Pam Treadway, M.Ed. Senior Clinical Consultant September 19, 2013 THURSDAY TARGETED TRAINING: A Comprehensive Look at Quarterly Summary Reports Pam Treadway, M.Ed. Senior Clinical Consultant September 19, 2013

Agenda Review of Regulations and BAS Expectations Monthly Progress Notes to Quarterly Summary Report Examples Final Considerations

Regulations & Expectations

EXPECTATION: ENCOUNTER FORMS All AAW providers, except for Assistive Technology and Environmental Modification, must complete Encounter Forms each time a service is rendered SCs are exempt from completing Providers maintain Encounter Forms in their records

REGULATION “DPW Rules & Regulation, Title 55: Chapter 51.15: Provider Records,” a provider must “document that the [services] for which it claims payment were provided to the participant and that information submitted in support of the payment is true, accurate and complete.”

ENCOUNTER FORM PURPOSE Describe what occurred during service Remind staff that service activities must relate to goals and objectives (Summary of Activities) Verify PROMISe claims (financial accountability) Serve as a reference for the provider when compiling the Monthly Progress Note

REGULATION: MONTHLY PROGRESS NOTES “DPW Rules & Regulation, Title 55: Chapter 51.16: Progress Notes,” a provider shall “complete a monthly progress note that substantiates the claim for the provision of a [service] it provides at least monthly. A provider shall maintain [Monthly Progress Notes] in a participant's record.”

MONTHLY PROGRESS NOTE PURPOSE To report to the SC on the participant’s progress made toward goals and objectives. To help communicate changes in service needs To justify the need for change

WHY ARE WE DOING ALL THIS PAPERWORK?

For the ISP team to…… Evaluate whether progress is being made toward goals and objectives in the ISP that are linked to the service (need to be specific to the objective written) Example: Objective- When given the opportunity at work, Matt will respond to a greeting by saying “hello” 100% of the time without job coach prompts for one quarter. Progress- Based upon the data, this month Matt has responded to a greeting 85% of the time independently with no prompts. Document that provider activities are aligned with the goals and objectives agreed upon by the ISP team Ensure that the service is being delivered in the way it is intended per the ISP and the AAW service definition (scope, limitations, staffing, etc.).

From monthly progress notes to quarterly summary reports

Monthly Progress Note (MPN): Guidelines All services must submit monthly progress notes, except for SC, Assistive Technology, and Environmental Modification Services that are not required to have objectives must submit MPN Service providers should be aware of which objectives are linked to their service Progress should be reported on each objectives for which the service is responsible Progress needs to be reported in quantifiable terms (compare to criteria)

Monthly Progress Note (MPN): Provider Guidelines If the service is occurring on a less than monthly frequency, the provider should complete one Monthly Progress Note for each time the service is provided.        This form must be submitted each month to the participant’s SC no later than the 10th of the following month. Be sure to keep copies of Monthly Progress Notes in the participant’s file to be referenced during monitoring.

Services Exempt from Objectives Services that are paid by a single unit and/or primarily support caregivers are not required to have objectives: Assistive Technology* Behavioral Specialist (Plan Development) Environmental Modifications* Family Counseling Family Training Job Assessment Job Finding Respite Supports Coordination* * No MPN required

MPNs and QSRs Start with Objectives Objectives should be aligned with the goals developed by the team Objectives should be developed asking the following questions: When will the person practice, learn and use the skill/behavior? (CONDITION) What exactly is the behavior/skill that will be practiced, learned and used? (BEHAVIOR) How do we know that mastery was achieved? (CRITERIA) Supports should be implemented working towards the goals/objectives using best practices Data should be kept based upon the specifics of the goals/objectives For example, using a task analysis or collecting information on duration, frequency, etc regarding the skill/behavior Report the data and anecdotal information to the SC in a consistent manner (using a quarterly report format)

Some examples.....

Sample MPN without Objectives Goal Objective Monthly Report Suggested Next Step Employment: Job Assessment N/A (objectives not required for Job Assessment) The Job Assessment for Chris is in progress. He completed two job tryouts in August (ABC Pet Supply and Martin’s Veterinary Hospital). The final job tryout is scheduled for beginning of September. Continue

Sample MPN without Objectives Goal Objective Monthly Report Suggested Next Step Respite N/A (objectives not required for Respite) Mitchell received in-home respite for 5 consecutive days in the month of August while his parents were on a business trip.

Incorrect MPN Goal Objective Monthly Report Suggested Next Step Independent Living Skills When with CI staff, Erin will demonstrate how to do laundry with assistance. Erin does her laundry with her CI staff on most Fridays. Sometimes she doesn’t feel like doing it and will ask to postpone doing it until Saturday mornings. Continue

Incorrect MPN Goal Objective Monthly Report Suggested Next Step Coping Skills When in the community (e.g. shopping at the mall, eating at a restaurant) and it becomes crowded and noisy, Robin will ask to find somewhere quiet to take a break instead of yelling or hitting staff, 4 out of 5 consecutive visits into the community for two months. Robin doesn’t like going to the mall. Staff and family report that she has hit them several times while they were on a community outing. Continue

MPN to QSR: ONE service across one quarter

Final Considerations MPNs and QSRs need to reflect progress on all objectives Keep number of goals and objectives to a reasonable level If objectives are not written correctly by the provider, then reporting is going to be problematic Remember – Objectives Cheat Sheet Follow-up with provider if revisions were requested to objectives

Final Considerations Behavioral Specialist should report progress on the Desired Behavioral Outcomes in the BSP Providers should be making data-based decisions Objectives should not continue indefinitely if progress is not indicated – look for decisions to be included in MPN If changes are not indicated to objectives when there is a lack of progress or regression, this must be brought to the team’s attention

Resource Virtual Training Center: http://bastraining.tiu11.org/ Path: Adult Autism Waiver(AAW) Information > AAW Provider Training and Information > Communication to Providers > Guidance on Reporting Requirements