RC Measures Workgroup - Shared screen with speaker view
Who can see your viewing activity?
Si alguien necesita interpretación en español, haga clic en el globo blanco en la parte inferior de la pantalla con la etiqueta "Interpretation." Luego haga clic en “Spanish” y seleccione "Mute original audio.”
La presentación de hoy se publicará en el sitio web del DDS en: https://www.dds.ca.gov/initiatives/ds-task-force/
Oops, wrong link for today's materials above - this is the correct one: https://www.dds.ca.gov/initiatives/stakeholder-events/
Diana Pastora Carson
Thank you, Joyce. Yes.
I appreciate and support the approach - of including measurements that can be credibly measured at this point - and working on the others for later possible inclusion when its possible to identify or create ways that can credibly be measured. That underscores that this is - and should be a work in progress so that performance measures will always be as credible and meaningful as possible. So thanks for this approach and listening to all of us.
Thank you Joyce - I agree. That is important
Would it be fair to look at common performance by a similar organization at other systems who serve people with DD - that have certain similar functions (ie case management, eligibility determinations, assessments, etc) such as counties (IHSS) and Medi-Cal managed health care plans or school district special education programs? Reason is to underscore CalHHS (CA Health and HUman Services) "whole person" care approach in the guiding principles. Also it might provide important data to replicate a best practice or to address a disparities that is happening across systems or in one. I know this is likely something we would have to look at in the future given the work needed to make this happen - but we need to try to do this to help all of us to get out of our siloes - and help give us a perspective on how things are working - and not working not just in this silo - but others. For instance, I know from experience and as a stakeholder that disparities occurs across ALL systems in ALL siloes.
Also, what we do here can help drive public policy and changes in state law that can make "meaningful comparisons" more possible across systems - so it underscores the whole person and is person centered.
Geographic differences, population ethnic and economic demographics differ (think difference between Inland Empire or Alta CA RC and Westside RC or Redwood Coast
I agree with Marty. This is an exciting step forward but it would be advantageous to look at what is happening outside the Regional Center system to identify what is happening in other systems, how this impact the whole person, and to identify best practices.
Sort of....7 7 7 also was about the seven who are "good" 7 who are "medium good" and 7 not so good. Thank god it wasn't 666 cuz then Satan is involved. LOL
I take back about agreeing with Marty, LOL!
In addition to understanding variation in the underlying assumptions of "similar organizations" or "differences in environment", it is important to use "variation" to look at differences in outcomes both explained by differences in input, but also by differences in the process which we can control and positively impact.
Agree with Dora's point: " that we should be comparing "similar" regional centers. Use the "similar schools" ratings as example" and if we did that in the right way, it would also address point by Ruby, which I think is important and critical.
Median rates may also pay a role in performance,
As a parent advocate, an IF and a PCP, I think one of the main things to establish is a “consistency” among the services that can be provided to support our Neurominority individuals. A standard set of services that can be made available for families to understand that there can be these supports for these families and individuals. For example, a new family or individual self advocate may never know how they can be supported, thereby exacerbating the disparity among immigrant and ethnic populations and even among self advocates, if this information is not proactively shared with them.
Diana Pastora Carson
Yes, Kavita! Yes, Mark!
in my opinion, the families with No POS and very LOW POS should have their own system or program, if the family is not having any contact with the RC there should be someone from RC finding out why and how is the clients doing. Especially with minorities there is a lot of cultural, financial and much more situations that are not providing services needed for the client.
Absolutely - agree with Mark and Kavita. Also like what Karen is underscoring - about using benchmarks and measuring improvements from those levels (from a certain point in time) would help regional centers - all of us really - to succeed. I think that is an important point - that measurements (including quality incentives) should also be about helping to succeed as much as it is about showing where people or people in organizations need to do better.
@Dora, please make sure you are posting your comments in the chat to "Everyone," not just hosts & panelists.
Knowing what the benchmarks are for all Regional Centers is just as important as the variations.
Agree with Josefina - also Beth (on median rates)
Miriam Rodriguez 01:45 PM (translation)How are we supposed to know about the places and support services available if they don't talk to us about the lists or what services we have
Establishing a Gold standard of service (making literature and resources available) for all neurominority individuals and their families along with a standardized training for all SCs in these services, and the possibilities of obtaining these services or seeing if they qualify for the same is crucial to ensure that the RC supports and services are NOT about what they will pay for or not, and actually more about What will best support the consumer in leading a life of dignity ! This training (which ought to be periodic and mandated, and the dissemination of information) is quintessential to the successful work of DDS ! Right now, the information is on a “dont ask dont tell” basis
exactly Fanny !
Jeannet Krause 01:46 PM (translation)I can't see Dora's or Rubí's comments?
Thank you, Tim. The system must revolve around the person. Not the person revolving around the system.
What I gained from Tim's comments was that our metrics need to be based on the client's perception of quality services, not the provider's operational imperatives.
Diana Pastora Carson
What is reasonable variation between Regional Centers when things like what Tim has described and what other individuals and families continue to describe continue to happen? How can we call regional centers part of a statewide system when there is so much variation among the experiences of people who are part of the “system?”
Jeannet Krause 01:51 PMI support what Dora Contreras, Rubí Saldana and Elizabet Gomez are saying…. Atte Jeannet Cardenas
Yes! Person-centered outcomes!
Agree with Harry and Beth and Tim. Many of us have advocated that while output measures (utilization) have a place in terms of measuring but is NOT an outcome that has anything to do with the outcome of my sister or any individual or family. The state (and feds) have long used output (utilization) as the means to measure a program or the needs of people who need help. We need to shift from utilization measures only - and focus on outcomes that connect in some way to the person (person centered). Which is not easy. But we need to do it.
Hey Dora - you need to address to "Everyone" and hnot just "hosts and panelists"
Thanks Nancy - appreciate that. Some of us are using chat so we can add to the meeting but also keep the meeting moving. Also cuz I type a lot faster than I talk.
Miriam Rodriguez 01:51 PM (translation)Why do us the Latinos don’t have the same opportunity and the same services and information as other ethnic groups in SARC? There is so much uncertainty in the support or harassment. We only have the right to 24 hours of respite and still they send us forms to pay the RC
Re-posting Dora's comments:From Dora Contreras to All Panelists 01:55 PMI agree with Tim. Timelines need to be met and person centered needs to be defined especially .for our Hispanic community.
sometimes you may get a bad coordinator that don't care and making it harder for the consumer
Re-posting Dora's comments:From Dora Contreras to All Panelists 01:42 PMI am in agreement with Marty regarding geographic differences, ethnic differences,etc. when defining person centered.
Re-posting Dora's comments:From Dora Contreras to All Panelists 01:38 PMWe should be comparing “similar” regional centers. Use the “similar schools” ratings as an example.
Actually, my comment was for this group to hear about what are the benchmarks for ALL Regional Centers right now? Before we get into the variations.
Agree with Dora 100% too long to actually receive the service.
I agree with Dora
but I think that it depends on the coordinator too on how quickly things get done
I am not sure if you could see my hand raised Mary Lou - :) But I just wanted to chime in and share that one of the performance measures or benchmarks ought to be on service coordinators’ service delivery. Setting up expectations even for the staff of the RC or Service coordinators and setting up the premise for their positions being to be one of “person centered service” to be able to support that individual in leading a life of dignity in the community, as opposed to being one of a more bureaucratic officer who is there to just help with the administrative coordination of a Govt based service system, would bring about that Paradigm shift in thinking and service delivery of the Service coordinators themselves- which would eventually translate to consumer satisfaction !
When a regional center consumer or parent of a regional center consumer gets a bad Service Coordinator who doesn’t care about the regional center consumer, then go up the chain of command. First go to the program manager (the supervisor of the Service Coordinator), if that doesn’t help go to the Director of Client Services (if that doesn’t help) go to your regional center’s Office of Client Advocacy Attorney for help. If all of this fails to produce results, talk to your regional center’s Executive Director.
Thanks, Rick! Agree!
Diana Pastora Carson
Good point Rick - if we found a credible way to link person centered needs to person centered outcomes (which is difficult but not impossible to do in some way), that in turn address problems or unintended (or maybe even intended) consequences of variations that result in a person not getting services - when someone else is able to.
I agree with Kavita . A lot of decisions are made by the SCs without merit.
It all comes back to the purest definition of "Quality" which is: "Delivery of the desired outcome regardless of the provider or location of service delivery."
I agree with Marty. Putting something in place which would make everyone successful.
In my opinion, we need to give more opportunities to the family to understand the system, more opportunities to talk about the way the SC explain the system or asked about the actual situation the family is going through.
Celia Lopez 02:11 PM (Translation)I have a daughter diagnosed with Autism, but the Regional Center does not want to give her eligibility, they have discriminated against me, I already went to mediation and there is no response from them.
Ruby Saldana 02:13 PM (translation)Thank you Dora, we know we have a voice through you and our dear brother Marty Omoto.
Measurers need to measure urgency - measure how people in crisis are helped (Beth and Connie Lapin have raised this issue a lot over the many, many, many years)- and how the measures look at when people are helped or receive services they need - as much as measure the services once they receive it.
Diana Pastora Carson
Thank you, Eva!!! Yes!
exactlyyyyy !!!! eva !!!!
Amen !!! It should not matter no matter where you are ..you deserve to be supported no matter what !
Yes Eva, I totally agree .
Appreciate the discussion and engagement of this group. I believe that DDS, Regional Centers, Providers, Families and Individuals all have the shared goal of supporting individuals to live the lives they choose. I appreciate the efforts to align the incentives in the systems towards this shared goal.
Agree with Eva and everyone else - ultimately the measures need to be about the person-centered needs linked to the outcome to that need. Variations can occur among RCs depending on demographics, geography, costs of living because its a different resource issue (and measure) for Alta, Tri-Counties or Inland to do outreach in their enormous service area versus one with a smaller catchment area or a catchment area that has multiple language needs versus one that may not. (and that also means a difference in resources provided)
exactly Joyce ! i had a similar experience - as do many of our families at PRAGNYA - some service coordinators do not even check in with the families till the ipp is due - little wonder that there is a disparity in POS as well because there is barely any connection between the SC and the individual or family !
Rubi Saldana 02:27 PM (translation)Eva Casas, thanks for the support, of course, it would have to be the same, it is illogical how the system works at this time the standard and measures are totally illogical.
Exactly Beth!! Some families do not have internet, how can they get informed!!
Support and agree with Beth Burt (who has been an advocate for so many, many, many decades). Also - Pam Scarano from CVS (Community Vocational Services) in Fresno has raised some good ideas (and concerns too) in previous workgroups on different approaches of linking person centered planning and needs to outcomes on a systemic statewide level.
Thank you Kecia for raising that. Where does those issues connect with the measures we are talking about?
Thank you for sharing this kecia !
Amen to that Diana !
Thanks Diana for sharing that - and also your comments - support that. Also - so great to "see" you again!!!
agree with you Rick
Diana Pastora Carson
That’s right, Karen.
Are “variations” in provider incentives on quality (another workgroup) also being considered?
Diana Pastora Carson
Thank you for inviting us to share in these conversations.
Absolutely Rick ! The power dynamic in the SC and Consumer relationship plays a huge role in that Implicit Bias … and hence requires a complete paradigm shift which can only be accomplished through periodic training and establishing the “gold standard of service”
I think Mark's question is important. We need to consider that. Also on other factors - how do the measures cover things like # of fair hearings; complaints (on the negative side of things) or levels of disparities as measured by population or by recorded unmet need; or lack of person centered plans, etc - and also measuring the positive things too (when equity issues are addressed; when people's crisis are met in a timely way and in a way that resolves a crisis, when services are provided in a timely way. Need to measure - as we have said - person centered needs - linked to outcomes of those needs. This includes infants and toddlers in Early Start - and the children and families in the ages 3-4 category covered by provisional eligibility for Lanterman.
Mary Lou Bourne
Thank you everyone for such a robust and informative conversation today!
Thank you Nancy for the nice summary of key take-aways. Using your tagline as a literature search lead to this interesting article: https://www.thejournalofprecisionmedicine.com/the-journal-of-precision-medicine/maximize-healthcare-performance-by-reducing-unwarranted-variations/
Thank you all, this was a very good meeting.