1. PEONIES: Making self determination and self direction the root of quality Sara Karon, Ph.D. Director, the PEONIES Project Center for Health Systems Research and Analysis SDS Conference Milwaukee, WI October 13, 2009

2. 2 SDS Conference Milwaukee, WI October 13, 2009 Purpose of this session Explain the role of Personal Experience Outcomes in service planning, quality assurance and improvement, and especial in Self Determination and Self-Directed Services Introduce PEONIES, which is a system for using Personal Experience Outcomes to accomplish all of these things

3. 3 SDS Conference Milwaukee, WI October 13, 2009 What are outcomes? In general, outcomes are the result of combining things (structure) and doing something with them (process) Example:  Take flour, water, sugar, eggs (the things, or structure)  Mix them and bake (the process)  Result is a cake (the outcome)

4. 4 SDS Conference Milwaukee, WI October 13, 2009 People are not cakes! We can take the same things (personal care assistance, transportation, health care, our minds and bodies) and use them to achieve different things  A job of your choosing  Volunteer activities  Hobbies  Feeling strong

5. 5 SDS Conference Milwaukee, WI October 13, 2009 What are Personal Experience Outcomes? Personal experience outcomes recognize that people are not cakes Personal experience outcomes are Goals, Dreams, Desires, Wishes, of what you want your life to be.

6. 6 SDS Conference Milwaukee, WI October 13, 2009 Personal Experience Outcomes Areas CHOICE  I decide where and with whom I live.  I make decisions regarding my supports and services.  I decide how I spend my day. HEALTH AND SAFETY  I have the best possible health.  I feel safe.  I am free from abuse and neglect. PERSONAL EXPERIENCE  I have relationships with family and friends I care about.  I work or do other activities that are important to me.  I am involved in my community.  My life is stable.  I am respected and treated fairly.  I have privacy.

7. 7 SDS Conference Milwaukee, WI October 13, 2009 Personal Experience Outcome Areas are NOT Personal Experience Outcomes Personal experience outcome areas  Describe a general concept, but not what you want  Do not change over time  Can be used to organize information and measure quality Personal experience outcomes  Describe what you want your life to be like  Are different for each person  Can (and should) change over time

8. 8 SDS Conference Milwaukee, WI October 13, 2009 Personal Experience Outcomes Provide Direction “If you don’t know where you’re going, you’ll end up someplace else” Yogi Berra

9. 9 SDS Conference Milwaukee, WI October 13, 2009 What do you want your life to be? What is important to you? What do you want to do or to be? Where do you want to do it or be it? When do you want to do it or be it? How do you want to do it or be it?

10. 10 SDS Conference Milwaukee, WI October 13, 2009 What do you want now? In the future? Some things are good now, and you want them to continue Some things could be better now, and you want them to change now Some things are long-term goals, and you want to work toward them, sometime (now or later)

11. 11 SDS Conference Milwaukee, WI October 13, 2009 Whether you get support through  Family Care,  Family Care Partnership,  IRIS,  Any other program, or  No program at all thinking about Personal Experience Outcome Areas Can Help Support Self Determination

12. 12 SDS Conference Milwaukee, WI October 13, 2009 Using Personal Experience Outcomes to Help Develop Support Plans What will it take to achieve or maintain your goals?  People  Things  Actions

13. 13 SDS Conference Milwaukee, WI October 13, 2009 Putting the pieces together What are the pieces needed to support your goal? Do you have these pieces already? Are the pieces working for you?  Is there enough?  Are they doing what you need?  Are they working in a way that you like?

14. 14 SDS Conference Milwaukee, WI October 13, 2009 Whether you help put the pieces together or someone else does it all for you, this is a part of self-determination. You are the one who decides whether things are working well for you.

15. 15 SDS Conference Milwaukee, WI October 13, 2009 What is PEONIES? Personal Experience Outcomes iNtegrated Interview and Evaluation System Developed by researchers at the UW-Madison, with input and support from stakeholders PEONIES uses Personal Experience Outcomes to help measure and assure quality of long-term care services

16. 16 SDS Conference Milwaukee, WI October 13, 2009 PEONIES Provides Structure for Using Personal Experience Outcomes A structured way to learn about:  outcomes that people want  success in achieving and maintaining outcomes  the supports needed to achieve or maintain outcomes  how well people are being supported in their outcomes

17. 17 SDS Conference Milwaukee, WI October 13, 2009 PEONIES and Care Management Care managers can use PEONIES to help learn  What is important to you  What you want to continue  What you want to change  How to support your goals  Whether supports are working well for you

18. 18 SDS Conference Milwaukee, WI October 13, 2009 PEONIES and Quality PEONIES Can Be Used to Learn About Quality  Are people achieving the outcomes that are important to them?  Are people receiving supports for achieving the outcomes that are important to them?

19. 19 SDS Conference Milwaukee, WI October 13, 2009 Why Measure Quality? Understand each person’s situation Look at groups of people to help understand how well the system is working  Are people who get supports from one organization doing better than those who get support from a different organization?  Are certain types of people being more or less supported than others?  Are the services people get being useful to them?

20. 20 SDS Conference Milwaukee, WI October 13, 2009 I am involved in my community What is the status of the outcome that was identified? 61% achieved or in progress What percentage of respondents was able to identify an outcome? Was the outcome sufficiently supported?

21. 21 SDS Conference Milwaukee, WI October 13, 2009 How can PEONIES measures be used? Care organizations – identify areas of weakness and make improvements Care organization – identify areas of strength and help others improve State – assure that organizations are doing what they need to do Public – learn how organizations are doing, so we can make better choices and can advocate for change

22. 22 SDS Conference Milwaukee, WI October 13, 2009 Example of PEONIES measures Organization Outcome Identified Outcome Achieved Outcome Supported Organization A73%57%60% Organization B71%55%45% Organization C45%36% Organization D76%58%64% TOTAL66%52%

23. 23 SDS Conference Milwaukee, WI October 13, 2009 For More Information Contact us at any time with more feedback, comments, or questions:  peonies@chsra.wisc.edu peonies@chsra.wisc.edu  Sara Karon (sara@chsra.wisc.edu)sara@chsra.wisc.edu  Mary Schlaak (mary@chsra.wisc.edu) Visit our website:  www.chsra.wisc.edu/peonies/peonies_index.html