1. Chester County Independent Monitoring for Quality (IM4Q)
Independent Monitoring Corporation
331 Gordon Drive
Exton, PA 19341
Updated June 2018

2. Intent & Purpose of Independent Monitoring (IM4Q)
IM4Q adds a perspective on quality that does not focus on
regulation, process or compliance issues. IM4Q often
reinforces what human service professionals already
know about the person or raises issues that they would want
to know.
The purpose of IM4Q is to provide information obtained
from interviewing people receiving services and supports in
the ID System to:
Improve their Quality of Life
Improve the Quality of PA’s Intellectual Disability System
Offer an additional safeguard for the health and wellbeing of individuals receiving services

3. Some Guiding Principles of IM4Q
Independence: Local IM4Q Programs have no conflict of interest with providers of service and the County MH/IDD Program.
Community Participation: Family members, people with disabilities and concerned citizens monitor services and supports.
Accountability: The agencies who receive reports on this information are responsible to use it for quality improvement purposes.
IM4Q Chester County and State

4. IM4Q Chester County and State
The Where and Why of IM4Q
Several years ago, Pennsylvania determined that they needed to look at the quality of services and subsequent improvement and options of these services provided to individuals with developmental disabilities. As a result, the Office of Developmental Programs (ODP) convened a workgroup to develop a Multi-Year Plan in 1997 to address these needs.
One of the outcomes and recommendations was that local monitoring groups, independent of the service system, could best measure individual and family satisfaction with the services and supports being provided to them.
As a result, in 2001, IM4Q programs were established in PA counties.
IM4Q Chester County and State

5. IM4Q Chester County and State
How IM4Q Works
ODP selects a representative sample of people receiving services and families each year to be interviewed.
Local IM4Q Teams interview people receiving services and families in the sample, and share their considerations after the interview with the AE, providers, the individuals and their families as applicable.
The AE addresses IM4Q Team considerations and uses survey results to improve the person’s services.
The IM4Q Program enters the results of interviews in HCSIS (Home and Community Services Information System) where aggregate results are accessed by providers, County Programs and ODP for improving the quality of the service system.
IM4Q Chester County and State

6. How IM4Q Improves the Services System
Provides independently-gathered information on service quality, satisfaction and outcomes.
Serves as a safeguard by identifying “Major Concerns” affecting health and safety.
Helps to identify “promising practices” as well as areas needing improvement.
Provides a consistent source of information to measure the effect of program practices and quality improvement actions.
IM4Q data results feed information into performance system measurements.
IM4Q Chester County and State

7. IM4Q Chester County and State
What IM4Q Is and Is Not
IM4Q is one aspect of quality measurement within the ID system quality framework.
IM4Q is a measurement of quality, consumer satisfaction and outcomes.
IM4Q is a SNAPSHOT of quality to be used for quality improvement purposes.
IM4Q is not the only measurement of quality. Others, like incident management and licensing also need to be considered.
IM4Q is not a measurement of compliance with standards.
IM4Q Chester County and State

8. IM4Q Role of Supports Coordinators
Explain IM4Q purpose and operations to consumers, families and support professionals.
May obtain and organize some demographics information.
Coordinate quality improvement with providers of service, families and individuals.
Champion quality improvement.
IM4Q Chester County and State

9. Service Provider Roles
Provide demographic information needed by the IM4Q Program.
Assist in answering IM4Q interview questions that the person can’t answer.
Use aggregate IM4Q information to improve services by reviewing reports made available in HCSIS and reports generated by the Chester County IM4Q program.
IM4Q Chester County and State

10. WHO PARTICIPATES IN IM4Q SURVEYS? (Fiscal Years 2012 through 2017)
Statewide – Over 5320 individuals are interviewed yearly, including people living in State Centers.
Chester County – Yearly – 152 individuals living in a residential setting, with their families, or independently.
Demographics of Chester County individuals interviewed
during the period 2012 through 2017:
406 Living in a residential setting (Community Homes)
81 Living in a residential setting (Private ICF)
46 Living in a shared living setting
194 Living independently or with family
21 Living in other settings (PCH, Dom Care, Nursing Facilities, Children’s Facilities)
TOTAL
IM4Q Chester Count and State

11. HCSIS drawn sample of interviews
5 SAMPLE GROUPS are interviewed in Chester County. ODP provides HCSIS Sample:
25 PFDS Waiver
97 IM Sample
30 National Core Indicators (NCI)
30 NCI Family Guardian Surveys mailed out by County to families whose relative lives in a residential program
30 NCI Adult Family Surveys mailed out by County to families whose relative lives at home with the family
IM4Q Chester County and State

12. IM4Q Reports Available to the Public
Chester County IM4Q Reports, FAQ’s and Background & Information on the Chester County Website at
Institute on Disabilities Statewide Summary at the Office of Developmental Programs (ODP)’s Website at
IM4Q Chester County and State

13. Terms and Abbreviations
National Core Indicators (NCI): A survey used to compare Pennsylvania’s performance with other participating states.
Essential Data Elements (EDE): The standard Pennsylvania survey tool developed by Temple University’s Institute on Disabilities.
Family, Friend, Guardian (FFG): That portion of the EDE survey used to obtain satisfaction information from family, friends and guardians.
IM4Q Chester County and State

14. Terms and Abbreviations (cont.)
Closing the Loop: Follow-up actions taken in the community intellectual disability system to address IM4Q findings and team considerations. Actions can occur on an individual, provider, county and/or statewide level.
NCI Family Surveys: Two surveys, one for families living with the person receiving services and the other for families living apart from the person, are included in the National Core Indicators portion of IM4Q.
IM4Q Chester County and State

15. The Interview Questionnaire: Essential Data Elements (EDE)
The EDE is the interview instrument used by monitoring teams to ask 118 questions. It is a combination of the NCI project questions and IM4Q questions.
The IM4Q Monitoring Team also completes 15 additional questions in the EDE after the visit with the individual.
A Family/Friend/Guardian Survey is also completed which consists of 33 questions.
HSRI (Human Services Research Institute) publishes NCI reports to individual Counties and Temple University’s Institute on Disabilities publishes reports for all projects within IM4Q.
IM4Q Chester County and State

16. Employment and Habilitation Pilot
Chester County participated with five other counties in the ODP Habilitation Pilot.
40 individuals who attended day programs and/or work in the community and their families were surveyed each year during a six year period ( ).
The purpose of the pilot was to ascertain satisfaction with day activities/services and the individual and families understanding of availability of habilitation services.
IM4Q Chester County and State

17. IM4Q Chester County and State
Transition Pilot
In Chester County was selected to participate in the ODP Transition Pilot.
73 individuals between the ages of 14 and 22 and their families were surveyed during a six year period.
The purpose of the pilot was to gather information about how the transition process is conducted in the school system and to see if it is preparing individuals for employment and/or further education after school.
IM4Q Chester County and State

18. SATISFACTION – EDE Responses 2012-2017
The first two sections of the EDE ask questions related to the individual’s satisfaction with their home, work, happiness, privacy and their people with whom they live and work.
Only the individual being interviewed can respond to the questions in the Satisfaction section of the EDE.
IM4Q Chester County and State

19. Satisfaction Scale with Day/Work Activity
IM4Q Chester County and State

20. Satisfaction Scale With Living Arrangement
IM4Q Chester County and State

21. Other Satisfaction Data
Have friends that are not staff or family members
State: 73.2%
Chester County: 72.4%
Report they always have privacy
State: 96.4%
Chester County: 97.2%
IM4Q Chester County and State

22. Other Satisfaction Data (cont.)
Report that staff always knock on bedroom door before entering
State: %
Chester County: 84.8%
Report that people knock/ring bell before entering their home
State: %
Chester County: 90.6%
Report that housemates are nice or very nice
State: %
Chester County: 84.6%
Report that they usually feel happy
State: %
Chester County: 82.4%
IM4Q Chester County and State

23. Other Satisfaction Data (cont.)
Report that staff who work with them in their home are very nice or nice:
State: %
Chester County: 94.0%
Report that staff who work with them at their day activity are nice or very nice:
State: %
Chester County: 92.6%
IM4Q Chester County and State

24. Dignity/Respect and Rights – EDE Responses 2012-2017
Only the individual being interviewed may respond to the questions in this section of the EDE.
IM4Q Chester County and State

25. Dignity, Respect & Rights Do you vote? If not, would you like to vote?
IM4Q Chester County and State

26. Other Dignity, Respect & Rights Data
Report that they always carry some type of ID
State: %
Chester County: 49.2%
Report that they never carry some type of ID
State: %
Chester County: 21.4%
IM4Q Chester County and State

27. Dignity/Respect and Rights Supports Coordination Services
Report that Supports Coordinator helps them get what they need if they ask:
State: 90.8% Chester County: 92.4%
Individuals are told how much money was in their annual budget:
State: 68.2% Chester County: 52.0%
IM4Q Chester County and State

28. Choice and Control EDE Responses 2012-2017
IM4Q Chester County and State

29. Choice & Control Do you have a key to your home?
IM4Q Chester County and State

30. IM4Q Chester County and State 2012-2017
Choice & Control Other
Met their housemates before they began living together
State: 85.6% Chester County:88.8%
Individuals did not choose their housemates
State: 68.0% Chester County: 58.0%
Have their own bedroom
State: 66.6% Chester County: 71.4%
Personal mail is never opened without permission
State: 82.6% Chester County: 73.4%
IM4Q Chester County and State

31. Choice and Control Other (cont.)
Individuals always chose what to buy with their spending money
State: 56.8% Chester County: 49.2%
Individuals are always able to get in touch with family when they wish to
State: 87.2% Chester County: 85.2%
Individuals are always able to see friends whenever they wish to
State: 80.2% Chester County: 73.4%
IM4Q Chester County and State

32. Choice and Control - Communication
IM4Q Chester County and State

33. IM4Q Chester County and State
Employment
In , 29 individuals were interviewed that were employed in a community integrated setting.
Average hours worked per week:
State: 16 hours Chester County: 17 hours
Average hourly wage:
State: $ Chester County: $8.43
IM4Q Chester County and State

34. IM4Q Chester County and State
Employment
IM4Q Chester County and State

35. INCLUSION EDE 2012-2017 Responses
IM4Q Chester County and State

36. Inclusion – Community Participation
Visit with friends, neighbors, families at least weekly
State: 49.0% Chester County: 40.4%
Go to a supermarket at least weekly
State: 46.0% Chester County: 49.2%
Go to a restaurant at least weekly
State: 44.4% Chester County: 45.6%
Go shopping at least weekly (mall or department store)
State: 42.0% Chester County: 43.4%
IM4Q Chester County and State

37. Inclusion – Community Participation (cont.)
Go to a place of worship at least weekly
State: %
Chester County: 23.2%
Go on errands at least weekly
State: 17.8%
Chester County: 19.4%
Go to coffee houses/bars/taverns at least weekly
State: 10.4%
Chester County: 11.0%
IM4Q Chester County and State

38. Inclusion – Community Activities
Frequently go into the community for entertainment
State: %
Chester County: 47.2%
Frequently go to social events in community attended by people with and without disabilities
State: %
Chester County: 19.8%
Went on a vacation in the past year
State: %
Chester County: 57.0%
IM4Q Chester County and State

39. Inclusion – Adaptive Equipment
Individuals report that they have all the adaptive equipment they need
State: 88.0%
Chester County: 89.2%
Individuals report that adaptations have been made to home to make it accessible
State: 81.6%
Chester County: 85.0%
IM4Q Chester County and State

40. Family, Friend, Guardian Survey F/F/G Responses 2012-2017
The IM4Q Program conducts a F/F/G Survey with a family member, friend or guardian if the individual has someone in their life and if they give permission for the interview.
IM4Q Chester County and State

41. Family Satisfaction with Relative’s Home and Day Activity
IM4Q Chester County and State

42. Family Satisfaction with Home and Day Activity Staff
IM4Q Chester County and State

43. Family Survey - Relative’s Happiness
Family feels that their relative is happy or somewhat happy with their living situation:
State: 94.0% Chester County: %
Family feels that their relative is happy or somewhat happy with their day program:
State: 91.2% Chester County: %
Family feels that their relative is happy or somewhat happy with home staff.
State: 94.4% Chester County: %
Family feels that their relative is happy or somewhat happy with day program staff:
State: 95.4% Chester County: %
IM4Q Chester County and State

44. Family Satisfaction with Residential Staff
Feel there are enough staff in relative’s home
State: 88.8% Chester County: 93.4%
Feel that staff treat individuals’ with dignity and respect
State: 94.2% Chester County: 95.0%
Feel that ALL staff APPEAR to have the skills they need to support their relative
State: 85.2% Chester County: 86.2%
IM4Q Chester County and State

45. Family Satisfaction – Learning and Participating/Communication
Feel their relative gets enough opportunities to
participate in activities in the community
State: %
Chester County: 84.0%
Feel their relative seems to have the
opportunity to learn new things
State: %
Chester County: 87.2%
If relative does not communicate verbally,
communication system is in place & is being used
State: %
Chester County: 37.2%
IM4Q Chester County and State

46. IM4Q Chester County and State 2012-2017
What does it all mean
This presentation reflects an analysis of aggregate data related to IM4Q monitoring over five fiscal periods ( ; ; ; ; ).
The data used by Chester County’s IM4Q program was obtained from reports generated by Temple University’s Institute on Disabilities which provides statewide and countywide statistical reports each year to ODP, Administrative Entities, IM4Q and the community-at-large.
It compares PA data reflecting interviews with over 6,600 individuals yearly to Chester County interviews with 151 individuals yearly.
IM4Q Chester County and State

47. What does it all mean (cont.)?
Although the intent is that all IM4Q programs conform to the same interviewing and training methods, we need to bear in mind that data and responses may sometimes be interpreted somewhat differently depending upon the location and demographics of the interview as well as monitoring teams interpretations and impressions gained during the interview.
The EDE offers many options of responses to questions. This presentation focuses on primarily yes or no or always or never responses.
IM4Q Chester County and State

48. What do we believe we have learned specific to Chester County?
Chester County parallels PA overall results in many areas.
Chester County’s services to individuals with developmental disabilities excel in many areas; however, methods should be explored for improvement in other areas.
IT IS IMPORTANT TO REMEMBER THAT THESE ARE JUST STATISTICS!
IM4Q Chester County and State

49. CLOSING THE LOOP PROCESS
IM4Q encourages everyone involved in the Close the Loop process to be creative in their ideas for Quality Improvement in the individual’s life.
Individuals Families
Friends Staff
Providers IM4Q Monitors
Supports Coordinators
IM4Q Chester County and State

50. CLOSE THE LOOP ISP/IM4Q Connection
Closing the Loop is how the AE uses the IM4Q results to improve the overall service system and the life of the individual receiving services.
The source of the consideration may include the person with a disability, family, staff, friend, advocate or IM4Q team.
Depending on the issues, closing the loop can involve the work of numerous agencies, the supports coordinator, the family and the person receiving services.
The IM4Q program’s role is to bring issues to the attention of the AE, not to implement change.
The AE is expected to notify the IM4Q program regarding actions, based on monitoring team findings and considerations.
IM4Q Chester County and State

51. WHAT IS A CONSIDERATION AND WHY ARE THEY IMPORTANT?
The IM4Q Program submits a report after each visit which may include “Considerations”.
A “Consideration” is a request or perceived request for change or improvement indicated by the person, family, staff or monitor.
Considerations may result in changes or provide an opportunity to improve the quality of life of the person being interviewed!
IM4Q Chester County and State

52. Things to Remember About IM4Q Results
IM4Q Team considerations may need further clarification and follow-up with the individual, a Provider of Service or the IM4Q Program. The IM4Q Program will be glad to clarify any of its findings.
IM4Q Teams appreciate feedback on ways to improve their interviews and information sharing.
Not everyone needs to agree with all IM4Q Team considerations. What’s important is that IM4Q considerations are respectfully considered and acted on in an appropriate and timely manner.
IM4Q Chester County and State

53. Making Everyday Lives a Reality
As a result of the IM4Q reports to Chester County’s Supports Coordination Organizations and Providers of Service the following changes occurred during FY 12-13, 13-14, 14-15, & These reports often assist to emphasize and validate already recognized needs and supports.
Several individuals whose desire was to move out of their family homes did so and are now living in more independent settings.
Several families became more knowledgeable about waiver funding and their relatives are now receiving services to improve and maintain skills.
Many individuals are attending new vocational programs of their choice or are working with job coaches to find community employment. Others are receiving more appropriate and meaningful day activities.
Several families obtained funding to make adaptations to their homes and interior and exterior improvements were made to several other homes. A few individuals obtained adaptive equipment.
Several individuals expressed interest in learning new skills and are taking classes to achieve these goals.

54. IM4Q Chester County and State
FAQs
Is IM4Q participation voluntary?
Yes
How often are people asked to participate?
Once every 3-4 years
Can the person choose not to share his/her personal survey information?
Will IM4Q information affect a person’s eligibility for funding or services? No
IM4Q Chester County and State