Person-Centered Practices Self-Assessment

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Person-Centered Practices Self-Assessment

Transcript Of Person-Centered Practices Self-Assessment

Person-Centered Practices Self-Assessment
Mary Lou Bourne, National Association of State Directors of Developmental Disabilities Services
October 2020

Introduction
This Self-Assessment is designed to help leadership at human service agencies in States, Tribes, and Territories to measure their progress in developing a more personcentered system. It is designed for use by the administrative entities (“agencies”) with the authority to administer or operate federal programs for long-term services and supports, including home and community-based services. It can be used by the wide range of systems that oversee services and supports for people with disabilities of all ages, older adults with long-term service and support needs, and other health and social service programs.
How to Use It
We encourage you to take this Self-Assessment on a regular basis (for example, every six months). It should be completed by individuals who have a strong working knowledge of the operational activities of the system, including the administrative functions carried out by the Medicaid authority. Each State, Tribe, or Territory will vary in the use of the Self-Assessment, depending on the breadth of involvement with NCAPPS and other factors. For example, the Self-Assessment may or may not include the Older Americans act agency, the behavioral health and developmental disabilities agencies and/or any other administrative agency overseeing the availability of longterm services and supports. Individuals engaging in the Self-Assessment process should have the authority to use the information to pursue systems change efforts. If warranted, the Self-Assessment could be filled out by individuals at multiple levels in the organization (i.e., executives/senior administrators, mid-level managers, and frontline staff) who can provide diverse insights. If multiple individuals complete the Self-Assessment, it might be useful to examine average scores as well as measures of spread (e.g., standard deviation, absolute deviation). Once individuals within the agency have completed the Self-Assessment independently, they can meet to look at the scores, discuss discrepancies, and come to agreement on a single agency score. The Self-Assessment is divided into eight sections, as shown in the following graphic. Each represents a key area for consideration as agency leadership seeks to increase or expand person-centered practices.
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Person-Centered Practices Self-Assessment

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Leadership
How well people in charge know about and support person-centered practices

88
Person-Centered Culture
How person -centered is the system 's culture and how can person-centered approaches
help address risks

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Person-Centered Service Planning & Monitoring

-~0 0 Finance

How is the process for creating person-centered
plans and ensuring the services are working

How are agreements with providers structured and how
well are services helping people reach their goals

· 1- 0 Elisibility & Service Access
How person-centered is the intake and assessment
process for people seeking supports
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Workforce Capacity & Capabilities
How well staff know about and have the skills to
deliver person-centered planning and supports

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8 ,.... 8
Collaboration &
Partnership
How are partnerships with service users, families, service
providers, and advocacy organizations

L*i*J 8 ......... Quality& Innovation
The agency's mission and standards

Each of the eight sections describes observable practice and includes five statements from which to choose. It is very important to read through all of the statements before checking the one that best applies to your agency. Each statement includes bolded key terms to emphasize the most critical change. Choose the statement in each section that best corresponds with your progress to date. Many of the statements depict a succession of increasingly person-centered practices. If you’re having a hard time choosing between two statements, check the one that represents practices at your organization that have been fully and completely realized, even if the next statement represents practices that are started or somewhat implemented. In other words, in order to check the third box, confirm that your agency meets or exceeds the criteria described in the first and second boxes.
When first engaging in this assessment, many agencies find the majority of progress topping out in the first or second statements; this is to be expected and indicates there is room to grow in your agency. If you are making some progress, you might check the third statement. Good progress would mean checking the fourth statement, and excellent progress would mean that you’re checking the fifth statement. It takes
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Person-Centered Practices Self-Assessment
significant efforts to move from one statement to the next, and very few organizations score a four or five in every area.
How to Use Your Scores
The scores from this assessment can inform development of a systems change plan. Examining differences in scores between different programs or staffing levels in your agency might help you identify targeted efforts to support particular areas for improvement. The plan should describe how you will develop changes to move your system to a score of five (excellent progress). For example, if you score a two in one area, your action plan will focus on how to move to a three or four. In this way, the Self-Assessment can help you decide where to focus limited energy and resources. If you complete it on an ongoing basis, the assessment scores can help provide a picture of whether and how your agency is changing over time as you work toward greater levels of person-centered practice. Agency leadership can use the scores to understand whether their systems change efforts are effective and provide information for changing course if necessary.
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Person-Centered Practices Self-Assessment
Establishing Definitions to Help with the SelfAssessment
It will be helpful for your agency to agree to some basic definitions before you complete the Self-Assessment. Senior leadership should identify the following terms:
Leadership: What levels of leadership in addition to the highest-level executives are included in the definition of leadership for this assessment in your agency?
Strategic Plan: What document name is given to the guiding document that sets goals, initiatives, and strategies to be used by all divisions of the administrative agency to make decisions and set priorities? Sometimes this is called an annual planning document, a guiding document, or a strategic plan—or it may be something different. Identify the plan used in your agency to which these elements will be applied.
Direct Care Workforce: Who are the staff that would be identified as direct care workforce in this system? These are not necessarily agency employees; they may work for private provider agencies. However, in some states that deliver state-operated services, there may also be a direct care workforce who are state employees. The definition of direct care workforce here will be used to assess person-centered practices in Section 6.3.
Advocacy Organizations: Identify groups to include when assessing the agency’s engagement with Advocacy Organizations in Section 7.4.
Quality Management or Quality Review Council: What is the name of the committee or workgroup to be considered when assessing practices in Section 8.2? This group is typically created or established through the administrative agency and is charged with reviewing data that demonstrates the service delivery system’s performance and using such data to identify areas for improvement. Agencies typically assign such a committee or work group to guide or oversee quality improvement strategies for the full system on a regular basis. However, they do not carry out the tactical operations of quality improvement. This council or committee might also provide specific guidance to internal quality management offices or other related quality guidance and direction. Some agencies may have a work group or team focused exclusively on reviewing critical incidents or health/safety data and making recommendations on how to improve in this area. While it is a good first step, quality councils typically have a broader charter to include factors beyond health, safety and welfare.
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The Self-Assessment
Leadership
1.1 Leadership
 1 Our leaders recognize that person-centered planning is important and assign the appropriate authority to program directors to meet basic assurances.
 2 Our leaders recognize the role person-centered planning plays in establishing values in the system and assure program directors carry it forward.
 3 Our leaders value the impact person-centered planning has in people’s lives and on team effectiveness. We have formal feedback mechanisms to determine how personcentered planning is being implemented.
 4 Our leaders value the impact of person-centered planning and have been trained in person-centered planning. Our leaders recognize the applicability of person-centered principles to intake, assessment, planning and monitoring activities (person-centered practices).
 5 Our leaders demonstrate the value of person-centered practices by actively participating in training opportunities, promoting person-centered practices in all functional areas within our agency, and consistently communicate the importance of person-centered practices. Measures of person-centered practices are part of our regular quality improvement activities and senior leadership intentionally promotes the use of person-centered practices with other systems of care including justice, education, healthcare, additional social service agencies.
1.2 Strategy
 1 Our agency does not specifically address person-centered planning or practices in a strategic plan or other key strategy documents. The responsibility for person-centered planning and practices lies primarily with service provider agencies or case management agencies, not this agency.
 2 Our agency has a strategic plan, and our values include the importance of personcentered planning or practices, but we do not have a specific strategy to spread person-centered planning and practices.
 3 We have identified some of the areas of our system that we think will be affected by person-centered practices and have a clear strategy to address how we will meet the expectations. We have sought input from other stakeholders on how and where person-centered practices can be embedded into our system.
 4 Our strategy for implementing person-centered practices includes our assessment, planning and monitoring procedures, and training needed to fully understand this new approach. Our plan includes starting with agency leadership and management staff training.
 5 We have a clear vision and strategy for delivering person-centered practices. Our strategy is based on a good understanding of where we are now, and on the future expressed by people we support and other stakeholders. Our agency senior leadership team actively supports the strategy and has aligned resources to support the strategy. We are all held accountable for delivering on it. Person-centered practices inform all policy and guidance materials within our agency.
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1.3 Communication

1

We engage with the community using communications practices, but these practices do not specifically address person-centered principles and values.

2

We understand that for communication practices to be effective, all communications, policy, and practice must be aligned with person-centered principles and values.

3

We have begun discussions about a communication strategy that aligns all communications, policy, and practice with person-centered principles and values.

4

We have designed components of our communication strategy that align all communications, policy, and practice with person-centered principles and values. We are meeting with stakeholders to determine if the strategy ensures the right communication modes to reach all stakeholders, including diverse cultural and ethnic accessibility.

5

Our communication strategy aligns policy and practice with person-centered principles and values and includes a feedback loop to collect stakeholder input. The strategy also includes various modes of communication that best suit all stakeholders and is transparent, culturally responsive and accessible, and user friendly.

1.4 Law/Statute, Regulation, Policy, and Protocols/Guidance

1 2 3 4 5

We have not yet examined statute and regulations for specific areas that address the use of person-centered planning or practices.
Our agency recognizes the need to update governance documents to convey our values related to person-centered planning and practices.
Our agency has identified all regulations and policies that need updating to assure person-centered planning practices are defined and supported. Our agency has a work plan in place to accomplish the work.
We have a work team currently updating regulations, policies, and guidance documents to assure person-centered planning and practices are defined and clearly described.
Our policies, regulations, and guidance documents have been updated and fully implemented to ensure active promotion of person-centered practices, and these documents are aligned with our statute.

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Person-Centered Culture

2.1 Changing the Culture of the Service Delivery System

1

Our agency does not actively participate in shaping the culture of person-centered service delivery.

2

Our agency can influence the culture of our service delivery system, but we do not have a clear plan on how we will do so.

3

Our agency has developed a plan, including a communication plan, that describes expectations of all leaders and managers to engage with service users, family members, and service providers. The plan includes a clear set of person-centered principles to guide the practices of all staff across the full agency.

4

Our agency identifies areas where person-centered principles and practices have successfully been implemented in their interactions with partners and stakeholders; these stories are shared publicly.

5

Our agency staff routinely communicate about person-centered practices in all aspects of the service delivery system. We demonstrate person-centered principles through the use of personal narratives and other data during oversight meetings, utilization reviews, monitoring reviews, trainings, and feedback to all components of the system.

2.2 Promoting Cultural Competence through Person-Centered Planning and Practice

1

Our agency has a definition of cultural competency that incorporates current best practice in understanding cultural, ethnic, linguistic and other differences.

2

Our agency applies culturally competent knowledge and expertise in the development of person-centered planning procedures.

3

Our agency seeks to understand the diverse cultural and linguistic backgrounds of the people we serve and those who work in our agencies, and implements training in culturally competent, person-centered practices for all staff members.

4

Our agency has incorporated culturally competent practices into all person-centered tools and procedures and makes this information available to all stakeholders through training, written materials, social media and other means of communicating intended to reach all types of linguistic needs.

5

Person-centered planning tools and practices demonstrate best practice in engaging with all people we support in culturally competent methods and reflect individual cultural backgrounds and preferences.

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2.3 Person-Centered Approach to Risk

1

It is the responsibility of case management and/or providers to address all health and safety risks in the planning document, and compliance reviews assure this is met.

2

Our agency has an assessment and service planning process and procedures that require the team to identify and discuss all risks and how each risk will be mitigated. The policy includes a description of who is on the team and how they are identified.

3

Our agency has developed an assessment and service planning process that respects the cultural identity of the individual, and includes a discussion of what is important to the person and associated risks, how the individual prefers to address risk within their culturally accepted practice, and how the team (including legal guardians as appropriate) will assure a plan is in place to assure preferences are honored while also minimizing the impact of identified risks. Such assurances include how to resolve conflicts related to risk taking within the context of respecting culturally diverse and appropriate practices.

4

Our agency has developed and distributed guidance on how service planning teams will assess and identify the balance between a person’s desire and rights to take reasonable risks when exploring their community or learning new skills and the potential harm that may occur. The guidance includes how to develop a risk management plan for these situations, inclusive of supported decision making and conflict resolution procedures for all team members.

5

Our agency has worked with all stakeholders—including people who use services, families, service providers, case managers, and others—to develop and implement assessment, service planning, and service plan monitoring procedures that fully align with finding a balance between dignity of choice/risk and the supports provided. Included in this are assurances the person has demonstrated an informed understanding of the choices made.

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3. Eligibility and Access

3.1 Eligibility

1

Our agency relies on and uses deficit-based or clinical needs-based assessments completed by professionals to determine eligibility.

2

Our agency understands the need to include an interview with the person requesting enrollment along with assessments completed by professionals as part of the eligibility/intake process. The focus of intake and referral is not on potential paid services but on the goals and outcomes a person wants for their life, respecting their cultural and linguistic background.

3

Our agency is in the process of reviewing eligibility requirements to determine how to include a person-centered assessment in addition to professionals’ assessments when determining eligibility. We are removing discussions of services during intake and eligibility.

4

Our agency has developed a new process to determine eligibility that includes a person-centered assessment developed through conversations with people and their families or circles of support and clearly demonstrates respect for people’s cultural and/or ethnic background and identity.

5

Our agency has implemented the system-wide use of a person-centered assessment in addition to assessments from health providers to determine eligibility and make appropriate referrals to additional services, and our agency tracks our results to determine cultural and ethnic equity in access.

3.2 Cultural Relevance and Linguistic Accessibility

1

Our agency provides some informational materials in languages other than English but does not have a comprehensive plan for ensuring all informational materials are accessible to people whose proficiency in English language may be limited.

2

Our agency uses demographic data to understand the racial, ethnic, and linguistic backgrounds of people who are eligible for services and uses these data to develop linguistically accessible informational materials.

3

Our agency uses demographic data to understand the racial, ethnic, and linguistic backgrounds of people who seek out services and those determined eligible for services. We use these data to ensure informational materials are both linguistically accessible and racially, ethnically, and culturally relevant (i.e., pictures and examples depict people from different cultural backgrounds, and content is sensitive to cultural differences, practices, and customs).

4

Our agency partners with members of racially, ethnically, and linguistically diverse communities and uses demographic data to create culturally and linguistically accessible information distribution methods and materials.

5

Our agency uses demographic data and partners with members of culturally and linguistically diverse communities to develop and execute a strategy for implementation of entry procedures and distribution of informational materials which are accessible to people of all cultural, ethnic, and linguistic backgrounds.

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