Quality Assurance/Quality Improvement
Summary
Adopted 2009
Oregon’s developmental disabilities service system does not have an integrated and functional Quality Assurance and Improvement plan. An effective Quality Assurance and Improvement plan would provide Oregonians involved in the developmental disabilities service system with the tools necessary to identify problems in the system and make improvements.
Despite a number of efforts since the 1980’s, Oregon has not been able to address the issues of Quality Assurance and Improvement in a systemic manner. The lack of a working Quality Assurance and Improvement plan results in an inability to hold services accountable to our vision and values. Many developmental disabilities community members and others believe the state is not concerned enough about the quality of services; that decision making at the state and local levels is arbitrary; and that there is little accountability for poor services. Stakeholders express frustration with Oregon’s apparent failure to align service implementation with its values.
The Oregon Developmental Disabilities Council envisions a statewide Quality Assurance and Improvement plan that holds the state’s developmental disabilities service system accountable to ensure individuals with developmental disabilities are safe and secure in their homes and communities and that their informed and expressed choices are honored.
An effective Quality Assurance and Improvement plan contributes to and protects self-determination, independence, productivity, integration and inclusion of individuals with developmental disabilities in all facets of community life. A Quality Assurance and Improvement plan holds the service system accountable to ensure that individuals with developmental disabilities can exercise their rights to information, skills, opportunities, and supports to live free of abuse, neglect, financial and sexual exploitation, violations of their human and legal rights, and the inappropriate use of restraints and seclusion.
A Quality Assurance plan must include the following principles and practices:
- Individuals have access to home and community-based services and supports in their communities.
- Services and supports are planned and effectively implemented in accordance with each individual’s unique needs, expressed preferences, and decisions concerning his/her life in the community.
- There are enough providers who possess and demonstrate the ability to effectively serve individuals.
- Individuals are safe and secure in their homes and communities, taking into account their informed and expressed choices.
- Individuals receive support to exercise their rights and to accept personal responsibilities.
- Individuals are satisfied with their services and achieve desired outcomes.
- The system supports individuals to efficiently and effectively and constantly strive to improve quality.*
Our vision for Quality cannot be achieved unless the system also includes the following:
- Stated values that include dignity and respect for individuals with developmental disabilities and the right to exercise their rights and responsibilities
- Policies, procedures and practices to ensure informed choice
- Adequate funding
- Clear goals and objectives and the tools for measuring success
- Accurate and complete data
- Comprehensive and systemic analysis of data
- Systematic way to make change based on data analysis
- Technical assistance and training
- Methods to hold providers accountable and enforce contracts
- Protective services that are comprehensive, transparent and coordinated across services
Background:
The definition of quality service to people with developmental disabilities and how quality is measured has changed dramatically in the last 25 years. Initially, when most services were provided in institutions, quality was defined by regulators applying rules in institutional settings. When services began moving to the community, quality was often defined by both regulators and families in terms of health and safety. More recently, self advocates, families, and regulators have attempted to define quality to include quality of life, self determination and safety.
Oregon has made many efforts since the 1980’s to address the issues of Quality Assurance and Improvement in a systemic manner. These efforts usually began under pressure from advocates and federal regulators and then often fell by the wayside due to other workload pressures and priorities.
In the late 1980’s Oregon was one the first states in the nation to implement a program to monitor and address the issues of the quality of life for people with developmental disabilities in community residential programs. Project AIM (Advocates Involved in Monitoring) was funded to send dozens of trained volunteers into community based programs to monitor quality. The Residential Outcomes System (ROS) was created to document and measure independence, integration and productivity of people in community residential programs. These programs have been discontinued due to funding and question about how effective the programs were.
In the mid 1990’s Oregon stated its vision and values for developmental disability services, but policies and rules were not put in place to fully realize the vision and values. Then in early 2000’s, Oregon implemented a statewide Quality Assurance program following a self assessment it completed in anticipation of a CMS (Centers for Medicare & Medicaid Services) review.
As a result, Oregon mandated quality assurance throughout its Community DD
Programs and even funded Quality Assurance Coordinators at the local level to help develop and implement Quality Assurance systems. In 2007, the Seniors & People with Disabilities Division gathered stakeholder input to update its vision and values statements. Late in 2007, a series of articles in The Oregonian exposed a high rate of abuse and neglect of people with developmental disabilities, which lead to a flurry of legislative and administrative actions to shore up protections for individuals. One important action taken was to fund abuse investigators positions in every Community Developmental Disability Program.
While important data is being collected, currently there is no systematic approach to data analysis that would lead to system improvements. In other words, Oregon is data rich and information poor. In addition, barriers to improve our state system of Quality Assurance and Improvement include lack of agreement on:
- how to implement our stated values;
- what the Quality Assurance and Improvement plan should look like;
- how to balance health / safety and personal choice; and,
- the roles and responsibilities of the stakeholders.
Where are we now?
Oregon’s developmental disabilities service system is more complicated and diverse than ever. More people receive services and their needs are often more complex. The demands for person-centered thinking and self determination challenge old approaches. A strong Quality Assurance and Improvement plan is essential to transition to a service system that reflects our shared values and ensures that individuals with developmental disabilities are able to stay healthy and safe on their own terms; have access to both people and things that are important to them; have the opportunity to make choices in critical areas of life such as relationships, jobs, activities, supports, and where and how to live; and have the right to explore their own dreams and life journey.
Possible Future Activities:
General:
- Ensure that the OCDD Five Year Plan includes participating in the planning, design or redesign, and monitoring of State Quality Assurance and Improvement plan that affects individuals with developmental disabilities.
- Support the Oregon Developmental Disability Coalition’s recommendations for improving protective services.
- Support projects that promote cooperation between law enforcement agencies and protective services agencies so more abusers are brought to justice. Advocate and support statewide implementation.
- Advocate for a state DD Quality Assurance Committee that is well staffed, meets regularly and has broad stakeholder representation from OCDD, families, and people with developmental disabilities.
- Support efforts to promote Oregon’s vision and values and strategies for achieving them.
Legislative/Administrative Policy Advocacy:
- Support increase for direct care staff wages and benefits.
- Support funding and development of a “do not hire” database of DHS employees, contractors, and volunteers.
- Support funding and development of a statewide database for substantiated perpetrators of abuse or neglect.
- Identify clear measurable objectives for achieving a “quality” system of services.
- Identify or recommend tools or methods for measuring objectives.
- Support current and promised Senior and People with Disabilities initiatives related to Quality Assurance and Improvement.
- Support self-determined and person centered services and systems
- Advocate for a Statewide Quality Assurance and Improvement data system across all services
- Support revision of the Individualized Support Plan process
Public Involvement:
Support forums and other methods for informing the public and gathering public input that will:
- Help the Governor’s office, Community Developmental Disabilities Programs, DHS / Senior and People with Disabilities, and others better understand the issues that our Quality Assurance and Improvement systems need to address.
- Update the community on what is being done in Quality Assurance and Improvement.
- Provide the community with opportunities to ask questions and further clarify their priorities and concerns.
- Obtain input from advocates and self-advocates about what they believe the goals should be for a good Quality Assurance and Improvement plan in order to achieve a “quality” service system.
Training:
- Support and encourage training opportunities for Community Developmental Disability Program staff, direct care professionals, support brokerages, providers and community partners, self advocates, and families on the values that support an effective Quality Assurance and Improvement plan and how they can use it.
*Centers for Medicare and Medicaid Quality Framework
