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

Nancy - Thanks for the overview so far. Can you update also how all of this connects with the rate study implementation and quality incentives program? Also how the data side of things link to the CA Health and Human Services (CalHHS) Health Data Framework efforts - thanks.

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

Great reminder Marty - I will make sure I touch on those points today...

Those guiding principles of the CA Health and Human Services agency are important to unify the departments in their efforts toward long term services and supports, etc and to help us all to break down the silos and help all of us look at the "whole person" (or "whole child") linked to person centered services, supports and needs - and outcomes tied to that. The person centered outcomes is going to be a challenge (as Pam Scarano has said in the past) but its something we all need to work to make happen. Doing this right will help also further the issues of equity, and make sure differences with individuals, families, groups and communities are not only recognized but addressed (ie for instant, families with infants or toddlers who are deaf)

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

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

For me, the eight priority areas fall into three categories:

We need to all work to make sure that its more than just listening - but that the goals and other needs are done in a person centered process and included in all documents that direct and/or fund or authorize services including the IPP

Regarding accountability - , someone during our previous workgroup meetings asked the question if certain measures or standards are not met - what happens. Likewise, what incentives are given when measures or standards are met or exceeded? Also we need to be careful - all of us - in how we define a goal and how we measure success. Not reaching a goal or not succeeding in a goal may in fact be a good outcome. Pam Scarano and I and others have talked about this

The three categories are: satisfaction of clients and families who receive services, consumer employment, and fulfilling government mandates, i.e., fulfilling HCBS standards.

Those numbers - the data just mentioned by Mary Lou can be a part of the measures, but those are utilization and spending numbers that only tell a small part of the picture - but going back to individual person centered outcomes - how is that measured?

Marty, you are saying everything I am thinking.. Brilliant as always

also we need to think about how implementing these measures impact the people who provide services.

That was a mistake

Ignore that old file, I was trying to cut and paste Martys words

I have a question and want to be put in the question que - I don't see any hand for me to raise

Just found it under "reactions"

It may be helpful for workgroup members to get an update/status report on the Provider Self Assessments and the Departments Virtual Site Assessments for HCBS compliance.

Exactly Kathy !!!! Bingo ! The inconsistency is a key factor contributing to the disparity of service access

My definition of Quality: "Achieving the desired outcome(s) regardless of the provider or the location of service." This addresses the inconsistency in services across RC.

One other point I should have mentioned is that a key challenge is lack of quality programs and we need to give some consideration to the roll of RCs in recruiting new providers.

Workgroup Members: Please keep your comments as close to 1 min as possible if speaking to make sure we can get through all 8 areas. Longer thoughts/comments can be put in the chat to help make sure we get through the agenda. Thank you!

All RC consumers with no or low POS, should automatically receive specialized case management that should include solid interagency collaboration( foster care, Department of Mental Health, etc.)RC's should be proactive in identifying issues consumers are dealing with, such as food insecurities, experiencing homelessness etc.Regionals Centers should develop strong relationships with community-based organizations that are on the frontline addressing the community's concerns.

Great input Sherry. I especially like the special case management idea.

I agree Sherry, Low/ no POS should have a different system to reach them.

Hi Joshua Souder here from Inland

How would you differentiate low POS for those who are receiving everything they need compared to those not getting needed services?

Consider a metric that looks at the clinical benefit (such as physical therapy hours achieved for those in need of PT) and not just the financial benefit.

Great point Joshua

Desire for employment first yes I agree with Karen then you need to consider experience and skill set. Basic/Middle/Advanced:

Basic: Volunteer/Assessment of skills/Job Exploration Middle: Development of job choice/skills set development Advanced: PIP/CIE placement

I think one of the challenges in consumer employment is making people aware of the options available to them. Many people aren’t even aware of the CIE options and thus may not have expressed an interest in a job. It is also interesting to look at who can actually get employed—especially for someone with an intellectual disability.

Great point Beth re Dept of Rehab.

Support what Beth is saying - important that everyone is responsive not just monitoring or handling a case.

Yes Beth. I agree. Thanks for sharing.

Regional Centers, training Service Coordinators on the DOR system. Unfortunately, some Service Coordinators will refer the consumer to contact DOR, but will not provide any further assistance. Additionally, some RC staff may not have knowledge of the DOR system and how the system could serve the consumer. Stronger interagency relationship with DOR.

Great point Kavita- employer training is critical

One of the key areas, related to performance in Employment (and Community Engagement as well) is how well the individual is being supported to broaden life experiences so that their aspirations and future goals can be defined and expressed.

Thank you Roxy.

BUT to follow-up on the concern Beth raised - if someone is not being responsive - then what happens? How does the measurements or standards reflect that? But more important, how can the individual or family elevate the problem they are facing (in terms of someone not being responsive) so they can get the response or help needed. In other words - how do we make things happen so people are helped (and how do the measurements and standards also reflect)

Exactly Eric.

Is it employer training or is it really about working with employers to show how their business can be benefited by hiring individuals with different abilities that can diversify their workforce.

I agree Gabriel, If a person does not know their choices, are we giving them the breadth of those options.. We say the person does not want to work but without the life experience then the person may not know they have that choice..

Depending on what version of Zoom you have an how yours is set up - the "Raise Hand" feature will either be under the smiley face "Reactions" icon at the bottom of your Zoom screen, or you can open the "Participants Box"

I would ask the question what does employment mean? It could look different for many different people maybe the question could be what is your purpose or pursuing a purpose rather than a job so to speak. I think the conversation will be differnt

Integration vs inclusion is the bigger question

From an employment stand point, a major issue is the dearth of local businesses to see the benefit of hiring a person with a disability or IDD. While metrics are important to establish for the individuals, and Karen M's point about the person centered approach to determining the denominator based on the desire to be employment is well taken, one of the roles that the Regional Center (in conjunction with DOR) could be very helpful in would be the exposure and engagement of the local business communities about the viability of accessing this untapped resource pool of candidates. Simple metrics and targets could be based on contact and relationship building target Chambers of Commerce, BBB, etc. Addressing an employment rate of 14% for our community will have to be tackled on all sides

Pam's question is a good and important one - I think its both. Efforts need to work with people in businesses in addition to employment training.

With respect to this topic, the integration of consumers in the community, I hope that there can be a differentiation of the concept of being "IN" the community, versus being "OF" the community

To repeat Marty, integration needs to be person-centered. How many hours, types of activities, what kind of support, exercise, mental wellness, recreation. Needs to meaningful to that person

Jacquie—great point about being “of the community.”

General thought - the resources needed to properly collect, analyze, design solutions for improvement and repeating the whole process should be considered and identified. To properly accomplish the benefits from performance measures there needs to be sufficient resources to properly carry it out.

Good point Jacquie - similar in some respects to the old discussions back in the 1960's and early 1970's about community integration (racially) in public schools and the solution then to solve that - busing that took children out of their communities. In most cases that solution didn't work . There needs to be a good understanding and balance or else we can end up implementing solutions that are harmful or counter-productive or simply do not work. Inclusion is one thing. Integration is another thing. Sometimes it can be the same thing. Sometimes not.

The metric could be something as simple as "number of community-based partnerships sponsored by the RC"

I believe this gets done if vendors utilize their laison to help advertise what their organization offers

I think engagement in community is extremely important. If our overall goal over the first 50 years was to close large state institutions and support individuals living in what used to be called "the least restrictive" environment, what does that mean for an overarching goal moving forward (now that the DCs are closed). In my experience supporting people, it's in the "full community membership" (having REAL equal access to do what one wants and be seen as a valid member of a local community) that we see the embodiment of the core spirit of the Lanterman Act. I don't know how to "measure" that but what is called "social capital" or "quality of life" might be a place to look

Like employment options and skills set training

Eric - again, 100% agree with you ! :)

I agree with the lady, I think RC should do the outreach to big / important agencies not only CBO. Explaining the benefit of having a client that match what they do.

I agree with Harry! Person-centered planning is the heart of all of these priorities.

That is a great point Harry. It should start with the person centered plan ( a person's chosen way of life).

totally agree with Harry. It is foundational and helps lead to addressing the other issues and metrics. Also measurements need to reflect or measure unmet needs - that ultimately would come from a person centered plan where a service or need is not met

Recommend looking at the IHI (Institute for Healthcare Improvement) Toolkit for "What Matters to You" for older adults: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=http%3A%2F%2Fwww.ihi.org%2FEngage%2FInitiatives%2FAge-Friendly-Health-Systems%2FDocuments%2FIHI_Age_Friendly_What_Matters_to_Older_Adults_Toolkit.pdf&clen=2277407

I agree Harry. Great points.

Per usual, Harry speaks truth... and if the Performance Incentives are developed well from a Person Centerd perspective, THEN the outcomes measures connected will be more easily encountered. Capacity, skill building, and embrace of what can be a philosophical shift in some respects has to be foundational.

Yes Harry! Shift the system to revolve around the individual. Well said

We need to get to Person Centered Agencies where the agency shifts to meet the needs of the consumer. Our current system is always about the consumer having to shift. If we ever get to the system revolving around the chosen way of life of the consumer, we might get closer to true person-centered thinking.

Page 22 of the What Matters toolkit lists specifically how you can measure the success of a program in delivering person-centered care.

I agree Jacquie. The consumer has had to shift in some cases, and not always in their best interest.

Can we receive with each handout before our workgroup meetings the guiding principles of CHHS as a reminder of what we are directed to do.

Great job Harry and Marty spot on!

I agree Jacquie, we need to truly move to become person-centered agencies (systems change). It about "better lives, not better paper"

Are you looking at the needs and chooses of the consumer or are we looking at a checklist ? Good points Marty, if a person has food insecurity then nothing else matters ..

A priority area I'd like to see added is one for Transparency and Accountability - data needs to be presented in easy to understand way; increase uniformity amongst RC practices and POS guidelines/publish those/make them plain language; also, increase use of DDS clarifying letters and issue plan of corrections when measures not met. Also - to achieve equity, it's necessary to look at the whole person and take a multi-disciplinary approach. Too often, we hear from consumers and families say RCs decline approval for needed services because the service is not related to the developmental disability - but for underserved communities if you do not acknowledge barriers not related to the developmental disability, you will not make progress on reducing disparities.

One aspect of Person Centered Planning that we may not have discussed is that “nothing about the person without the person” - as a person centered planner myself, one emerging issue has been coming through is the family or caregivers wanting to have the plan done a lot of the time without the presence of the individual, attributing it to their inability to communicate - is there a way we can include a mechanism that the RC can track how much of the plan included the input, the presence of the individual themselves ? Everyone communicates and it is crucial to ensure the person is present for a person centered plan at least for a large portion of the time

Outcomes-based Measures should always be person centered. Consumers/families that provide the input for outcomes based measures should also be empowered to access that input online as recorded in a government funded survey or assessment, and request corrections.

Compliance with CBS rules is important for funding purposes and consistency, but I think this category is otherwise subsumed by the other categories.

For satisfaction purposes, I’d like to see a survey go to each client at least month before their annual IPP meeting to ask for input on their satisfaction with their services. That could then provide the basis for a person centered discussion of what’s best for that consumer.

Many families of color refer to the fair hearing process as the "unfair hearing" process - overwhelming, complex, skewed in favor of RCs which have in-house experts to testify, $ to hire outside counsel, etc.

I agree with Ardenna whole heartedly! My daughter was denied services twice before finally allowed to enter the regional center.

That means a more robust data system.. Big issue is we don’t know what we don’t know

Awesome suggestion Ardena!

I was just having this conversation around Deafness; it is not just about sign language but more critical is understanding the Deaf Culture. Why you should capitalize the D in Deaf is recognition of the culture..

All WORKGROUP MEMBERS, please stay signed in to Zoom for the break to facilitate assignments to Breakout Rooms

So refreshing Kavita, to hear that “everyone” can communicate. It is essential that the person’s whole life/current circumstances is considered when making decisions for their future. Non verbal should not mean non communicative.

Hey Amy should hv Marylou mention what you said in chat about workgroup members staying on during the break

There hasn’t been discussion of the implicit ableism that has been reported by many self-advocates. I feel like there aren’t enough voices of self-advocates in this workgroup.

Agree Judy

Sorry, my mute got stuck! yes, 2:00

Thank you Linda. We have an internal theory about PRAGNYA - that you cannot “not communicate” - even when we say nothing we are communicating something and even with any form of behavioral manifestation, it is a form of communication. It is important to have the individual whom we are looking to serve have a say in their plans

Thank you all; see you in a bit

Anyone who is NOT a Workgroup Member will be staying in the main room and having a discussion there.

still not added to a breakout -

pls let me know

havent received a request

I am not sure if I was added to my room since I didn’t receive the request to join :)

LIke Jacquie said, more than half the people we support do not have active family participation

Agree w Jacquie on importance of access- is there equity in hearing about potential services available

A, E and G

person centered planningequity in service access

Of course, if we choose E, then it must include C and D and B.

i got disconnected - and dropped out of my breakout room

Valid points Judy

Judy makes good points about IPP. This is why I believe innovation is important. RCs and agencies need support to turn this huge ship

I echo your thoughts Jami

That’s wrong to have Ipp without someone

How about asking: Was the person actually at their own IPP?

Public Poll Top 4:1) D- Person-Centered Planning (tied w/2)2) F- Consumer & Family Exp. & Satisfaction (tied w/1)3) A- Equity in Svc. Access & Purchase of Svc.4) C- Integration of consumers in the communityWorkgroup Member Top 4:1) A- Equity in Svc. Access & Purchase of Svc.2) D- Person-Centered Planning (tied w/2)3) F- Consumer & Family Exp. & Satisfaction4) G- Innovation in Svc. Availability & Delivery

Time Check - 5 minutes until we all come back together in this main room.

What happened? Group A got kicked out of our discussion.

Everyone is back in the main room now, the breakout sessions were only going until 3:10

Reposting just in case it doesn't show for people who were in the breakout rooms:Public Poll Top 4:1) D- Person-Centered Planning (tied w/2)2) F- Consumer & Family Exp. & Satisfaction (tied w/1)3) A- Equity in Svc. Access & Purchase of Svc.4) C- Integration of consumers in the communityWorkgroup Member Top 4:1) A- Equity in Svc. Access & Purchase of Svc.2) D- Person-Centered Planning (tied w/2)3) F- Consumer & Family Exp. & Satisfaction4) G- Innovation in Svc. Availability & Delivery

Great job Roy!

Thank you, Diana!

That was great Diana!

Thank you Diana!

Kaiser On The Spot survey

Thanks Beth!!1

Thank you Beth!! great reporting!!!

Great teamwork. Go team C!

IUJJJJ!!!

Great job Team C. Catherine & Jo!

Thanks Kathy--

Appreciate opportunity to participate and to the engagement of everyone on the call.

What a great day!! Thank you DDS and Group C as well.

IF you have more info you want to share from the discussions today, please email RCMeasures@dds.va.gov

Thank you all - much appreciated the passion, knowledge and commitment of this group!

Thank for the great input everyone. Great discussions both verbally and in the chat today!

Thanks all!

Thanks, everyone! Have a great evening!

Thanks Team D-- nice meeting you all

Thanks again