Projecting how much it will taketo accomplish outcomes with people; the imagine approach

3/4/15

What are Outcomes?

• Outcomes are the RESULTS we see from the support or service that is provided

• Outcomes describe how things will be different from how they are today; changes the person achieves

• They are specific, and are usually directly related to what is important TO a person, however they may also be related to what is important FOR the person

1. Focus on what the person wants to GAIN from the supports and/or services provided!

2. Answer the question; what is the desired impact? It will take time to get results:

Short term outcomes• Skills • Knowledge

Intermediate term outcomes• Behavior• Attitude

Long term outcomes• Values• Condition/ Status

Outcomes help everyone…

Outcomes…• Typically results in Social, Environment, or Economic

change in a person’s life (SEE)

• Are Specific, Measureable, Attainable, Results Oriented* and Timed (SMART)

• Focus on the person’s quality of everyday life; *you will be able to see, touch, feel, hear, or count the result

Person Centered Outcomes…• Answer the questions “so that…” or “in order to…”

– This is what makes an outcome person centered: the “so that” describes the uniqueness of the person

– It is the CONTEXT of the person’s life that creates the individuality

• Typically, if you can ask “why” and still answer the question, you haven’t gone far enough (continue to drill down.)

– If you haven’t answered the essence of the “so that/in order to”,

what you probably have is an action step for the desired outcome

imagine a new way to manage resources; it requires a Paradigm Shift

Moving Away From:

• Dependence on the system (The system is the expert, and the expert knows best)

• The system is capable of “rescuing” the family or the person supported through categorical services. Funds are constant as long as requirements are met whether or not the person wants/needs the service

Moving Towards:

• Enhance/promote/endorse the capacity of the family and the community to support people with disabilities – family and loved ones are the experts

• The system will collaborate with the person, their family and their community to find creative ways to promote the person’s desired outcomes by utilizing a variety of resources.

Have a Person Centered Stewardship Discussion

• We want fiscal sustainability:

• We address this as part of the person-centered process due to the system not having enough money to support people in the coming years

• It’s not a choice about considering other resources first. We must do our part to make sure we are partnering with other resources in order to be able to meet the needs of the future

• The county board cannot meet everyone’s level of need alone. It takes a village: our community partners, families, home health, Healthchek, state plan services, as well as a network of donations and volunteers within the community.

Critical to Quality!• Team conversations and involvement:• to develop outcomes• to determine “how much”

• Detailed Discovery Results• that explain how best to

support the person

• This cannot be done by SSA alone (in isolation)

How to start the conversation:• Start big – what are the areas in which the person needs support

to accomplish the outcomes?

• Through conversation you will get to the total number hours, miles, and items needed to accomplish each outcome based on:

1) Services/supports that wrap around the Action Plan to make it successful (see Discovery Results)

2) Risks and how addressed

3) Support Considerations

4) Action Steps

What conversations yield:

• In order to move towards a person’s outcome each team will have to have conversations that detail the scope and intensity of the person’s needs

• It’s a matter of being PERSON-CENTERED and looking at it person by person; no two people will be the same, even if they live in the same place

• The conversations will reveal opportunities to connect with family, natural supports like neighbors and friends, and with the community

You may have heard…

• We’re “costing out” the plan

• Correction: The Service Listing section of the outcome only projects hours and miles of service; what it will take to accomplish the outcome.

• Plan costs are determined in MSS/CPT. The PAWS still authorizes the service.

• We’re “paying for outcomes”

• Correction: We do want to know what our results are, what outcomes are achieved. However providers are still paid based on the services that were provided.

• This may change as DODD considers their reimbursement methodology.

Conversations inform the service listing….

• Project time / miles / items =

• Total time needed to accomplish an outcome rather than the provider staffing pattern.

• To do this, discuss:

1) Services/supports that wrap around the Action Plan to make it successful (see Discovery Results)

2) Risks and how addressed

3) Support Considerations

4) Action Steps

Costing out

Paying for outcomes

Service listing considerations….• A service listing does not replace projecting costs in CPT; nor should it be reconciled to CPT

• You will not see dollars in the service listing section of the plan

Service listing considerations….• Define things:

• Laundry activities could mean a number of things for different people = do the laundry beginning to end for the person, instruct the person beginning to end, do parts of the laundry steps and the person does other parts (number of hours would be significantly different)

• Payee services could mean a number of things to different people = paying bills only or metro paperwork, SS paperwork, etc (number of hours would be significantly different)

Use a person by person approach to develop the service listing

• How detailed you get when defining things depends upon what makes sense for the person:

• The level of support a person needs:• Do they have high service needs; will they continue to need

that because the services are specialized?• Have we fully explored opportunities to connect to community

and natural supports?

• How far along your county is with connecting people to community resources

What if the team does not agree?

• On the number of hours, miles, items?

• Continue talking and collaborating to get a better understanding • of how things get done• of supports required

Additional service listing considerations….

• Work with providers to determine which specific services support accomplishing the outcome (HPC, ADS, Voc Hab etc.):

• All services have allowable activities, be sure that you know (check rule) or ask what these are

• The selected service must have “a line of sight” to the outcome; it must match up to what the provider is able to do within the scope of the service

Process Quick View:• Focus on outcomes that are meaningful to the person

• Do not work backwards using a “we need to cover this service so let’s force an outcome” approach

meaningful outcome

services needed

project how much

How detailed should we get? You may get pretty detailed when deciding “how much” especially if your county is far along with connecting people to community and natural supports

• This activity takes time, creativity and trust

• Trust means respecting each other’s opinions and developing a partnership

• We need to help each other think in a different way

Step 1

…Step 64

56

Help each other get over the wall; when you are on step 5 you can see and understand step 6. But you have to get over the wall to see beyond that point…

We can’t climb the stairs in a single leap nor can we change team thinking through a single conversation!

To help you “over the wall”: what people are saying

“We don’t make assumptions. We look at it in this way, just because you have always had 24/7 support doesn’t mean you will always need that. We still look to other resources, natural supports etc. etc. We have had folks who used to have 24/7 supports that with the right supports in place have been able to move toward more independence.”

“This is person by person. Some of these folks have used remote monitoring and/or some have used more natural supports. Some people have met outcomes and become more independent and added alone time etc.”

To help you “over the wall”: what people are saying

“If we didn’t have these conversations I don’t know how we would get to the identification of what the person needs. We know that everyone is different whether they live by themselves, with their family, in a shared site etc. and the level of needs of each person is different. “

“When the team functions as a partnership the level of trust grows. Each member will always feel comfortable having open dialogue with others identifying needs, concerns and celebrations when good things happen. These partnerships occur when all team members are truly vested in the outcome that a person has chosen.“

Examples on the next slides provide a lot of detail;

• Use this level of detail when it makes sense for the person

• Use this level of detail when the climate of your county allows you to become more detailed in your approach 

• Use this level of detail when you and the team are ready (when you have made it over the wall!)

Outcome #1:• I spend time with family so that we can have a

relationship.

Outcome #2:• I have a job so that I can pay my rent.

Outcome #3:• I learn what it means to be healthy so that I don’t have

to go to the doctor so much.

EXAMPLES

To spend time with family, the person needs reminders to be calm (family drama tends to upset them) and to take their medication (the family doesn’t believe in medication)

• 1 hour a month driving• 2 hour visit• 2 hours to talk through things

Because of family interactions, the provider is the person’s payee:

• 1 hour a month paying bills• 1 hour a month reconciling• 4 hours a month assistance with

purchases• 1 hour a month assistance with JFS / SS

or other government agencies

I spend time with family so that we can have a

relationship

3 hours per week

(½ hr per day)

I have a job so that I can pay my rent

The person needs assistance learning coping mechanisms at work but this will come from the job coach. When we are talking with the HPC provider, focus on the Discovery results and what the home staff do to best support the person in getting ready for work:

• Teaching him / her to ensure their uniform is clean and pressed

• Talking each night about what made for a good day

• Helping the person to build the skills towards a good lifestyle (good sleep patterns, etc)

• Teaching him / her to pack a nutritious lunch

8 hours per week (1 hour per day)

I learn what it means to be healthy so that I don’t

have to go to the doctor so

much.

Because the family did not believe in doctors or medication, the person has a fear of doctors / dentists. It is important for them to go to the doctor as they have a lot of health concerns. The person would like to understand why. Appointments take a very long time (mentally preparing, they like to sit in the waiting room so they can be calm, and then decompressing when they get home)

• Counseling ( once per month) – 3 hours each = 36• Lab work (once per month) 3 hours ea = 36• Exercise (4 times per month) 2 hours each = 96• Discussions around drinking enough water and

what kinds of food are healthy 2 hours each day (8 hrs / month)

• Dentist (only dentist available is in Columbus; they have a lot of work to do) – 3 hours / month =36

Annually:• Vision (twice a year) – 1 ½ hours each• Family doctor (4 times a year) 1 ½ each

53.75 hours / week of ongoing

support (7.7 hours per

day)

Create schedule

HPC needed

Individual at work

Total hours

Imagine IS Service Listing

• Outcome 1 = 3 hours / wk• Outcome 2 = 8 hours / wk• Outcome 3 = 53.75

hours / week

Total PROJECTED hours of 64.75 / week

MSS

Schedule indicates a need for HPC hours • Monday – Friday 6:30-

8:30am• Monday – Friday 4:00-

11:00pm• Saturday 7:30am – 10pm• Sunday 7:30am – 10pm

Total of 70.5 hours

Alignment not reconciliation

If it’s close

If your team projects 64.75 hours / week by outcome and calculates 70.5 hours in MSS – this would typically be close enough.

If it’s not close

If your team projects 26.75 hours / week by outcome and calculates 60 hours in MSS – this would typically warrant additional work.Recommendations:1. Do not write an additional

outcome to fit things in unless you really did miss an important outcome

2. Review the existing outcomes with the team to see if items were missed

3. Review Discovery Results to ensure all items were listed

4. Ensure the individual really needs 60 hours of paid services

Your county will be determining if this is close enough

Entering the information in the imagine IS

I spend time with family so that we can have a

relationship

3 hours per week (½ hr per day)

Questions?MEORC SUPPORT• imagine@meorc.com

• David Mitchell – dmitchell@meorc.com• 740-432-4240

• Misty Croston – mcroston@meorc.com• 740-624-7643

• Nathan Mutschelknaus – nmutschelknaus@meorc.com• 740-398-8748

• Tara Nicodemus - tnicodemus@meorc.com• 740-501-2064

COUNTY SUPPORT SUBJECT MATTER EXPERTS• Angela Finck - angela.finck@lcountydd.org• Lois Everitt - leveritt@fairfielddd.com• Michelle Dexter - mdexter@fairfielddd.com