STRATEGIC PLAN FAQ & ANSWERS

2000 & 2002

The following are answers to questions raised at the stakeholder forums held during the Autumn
of 2000 for the rollout of the Department’s Strategic Plan.  The answers below represent the best thinking  of  the  plan’s  crafters  at  the  time  the  questions  were  asked.    The  work  of  the Implementation Groups, now in progress, may dictate changes to some of the answers as a result of their thoughtful consideration and work.  Some questions have been assigned to these groups for examination as part of the planning process and will require further work to answer.

This concludes the question and answers from the initial rollout forums.  As additional questions arise throughout the implementation of the strategic plan, we will look for opportunities to widely broadcast the answers for all to see.  We thank you for your time and input.

Strategic Objective #1:

Will DMR re-determine one’s eligibility through life?

In most instances, DMR will determine adult eligibility only once.   If sufficient assessment information is available at the time of assessment, we will not normally re-look at  adult eligibility.  There may be rare exceptions, (which is why our current regulations allow for the possibility of redetermination),  but in most cases adult eligibility  will be done only once. Children change throughout their developmental period, and it is possible that we will look at eligibility multiple times prior to the age of 18.  The Eligibility Group, however, is looking at the issue of how this process will occur for anyone eligible for the Department’s services.

What happens to current consumers with IQ over 70 when new eligibility begins?  How do we plan to stop serving those with  IQ  between 70-74?  What will happen to an individual in the system now who, on reevaluation, is found to have an IQ over 70?

These questions have been assigned to  a strategic planning work  group  for discussion and further proposal development.  For the time being, all current consumers will be assumed to be eligible.  The Department’s first and primary goal is to make sure everyone it supports, is supported well and safely.  Protocols will have to be established to handle redeterminations and changes in eligibility status.

Who will support those with developmental disabilities whom we currently support? DMR has and will continue to support  those  individuals with developmental disabilities within our system.  Given that our expertise and mandate are to serve individuals with mental retardation, the question of whether it is appropriate to serve people with developmental disabilities, in the absence of mental retardation, is a fair one.  DMR will work with the Executive Office of Health and Human Services (EOHHS) and other agencies to address this question.

Will we be kept up to date on inter-agency agreements as they develop?

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The  Department  expects  to  be  an  integral  partner  in  the  discussion  and   crafting  of interagency  agreements.  As agreements are made, we will ensure that their content and nature are appropriately disseminated and applied.

How will we ensure that other agencies abide by their agreements?

We  will  be  working  collaboratively  with  EOHHS  and  the  other  agencies  to  construct agreements that work for everyone involved.  This is the best way to make sure that the agreements are effective and implemented.

Who will decide which diagnosis is primary, and if a person is better suited for service by DMR or the Department of Public Health (DPH), Department of Mental Health
(DMH), etc?

Clinicians are expected to indicate which diagnosis is considered the principle one and we will rely heavily on their judgments.  Reasonable people will disagree on these judgments, and  we  anticipate  some  interagency  forum  and  conflict  resolution  mechanism  to  be developed to resolve disputes.

It is important to point  out that in most instances, individuals with dual diagnosis (Mental Retardation/Mental Illness) will remain the primary responsibility of DMR, established by a previous  interagency  agreement.    The  instances  when  the  principal  diagnosis  issue  will change this will be carefully detailed in a protocol that will have to be developed.

What will be the responsibility of area staff if all decisions are made at the regional level?  Isn't this an insult to area office staff?

The decisions we anticipate making at the Regional level are eligibility decisions, which will include clinical  assessment relative to level  and intensity  of support needs and individual resource mapping.   The critical functions of individual service planning and design will continue to be done at the Area level.  The assignment of eligibility to the Regional level is designed to provide greater clinical consistency regarding eligibility decision-making. It will help to free up Area office staff  for service coordination activities by  removing a time- consuming function. We value the work of our area staff and clearly no insult to area staff was intended.

Where will current intake staff go?  What will be their functions?

We have not yet determined what current Intake and Eligibility staff will do.  We anticipate some  role  for  Area  staff  in  the  intake  process,  although  it  is  likely  to  be  significantly delimited.  We have not yet developed details of this, but will keep everyone informed as we clarify these issues.  One thing is certain, there is plenty of work in the Areas to do.

After a determination is made, does the area office have any say in final decision?

The actual eligibility decision will be made at the Region.  The Area Office will not have a say in that decision.

What is going to be done to train appeal officers to be in sync with new plan?

We will have appropriate people designated by Central Office meet with appeal officers to explain our new eligibility standards.
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Who will do the assessment and how often or when will reassessments be done?

The assessments will be done by the Regional eligibility teams for new people and by service coordinators with staff assistance from clinicians who either work in Area Offices or at the regional level for existing consumers. For existing consumers with Individual Service Plans
(ISP), it would be done as part of the ISP process.

What assessment tools will be used?  Who will administer the tools?

The work  group  assigned to this objective will survey existing instruments in use in other states and  recommend a particular instrument, adapt an  existing instrument or  (less likely) create a new one for Massachusetts.  At that time we will be better prepared to determine who should apply the tool.

Will all vendors use the same assessments to determine support needed?

This will be a DMR  Assessment that will be done with information shared by the person, vendors, and others who know the person (friends, family guardians)

Does this apply to children?

No decision has been made yet concerning the application of a standard clinical assessment to children nor have we made a decision about whether the assessment of the tool should be the  same  for  adults  and  children.    This  is  an  area  which  will  require  a  good  deal  of exploration

Will currently eligible DD kids continue to keep family support allocations when they are not found eligible as adults?
We intend to use our children and transition surveys to help us figure out how many DD children we are currently serving.  This will help DMR and EOHHS to sort out how best to support these young adults.  Although it is not our intention to discontinue family support it should be understood that all of our family support allocations are based on an annual need prioritization and subject to legislative appropriation.

Will a mechanism  to approve movement between intensity of need levels restrict the ability to quickly respond to changing needs of an individual?

No, whatever we put in place should not be a cumbersome process. It will simply create a method to "check" for  accuracy to maintain  fairness  given resource decisions that may follow.

Where will pool of flexible funds come from?

We already have some flexible funds that we  use, for instance, to address emergencies throughout the  year.  The pool funds, like  emergency  funds, are all reprogrammed base funds.

Will individuals currently in service be assessed for intensity of need and will resources be reallocated based on those assessments over short and long term?

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Those currently in services will be  reassessed and information from the assessments will serve as a basis for dialogue to shift resources (reduce or increase) but at this time we do not see such shifts being "automatic.”

What type of data will be used to make decisions?

The status and changes  to individuals and their  needs, as reflected in the application of a standard clinical  assessment tool, may provide  one source of data to help make decisions. We intend to use our work groups to help think through and design what data elements are important  to  consider  as  we  move  to  create  standard  assessment  tools  and  practices  in general.

Will people get a determined level of support on an annual basis?

A review of the person's situation will lead to decisions being made as to the need to reassess in any given  year.  If not much has changed in a person's life then it would make sense to continue to use the existing assessment.

What will be done with existing contracts?

Once we have determined the direction our contracting system will take, all contracts will follow that course.  Recent RFR’s have been designed to yield contracting agreements that recognize the contract vehicle may change during the life of the procurement.

What will be the standards for cost corridors?

These have not been developed. However we have discussed the need to "price" our system in a manner that is similar to the methods used in the DD system across the country.  This is not simply taking our current costs and producing averages.   Instituting cost corridors will need to be done incrementally.  The current prevailing view is that cost corridors should first be used with new services and services associated with expansion funding.

How does cost corridor fit into self-determination?

Funding for self-determination has been produced via reprogrammed base funds and for individuals with new funds (such as Turning 22).  However, since real  self-determination efforts involve new program planning, the  cost guides used should fall  within the funding system that is developed for the Department.  Cost corridors need not be inconsistent with individualized  program  planning.    The  whole  basis  for  cost  corridors  is  to  build  in consistency with funding decisions throughout the department.

The use of a standard clinical assessment leading to a level and intensity of support need will support self-determination efforts by  giving the individual and his family a sense of what resources might be available to meet the individual’s needs.  This may in turn lead to the use of non-traditional providers as individuals make decisions about how to best meet their needs with the support of DMR.

Will there be an increase in state operated residential sites?

That will be taken up by the work group.

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How does the department prepare to embrace the idea of a legitimate role for the facilities?  How does this square with those who believe it is counter to the mission of the department?

Facilities exist now and people live there,  which means for those individuals and their families they are "legitimate" and part of DMR’s operating responsibility.  The real question for the work group is what should be their future role.  We need to be thoughtful about this issue and wait for the outcome of deliberations from the group, rather than anticipating a particular response before the question even has the opportunity for consideration.

Strategic Objective # 2

How will salary increases be incorporated to assist in recruitment and why doesn't the plan address salary levels?  (the vast majority of questions related to Objective #2 were related to salary issues)

The Department will continue to incorporate annual salary increase dollars, when available. The plan calls for recruiting and retaining qualified staff at all levels.   Salary is but one of many components that need to be considered.   The planning process will consider salary as well as the other components.

Where will  we get the  money  to implement  these goals?  Will there be new  funds to support training and other staff supports?

New funds for some of the workforce initiatives sponsored by the Department have already been made available.  Some of these new funds have already been allocated to this initiative; for example we have funded programs with UMass and the Community Colleges.  DMR will take a very close look  at how it uses existing training resources and determine if these resources are being used in the best way possible. We will need to examine what approaches need to be taken - a reallocation of some  current resources, the addition of some new resources, or perhaps both.

Will the Department  work with Human Resources Division (HRD) to substantially streamline the hiring process re posting, checking CORI, and having physicals in order not to lose potential employees?

The Department has arranged to meet with HRD on a regular basis to discuss both broad and specific hiring issues.  Items such as CORI and diversity are continuing to evolve resulting in some uncertainty in the overall hiring process. HRD is in the process of giving agencies the authority and responsibility to take over certain actions, which had previously required HRD involvement.  We need to focus on doing our end of things more efficiently - such as the time we take to get a job posted; the length of time a committee takes before starting and ending interviews; decisions on the candidates, just about all aspects of the process.  If ways can be found  to  improve  the  human  resources  functions  of  the  department  they  would  be implemented where possible.

Will people's jobs be changed or will there be new staff hired?

Some of the work or tasks that we are currently doing will stop and some new initiatives will start.  That may require peoples' jobs to change or call for additional staff.  We don’t  yet know what those tasks or activities are but it is clear that changes will occur and, as they do,

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we  will  need  to  evaluate  positions  and  peoples’  skills  against  the  new  activities,  in accordance with collective bargaining agreements.

What will the rulebook include?

This will be a fairly broad look at the overall administrative and operational functions in the department.  The emphasis will be on standardization and consistency  of  activities and approaches throughout the organization.  Expectations will be clearly expressed and guidance given to employees and contractors to help achieve a consistent standard of quality and to assure that individuals and families across the state have similar and constructive experiences with DMR.

What is the APD?
The APD is a federal Health Care Financing Administration (HCFA) acronym that stands for  Advanced  Planning  Document.     It  is  the  vehicle  the  federal  government  uses  to financially support the Medicaid Management Information System at the Division of Medical Assistance, (DMA).  DMR is working with the DMA to develop a module MMIS that will serve the DMR business and program needs in the future.  Essentially we are using the federal financing to develop a new management information system.   This system will be a subsystem of DMA’s MMIS.  The goal is for DMR to develop an MIS system that protects privacy and can be accessed by families, individuals, public officials and others interested in Department information and data.

Strategic Objective # 3:

What will be done to ensure that supports are provided in a culturally competent manner?

The Department has made a commitment to ensure equal access to services  across the Commonwealth. This would include the need to be sensitive to differences and experiences of the many diverse cultures that may want to access supports. Managers are encouraged to receive  and  provide  training  in  diversity  so  that  they  may  be  effective  in  supporting consumers from different cultures. Strategies  would include hiring staff directly from  the communities in which supports will be provided; contracting for services with providers who have established  effective cultural networks;  and reaching out in partnership with other community organizations who presently provide supports to respective cultures in an area.

Will there be more clinical supports located in area offices to respond to needs? Resources will need to be allocated so that area staff has accessibility to medical and clinical staff to assist them in addressing the needs of their consumers. It has not yet been determined whether  these  staff  will  be  assigned  and  supervised  at  an  area  or  regional  level,  or  a combination of the two.  Initially, it is unlikely that there will be sufficient resources for each Area office to have a full complement of clinical and medical staff. Perhaps this might occur over time as priorities are determined and resources are allocated. It is also likely that some medical and clinical support may be contracted.  Partnerships and collaborations could be developed with generic providers. Some of our collaborations may involved the use of DMR resources to supplement supports for our consumers.

Will we use clinical resources at the facilities or will they be contracted from elsewhere?

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We are not intending to replace the  generic health care system, but  rather to  enhance  and support  it  through  the  use  of  DMR  resources.    DMR  resources  include  staff,  funding, consultation, collaboration, and joint initiatives/partnerships.   It is important that the generic health care system be utilized and supported.   Our facility staff has much expertise that can be utilized strategically in the areas and regions; it will also be necessary to contract for some services given the numbers of consumers needing clinical supports, as well as geographical considerations.

Behavioral supports are often provided through a contracted agency – do we see this happening for health and clinical services now?
Behavioral and clinical supports  can  be  provided in a variety  of ways.  Each  way has its benefits. There will likely be a combination of DMR clinical staff and contracted supports. The roles may vary depending on the nature of the services.

Given the increasing numbers of individuals, who are medically involved, can we not afford to “group them” together in terms of efficiency?

A person's medical needs are just one consideration for why people might live together. There   are   many   other   factors   that   go   into   living   arrangements:   choice,   interests, compatibility, relationships etc.  Medical and clinical supports need to be flexible. A person's home should be preserved as their home.

Will we be standardizing computer systems in order to enter health, clinical, behavioral data – and if so, who will be entering this data?

If we are to benefit from data management, systems should be uniform. Who enters data has not yet been determined. There may be different methods to enter the data, but there should be consistency in what is entered, and how it is utilized.  The APD, referred to earlier, will take these issues into account as the project moves forward.

Will there be a difference between how the department and providers look at the needs of individuals?

Over time there should be much consistency  between how the Department and providers look at the needs of individuals.  Differences should be minimized as resources become more available, more equitably distributed, and more consistently utilized from area to area, region to  region.  Consistent  systems  need  to  be  developed  in  each  of  the  areas  and  regions. Providers will be included as these systems are developed and become operational.

Strategic objective # 4:

What are the foreseeable changes to the survey and certification process?

Right now that is hard to say, given that we have yet to embark in designing an integrated, comprehensive Quality Management (QM) system. What we can say at this point in time is that Survey and Certification will be a piece of an overall QM system that will review all the DMR services and supports. We know that nationally there is a move towards developing outcome-based   systems   to   evaluate   the   quality   of   supports   individuals   receive. Massachusetts has been ahead of the curve in developing such a system and many states are interested in our process and have contacted  us to find out more about our certification system. Given the national trend, the core of  the certification process, one that  reviews service outcomes, from the perspective of the individual, will remain the same.
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Will the goal of survey and certification be to have one set of standards and measurement criteria for everyone receiving federal funding?

Again, that will be an important piece to be discussed when the workgroup for Strategic Objective #4 convenes. The group will need to consider what services are being billed under the federal Waiver and ensure that the requirements from HCFA are met. However, our goal would  be  to  create  a  unified  QM  system,  one  that  would  apply  all  the  services  DMR provides, regardless whether they are billed under the waiver or not or whether they are provided in a facility or in the community.

Why not improve the current QUEST rather than change the S + C?

Over the years we have made changes in the survey instrument (QUEST) and survey process. We would expect to continue in this effort,  especially to build upon the aspect of service enhancement and technical assistance.  In addition, improvements may be made in Survey and Certification so that is fits well within the whole QM design.

Will the new quality management system cover all services DMR offers including family support, individual supports and transportation?

Yes, but this does not  mean that all DMR services will be subject to certification. Some services will naturally lend themselves to an individually based review such as we currently use in Survey and Certification. Other types of services may require a different type of review process, perhaps where we evaluate the "systems" used by the provider that support individuals.   Ideally, however, the information we collect about services should all have the same core elements so that we will be able to report on our entire system of services and supports in a comprehensive and integrated fashion.

How will the plan to integrate all quality management programs happen in the area offices?

A good question.  This will be an important  task for the workgroup, one that must be developed in conjunction with the QM system design.    It will also require that the QM workgroup collaborate with the other three workgroups to ensure that Area Office roles that may change as a result of strategic planning are well coordinated, are provided training and technical assistance where needed, and have adequate resources to do all the tasks.  Currently all Areas have some systems and deploy different staff to monitor the quality of the services provided to individuals. Therefore, we will need to confer with Regions, Areas and Facilities to see the systems they are using and what they see as important information to gather. But, since we want to create a unified, integrated QM system, we will, by necessity, need to have the system be the same within the Areas and Facilities.

What will be the timeline for implementation of these goals?

A plan for implementation will definitely be developed by the workgroup. Some aspects of the QM system are more time sensitive and will be implemented sooner.  But we will not develop the specific pieces of the QM system until we have developed a set of outcomes and process measures that can be applied across settings and services.

How will the department support agencies  with staff competencies to  meet the new expectations?
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We would need to ensure that, before the new system roles out, DMR staff and providers participate in training and orientation sessions.  One strategy would be to use the "train the trainers" approach so that there is local expertise within Providers, Regions, Areas and Facilities.  Regardless of the format for training, this will be included in the work plan that is developed by the group.

Will we have parallel systems for a while?

While we would not want to stop monitoring systems currently being used, our goal would be to avoid parallel systems that go on for a long period of time.  Otherwise we may confuse people and potentially overload them with too much work.

Spring 2002 Strategic Planning
Frequently Asked Questions

On the following pages, the Department has attempted to provide answers to questions raised by participants in a series of st  ta ewide forums regarding DMR Strategic Planning. The forums cont  ia ned presentations on those workgroups who had achieved either significant milestones or comp   ilet on of their assigned tasks.  Ad  id tional summa        fries o the work on the remaining objectives will be published shortly.

The workgroup responses to th        rese F equently Asked Questions reflect th     ie d         tfferen stages of completion  for each of the objectives.    As further progress is made or information is learned or obtained, some of the answers may change.   The Department will provide updates th                irough bullet ns or upd  ta es to the DMR web page.

FORUM Q&A’s
JUNE, 2002

A. FACILITY RELATED QUESTIONS:
1.  What are the criteria for facility admission? How were they determined? Admission to the Department’s large, intermediate Care Facilities for the Mentally Retarded (“ICF/MRs”) is restricted to individuals with  mental

retarda ion who havet

 attained the age of

22 and a e eligr

ible for DMR

services  meet,

 the level o  caf

re for an ICF/MR and need active t eatr

ment.

DMR mus  maket

 a determination that, the individual’s needs cannot be

met in another set it ng, that  ht

e absence of facility residential services will

pose heal ht

 and safety hazards to the individual or others, and

that the

facility residential services are the least restrictive and most appropria et
for the individual.

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2.  If today someone wanted to be admitted to Hogan could they be?

erAdmission to a facility is not determined  by choice only.  The e ar

admissions criteria that must be met  includi,

ng a determination by DMR

that the facility is the least restrictive and most appropriate setting for the

adult with men alt

 retardation.

3.  Has there been any thought of making a reverse integration model which would create a diverse community on the grounds of those institutions?

A reverse integration model was one, amongst a number of options,
discussed by the fa   tcili y work group.  Guidelines for the use of  facility properties will be developed.

4.  Are there other integrated community models for group residential home-sites in addition to single family or apartment housing?

The Department is looking at various types of housing that might be

available, affordable, accessible,
living in the community.

and appropriate  to support individuals

5.  Why don’t families have options and knowledge?

Getting people  the information they  need in order to make plans and decisions is on    fe o  the Department’s greatest challenges.  There is a work group   develo  ip ng   recommend  ta ions   on   how   DMR   can   improve communic  ta ions and access to info     trma ion on services, supports and   t o her subjects that are important to individuals and families.

6.  Do community facilities depreciate?

Yes,  generally  the  ow        fner  o   the  house  may  depreciate  the  cost    f  o acquiring and improving the house by deducting the cost of the home, for accounting and tax purposes, over the number of years that the house will be used.

7.  Will “choice” people be given same funding in institutions and community?

The types and amount of supports that individual     rs a e offered  will be based on their assessed needs.  The costs of providing those services in different set it ngs must be taken into account in offering the service .s

8.  Are facilities subject to a  quality  assessment process other  than the current federal Title 19?

No.  Title XIX  of the Social Security Act sets the standard that DMR facilities must meet to be certified as intermed  tia e care facilities for people with mental retardation.  The facilities are  subject to  an annual  survey that  is  outcomes-based,  resident-based,  and  uses  a  resident-focused

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approach.    The  approach  looks  at  residen   ret

sponses  and  s afft

performance.  The requirements tha  tt

he facility must meet as an ICF/MR

include such areas as  a,

ct vei

rt ea mt

ent services, client p or

tection, client

behavior and health care services.

9.  The minority report  (ARC/MASS/MFOFC) of the Facility Committee provides a different interpretation of data – with  different projected  outcomes.  Will this report be considered?

The Strategic Planning Steering Committee reviewed and considered the report submitted by ARCMass and MFOFC.

10. Why should there be a choice between facilities and community?  I thought there was a mandate to close the facilities?

There is no mandate to close the facilities.  There is, however, a federal

requirement that persons eligible for admission to a DMR facility  wh,
offered Medicaid community services, be given a choice between institutional and community-based services.

o are

11. Is it true that under the consent decree, a person admitted to a facility for 30
consecutive days or 60 days in one calendar year becomes a class client?

Under the 1993 Final Order in the Ricci case, only individuals admitted to the Monson, Templeton, Wrentham or Fernald Developmental Centers for more than 30 consecutive da      rys o  more than 60 days during any 12 month period would become a Ricci class member.

12. Why only adults?

Admissions to DMR facilities are restricted to adults.  In Massa         tchuset s, the special ed     tuca ion system and the network   f o  residential schools and
tpedia ric nursing facilities meet the specialized service needs of children with mental retardation.

13. Is a community placement a group home or individualized community support?

A “community placement” can refer to several different residential support models.  Generally, a community placement occurs when arrangements are made for an individual to live in a home, other than the family home, in the community with 15 or more hours per week of support.  A more detailed description of various community placement models can be found on our Website.

14. You discussed the  “Facilities”.  What will  be available for the  people on the
“Boulet wait list lawsuit” regarding community placement?  You discussed the
Ricci class members and the nursing homes.

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The Boulet sett ementl

 agreement provides for funding and resources to

enable DMR to offer community placements to  ht

e Boulet class members.

Again   a  de,         tailed  description  of  the  community  placement  models  is available on the DMR Website.  In  addition, federal law requires that

individuals who receive these services paid for through  ht

e Medicaid Home

and Community Based Waiver are offe er

d a choice between community

placement and placement in a large facility.

15. This is a room full of families who wanted Belchertwown State School closed 10 years ago.  To W. MA the principle of fairness and equity is this:  No services for our family members greater than 1 hour travel from Pittsfield, not beyond 91, from East of Rt. 91, no further than Worcester.  How many people on Steering Committee from W. MA?  What do we have to do to get you to understand that we in W. MA don’t need/want facilities  but rather services/supports closer to their families?

The Department of Mental Reta    trda ion suppo tr s individuals with mental retardation and their families in all parts of the st  ta e.  Th                  lese individua s and families have different needs, interests and values.  There is a range of opinions held by individuals and families about the need and the future of facilities and the resources they repres    .ent   In examining the qu    iest on about the future role of facilities, DMR, including the Steering Committee,

is guided by several principles that include

tno  only fairness and equit  ,y

but   also   balancing   competing   interests,   addressing   DMR’s   legal responsibilities, and using data to inform decision-making.

The  Department  strives  to  provide  services  that    r  a e  in  geographic proximity to a consumer’s family.  Although  t i  may not always be possible to  honor  requests       t  tha   specific  services  be  provided  in  a  specific geographic location, every effort is made to keep services close to  an
iind vidual’s area   f o  mean    fing      iul t e. The expansio     fn o  community-based residential services in Western Massachus   tet s through the Boulet funding and the nursing home initiative has been robust and proportional to the population.

16. How much money does DMR pay for one person living in a facility?  How much for one person living at home with parents?

In Fiscal Year 2002, the cost of caring for an individual in one of the Department’s ICF/MRs was, on average,  $182,000 per yea .r   Ma      fny o th                   lese  individua s  have  intensive  and  pervasive  health  and  behavioral needs.  The cost   fo  supporting an individual to live at home with his or her
parents will depend on the severity and intensity of the need that cannot

be met by  available natural supports.

 For many individuals living with

their  families,  DMR  is  paying  for  serv                  tice  coordina ion,   their  day program/supported employment, transportation, and family support.  The average  annual  cost  to  support  individuals  living  at  home  with  their families through family supports, day supports    r, t ansportation,  plus the service coordination necessary to arrange these services, is $15,600.  In addition,  these  individuals  can  access  other  types  of  supports  and
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benefits,  not  available  to  individuals  living  in  the  facilities,  such  as supplemental security income payments, personal care attendants, day

habilitation, adult day heal ht

, and housing subsidies.

17. What does it mean if you don’t want your child or grandchild in an institution? What would be available to help the family?

For families caring for their adult son or daughter, or sibling or grandchild,
ta  home, the Department typically will provide a day program or supports, transportation  to  the  day  program,  service  coordination  and  “family supports,” such as respite or   t o her supports.     f  I  the Department has determined that the individual needs residential supports, and if resources

ra e available,  a family who do        tes no  want

their son or daughter in an

“institution”  will  have  many  service  options.    The  DMR  community residential service system continues to expand with the increases in the DMR annual ap  rp opriations.

18. When will it be determined what facilities will remain open?  Will this be done on a regional basis?  How are regions defined?

The report of the facility work group ha                   ts been submit ed for review by the Steering Committee who will make reco            tmmenda ions to the Commissioner about the future of the facilities, including how many facilities will remain open.  The decision will be made from a statewide, not regional, perspective.

19. What is the difference between a facility bed and a community bed?

The word facility is used to refer to our larger institutions.  A community bed one located in some community     t set ing – non-institutional.

20. Instead of keeping all facilities open, why not just 2 or 3 and use the savings on improving community residences and staff?

Any  savings  achieved  through  facility  closure  could,  if  available,  be redirected to improve community residences and staff or to address other need    fs o  the DMR service system.

21. When you reduce the facility beds by moving people out of these facilities, do you have community services ready for them?

DMR does not place individuals out of a facility without making sure that appropriate supports  and arrangements are available and made for the
iind vidu  la  in his/her ne       tw set i   .ng

22. If you have beds available in “facilities” will you still offer the choice of facility or home (community) or will people be forced to use facilities until they are full?

13

Departmental policy is not to direct admissions to facilities in order to keep the facilities “full.”  Only those who meet the specific criteria for admission would be considered for facility admission.

B. HEALTH CARE RELATED QUESTIONS:
1.  Define standards of health care?

The Department o  Mef

ntal Retardation regulations require that individuals

receive an annual physical exam    As p.

art of strategic management group

#3 a clear set of health care screening s at

ndards has been developed.

The  standards   beg n  wi

ith  a  set  of  routine  screenings  that  a er

recommended  for  the  general  public  at  specific  ages  and  a e  tr

hen

expanded  to  include  specific  issues  that  individuals  with  particular conditions (e.g. down’s syndrome) should be screened for at particular ages.

2.  What is health status review tool?

The health status review tool is a checklist for direct support professionals to complete in order to effectively communicate complete health care
tinforma ion to a      l hea th care provider.  The questi           tons rela e to all aspects of a person’s health including sleep, nutrition, and various bodily functions

and  systems.    The  qu    iest ons  are  very  specific  and  rely  on

id rect

ob       tserva ion by di    trec  support pr  fo essionals.  The ob       tserva ions so recorded will help the health care provider  conduct  a more  thorough exam and detect and treat health care issues more effectively.

3.  Who is implementing all of this? Time lines and costs excepted?

The tools and processes that have been proposed will be piloted during the Summer of 2002.  Revisions will be made based upon feedback and orientation will be conducted with providers and area                i offices.  T melines
fwill be developed a ter completion of the pilot.  The Department is in the process of evaluating any cost implications.

4.  Why do providers have their own peer review committees?

According to                 t DMR regula ions, providers may either have their own Peer
Review Committees, or rely upon DMR Regional Committees.

5.  How are you obtaining health care providers that will work with MR people?

For the most part, DMR does not directly  arrange for or contract with health care providers for the individuals we serve.  When an in  id vidu  la  is living with his/her family, the family typically assumes this responsibility. In  the  DMR  provider  system,  under  their  contracts  with  DMR,  most provid       rers a e responsible for finding and utilizing health care providers for the individuals they support.  Regulations require that providers promote op it mal  hea tl h    f  o   individuals  through  arrangements  for  coordinated

14

routine, preventive, specialty and emergency heal ht

 care, professional

clinical services and availability of first aid supplies.  Support for finding

new hea tl h care p or

viders can be obtained through the New England

Index and the Federation for Children with Special Needs.

6.  Why did O’Meara’s group (Health Group) spend so much time on Mental Health services availability and not on MR?

The primary focus of this work group was on mental health and behavioral support need    fs o  individuals w ti h MR.    There is a need for these services because  ment  la   hea tl h  and  behavioral  support  needs  appear  fairly frequently among individuals served by DMR perhaps 30 % or more.

7.  How is the Department preparing for the increasing Alzheimer’s issues?

DMR recognizes that our population is aging and that individuals we support will be more prone to Alzheimer’s and other condit             iions relat ng to the aging process.  Much of the work of the strategic management group has been geared to looking at screening  and developing health care support plan                    ls for individua s with specific medical conditions.   DMR will continue  to  look  at  what  kinds  of  supports,  both  specialized  DMR 
(additional staffing and clinical expertise) and generic (home health aides,
VNA, etc.) will be necessary to continue to support              l individua s  as they age.

8.  Is DMR doing anything to track  the cause of death of deceased individuals served by DMR?

Yes.  In fact, DMR has a well-developed reporting, tracking and clinical mortality review proce               tss.  All dea hs are reported within 24 hours and in- de  tp            lh clinica  reviews are done on those who meet criteria established by the Depart       .ment   On an annual basis, U/Mass Medical School/Shriver Center, will conduct an independent mortality review of a       tll dea hs of DMR
iind viduals over the age of 18.  Reports will include detailed information regarding location, age and cause of death.

9.   When doctors choose to ignore/not actively pursue symptoms of distress by MR individuals who may not have the verbal ability to describe their pain, what can DMR do to provide medical advocacy?

If individuals or their families are di    tssa isfied with medical care, they may avail th               femselves o  the grieva        rnce p ocedures regarding inadequate hea tl h care that are availa  lb e to the general popu   ilat on.  These include the Bo  ra d of Registration in Medicine for physicians, Department of Public Health and Hospital Boards for hospital care.  Fortunately, denial of quality health care to individuals with mental reta    trda ion is less likely than it may have been in the past, largely due to the efforts of families, providers and DMR area offices.  Howeve ,r  the strategic management group did identify this as an issue.  That is why several of the recommendations include training

15

direct care and o hert

staff in how to communica et

 informa iot

n to heal ht

care providers and how to be a good health care advocate.  In addition,

the  group  has  developed  a  tool  that

will  facilitate  communica it on

regarding a person’s  health status so that the health care  provider has

better information upon which to base a diagnosis   Fin.

ally, the group has

developed guidelines to assis  diret

ct support professionals to recognize

early signs and symp ot
initiated.

ms of illness  so that appropriate ac it on can be

10. Is  there  a  list  of  MDs  in  the  community  providing  excellent  care  for  DMR
consumers?  Especially in specialty areas?

The New England Index, that is maintained by the Shriver Center, and the Federa it on for Children with Special Needs both maintain a database of physicians and   t o her health care pr  fo essionals.

11. What alternatives to a person’s lifestyle have been tried before pulling someone into  the  mental  health  system,  like  a  more  interesting  job  and  community activities?

The  ISP  process  provides  an  opportunity  to  explore  and  propose reasonable alternatives for individuals who may appear  to need mental health supports.  Understanding that mental health/behavioral needs may appear in as many as 30% of the DMR population, we must be careful not to  unduly  delay  or  defer  necessary  treatment  and  supports.    Early recognition, identification and intervention are the primary approaches to be taken and interventions can include alternative program approaches or mental      l hea th referral.

12. Peer Review – How many people with MR or they’re families have been allowed input, beside staff members, to these groups?

A behavior plan requires the informed consent of the individual served or

their family/guardian.  Behavior plans are part

fo  the ISP, so the same

type of participation in their development should occur.

13. Why do residents of W.MA have to travel 1-2 hours (one-way) to receive MH or
Behavioral Services (outside of Region)?

Strategic  Plan  Objective  #3  look     ts  a   resources  in  the  community  to provide  mental  health  and  behavioral  supports.  The  distribution  of supports is such th  ta   sometimes people must travel a distance to have either a specialty MH provider involved, or to decrease the amount of time that they have to wait for an appointment.

14. A majority of the people who have MR/DD that I know do not use Mental or Behavioral Health Services.  What percentage of people served need Behavioral or Mental Health services?

16

Our data indicates that approxima et

ly 30  % or more of the individuals

served by DMR a e rer

ceiving some type of specific mental health service

or behavioral supports. Some 18 % of the adults in residential or day 

programs have behavior plans  man,

y individuals receive medicine for a

mental heal ht

 diagnosis, and still others are involved in  some type of

mental hea tl h counseling or supportive therapy.

15. What  percentage  of  funds  allocated  to  community  services  is  used  for  MH
services?

Because mental hea tl h               r services a e generally provided along with medical services through a larger medical service contract, we ca     tnno  break out this specific cost at this time.  However, the Mental and Behavioral Health Workgroup is examining this data.

16. Have you considered requiring that each residence have one or two appointed staff to be assigned medical visit staff?  Allowing direct care staff to be the liaison between physician and clients’ healthcare is not very productive.  Many direct care staff do not have the capability to be medical interviewers.

Many providers already do this.  Some may even have the RN (if they have one) go on medical visits.  This option is not always feasible, however, and therefore it is imperative that direct support professionals have availa  lb e tools to assure that a hea tl h care visit is successf  .ul   This
linc udes  ma       fny  o   th      re  p ocesses  and  instruments  th  ta   have  been developed by the strategic management group.

C. WORKFORCE TYPE QUESTIONS RELATED TO HEALTH CARE AND QUALITY:
1.  How to ensure quality and qualified staff?

Recruitment  and  retention  are  key  elements    f  o   our  st   tra egic  plan workforce goal #2.   We know that identifying new potential workers will be a challenge given the changing demographics in our state as well as the nation.  We  are  continually exploring new ways to make our work attractive  to  new  workers.    This  means  connecting  with  secondary ed     tuca ion, community colleges and higher  education in mo      rre o ganized ways.  Once we have done this we will need to concentr  ta e on what keeps people in th         .e field  Clearly improved wages is an importa  tn             , element  as well as, job satisfaction, benefits, and a supportive work environment.

2.  Define training/cultural change preparation.

St   tra e  ig c planning is ul it     tma ely about po   isit oning DMR to learn to manage strategically.    Part  of  this  effort  is  to  change  the  culture  of  the organization  through  a concerted  organizational development plan.  For example, the Advance Planning Do          ,cument  the Department’s effort to secure  a  new  computer  system,  is  a  wa      fy  o   changing  the  work enviro         ,nment  thereby chan  ig ng the organization  la  culture.  When the

17

Department   has   an   effective   da at

   reporting   system   that   allows

communica it on across all systems, it  will be able to more effectively

manage all aspec s of itt

s work, including addressing quality issues, critical

inciden st

 e,

tc. We are also working on the development of a management

institute tha  will help mat

nagers to understand and communica et

 the

changing prac it ces in a consistent way across the organization.   This will insure that the department’s policies practices are applied consisten lyt

across the Regions. This focus on the change process cu st
of agencies, businesses, etc.

 across all types

3.  More and more responsibilities are being put on direct care staff (MRW1s), how can DMR continue to  place more and more responsibilities on the lowest paid people in system, many direct care workers are well intentioned, but are not fluent in English, do not have American work ethic and not always able to expressive themselves, don’t you think our residents are being victimized by this?

Our st  ta e and our country are becoming increasingly diverse; in fact we have  always  been  proud  of  our  “melting  pot”  heritage.    In  the  MR community it is highly likely th  ta  people from diverse backgrounds will be in direct care positions.  This   i k nd of phenomenon has   l a ways been true 

for new populations.

We can all learn and be enriched from divers ti y.

As part of its recruitme  tn  and retention efforts, the Department is focusing upon developing a     f uni orm tr  ia ning curriculum for direct care workers and others in the organization to give them the tools to be successful.  The Department works in partnership with our providers to ensure th  ta  direct care workers get the  training they need.  In some cases, English as a second  language  is  being  taught  to  enable  direct  care  workers  to communicate more effectively with clients, and to offer them a chance to improve their skills and opport     iunit es.

D.  ECONOMICS RELATED QUESTIONS:
1.  Costs of meeting needs will vary in  different communities.  Are these cost variations being considered?  Is there an index factor that differentiates cost of living factors for different parts of the state (i.e., costs in Boston are higher than in Pittsfield)?

We have discussed the impact of geography on costs  particu,

larly on

salaries of direct care workers and on real esta et

 T.

she Commit ee it

currently in the process of reviewing the ove ar

ll structure for establishing

appropriate contract ra et

s based upon needs assessments. We will be

returning to an index or cost

adjus met

n  ft

actor for geography after the

basic approach to contracting is set. We  may well look  at actual cost

varia ions in tt

he human services field rather than adopting general figures

that might not be relevant to the human services industry.

18

2.  Is The Inventory for Client and Agency Planning (ICAP) being rolled out in April
2002?  Is this another DMR “releveling” of existing consumer base?  When will
ICAP and Mass. Assessment be used statewide?

The ICAP was pilo et

d during the month o  Jf

une, 2002 with a sample of

about 200 to 250 people. During the early part of FY 2003 we will begin to

determine the bes  wayt

 to roll out ICAP statewide for all DMR consumers.

An exact timetable has not yet been determined.  Over time,  we do expect that resources will be reallocated according to consumer need as measured through ICAP, and a supplemental tool to determine what other resources may be available to individuals served by DMR.

3.  If you were looking  at assessment and allocations why did you not consider
Wisconsin or Louisiana and were any of these states having a family support bill?

The Workgroup did review materials from 10 states and had a conference

where 4 st  ta       res p esented their models before moving forw  ra d

iw th our

recommendations Neither Wisconsin nor Louisiana were pu    irsu ng such a change.

4.  You whipped quickly past a major issue that I’d like to hear explained.  Please explain consumer control through the purchase of services.

In one of the potential options und             ter curren  consid    tera ion, we hope to have a system of allocation of DMR funding based on the ICAP and Mass.
Supplemental Assessment th  ta  is linked to the consumer. Also under consid    tera ion is a plan whereby the consumer could arrange supports di    trec       ily w th providers. Assistance to arrange services would be available from the DMR Service Coordinator  and other program staff in the Area Office.  There  would  be  info     trma ion  available  to  consumers  about providers including a profile of what services are provided by them and may have related information on experience. Providers would be  on an
“approved list” based on cert     tifica ion and other “qualifying inform  ta ion”. It is likely that some safeguards will be built into this process to provide adequate notice to providers if consumers wish to move their funding to another provider or service, e.g., an open enrollment period.

5.  We have a 19 year old son, handicapped, his diagnoses are mental retardation with immobility, speech problems, epilepsy, incontinence, he is not able to feed himself, he needs 24 hour supervision.  Can his mother continue to be his care provider and be paid by the system that provides assistance to families with patients with mental retardation?

We can provide supports to the home as described in the Department’s Family Support Guidelines which include many fo        frms o  assistance such as in home paid staff, community recreation, respite care etc. However, under current federal and state program requirements, the Department cannot pay parents for the care they provide to their children.

19

6.  What about individuals who have an ISO who need supports so that the provider doesn’t take the whole amount of money?  In other words “to buy services as needed.”

One of the  underlying assumptions in the ISO model is that funding
fshould only be used according to what is really needed by the person  I.

the person actually didn’t need all  ht

e funding as originally planned, the

excess would be available to someone whose needs may have changed or for someone else in need w ti hin the DMR system.

E.  ELIGIBILITY RELATED QUESTIONS:
1.  Will people who are eligible now continue to be eligible or do they need to reapply?

The Work Group on Eligibility has completed its work and forwarded a

recommendation  to  the  Stra et

gic  Plan  Steering  Commit ee.t

Pending

interna  reviewl

 o  tf

hese recommendations, and, following that, public

comments on any proposed changes, the Department will con inue tt
the current eligibility standards and process.

o use

2.  What  about  children  services?    Nothing  has  been  mentioned  re:  children’s services?  This presentation focused on Adults with MR. What about children, birth – 18?

The  Workgroup  made  some  recommendations  regarding  children’s eligibility that   r a e st                       till undergoing in ernal DMR review. Our children’s

eligibility will remain the same until

there is a public pr           rocess a ound

proposed changes to our eligibilit           ty regula ions.

3.  How come with a family with four DMR eligible children why only one gets any service?  I’m told because it’s family support program.

Family support is designed to support families and clearly if a family has more than one family member with a disability our support for th  ta  family will be greater subject to appropriation from the legi    tsla ure. We suggest that families who find themselves in this situ  ta ion discuss their individual concerns with the Area Office Directo .r

4.  I recently completed an “intake” with a representative from “ARC” (1/30/02) sent by the DMR.  My son is 2 ½ and has ASD.  Tonight you spoke of goals to map guidelines for supports and resources, however, I was told there is no “list” of supports available to be presented to families.  What will the “intake” accomplish for  my  family?    How  will  we  know  how  to  tap  in  to  DMR  for  help?    No professionals came out for intake – only nice “administrator” – no interaction took place with child as was mentioned during tonight’s presentation.

This question highlights many of the Strategic Plan goals that we hope to accomplish in the future: clear information about what kinds of resources

20

and supports exist so that families can choose from an array of options and a regional eligibility team process staffed by professionals with the

ability to ac ut

ally observe the person in natural set it ngs.  The goal of our

plan is to t y tr
years.

o achieve these items over the course o  tf

he next three

Currently, however, publications exist which describe in some detail the types  of  services  available.    For  example,  for  families  of  children determined to be eligible, the “Family Supports Guidelines” describes the services available.

5.  Are the Regional Team members going out to the individuals and family or are they going to have to do the intake at the Regional Office?  If so, how are the individuals and families going to get to the Regional Teams?

We  expect  members  of  the  Regional  Eligibility  Teams  to  go  out  to individuals and families.  Meetings may take place in the family home, the
ra ea office, a community program, etc.  If individuals and families want to come to the Regional office for intake, that is also an option.

6.  How are Regional Teams going to manage cultural/language issues?

The   Regional   Team   composition   must   take   into    account   the cultural/linguistic issues of potential  applicants. Our staffing pattern will reflect,  to  the  greatest  extent  possible,  the  cultural  diversity  of  the community.    Additionally,  it  is  our  intention  to  make  materials  and application forms av  ia lable in a variety of languages.

7.  Do these teams come to your house?  Do they include autistic individuals under the Department still?

A team member can come to your house to gather information, observe your family member and   i d scuss th      te na ure   fo  DMR supports and services with you and your family member.

8.  Who are the additional 3 members of the eligibility team?

Each eligibility team consists of a doctoral level licensed psychologist, a clinical social worker, a number of eligibility specialists, access to a RN for consultation, and an administrative assistant.

9.  What assessments would they use for eligibility determination?

We will use standardized intelligence tests such as the Wechsler and the
,Binet   the  Vinela   ,nd   Measures  of  Adaptive  Function    ,ing   School  and Hospital Reports, Medical Reports and  the Inventory Client and Agency Planning Tool (ICAP) coupled w ti h the Mass Supplemental Assessm    .ent

10. When will we know exactly who is eligible?

21

We will continue to use our current eligibility for the foreseeable fu ut

re. If

we move to change  our eligibility   ht

ere will be a  public process for

ind vidi

uals to share their concerns wi ht

 us.

11. When will the new DMR intake forms be ready?

Our plan is to have the forms available at the beginning of July, 2002.

F.  QUALITY RELATED QUESTIONS:
1.  We can collect mountains of data/info. But without properly analyzing the data we cannot utilize these data and put them into useful work.  How far away is your QMIS to reaching this goal?

That is the purpose of the strategic management group charged with the responsibility of coming up with a quality management and improvement system.  The group is looking at what kind of information we  want to collect, ways in which data can be transmitted to families, providers, and DMR managers so that it is easily understood, and mechanisms to assure that the data is analyzed by a variety of stakeholders.  Most importantly, we will be recommending systems to assure that the information gets used to       t crea e service improvements.              f  Many o  the data systems are already in place to give us critical           t informa ion regarding the quality of our supports.  Others still need to be developed.  The biggest challenge will be inte    tgra ing our information systems and developing the MIS capability to implement our vision.  It is difficult to place an exact timeline on this. We are, however, already reporting on critical quality indic  ta ors and will continue to move towards an integrated QMIS system.

2.  Do you put the survey data as well as individual profiles into a central location
(data storage) but accessible by regional/area offices?

Regional and area offices have access to individual profiles through the
Consumer  Registry  System  and  the  electronic  Individual  Service  Plan
(ISP).    D  ta a  generated  by  the  survey  and  certification  process  is maintained in a central database, so th  ta  all ratings regarding the services
lof individua s collected as part of the survey and cert     tifica ion process can be aggregated.  In addition, all provider levels of cert     tifica ion and    t ra ings in specific qualit             ry of life a eas can be compared.

3.  Would you further explain what you mean by medication utilization analysis
(e.g.)?

Currently,  DMR  collects             t  informa ion  regarding  medication  usage  for anxiety, behavior or mood disorders through the National Core Indicators
.Project   While this is useful, it does              tnot get a  the level of detail      ttha  will be helpful over time.  We would like to be able to gather information on medication usage for all the individuals we support so that we can track trends and patterns over time.
22

4.  What is the system in place for reporting medication errors?

Under the regulations of the statewide Medication Adminis ratit

on Program

(MAP)  non-licensed   staff  (non-RN’s  and  LPN’s)  are  au ht

orized  to

administer medications af et

r they have successfully completed a training

program and passed bo ht

 a writ et

n and skills test.  Providers utilizing MAP

certified staff are required to report any medication occurrence to DMR.

An occurrence is de if ned as any time an individual misses or rece vi

es their

medication a  tht

e wrong time, wrong dose, wrong rou et  , or gets the

wrong medication.  Follow up is done and data is maintained on every

med cai

it on occurrence statewide.  This is compared to  ht

e to at

l number of

dosages given.

G. GENERAL STRATEGIC PLAN QUESTIONS:
1.  There were many objectives that were either a) not covered or b) remain to be decided.  As these items are finalized is the Department’s website updated?  If not, how we can know what decisions have been made?

At these public forums we shared the work products of some but not all of ou    rr g oups. Later in June we intend to publish summa        fries o  the st  ta       fus o all of our work groups.  As it        rems a e finalized we will update our website.

2.  What will the Strategic Plan cost DMR?

To implement the St   tra egic Plan, the Department will utilize  current resources;  as  in  any  orga     tniza ion,  the  Department  will  regularly reexamine costs and benefits of its activities.   Practices adopted through implementation of the Strategic Plan are among the Department’s current
priorities.

3.  If the Strategic Plan started 18 months ago, why is it that advocates were only part of the plan in the last 6 months?

tAdvoca es  have  been  involved  since  the  Plan  began,  first  in  our environmental assessment and then in our work groups.      r Rep esent  ta ives from 5 advocacy groups were invited to join work groups and many did so.  All  of  our  work  groups  have  benefited  from  the  diversity  of perspectives of the stakeholders.

4.  How many workgroups have finished their work? How many presented final reports?

The Eligibility and Regional Team  work group has completed its work. The Facility work group has also completed its work. The Rule Book,

Recruitment and Retention, and Family

rPa tnership groups will complete

their  work  shortly.    The  Workgroups’  products  are  presented  to  the Steering  Committee  that,  in  turn,  makes  a  recommendation  to  the Commissioner   to   accept,   modify,   or   reject   the   work   group

23

recommendation.

 To date only the Regional Team  component of the

Eligibility  Work  group  has  been  accep ed  by  tt
implementation.

he  Commissioner  for

5.  When someone goes into  a Nursing  Home will the Strategic Plan follow  the client?

The Strategic Plan is not a service.  It is a plan for how the Department should manage the compelling issues that confront it. It is a tool to assist the Department in managing itself.  It is not a th                       ting or service, ra her it is a blueprint or guide for future activities.

6.  Are the strategic plan services geared to state ops vs. the private providers?  Is everyone in the field getting the same message regarding your plan?

Changes  th  ta   occur  through  Strategic  Planning  will  effect  all  DMR providers, pr    tiva e or state-oper  ta    .ed  The reason for the forums, the FAQS, and the summaries is to insure that everyone gets the  same message throughout the DMR community: public,        tpriva e, individuals and families.

7.  How much confidentiality is left after all this information is shared?

No individual client’s confidential info     trma ion has been shared through strategic planning processes an                           rd none will be sha                   ied.  Respect ng and protecting confidentiality is critical to the success of our mission.

8.  With all these meetings, were any held with families and individuals?

Yes, many meetings were held with families and individuals.

9.  What is the timeframe for the plan to be reviewed by the public?  How can you make this plan user friendly?

We provide frequent opportunities for public review and input of Strategic Plan products through forums like these.  We are always interested in how we can make our   lp an and its work user friendly.  Please feel free to offer us suggestions about how to best to do this.

10. What are you going to do about Grandparents raising their Grandchildren?

This is a new area for us and we are eager to learn from Grandparents

about  their part      ricula   needs and how they
other families.

ra e similar or di        tfferen  from

11. What does all this mean to the less knowledgeable consumers?

As we develop the Plan a tc i   ivit es,  it means th  ta  people will know and understand what we do, how we do it, and what choices they can make about their services and supports.

24

12. How do you plan to make families educated consumers specifically?

We believe th  ta  inform  ta ion is the most powerf  lu  tool that we have and our Family Partnership work group will develop what kind of information and in what form  ta  will be most helpful to families.  We also know that families learn enormously  from each other and we want to encourage opportunities for families to network with each other.

13. How do you expect the cuts in the 2003 budget to affect the strategic plan? Budget cuts  are always difficult to manage but  one of  the reasons we began our Strategic Plan was to help us manage in difficult times as well as  good  times.    Str  ta egic  Management          r  is  lea ning  how  to  manage differently; the Plan helps us do t    .hat

14. A suggestion:  Create a list of service providers that will provide services to people with an ISO as needed, when needed.

This is an excellent suggestion and we will work on it.

15. Has there been any  discussion on changing the name of the Dept. (“Mental Retardation”) in any of the groups?  We would see more respect that way. Would  you  ever  consider  changing  the  term  used  for  the  Department  (of)
“Mental Retardation”?  This would seem  to be a first step toward improving community relationships and developing “maturity”.

We have worked with the Statewide Advisory Co       tmmit ee and the Self- Advocates to explore changing the name of the Department. In order to accomplish  this  we  would  need  to  change  our  statute  and  only  the Legislature can do t    .hat   We would also have to agree on what our name should be in the futur  .e     i  L ke many issues that confront us there is a wide range of opinions about this.

25