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Quality Incentives Workgroup - Shared screen with speaker view
Taylor Collison
Submit written comments to QualityIncentives@dds.ca.gov
Amy Wall
Corrección: La presentación de hoy se publicará en el sitio web del DDS en: https://www.dds.ca.gov/initiative/stakeholder-events/
Jacquie Foss
Will be interesting to look at turnover by service type and the wages paid in these service type. Higher wage = low turonover ?
Jacquie Foss
Workforce and competitive wage will be critical in this discussion . Perception= low wage high turnover or is it a fact low wage = high turnover ?
Tania Morawiec, SCDD
yes, tenure, career laddering and wage rates at point of entry into field as opposed to solutions for wage stagnation for more experienced employees
Daniel Hogue
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.
Amy Wall
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.
eric ciampa
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.
eric ciampa
what Judy just said ;)
Jacquie Foss
Does a person who has long-term DSP achieve outcomes more consistently than those with high turnover rate?
eric ciampa
on average, I believe yes. In every particular case? probably not. everything has to get to the individual level.
William Leiner
Also concerned about the idea of using this process to incentivize legal compliance (like language access)
Tania Morawiec, SCDD
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.
Judy Mark
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.
Donna Feingold
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.
Tania Morawiec, SCDD
Of course. Sometimes these things go together-sometimes not... Can we say required ed and upskilling of staff is an outcome?
Marty Omoto
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
Doug Pascover
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.
eric ciampa
Only if it directly benefits individuals we serve Tania.
Doug Pascover
Agree, Marty, thank you.
William Leiner
Leslie, I need a breakout room too.
Tamara Kidwell
I think I need one too
Doug Pascover
Shoo, Will.
Marty Omoto
It isn't different Rennie. Person centered - child centered - is centered on the person or the family persons needing services
Marty Omoto
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
Marty Omoto
Agree Leslie!
William Leiner
Can you please put me back in my breakout room? Got disconnected. Thank you.
Marty Omoto
LOL. Will!!!
Doug Pascover
Marty, shouldn’t you be at the grown-up table too?
Marty Omoto
Traci Hollinger
Non-standard goals for each person by the regional center
Doug Pascover
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.
Traci Hollinger
Many IPP's have the same three goals
Donna Feingold
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
Daniel Hogue
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.
Daniel Hogue
The planning process is designed with my input and respects my cultural background and personal beliefs.
Scott Shepard
The goals should be person centered vs. program/agency centered
Daniel Hogue
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.
Doug Pascover
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.
Donna Feingold
instead of measurable goals, we should be talking about meaningful goals
Daniel Hogue
Agreed Donna!
Vivian Haun
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.
Harry Bruell
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;
Vivian Haun
Is this measure for a provider who assists in the development of a PCP, like an independent facilitator?
Rennie Saltzman
I believe the measure can be used by any support person. I can check right now @vivian
Donna Feingold
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.
Daniel Hogue
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.
Rennie Saltzman
here is a link to the Canadian Occupational Performance Measure https://www.thecopm.ca/
Scott Shepard
A person centered plan / person centered planning should GUIDE the IPP/IEP
Traci Hollinger
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
Scott Shepard
Perhaps the question is: Does this individual have a person centered plan that guides their IPP/IEP?
Vivian Haun
Yes Scott! I agree.
Donna Feingold
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.
Daniel Hogue
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.
Vivian Haun
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?
Doug Pascover
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.
Donna Feingold
I agree Dan that if the measures aren't easy to identify and measure, it is going to be very challenging for everyone.
Daniel Hogue
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.
Vivian Haun
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.
Pamela Scarano
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.
Kelly Grimes
Kelly Grimes
Jae Lim
kic not woking
Jae Lim
Vivian Haun
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.
Doug Pascover
It ain’t a small task.
Donna Feingold
You can start with the One Pager (which is a great visual tool for the folks we support)
Daniel Hogue
Perfect Donna... great first step
Elizabeth Grigsby
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.
Daniel Hogue
Amen Elizabeth!
Harry Bruell
Thank you Elizabeth - beautiful statement and so true.
Tania Morawiec, SCDD
assistive technology and communications tech, decentralization and transportation provision for meaningful comm engagement
Rennie Saltzman
We are almost never invited to IFSPs
Sheri Rosen
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.
MaryLou Bourne
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
Daniel Hogue
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?
William Leiner
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.
Matthew Omelagah
Great meeting today. Sorry I have to jump off for another meeting. Thanks
Diva Johnson
Thank you everyone, I have another meeting to attend:)
Tania Morawiec, SCDD
I must go to another meeting-thank you all for your work and ideas. keep up the good fight
Mark Klaus
I have to jump off to another meeting -- my apologies.
Judy Mark
I completely agree, Liz. There needs to be something done about the implicit bias against people who don’t communicate using speech.
William Leiner
Thank you for sharing this, Elizabeth. So on point.
Donna Feingold
Well said, Liz!
Mark Melanson
Well said, Elizabeth!
Nancy Bargmann
Sorry everyone - I need to go to another meeting, but appreciated everyone's discussion and work. Looking forward to continuing discussion.
Amy Wall
Email: QualityIncentives@dds.ca.gov
Mike Pereira
Take care everyone