete daily activities or for medical conditions. Adults in this level need greatly enhanced supports due to their behavioral challenges.

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Support Levels

Sum: Sections A, B, & E Section 3A Med Support Section 3B Behavior Support

1

Least Support Needs 0 to 22 0 to 6 0 to 6

2

Mild or Moderate Support Needs 23 or 30 0 to 6 0 to 6

3

Mild to Moderate Support Needs & Moderate Behavioral Challenges 0 to 30 0 to 6 7 to 10

4

Moderate Support Needs & Mild to Moderate Behavioral Challenges 31 to 36 0 to 6 0 to 10

5

High Support Needs & Mild to Above Average Behavioral Challenges 37 to 52 0 to 6 0 to 10

6

Extraordinary Medical Challenges Any 7 to 32

r Verified

Extraordinary medical risk

0 to 10

7

Extraordinary Behavioral Challenges Any Any 11 to 26

r Verified

Danger to others or Extreme self-injury risk

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1,780 People by Support Level & Living Option

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Level Distribution by Living Setting Living Setting Total SIS Interviews Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Overall 1,780 620 (35%) 457 (26%) 149 (8%) 235 (13%) 29 (2%) 115 (6%) 175 (10%) Agency Care 633 103 (15%) 168 (27%) 66 (10%) 137 (22%) 10 (2%) 55 (9%) 92 (15%) Foster Home 305 94 (31%) 94 (31%) 30 (10%) 37 (12%) 3 (1%) 15 (5%) 32 (10%) Independent 311 230 (74%) 43 (14%) 17 (5%) 7 (2%) 0 (0%) 5 (1%) 18 (6%) Family 421 161 (38%) 121 (29%) 24 (6%) 50 (12%) 16 (4%) 27 (6%) 22 (5%) Other/N.S. 110 39 (35%) 31 (28%) 12 (11%) 4 (4%) 0 (0%) 13 (12%) 11 (10%)

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Overall Agency Care N = 633 Foster Care N = 305 Independent Living N = 311 Parent/Extended Family N = 421

Level Distribution by Living Setting (n= 1,780)

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FY 2015 Spending by Sum A-B-E score (Support Needs Score)

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Explaining Boxplots

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Fiscal Year 2015 Expenditures 633 People in Agency Care by Level

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25th % Median 75th % Min Max Level 1 $54,049 $69,660 $82,655 $1,632 $286,335 Level 2 $62,638 $75,938 $95,923 $1,280 $222,716 Level 3 $70,576 $99,818 $148,130 $31,715 $420,058 Level 4 $64,242 $82,873 $109,659 $20,414 $204,845 Level 5 $63,460 $82,822 $114,610 $37,058 $141,251 Level 6 $79,774 $113,986 $133,940 $39,595 $195,158 Level 7 $79,012 $123,035 $194,984 $1,280 $319,506 Overall $63,349 $82,873 $121,746 $1,632 $420,058

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Fiscal Year 2015 Expenditures 305 People in Foster Care by Level

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25th % Median 75th % Min Max Level 1 $13,038 $28,375 $45,169 $7,118 $68,608 Level 2 $15,042 $23,953 $40,774 $4,539 $74,464 Level 3 $25,346 $36,807 $57,548 $14,299 $144,546 Level 4 $21,626 $28,916 $42,993 $2,278 $94,400 Level 5 $15,773 $82,822 $40,018 $3,650 $52,140 Level 6 $35,861 $40,097 $53,251 $23,229 $78,413 Level 7 $10,280 $55,845 $63,758 $10,280 $203,203 Overall $17,866 $30,229 $50,533 2,278 $203,203

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Fiscal Year 2015 Expenditures 311 People in Independent Living by Level

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25th % Median 75th % Min Max Level 1 $4,792 $8,730 $17,043 $1,336 $50,671 Level 2 $7,119 $11,013 $14,802 $3,456 $37,843 Level 3 $5,385 $25,739 $37,125 $1,884 $59,342 Level 4 $31,133 $38,998 $63,731 $8,824 $136,645 Level 5

Level 6

$9,349 $14,684 $20,379 $3,833 $25,894 Level 7 $8,980 $24,355 $33,225 $2,675 $70,679 Overall $5,225 $9,734 $19,968 $1,336 $136,645

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Focus on Individuals Living Home with Families

People adults living home with families have more complicated spending patterns.

They may access a variety of CLdS services, such as in-

home “enhanced support”, several forms of respite, day services, transportation, crisis support, specialized therapies, and other expenses.

Service use patterns (and so spending) vary by

individual.

Service use may not be consistent month to month,

and may involve several months in the year with no spending

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Fiscal Year 2015 Expenditures People Living with Families

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25th % Median 75th % Min Max Level 1 $3,414 $8,174 $17,549 $160 $53,521 Level 2 $7,151 $16,429 $36,321 $107 $48,838 Level 3 $7,081 $22,131 $36,401 $240 $65,025 Level 4 $11,098 $30,914 $66,078 $435 $66,078 Level 5 $17,448 $38,529 $49,352 $5,034 $68,505 Level 6 $19,532 $35,579 $50,879 $1,284 $103,671 Level 7 $12,653 $38,035 $57,550 $1,679 $102,297 Overall $6.719 $15,704 $32,005 $107 $103,671

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Illustration of the Number of People Living Home with Families Who Use Each Service (FY 2015)

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Illustration of the Number of People Living Home with Families Who Use Each Primary Service Type (FY 2015)

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Service Type Number Using Service Percent of 421 Using Service Total Cost Average Cost per Individual User Clinical services 27 5.7% $30,246 $1,120 Crisis services 3 0.70% $7,364 $2,455 Day services 308 73.2% $5,837,665 $18,953 Residential services 66 15.7% $713,498 $10,810 Respite 188 44.7% $1,014,348 $5,395 Transportation 181 43.0% $681,670 $3,766

Service Use and Costs of 421 Individuals Living at Home with Families by Primary Service Type (FY 2015)

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Service Use of Individuals Living at Home with Families (FY 2015)

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Service Use of Individuals Living at Home with Families by Primary Service Type (FY 2015) Residential Services (n = 66)

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25th % Median 75th % Min Max Level 1 $1,797 $7,626 $13,020 $84 $31,747 Level 2 $985 $2,857 $12,467 $248 $46,256 Level 3 $11,934 $11,987 $14,504 $329 $23,123 Level 4 $2,192 $3,700 $6,178 $1,408 $14,433 Level 5

$21,411
Level 6

$5.363 $10,785 $31,017 $294 $49,070 Level 7 $5,271 $12,829 $31,401 $1,346 $47,266 Overall $1,738 $6,890 $14,265 $84 $49,070

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Service Use of Individuals Living at Home with Families by Primary Service Type (FY 2015) Respite Services (n = 188)

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25th % Median 75th % Min Max Level 1 $839 $1,890 $4,097 $10 $12,548 Level 2 $1,590 $3,192 $5,106 $152 $19,353 Level 3 $1,554 $3,560 $4,563 $280 $20,574 Level 4 $1,593 $6,746 $9,171 $294 $20,860 Level 5 $5,016 $5,280 $14,987 $94 $16,513 Level 6 $1,675 $3,201 $6,949 $972 $26,310 Level 7 $2,944 $5,712 $13,770 $1,679 $43,803 Overall $1,568 $3,306 $6,823 $10 $43,808

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Day Service Use by Living Setting Living Setting Total SIS Interviews Any Day Services Regular Special Rate Other Overall 1,780 1,190 (66.9%) 1,134 (63.7%) 765 (67.5%) 71 (4.0%) Agency Care 633 468 (74.0%) 464 (73.3%) 329 (71.0%) 4 (<1%) Agency Care 24 hour 172 Foster Home 305 234 (76.7%) 228 (74.8%) 159 (52.1%) 7 (2.3%) Foster Home 24 hour 36 Independent 311 147 (47.3%) 125 (40.2%) 46 (36.8%) 32 (10.3%) Family 421 308 (73.2%) 289 (68.6%) 208 (71.9%) 35 (8.3%) Other/N.S. 110 33 (30.0%) 28 (25.5%) 23 (82.1%) 3 (2.7%)

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Day Service Use by Living Setting Level Total SIS Interviews Any Day Services Regular Special Rate Other Overall 1,780 1,190 (66.9%) 1,134 (63.7%) 765 (67.5%) 71 (4.0%) 1 610 388 (63.6%) 348 (87.0%) 165 (47.4%) 58 (9.52%) 2 457 329 (72.0%) 321(70.2%) 195 (60.7%) 8 (1.8%) 3 149 100 (67.1%) 98 (65.8%) 76 (77.6%) 0 (0.0%) 4 238 179 (75.2%) 177 (74.4%) 153 (86.4%) 1 (<1%) 5 29 21 (72.4%) 21 (72.4%) 21 (100%) 0 (0%) 6 112 75 (67.0%) 74 (98.7%) 68 (91.9%) 3 (2.7%) 7 175 100 (57.1%) 97 (55.4%) 87 (89.7%) 1 (<1%)

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Next Steps

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Sales & Savage

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CLdS Intends to

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Increase resources to connect people to their

communities

Increase competitive employment for

participants

Sharpen and adjust the service array
Align our effort per person with assessed

support needs

Assist service providers to refine and/or grow

their array of services

To ensure a fair system with the implementation
f a standardized assessment model
Provide a long-term sustainable system of

supports

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There is still more to do

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Departmental implementation team has been largely set.
Work is proceeding with HSRI to consider findings related to support

needs assessments, spending analyses and other related issues.

CLDS has engaged with Helen Sanderson Associates (HSA) Canada

regarding providing staff with Person Centered Thinking training.

A phased in approach to making and system changes was chosen.
A pilot will begin on January 1 starting with new admissions to the

CLDS system.

Rollout elsewhere will take time, and will be discovered through

continued achievement and discussion.

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In-depth understanding of money spent per service type

(respite, supports to family, day services, transportation, clinical services, and crisis services).

Discussions between CLdS and stakeholders about the type

and amount of supports that will be made available to individuals living home with families at each support level.

Policy decisions by CLdS about investment in services for

individuals living home with families.

Settle on anticipated service use and supports budgets for

individuals living home with families.

Assure needed infrastructure for supports planning and

exceptions review.

Enrollment of first group of individuals living home with

families—SIS assessments are currently underway.

Focus on Individuals Living Home with Families: What’s Next?

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Person-Centered Planning

Individuals define their goals and aspirations.
SIS assessment results can be used to understand areas of

strength and areas where the individual needs support.

Individuals (and their families, when applicable) are made

aware of their supports budget before the planning meeting takes place.

Individuals have some degree of authority and flexibility to

choose which services to purchase.

Individuals work with their circle of support to decide on the
ther types of support that they require to achieve their goals

(relationships, community based, etc.)

All paid and non-paid supports work in harmony to help the

person achieve their defined goals.

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Discussion and Questions

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Dancing with Dragons

“The final act in performing a creative act is letting

go. … As we create new support practice, the

proverbial beast is provoked. We are knocked off

ur centers as we move into unknown territory

without the anchor of our legacy services. This requires… as Rebecca Chan says, [that we] Dance with our Dragons.”

Hanns Meissner, Blue Space, p. 146

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