Today’s Vision…Tomorrow’s Reality Office of Developmental Programs Today’s Vision…Tomorrow’s Reality Futures Planning Implementation Proposal December 17, 2013

Perspectives

Today’s Vision

ODP Mission and Vision Futures Planning is founded on the Mission and Vision of the Office of Developmental Programs (ODP): Mission The mission of the Office of Developmental Programs is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives. Vision Our vision is to continuously improve an effective system of accessible services and supports that are flexible, innovative and person-centered.

Futures Planning Purpose Enrich chances for meaningful lives for Pennsylvanians with developmental disabilities Ensure the service system achieves quality outcomes for individuals and families Reduce service system complexity to simplify access to services Develop a service delivery system that is more fair and carefully manages taxpayer resources

Planning Structure Extended Team/Action Plan Teams ODP Core Team Source of exchange between staff and Core & Extended Teams Provided input Provided Subject Matter Expertise as needed to Core and Extended Teams ODP Team members acted as Action Plan Team Co-Leads All stakeholders had multiple and varied opportunities to offer suggestions and give feedback Everyone was encouraged to get involved and spread the word ODP Leadership Staff Participated in Extended Team Used feedback from community & staff in draft recommendations ODP and Stakeholders worked together through consensus Drafted recommendations on service system redesign based on existing mission and vision statements Incorporated feedback from community & staff into final recommendations Extended Team/Action Plan Teams ODP Core Team ODP Team Broader Engagement: Community & Staff

Statewide Stakeholder Representation Individuals and Families Providers County/Administrative Entity Staff Advocacy Organizations University Partners State Agency Partners

Futures Planning Time Line Futures Planning Began Jan 2013 First Extended Team Meeting Long Range Goals Developed First Public Comment Mar 2013 Objectives Developed May 2013 Action Plan Teams Formed Jun 2013 Second Public Comment Aug 2013 Final Public Comment Self-Advocate and Family Open Forums Oct 2013 Action Plans Finalized Nov 2013

Public comment periods advertised through the website Stakeholder Outreach Expectation of Extended Team to be a link or liaison with their respective community groups Website for all Futures Planning materials http://www.odpconsulting.net/odp-futures-planning/#.UbDOpPk-ZzD Public comment periods advertised through the website Statewide listening tours throughout the year by the Deputy Secretary Two open forums at the PA Disability Employment and Empowerment Summit (PADES) Five regional self-advocate and family forums hosted by ODP

Tomorrow’s Reality

Tomorrow’s Reality - Long Range Goals Each person is supported to: 1. Live and lead a productive, self-determined and safe life. 2. Make informed choices. 3. Enjoy real opportunities for a variety of relationships in which they are accepted, valued, and included. 4. Access services and supports throughout life that are creative and flexible. 5. Have their family and/or circles of support respected and assisted as needed with the understanding that the needs of the individual come first. 6. Receive well-coordinated quality supports and services from natural, public and private sectors. 7. Receive high quality services and supports in inclusive community settings. 8. Choose to self-direct paid services and supports within a defined budget based on assessed need. 9. Access the full range of technology to promote independence, inclusion, productivity and self-determination. 10. Experience seamless transitions throughout the life span. 11. Have the services and supports for their desired work, vocation and/or education. 12. Access unique, innovative, non-traditional services and supports.

ODP Futures Planning Objectives Each person’s budget is based upon assessed needs, and the individual will know and be able to control the services within their budget. Review and revise qualifications so that people will be supported by professionals who are appropriately qualified and trained to their individuals’ needs, including a focus on people with complex physical or behavioral health needs. Define a process to support creation of and funding for newer, better, reduced-cost ways to provide services. Integrate flexible models of service that can support peoples’ changing needs in their home communities, including supporting people through a physical or behavioral health crisis. Determine the best and simplest system to manage services to improve outcomes. Develop steps to define quality measures. The results of the measures then can be used to develop an action plan to improve quality of life for those supported by the ODP system. ODP will work with individuals, families, providers and others to develop meaningful measures that go beyond the minimum standards. Develop design options for a pilot program for managed care of developmental disability services. Pennsylvania will be an Employment First state. Employment is the first priority for people with disabilities.

Action Plan Development The eight work groups of the Extended Team developed action plans for each objective to move ODP toward the overall Long Range Goals. These plans included: Action items that will achieve the overall objective Action steps required to achieve the action item For ease of understanding, each action plan was summarized for the final public comment period and public forums All comments from public input and open forums were considered in the development of the Action Plans

Action Plan Prioritization The Core Team brought together the eight separate Action Plans and prioritized activities in a first phase implementation proposal for 2014. Consideration was given to: DPW Strategic Plan ODP Mission and Vision Themes across action plans Action items that needed to occur before other action items Action items that are realistic and doable Staff and financial resources

Implementation Proposal Based on the prioritization process, selected activities from all eight objective action plans are proposed Expected outcomes and resource needs are considered Necessary first steps for the long term success of the Futures Plan fall into the following areas: Using a Person-Centered Assessment Identifying Service Needs and Gaps Improving Provider Qualifications Ensuring and Enhancing Quality Designing Broad System Change

Implementation Proposal Structure Implementation proposals are structured as follows: Objective Number Reference Selected Action Items Expected Outcomes Time Line

Using a Person-Centered Assessment

Implementation Proposal – Person Centered Assessment Person-Centered Needs Assessment and Budget Process (Objective #1) SELECTED ACTION ITEMS Evaluation of current assessment process through interviews with individuals, families and other stakeholders Evaluation of available tools Finalize tool(s) to be used Create exception and appeals processes Explore establishing all service rates based on the cost to serve people with similar needs Explore relationship between assessment scores and budget ranges Develop operational process, including waiver, regulation, fiscal and other changes Create measures and begin monitoring to establish baselines

Implementation Proposal – Person Centered Assessment Person-Centered Needs Assessment and Budget Process EXPECTED OUTCOMES Provides more evidence-based understanding of services and supports that are focused on individual needs Provides individuals the opportunity to control their services and budget Offers consistency of practice Anticipated savings due to simpler process, allowing for the expansion of the number of people served Provides chance to more accurately connect needs to the budget Long range impact will be determined after development of the assessment and link to budget TIME LINE Selected action items will be done over 12 months 2-3 years to complete the full needs assessment and budgeting process

Identifying Service Needs and Gaps

Implementation Proposal - Service Needs and Gaps Innovative Services and Supports (Objective #3) SELECTED ACTION ITEMS Develop and implement the standards and process for the introduction of new/different ways that address services and supports Identify resources that aren’t currently used or that are not used enough EXPECTED OUTCOMES Encourages creativity and innovation in program development and service delivery Allows ODP to know what else can be provided in a more efficient way than what is currently being offered Anticipated savings at an individual level Overall, provides data that shows gaps and how changes can be made May identify resources that aren’t currently used TIME LINE 12 months Ongoing assessment and evaluation of new process and standards

Implementation Proposal – Service Needs and Gaps Supports for Changing Needs in Times of Crisis and Transition (Objective #4) SELECTED ACTION ITEMS Conduct gap analysis with a cross-system team to determine what currently exists, what is working, and activities that can be easily replicated Continue implementation of Dual Diagnosis Initiative focusing on regional stabilization teams EXPECTED OUTCOMES Reduction in costs for people by providing support before a crisis occurs and before issues happen during a key transition period Use of supports that improve quality of life and avoid more intensive or higher cost services TIME LINE 6-9 months; some things already in process

Implementation Proposal – Service Needs and Gaps Employment First (Objective #8) SELECTED ACTION ITEMS Implementation of this Action Plan along with the Governor’s employment initiative and work among agencies including the State Employment Leadership Network (SELN) EXPECTED OUTCOMES Improved quality of life for individuals through gainful employment as a respected member of their community Long term savings in improved outcomes by people working and being less dependent on public supports TIME LINE 12+ months

Improving Provider Qualifications

Implementation Proposal – Provider Qualifications Provider Qualifications (Objective #2) SELECTED ACTION ITEMS Conduct a review of service definitions (current and proposed) and provider qualifications to identify necessary changes Align and improve training with current and proposed provider qualifications; identify training gaps; complete development of pre-enrollment training; create a record of current ODP training offerings Explore workforce development activities through higher education and vocational education Create a training curriculum about intellectual disability and autism for Certified Nursing Assistants

Implementation Proposal – Provider Qualifications Provider Qualifications (Objective #2) EXPECTED OUTCOMES Enhanced quality of life for people Increased provider capacity Improved staff expertise in supporting people with intellectual disabilities and autism Workforce having proper training results in less time to learn the job and improved length of time on the job Proper training creates better management for individual behavioral challenges and physical health reducing the need for increased staffing TIME LINE 12-18 months

Ensuring and Enhancing Quality

Implementation Proposal – Ensuring and Enhancing Quality Quality (Objective #6) SELECTED ACTION ITEMS Identify quality of life and outcome measures Collect data on existing quality measures and data sources and gaps Publish first list of selected quality measures Create provider profiles and determine whether providers or ODP will collect and display the profile information Build structure for quality improvement projects EXPECTED OUTCOMES Remove data and reports that are currently being collected and developed but not used Anticipated savings because of quality monitoring and improved outcomes Long term reduction in services that don’t achieve individual outcomes Improved individual outcomes due to better options over time TIME LINE 18-24 months

Designing Broad System Change

Implementation Proposal – Broad System Change Create the Best and Simplest System of Services and Supports (Objective #5) SELECTED ACTION ITEMS Review current and new support and system options Improve the Individual Support Plan (ISP) Reevaluate required duties of Administrative Entities and the Operating Agreement Reevaluate required duties of Supports Coordination Agencies and the Provider Agreement and related policies Train Supports Coordinators about ISP monitoring (already happening)

Implementation Proposal – Broad System Change Create the Best and Simplest System of Services and Supports EXPECTED OUTCOMES Improves focus on outcomes for people in the ISP process Improves Supports Coordination focus on identifying risk factors and addressing them early Maximize and strengthen chances for community inclusion and use of natural supports Improvements to ISP monitoring for intended outcomes TIME LINE 9-12 months

Implementation Proposal – Broad System Change Integrated, Coordinated Support (Objective #7) SELECTED ACTION ITEMS Design an integrated, coordinated model of support that addresses the needs of individuals with developmental disabilities and can lead to a pilot after Year 1 EXPECTED OUTCOMES Improved individual outcomes and quality of life if supports are coordinated Anticipated savings will be measured through the pilot model TIME LINE 12 months

Support Implementation Activities to Support Implementation

Activities to Support Implementation Stakeholder Input/Data Collection Assess the current ODP service system through data collection and stakeholder interviews, surveys, focus groups, etc. Resources Evaluate internal resources that can be realigned and redeployed Evaluate new resources required, some of which may be flexible, short-term or specific to a single task Communication Implement a communication strategy that continually informs and engages stakeholders, both internally and externally Policy Revisions Assess current policies for relevance, clarity and the need for new and changed policies (including changes to Medicaid Waivers) Information Technology Assess current information technology needs

Proposed Implementation Structure Implementation of all proposals will require a great deal of effort and coordination A proposed structure will guide implementation: Deputy Secretary Executive Leadership Team Project Manager Steering Committee Implementation Teams Extended Team Stakeholders

Staffed by members of the ODP Executive Leadership Team Steering Committee Charged with oversight and coordination of integrated Action Plan implementation Staffed by members of the ODP Executive Leadership Team Reports to the ODP Executive Leadership Team and DPW Leadership Led by the ODP Project Manager Guided by a project work plan Gives regular reports to ODP and DPW Leadership and the Extended Team that include: Project status Major milestones Anticipated challenges Updates on communication with stakeholders Suggested changes to project work plan Acts as a liaison between the ODP Executive Leadership Team and Implementation Team leads

Initial Implementation Time Line Start ODP Steering Committee Form Implementation Teams Continue evaluation of internal resources that can be realigned Develop and start using communication strategy Jan 2014 Begin stakeholder input activities Collect data from other states Implementation teams begin work Feb 2014 Extended Team update meeting Finish stakeholder input activities for initial assessments Evaluate other work supporting all objectives– policy, regulation, waiver amendments, IT changes, training/ education; strategy Mar 2014

Planning for 2015 will revisit these suggestions Next Steps - 2015 These proposals are meant to create the foundation for full realization of the ODP Futures Plan The Extended Team worked in partnership with ODP to determine additional short term objectives and parking lot issues Planning for 2015 will revisit these suggestions

Tomorrow – A Story Perspectives

Today’s Vision…Tomorrow’s Reality Thank you to everyone who took part in and gave input to The Office of Developmental Program’s Today’s Vision…Tomorrow’s Reality