The Strategic Management Process

In March 2001, the Department embarked upon a strategic management planning process to address several critical areas of concern to the Department and its key stakeholders. One of the key objectives identified was to establish effective and consistent health, clinical and behavioral supports for persons with intellectual disabilities across the departmental system.

The materials here offer several useful tools, instruments and processes to address these goals. They are presented as part of the Department's continuing commitment to supporting quality health care services.

Rationale for Recommendations

The Department acknowledges that there are a myriad of issues which impact upon access to and coordination of quality health care services for individuals with intellectual disabilities. The materials presented here place a high priority on prevention, early detection and health promotion activities. Preventive and routine screening, health promotion, early detection, treatment and follow up on health care concerns represent the cornerstone of quality health care supports for everyone. Unlike the general population, however, some people with intellectual disabilities cannot report and describe signs and symptoms of illness, some do not have full medical histories and many rely upon direct support professionals to be their health care advocates.

Through direct interviews with providers, staff, and with input from family members, the Department identified several key issues that affect the quality of health care services that individuals receive. These include:

  • Difficulty on the part of the individual to communicate symptoms to both direct support professionals and health care providers.
  • The need for better tools that would allow direct care professionals to more effectively communicate the health care needs or issues of the individuals they support.
  • Incomplete or poorly communicated information from the health care provider that impacts on follow-up and ongoing health care management.
  • Lack of complete and thorough medical histories needed to enable a health care provider to make appropriate assessments, diagnoses and treatment recommendations.
  • Lack of consistent routine/preventive health care screening standards adjusted for age and specific syndromes associated with intellectual disability.
  • Lack of systems to observe and report changes in health and mental health status.
  • Lack of systems to trigger a clinical consultation when certain health care issues emerge.

In an attempt to address many of the above issues, we developed specific standards, tools, and systems in cooperation with our providers, staff, health care providers and individuals working in the community.

Pilot Study of Health Care Protocols

In early 2003, we "field-tested" the forms and systems with 15 volunteer provider agencies from across Massachusetts. The participating provider agencies used all of our proposed forms and systems for a period of 2 months. Written feedback, focus groups, and telephone interviews helped us to modify the forms to ensure that they will serve their intended purpose in the community.

(added September 2007)

Once the initiative was rolled out across the state, the Department followed up with providers and staff to assess how the implementation has progressed. Based on findings of a 2005 survey and focus groups in 2006, we revised guidance in several areas and has begun developing supplemental training material to help providers and families learn about key elements of the Health Promotion and Coordination Initiative.


This information is provided by the Department of Developmental Services.