Submit written comments to QualityIncentives@dds.ca.gov

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

Will be interesting to look at turnover by service type and the wages paid in these service type. Higher wage = low turonover ?

Workforce and competitive wage will be critical in this discussion . Perception= low wage high turnover or is it a fact low wage = high turnover ?

yes, tenure, career laddering and wage rates at point of entry into field as opposed to solutions for wage stagnation for more experienced employees

Totally agree with you Jacquie. DSP turnover will ALWAYS preclude a vendor from meeting the threshold of quality and incentive pay as long as rates can't afford quality staff.

If you are a member of the public in need of ASL interpretation, please post a Zoom chat so we can have you follow the interpreters.

We need to continue to be careful about unintended consequences. For example, an outcome of “days to place someone in employment” might encourage providers to place an individual in the quickest job and not the right one. A low turnover goal might encourage providers to not terminate a worker who is not best for the individual. The farther these goals are from a report for an individual receiving services the more it can lead to unintended consequence. We need to stay focused on reports from clients on their individual goals.

what Judy just said ;)

Does a person who has long-term DSP achieve outcomes more consistently than those with high turnover rate?

on average, I believe yes. In every particular case? probably not. everything has to get to the individual level.

Also concerned about the idea of using this process to incentivize legal compliance (like language access)

Agreed, but isn't a turn over an issue with the satisfaction of the person served? High turn over impacts trust, relationships and developing connections to support truly individualized services. From my time as a fidelity reviewer for services, PWD cited turn over as a frustration and hurtful departure of trusted service providers.-they had to tell their story and advocate for their needs and goals OVER and OVER again. It's hard for providers but its harmful to people who have disabilities.

I agree that keeping your staff - if the person wants them to stay - is very important. Also choice of the staff is critical. But that is not an outcome.

it's not just about the tenure of the staff but their level of skill and their ability to engage with the people they support.

Of course. Sometimes these things go together-sometimes not... Can we say required ed and upskilling of staff is an outcome?

If continuity of supports and services are identified by a person (or family) as critically important, if stability, quality, etc of supports is linked to having the same staff person as long as possible - then all those things can be outcomes

Judy, I agree. Also, keeping staff is the job of the client, family and provider, along with wages and benefits. It is not just a function of rates.

Only if it directly benefits individuals we serve Tania.

Agree, Marty, thank you.

Leslie, I need a breakout room too.

I think I need one too

Shoo, Will.

It isn't different Rennie. Person centered - child centered - is centered on the person or the family persons needing services

The same principle applies to those people with developmental disabilities (or actually any disability) who are underage. The service plans and directives all need to be person centered, taking into account the person needing the services, the family persons, etc

Agree Leslie!

Can you please put me back in my breakout room? Got disconnected. Thank you.

LOL. Will!!!

Marty, shouldn’t you be at the grown-up table too?

Ooops

Non-standard goals for each person by the regional center

There have been a fair bit of study around the outcomes of person-centered planning including more goals achieved, higher client satisfaction and lower caregiver turnover. If you find the outcomes that are expected, that can be measured to validate the person-centeredness.

Many IPP's have the same three goals

There is definitely a certain way to write Person Centered plans and the way the person served is involved in the process and in the goal setting including giving them the authority of who comes to their meeting, it is held where they want it, it includes what is important to them,, etc

Agree with you Donna... each of those questions would be good on a satisfaction survey. For me, it is the individual's perception of the quality of inputs and the eventual outcomes that determine the quality of the plan.

The planning process is designed with my input and respects my cultural background and personal beliefs.

The goals should be person centered vs. program/agency centered

Whenever possible... shouldn't the person supported be the "keeper" of the plan? Sure, the RCs can store the plan, but the plan should be accessible to the person served and modified based on their timing and their needs.

Scott, you know as well as I do how good programs/agencies at pretending program/agency centered goals are person centered. It’s our top competence.

instead of measurable goals, we should be talking about meaningful goals

Agreed Donna!

Thanks Leslie. I am confused re: the attribution of this measure. My understanding is that we are talking about quality incentives for providers. But I think it's the responsibility of the regional center to make sure that someone either has a PCP, or that the IPP reflects person-centered thinking.

Steps along the way: 1) establishment of statewide standard for a Person-Centered IPP, annual goals and measurement; 2) number (and %) of providers, RCs, individuals trained in facilitating person-centered plans;

Is this measure for a provider who assists in the development of a PCP, like an independent facilitator?

I believe the measure can be used by any support person. I can check right now @vivian

it hasn't necessarily been the regional centers that have been doing person centered plans. It's important that those who are directly providing services know how to provide person centered services and thus has a person centered plan.

Because the statute is about developing performance incentive standards for providers, we should be focusing on the outcomes that are in the control of the provider.

here is a link to the Canadian Occupational Performance Measure https://www.thecopm.ca/

A person centered plan / person centered planning should GUIDE the IPP/IEP

Using the Person Centered Planning is what helps create a solid IPP plan, but the Regional Center should also practice using the tools to create the plan

Perhaps the question is: Does this individual have a person centered plan that guides their IPP/IEP?

Yes Scott! I agree.

It probably also depends on where the person lives, their age, types of services they receive, etc. For those providers who support people to live in their own homes, they often take the lead in the person centered planning.

what we need to get are measures that are less subjective and more objective. I'm concerned that with loosely defined measures, too much will be left to interpretation and, in the end, will not be effective.

But the question is how to frame the measure from the provider perspective. What does a provider need to be able to do/demonstrate to help their client end up with a PCP that meets the desired criteria?

I agree, Daniel. The two opposing dangers are, on the one hand, standards that are so rigid and measurable that they don’t adapt to the person and, on the other hand, standards so freely designed that they turn into IPPs.

I agree Dan that if the measures aren't easy to identify and measure, it is going to be very challenging for everyone.

Agreed Doug... also, we need to determine levels of acceptability. No provider, unless they are PERFECT, will meet measures at 100%... so, where is the cutoff of acceptance? Seems that some of these logistics/criteria need to be worked out before we conclude the measurements.

Daniel and Doug-- I agree that striking the right balance is key. I think I heard the Department saying for each measure area, they want to use a mix of both subjective/personally reported outcomes and more objective/externally measured outcomes.

I agree with Scott the PCP should guide the IPP/IEP from their Vendors are responsible for their portion of the plan. Then move into the satisfaction survey process and analysis of outcomes.

MICHIGAN DEPT OF COMMUNITY HEALTH PRACTICE GUIDANCE FOR PERSON CENTERED PLANNING

https://www.michigan.gov/documents/ltc/PCPpracticeguidelines0616081__2__240323_7.pdf

kic not woking

mic

Daniel-- Good point. I don't think measures have to only be based on meeting a minimum cut-off. They can also be based on the percentage of your staff that meet a certain criteria. Or they can be based on how much growth or improvement the provider showed compared to the previous year.

It ain’t a small task.

You can start with the One Pager (which is a great visual tool for the folks we support)

Perfect Donna... great first step

Our community is sad, it’s never gonna change if our way of thinking doesn’t change. People without disabilities need to experience what we go through every day. In order to understand what it’s like to be put in a box everyday. And not being seen. I have a disability. I’m gonna make it doggone sure the people I work with are being seen.

Amen Elizabeth!

Thank you Elizabeth - beautiful statement and so true.

assistive technology and communications tech, decentralization and transportation provision for meaningful comm engagement

We are almost never invited to IFSPs

We are not either Rennie. Even if we did the eligibility evaluation, we are not participants in the initial IFSP in many regional centers. Some are wonderful at including us.

Ensure the person directs the comprehensive person-centered planning process to the best of their abilities, including people who have alternative ways of communicating and complex behavioral needs.Targeted 2025 person centered planning measure

But if this is measuring the quality of the vendor (because it's tied to the incentives), what are the measurements that the vendor is responsible for and outcomes that the vendor is accountable to?

Thank you, Mark for reporting out. Also good discussion about how "check the box" training about person centered planning, DEI, etc. alone is not enough.

Great meeting today. Sorry I have to jump off for another meeting. Thanks

Thank you everyone, I have another meeting to attend:)

I must go to another meeting-thank you all for your work and ideas. keep up the good fight

I have to jump off to another meeting -- my apologies.

I completely agree, Liz. There needs to be something done about the implicit bias against people who don’t communicate using speech.

Thank you for sharing this, Elizabeth. So on point.

Well said, Liz!

Well said, Elizabeth!

Sorry everyone - I need to go to another meeting, but appreciated everyone's discussion and work. Looking forward to continuing discussion.

Email: QualityIncentives@dds.ca.gov

Take care everyone