1. Self-Determination & Individualized Funding Can We “Trust” Consumerism, OR Is “Regulation” Necessary?

2. Considerations for External Monitoring l Public Money is Being Spent l Basic Health and Safety Responsibilities Legal Moral l Vulnerable Population l Recent Situations CA, DC, etc. l Short Track Record for SD/IF

3. Monitoring Possibilities l Federal Rules, Regulations and Inspections (ala HCFA) l Local/Regional Licensing l “Program” Process Certification l External Accreditation l Accepted Quality Indicators l Local Ombudsman/Advocate l Some Combination of the Above

4. Sometimes We Feel A Bit Like This “I have met the enemy, and he is US!” Pogo, Walt Kelly

5. National Accreditation l Not “Regulatory” - Not Rules l External, Impartial Observation l Standards = Quality Indicators l Focus on Results/Impacts in Life l Quality Improvement Structure l May Provide Information for Informed Choice/Decision Making/Service Access

6. Implied Information l A Commitment to: Consumer Partnership Available Service Results Data Qualified/Trained Staff On-going Quality Improvement External Observation Efficient, Effective Resource Use

7. Real Information l Access to 25,000 Services l Access to 100,000s of Direct Service Professionals l Consumer Information Products Consumer and Family Guide to Quality Services Using Individual Centered Planning for Self-Directed Services How to Choose a Provider

8. Possible Combination of Monitoring Activities l “Deemed” Status Initial Service Licensing Compliance Achieve National Accreditation Absence of Formal Public Allegations Consumer/Family/Funder Satisfaction Annual Re-licensing - Waived or Reduced Local “Hotline”, Emergency Response, Technical Assistance, Problem Solving, Complaint Resolution, etc.

9. There are NO Guarantees! l Abuse Can Happen in ANY Setting l There are “Good” People and “Not- So-Good” People l There is always risk in everything l Information/Experience/Planning Minimize the Risks and Danger “Be Prepared!”

10. What Do You Think? l How do we balance risk and responsibility? l How do we balance informed choice and concerns of well- being? l How do we stay out of the way and offer some protection to all the parties?

11. Audience Comments/Answers l Can SD and accreditation co-exist? l What is an appropriate role for accreditation (Carf)? l A Natural tension between SD, Individual Choice, and accreditation is healthy - we may need new assumptions for a new service delivery system?

12. Audience Comments/Answers l Some states use a multiple approach to QA - in concert with one another. l Regulations/standards are not necessarily in line with consumer preferences - they should be! l Paper on the wall - certificate - doesn’t assure safety!

13. Audience Comments/Answers l Emphasize the local consumer component of any accreditation system. l Consolidate/simplify systems. l SD is about “relationships” any system needs a focus on people. l SD will sort out “bad” supports.

14. Audience Comments/Answers l Current confusion between funding and regulation roles. l Some regulation, auditing or accountability is necessary - the question is how much and what kind.

15. For More Information Contact: CARF Employment and Community Services Division, 4891 East Grant Road, Tucson, AZ 85712 Phone (520) 325-1044, FAX (520) 318-1129, Dale Dutton, x 133, or Paul Andrew, x112 Internet addresses: http://www.carf.org email: pandrew@carf.org, or ddutton@carf.org