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La presentación de hoy se publicará en el sitio web del DDS en: https://www.dds.ca.gov/initiative/stakeholder-events/

¿Comentarios? ¿Preguntas? Mande su correo electrónico a QualityIncentives@dds.ca.gov

Good afternoon, everyone.... Happy Holidays!

Comments? Questions? Email QualityIncentives@dds.ca.gov

Today’s materials are posted on the DDS website at: https://www.dds.ca.gov/initiative/stakeholder-events/

All are great but 1st two are very important. :)

choice, individualization, person-centered, culturally responsive, HCBS, accountability, transparency, flexibility-all key

All of them feel really important

These are all good.

Consumer choices, services be culturally and linguistically responsive, HCBS along with the rest are important

I totally agree. Thanks, Diva!

All are great... 1st two are most important and foundational.

I think developing a framework for whole person assessment to guide services is helpful-exploring SAMHSA's 8 dimensions of wellness and the social determinants of health inform quality of service in a meaningful way

I agree with all, but not sure how developmental center resources can be used. Are there examples of what resources are available.

We cannot lose sight of how we collect measures-what voice is heard. Studies show provider input varies from self-report

TRUE

Best practice exemplified via case study can help clarify expectations in the field

I agree with Judy. HCBS covers so many areas.

Good Point - HCBS compliance is a measurable outcome.

Within the Providers control and not the Provider controlling the individuals choice is a very different conversation..

Exactly, Jacquie!

I forgot to introduce myself, sorry! Judy Mark, President of Disability Voices United and parent of a 24 year old son who is a participant in the Self-Determination Program

everyone knows you, judy, lol

Me too. I forgot to introduce myself: Eric Zigman, Executive Director Golden Gate Regional Center. In relation to Jacquie and Judy's comment, a core foundational element of quality management is that "the customer defines quality" Those we serve should be defining what quality is for themselves on an individual basis, and hopefully (through some process) on a system-wide basis. It will be a challenge to scale from quality expectations and experience of hundreds of thousands of individuals who are served in our system, and formulate the systemic measures that will help us measure whether we are going in the right direction. Mary Lou may have experience and knowledge of how we do that...

The two workgroups are very intertwined.

NCI will be great to tap but it, like other data sources, is limited. NCI’s community inclusion data suggests thatindividuals are participating in a wide range ofcommunity activities, but to what extent theindividual is fully engaged in their community duringthe activity is less fully explored. So data sources, existing measures, need for evolution or expansion of those measures, and resources (funds/researchers/MOUs) for collection need to be part of the conversation.

Totally agree, Sascha! Quality is directly related to expectations. Some measure should be in supporting the exploration of possibilities. So individuals can choose from a "horizon" of choices" !!

Addressing the work force crisis will be critical to offering person centered supports

If we can assume that better trained staff contribute to better quality supports, we can correlate incentives with staff training such as DSP training, RBT if appropriate, and definitely PCT!

Totally agree with you Alona

A few of these seem more like measures for a regional center rather than a service provider.

This is a great example of how the RC measures may overlap with Service Provider Quality incentives

We still need to be wary of measuring utilization vs. quality of services

So utilization could be a factor in determining quality measures ?

Quality and Outcome measures should be linked because a quality service provider should be supporting a person to have good outcomes.

Victor- yes... and in all actuality, these are examples of type of measures that would be applicable to a general principle, and this example, though seemingly directed at Rcs (per Judy) does have contextual relation to a service provider- particularly process measures, performance, quality, and ultimately outcome measures... good service providers should be assessing these types of measures for themselves and overlay that on top of the participant's choices preferences, etc. as a means to define success for a participant in terms of quality of life

whether an entity exists is the structural measure. whether a process exists is a process measure. how much of it is happening (a count of activity, or utilization of a service) is a performance measure. whether it is being done "well" is the quality measure. and it can be difficult to measure quality without also knowing the process and performance measure. and does something being done well actually make a difference?, is the outcome measure.

great examples-so complex. Measures and best practices are easier when tied to evidence based practices and fidelity scales. This evaluation is more accurate with a 3rd party reviewer because self-eval of EBP implementation is challenging-especially when the provider does not have proper TA to understand, design and support implementation. This is a resource issue

Does the field have the resources they need? HCBS implementation success often involves decentralization and resources for community based teams-tech, etc... provider transformation is a part of this so do we incentivize that?

Ultimately, as Victor and others have mentioned, the CAPACITY for Data Collection, as well as the versatility of using the raw data will be critical. As everyone agreed, having 150 measures is untenable- so would having 150 data points. How data is aggregated and synthesized can glean notable information- especially in the areas of service disparities as well as the difference between utilization and choice driven satisfaction with services.

EX-DSP training in implicit bias is essential and helpful but what other markers do we need to support individualization of services and person centered planning? Trauma informed care and motivational interviewing skills can be very helpful when engaging and supporting people who have disabilities in a meaningful way.

Thanks everyone. I have to jump into another meeting. Good discussion.

As for processes, in the central valley we have not had "trained" employment support staff employed by the vendors so getting to a permanent job position is not successful. There needs to be certain training expected at the vendor level.

Or when referring to employment consider naming it as "employment focused " so you can include volunteer positions or job training.

best practice in knowledge translation when sharing info with the community is essential

HI All: We are very concerned that we are talking about the incentive program that is going to be just the 10% variable portion. I think we have a serious STRUCTURAL problem that is being able to hire and retain staff in California. The cost of living is no longer attractive or sustainable and the payments we can provide to meet the needs of the consumers as we reopen after the pandemic. I think we have a serious program and we have an urgency.

As long as it does not lead to how we do not meet the needs of the consumer, there will always a balance that we must be cognizant of that we can not create a list of reason why we have not met the measure but we have a list on how to meet the measure. At the end of the day we must remain vigilant on person centered supports and making sure we do not have this be a provider centric conversation.

`Be well, thank you.