Val Bradley and Sarah Taub Human Services Research Institute November 2002 National Core Indicators: How Does Orange County Compare? Phase IV (2001-2002) Results

Project Beginnings NASDDDS and HSRI collaboration Launched in 1997 Seven field test states + steering committee ~60 candidate performance indicators Development of data collection instruments

What has NCI Accomplished? Nationally recognized set of performance and outcome indicators for developmental disabilities service systems Benchmarks of performance Trend data at the state & national level Reliable data collection methods & tools

What are the Core Indicators? Consumer Outcomes: Satisfaction, choice, employment Provider Agency/Workforce Stability: Staff turnover System Performance Cost/Utilization Access Protection of Health and Safety Incidents, Mortality, Restraints

Recent Developments Currently 22 states plus Orange in Phase V of data collection Mobilization of subcommittees to address specific issues Governing structure will continue Staff will continue to seek other sources of funding (e.g., Kennedy Foundation) Next meeting will be in late July

Specific Recommendations States want to continue to work on comparability of health and welfare indicators Until then states will receive information on whether or not their particular trend line has changed (e.g., with respect to restraints) Wellness items will be added to consumer survey (i.e., obesity, smoking, and exercise)

Specific Recommendations Family support indicators have been added to indicator list New states will be mentored by “veteran” states Should pursue a “quality consortium” when new Real Choice grants are announced Name change to National Core Indicators (NCI)

Participating States Phase V WA IN AZ UT NC IL IA OK VT WV KY PA MA DE RI CT MT WY NE HI Orange County AL SD SC ME

What Are State Doing With the Data? Pennsylvania – External monitoring and quality improvement South Carolina – Core of external monitoring Wyoming – Annual reports Massachusetts – Strategic planning Maine and South Dakota – Provider profiles North Carolina – Health indicators

National Core Indicators Selected Results: Orange County and National Benchmarks

Provider Survey Measures Staff Stability and Board Representation 38 agencies reported data 21% of agencies reporting provide both residential and day supports 5 NCI states collected provider survey data in Phase IV

Staff Turnover Rates FY1999-FY2001

Provider Survey: Staff Stability

Consumer and Family Representation on Agency Boards of Directors (FY2001)

Areas of Strength Staff stability: Orange County’s turnover rate was the second lowest out of 5 NCI states reporting Board representation: Orange County reported the highest percentage of consumers who were voting members on agency boards of directors

Adult Family Survey Surveys of families with an adult family member living at home 881 surveys returned (out of about 2900) Average age of respondent = 59 90% of respondents were parents Most common supports received: transportation (61%) day services (61%) financial (40%) out-of-home respite (27%) in-home support (21%)

Adult Family Survey

Adult Family Survey

Adult Family Survey

Adult Family Survey RCOC State Avg 88% 80% 93% 77% 58% 60% (% shown = “yes” response) RCOC State Avg Staff respect your choices and opinions 88% 80% Staff are respectful and courteous 93% Family has been informed of agency’s grievance process 77% 58% Family satisfied with grievance resolution 60%

Adult Family Survey RCOC State Avg 61% 57% 54% 51% 84% 68% 46% 39% (% shown = “yes” response) RCOC State Avg Supports offered meet family’s needs 61% 57% Help was provided in a crisis situation 54% 51% Translators are available if necessary 84% 68% Staff help connect family to natural supports 46% 39%

Adult Family Survey RCOC State Avg 62% 69% 33% 40% 32% 45% 41% 49% (% shown = “yes” response) RCOC State Avg Day provider involves family in important decisions 62% 69% Family chooses support workers 33% 40% Family knows how much $ is spent on family member 32% 45% Family decides how the $ is spent 41% 49%

Areas of Strength Provision of informational material to families Cultural competence (providing materials and assistance in native languages) Respectful, knowledgeable staff Process for filing and resolving grievances Provision of needed services

Potential Areas for Improvement Choice of support providers Involvement of families in decision-making Information about and control over budgets

Consumer Survey 456 surveys completed 81% were able to respond to Section I (compared with average 67% across other NCI states, this was the highest response rate out of all 16 states) 11% spoke primary language other than English (0.3% across all states)

Level of MR - National Sample

Place of Residence – National Sample

Consumer Survey Analysis Four “scales” were created to combine sets of related items Scales are considered to be reliable if alpha > .70 Service Coordination (.80) Community Inclusion (.89) Support-Related Choices (.92) Personal Choices (.95)

Consumer Survey Analysis Service Coordination Scale Person knows service coordinator Service coordinator helps people get what they need Service coordinator asks people what is important to them

Consumer Survey – Service Coordination Scale Results Orange County’s score = 0.83 90% know who their service coordinator is 80% said that the service coordinator helps them to get what they need 71% said that the service coordinator asked them what was important to them Average for other 15 states = 0.81 No significant difference

Consumer Survey Analysis Community Inclusion Scale Goes shopping Goes on errands or appointments Plays sports or exercises Goes out to eat Attends religious services Belongs to clubs or community organizations Goes out for entertainment

Consumer Survey – Community Inclusion Scale Results Orange County’s score = 0.81 Average for other 15 states = 0.78 Orange County scored significantly above average

Consumer Survey Analysis Support Related Choices Scale Chose job or day activity Chooses support staff at home Chooses support staff at job/day activity Chose service coordinator Chose residence

Consumer Survey – Supports Related Choices Scale Results Orange County’s score = 0.65 Average for other 15 states = 0.61 Orange County scored significantly above average

Consumer Survey Analysis Personal Choices Scale Chose roommate Chooses daily schedule Chooses what to do in free time Chooses what to buy with spending money

Consumer Survey – Personal Choices Scale Results Orange County’s score = 0.80 Average for other 15 states = 0.75 Orange County scored significantly above average

Consumer Survey – Relationships RCOC State Avg Proportion of people who have friends outside family and service system 75% 71% Proportion of people who have a close friend 81% 80% Proportion of people who can see friends when they want 79% Proportion of people who can see families when they want 70% 76%

Areas of Strength Supporting participation in community activities Supporting individuals to make decisions, offering choices

Potential Areas for Improvement Aim for better than average scores on service coordination indicators (keeping in mind that caseloads are high in CA) Increase focus on self-determination, opportunities for individuals (and families) to exercise control over their own supports (hiring staff, etc.)

What Do You Do With the Information? Include at your web site Prepare annual reports Develop provider profiles Use with sister agencies Use in allocation decisions Use to spot red flags

For More Information Final Reports for Phase IV will be available on HSRI’s website by the end of the November: www.hsri.org