1. Human Services Research Institute
building on abilities
Designing Supports Budgets Based on Assessed Supports Needs
December 2015
John Agosta
Megan Villwock
Human Services Research Institute
7690 SW Mohawk Street
Tualatin, OR
Strengthening CLdS

2. Today’s Agenda Introductions Data presentation and analysis Next steps
Vulnerable Persons Act & driving principles
Project intentions
Data presentation and analysis
General approach
Supports needs assessment
Level assignment
Support needs by level by residence and spending
Focus on people living home with family
Next steps
Questions and discussion
Strengthening CLdS

3. Manitoba Family Services Departmental Vision
Manitobans with developmental disabilities are supported to achieve their fullest potential through inclusion in society, in economy, and in the labor market.
Strengthening CLdS

4. VPA Philosophical Framework
Individuals with Disabilities should have the opportunity to:
Lead satisfying, productive lives in their communities.
Make their own decisions & direct their own lives, with support if necessary.
Take risks that they & their support network deem appropriate.
Use services that are available to all members of society with adaptation & support where possible.
maintain family bonds & develop relationships that are a natural part of life.
Supportive & protective services for individuals with disabilities should be individualized, community based & non-segregated.
When individuals are vulnerable & at risk of suffering harm to themselves or others, their rights & freedoms must be respected & the least restrictive form of support used.
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5. Equitable & personalized funding within limited resources
Blending Together Principles Related to Service Delivery & System Management
Services & supports that people with intellectual and developmental disabilities prefer
A person-centered & sustainable system
Equitable & personalized funding within limited resources
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6. 1 2 Project Tasks 8 Tasks 7 Tasks 15 Tasks Total Phase
Phase 1 we’ll take a look at the current services for people with intellectual & other developmental disabilities and decide how they might be changed to make sure everybody’s needs are met.
Phase 1 2
Phase 2 we’ll build a supports budget system with help from the Supports Intensity Scale (SIS) & a matching provider rate schedule. We’ll focus on those living at home with families first.
15 Tasks Total
8 Tasks
7 Tasks
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7. Data Presentation Data presentation and analysis General approach
Supports needs assessment
Level assignment
Support needs by level by residence and spending
Focus on people living home with family
Strengthening CLdS

8. General Approach
An assessment assists with establishing supports budgets. The supports budget framework provides policy makers with information necessary to make fiscal choices that are fair & predictable, make the best use of available money, and are consistent with driving system principles.
Allocating resources to people based on their assessed level of need means that each person receives what they need, no more no less.
The supports budget framework established a best fit solution for most but takes care to accommodate individuals with extraordinary needs.
Strengthening CLdS

9. Person Centered Planning
Looking Things Over
Assess Needs
Level Assignment
Supports Budget
Person Centered Planning
Service Delivery
Understanding the Process
SIS Interview
Sharing Results
SIS Results
Verification Results (SQs)
Level Assigned
Assessed need
Residence
Policy Intentions
Supports Budget Control
Choice about Services
Base & Add- on Services
Policies TBD
Supporting Policies, Rules & Regulations,
and Communication
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10. Personal Supports Budgets
SIS Assessment
Supplemental Questions
Verification
Level Assignment
Personal Supports Budget
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11. Supports Intensity Scale
Assess Needs:
Supports Intensity Scale
Administration: Interview the person and others who know the person. Requires solid interviewing skills
Measures general support needs of an individual producing a number of scores
Includes basic support need areas like:
A. Home Living Activities,
B. Community Living Activities,
C. Lifelong Learning Activities
D. Employment Activities
E. Health and Safety Activities
F. Social Activities
SIS ABE – refers to the sum of the scores for these 3 areas that have been found useful in helping resource allocation
Identifies Medical and Behavior problems which are also significant cost predictors
Strengthening CLdS

12. Supplemental Questions and Verification
During the SIS assessment, additional questions, called Supplemental Questions, are asked. These pertain to medical and behavioral support needs.
Particular responses may indicate that further review of support needs is warranted. If so, additional questions are asked regarding:
Severe medical risk;
Severe community safety risk for people with a related legal conviction;
Severe community safety risk for people with no related legal conviction;
Severe risk of harm to self.
Answers to these questions may trigger a review of individual records review called verification.
Verification is a process where CLdS staff review individual records to get a better idea of the individual’s particular needs.
Strengthening CLdS

13. SIS Assessment Status (11/18/15)
Living Setting
Population
Percent of Population
Total SIS Assessments
% Complete
Agency Care
1,453
25%
633
44%
Foster Home
826
14%
305
37%
Independent
1,042
18%
311
30%
Family
2,080
36%
421
20%
Other
407 7%
110
27%
Total
5,808
100%
1,780
31%
Strengthening CLdS

14. SIS Assessment by Region (11/18/15)
Target Number
Total Assessments*
% Complete
Central
255
100%
Eastman
170
149
88%
Interlake
173
171
99%
Northern 66 60
91%
Parkland 73
Westman
268
Winnipeg
1038
804
78%
Total
2,043
1,780
87%
* An additional 158 SIS assessments have been completed, but were excluded from further analysis because the individuals did not have full-year financial data
Strengthening CLdS

15. Number of People by Supports Need Score (low to high)
(11/18/15)
The scale shown is the sum of 3 SIS sub-scales regarding Home Living (A), Community Living (B) and Health & Safety (E).
The combined scale (Sum A-B-E) can range from 8-52, low to high.
Findings
People: 1,780
Mean: 24.73
Median: 25
Range:
Strengthening CLdS

16. Comparison of Results in Manitoba with Other Jurisdictions
Number of Individuals
Supports Need Index
Sum of Part A, B, and E
Medical Need Score
Behavioral Need Score
SIS Norm
1,306
100.00
30.00
3.23
4.99
Manitoba
1,780
93.17
24.73
1.33
3.20
Alberta
5,061
91.77
24.81
1.86
3.73
Tennessee *
5,765
102.67
30.36
1.45
2.87
Virginia **
1,275
102.82
30.16
1.96
2.64
Oregon *
5,119
106.33
31.62
1.99
5.06
New Mexico *
3,218
106.31
31.75
3.13
4.82
Utah
4,114
102.15
30.09
2.22
4.09
Rhode Island
3,007
101.75
29.72
2.02
4.19
Kentucky *
3,476
99.76
28.93
1.92
4.28
Georgia
10,574
99.40
28.62
1.39
2.69
Maine *
2,324
98.71
28.35
2.04
4.64
Louisiana *
4,091
98.23
29.95
3.33
3.10
Colorado
6,849
97.49
27.91
2.99
5.55
* States with partial population for HCBS population **Weighted for entire HCBS population.
Strengthening CLdS

17. Level Assignment: Seven Levels
Levels must account for a range of support needs, but also categorical needs.
Policy makers may adjust the services array, with different expectations about service use.
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18. Seven Support Level Descriptions1
Adults in this level have low support need, including some to no support need for medical and behavioral challenges. They can manage many aspects of their lives independently or with little assistance. 2
Individuals in this level need more support than those in Level 1, but their support needs are minimal to modest in a number of life areas. Adults in this level have moderate support needs and little to no support need for medical and behavioral challenges. 3
Adults in this level have low to moderate support needs as in Levels 1 and 2. They also have an increased, though not extraordinary, support need due to behavioral challenges. 4
Adults in this level have moderate to high support needs. They need help with life activities on a daily basis. They may have behavioral support needs, but these needs are not extraordinary. 5
Adults in this level have high to maximum support needs. They need help with life activities typically requiring hands on support and/or oversight throughout the day. They may have behavioral support needs, but these needs are not extraordinary. 6
Adults in this level have extraordinary need for medical support Individuals in this level may have behavioral needs, but these needs are not extraordinary. 7
All adults in this level have extraordinary behavioral challenges, regardless of their support need to complete daily activities or for medical conditions. Adults in this level need greatly enhanced supports due to their behavioral challenges.
Strengthening CLdS

19. Section 3B Behavior Support
Support Levels
Sum: Sections A, B, & E
Section 3A Med Support
Section 3B Behavior Support 1
Least Support Needs
0 to 22
0 to 6 2
Mild or Moderate Support Needs
23 or 30 3
Mild to Moderate Support Needs & Moderate Behavioral Challenges
0 to 30
7 to 10 4
Moderate Support Needs & Mild to Moderate Behavioral Challenges
31 to 36
0 to 10 5
High Support Needs & Mild to Above Average Behavioral Challenges
37 to 52 6
Extraordinary Medical Challenges
Any
7 to 32
or Verified Extraordinary medical risk 7
Extraordinary Behavioral Challenges
11 to 26
or Verified Danger to others or Extreme self-injury risk
Strengthening CLdS

20. Level Distribution by Living Setting
1,780 People by Support Level & Living Option
Level Distribution by Living Setting
Living Setting
Total SIS Interviews
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Overall
1,780
620 (35%)
457 (26%)
149 (8%)
235 (13%)
29 (2%)
115 (6%)
175 (10%)
Agency Care
633
103 (15%)
168 (27%)
66 (10%)
137 (22%)
10 (2%)
55 (9%)
92 (15%)
Foster Home
305
94 (31%)
30 (10%)
37 (12%)
3 (1%)
15 (5%)
32 (10%)
Independent
311
230 (74%)
43 (14%)
17 (5%)
7 (2%)
0 (0%)
5 (1%)
18 (6%)
Family
421
161 (38%)
121 (29%)
24 (6%)
50 (12%)
16 (4%)
27 (6%)
22 (5%)
Other/N.S.
110
39 (35%)
31 (28%)
12 (11%)
4 (4%)
13 (12%)
11 (10%)
Strengthening CLdS

21. Level Distribution by Living Setting (n= 1,780)
Overall
Agency Care
N = 633
Foster Care
N = 305
Independent Living
N = 311
Parent/Extended Family
N = 421
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22. FY 2015 Spending by Sum A-B-E score (Support Needs Score)
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23. Explaining Boxplots Boxplots Coming! What’s a boxplot?
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24. Fiscal Year 2015 Expenditures 633 People in Agency Care by Level
25th %
Median
75th %
Min
Max
Level 1
$54,049
$69,660
$82,655
$1,632
$286,335
Level 2
$62,638
$75,938
$95,923
$1,280
$222,716
Level 3
$70,576
$99,818
$148,130
$31,715
$420,058
Level 4
$64,242
$82,873
$109,659
$20,414
$204,845
Level 5
$63,460
$82,822
$114,610
$37,058
$141,251
Level 6
$79,774
$113,986
$133,940
$39,595
$195,158
Level 7
$79,012
$123,035
$194,984
$319,506
Overall
$63,349
$121,746
Strengthening CLdS

25. Fiscal Year 2015 Expenditures 305 People in Foster Care by Level
25th %
Median
75th %
Min
Max
Level 1
$13,038
$28,375
$45,169
$7,118
$68,608
Level 2
$15,042
$23,953
$40,774
$4,539
$74,464
Level 3
$25,346
$36,807
$57,548
$14,299
$144,546
Level 4
$21,626
$28,916
$42,993
$2,278
$94,400
Level 5
$15,773
$82,822
$40,018
$3,650
$52,140
Level 6
$35,861
$40,097
$53,251
$23,229
$78,413
Level 7
$10,280
$55,845
$63,758
$203,203
Overall
$17,866
$30,229
$50,533
2,278
Strengthening CLdS

26. Fiscal Year 2015 Expenditures
311 People in Independent Living by Level
25th %
Median
75th %
Min
Max
Level 1
$4,792
$8,730
$17,043
$1,336
$50,671
Level 2
$7,119
$11,013
$14,802
$3,456
$37,843
Level 3
$5,385
$25,739
$37,125
$1,884
$59,342
Level 4
$31,133
$38,998
$63,731
$8,824
$136,645
Level 5 -
Level 6
$9,349
$14,684
$20,379
$3,833
$25,894
Level 7
$8,980
$24,355
$33,225
$2,675
$70,679
Overall
$5,225
$9,734
$19,968
Strengthening CLdS

27. Focus on Individuals Living Home with Families
People adults living home with families have more complicated spending patterns.
They may access a variety of CLdS services, such as in- home “enhanced support”, several forms of respite, day services, transportation, crisis support, specialized therapies, and other expenses.
Service use patterns (and so spending) vary by individual.
Service use may not be consistent month to month, and may involve several months in the year with no spending
Strengthening CLdS

28. Fiscal Year 2015 Expenditures People Living with Families
Median
75th %
Min
Max
Level 1
$3,414
$8,174
$17,549
$160
$53,521
Level 2
$7,151
$16,429
$36,321
$107
$48,838
Level 3
$7,081
$22,131
$36,401
$240
$65,025
Level 4
$11,098
$30,914
$66,078
$435
Level 5
$17,448
$38,529
$49,352
$5,034
$68,505
Level 6
$19,532
$35,579
$50,879
$1,284
$103,671
Level 7
$12,653
$38,035
$57,550
$1,679
$102,297
Overall
$6.719
$15,704
$32,005
Strengthening CLdS

29. Illustration of the Number of People Living Home with Families Who Use Each Service (FY 2015)
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30. Illustration of the Number of People Living Home with Families Who Use Each Primary Service Type (FY 2015)
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31. Percent of 421 Using Service Average Cost per Individual User
Service Use and Costs of 421 Individuals Living at Home with Families by Primary Service Type (FY 2015)
Service Type
Number Using Service
Percent of 421 Using Service
Total Cost
Average Cost per Individual User
Clinical services 27
5.7%
$30,246
$1,120
Crisis services 3
0.70%
$7,364
$2,455
Day services
308
73.2%
$5,837,665
$18,953
Residential services 66
15.7%
$713,498
$10,810
Respite
188
44.7%
$1,014,348
$5,395
Transportation
181
43.0%
$681,670
$3,766
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32. Service Use of Individuals Living at Home with Families (FY 2015)
Strengthening CLdS

33. Residential Services (n = 66)
Service Use of Individuals Living at Home with Families by Primary Service Type (FY 2015)
Residential Services (n = 66)
25th %
Median
75th %
Min
Max
Level 1
$1,797
$7,626
$13,020
$84
$31,747
Level 2
$985
$2,857
$12,467
$248
$46,256
Level 3
$11,934
$11,987
$14,504
$329
$23,123
Level 4
$2,192
$3,700
$6,178
$1,408
$14,433
Level 5 -
$21,411
Level 6
$5.363
$10,785
$31,017
$294
$49,070
Level 7
$5,271
$12,829
$31,401
$1,346
$47,266
Overall
$1,738
$6,890
$14,265
Strengthening CLdS

34. Service Use of Individuals Living at Home with Families by Primary Service Type (FY 2015)
Respite Services (n = 188)
25th %
Median
75th %
Min
Max
Level 1
$839
$1,890
$4,097
$10
$12,548
Level 2
$1,590
$3,192
$5,106
$152
$19,353
Level 3
$1,554
$3,560
$4,563
$280
$20,574
Level 4
$1,593
$6,746
$9,171
$294
$20,860
Level 5
$5,016
$5,280
$14,987
$94
$16,513
Level 6
$1,675
$3,201
$6,949
$972
$26,310
Level 7
$2,944
$5,712
$13,770
$1,679
$43,803
Overall
$1,568
$3,306
$6,823
$43,808
Strengthening CLdS

35. Day Service Use by Living Setting
Total SIS Interviews
Any Day Services
Regular
Special Rate
Other
Overall
1,780
1,190 (66.9%)
1,134 (63.7%)
765 (67.5%)
71 (4.0%)
Agency Care
633
468 (74.0%)
464 (73.3%)
329 (71.0%)
4 (<1%)
Agency Care 24 hour
172
Foster Home
305
234 (76.7%)
228 (74.8%)
159 (52.1%)
7 (2.3%)
Foster Home 24 hour 36
Independent
311
147 (47.3%)
125 (40.2%)
46 (36.8%)
32 (10.3%)
Family
421
308 (73.2%)
289 (68.6%)
208 (71.9%)
35 (8.3%)
Other/N.S.
110
33 (30.0%)
28 (25.5%)
23 (82.1%)
3 (2.7%)
Strengthening CLdS

36. Day Service Use by Living Setting
Level
Total SIS Interviews
Any Day Services
Regular
Special Rate
Other
Overall
1,780
1,190 (66.9%)
1,134 (63.7%)
765 (67.5%)
71 (4.0%) 1
610
388 (63.6%)
348 (87.0%)
165 (47.4%)
58 (9.52%) 2
457
329 (72.0%)
321(70.2%)
195 (60.7%)
8 (1.8%) 3
149
100 (67.1%)
98 (65.8%)
76 (77.6%)
0 (0.0%) 4
238
179 (75.2%)
177 (74.4%)
153 (86.4%)
1 (<1%) 5 29
21 (72.4%)
21 (100%)
0 (0%) 6
112
75 (67.0%)
74 (98.7%)
68 (91.9%)
3 (2.7%) 7
175
100 (57.1%)
97 (55.4%)
87 (89.7%)
Strengthening CLdS

37. Next Steps
Sales & Savage
Strengthening CLdS

38. CLdS Intends to
Increase resources to connect people to their communities
Increase competitive employment for participants
Sharpen and adjust the service array
Align our effort per person with assessed support needs
Assist service providers to refine and/or grow their array of services
To ensure a fair system with the implementation of a standardized assessment model
Provide a long-term sustainable system of supports
Strengthening CLdS

39. There is still more to do
Departmental implementation team has been largely set.
Work is proceeding with HSRI to consider findings related to support needs assessments, spending analyses and other related issues.
CLDS has engaged with Helen Sanderson Associates (HSA) Canada regarding providing staff with Person Centered Thinking training.
A phased in approach to making and system changes was chosen.
A pilot will begin on January 1 starting with new admissions to the CLDS system.
Rollout elsewhere will take time, and will be discovered through continued achievement and discussion.
Strengthening CLdS

40. Focus on Individuals Living Home with Families: What’s Next?
In-depth understanding of money spent per service type (respite, supports to family, day services, transportation, clinical services, and crisis services).
Discussions between CLdS and stakeholders about the type and amount of supports that will be made available to individuals living home with families at each support level.
Policy decisions by CLdS about investment in services for individuals living home with families.
Settle on anticipated service use and supports budgets for individuals living home with families.
Assure needed infrastructure for supports planning and exceptions review.
Enrollment of first group of individuals living home with families—SIS assessments are currently underway.
Strengthening CLdS

41. Person-Centered Planning
Individuals define their goals and aspirations.
SIS assessment results can be used to understand areas of strength and areas where the individual needs support.
Individuals (and their families, when applicable) are made aware of their supports budget before the planning meeting takes place.
Individuals have some degree of authority and flexibility to choose which services to purchase.
Individuals work with their circle of support to decide on the other types of support that they require to achieve their goals (relationships, community based, etc.)
All paid and non-paid supports work in harmony to help the person achieve their defined goals.
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42. Discussion and Questions
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43. Dancing with Dragons
“The final act in performing a creative act is letting go. … As we create new support practice, the proverbial beast is provoked. We are knocked off our centers as we move into unknown territory without the anchor of our legacy services. This requires… as Rebecca Chan says, [that we] Dance with our Dragons.”
Hanns Meissner, Blue Space, p. 146
Strengthening CLdS