annual program performance report template...

ANNUAL PROGRAM PERFORMANCE REPORT TEMPLATE FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

Page | 1 DRAFT –May 2017 - PPR Reporting Template Note: Section numbers and minor section title changes may occur

OVERVIEW:ThistemplateincorporatesnewinformationbeingrequestedaspartoftheProgramPerformanceReport(PPR)comprehensivereporting.Itincludesthefollowingsections:

Section AreaI. Identification

II. ComprehensiveReviewandAnalysis(CRA)

III. StatePlanImplementation

IV. ProgressReport

V. CouncilFinancialInformation

VI. MeasuresofCollaboration

ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

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DRAFT – May 2017 Program Performance Report DRAFT Template

ANNUALPROGRAMPERFORMANCEREPORT(PPR)SECTIONI:IDENTIFICATIONPURPOSE:ToprovideidentifyinginformationofthereportingCouncil

1. State/Territory:2. FederalFiscalYearReporting:October1,20_throughSeptember30,20___3. ContactpersonregardingPPRinformation:4. Contactperson’sphonenumber:5. Contactperson’se‐mailaddress:

6. ExecutiveDirectorname(ifdifferentfromcontactperson):

7. ExecutiveDirector’sphonenumber:

8. ExecutiveDirector’semailaddress:


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SECTIONII:COMPREHENSIVEREVIEWANDANALYSISPURPOSE:ToprovideanupdatetotheComprehensiveReviewandAnalysis

ComprehensiveReviewandAnalysis‐Update‐[Section124(C)(3)]TheDDActrequiresthefollowingannualdescriptions:

adequacy of health care and other services, supports and assistance that individuals with developmental disabilities inIntermediateCareFacilities(ICF)receive;

adequacyof health care andother services, supports, and assistance that individualswithdevelopmental disabilities servedthroughhomeandcommunity‐basedwaiversreceive;

AIDDinterpretsthisasannualupdatesto: adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in

IntermediateCareFacilitiesreceive;(ICFupdates) adequacyof health care andother services, supports, and assistance that individualswithdevelopmental disabilities served

throughhomeandcommunity‐basedwaivers(HCBW)receive;(HCBWupdates) Andothersectionsthatapply(e.g.:stateinformation,portraitofstateservices,analysisofstateissuesandchallenges,rational

forgoalselection,collaboration). FederalandstateinitiativesimpactingpeoplewithDDandtheirfamiliesintheState/Territory

Note:(*)‐Adequacymaybedescribedintermsofqualityand/orpopulationsservedversusneed.


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SECTIONIII:STATEPLANIMPLEMENTATIONPURPOSE:ToprovidethecontextofwhatwillbereportedinthePPR.SectionIIIiscomprisedof3reportingareas:(A)Introduction;(B)evaluationofstateplanimplementation;(C)InputonNationalPriorities

A. Introduction Inthissectionprovideanexecutivesummarywithcohesiveinformationthatprovidesanoverviewofthereportincluding,butnotlimitedtothefollowing:(1)targetedareasofemphasis,(2)strategiesusedtoimplementactivities;(3)significantaccomplishmentsand/orbarrierstostateplanimplementation;(4)needsrequiringstateplanamendmentsNote:detailedinformationwillbeprovidedbelowinSectionIVCultural Diversity DescribetheCouncil’soveralleffortstoaddresstheneedsofindividualswithdevelopmentaldisabilitiesandtheirfamiliesofadiverseculturethroughitsstateplansupportedactivities.


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B. EvaluationofStatePlanImplementation[Section125(c)(5)and(c)(7)]Inthissectionreportontheevaluationactivitiesconductedandresults.Thereportshouldinclude:B1.EvaluationActivitiesDescribetheevaluationactivitiesundertakenduringthefiscalyearbeingreported,includingevaluationactivitiesconductedtostrategicallyassesstheoverallprogressanddirectionofthestateplanimplementationB2.EvaluationResultsReportthebroadresultsoftheevaluationactivitiesdescribedabove(B1),includingabroadassessmentoftheoverallprogressofCouncilsupportedactivities.B3.LessonsLearnedandFutureworkoftheCouncilReportonhowtheCouncilwilluselessonslearnedfromstateplanimplementationandthedatagatheredfromtheevaluationactivitiestomoveforwardtheworkoftheCouncil?

C. InputonNationalPriorities


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SECTIONIV:STATEPLANIMPLEMENTATIONPROGRESSREPORTSectionIV.A.DetailedProgressReportonGoalsGoal#1:GoalstatementwouldbetakendirectlyfromStatePlan Area(s)ofEmphasis:

AreaofEmphasis PlannedforthisgoalTakendirectlyfromStatePlan;areascheckedoff

AreasaddressedTobecompletedannually;CouncilchecksoffAreas

QualityAssurance

EducationandEarlyIntervention

ChildCare

HealthEmployment

Housing

Transportation

Recreation

FormalandInformalCommunitySupports


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Strategies:

**Strategies

**AsidentifiedinSection125(c)(5)(A‐L)oftheDevelopmentalDisabilitiesAssistanceandBillofRightsActof2000(PL106‐402)

PlannedforthisgoalTakendirectlyfromStatePlan;strategiescheckedoff

StrategiesUsedTobecompletedannually;CouncilchecksoffStrategiesUsed

Outreach Training TechnicalAssistance SupportingandEducatingCommunities InteragencyCollaborationandCoordination CoordinationwithRelatedCouncils,CommitteesandPrograms

BarrierElimination SystemsDesignandRedesign CoalitionDevelopmentandCitizenParticipation

InformingPolicymakers DemonstrationofNewApproachestoServicesandSupports

Demonstrationofprojectsandactivities OtherActivities


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Intermediaries/Collaborators:

Collaborators Definition of collaborator: someone who works with another person or group in order to achieve or do something

PlannedforthisgoalTakendirectlyfromStatePlan;Collaboratorscheckedoffasplanned

ActualTobecompletedannually;CouncilchecksoffplannedCollaboratorswhoactuallyparticipatedoraddscollaboratorsnotpreviouslyplanned.

StateProtectionandAdvocacySystem UniversityCenter(s) StateDDagency Other: Other: Other:


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1. Goal#1:2. StatePlanObjective1:

Checktheappropriateboxforeachofthequestionsbelow:

3. ThisObjectiveis:Individual&FamilyAdvocacy SystemChange CapacityBuilding

4. ThisObjectiveis:

New Ongoing Completed

5. ThisObjectiveis:a. FulfillingtheSelf‐AdvocacyDDActRequirement Yes Nob. TargetedDisparity Yes Noc. DDNetworkCollaboration Yes Nod. AdemonstrationprojectofNewApproachestoServicesandSupports Yes No,IfYes,Indicateprojectnameand

originalstartdateforthiseffort:nameofproject;mm/yye. Ademonstrationofprojectsoractivities Yes No,IfYes,indicateprojectoractivitynameandoriginalstartdateforthis

effort:nameofproject/mm/yy6. StageofImplementationforsystemschangeactivities:

planning implementation outcome/fullyintegrated

Background/Context7. Provideanoveralldescriptionofthisobjective:

Thedescriptionshouldataminimumprovidebackgroundinformationontheobjectivetoestablishacontextfortheactivities.


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Goal#1 Objective#1:

8. ExpectedOutputsListexpectedoutputsfromannualworkplan1.2.3.

9. OutputsAchievedListoutputsachieved1.2.3.

ProgressReport10. Thereportshouldincludethefollowing:

Anarrativeprogressreportthatcohesivelydescribestheactivitiesthatwereimplementedtowardachievingtheobjective,includinghowtheidentifiedstrategywasused,howtheactivitywasimplemented,challengestoachievingtheobjectiveandunexpectedbenefits.

Forsystemchangeactivities,includeadescriptionofthestageofimplementation(planning,initiation,implementation,outcome/fullyintegrated)ofthesystemchangeinitiative.

Allnarrativesmustdescribewhatnumbersmakeuptheperformancemeasuresnumberfortheactivitiesbeingreportedinthenarrative. Asummaryofevaluationactivitiestomonitorprogressandimpactofcouncilsupportedactivitiesfortheobjective;datacollectedduring

theyear,datasources,anddatacollectionmethods;(logicmodelandevaluationplanmaybeattachedtothereport).

11. ExpectedOutcomes(matchestheexpectedoutcomesfromtheannualworkplanasitrelatestotheobjective)Listtheexpectedoutcomesfortheactivitiesdescribedfortheobjectivefromtheannualworkplan

12. Outcomesachieved

13. Progresstowardsachievingoutcomesforoverallobjective:Theannualreportshouldincludeanassessmentastotheextenttowhichprogresswasmadeontheintendedoutcomesfortheobjective.

14. Additionally,includestoriesofculturallydiversepeoplewithdevelopmentaldisabilitieswhoselivesarebetterbecauseofCouncilworkonthisactivity(e.g.,becamebetteradvocatesforthemselvesandothers,becamemoreconnectedtothecommunity).StoriesofpolicyorlegislativechangesthathappenedasaresultofCouncilindividualadvocacyworkthatarelikelytopositivelyimpactthelivesofpeoplewithdevelopmentaldisabilitiesorthatwillpreventapotentialnegativeimpact(e.g.,createddeleted,refinedprogramsand/orlegislation,reallocateduseoffunds,organizationalsystemschangeasaresultofevidencebasedpractices).


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RepeatthispageforeachgoalandobjectivesasnecessaryfortheindividualCouncil’s5‐yearstateplan

2. Goal#NarrativeInthissection,foreachgoalreportedforthisreportingperiod,provideanoverallcohesivedescriptionof:

• theextenttowhichprogressisbeingmadeinachievingtheintendedoutcomesoftheGoalforthereportingyear;

• theextenttowhicheachgoalwasorwasnotachievedforthereportingyear;• whereapplicable,factorsthatimpededgoalachievementforthereportingyear• needsthatrequiresubstantivestateplanamendment(goalonly)

4YearOverview(FY2020)AdescriptionofhowtheCouncilwilluseandbuildfromknowledgegainedandprogressmadetomoveforwardinthenextstateplancycle(FY2022‐2026).5YearOverview(FY2021)ForthefinalPPR(FY2021)ofthisstateplancycle,provideanoverallanalysisoftheoutcomesachievedduringthefive‐yearstateplancycle.Thedescriptionshouldincludetheextenttowhichdiversestakeholdersaresatisfiedwithcouncilactivitiesthatpromoteself‐determinationandcommunityparticipationforindividualswithdisabilitiesandfamilies,resultsofothertypesofinformationgatheringsuchasfocusgroups,surveys,orotherfeedbackorinputmethodswithindividualswithdevelopmentaldisabilitiesandfamiliesandmajoraccomplishmentsandfactorsimpedinggoalachievement(ifapplicable)


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SectionIV.B.Individual&FamilyAdvocacyPerformanceMeasure(ByGOAL)IndividualResponses(individualswithDDandFamilymembersonly)

DemographicData****ThisisanaggregatednumberfromallindividualresponsescollectedforthereportingFFY

Race/Ethnicity # % Gender # %White,alone Female BlackorAfricanAmericanalone Male AmericanIndianandAlaskaNativealone

Other

Hispanic/Latino Asianalone NativeHawaiian&OtherPacificIslanderalone

Twoormoreraces Raceunknown

Category # %IndividualwithDD ThisisIFA1.1

FamilyMember ThisisIFA1.2

Geographical

Urban

Rural


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I. OutputMeasuresObjective# PerformanceMeasure

PerformanceMeasure

IFA1.1ThenumberofpeoplewithdevelopmentaldisabilitieswhoparticipatedinCouncilsupportedactivitiesdesignedtoincreasetheirknowledgeofhowtotakepartindecisionsthataffecttheirlives,thelivesofothers,and/orsystems

IFA1.2ThenumberoffamilymemberswhoparticipatedinCouncilsupportedinactivitiesdesignedtoincreasetheirknowledgeofhowtotakepartindecisionsthataffectthefamily,thelivesofothers,and/orsystems

1. SpecifyObjective#

2. SpecifyObjective#3. SpecifyObjective# 4. Addadditionallinesas

needed

Denominator:TOTAL#ofOutputRespondents:


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II. OutcomeMeasuresPerformanceMeasures Percent(%)IFA2.1AfterparticipationinCouncilsupportedactivities,thepercentofpeoplewithdevelopmentaldisabilitieswhoreportincreasingtheiradvocacyasaresultofCouncilwork.

IFA2.2AfterparticipationinCouncilsupportedactivities,thepercentoffamilieswhoreportincreasingtheiradvocacyasaresultofCouncilwork.

Sub‐OutcomeMeasures Projects

#Peoplewith

developmentaldisabilities

#FamilyMembers

Thenumber(#)ofpeoplewhoarebetterabletosaywhattheywant/saywhatisimportanttothem

1. SpecifyObjective# # #2. SpecifyObjective# # #

3. Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #

IFA2.3Thepercentofpeoplewhoarebetterabletosaywhattheywantorsaywhatservicesandsupportstheywantorsaywhatisimportanttothem

Totalsub‐outcome#/IFA1.1total=X%



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#Peoplewith


#FamilyMembers

Thenumber(#)ofpeoplewhoareparticipatinginadvocacyactivities


3. Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #

IFA2.4Thepercentage(%)ofpeoplewhoareparticipatingnowinadvocacyactivities




#Peoplewith


#FamilyMembers

Thenumber(#)ofpeoplewhoareon cross disability coalitions, policy boards, advisory boards, governing bodies and/or serving in leadership positions.


3.Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #


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IFA3ThepercentofpeoplesatisfiedwithaprojectactivityIFA3.1Thepercentage(%)ofpeoplewithdevelopmentaldisabilitieswhoaresatisfiedwithaprojectactivity

IFA3.2Thepercentage(%)offamilymemberssatisfiedwithaprojectactivity


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SectionIV.C. SystemChangePerformanceMeasures(ByGoal)

SC1:OutputMeasuresThenumberofCouncileffortstotransformfragmentedapproachesintoacoordinatedandeffectivesystemthatassuresindividualswithdevelopmentaldisabilitiesandtheirfamiliesparticipateinthedesignofandhaveaccesstoneededcommunityservices,individualizedsupports,andotherformsofassistancethatpromoteself‐determination,independence,productivity,andintegrationandinclusioninallfacetsofcommunitylife.

Objective SC1.1Thenumberofpolicyand/orprocedurecreatedorchanged1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#

Objective SC1.2Thenumberofstatuteand/orregulationscreatedorchanged1,SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#

Objective SC1.3Thenumberofpromisingand/orbestpracticescreatedand/orsupported SC1.3.1Thenumberofpromisingpracticescreated SC1.3.2ThenumberofpromisingpracticessupportedthroughCouncilactivities


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SC1.3.3.Thenumberofbestpracticescreated SC1.3.4ThenumberofbestpracticessupportedthroughCouncilactivities

1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#

Objective SC1.4ThenumberofpeopletrainedoreducatedthroughCouncilsystemicchangeinitiatives


Objective SC1.5ThenumberofCouncilsupportedsystemschangeactivitieswithorganizationsactivelyinvolved



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SystemsChangeSC2:OutcomeMeasures

OutcomeMeasures Number(#)SC2.1ThenumberofCouncileffortsthatledtothecreationorimprovementofbestorpromisingpractices,policies,procedures,statuteorregulationchanges.(sub‐measures2.1.1;2.1.3)

SC2.2ThenumberofCouncileffortsthatwereimplementedtotransformfragmentedapproachesintoacoordinatedandeffectivesystemthatassuresindividualswithdevelopmentaldisabilitiesandtheirfamiliesparticipateinthedesignofandhaveaccesstoneededcommunityservices,individualizedsupports,andotherformsofassistancethatpromoteself‐determination,independence,productivity,andintegrationandinclusioninallfacetsofcommunitylife.(sub‐measures2.1.2;2.14)


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III.Sub‐OutcomeMeasures Objective SC2:Suboutcomemeasures

SC2.1.1

#ofpolicy,procedure,statuteorregulationchangesimprovedasaresultofsystemschange.

SC2.1.2#Policy,procedure,statuteorregulationchangesimplemented.


Objective SC2.1.3

#ofpromisingand/orbestpracticesimprovedasaresultofsystemschangeactivities.

SC2.1.4#ofpromisingand/orbestpracticesimplemented

1. SpecifyObjective#2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#


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Additionalgoal/objectivereportingfieldswouldbecreatedbasedontheindividualCouncil’s5‐yearstateplan.


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SECTIONV:COUNCILFinancialInformation[Section124(c)(5)(B)and125(c)(8)]CouncilisitsownDSA:____Yes ____No

FiscalInformationforProgrammaticPurposesONLY

Purpose:Inthissection,Councilsaretoidentifytheobligationandliquidationstatusforthe3FFYoffunds

1. FiscalYear YR2. ReportingPeriod MM/DD/YR‐MM/DD/YR3. TotalFederalFiscalAwardforReportingYear $4. StateFundsContributingtoCouncilStatePlanActivities $5. AdditionalCouncilFundsUsedforOtherActivities $6. FederalShareofExpenditures $7. FederalShareofUnliquidatedObligations $8. UnliquidatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–

FederalShareofexpenditures–FederalShareofunliquidatedobligations$

9. MatchRequired $10. MatchMet $11. MatchUnmet $


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Dollarsleveragedforthereportingyearbeingreported:$

1. FiscalYear YR2. ReportingPeriod MM/DD/YR‐MM/DD/YR3. TotalFederalFiscalAwardforReportingYear $4. StateFundsContributingtoCouncilStatePlanActivities $5. AdditionalCouncilFundsUsedforOtherActivities $6. FederalShareofExpenditures $7. FederalShareofUnliquidatedObligations $8. UnobligatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–

FederalShareofexpenditures–FederalShareofunliquidatedobligations)$

9. MatchRequired $10. MatchMet $11. MatchUnmet $

FiscalYear YR1. ReportingPeriod MM/DD/YR‐MM/DD/YR2. TotalFederalFiscalAwardforReportingYear $3. StateFundsContributingtoCouncilStatePlanActivities $4. AdditionalCouncilFundsUsedforOtherActivities $5. FederalShareofExpenditures $6. FederalShareofUnliquidatedObligations $7. UnobligatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–

FederalShareofexpenditures–FederalShareofunliquidatedobligations)$

8. MatchRequired 9. MatchMet 10. MatchUnmet


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SECTIONVI:MEASURESOFCOLLABORATIONPurpose:Inthissection,CouncilsaretodiscusscollaborativeeffortswithspecificDDNetworkpartnersandothercollaboratorsseparatefromtheplannedDDNetworkCollaborationgoal/objective.1. Identifythecriticalissues/barriersaffectingindividualswithdevelopmentaldisabilitiesandtheirfamiliesinyourStatethatthe

CouncilandtheP&A,theCouncilandtheUCEDD,theCouncilandothercollaboratorsmayhaveworkedonduringthereportingperiod

2. IdentifytheAreaofEmphasiscollaborativelyaddressedbytheDDCouncilandCollaborators

AreaofEmphasis[CheckApplicablearea(s)] 8.Recreation

1.QualityAssurance 1. QualityofLife2.EducationandEarlyIntervention 2. Other‐AssistiveTechnology3.ChildCare 3. Other‐CulturalDiversity4.Health 4. Other‐Leadership5.Employment 5. Other‐pleasespecify6.Housing 14.Other‐pleasespecify


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7.Transportation 15.Other‐pleasespecify

ThereportshouldincludeanarrativeprogressreportthatcohesivelydescribestheactivitiesthatwereimplementedbytheCouncilandtheP&A,theCouncilandtheUCEDD,theCouncilandothercollaborators.DDNetwork.Foratleastoneoftheissues/barriersidentifiedabovedescribe:(a)theissue/barrier;(b)collaborativestrategiestoaddressissue/barrierandexpectedoutcome(s);(c)theDDC’sspecificroleandresponsibilitiesinthiscollaborativeeffort.IncludeanytechnicalassistanceexpertiseDDCouncilstaffcanprovidetootherStatesinthisarea;(d)brieflyidentifyproblemsencounteredasaresultofthiscollaboration,andtechnicalassistance,ifany,desired;and(e)anyunexpectedbenefitsofthiscollaborativeeffort.

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