These are excerpts from the June edition.
Note: This article is based on an extended conversation with Ron Willsey, Director of Community Services for San Andreas Regional Center located in Campbell, California.
In these times of heightened tension in the California developmental service system, there are a lot of committed people going about the day-to-day practice of making quality assurance everyone's business. This is a profile of one such effort in the Bay Area.
Quality Assurance Advisory Committee
There is a strong base of commitment to assuring quality services in the San Andreas area. About three years ago, this commitment was formalized by the development of a Quality Assurance Advisory Committee. The Committee is made up of people served by the regional center, family members, service providers, staff from San Andreas as well as Agnews Developmental Center. With bylaws, a mission statement and officers, this hard-working committee meets on a monthly basis. Among other things, the committee assisted in the field test of Looking at Life Quality. Recently, they were asked by the San Andreas Board of Directors to become a permanent advisory committee.
The Committee firmly endorses the work of the regional center in developing a comprehensive, quality assurance system which: (1) includes a variety of formal and informal activities; (2) fosters the growth of a trusting relationship between people served, their families, services providers, and the regional center; (3) focuses on a balance of quality enhancement as well as monitoring; (4) develops a cooperative relationship between state and local monitoring agencies (e.g., Community Care Licensing); and, has at its core "personal contact" with every individual using regional center services. The following is a brief description of each of those components:
Personal Contact. The core of the system is someone in everyone's life who asks [on a regular basis] How are things going? of the individual and/or family or significant others. This might be the service coordinator, a family member, a life quality visitor, a friend, or [hopefully] all of these persons. The idea is to build the capacity of those who know and care about someone to be a part of an individualized quality assurance team.
Standards Compliance. While quality enhancement, technical assistance and training are important, basic standards compliance (e.g., Title 17, 22 is also a vital part of the system. That is, do service agencies provide basic health and safety, respect for individuals served, and do they offer support which meets the needs of the individuals they serve? The challenge to San Andreas is to personalize those basic standards so that they reflect the valued outcomes of developmental services (e.g., choice, relationships, lifestyle, health and safety, rights and satisfaction).
Agency Evaluation. In the evolving San Andreas system, service agencies are encouraged to develop internal methods of evaluation and quality assurance through the development of a program design. That is, a way to determine what the agency's customers think of the service, what they do well and what they could do better. There is no precise prescription on how to do this, which allows service agencies the opportunity to work with the people they serve and their families to develop a customized system. This effort reflects a commitment to continuous quality improvement.
Quality Review Teams. The system also includes a quality review process which is completed by review teams made up of people served, family members, regional center staff and service providers. These teams use a visiting process and develop a written report based on agency review guidelines. All team members are trained in the process and service agencies are encouraged to take the training and to complete a self-assessment prior to the team visit.
Technical Assistance and Training. In partnership with local service provider organizations, San Andreas identifies and supports a variety of technical assistance and training activities. This may range from a workshop on Psychiatric Medications or Person-Centered Planning to a peer review and consultation requested by a service agency.
Cooperative Relationships. San Andreas meets monthly with staff from the Community Care Licensing section of the Department of Social Services. The focus of these meetings is to review issues and concerns regarding licensed residential and day services. There are also monthly meetings with the Service Providers Association, Service Providers Advisory Committee and the Residential Service Providers Association as well as regular meetings with the Supported Employment and Living Team and the Supported Living Round Table. The regional center has also worked hard to build a cooperative relationship with Area Board VII through joint advocacy, training and legislative efforts. In fact, the Area Board has been contracted to complete the life quality assessments with individuals living in the four-county area.
In Conclusion. While this is a system of quality assurance and enhancement that is still evolving, it's roots are firmly established. That is, a system that focuses on a variety of activities, involving everyone and looking at one person at a time.
Some Thoughts About Using
A Conversation with a Friend
A Conversation with a Friend [developed by Partners in Consulting] is a wonderful way to approach a conversation with someone about life quality. It has become a preferred way to train visitors and many continue to use it as the primary method of structuring their conversations. In the year since its development, several adaptations have been noted from regional centers around the state. Here are two of those best practices.
The Bottom Line Question. Use the bullet point questions as prompts and a way to start the conversation in a given outcome area. By moving the bolded question to be bottom, the bullet point questions become prompts leading to the bottom-line, all things considered question.
Here's how it looks now.
Here is a suggestion for reorganizing the questions as prompts for a bottom line question.
A Visual Strategy for Recording Answers. Some people work better with visual prompts as a reminder of the different ways that someone might answer an all things considered question [like Do you make everyday decisions for yourself?] Consider using a three response visual cue card that looks like the following:
You could develop a set of 25 cards, one for each of the bottom-line outcome questions. Responses in the middle or left category would be rated as Okay for Now while the right category would be Needs Follow-Up.