Transcript Independent Monitoring for Quality (IM4Q)

Chester County Independent
Monitoring for Quality
(IM4Q)
IM4Q
Independent Monitoring Corporation
331 Gordon Drive
Exton, PA 19341
610-594-0290
Intent & Purpose
of Independent Monitoring
(IM4Q)
IM4Q adds a perspective on quality that does not focus on
regulation, process or compliance issues. IM4Q often
reinforces what human service professionals already
know about the person or raises issues that they would want
to know.
The purpose of IM4Q is to provide information obtained
from interviewing people receiving services and supports in
the ID System to:



Improve their Quality of Life
Improve the Quality of PA’s Intellectual Disability System
Offer an additional safeguard for the health and wellbeing
of individuals receiving services
Some Guiding Principles of IM4Q
 Independence: Local IM4Q Programs have
no conflict of interest with providers of service
and the County MH/IDD Program.
 Community Participation: Family members,
people with disabilities and concerned citizens
monitor services and supports.
 Accountability: The agencies who receive
reports on this information are responsible to
use it for quality improvement purposes.
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The Where and Why of IM4Q
 Several years ago, Pennsylvania determined that they
needed to look at the quality of services and subsequent
improvement and options of these services provided to
individuals with developmental disabilities. As a result,
the Office of Developmental Programs (ODP) convened a
workgroup to develop a Multi-Year Plan in 1997 to
address these needs.
 One of the outcomes and recommendations was that
local monitoring groups, independent of the service
system, could best measure individual and family
satisfaction with the services and supports being
provided to them.
 As a result, in 2001, IM4Q programs were established in
PA counties.
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How IM4Q Works
 ODP selects a representative sample of people receiving
services and families each year to be interviewed.
 Local IM4Q Teams interview people receiving services
and families in the sample, and share their
considerations after the interview with the AE, providers,
the individuals and their families as applicable.
 The AE addresses IM4Q Team considerations and uses
survey results to improve the person’s services.
 The IM4Q Program enters the results of interviews in
HCSIS (Home and Community Services Information
System) where aggregate results are accessed by
providers, County Programs and ODP for improving the
quality of the service system.
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How IM4Q Improves the
Services System
 Provides independently-gathered information
on service quality, satisfaction and outcomes.
 Serves as a safeguard by identifying “Major
Concerns” affecting health and safety.
 Helps to identify “promising practices” as well
as areas needing improvement.
 Provides a consistent source of information to
measure the effect of program practices and
quality improvement actions.
 IM4Q data results feed information into
performance system measurements.
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What IM4Q Is and Is Not
 IM4Q is one aspect of
quality measurement
within the ID system
quality framework.
 IM4Q is a measurement
of quality, consumer
satisfaction and
outcomes.
 IM4Q is a SNAPSHOT of
quality to be used for
quality improvement
purposes.
 IM4Q is not the only
measurement of quality.
Others, like incident
management and
licensing also need to be
considered.
 IM4Q is not a
measurement of
compliance with
standards.
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IM4Q Role of Supports
Coordinators
 Explain IM4Q purpose and operations
to consumers, families and support
professionals.
 May obtain and organize some
demographics information.
 Coordinate quality improvement with
providers of service, families and
individuals.
 Champion quality improvement.
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Service Provider Roles
 Provide demographic information
needed by the IM4Q Program.
 Assist in answering IM4Q interview
questions that the person can’t answer.
 Use aggregate IM4Q information to
improve services by reviewing reports
made available in HCSIS and reports
generated by the Chester County IM4Q
program.
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WHO PARTICIPATES IN IM4Q SURVEYS?
(Fiscal Years 2008 through 2013)
Statewide – Over 6,690 individuals are interviewed yearly, including
people living in State Centers.
Chester County – Yearly -168 individuals living in a residential setting,
with their families, or independently. (151 were visited in 2012-13)
Demographics of Chester County individuals interviewed
during the period 2008 through 2013:
413
115
50
219
27
Living
Living
Living
Living
Living
824
in a residential setting (Community Homes)
in a residential setting (Private ICF)
in a shared living setting
independently or with family
in other settings (PCH, Dom Care, Nursing Facilities,
Children’s Facilities)
TOTAL
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HCSIS drawn sample of interviews
5 SAMPLE GROUPS are interviewed in Chester County.
ODP provides HCSIS Sample:
1.
30 PFDS Waiver
2.
108 IM Sample (1/3 of residential each year)
3.
30 National Core Indicators (NCI)
4.
30 NCI Family Guardian Surveys mailed out by County
to families whose relative lives in a residential program
5.
30 NCI Adult Family Surveys mailed out by County to
families whose relative lives at home with the family
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IM4Q Reports Available to the
Public
 Five Year Comparison of Monitoring
on the Chester County Website at
www.chesco.org/mhidd
 2012-13 Institute on Disabilities
Statewide Summary at the Office of
Developmental Programs (ODP)’s
Website at www.odpconsulting.net
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Terms and Abbreviations
 National Core Indicators (NCI): A survey
used to compare Pennsylvania’s performance
with other participating states.
 Essential Data Elements (EDE): The
standard Pennsylvania survey tool developed
by Temple University’s Institute on Disabilities.
 Family, Friend, Guardian (FFG): That
portion of the EDE survey used to obtain
satisfaction information from family, friends
and guardians.
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Terms and Abbreviations
(cont.)
 Closing the Loop: Follow-up actions taken in
the community intellectual disability system to
address IM4Q findings and team
considerations. Actions can occur on an
individual, provider, county and/or statewide
level.
 NCI Family Surveys: Two surveys, one for
families living with the person receiving
services and the other for families living apart
from the person, are included in the National
Core Indicators portion of IM4Q.
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The Interview Questionnaire:
Essential Data Elements (EDE)
 The EDE is the interview instrument used by
monitoring teams to ask 70 questions. It is a
combination of the NCI project questions and
IM4Q questions.
 The IM4Q Monitoring Team also completes 15
additional questions in the EDE after the visit with
the individual.
 A Family/Friend/Guardian Survey is also
completed which consists of 30 questions.
 HSRI (Human Services Research Institute)
publishes NCI reports to individual Counties and
Temple University’s Institute on Disabilities
publishes reports for all projects within IM4Q.
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Employment and Habilitation Pilot
 Chester County participated with five other
counties in the ODP Habilitation Pilot.
 40 individuals who attend day programs
and/or work in the community and their
families were surveyed each year during a
six year period (2005-2011).
 The purpose of the pilot was to ascertain
satisfaction with day activities/services and
the individual and families understanding of
availability of habilitation services.
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Transition Pilot
 In 2011-12 Chester County was selected to
participate in the ODP Transition Pilot.
 72 individuals between the ages of 14 and 22
and their families were surveyed in 2012-13.
 The purpose of the pilot is to gather
information about how the transition process is
conducted in the school system and to see if it
is preparing individuals for employment and/or
further education after school.
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SATISFACTION – EDE Responses
2008-2013
 The first two sections of the EDE ask
questions related to the individual’s
satisfaction with their home, work,
happiness, privacy and their people with
whom they live and work.
 Only the individual being interviewed
can respond to the questions in the
Satisfaction section of the EDE.
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Satisfaction Scale with
Day/Work Activity
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Satisfaction Scale
With Living Arrangement
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Other Satisfaction Data
 Have friends that are not staff or family
members
State:
73.2%
Chester County: 72.4%
 Report they always have privacy
State:
95.4%
Chester County: 96.4%
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Other Satisfaction Data (cont.)

Report that staff always knock on bedroom door before entering
State:
83.8%
Chester County:
81.6%

Report that people knock/ring bell before entering their home
State:
89.8%
Chester County:
87.0%

Report that housemates are nice or very nice
State:
88.4%
Chester County:
87.6%

Report that they usually feel happy
State:
82.6%
Chester County:
84.0%
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Other Satisfaction Data (cont.)
 Report that staff who work with them in their
home are very nice or nice:
State:
94.6%
Chester County:
94.6%
 Report that staff who work with them at their
day activity are nice or very nice:
State:
94.8%
Chester County:
94.8%
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Dignity/Respect and Rights – EDE
Responses 2008-2013
 Only the individual being interviewed
may respond to the questions in this
section of the EDE.
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Dignity, Respect & Rights
Do you vote? If not, would you like to vote?
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Other Dignity, Respect & Rights Data
 Report that they always carry some type of ID
State:
60.6%
Chester County:
57.0%
 Report that they never carry some type of ID
State:
20.4%
Chester County:
20.8%
 Always have someone in their life to help them
State:
92.2%
Chester County:
90.0%
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Dignity/Respect and Rights
Supports Coordination Services
 Report that Supports Coordinator
helps them get what they need if
they ask:
State: 88.8%
Chester County: 90.6%
 Individuals are told how much
money was in their annual budget:
State: 67.4%
Chester County: 51.2%
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Choice and Control
EDE Responses 2008-2013
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Choice & Control
Do you have a key to your home?
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Choice & Control
Other
 Met their housemates before they began
living together
State: 82.4%
Chester County:91.4%
 Individuals did not choose their
housemates
State: 67.6%
Chester County: 56.6%
 Have their own bedroom
State: 79.8%
Chester County: 78.0%
 Personal mail is never opened without
permission
State: 80.6%
Chester County: 77.8%
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Choice and Control
Other (cont.)
 Individuals always chose what to buy
with their spending money
State: 65.6%
Chester County: 57.4%
 Individuals are always able to get in
touch with family when they wish to
State: 88.6%
Chester County: 83.0%
 Individuals are always able to see
friends whenever they wish to
State: 80.8%
Chester County: 74.4%
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Choice and Control Communication
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Employment
In 2012-13, 20 individuals were interviewed
that were employed in a community
integrated setting.
Average hours worked per week:
State: 18 hours
Chester County: 12 hours
Average hourly wage:
State: $8.34
Chester County: $7.79
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Employment
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INCLUSION
EDE 2008-2013 Responses
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Inclusion – Community
Participation
 Visit with friends, neighbors, families at
least weekly
State: 56.0%
Chester County: 41.2%
 Go to a supermarket at least weekly
State: 44.8%
Chester County: 46.6%
 Go to a restaurant at least weekly
State: 42.8%
Chester County: 41.2%
 Go shopping at least weekly (mall or
department store)
State: 41.8%
Chester County: 41.8%
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Inclusion – Community
Participation (cont.)
 Go to a place of worship at least weekly
State:
29.6%
Chester County: 26.0%
 Go to a bank at least weekly
State:
13.8%
Chester County: 15.8%
 Go to coffee houses/bars/taverns at least
weekly
State:
7.4%
Chester County: 4.8%
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Inclusion – Community Activities
 Frequently go into the community for
entertainment
State:
Chester County:
56.0%
52.0%
 Frequently go to social events in
community attended by people with and
without disabilities
State:
Chester County:
34.2%
24.8%
 Went on a vacation in the past year
State:
Chester County:
47.6%
60.4%
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Inclusion – Adaptive Equipment
 Individuals report that they have all
the adaptive equipment they need
State:
88.6%
Chester County: 89.4%
 Individuals report that adaptations
have been made to home to make it
accessible
State:
82.0%
Chester County: 85.6%
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Monitoring Teams and IM4Q
Program Impressions
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Monitoring Team Impressions
 Caregivers expectations regarding growth
reported as high or very high
State:
Chester County:
56.6%
46.0%
 Staff OBSERVED recognized the individuals
in ways that promoted independence
State:
Chester County:
85.2%
90.8%
 Staff OBSERVED treated individuals with
dignity and respect
State:
Chester County:
95.6%
97.8%
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Family, Friend, Guardian Survey
F/F/G Responses 2008-2013
The IM4Q Program
conducts a F/F/G Survey
with a family member,
friend or guardian if the
individual has someone
in their life and if they
give permission for the
interview.
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Family Satisfaction with Relative’s
Home and Day Activity
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Family Satisfaction with Home and
Day Activity Staff
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Family Survey
- Relative’s Happiness

Family feels that their relative is happy or somewhat
happy with their living situation:
State: 94.0%

Chester County:
90.6%
Family feels that their relative is happy or somewhat
happy with home staff.
State: 95.0%

94.6%
Family feels that their relative is happy or somewhat
happy with their day program:
State: 90.8%

Chester County:
Chester County:
97.2%
Family feels that their relative is happy or somewhat
happy with day program staff:
State: 95.8%
Chester County:
IM4Q Chester County and State
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97.8%
45
Family Satisfaction with
Residential Staff
 Feel there are enough staff in relative’s home
State: 89.8%
Chester County: 90.0%
 Feel that staff treat individuals’ with dignity
and respect
State: 94.4%
Chester County: 95.4%
 Feel that ALL staff APPEAR to have the skills
they need to support their relative
State: 85.8%
Chester County: 85.8%
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Family Satisfaction – Learning and
Participating/Communication
Feel their relative gets enough opportunities to
participate in activities in the community
State:
Chester County:
86.2%
82.8%
Feel their relative seems to have the
opportunity to learn new things
State:
Chester County:
88.0%
87.6%
If relative does not communicate verbally,
communication system is in place & is being used
State:
Chester County:
33.6%
34.0%
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What does it all mean
 This presentation reflects an analysis of aggregate
data related to IM4Q monitoring over five fiscal
periods (2008-2009; 2009-2010; 2010-2011; 201112; 2012-13).
 The data used by Chester County’s IM4Q program was
obtained from reports generated by Temple University’s
Institute on Disabilities which provides statewide and
countywide statistical reports each year to ODP,
Administrative Entities, IM4Q and the community-atlarge.
 It compares PA data reflecting interviews with over
6,600 individuals yearly to Chester County interviews
with 168 individuals yearly.
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What does it all mean (cont.)?
 Although the intent is that all IM4Q programs
conform to the same interviewing and training
methods, we need to bear in mind that data
and responses may sometimes be interpreted
somewhat differently depending upon the
location and demographics of the interview as
well as monitoring teams interpretations and
impressions gained during the interview.
 The EDE offers many options of responses to
questions. This presentation focuses on
primarily yes or no or always or never
responses.
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What do we believe we have
learned specific to Chester County?
 Chester County parallels PA overall
results in many areas.
 Chester County’s services to individuals
with developmental disabilities excel in
many areas; however, methods should
be explored for improvement in other
areas.
 IT IS IMPORTANT TO
REMEMBER THAT THESE ARE
JUST STATISTICS!
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Where Chester County Excels in
Options and Services compared to PA
 3.2% MORE report never feeling lonely.
 4% MORE choose their daily schedules.
 3.6% MORE report that necessary
adaptations have been made to their
homes.
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Where Chester County Excels
(cont.)
 2% MORE go to the bank or ATM weekly.
 12.8% MORE went on a vacation in the
past year.
 11% MORE choose their housemates.
 4.4% MORE had a choice of where they
lived.
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Potential Improvement Areas (cont.)
 3.6% less report they always carry ID
 5.4% less report they have a key to their
home.
 6.4% less report they are able to see their
friends when they wish.
 3.6% less report they attend a place of
worship weekly.
 9% less choose their Supports Coordinator.
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Areas where Chester County might
concentrate on Improvements to Supports
and Services compared to PA State analysis
 8.2% less always choose what to buy with
their spending money.
 14.8% less report that they visit with friends,
neighbors, family on a weekly basis.
 9.4% less report that they participate in
events in the community that are frequented
by people with and without developmental
disabilities.
 10.6% fewer monitoring teams report that
caregivers expectations regarding growth was
reported high or very high.
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CLOSING THE LOOP
PROCESS
IM4Q encourages everyone involved
in the Close the Loop process to be
creative in their ideas for Quality
Improvement in the individual’s life.
Individuals
Families
Friends
Staff
Providers
IM4Q Monitors
Supports Coordinators
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CLOSE THE LOOP
ISP/IM4Q Connection





Closing the Loop is how the AE uses the IM4Q results to
improve the overall service system and the life of the
individual receiving services.
The source of the consideration may include the
person with a disability, family, staff, friend,
advocate or IM4Q team.
Depending on the issues, closing the loop can involve
the work of numerous agencies, the supports
coordinator, the family and the person receiving
services.
The IM4Q program’s role is to bring issues to the
attention of the AE, not to implement change.
The AE is expected to notify the IM4Q program
regarding actions, based on monitoring team findings
and considerations.
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WHAT IS A CONSIDERATION AND
WHY ARE THEY IMPORTANT?
 The IM4Q Program submits a report after each
visit which may include “Considerations”.
 A “Consideration” is a request or perceived
request for change or improvement indicated by
the person, family, staff or monitor.
 Considerations may result in changes or provide
an opportunity to improve the quality of life of
the person being interviewed!
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Things to Remember About
IM4Q Results
 IM4Q Team considerations may need further clarification
and follow-up with the individual, a Provider of Service
or the IM4Q Program. The IM4Q Program will be glad to
clarify any of its findings.
 IM4Q Teams appreciate feedback on ways to improve
their interviews and information sharing.
 Not everyone needs to agree with all IM4Q Team
considerations. What’s important is that IM4Q
considerations are respectfully considered and
acted on in an appropriate and timely manner.
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Making Everyday Lives a Reality
As a result of the IM4Q reports to Chester County’s Supports
Coordination Organizations and Providers of Service the following
changes occurred during FY 09-10, 10-11, 11-12, 12-13. These
reports often assist to emphasize and validate already recognized
needs and supports.

Several individuals whose desire was to move out of their family homes
did so and are now living in more independent settings.

Several families became more knowledgeable about waiver funding and
their relatives are now receiving services to improve and maintain skills.

Many individuals are attending new vocational programs of their choice
or are working with job coaches to find community employment. Others
are receiving more appropriate and meaningful day activities.

One family obtained funding to make adaptations to their daughter’s
bathroom and interior and exterior improvements were made to several
other homes. A few individuals obtained adaptive equipment.

Several individuals expressed interest in learning new skills and are
taking classes to achieve these goals.
FAQs
 Is IM4Q participation voluntary?
 Yes
 How often are people asked to participate?
 Once every 3-4 years
 Can the person choose not to share his/her
personal survey information?
 Yes
 Will IM4Q information affect a person’s
eligibility for funding or services?
 No
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