Basic Assurances Overview ® : Introduction to a Guided Self Assessment.

Basic Assurances Overview®:Introduction to a Guided Self Assessment

CQL | The Council on Quality and Leadership CQL | The Council on Quality and Leadership

Who we are……

• International not-for-profit organization dedicated to the definition, measurement, and improvement of personal and community quality of life for people with disabilities and people with mental illness.


Vision – A world of dignity, opportunity and community inclusion for all people.

Mission – To provide leadership for greater world-wide inclusion and quality of life for people with disabilities

CQL | The Council on Quality and LeadershipCQL | The Council on Quality and Leadership

Partners in Excellence; Leadership for the Journey.• CQL is at the forefront of improving the quality of

services and supports for people with disabilities and people with mental illness.

• We have been leading this effort for more than three decades.

• Everyone has a right to a life of dignity, opportunity and community inclusion.

• Our journey continues with the daily work of establishing real connections between disabilities’ theory and practice


1970s and 1980s: Basic Assurances® and Compliance in Services

• CQL (then the Accreditation Council) developed national consensus standards for organizations providing services to people with intellectual disabilities.

• The standards reflected the principles and values of professionals, families, provider organizations and government agencies.

• These standards (1971, 1973, 1978, 1981, 1985, 1987 and 1990) were incorporated into federal court rulings, the Health Care Financing Administration’s (now CMS) Medicaid standards and numerous state licensing requirements.

1990s: Personal Outcome Measures®

• CQL developed the Personal Outcome Measures® by holding focus groups with people with disabilities and their families.

• The Personal Outcome Measures ® were piloted in two states and ten field tests occurred in the United States and Canada.

• CQL’s initiative in redefining quality in terms of personal outcomes influenced subsequent development of person-directed approaches in numerous states, at CMS and within intellectual disabilities and mental health communities.

CQL | The Council on Quality and Leadership


2000s: Social Capital and Community Life®

• CQL is now focusing on the social and community context for the attainment of personal quality of life. • Strong social capital enables all of us to live healthier and happier lives, increase our community affiliations, and exercise choice and self-determination. • The challenge of organizations and support groups is not only to engage in person-directed processes; rather it is to use the person-directed orientation to build social capital and Community Life® for all people.


Personal Outcome Measures


• My Self• My World • My Dreams

CQL | The Council on Quality and Leadership CQL | The Council on Quality and Leadership My Self

1. People are connected to natural supports.

2. People have intimate relationships.3. People are safe.4. People have the best possible health.5. People exercise rights.6. People are treated fairly.7. People are free from abuse and neglect.8. People experience continuity and security.9. People decide when to share personal

information.


My World

1. People choose where and with whom they live.2. People choose where they work.3. People use their environments.4. People live in integrated environments.5. People interact with other members of the

community.6. People perform different social roles.7. People choose services.


My Dreams

1. People choose personal goals.2. People realize goals.3. People participate in the life of the

community.4. People have friends.5. People are respected.


My World

My Focus: What is most important to me now.

My Self

My Dreams

My Focus

FAA Level of Safety FAA Level of Safety

“The FAA has one level of safety, and there’s no compromise. The airlines that meet it can fly. Those that can’t become part of a business-school case study.”

Marion Blakey, AdministratorFederal Aviation Administration

Basic Assurances®

Basic Assurances®

• Essential, fundamental and non-negotiable requirements for all service and support providers

• Includes the areas of Health, Safety, Human Security

• Viewed from the person’s perspective

Basic Assurances® Basic Assurances®

The Basic Assurances® use three terms to distinguish levels within the measures:

• Factor refers to the main topic area.• Indicators are the specific expectations for

that factor.• Probes are designed to assist in determining

the presence of the indicator within the organization or system.

Rights Protection and Promotion


• The organization implements policies and

procedures that promote people’s rights.• The organization supports people to exercise

their rights and responsibilities.• Staff recognize and honor people’s rights.• The organization upholds due process

requirements. • Decision-making supports are provided to

people as needed.

Dignity and Respect Dignity and Respect

• People are treated as people first.• The organization respects people’s concerns

and responds accordingly.• People have privacy.• Supports and services enhance dignity and

respect.• People have meaningful work and activity

choices.

Natural Support Networks


• Policies and practices facilitate continuity of natural support systems.

• The organization recognizes emerging support networks.

• Communication occurs among people, their support staff and their families.

• The organization facilitates each person’s desire for natural supports.

Protection from Abuse, Neglect, Mistreatment and Exploitation


• The organization implements policies and

procedures that define, prohibit and prevent abuse, neglect, mistreatment and exploitation.

• People are free from abuse, neglect, mistreatment and exploitation.

• The organization implements systems for reviewing and analyzing trends, potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation, and injuries of unknown origin and deaths.



• Support staff know how to prevent, detect and

report allegations of abuse, neglect, mistreatment and exploitation.

• The organization ensures objective, prompt and thorough investigations of each allegation of abuse, neglect, mistreatment and exploitation, and of each injury, particularly injuries of unknown origin.

• The organization ensures thorough, appropriate and prompt responses to substantiated cases of abuse, neglect, mistreatment and exploitation, and to other associated issues identified in the investigation.

Best Possible Health Best Possible Health

• People have supports to manage their own health care.

• People access quality health care. • Data and documentation support evaluation of

health care objectives and promote continuity of services and supports.

• Acute health needs are addressed in a timely manner.

• People receive medications and treatments safely and effectively.

• Staff immediately recognize and respond to medical emergencies.

Safe Environments

Safe Environments

• The organization provides individualized safety supports.

• The physical environment promotes people’s health, safety and independence.

• The organization has individualized emergency plans.

• Routine inspections ensure that environments are sanitary and hazard free.

Staff Resources and Supports


• The organization implements a system for staff recruitment and retention.

• The organization implements an ongoing staff development program.

• The support needs of individuals shape the hiring, training and assignment of all staff.

• The organization implements systems that promote continuity and consistency of direct support professionals.

• The organization treats its employees with dignity, respect and fairness.

Positive Services and Supports


• People’s individual plans lead to person-centered and person-directed services and supports.

• The organization provides continuous and consistent services and supports for each person.

• The organization provides positive behavioral supports to people.

• The organization treats people with psychoactive medications for mental health needs consistent with national standards of care.

• People are free from unnecessary, intrusive interventions.

Continuity and Personal Security


• The organization’s mission, vision and values promote attainment of personal outcomes.

• The organization implements sound fiscal practices.

• Business, administrative and support functions promote personal outcomes.

• The cumulative record of personal information promotes continuity of services.

Basic Assurances® System

Basic Assurances® System

• The organization monitors Basic Assurances®.• A comprehensive plan describes the methods

and procedures for monitoring Basic Assurances®.

Exercise: Are you on B.A.S.E?

Exercise: Are you on B.A.S.E?

• Basic Assurances® Short Evaluation

Field ExperiencesField Experiences

• 2 Basic Assurances® Certifications in 2 states (RI, LA)

• National Network Basic Assurances® Certification – Mosaic (2 times)– Bethesda Lutheran Communities

• Over 300 accreditation reviews using Quality Measures 2005 ® since May 2005

• Predictors of Success– 23 key indicators

• Implemented Basic Assurances® Monitoring System (Factor 10)

Field Experiences: Key IndicatorsField Experiences: Key Indicators

Top 7 strongest predictors:• The organization upholds due process requirements. • People have supports to manage their own health care. • The organization monitors Basic Assurances®. • Staff recognize and honor people’s rights. • Policies and practices facilitate continuity of natural

support systems. • The cumulative record of personal information promotes

continuity of services. • The organization has individualized emergency plans.

Field Experiences: Key IndicatorsField Experiences: Key Indicators

Predictors 8 – 12:• The organization implements systems for reviewing and

analyzing trends potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation and injuries of unknown origin and deaths.

• The organization provides individualized safety supports. • People are free from unnecessary intrusive interventions. • People receive medications and treatments safely and

effectively. • The physical environment promotes people’s health

safety and independence.

Field Experiences: Key Indicators Field Experiences: Key Indicators

Predictors 13 – 17:• Decision-making supports are provided to people as

needed. • The organization implements systems that promote

continuity and consistency of direct support professionals. • People have meaningful work and activity choices. • The organization provides positive behavioral supports to

people. • The organization ensures objective prompt and thorough

investigations of each allegation of abuse, neglect, mistreatment and exploitation and of each injury, particularly injuries of unknown origin.

Field Experiences: Key Indicators

Field Experiences: Key Indicators

Predictors 18 – 23:• The organization respects people’s concerns and

responds accordingly. • People’s individual plans lead to person-centered and

person-directed services and supports. • The organization implements an ongoing staff

development program. • The support needs of individuals shape the hiring training

and assignment of all staff. • A comprehensive plan describes the procedures for

monitoring Basic Assurances®. • People access quality health care

Field Experiences: ChallengesField Experiences: Challenges


•Indicator B: The organization supports people to exercise their rights and responsibilities

•Indicator D: The organization upholds due process requirements

•Indicator E: Decision-making supports are provided to people as needed

Field Experiences: Challenges


Dignity and Respect

•Indicator E: People have meaningful work and activity choices


•Indicator A: Policies and practices facilitate continuity of natural support networks

•Indicator B: The organization recognizes emerging support networks



•Indicator B: People are free from abuse, neglect, mistreatment and exploitation

•Indicator C: The organization implements systems for reviewing and analyzing trends, potential risks and sentinel events including allegations of abuse, neglect, mistreatment and exploitation, and injuries of unknown origin and deaths


Best Possible Health

•Indicator A: People have supports to manage their own health care

Safe Environments

•Indicator A: The organization provides individualized safety supports

•Indicator C: The organization has individualized emergency plans





•Indicator A: People’s individual plans lead to person-centered and person-directed services and supports

•Indicator C: The organization provides positive behavioral supports to people

•Indicator D: The organization treats people with psychotropic medications for mental health needs consistent with national standards of care

•Indicator E: People are free from unnecessary, intrusive interventions



Basic Assurances® Systems

•Indicator A: The organization monitors Basic Assurances ®

•Indicator B: A comprehensive plan describes the methods and procedures for monitoring Basic Assurances ®

Basic Assurances®Basic Assurances®

Factor One

Rights Protection and PromotionCheck if

yesSupporting Information

A.The organization implements policies and procedures that promote people’s rights.Probes:

1.Does the policy define the organization’s commitment to protect and promote people’s rights?

2.Does the policy contain a listing of rights afforded all citizens as indicated by the United Nation’s Declaration of Rights and by the constitution and laws of the country in which people reside?

System Practic

e

Definitions and Decision Making

Definitions and Decision Making

• Systems – organizational supports that provide the structure for organizational practice. These can be policies and procedures, staff training, or other types of systems – ensure sustainability

• Practice – what is observed in daily operations. This demonstrates how an organization’s supports are put into action

Exercise instructions

Exercise instructions

• Read narrative for your assigned Factor in the manual

• For each indicator, list examples of systems that support

• For one indicator, list three suggestions to validate practice

What about Personal Outcome Measures®?What about Personal Outcome Measures®?

Strong Systems + Good Practice = RESULTS!!

Self Assessment Tips

Self Assessment Tips

• Start NOW• Involve multiple stakeholders• Assume learning will cause change

– Expect a “messy” self assessment document• Remember – these are person focused

assurances• Avoid overly complex design• Communicate, communicate, communicate!

Self Assessment Process

Self Assessment Process

• Thoroughly review each factor and its indicators in “teams”– List organizational systems that support each

indicator• Describe how systems work (independently

and together) and identify gaps or need to revise– Consider data in particular

• Dig deeper – review each indicator and the probes – Cross reference with systems list

Self Assessment Process (continued)

Self Assessment Process (continued)

• Develop tools (assessments, data collection

formats) and revise policy as needed. Eliminate redundant or unnecessary tools

• Develop flow chart for each factor including person(s) responsible, time frames, method for analysis

• Identify reporting mechanism and time frames for summarizing to the larger organization (Factor 10)

Suggested Strategies to Validate Practice

Suggested Strategies to Validate Practice

• Talk with people (Personal Outcome Measures® interviews, targeted interviews, focus groups)

• Talk to families and staff• Spend time with people informally• Document review• Analyze for gaps between identified systems

and practice

A world of dignity, opportunity and community for all people

www.c-q-l.org

Basic Assurances Overview ® : Introduction to a Guided Self Assessment.

Documents

leadership slide

disabilities slide

community quality of

focus slide

community life cql

quality of services

services cql

practice slide