Core

Indicators

Project

An Overview of How ConnecticutIs Using the NCICONSUMER SURVEYFAMILY SUPPORT SURVEYCHILDREN’S SURVEY

State of Connecticut Department of Mental Retardation

Prepared by the DMRSTRATEGIC LEADERSHIP CENTER

July 2003

Use In Connecticut

National Core

Indicators

NCI

CONTENTS

1.Overview of the CIP2.Connecticut’s Participation3.Examples of Data Analysis and

Communication4. Special Issues and Use of NCI

in Quality Review System

NCI

Purpose of the Core Indicators Project Develop, field-test, & disseminate a nationally recognized

set of PERFORMANCE INDICATORS that can be used in any state to gauge the effectiveness of specialized, publicly-funded DD services and supports.

Establish corresponding NORMS & STANDARDS as a basis for assessing and interpreting the indicators.

Design a CONSUMER SURVEY instrument and protocol for assessing system performance through the eyes of individuals who receive and rely on state DD agency funded services and supports.

Identify PRACTICAL APPROACHES for collecting, tracking and reporting the performance data in an economical and efficient manner.

National Coordinators

NASDDDSNational Association of State Directors of Developmental Disabilities Systems

HSRIHuman Services Research Institute

The National Core Indicators is managed and coordinated by

Information about the NCI, including updatescan be found at:

www.hsri.org

CURRENT Participating States

Connecticut was one of six charter statesin Phase I of the Core Indicators Project

• Alabama • Arizona• Connecticut• Delaware• Hawaii• Illinois• Indiana• Iowa• Kentucky• Massachusetts• (Minnesota)• Montana

22Participating Sates

• Nebraska • North Carolina• Oklahoma• Pennsylvania• Rhode Island• South Carolina• South Dakota• Utah• Vermont• Washington• West Virginia• Wyoming

Plus: Orange County, CA

Orange County

N.C.I. is GROWING year by year.About ½ of the country is now participating! (as of September 2002)

Why is Connecticut Participating?

To establish benchmarks for the department’s performance objectives.

To measure the effectiveness of services and supports provided over time.

To provide a mechanism for collecting information to be used in the new Quality Review process

To inform the department’s strategic planning process. To measure Connecticut's performance nationally and

against states with similar demographics. To influence the process and assure it is consistent with

Connecticut’s values and service delivery system.

?

6 MAJOR INFORMATION COLLECTION ACTIVITIES

METHOD WHO Description

Consumer Survey Random sample of 400+ adults receiving CM plus one other DMR service

Cross-section of living arrangements. Personal face-to-face interview conducted during the late Fall and Winter months.

Family Support Survey

Random sample of 1000 families – receive CM plus one other DMR service

Mailed survey sent to families of adults receiving DMR support who live at home. Survey usually completed in the Spring.

Children/Family Survey

Random sample of 1000 families of children - receive CM plus one other DMR service

Mailed survey sent to families of children receiving DMR support who live at home. Excludes B3. Completed in Spring.

Family/Guardian Survey

Random sample of 1000 families – receive residential services

Mailed survey sent to families of adults receiving residential support outside of the home. Completed in Spring.

System Level Data

DMR System Demographic and fiscal data. Includes mortality, injury and unusual incident rates. Financial/Medicaid data to be coordinated with Braddock research.

Provider Survey Private Providers under contract with DMR

Mailed survey that collects information about private provider staff retention and board membership

CONSUMER SURVEYMAJOR CATEGORIES COVERED IN THE INTERVIEWS

1. HEALTH 2. SERVICES3. INCLUSION4. CHOICE5. RESPECT &

RIGHTS6. PROTECTION &

RIGHTS

7. CASE MANAGEMENT

8. ACCESS9. SAFETY10. SATISFACTION11. RELATIONSHIPS12. ACCEPTABILITY13. STABILITY

QUESTIONS:

Specific Questions on the Survey

CATEGORYCONCERN: Area or issue under assessment

ALL PERCENTAGES REFLECT POSITIVE ORIENTATION

0.0%

20.0%

40.0%

60.0%

80.0%

Pe

rce

nt

Ag

ree

me

nt

High 35.0% 30.9% 68.3% 48.7% 71.6%

Low 11.2% 3.2% 25.2% 11.5% 37.5%

CT 35.0% 29.8% 25.2% 25.7% 55.2%

Supp Empl

Grp EmplShel

Empl*Non-Voc

DayComm Partic

1/10 5/102/10 1/10 3/10

HIGH Rank of 1, 2 or 3

MIDDLE Rank of 4, 5, 6 or 7

LOW Rank of 8, 9 or 10

Connecticut Ranks

EXAMPLE OF DATAOur display of data includes the following information:

Highest Score for each item

Lowest Score for each item

CT’s Rank out ofTotal StatesReporting DataNote: LOWER number is aBetter (Higher) Rank. 1 isBest and 10 is worst.

CT’s Score for each item

Example:INCLUSION

HIGH Entertainment

MIDDLE Shopping, Errands

LOW Exercise, Eat out, Religious

Services

Connecticut Ranks

CONCERN: People use integrated community services and participate in everyday community activities.

ALL PERCENTAGES REFLECT POSITIVE ORIENTATION

40.0%

60.0%

80.0%

100.0%

Pe

rce

nt

Ag

ree

me

nt

High 100.0% 100.0% 84.2% 91.2% 94.1% 71.2%

Low 88.3% 92.8% 67.5% 71.4% 86.6% 42.9%

CT 92.8% 95.0% 69.5% 86.8% 88.5% 50.6%

Shopping Errands ExerciseEntertain

mentGo out to

EatReligious

Serv

6/10 6/10 8/10 2/10 8/10 9/10

QUESTIONS:1. Do you go Shopping?

2. Do you go out on errands and appointments?

3. Do you go out to exercise or play sports?

4. Do you go out for entertainment?

5. Do you always eat at home-or do you sometimes go out to eat? (Percent who go out to eat).

6. Do you go to religious services or events?

CONCERN: People receive the same respect and protection as others in the community.

Example:PROTECTION & RIGHTS

HIGH

MIDDLE Enter home w/o asking, Enterbedroom, Use phone, Be leftalone when want to

LOW Open mail, Be alone with guests

Connecticut Ranks

ALL PERCENTAGES REFLECT POSITIVE ORIENTATION

QUESTIONS:1. Does anyone ever open your mail without permission? [% no and

some opened]

2. Does anyone come into your home without asking? [% no}

3. Does anyone come into your bedroom without asking? [% no]

4. Are you allowed to use the phone when you want to? [% yes]

5. When you have guests over, can you be alone with them or does someone have to be with you? [% yes or not always]

6. Can you be by yourself as much as you want to? [% yes]

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Pe

rce

nt

Ag

ree

me

nt

High 94.2% 94.2% 91.5% 100.0% 97.6% 97.1%

Low 58.7% 67.6% 70.3% 94.7% 86.2% 78.4%

CT 82.3% 82.6% 81.4% 96.7% 86.9% 89.6%

Open Mail

Come into

Home

Come into

Bedroo

Use Phone

Alone with

Guests

Be by Self

8/10 5/10 5/10 5/10 8/10 5/10

CHANGES OVER TIME

COMPARISON OF TrendsON THE NCI CONSUMER SURVEY

Since Connecticut has completed the survey for 3 years now, can also look at

Example:CHANGE: Health & Services

50%

60%

70%

80%

90%

100%

1999 91.7% 67.3% 71.8%

2000 87.4% 57.7% 67.8%

Recent Physical Exam

Recent OB/GYN Exam Recent Dental Exam

H

H

H

HH

M

Comparison of 1999 & 2000CIP Consumer Survey for CT

HEALTHSlight decline in all 3 areas. Still rank in highest grouping for OB/GYN and Dental Exams.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 99.4% 16.9% 64.8% 92.3% 21.1% 62.9%

2000 95.5% 17.8% 61.6% 80.4% 23.0% 57.5%

Case Mngmnt

Asst Tech Clinical Transp Respite HCBS

H

H

H

M

H

L

Comparison of 1999 & 2000CIP Consumer Survey for CT

H

M

M

M

H

M

SERVICESSlight decline in Case Management and Clinical Services. Larger decline in Transportation. Slight improvement in Assistive Technology and Respite.

1999 CIP RESULTS

2000 CIP RESULTS

H 1 2 3M 4 5 6 7L 8 9 10

Rank

KEY FOR READING GRAPHS

• FAMILY SUPPORT SURVEY• FAMILY/GUARDIAN SURVEY• FAMILY/CHILDREN SURVEY

The same type of analyses are also completed for the Family Surveys

ALL PERCENTAGES REFLECT POSITIVE ORIENTATION

HIGH

MIDDLE Receive Information, Easy to Understand, Changes in Staff, Staff Speak Language

LOW Choose Providers, Choose Staff

Connecticut Ranks

INFORMATION, CHOICE & LANGUAGE

QUESTIONS:1. Do you receive information about services and supports that

are available to your family?2. If you receive information, is it easy to understand?3. Do you choose the agencies or providers that work with your

family?4. Do you choose the support staff that work with your family?5. Are frequent changes in support staff a problem for your

family?6. If English is not your first language, are there staff who speak

with you in your preferred language?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Pe

rce

nt

Ag

ree

me

nt

High 59.2% 72.7% 67.7% 46.8% 28.4% 69.2%

Low 30.5% 57.4% 31.4% 10.3% 18.6% 29.2%

CT 41.2% 64.8% 51.0% 19.7% 22.4% 50.0%

Receive Information

Info Easy to Understand

Choose Providers

Choose Staff

Changes in Staff are Problem

Staff Speak Preferred Language

7/11 5/119/115/11 9/11 6.5/11

Example: FAMILY SUPPORT

QUESTIONS:1. Do you receive information about services and supports that are

available to your family?

2. If you receive information, is it easy to understand?

3. Do you receive information about the status of your child’s development?

4. If yes, is this information easy to understand?

5. Do you get enough information to help you participate in planning services for your child?

6. If your family has a service plan, did you help develop the plan?

ALL PERCENTAGES REFLECT POSITIVE ORIENTATION

HIGH

MIDDLE Receive information about services, Receive information about development, Information re: development easy to understand

LOW Enough information to plan,

Got help developing the plan, Information is easy to

understand

Connecticut Ranks

CONCERN: People receive information that is understandable and useful in the planning process.

Example:INFORMATION& PLANNING

20%

30%

40%

50%

60%

70%

80%

90%

Pe

rce

nt

Ag

ree

me

nt

High 62.1 73.6 55.5 69.5 64.0 82.5

Low 32.1 51.1 26.3 60.3 30.6 54.7

CT 41.8 66.8 30.5 65.3 35.8 59.7

Receive Information

Info is Easy To

Understand

Status of Developmen

t

Understand Dev Info

Enough Info to Plan

Help Develop Plan

3/6 5/6 4/6 4/6 5/6 5/6

To date, small sample sizes, random selection, and timeliness of the national analyses have presented some special challenges for using the NCI as part of a DMR QA/QI process.

SPECIAL CONCERNS & FUTURE PLANS

NEW DIRECTION:The NCI will become an integral component of the new enhanced QI process within DMR. The Consumer Survey – with supplemental items – will form the basis for evaluating personal outcomes. Survey data from families and guardians will be integrated into a consolidated QI report for assessing the full DMR system, regions, and service providers.

STEP 1 – DATA ANALYSIS• Regional/Provider Data Analysis (including NCIsurvey satisfaction data)

• Provider Organizational Self-Assessment

STEP 2 – SAFETY CHECKLIST PROBES• Emergency Planning• Environmental Safety – Facility/Home

STEP 3 – PERSONAL OUTCOMES REVIEW

FOCUS AREAS• Planning & Personal Achievement

• Relationships & Community Connections• Choice & Control• Rights, Respect & Dignity• Safety• Health & Wellness

COMPONENTS• NCI Consumer Survey

• Supplementary interview with the Person• Interview with Support Provider• Observations• Record Review

STEP 4 - SUMMARIZE FINDINGS

STEP 5 - PROVIDE FEEDBACK

STEP 6 - IMPROVEMENT PLANNING Individual/Regional/State

Levels

New Quality Review in CT to include NCI

More Information on theNational Core Indicators can be found at

www.hsri.orgInformation regarding Connecticut’s participation

can be obtained by contacting

The Connecticut State Department of Mental Retardation

barbara.pankosky@po.state.ct.usbeth.mcarthur@po.state.ct.us