2010 TECHNICAL ASSISTANCE EVALUATION REPORT SUMMARY The provision of training and technical assistance (TA) to provider agencies is an integral component of the D.C. Health Resources Partnership’s (DCHRP) mission to expand the community health care capacity to serve individuals with intellectual and other developmental disabilities (IDD). The Research and Evaluation Team (RET) of Georgetown University Center for Child and Human Development (GUCCHD) conducted telephone interviews on behalf of the DCHRP to gather feedback regarding the TA provided. Executive directors, nursing directors, Qualified Developmental Disability Professionals (QDDPs) and house managers from each agency were contacted for the interviews. A total of 29 individuals completed the interviews, with a response rate of 100%. The interviews consisted of closed- and open-ended questions, with an emphasis on satisfaction with various aspects of TA. In a few cases, responses were compared based on role of the respondent and the size of the agency, and responses from comparable questions on the 2006 DCHRP evaluation were also examined to observe notable differences Highlights: 90% of respondents were satisfied to very satisfied with the TA they received from DCHRP. Over 82% of respondents noted that the DCHRP responded quickly to their requests and that they and their agencies were better prepared to improve the lives of and achieve better health outcomes for individuals with developmental disabilities as a result of the TA. There were marked increases in the use of information and strategies provided by DCHRP and the use of the DCHRP website when compared to responses from the original 2006 DCHRP evaluation. Georgetown University Center for Child and Human Development University Center for Excellence in Developmental Disabilities

Overview of TA provided Most respondents reported receiving consultation around IDD (96.6%) and monitoring of service provider standards (89.7%). All received TA on-site, while over two-thirds also received TA over the phone. The vast majority of respondents (89.7%) reported that their TA request was addressed quickly. Types of TA provided by DCHRP as reported by provider agencies 79.30% 89.70% 96.60% Information Training Monitoring of service provider standards Consultation around IDD

Perceived Goals of DCHRP TA Respondents were given a list of statements and asked to report whether, in their opinion, each statement was a goal of DCHRP. Out of the five statements listed, all respondents affirmed that providing agency staff with the information needed to help them improve was a goal of DCHRP, followed closely by the goal of improving the development and use of the health care management plan. Respondents from larger agencies and executive directors appeared to be less inclined to affirm that a particular statement was a goal of the DCHRP. Respondents suggested additional goals for DCHRP in terms of improving the health care of individuals with developmental disabilities. As the sample below indicates, many of these aims reflected support for enhance reporting requirements and the development of standards.  “Work with agency staff to review the medical and ISP (Individual Service Plan) records to ensure that all immediate appointments and recommendations are followed through.”  “Provide standards that are uniform throughout the District.”  “Provide training and network meetings so that providers and nurses get to meet with each other and… make everybody on the same page.”

Satisfaction with TA provided The vast majority of respondents were satisfied or very satisfied with the overall TA they received from DCHRP and with the DCHRP experience overall, inclusive of other DCHRP services outside of TA. In addition, high percentages of respondents felt that the TA made them more personally aware of the range of resources available from DCHRP (89.7%) and prepared them to provide high quality health services that address the health disparities of individuals with developmental disabilities. Respondents felt that DCHRP TA was effective in addressing their needs and that DCHRP addressed their needs in a creative and responsive way (68.9%).

In general, respondents felt strongly that staff, administrators and management responded to and made use of the strategies provided by DCHRP. Examination of the responses below shows that 72% or more of respondents were very satisfied or satisfied with the impact of TA as judged by each criterion listed except one (personnel and budget to use the new strategies provided). Satisfaction with Impact of TA Not only do respondents feel that they have the knowledge and tools to implement the strategies provided by DCHRP, they overwhelmingly reported (82.8%) that they had started using the strategies as well. Examination of the examples of ways in which respondents used the TA revealed that they implemented or had started to implement:  Revised healthcare management care plan  Revised healthcare passport  Healthform 123  End of life planning forms,  Self-medication training assessments  Behavior Support Plans  Increased use of DCHRP’s specialists

“Staff attitudes definitely changed, so when you are giving them some work order or asking them things they are more willing to talk about and give you information that earlier they were not. If you ask what is a person's diagnosis or diet, they are referring to [the] health passport; if there's an issue they're referring to [the health] management care plan, so definitely a big change there." Over 75% of respondents were satisfied or very satisfied with their agency’s ability to improve in various areas of medical management of IDD as a result of the TA. The majority of respondents (86.2%) noted that the TA will help their agency achieve better health outcomes for IDD because the information provided would increase the expertise of staff and translate into better care for the individuals. Additionally, 70% of respondents felt that positive changes occurred in staff attitudes and staff knowledge as a result of the TA.

Use of DCHRP Website Almost 70% of respondents reported using the DCHRP website, an increase of 50% from the 2006 evaluation. All respondents who have used the DCHRP website were satisfied or very satisfied that it was a useful resource. The graph indicates how what resources respondents primarily used the website for: "We are now really, really training our staff on the health passport, on the HMCP before they can even come in contact to work with our individuals. And the end of life planning is now implemented with our ISP…And the CEUs (Continuing Education Units) attending different trainings like the speech and language studies, speech and language CEUs when taking care of the aging individuals...it's quite a lot of them I can't even mention them in this minute!” Over 82% of respondents noted that they or their agencies have started special initiatives, formal plans for improvement or staffing changes as a result of the TA provided. Respondents noted that they had made changes largely in three areas: increased staffing, more frequent and informative training and improved use of tools.

Recommendations For more information on this evaluation, please contact Bruno Anthony, Ph.D, Director of Research and Evaluation of GUCCHD For more information about the DCHRP please visit: Respondents were largely satisfied to very satisfied with the content, responsiveness and impact of the TA they received from DCHRP and reported that the DCHRP responded quickly to their requests. They felt that they were personally more aware of resources and more prepared to provide high quality health services that address the health disparities of individuals with developmental disabilities. “Most nurses come out of school with a degree in nursing, which is generic; maybe medical, surgical... Developmental disability nursing is not something that is taught in the classroom. With DCHRP, nurses are able to blend in and medical/surgical nurses are now being exposed to learn developmental disability nursing. It is a specialty that is hidden but it's coming out now and this learning, how to handle and deal with individuals with a disability, physical and developmental disability, is through the advocacy and teaching of DCHRP.” Recommendations based on the results of the evaluation and direct suggestions of respondents include:  Increase the involvement of executive directors and house managers in TA activities. Develop methods to enhance use of the information on DCHRP website (such as through a newsletter).  More frequent TA: Many of the respondents wanted to see DCHRP provide more TA, “at least once a month,” as well as more opportunities for training.  More training with direct care staff: Most of the respondents asked that DCHRP expand their training target beyond nurses and QDDPs and provide support with direct support staff.  More standardized forms and tools:. Most respondents requested that DCHRP actually provide “additional standardized forms, protocols and assessment tools for all providers,” reasoning that it sped up paperwork.  More agency-centered training: Respondents noted that they wanted to receive TA based on “each agency's concerns and problems” and based on the “present budget” that each agency has, instead of ‘one-size fits all’ models.