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                                                TABLE OF CONTENTS




Introduction ........................................................................................................................................................ i
Mission and Vision ............................................................................................................................ Section 1
Organizational Chart ...................................................................................................................... Section 2
Overview of Quality Management Plan and Outcomes .......................................................... Section 3
           Assessment of Consumer Outcomes
           Review of Purposes
           Marc Center’s Unique Strengths, Abilities and Opportunities
           Strategic Implications
Critical Incident Reporting Analysis ............................................................................................... Section 4
Community Day Services ................................................................................................................. Section 5
Community Support Services .......................................................................................................... Section 6
Community Living Services .............................................................................................................. Section 7
Employment Related Services ........................................................................................................ Section 8
Behavioral Health Services ............................................................................................................. Section 9
Administrative/Support Services .................................................................................................. Section 10
                                   FY2008-2009
                            QUALITY MANAGEMENT PLAN
                                       AND
                        ASSESSMENT OF CONSUMER OUTCOMES

INTRODUCTION

Marc Center is committed to the provision of quality services throughout the organization.
This is a commitment made not only to the children and adults who receive services, the
family members of service recipients and funding sources; but also to the community-at-
large and other stakeholders. As an organization, we firmly believe that we have a re-
sponsibility to provide services that meet the needs of the citizens in our community in the
best manner that we, as professionals and paraprofessional in our field, can provide. We
believe that the provision of quality services is an ongoing challenge that involves a com-
mitment toward continuous improvement every day. Further, we embrace the concept that
our customers define quality. From our perspective, the hallmark of quality services is de-
fined by customer astonishment (i.e., satisfaction). Framed within this model, astonishment is
enhanced by meeting people’s wants, not just their needs.

Marc Center is governed by a Board of Directors that is responsible for oversight of the
business operations of the organization. This is done through the hiring and supervision of
the President & CEO of Marc Center who maintains responsibility for day-to-day opera-
tions. The President & CEO works with the board to design a functional organizational
chart to assure all services are staffed accordingly.

The organization is comprised of a management team led by the President & CEO and
consisting of the Chief Administrative Officer, Chief Financial Officer, Chief Operations
Officers and Executive Vice Presidents. Each member of the Executive Council is responsi-
ble for ensuring that information is disseminated among the appropriate lines of supervi-
sion, based upon departmental assignments within the organizational chart, to members of
the Administrative Council (comprised of the management team and program directors) or
other assigned staff.

Marc Center maintains two standing internal committees, Safety and Quality Manage-
ment, as a part of its ongoing operational commitment to quality services. Both committees
meet on a monthly basis and are comprised of representation from throughout the organi-
zation.

The purpose of the Safety Committee is to review and oversee all safety-related concerns
and issues within the organization, as well as to promote safety awareness and training,
thus ensuring a safe environment for consumers and employees.

The purpose of the Quality Management Committee is to determine the format and ac-
tions for the handling of all agency procedures and forms to assure conformance and
compliance to all applicable internal and external requirements. In addition, the commit-
tee:
   •   Assesses the degree to which services provided are relevant to the individual
   •   Assesses the degree to which services are accessible and obtainable

                                          Introduction
                                                i
   •   Determines staff credentials and professional standards of care
   •   Coordinates needed services across the organization
   •   Assesses the degree to which services are provided in an appropriate manner
   •   Determines the capability to produce the desired outcome
   •   Determines the relationship between the outcome and resources used
   •   Determines the degree to which interventions, including identification of risk factors,
       promote health and prevent disability
   •   Assesses the degree to which staff reflect sensitivity and respect
   •   Assesses the degree to which services are provided in accordance with perception
       of promptness (access to care)

Over the past six years, Marc Center has continued with the AIMS (Agency Incident Man-
agement System) Subcommittee, which meets on a quarterly basis. This committee a sub-
committee of the Quality Management Committee and is comprised of members from the
Safety and Quality Assurance committees. The purpose of AIMS is to track and trend all
agency incidents, accidents, complaints and grievances.

In addition to these standing committees, Marc Center also utilizes workgroups, depart-
mental specific committees or other short term committees/groups to address issues or
projects as they arise in an effort to achieve continuous improvement in the provision of
quality services.

With this firm commitment to the provision of quality services, Marc Center engages in an
annual process to measure itself and performance within specific areas identified as indi-
cators of quality. These areas are: astonishment (satisfaction), performance, access to ser-
vice and care, effectiveness, and efficiency. Within these areas, each department has
measurable objectives with which to compare their performance during the course of the
year. These objectives are specific to the services provided within each department that
enable staff to measure the level of quality services at year-end.

At the end of each fiscal year, Marc Center administrative staff updates the Quality
Management Plan and Assessment of Consumer Outcomes. This update results in the crea-
tion of a detailed report for each department that identifies the year-end statistical re-
sults, an analysis of the results and a plan for improving outcomes in the upcoming year.
Finally, the report includes strategic implications based on information obtained in this as-
sessment process and responses to questions relative to Marc Center’s unique strengths,
abilities and opportunities.




                                         Introduction
                                               ii
                                           Working Together…Enriching Lives

             Marc Center provides opportunities for people to be actively involved in determining
                              where and how they live, learn, work, and play.




                        “The best way to predict the future is to invent it.” In building upon its foundation for future services, Marc
                        Center’s image is driven by empowerment, respect, interdependence, innovation and commitment. To this end
                        Marc Center will:
•Serve individuals of all ages who seek assistance/support in achieving independence and self-sufficiency.
•Promote services which embody educational, rehabilitative, social and living options in community settings.
•Provide services which lead to independence, improved productivity and increased integration.
•Extend hope and support to the people of the world who are committed to the concept of self-sufficiency and independence.
•Improve the quality and cost efficiency of services provided by our organization.
•Have a vital presence in selected local, national and international markets.
•Advocate in the development/promotion of public policy which addresses the needs and concerns of people who are interested in
increased self-sufficiency and independence.
                                                                      Board of Directors




                                                                       Tom Verploegen
                                                                       Board Chairman



                                                                        Randy Gray
                                                                      President & CEO

                                         Barbara J. Smith-Odum
                                          Executive Assistant




       Michael Franczak, Ph.D.                 John Moore                           Pat Gilbert                                                 Kay S. Moore
    Chief Operations Officer - BHS        Chief Financial Officer           Chief Administrative Officer                                 Chief Operations Officer - DD


                                                                                                                Lisa Wrobel
                                                                                                           Administrative Assistant                            Community Day Services
    Behavioral Health Services                Finance and
Director of Residential and Housing           Accounting                      Physical Facilities and
            Steve Hilger                                                          Transportation
                                                                              Director: Mark Tompert                 Holly Collins
                                                                                                              Executive Vice President                       Janey Durham
                                                                                                           Community Living and Day Services             Executive Vice President
 Behavioral Health Services           Information and Technologies                                                                                     Employment Related Services
Director of Outpatient Services            Director: Norm Duve       Human Resources and Training
                                                                        Director: Neil Bourque

                                                                                                             Community Living Services
   Behavioral Health Services                                                                                                                                   924 Campus
 Director of Quality Management
         Ramsey Riddell

                                                                                                              Community Support Services                  Marc West
                                                                                                             Director: Denise Phelan-Propst

                                                                                                                                                        Freestone Rehabilitation Ctr.



                                                                                                                                                                         Corporate
                                                                                                                                                                         Rev: June 2009
                                             MARC CENTER
                                       QUALITY MANAGEMENT PLAN
                                                  AND
                                   ASSESSMENT OF CONSUMER OUTCOMES

Date: September 1, 2009                        Reporting Period:           July 1, 2008 – June 30, 2009

 DEPARTMENT REVIEWED:
                                                    X         Community Day Services

                                                    X         Community Support Services

                                                    X         Employment Related Services

                                                    X         Community Living Services

                                                    X         Behavioral Health Services

                                                    X         Administrative Services

 REVIEW OF PURPOSES:

   X       Purposes have been reviewed and continue to meet the intent of the agency.
           Operational values have been revised to reflect commitment to our customers.

   X       Purposes have been reviewed and the following changes are recommended:
           See attached narrative.

 CASELOAD CHARACTERISTICS:

   X       Reviewed

   X       The following changes are noted from the previous report:

Marc Center continued to experience dramatic program expansion in program areas during
FY2008-2009 despite the economic downturn and reduction in rates for existing services.
Program expansion has been realized with the addition of nine Dialectical Behavioral Therapist
counselors, the rollout of outpatient clinics, the approval of a federal HUD project, the acquisition
of affordable housing through NSP, an affiliation with Banner Health for food service, and service
expansions in the West Valley and in the Prescott area. Growth in housing conforms to our
analysis of demographics and the aging of persons served with Marc Center focusing more
attention on supported/affordable housing and assisted living.




Overview of QM Plan and Outcomes               Page 1 of 14                                   FY2008-2009
 PROGRAM EFFECTIVENESS:

    X      Programs generally met expectancies.

    X      Programs deviated in the following areas:

Marc Center has continued to grow CSS services and community-based BHS services, given their
cost effectiveness. Greater emphasis has been placed on community employment options
commensurate with individual skills, interests and job availability with the focus on social
enterprises and franchise opportunities, such as UPS, food services, opportunities for consumers,
and eBay sales. Supported/affordable housing and assisted living services will be incorporated
throughout Marc Center’s continuum of programs. The primary initiative in our strategic plan is to
expand existing services through enterprise activities and pursue new program initiatives that
increase the number of persons served, despite reimbursement rates continuing to diminish for
existing services.

    X      Program outcomes met agency purposes (note deviations):

 CORRECTIVE ACTION:

 Plans for correction or program improvement are attached to individual departmental
 narratives.

 RECOMMENDATIONS FOR CHANGE:

    X      System continues to meet needs.

Marc Center’s customers define quality. System and process review and revisions will include
stakeholder and customer input on objectives and outcome expectancies. Outcome measures now
include objectives related to access to care and services. Data analysis includes strategic
implications that are included into the strategic plan. Finally, we will incorporate return-on-
investment information relative to outcome expectancies.

 DATE OF REVIEW BY BOARD OF DIRECTORS: September 24, 2009

 DISTRIBUTION OF OUTCOME EVALUATION REPORTS:

    X      Annual Report and Newsletter

    X      Other

Distributed to the Board of Directors, funding sources, individuals served, chief operations officers,
executive vice presidents and department directors. Executive summaries are distributed to
various stakeholders.

President/CEO:          Randall L. Gray                               Date    September 25, 2009

Overview of QM Plan and Outcomes              Page 2 of 14                                  FY2008-2009
                                              MARC CENTER
                                       QUALITY MANAGEMENT PLAN
                                                  AND
                                   ASSESSMENT OF CONSUMER OUTCOMES

                                       JULY 1, 2008 – JUNE 30, 2009
                                          REVIEW OF PURPOSES

Marc Center’s quality management plan and assessment of consumer outcomes system enables it
to identify the results of services and the effect of the programs on persons served. These systems
define the expected input to, and processes and outcomes of, services for persons served. The
enclosed outcome evaluation narrative report for FY2008-2009, as approved by the Board of
Directors at its September 2009 meeting, clearly substantiates that existing services are meeting
the needs of children and adults with disabilities.

The principle objectives and the purposes of Marc Center’s bylaws specify that the organization
“promotes the general welfare of persons with special needs or life supports, including but not
limited to age, recovery and end of life care, developmental and physical disabilities, as well as
people with behavioral needs.” As a further demonstration of a consumer-driven philosophy, the
mission statement reads as follows:

          Marc Center provides opportunities for people to be actively involved in determining
                           where and how they live, learn, work, and play.

In FY2007-2008, Marc Center revised its value statements with emphasis on achieving
operational values referred to as FIRST CHOICE. The acronym for this terminology references:
Flexibility, Independence, Respect, Safety, Teamwork, Customer, Honesty, Outcomes,
Improvement, Compassion, and Excellence. The intent is commitment to a common purpose,
common set of goals, and a common approach to problem resolution. Shared values and vision
offer the unified force for developing organizational structure and refining management
information systems that are driven by customer/consumer needs. As referenced in the
management report, programs have been expanded to serve more people with added emphasis
on the philosophies of choice, options and community integration. The expansion of all services
within community integrated settings demonstrates Marc Center’s effort to be responsive to
customer needs. Marc Center continues to experience a dramatic increase in behavioral health
services during these past few years.

Despite shrinking state and federal funds, we have been able to increase our financial solvency
and secure corporate worth by aggressively pursuing the acquisition of properties used to
provide day and residential services. Converting from a rental philosophy to one of ownership
has enabled Marc to maintain an asset-to-liability ratio in excess of 5:1 and a positive cash flow,
both of which leverage our capability for future expansion of programs in response to community
need. Responding to this need further meets our purposes within our community. Obtaining tax
exempt bond funding this year has enabled Marc Center to consolidate existing debt at a lower
interest rate and to construct additional facilities to accommodate growth.

Boxsmart partnered with Marc Center providing reverse integration. Thirty-five to 5 consumers
work alongside Boxsmart staff daily. Boxsmart’s entire operation is operated from our Extension
site. Consumers assist in the operation of machinery, unloading of trucks and sorting products.


Overview of QM Plan and Outcomes                 Page 3 of 14                               FY2008-2009
Marc Center has continued to incorporate within its outcome evaluation system measures that are
associated with assessment of program quality and feedback on consumer satisfaction. Each
department has integrated outcome measures of consumer satisfaction of program quality into
their respective management information systems. Emphasis is being placed on revisions with
stakeholder input. We are also refining management information systems to emphasize the return
on investment for stakeholders relative to our outcome expectancies.

Additional objectives related to access to service and care have been introduced into the system
and focus on objectives pertaining to: length of time from first referral to intake; length of time
from intake to program placement; percent of individuals referred and accepted who meet
eligibility criteria; percent of plans that demonstrate sensitivity to cultural issues; percent of
individuals referred for alternative services when needs cannot be met by Marc Center; and,
percent of individuals accepted into a program based upon available services that are targeted
to meet projected needs. These objectives correlate to some of the measures that are being
tracked with relation to the intake and discharge process.

Community integrated program options are driven by consumer choice. Additional community-
based employment sites have been introduced to the supported employment program. New
subcontracts have been secured, which offer more marketable skill training for people served and
enable a more appropriate assessment of interests and attitudes.

The current average number of individuals in CLS homes is 4.5 and in BHS home 4.25. This
movement coincides with the philosophy of smaller family settings driven by consumer choice.
Within the last year, we have relocated two residences back to their home counties which met with
high satisfaction from the individuals, their families and the funding sources. Program expansion
continues within the Employment Related Services and CSS program areas. CSS has expanded to
Prescott and Prescott Valley in Yavapai County, and the In-Home Supports Children’s program
has grown from one client served to 16 during the past year.

The direction of Marc Center services incorporate the accepted philosophies of choice, consumer-
driven services, integration and smaller settings. We work with families to identify solutions to
existing challenges and help to coordinate services that meet individual needs. We have also
promoted a better understanding by the public of the problems confronting people with
disabilities, through various media avenues. More emphasis is being placed on services in our
mission statement, rather than specific target populations to be served. This has resulted in
continued growth this past year and the future consideration of programs for people with
traumatic brain injuries, as well as serving individuals with more intensive medical care needs,
including hospice services and assisted living.

Marc Center recognizes that quality in a service is not what we as an organization put in; it’s what
the customer gets out of it. True quality is a perception that is based on the individual’s value
system. It relies heavily on culture, life experiences and expectations of each individual.




Overview of QM Plan and Outcomes             Page 4 of 14                                 FY2008-2009
MARC CENTER’S UNIQUE STRENGTHS, ABILITIES AND OPPORTUNITIES

Is what we do a real value for the price?

State funded services disconnect customers from the price decision. In other words, most customers
are unaware of the variables that impact upon price or cost of service so they are unable to
make any type of economic decision relative to value. This is unfortunate given the correlation of
the relationship between value and price. As in any business, customers will pay the price if they
obtain value for the service. This prompts the following questions: How would customers respond
to the question of value if they knew how much each service cost? What if customers had to
choose between basic and upgrade services?

Families are beginning to understand this as they utilize the voucher method of purchasing services
for their family members. Most contract rates are capped or at AHCCCS/ALTCS levels and are
only COLA (cost of living allowance) enhanced, if at all, on an annual basis. The caveat is that
Marc Center, through the diversification of funding sources, grant awards and donations can
enhance existing services more than most organizations. Even with this added value, organizations
realized cuts in rates per unit in their DDD contracts this year. The full economic impact of this
change will not be known until the end of next fiscal year.

State and local governments are currently examining all program expenditures and the efficiency
of these programs to solve the current budget shortfalls. To address these issues, to demonstrate
the actual measured value delivered to the state, and to prove efficiency of Marc Center
operations, Marc Center retained the Community Services Analysis LLC to conduct an independent,
third-party analysis of the actual Taxpayer Return on Funding Investment delivery by Marc
Center. The results of this study show:

    •    The Taxpayer Return on Investment (ROI) from Marc Center is 157%, meaning that for
         every tax dollar spent for Marc Center’s services, $1.57 of actual value is delivered to
         the community.

               The Taxpayer ROI for Home and Community Based Services is 158%.

               The Taxpayer ROI for Employment Related Services is 201%.

               The Taxpayer ROI for Behavioral Health Services is 128%.

    •    State and federal money funds only 90.2% of the resources needed for these services.

Feedback from customers suggests that Marc Center delivers optimal services for the lowest price
and offers added value for that price. Since 73% of our operating budget (up from 70% in the
previous year) is associated with personnel and ERE, it is appropriate to focus on the feedback
from various stakeholders regarding the quality of our staff. Additional analysis would suggest
that we analyze the acceptable staff-to-client ratios established by funding sources which are
adjusted every five years based upon the principle of rebasing. A summary analysis of these
perspectives suggests the following relative to value and price:

    •    Marc Center is recognized for the tenure and quality of its management staff and we
         have received satisfactory comments from various stakeholders relative to personnel. We
         currently have high quality personnel due in part to the economic downturn which has led
         to more highly skilled people seeking employment and being available to accept positions

Overview of QM Plan and Outcomes            Page 5 of 14                                 FY2008-2009
         within our organization. Our focus is now on the concept of staff retention. Our one-year
         employee retention rate increased from 69% to 75% during FY2008-2009 due to a
         combination of factors, including the current economic climate, increased supervisory
         training, and an employee recognition program called ‘Spot Award’.

    •    From our perspective, state funding sources and the consultants who determine rate
         structure have a tendency to elevate the acceptable ratio rates relative to staff and
         number of consumers supervised. This approach contradicts significant trends that
         demonstrate more challenging behaviors and severe medical challenges exhibited by new
         referrals. Based upon this trend, we would suggest ratios of supervision that increase the
         number of staff. Clearly, this statistical analysis, coupled with significant demographic
         trends, dramatically impacts the concept of value for price. It also suggests that we need
         to impact upon the rebasing process with more advocacy efforts from our families, as well
         as from professionals. However, we must place greater emphasis on the principles of staff
         recruitment and retention, as well as impacting the rebasing process which establishes the
         rates.

We should also consider whether the value of our services delivered is better than other
providers. We do this by listening to our customers and obtaining their feedback from various
surveys that they have developed. From our perception, real value for price relates to quality;
and quality in a service is not what we, as an organization, put in, it is what the customer gets out
of it. No matter how much an organization or funding sources do to control and establish quality,
customers define it. When recipients of service define quality, they judge whether or not the right
things are done in ways that meet their own needs and expectations. Therefore, the response to
this question really reveals itself in three outcome measures: customer satisfaction, increased
referrals and higher profit margins for the company. Marc Center has exceeded all three of its
expected outcome measures in every department relative to both effective and efficiency
measures in these areas.

Overall, Marc Center provides services and supports that produce positive outcomes, such as
improved quality of life, reduction in symptoms and improved functional skills at a reasonable
cost. Other stakeholders, family members and staff also report satisfaction with services. With
respect to service expenses, Marc Center’s costs per positive outcome are significantly less than
would be incurred for inpatient or other services at a higher level of care.

What business are we really in?

The business we are in is reflected in our mission: to provide opportunities for people to determine
where and how they live, learn, work and play. Stated differently, we are in the business of
adding value to an individual’s life. “Live, learn, work, play – your hope; our help – together.”
Or, as expressed by our tag line, “Working Together…Enriching Lives.”

Essentially, Marc Center is in the change and recovery business. Consumers and referral sources
seek our services because the person, their family or other organizations identify something in the
person’s life that needs to change, and we should act as visionaries to assist consumers in
constructing the supports they desire to achieve astonishing results. Consumers continue to
participate in our services because we are effective in helping them achieve the outcomes they
desire.

The ability to answer this question is also predicated upon important management information
systems that Marc Center utilizes, including a market-base plan, strategic positioning, a
comprehensive outcome measurement system and quality management report, and a return-on-
Overview of QM Plan and Outcomes             Page 6 of 14                                  FY2008-2009
investment analysis. We are in the business of community rehabilitation that responds to the needs
of people. Meeting needs correlates with higher levels of self-sufficiency and improved quality of
life, as indicated by families and persons served through a variety of input mechanisms such as
surveys. We also must ensure that our business meets the expectations of government and other
funders, and that the organization remains financially viable so we may continue to provide
excellent services to the individuals we serve.

It is worth noting that current demographic trends will serve as the catalyst for program initiatives
over the next five years that focus on supported housing, assisted living, hospice, additional
vocational training options within the community (more enclaves), and expanded home and
community-based as well as behavioral health services. Facilitating these program initiatives will
require us to focus on return-on-investment outcomes, as well as evidence-based practices that
support our approach. From our perspective, the advancement of evidence-based practice is
defined as the conscientious, explicit and judicious use of current best evidence in making decisions
regarding the care of persons served. This approach places additional emphasis on financial
viability and management capability. In other words, we should be focused on delivering the best
possible services to our clients, based on the best clinical practices available from the research
evidence whenever possible.

Do we have an exclusive benefit?

While there are many providers in Arizona, Marc Center stands above most in our achievement of
outcomes and our fidelity to true person-centered recovery process. Our reputation with
stakeholders, family members, consumers and referral sources is that we will take challenging
issues and attain a positive outcome. We also offer a person-centered approach that respects the
individuals’ choices and allows them to determine their course of care. Many providers espouse
this approach, but few are able to live up to it.

While the profile of services appears similar to other provider agencies, Marc Center excels in
the management of resources, advocacy and forward out-of-the-box thinking. Our competitive
analysis has identified distinguishing characteristics that are exclusive to our organization.

    •    There is a high degree of program integrity recognized and respected by policy makers
         and funding sources.

    •    There is a commitment to follow through and recognize that what we say is what we do.

    •    We have sustained growth in a planned manner, based upon a balance between
         capability and need.

    •    We offer person-centered and individualized services that emphasize choice and options.

    •    We have implemented management information systems driven by customer needs, rather
         than organizational directives.

    •    We have established a continuum of care and services, with a mission focused on service
         rather than strictly on a targeted population.

    •    We have positioned ourselves with a local, national and international presence in the
         delivery of habilitation and rehabilitation services for children and adults in our programs.


Overview of QM Plan and Outcomes              Page 7 of 14                                  FY2008-2009
    •    Service direction is guided by a spirit of grassroots volunteerism from families, board
         members and the community at large.

    •    Marc Center operates on the premise of a dual-role perspective of advocacy and direct
         services.

    •    Marc Center embraces change and has a clear vision that underscores its ability to remain
         competitive and to serve as a leader in the provision of quality services to people served.

    •    Marc Center values that staff recognizes the importance of listening and trains to the
         principle that the person who asked the last question and genuinely listens to the response
         will learn more about the person’s needs.

    •    Based upon customer feedback and the increase in referrals, Marc Center recognizes that
         its primary competitive edge is predicated upon expedited access to service.

    •    Based upon a continuing increase in families and individuals served, which has doubled
         our census over the last seven years from 1,600 to over 3,200 people receiving services,
         it is evident that what we do is a value for the price, reflects what people want and
         desire, and indicates that our service lends itself to repeat business.

Who are our customers?

Marc Center defines its customers as the people who purchase or receive our services, someone
who has need for or wants our services, and/or anyone who interacts with our organization.
Adequately identifying customers requires us to profile their needs and characteristics, and to
conduct a customer analysis. This results in a better understanding of customer needs and wants. In
other words, identifying our customers is not sufficient. It is more important to understand why they
need our service, how they will benefit from our service, how they decide to select their provider,
how often they will need our service, and other pertinent demographic information.

Marc Center is a large organization with a complex customer base comprised of children and
adults with physical, developmental, mental, and behavioral health disabilities; their families; our
employees; state government agencies; local employers and businesses; philanthropic
organizations; public schools; city, county and state governments; and the general public. Given
the size of our marketplace, Marc Center groups our customers into market segments or different
sets of potential customers most likely to use our services. These market segments are identified by
taking into consideration primary characteristics which would distinguish between different groups
of customers by factors such as age, gender, frequency of involvement, place of residence, and
lifestyles.

What do they want and desire?

Our customers want quality services that are safe and provided in locations that are accessible.
They desire for us to be good neighbors and members of the community-at-large.

The following information is summarized from surveys during the past year from our various
customers:

    •    Families and Individuals – Consumers and family member want to be respected and to
         receive quality care that helps them obtain their desired outcomes.
Overview of QM Plan and Outcomes              Page 8 of 14                                 FY2008-2009
    •    Funding sources – Our funding sources expect us to follow all of the procedures, rules
         and regulations they and their associated regulatory bodies specify through contract,
         meet the objectives that they set for access to care and outcomes, and achieve these
         outcomes in a cost-effective manner.

    •    Employees – Marc Center staff expect to be supported in their jobs, receive a fair wage
         and benefits, be respected by administration, and be heard when issues that affect their
         job satisfaction arise. Employees expect the agency to be a leader and promote fairness.
         We infer from their input that the work people choose to do contributes meaning to their
         lives, and job satisfaction is enhanced by recognition, encouragement and support.

    •    Government Agencies – Regulators expect compliance to regulatory standards, involving
         input, accessibility, accountability, rights, health and safety, human resources, leadership,
         legal requirements, financial planning, governance, individual-centered planning, quality
         assurance, service coordination, and all services.

    •    Businesses – Our business partners expect products and services delivered on time,
         competitive pricing and good public relations.

    •    Philanthropy – We do what we say we will do. We collaborate. We demonstrate our
         integrity. We leverage their resources with our own.

    •    General Public – The community expects us to be responsive to their concerns and to
         provide effective services to all community members who need them.

How can we most effectively communicate with our customers?

Marc Center is moving toward a totally electronic format for forms, reports, data tracking and
information exchange. Email addresses are being collected from families and funding sources
which will enable us to more effectively and efficiently communicate with families, caregivers,
employees and funding sources. Our newsletter is still mailed to those few families that have
requested this format; however, most families now receive the newsletter, daily communication
notes and other updates via email. This next year, Marc Center will initiate electronic formats for
most forms and required reports.

We will need to communicate with our customers in their primary method of communication, be it
signing, native or foreign languages, etc. Rural, religious, cultural and native service provision is
changing on a daily basis and they will want us to be knowledgeable in their personal, local and
regional challenges. With the proper amount of research and preparation, we can achieve these
challenges and place the future consumer purchasing services at Marc Center at ease. In return,
they will become powerful marketing entities to our continued success.

Every interaction, whether in person or written, is an opportunity to show stakeholders that we
deliver more than we promise. Our interactions with consumers and family members need to be
informative, respectful and geared toward meeting the needs they express. Communications with
the Arizona Department of Economic Security, the Regional Behavioral Health Authorities, the
Arizona Department of Health Services, the Arizona Health Care Cost Containment System and
the Arizona Long Term Care Health Plans must be responsive to their issues, demonstrate that we
understand the rules and regulations, be timely, and also articulate that we provide cost-efficient
positive outcomes. Communication with the community has to be responsive to their issues,

Overview of QM Plan and Outcomes              Page 9 of 14                                  FY2008-2009
informative and factual. Communication with staff must be clear, anticipatory of additional
questions, and timely. Continued use of print and broadcast media also represents an effective
means of communicating with our customers.

Finally, the most effective means of communication is to be a good listener and to ask questions in
order to truly understand the needs and wants of our customer base.

How can we best distribute our services/products to them?

We can best distribute our services by remaining flexible and thinking outside the box, as well as
being open to different ventures that will provide funding flexibility. If we generate increased
revenue from the private sector, it will help fund our existing and future programs. Marc Center
must identify money-making services for which customers will pay significantly increased rates.
This approach acknowledges the correlation between value and price (what people are willing to
pay). These non-government funded services can and should subsidize Marc Center’s other
businesses. The introduction this past year of enterprise and business activities, including ProMarc
(housing expansion and property management), third-party referrals from private insurance plans
and the contract with Banner Health, represent alternative funding sources that will contribute to
future program growth.

Information technology and face-to-face contact will be critical to our successful outreach
program. This will enable us to disperse our support systems with optimum effectiveness and
efficiencies. It will be imperative to locate ourselves within each community, large or small, so that
services are available and accessible when the service recipient is in need of critical services.

Marc Center must be an organizational trademark that all referral sources, consumers, family
members, and the community-at-large recognize and associate with quality services. Marc Center
programs must be represented by speakers at conferences, members of other organizations such
as the Maricopa Providers Association and the Arizona Alliance for the Mentally Ill, as a
requested speaker on other subjects, and as a collaborator with other like-minded agencies. In
addition, customer engagement requires going to where the customers are located. That could
mean additional outreach to homeless shelters, clinics, PCP offices, supervisory care homes,
religious organizations and other community meetings.

Does our service lend itself to repeat business?

Repeat business is based on developing a positive relationship with the persons served and the
referral sources. Marc Center has established a reputation for providing quality care, and most of
our referrals are from sources that have used our services in the past or have heard about our
services through colleagues.

Based upon the steady growth from all funding sources over the past ten years, it is evident that
our service lends itself to repeat business. Given our successful outcomes in job placement,
community living and in improved self-sufficiency goals, almost all stakeholders have continued to
encourage referrals to Marc Center. In addition, most managed care contracts incorporate
language that gives the consumer the option of choosing from which agency to receive services.
Marc Center has enjoyed a successful 52-year history of service delivery in its geographic area
culminating in numerous awards and recognition. This service distinction, coupled with ongoing
community support and a strong public relations program, continues to position our agency for
repeat business as demonstrated by the chart shown on the following page.



Overview of QM Plan and Outcomes             Page 10 of 14                                  FY2008-2009
Overview of QM Plan and Outcomes   Page 11 of 14   FY2008-2009
                                      STRATEGIC IMPLICATIONS
                                       FOR NEXT FISCAL YEAR


Community Day Services

    •    Secure additional state-of-the-art equipment for sensory, motor, communication and
         recreational skill development through grant sources and donations.

    •    Change the reporting formats currently being used to an electronic format for all data
         collection, billing, progress summaries and funding source and family/caregiver
         communication. Progress reports to our funding source will be done via secured email.

    •    Move all client master files to an electronic file format.

    •    Engage all staff in leadership-style training modules. All employees will benefit from
         further training on program operations, budgeting, strategic visioning, service delivery
         options and leadership skills. Short 30-minute modules will be developed for all
         employees to gain new skills through monthly in-service training.

    •    Pursue program growth of more than 10% in individuals served. The 924 CDS program,
         CC’s Place (Building 2) and the Cortney’s Foundation have utilization capacity to increase
         the number served. Furthermore, Freestone will be able to expand its number served when
         they expand into the other half of their building following the exit of ERS individuals to
         other sites. Ten percent growth is not unreasonable to expect during the next year.

Community Living Services

    •    Focus on recruitment and retention of a more experienced workforce.

    •    Consider the establishment of comprehensive senior programs and service options for the
         elderly and aging population, including retirement.

    •    Pursue residential service sites that accommodate private-pay individuals.

    •    Focus on alternative living options, including independent apartment type and congregate
         residential settings that are privately funded and expand the continuum on service
         delivery for Marc Center’s Community Living Services program.

    •    Continue to improve efficiency measures which include consolidation of van trips,
         identification of discount purchasing programs, and implementation of scheduling and
         billing software.

Community Support Services

    •    Continue to expand referral base for existing services and the active solicitation of new
         services, including but limited to: private pay in-home supports, senior/geriatric
         coordination of care services.


Overview of QM Plan and Outcomes               Page 12 of 14                             FY2008-2009
    •    Continue enhancement of departmental operational procedures to ensure efficient and
         effective service delivery thus continuing high quality service.

    •    Continue to identify and pursue new revenue sources for in-home supports to enhance the
         continuum of care and eliminate service gaps.

    •    Refine employee recruitment/retention procedures to ensure the needed FTE support in the
         geographically challenged areas; e.g., Peoria, Tolleson, Glendale and Surprise.

    •    Develop and implement enhanced marketing strategies to solicit service acquisition to all
         identified demographic groups.

    •    Focus on alternative living options, including independent apartment style and congregate
         residential settings that are privately funded and expand the continuum of service
         delivery for Marc Center’s Community Living program.

Employment Related Services

    •    Pursue construction of East Valley vocational training site and complete renovations of
         existing West Valley sites.

    •    Continue to make the West Valley vocational site computer lab fully functional.

    •    Based upon family and individual feedback, identify and secure additional community
         enclave opportunities to provide training options for individuals transitioning to community
         employment.

    •    Emphasize social enterprises as a means to augment new funding streams and to derive
         new marketable skill contracts for consumers via eBay, vendor cart sales, landscaping,
         janitorial, computer training; i.e. micro-enterprises and/or consumer operated businesses.

    •    Pursue referrals from SCAN, Mercy Care, Bridgeway Insurance, as well as other private
         insurance carriers.

    •    Continue to develop and promote the Ticket-to-Work program as a means of generating
         additional funding opportunities.

    •    Pursue co-location in additional outpatient clinics providing prevocational services and job
         development.

Behavioral Health Services

    •    Continue to develop alternative living options, including apartment style and congregate
         residential settings for individuals who participate in programs, such as Assertive
         Community Treatment (ACT), and expand the continuum on service delivery for Marc
         Center’s Behavioral Health Services program.

    •    Continue to improve efficiency measures with full implementation of an electronic medical
         record and billing system (PACE+™).


Overview of QM Plan and Outcomes              Page 13 of 14                                FY2008-2009
    •    BHS continues to accept individuals with more challenging behavioral health needs than it
         has served in the past, and the percentage of individuals discharged to a higher level of
         care is increasing. Given this trend, more frequent and interdisciplinary reviews of the
         reasons for individuals being discharged should be undertaken. Reviews will include
         comparison of discharges to the number and types of incident reports, complaints, and
         staff turnover for individuals discharged to a higher level of care from Community Housing
         and Level II Residential programs.

    •    The state Access to Care standard that specifies outpatient services will be made
         available to individuals within 23 days of their intake appointment is difficult to achieve
         on a consistent basis due to an ever-increasing number of Medicaid-eligible people
         requesting behavioral health services. Continuous monitoring of the number of completed
         intakes, length of stay, timely discharges, and no-show rates will be used for comparative
         analysis to determine when the BHS Outpatient Clinic must suspend referral acceptance in
         order to maintain quality outcomes for individuals currently receiving services.

    •    The Village Program aims to help individuals develop the skills and abilities needed to
         live independently and maintain self-sufficiency. As a contributor to the organization’s
         social Return-on-Investment and to further increase positive outcomes and astonishment for
         persons served, the East and West Village programs will strive to increase the ratio of
         skills training to personal assistance services.

    •    Funding sources and state authorities are focusing their contract and compliance reviews
         on staff completing required behavioral health training. Processes for tracking and
         documenting completion of training requirements and assessment of post-training
         competency will be upgraded to provide real-time reporting to staff and supervisors.

Administration/Support

    •    Continue to focus on employee recruitment and retention initiatives that stabilize our
         workforce and help us to ensure continuity in service delivery.

    •    Continue to focus on competency-based training for employees, especially those areas
         pertaining to HIPAA, other federally mandated areas, and training topics such as
         supervisory leadership.

    •    In recognition of the existing economic recession and reduction in state revenues to support
         our programs, pursue alternative funding sources.

    •    Enhance assessment of program quality for all programs, ensuring that systems are
         consumer-driven and responsive to consumer needs.

    •    Introduce new information technology that facilitates program effectiveness, efficiency,
         safety, as well as positive outcomes for consumers, families and other stakeholders.

    •    Pursue collaborative joint ventures, including mergers.

    •    Continue to reduce Workers Compensation injuries, thereby demonstrating improved
         safety awareness for staff and individuals receiving services.


Overview of QM Plan and Outcomes              Page 14 of 14                                FY2008-2009
                                                  FY2008-2009
                                           QUALITY MANAGEMENT PLAN
                                                      AND
                                       ASSESSMENT OF CONSUMER OUTCOMES

                                       CRITICAL INCIDENT REPORTING ANALYSIS

                                        Consumer-Related Incidents and Accidents

Information and data gathered from consumer-related incident reports is aggregated using the
Agency Information Management System (AIMS). Trends are reviewed at the program level on a
regular basis to evaluate the types and frequency of incidents, patterns of occurrences, and to
provide a forum for suggesting opportunities for improvement within the program or across the
organization. Executive leadership reviews trends on an annual basis.




                                                        Chart 1

Accidents and Injuries

In FY2008-2009, only 32 (17%) of consumer accidents and injuries required some form of first
aid from staff or medical attention from an outside responder such as a primary care physician,
urgent care, emergency room, or paramedics.

Deaths

No deaths occurred while consumers were receiving care or services in a Marc Center home or
while at a Marc Center facility or agency-sponsored activity. Notification of the mortalities was
received from family members or external sources and was recorded in the AIMS system for the
purpose of internal documentation and/or to meet state or funding source regulations.


Critical Incident Reporting Analysis                    Page 1 of 4                    FY2008-2009
Suicide Attempts

Due to the serious potential threat that is posed by any suicide attempt, every incident is
reviewed in depth at the program level at the time of the occurrence. All nine suicide attempts
occurred in, or were reported through BHS programs. In FY2007-2008 and FY2008-2009, one
occurrence was reported in the BHS Level II Residential program each year. Four and five
incidents were reported in the BHS Community Housing program in respective years. Three of the
suicide attempts reported in FY2008-2009 occurred while the consumer was in the community-at-
large or in their independent home environment.

Beginning in FY2008-2009, suicide attempts are listed in a separate reporting category to
improve tracking, trending and reporting capabilities.

Consumer Conduct

Incidents reported in this category can range from a consumer’s habitual behavior of grabbing
food away from a housemate to another consumer repeatedly declining to take prescribed
medication. While these occurrences do not appear serious when viewed independently, ongoing
reporting and recording of occurrences can reveal trends that emerge when this information is
tracked over time. Repeated inappropriate behavior may indicate that a change to the
consumer’s behavior plan is warranted or that a different level of care may be more
appropriate.

Incidents reported in the Consumer Conduct category have been increasing over the past four
years. The increase is viewed as a positive trend attributable to additional and enhanced training
and education provided to staff who now have a better understanding of the importance of
documenting and reviewing unusual behaviors. Stated differently, the increase in incident reports
may not be attributed to actual incidents, but more thorough reporting.

Medication Errors

The increase in the number of medication errors reported is also viewed as a positive trend
resulting from enhanced training and education provided to staff. The Medication Error category
of incident reporting includes various subtypes including missed doses, wastage of medication that
is dropped or damaged, possible adverse reactions to medication, and issues related to
consumers self administering their own medication.

No serious incidents or adverse reactions occurred that required medical attention and no
alarming trends were identified in FY2008-2009. Further education will be provided to staff in
the upcoming year that when a consumer declines to take a medication, unless he or she is court
ordered to take the medication, the occurrence should be recorded in the Consumer Conduct
category of incidents.




Critical Incident Reporting Analysis        Page 2 of 4                                 FY2008-2009
                                             Chart 2

Complaints, Grievances and Appeals

All complaints, grievances and appeals were handled in a timely and appropriate manner.

Facility Incidents

Facility incidents were minimal and none were serious.

Human/Civil Rights/Abuse Allegations

Thorough and timely investigations were conducted on all allegations of possible abuse or
violation of a consumer’s human or civil rights. The majority of allegations were found to be
unsubstantiated. One allegation was found to be valid, and the involved staff member received
coaching and retraining on appropriate boundaries with consumers.

Self Abuse

In FY2008-2009, the BHS and CDS programs each reported four instances of a consumer self-
harming, and the CLS and ERS programs reported one instance each. Three of the incidents
required emergency medical attention, but the self-inflicted injuries were not serious or life
threatening.




Critical Incident Reporting Analysis         Page 3 of 4                            FY2008-2009
Other

Incidents recorded in this category were not serious and are mainly used for identifying staff
training needs and unusual trends. While these reports continue to be valuable for internal quality
assessment purposes, this category will be eliminated from next year’s report.

                                                      Vehicle Safety

Through ongoing review and discussion at Marc Center’s Safety Committee meetings, self-
assessment of the agency’s transportation program is conducted on an ongoing basis to ensure all
applicable federal, state, county, and city requirements are met. The Safety Committee is com-
posed of direct-service staff, administrative staff, individuals receiving services, and a member
from SCF Arizona. Input from committee members is solicited at each meeting regarding how to
improve safety for the individuals we serve, families, staff, and the community-at-large. During
FY2008-2009, reverse-printed labels were placed on the inside glass of the driver’s doors, which
offers a high visibility message to the operator every time they unlock the door. The label states:
“No trip is so important and no time so urgent that we cannot strive to arrive safely”.

Marc Center tracks and measures vehicle safety of its 390 drivers and 62 vehicles through nu-
merous mechanisms, including Safety First, GPS, moving violations, and reportable accidents. Dur-
ing FY2008-2009, there were 41 negative driving events. These events consisted of 12 Safety
First infractions, 15 accidents, four GPS warnings and 10 moving violations. Any negative event is
collaboratively addressed by Marc Center’s driver trainer, the involved employee and the em-
ployee’s supervisor, and often involves additional drivers’ training for the employee.

                                            Employee Accident Claims Analysis

Employee injuries and accidents are addressed individually at the time of occurrence by the em-
ployee’s supervisor. Immediate action is taken to prevent future occurrences of a similar nature by
the same employee or another person in the same situation. Means of taking action may include
immediately removing a hazard from the workplace, entering a maintenance request into the
MPulse system for a necessary repair, or presenting a proposal to the Safety Committee for a
future project.

There were 20 employee-related critical accident/injuries reported during FY2008-2009. The
breakdown of accidents were: seven by consumers, two by auto accident, eight by falls, one by
laceration, and three by strains. While each incident was appropriately handled on an immediate
basis with the injured employee, trend analysis was useful for the Safety Committee to address
the matter on an agency wide level.

                                       Summary of Critical Incident Reporting System

Due to shortfalls in the state budget and cutbacks from funding sources, enhancements to the data
collection and reporting systems that were recommended in last year’s report were not fully
implemented because sufficient human and technological resources could not be made available.
Opportunities for improvement in the upcoming year will include refinements and improvements to
the incident reporting process and training provided to staff.




Critical Incident Reporting Analysis                     Page 4 of 4                     FY2008-2009
                                                       MARC CENTER
                                                 QUALITY MANAGEMENT PLAN
                                                            AND
                                             ASSESSMENT OF CONSUMER OUTCOMES

Date:       September 1, 2009                                                     Reporting Period: July 1, 2008 to June 30, 2009

Completed by:            Kay S. Moore                                                    Department: Community Day Services


I.    INDIVIDUAL CHARACTERISTICS

            Total Number Served:             135                                    Total Daily Capacity:          155

     AGE GROUP           RACE BACKGROUND                 CITY                         DISABILITY                      PRESENT LIVING
  0 -3         0     White                   104   Chandler        2    Cognitive Disability              12     Parent's Home         54
 4 - 12        0     Black                    6    Tempe           4    Cerebral Palsy                     1     Foster Home/ADH/CDH   14
 13 - 17       0     Asian                    4    Gilbert         6    Epilepsy                           0     Adoptive Home          0
 18 - 21       6     American Indian/         3    Mesa           96    Autism Spectrum                    5     Grandparent's Home     0

 22 - 30      38     Alaskan Native            0   Queen Creek      7   Multiple Disabilities             109    Group Home            58
 31 - 44      49     Native Hawaiian/Other     0   Scottsdale       5   Dually Diagnosed (DD/MH)           2     Rent                   0
 45 - 55      32     Pacific Islander          1   Apache Jct.     13   Developmental Delay                5     Own Home               3
 56 - 65       9     Other/Multi Racial       12   Phoenix          1   Physical Disability                1     Other                  6
  66+          1     Unknown                  5    Other:           1   Depression/Depressed Mood          0     TOTAL                 135
TOTAL         135    TOTAL                   135   TOTAL          135   Anxiety/Stress                     0
   GENDER                       ETHNICITY BACKGROUND                    Substance Abuse                    0
Male           80    Hispanic                                     12 Psychotic/Schizophrenic               0
Female         55    Not Hispanic                                 118 Serious Mental Illness Treatment     0
                     Unknown                                       5    General Mental Health              0
                                                                        Co-Occurring disorder (SA/MH)      0
TOTAL         135 TOTAL                                           135 TOTAL                               135


II. DATA RESULTS - Please attach actual total numerical results on outcome evaluation form.

      SCORE:         109.4

III. NARRATIVE RATIONALE - Please attach rationales which are relavant to data above, if possible.

IV. RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES - Attach, if
    applicable.

V. RECOMMENDATIONS FOR PROGRAM CHANGES TO ASSIST IN MEETING OUTCOME
   EVALUATION OBJECTIVES - Attach, if applicable.

Submitted By: Kay S. Moore                                                                                     Chief Operations Officer, DD


President & CEO: Randall L. Gray                                                                         Date: September 1, 2009



Community Day Services                                           Page 1 of 15                                                    FY2008-2009
                                                               MARC CENTER
                                                         QUALITY MANAGEMENT PLAN
                                                                    AND
                                                     ASSESSMENT OF CONSUMER OUTCOMES

                                                             COMMUNITY DAY SERVICES
                                           TIME OF          DATA          OBTAINED            EXPECTANCIES       RELATIVE                         LAST
          PRIMARY OBJECTIVE                MEASURE         SOURCE            BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
ASTONISHMENT
1. a. Percent of consumers/                Annually      Satisfaction     Support
       family members who indicate                         Survey        Coordinator
       the program exceeds their
       expectations in the following
       assessment areas:
          * Convienience of Location                                                    60         70      80       2         80       2.3         80
          * Cleanliness/Safety                                                          60         70      80       2         81       2.3         81
          * Transportation                                                              60         70      80       2         87       2.5         87
          * Community Activities                                                        60         70      80       2         63       1.8         63
   b. Offers choices and a variety                                                      80         90     100       2         79       1.8         79
       of meaningful activities.
   c. Responsive to concerns                                                            80         90     100       2         86       1.9         86
   d. Friendly, courteous, caring                                                       80         90     100       2         86       1.9         86
   e. Communication                                                                     80         90     100       2         86       1.9         86
   f. Professional Conduct                                                              80         90     100       2         82       1.8         82
   g. Ability to provide resources                                                      80         90     100       2         84       1.9         84
       and information
   h. Satisfied with services received                                                  80         90     100       2         82       1.8         82
   i. Do services meet your                                                             80         90     100       2         93       2.1         93
       expectations?
   j. Are services effective and                                                        80         90     100       2         94       2.1         94
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals who            Monthly           Monthly          Support     20         35      50       2         9        0.5         44
   experience improvement or                                Report        Coordinator
   progressive move during the
   program year.

2. Percent of ISP objectives met           Monthly         Monthly        Support       50         75     100       5         22       1.5         52
   within specified target date.                           Report        Coordinator

3. Percent of individuals whose            Annually       Satisfaction    Support       80         90     100       4        100       4.4        100
    individual program plans indicate                       Survey       Coordinator
    identification of behavioral
    supports and/or timely
   modification to the BTP which
    assures appropriateness of
    service delivery.

4. Percent of individuals who              Monthly         Monthly        Support       80         90     100       5         84       4.7        100
   express at discharge that services                      Report        Coordinator
   provided facilitated community
   integration and/or self-sufficiency.

EFFECTIVENESS
1. Percent of compliance to HCBS           Annually         Staff          Director     80         90     100      10        100      11.1        100
   certification requirements.                              Matrix

2. Percent of individuals who              Annually         Annual        Program       60         70      80      10        100      14.3        100
   maintained or increased skill                             Skills      Coordinator
   levels as indicated on annual                           Checklist
   assessment.



Community Day Services                                                   Page 2 of 15                                                        FY2008-2009
                                         TIME OF     DATA        OBTAINED            EXPECTANCIES       RELATIVE                         LAST
          PRIMARY OBJECTIVE              MEASURE    SOURCE          BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
3. Number of community outing            Monthly     Activity    Program       10         20      30      10        1.25      0.6         20
   hours per individual/month.                      Calendars   Coordinator

EFFICIENCY
1. Percent of placements of              Monthly     Monthly     Program       80         90     100       5         86       4.8         88
   persons served is maintained.                     Report     Coordinator

2. Percent of positive variance of       Annually    Budget       Director     10         5       1        5       20.94     20.9        0.5
   actual year-end budget to                        Variance
   projected budget.                                 Report

3. Percentage of CDS transportation      Annually    Monthly     Support       70         80     100      10         92      11.5        100
   provided to consumers whose ISP                   Report     Coordinator
   teams have requested this service.

ACCESS TO SERVICE/CARE
1. Average number of days between        Monthly     Monthly     Program       15         10      5        5         7        3.5         8
   the date of referral and the date                 Report     Coordinator
   of program placement.

2. Percent of individuals referred       Monthly     Monthly     Program       80         90     100       5        100       5.6        100
   for alternative services when needs               Report     Coordinator
   cannot be met by Marc Center.

TOTAL                                                                                                     100                109.4




Community Day Services                                          Page 3 of 15                                                        FY2008-2009
                                      FY2008-2009
                               QUALITY MANAGEMENT PLAN
                                          AND
                           ASSESSMENT OF CONSUMER OUTCOMES

                                   COMMUNITY DAY SERVICES

NARRATIVE RATIONALE

This report summarizes measures of efficiency, effectiveness, access to service and satisfaction for
all primary and supplemental measures. The information summarized within this report is utilized
in strategic planning and in the Technology and Accessibilities plans. Marc Center also publishes
the outcome report for all stakeholders as well as posts it to its website.

This year marks the second year of Marc Center’s stakeholder designed satisfaction survey as
posted on Marc Center’s website. The satisfaction survey was designed by those we serve and/or
their families. They offered what criterion defines quality and service for them in the survey’s de-
sign. The survey is available on Marc Center’s website throughout the year soliciting customer sa-
tisfaction information to support Marc Center’s belief in continuous quality improvement. Marc
Center also added a quality assurance hotline, called Silent Whistle, as part of their belief in con-
tinuous quality and service improvement.

Fiscal Year 2008-2009 Summary

Community Day Services experienced growth this past year to a total of 135 served from July 1,
2008 through June 30, 2009. CDS also experienced 22 discharges this past year, resulting in a
net increase of 13 individuals over the previous fiscal year. The economic downturn and the 10%
rate reduction from the Division of Developmental Disabilities (DDD) required Marc Center to
make drastic changes to this program in March 2009. Several administrative and non-billable
positions were eliminated and the employees in these positions opted to assume other positions
within Marc Center’s CDS program without a loss in pay due to the lateral shift they experienced.
Marc Center values the training and experience of its tenured employees and opted to retain as
many of these employees as possible.

The growth experienced this past year has mostly occurred from individuals transferring from a
competitor of Marc Center, with the preponderance of these occurring since March 2009. This
past year, Marc Center has experienced the highest growth in day programs over the past ten
years. The 22 individuals discharged have been for a variety of reasons. Several moved from the
area, likely after their primary caregiver was laid off from their employer. We also experienced
four individuals opting to go with another day program provider in Queen Creek following the
closing of our Queen Creek location. This closure was necessary due to the funding cuts by the Di-
vision of Developmental Disabilities (DDD). Individuals were transferred from our Ocotillo site to
the Freestone location; however, eventually four of the nine served transferred to another provid-
er closer to their home rather than have a 3-hour daily commute.

Beginning March 2009, Community Day Services implemented a selective activity calendar for all
community outings. Many more expensive outings were reduced in favor of outings that had
smaller fees. Employees also sought out donations for plays, concerts, parks, ball games and ma-
jor sporting events and we were successful in obtaining many of these items from our generous


Community Day Services                        Page 4 of 15                                 FY2008-2009
community. As a result of letters written soliciting equipment donations for all day programs, sev-
eral pieces of exercise equipment, games, tactile materials and computer software were donated
since February 2009. In addition to selective outing calendars, inside activities were expanded
with renewable resources (i.e., exercise equipment, games, software, etc.) and activities that re-
quired consumable high-cost supplies were decreased. Many community members volunteered
their time and brought culture, music, dance and pets to our day programs without our individuals
having to go out into the heat. Despite the economic downturn and rate cut, Marc Center continues
to provide for community outings several days each week at all sites believing that individuals
must experience the community for their own personal growth and development. These initiatives
have reduced incident reports because there are smaller groups per outing.

Nationally, statistics reveal a significant increase in the number of persons served in day pro-
grams between 2002 and 2006. In 2006, 250,000 were served nationally in day program and
by 2006 that number had increased to 303,000. If Marc Center continues to respond to ex-
pressed needs of our individuals served and their families, it is likely that significant growth will
occur over the next few years as smaller agencies providing a single service module program will
not be able to survive the drastic rate cuts imposed by funding sources. Unfortunately, as those
smaller providers cease to exist, Marc Center may be the beneficiary of the individuals they
served. As predicted in last year’s outcome report, Marc Center experienced part of its growth
from individuals aging out of school programs. Six individuals served this past year came from
high schools at age 22. These individuals come to us with more severe challenges than many of
our existing adults, resulting in unique challenges with our program-based curricula at all loca-
tions. Thirty-nine of the individuals served are over the age of 45, requiring a lower intensity of
activities than their 22-year-old counterparts. As a result of more challenging disability, Marc
Center needed to make adjustments for age and disability with smaller group activities.

Marc Center’s Cortney’s Foundation day program opened in August of 2008, operating from the
924 day program site. In February of 2009, Cortney’s Foundation opened their new state of the
art facility in Scottsdale. Starting with two individuals from the Scottsdale school district, this pro-
gram finished the year serving a total of seven individuals. Major fundraising for this site was
conducted by Cortney’s Foundation Board culminating with a Golf Tournament which raised
enough funds to supply the program with activity materials, small equipment, and tickets to events,
additional hydrotherapy and music therapy.

During FY2007-2008, Community Day Services raised the base starting wage for Direct Support
Providers (DSP) from $7.50 to $8.00 per hour in response to continued turnover concerns from our
stakeholders and increased difficulty in recruitment. This increase in base wage has increased the
number of employment applicants to the day program. Within the last year, the day program has
realized a decrease in turnover (please see turnover rate info in the HR section). During FY2008-
2009, the Ivyglen day program began paying a differential to its direct-care providers given the
functional impairment challenges experienced by the population at this site. This differential also
parallels the rate differential allocated for individuals employed in the community living sites.

This fiscal year marked the full first year the Division of Developmental Disabilities (DDD) imple-
mented the program monitoring system for day programs. Marc Center staff participated in the
DDD committee to advance our feedback regarding the proposed monitoring process. All three of
Marc Center’s CDS program sites were monitored during this reporting period. All three sites
were commended for their high levels of compliance to these reviews.



Community Day Services                         Page 5 of 15                                  FY2008-2009
As the number of individuals in need of day services and living supports will increase 38% by the
year 2020 1, Marc Center’s ability to respond with necessary services will need to continually
evolve to serve a more aged population of individuals with disabilities and natural aging issues
such as Alzheimer’s and Dementia. Marc Center will explore expanding the day services curricu-
lum to better serve a more diverse service population, such as those with normal aging issues. In
2009, Marc Center was awarded a HUD grant to build alternative housing at Oasis Park, known
as The Villages at Oasis Park. This 5-acre parcel owned by Marc Center (and the current site for
the Freestone day program) will also include a 4,800 square foot community day services build-
ing that will provide services to our current Freestone population and senior citizens who will be
residents of The Villages at Oasis Park.

Recent research has shown that more than 15,923 2 individuals with developmental disabilities are
living with caregivers over the age of 60 in Arizona. Many of these dependents do not receive
any services outside their home. As the aging caregiver approaches their 80s and 90s, it is feasi-
ble that their loved ones will be in their 50s or 60s and have not had services since they were in
school at age 22. It is probable that a large portion of these individuals will need day services
when their caregivers find themselves unable to care for them. The Villages at Oasis Park will al-
low for both parents and aged adult children to live within proximity of each other in separate
units but with the services and support they need.

CDS staff remains dedicated to strong efforts to resolve our challenges of reaching out to more
underserved areas in Arizona. Growth in CDS will need to primarily come from mer-
ger/acquisitions, new request for proposals for new service areas and by opening new program
locations in underserved areas. Staff will continue to target service changes/enhancements (i.e.
location and size of service sites), unique transportation options, after hours options for families
and new service options for the elderly and young adult. CDS staff embraces the idea that al-
liances and mergers, coupled with enhanced quality and innovation will reduce the duplicative
and excessive nature of programs in our primary service.




1
   Don Wehbey, Jack York, Cheri Levenson and Frances Griego - DES Economists, Arizona’s Forecast Update Shows
Job Growth of 4.3% During 2007-2008 – 113,700 Jobs (Arizona Department of Economic Security, Research Admin-
istration, September 6, 2007)
2
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Community Day Services                             Page 6 of 15                                       FY2008-2009
ASTONISHMENT

Objective #1 – Percent of Individuals Served Expressing Astonishment




                                               Chart 1

Community Day Services employees gauge their success or failures regarding service provision
and systems integrity by reviewing survey results combined with comments provided by respon-
dents. The high satisfaction scores can be attributed to several factors: strength-based curriculum,
meeting the needs of those we serve and a positive day environment.

CDS staff continues to see positive results from the CDS program curriculum, which specifically tai-
lors nine separate service approaches, (master core curriculum, autism spectrum disorders, medi-
cal, cognitive disability, elderly, pre-vocational, deaf, blind and traumatic brain injury). Continued
work on refinement of this curriculum will enable us to further stabilize, enhance and market our
growth opportunities within the state of Arizona.




Community Day Services                        Page 7 of 15                                 FY2008-2009
PERFORMANCE

Objective #1 – Percent of Individuals Served Who Experienced Progressive Moves
Objective #2 – Percent of ISP Objectives Met within Specified Target Date
Objective #3 – Percent of Individuals Who Increased or Maintained Their Skill Level
Objective #4 – Percent of Individuals Who Express at Discharge that Services Provided Facili-
                tated Community Integration and/or Self-Sufficiency.




                                              Chart 2

Progressive moves are measured when an individual transfers to a less restrictive setting or when
an individual transitions to an employment program or other community integrated situation.

Chart # 2 demonstrates that 9% of the individuals receiving CDS services experienced a progres-
sive move during this reporting period. However this data is not reliable and further training is
needed within the programs to validate the statistical data and inferences. Training will be con-
ducted over the next three months on this topic.

CDS program data continues to indicate that new referrals received are more medically and be-
haviorally challenging, which require an enhanced level of supervision, additional training in med-
ical protocols and a more refined style of writing measurable individual objectives. Objectives this
past year focused more on what each individual expressed as a desire that was attainable,
based on strengths rather than challenges. As a result, those completing at least 65% of their ob-
jectives decreased to 22%, which is a drop of 30% over last year. This score is also reflective of
opening Cortney’s Foundation day program where individuals are more physically and mentally
challenging.



Community Day Services                       Page 8 of 15                                 FY2008-2009
Further analysis of the day services data indicates that many consumers are in a phase of their
lives where deficit skill acquisition is not of primary importance. Many individuals have reached
their full potential, oftentimes due to aging. Therefore the focus of their program is to “maintain”
level of functioning and abilities. In response to this growing need, the elderly service model op-
tion launched two years ago at the 924 location. Individuals in this program have a modified day
which includes periods of rest and quiet. This program has become popular with many of the indi-
viduals served over the age of 45. It is evident that this program will continue to grow and will
continue to expand to other locations, as age and need warrants.

EFFECTIVENESS

Objective #1 – Percent of Compliance to Certification Requirements




                                              Chart 3

The primary funding source for the services provided by Marc Center’s CDS department is the
Department of Economic Security Division of Developmental Disabilities DES/DDD. This entity de-
fines all service standards in day programs. Requirements for certification through DDD include
employee training at orientation and annually, case records maintenance, and facilities mainten-
ance and safety. Documentation of compliance is maintained on the agency staff matrix, which is
submitted to the Home and Community Based Services certification office annually. An audit is
performed by this entity every other year.

As indicated in Chart 3, the CDS department achieved 100% compliance with all HCBS certifica-
tion requirements. This continues the trend initiated two years ago, when CDS achieved 100%
compliance. This outcome exceeds the goal expectancy of 90% for this objective. Due to the
state’s budget crisis, our Ivyglen day program was not monitored this past year.




Community Day Services                       Page 9 of 15                                 FY2008-2009
EFFICIENCY

Objective #1 – Percent of Placements Maintained




                                            Chart 4
During FY2007-2008, 100% of the placements of persons served were maintained. This is an in-
crease of 86% over last year. No discharges that have occurred this past year to a more re-
stricted environment.
Objective #2 – Percent of Budget Variance




                                            Chart 5


Community Day Services                   Page 10 of 15                            FY2008-2009
The CDS program operated within a 20.94% positive variance in comparing budgeted income to
actual income for FY2008-2009.

The income for the CDS program is based on the unit of service delivered to each consumer who
attends the program. Stated differently, Marc Center is not reimbursed for vacancies. The rate
paid for each unit of service is based on the staff to consumer supervision ratio provided during
the course of service delivery. Therefore, given the complex nature of estimating income based on
the variables of consumer attendance and vacancies, staff attendance and vacancies, as well as
varying levels of supervision needs of consumers, the 20.94% variance is acceptable.

Transportation

As specified in contract, CDS currently transports 100% of their service recipients requesting this
service to and from their day programs. CDS departmental transportation services will not be
able to explore the feasibility to contract with a transportation provider in the future. Transporta-
tion is bundled with the day services and changing this service will jeopardize the day program
services for each individual.


ACCESS TO SERVICE/CARE

Objective #1 – Average Number of Days between the Referral and Program Placement.
Objective #2 – Percent of Individuals Referred for Alternative Services when needs cannot be
               met by Marc Center.




                                              Chart 6



Community Day Services                       Page 11 of 15                                 FY2008-2009
CDS program staff track the number of days between the date a referral for service is received
and the date service delivery begins in order to assure that individuals are able to access services
in a timeframe that is responsive to the needs of the individual and their family. As indicated in
Chart 7, the program has demonstrated improvement in this area in the past year and exceeds
the minimum goal expectancy.

Referrals for service are not obtained until the consumer and their family has had the opportunity
to tour/observe as many programs as necessary to make an informed choice for possible place-
ment. Once the consumer/family selects a day program, the funding source forwards the referral
to the provider chosen by the consumer/family.

CDS supervisory staff consumes a considerable amount of time marketing program services to
these consumers. Families that do not choose to participate in our program rarely notify us of their
decision.

Even though Marc Center has limited influence on minimizing the number of days between referral
and service, this outcome objective is important to track as an indicator of potential advocacy ef-
forts that may be necessary to minimize delays in start date. Clearly, advocacy may be indicated
with referral sources if we see an increase in the number of days between referral and intake for
service delivery.


Conclusion

Marc Center’s CDS program has experienced the most growth in the past year of any of the DD
programs, adding a net total of 13 individuals to the existing 4 sites. These individuals have aged
out of school, transferred from another day program, or relocated to our service area. Individuals
have come to Marc Center to receive services, even at a time when Marc Center has reduced
staff hours from 8 to 7.5 for many employees. Transportation routes are more efficiently set up
and monitored, given that many employees work only a 7.5 hour day. On occasion and for a few
routes, employees must work beyond the 7.5 hours to accommodate the transportation pickup and
drop-off times. During the next year, CDS will assess its current service areas and determine if it is
feasible and economically advantageous to locate a new CDS program in another underserved
area or to consolidate any current locations. Marc Center’s philosophy is to serve individuals in
close proximity to home and in smaller settings. However the current economy may necessitate a
further review of this model. Financial concerns will impact this decision, as the threat of reduced
hourly rates in 2009 may cause this program to suspend an additional location, unless another
funding source can be secured.

Beginning in August 2009, all programs funded by the Division of Developmental Disabilities will
move to electronic reporting/billing software. This format will streamline the billing and atten-
dance tracking for all individuals served. What previously took more than 64 hours of labor will
now be accomplished in less than six hours total for the month. This format will also provide timely
reports that can be checked as often as desired. Monitoring of staff ratios can now be done dai-
ly, allowing for more effective and efficient managing of the programs.

Marc Center has updated program and sensory equipment during last year. More than $25,000
has been received from charities and foundations to replace equipment and supplies that allow us
to better serve people with more severe disabilities. As a result of contributions, flat screen televi-


Community Day Services                        Page 12 of 15                                 FY2008-2009
sions, Nintendo Wii game consoles, bubble towers and recliner chairs will be added within the
first quarter of FY 2009-2010. These equipment purchases have enhanced therapeutic value for
our clientele.

Community Day Services continues to be challenged by the number of new small providers in the
east valley that began in fiscal year 2006. However, several of these small providers will not be
able to survive the economic downturn. In fact, a few our referrals have originated from these
small providers, and we anticipate that financial constraints will contribute to further referrals.
Staff is determined to market a niche for Marc Center’s day programs that will brand us as a
unique program provider, utilizing techniques, equipment, curriculum, outings and enhancements
that no other provider will be able to match. We will use this uniqueness as our marketing toolbox
to invite new individuals to seek their services from Marc Center.




Community Day Services                      Page 13 of 15                                FY2008-2009
RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES:


EFFECTIVENESS

It is recommended that an objective to measure the number of community outings per individual
served be added for the upcoming year and that we delete the objective that measures communi-
ty outing hours. This change will more accurately reflect Marc Center’s commitment to include our
population in the community. In addition, this promotes a higher quality of life and social skills at-
tainment. It also provides excellent educational opportunities for both those served and the gen-
eral public. As a “community” day services program, we should be tracking our community outing
time, even in these more challenging economic times.


EFFICIENCY

It is recommended that objective #3 be deleted from next year’s outcome evaluation system.
Transportation is bundled with the day services for each person Marc Center transports from their
caregiver’s home. If transportation is eliminated for some individuals served, a vendor call Quali-
fied Vendor process would be initiated and these individuals would relocate to another provider.
Since Marc Center has established goals for growth, this would be counterproductive to that goal.



RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clear-
ly present results, using various types of performance analysis tools and processes. Specifically,
the research study generated metrics such as:
    • Return-On-Investment (ROI);
    • Output and Outcome Trends and Comparisons; and,
    • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax
        dollar spent for Marc Center’s services, $1.57 of actual value was delivered to the com-
        munity.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple
different types of services will allow Marc Center to more specifically highlight areas of efficiency
performance, and to analyze results that clearly show the operating trends of the organization.



Community Day Services                        Page 14 of 15                                FY2008-2009
This information has been integrated into the outcome evaluation system and enables various
funders and donors to more easily determine the effectiveness of their respective donations and
support.

As a means of providing more efficient adjustments in the program throughout the year, man-
agement will continue the implementation of a scorecard system to track outcomes on a monthly
basis within our outcome evaluation system. Such an approach allows for the measurement and
assessment of other pertinent criteria as determined by respective department management.




Community Day Services                    Page 15 of 15                              FY2008-2009
                                                      MARC CENTER
                                                QUALITY MANAGEMENT PLAN
                                                           AND
                                            ASSESSMENT OF CONSUMER OUTCOMES

Date:          September 1, 2009                                                  Reporting Period: July 1, 2008 to June 30, 2009

Completed by:           Holly Collins                                                     Department: Community Support Services


I.     INDIVIDUAL CHARACTERISTICS

               Total Number Served: 109                                             Total Daily Capacity:        86 (average monthly)

                                                                                                                     PRESENT LIVING
     AGE GROUP          RACE BACKGROUND               CITY                            DISABILITY                       SITUATION
       0 -3    14     White                90   Chandler          19    Cognitive Disability               25   Parent's Home         77
      4 - 12   47     Black                 8   Tempe              2    Cerebral Palsy                     23   Foster Home/ADH/CDH   6
     13 - 17   25     Asian                 3   Gilbert           11    Epilepsy                            7   Adoptive Home          5
     18 - 21    4     American Indian/      4   Mesa              52    Autism Spectrum                    19   Grandparent's Home     8
     22 - 30    5     Alaskan Native            Queen Creek        6    Multiple Disabilities              14   Group Home
     31 - 44    7     Native Hawaiian/Other     Scottsdale         2    Dually Diagnosed (DD/MH)            4   Rent                   6
     45 - 55    2     Pacific Islander       2 Apache Jct.              Developmental Delay                     Own Home               4
     56 - 65    1     Other/Multi Racial     2 Phoenix            6     Physical Disability                7    Other                  3
       66+      4     Eastern Indian            Other:            11 Depression/Depressed Mood                  TOTAL                 109
TOTAL          109    TOTAL                 109 TOTAL            109 Anxiety/Stress
   GENDER                       ETHNICITY BACKGROUND                    Substance Abuse
Male            71 Hispanic                                       19 Psychotic/Schizophrenic
Female          38 Not Hispanic                                   90 Serious Mental Illness Treatment
                      Unknown                                           General Mental Health              10
                                                                        Co-Occurring disorder (SA/MH)
TOTAL          109 TOTAL                                         109 TOTAL                                109


II. DATA RESULTS - Please attach actual total numerical results on outcome evaluation form.

       SCORE:         124.3

III. NARRATIVE RATIONALE - Please attach rationales which are relavant to data above, if possible.

IV. RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES - Attach, if
    applicable.

V. RECOMMENDATIONS FOR PROGRAM CHANGES TO ASSIST IN MEETING OUTCOME
   EVALUATION OBJECTIVES - Attach, if applicable.

Submitted By: Holly Collins                                                                             Executive Vice President, CLS/CSS


President & CEO: Randall L. Gray                                                                         Date: September 1, 2009



Community Support Services                                    Page 1 of 10                                                      FY2008-2009
                                                        MARC CENTER
                                                  QUALITY MANAGEMENT PLAN
                                                             AND
                                              ASSESSMENT OF CONSUMER OUTCOMES

                                                     COMMUNITY SUPPORT SERVICES
                                          TIME OF       DATA          OBTAINED            EXPECTANCIES       RELATIVE                        LAST
           PRIMARY OBJECTIVE              MEASURE      SOURCE            BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ASTONISHMENT
1. Percent of consumer/family             Annually    Satisfaction    Support
   members who indicate the                             Survey       Coordinator
   program exceeds their
   expectations in the following
   assessment areas:
       * Convienience of Location                                                   60         70      80       1        100       1.4        100
       * Cleanliness/Safety                                                         60         70      80       1        100       1.4        100
       * Transportation                                                             60         70      80       1        100       1.4        100
       * Community Activities                                                       60         70      80       1        100       1.4        100
   b. Offers choices and a variety
       of meaningful activities.                                                    80         90     100       1        100       1.1        100
   c. Responsive to concerns                                                        80         90     100       1        100       1.1        97.5
   d. Friendly, courteous, caring                                                   80         90     100       1        100       1.1        100
   e. Communication                                                                 80         90     100       1        100       1.1        92.5
   f. Professional Conduct                                                          80         90     100       1        100       1.1         95
   g. Ability to provide resources
       and information                                                              80         90     100       1        100       1.1        90
   h. Satisfied with services received                                              80         90     100       1        100       1.1        89
   i. Do services meet your
       expectations?                                                                80         90     100       1        100       1.1        92.5
   j. Are services effective and
       helpful?                                                                     80         90     100       1        100       1.1        92.5

PERFORMANCE
1. Percent of habilitation objectives     Monthly       Monthly        Director     85         95     100      10         95      10.0        84
   met within specified target date.                    Report

2. Percent of individuals who express     Monthly       Monthly        Director     85         95     100       7         97       7.1        92
   at discharge that services provided                  Report
   facilitated community integration
   and/or self-sufficiency.

3. Percent of service authorizations in   Monthly       Monthly        Director     95         97     100       8        100       8.2        100
   place prior to initiation of service                 Report
   delivery.

EFFECTIVENESS
1. Percent of compliance to HCBS          Annually      Staff         Support       80         90     100      10        100      11.1        100
   certification requirements.                          Matrix       Coordinator

2. Percent of adult consumers who         Annually     Individual      Director     85         90      95       7        100       7.8        100
   continue living independently in the                 Support
   community as a result of the                          Plans
   support services received.

EFFICIENCY
1. Percent of positive variance of        Annually      Budget         Director     10         1       5        5        8.70     43.5       (7.70)
   actual year-end budget to                           Variance
   projected budget.                                    Report




Community Support Services                                           Page 2 of 10                                                        FY2008-2009
                                             TIME OF    DATA      OBTAINED            EXPECTANCIES       RELATIVE                         LAST
           PRIMARY OBJECTIVE                 MEASURE   SOURCE        BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
ACCESS TO SERVICE/CARE
1. Average number of days between            Monthly   Monthly     Director     25         15      5       10         6        4.0          6
   the date of referral and assignment                 Report
   of direct-service staff.

2. Average number of days between            Monthly   Monthly     Director     15         10      5       10         3        3.0          3
   assignment of direct-service staff to               Report
   onset of service delivery.

3. Average number of days between            Monthly   Monthly     Director     15         10      5       10         2        2.0          2
   identification for need of new                      Report
   direct-service staff and assignment
   of new direct-service staff.

4. As appropriate, percent of plans that     Monthly   Monthly     Director     70         80      90       5        100       6.3         100
   demonstrate sensitivity to the cultural             Report
   diversity of the person to be served.

5. Percent of individuals referred for       Monthly   Monthly     Director     70         90     100       5        100       5.6         100
   alternate services when needs                       Report
   cannot be met by Marc Center.

TOTAL                                                                                                     100.0               124.3




Community Support Services                                       Page 3 of 10                                                         FY2008-2009
                                         FY2008-20089
                                   QUALITY MANAGEMENT PLAN
                                              AND
                               ASSESSMENT OF CONSUMER OUTCOMES

                                  COMMUNITY SUPPORT SERVICES
                              (HOME AND COMMUNITY BASED SERVICES)
                         (BEHAVIORAL HEALTH CHILDREN’S IN-HOME SUPPORTS)

NARRATIVE RATIONALE

This report summarizes measures of efficiency, effectiveness, performance, access to service and
astonishment for Marc Center’s Community Support services Department (CSS) program.

Marc Centers Consumer/Family Quality of Services/Astonishment survey was designed by those
we serve and/or their families. They offered what criteria define quality and service for them in
the survey’s design. The survey is completed at the consumer’s annual service plan meeting and is
available on Marc Center’s website throughout the year soliciting customer satisfaction information
to support Marc Center’s belief in continuous quality improvement. Marc Center also added a
quality assurance hotline, called Silent Whistle, as part of our belief in continuous quality and ser-
vice improvement.

Fiscal Year 2008-2009 Summary

The Community Support services program served 109 individuals during FY 2008-2009. This is a
decrease of 9 individuals from the previous year’s 118 served. More importantly, while the num-
ber of consumers served decreased, CSS program units have grown 36% since the end of
FY2007-2008. In FY 07-08, CSS provided 59,401 units of service compared to FY2008-2009’s
total units of 80,609. We anticipate that this program will continue to grow over the next year in
Maricopa County. As a result of this conflicting data, we may want to capture a supplemental
measure that tracks units of service for attendant care, habilitation and respite.

CSS concluded its first year contract with Yavapai County Long Term Care. In addition, we ex-
panded our DDD contract to include what is recognized as District III by the State of Arizona and
successfully marketed in-home private pay services. This provided Marc Center with an opportuni-
ty to serve Prescott and the surrounding areas with hourly in-home support services that include
respite, personal care, habilitation and attendant care. DES/DDD and Yavapai County funding
sources have contributed to the growth of the CSS program. Challenges of providing services in
this region have been slower than projected due to lack of funding. In addition, we acknowledge
that it is difficult to divert funding and/or alter referral stream to a new agency when families
and individuals served have acclimated to existing systems of care. As a result of imbedded sta-
tus quo, funding sources have been somewhat restricted in their ability/willingness to release ad-
ditional authorizations for service. We continue to seek out additional revenue sources for the re-
gion and continue our aggressive marketing strategy.

The CSS program’s growth correlates to an organization’s ability to hire Direct Support Providers
(DSPs). Marc Center receives an average of 215 referrals each quarter – just for Maricopa
County. Barriers in our ability to recruit DSPs include: wage, distance, time of required service,
additional qualifications. With the slowing of Arizona’s economy, we have observed families leav-


Community Support Services                    Page 4 of 10                                 FY2008-2009
ing the county/state for work; families moving in with other extended family members; and/or
one parent becoming unemployed, resulting in less CSS service required.


ASTONISHMENT

Objective #1 – Percent of Stakeholder’s Astonished




                                             Chart 1

As indicated in the chart above, this year’s results reveals that 100% of survey respondents re-
port that services exceed their expectation and that they are satisfied with the services received.
Comments received this year indicated that departmental, as well as agency-wide, systems exist
and are functional. In addition, stakeholders consistently express satisfaction with services. This
elevated score could be indicative of the services delivered, in addition to the timely delivery of
services that families realize, following several months of delay.




Community Support Services                  Page 5 of 10                                 FY2008-2009
PERFORMANCE

Objective #1 – Objectives Met within Specified Targeted Dates
Objective #2 – Services Facilitated Community Integration




                                              Chart 2

Ninety-five percent (95%) of Marc Center’s CSS program consumers receiving habilitation servic-
es achieved their program objectives this past year. Ninety-seven percent (97%) stated that their
program services facilitated community integration with 100% of authorization received prior to
service delivery. This is attributed to improved staff training and a concerted effort to capitalize
on each individual’s strengths to meet needs.




Community Support Services                   Page 6 of 10                                  FY2008-2009
Community Support Services Growth Fiscal Year 2008-2009




                                                Chart 3

Marc Center’s CSS program has experienced growth in the past three years as demonstrated in
Chart 3. During FY2008-2009, CSS provided the following units of service:

                   DDD – 56,103.75 units to 94 consumers (92 in Maricopa County and two in Yava-
                    pai County)

                   Mercy Care – 5,506 units to one consumer in Maricopa County

                   Yavapai County Long Term Care – 5,695 units to three consumers in Yavapai
                    County

                   BHS-HIS – 13,304 units to 11 consumers in Maricopa County

Based upon family and consumer feedback, the growth is attributed to quality services access to
services and Marc Center’s ability to offer creative and innovative services that are responsive to
the needs of persons served.




Community Support Services                     Page 7 of 10                               FY2008-2009
ACCESS TO SERVICE/CARE

Objective #1 – Average Number of Days between Referral and Program Placement.
Objective #2 – Percent of Individuals Referred for Alternative Services when needs cannot be
               met by Marc Center.




                                               Chart 4

The average number of days between the date Marc Center Home and Community Support Ser-
vices program received a referral for service and the date CSS was able to assign a direct-
service staff that was agreeable to the individual/family was six, as depicted in the above chart.
This demonstrates a decrease in average days from the previous year and falls within the goal
expectancy for this outcome.

The average number of days has been steadily decreasing over the last two years. This is due to
CSS management staff starting to identify service needs from the time of the initial service inquiry
and/or referral. By obtaining the necessary information (i.e., service needed, schedule needed,
authorized hours, special training needed, gender preferences, etc.) at the time of service inquiry
and/or referral, management staff can begin the process of pairing available existing staff,
identifying hiring needs, and/or pairing new staff already in training immediately.

Additionally, CSS management staff worked with individuals and/or families needing service and
potential staff to arrange the pre-service meeting as soon as possible. A pre-service meeting is
scheduled between the individual receiving services and potential direct support staff so that the
individual and/or family can make an informed decision about hiring the direct support staff or
not and to help familiarize the staff with their particular individual’s service needs. The CSS Sup-
port Coordinator facilitates this meeting with the intent of establishing the “team” that will support


Community Support Services                    Page 8 of 10                                  FY2008-2009
the individual’s needs (i.e., the direct support provider, HCBS management staff, the individual
receiving services, and the family, as appropriate.)

Finally, whenever possible, the pre-service meeting is held while new staff is still in training so that
upon the completion of training, direct service can begin immediately. However, the choice of di-
rect support provider is always made by the individual and/or family receiving services, so there
are occasions when a different direct support provider must be found because the individual
and/or family chose to not accept the proposed direct support provider. The individual and/or
family is our customer, so their decision is to accepted or reject the provider is strictly up to them.


Conclusion

Marc Center’s CSS program will continue to confront challenges relative to rising fuel costs and
the difficulty in recruiting DSPs in sectors of our geographic area. Portions of our geographic area
introduce extensive travel distance to family homes for the provision of family services and dis-
suade staff from considering these positions. These considerations limit the distance that DSPs are
willing to travel, especially since there is no guarantee that families will consent to staff selection
as the primary caregiver. The cost of fuel also plays a factor in recruiting DSPs who must travel to
924 North Country Club Drive for their training. Online web-based video training would ease this
situation tremendously.

Management of CSS has been informed by families served that DDD support coordinators have
begun to more closely evaluate the number of units authorized in relation to the actual number of
units activated by a consumer. Marc Center will advocate for families directly, as well as educate
families to advocate for themselves to retain necessary service units.

With an anticipated 10% reduction in funding from DDD for FY2009-2010, Marc Center has
proposed automation in its systems to be as efficient as possible. Software acquisition that will
track service authorization and utilization will be essential to the CSS program.




Community Support Services                     Page 9 of 10                                  FY2008-2009
RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES:

There are no recommendations for changes, with the exception of adding a supplemental meas-
ure that tracks units of service, in addition to number of people served.


RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clear-
ly present results, using various types of performance analysis tools and processes. Specifically,
the research study generated metrics such as:
    • Return-On-Investment (ROI);
    • Output and Outcome Trends and Comparisons; and,
    • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax
        dollar spent for Marc Center’s services, $1.57 of actual value was delivered to the com-
        munity.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple
different types of services will allow Marc Center to more specifically highlight areas of efficiency
performance, and to analyze results that clearly show the operating trends of the organization.
This information has been integrated into the outcome evaluation system and enables various
funders and donors to more easily determine the effectiveness of their respective donations and
support.

As a means of providing more efficient adjustments in the program throughout the year, man-
agement will continue the implementation of a scorecard system to track outcomes on a monthly
basis within our outcome evaluation system. Such an approach allows for the measurement and
assessment of other pertinent criteria as determined by respective department management.




Community Support Services                   Page 10 of 10                                 FY2008-2009
                                                    MARC CENTER
                                              QUALITY MANAGEMENT PLAN
                                                         AND
                                          ASSESSMENT OF CONSUMER OUTCOMES

Date:          July 1, 2009                                                    Reporting Period: July 1, 2008 to June 30, 2009

Completed by: Holly Collins                                               Department:                Community Living Services


I.     INDIVIDUAL CHARACTERISTICS

               Total Number Served:      102                                     Total Daily Capacity:        102

     AGE GROUP              RACE BACKGROUND         CITY                           DISABILITY                        SITUATION
       0 -3            White             95  Chandler                Cognitive Disability               22 Parent's Home
      4 - 12           Black              1  Tempe              8    Cerebral Palsy                      1 Foster Home/ADH/CDH
     13 - 17           Asian              1  Gilbert            4    Epilepsy                              Adoptive Home
     18 - 21        American Indian/      4  Mesa              72    Autism Spectrum                       Grandparent's Home
     22 - 30    10 Alaskan Native            Queen Creek        9    Multiple Disabilities              79 Group Home              102
     31 - 44    40 Native Hawaiian/Other     Scottsdale         4    Dually Diagnosed (DD/MH)              Rent
     45 - 55    32 Pacific Islander       1 Apache Jct.         5    Developmental Delay                   Own Home
     56 - 65    17 Other/Multi Racial        Phoenix                 Physical Disability                   Other
       66+       3 Unknown                   Other:                  Depression/Depressed Mood               TOTAL                 102
TOTAL           102 TOTAL                102 TOTAL            102 Anxiety/Stress
   GENDER                        ETHNICITY BACKGROUND                Substance Abuse
Male             65 Hispanic                                   11 Psychotic/Schizophrenic
Female           37 Not Hispanic                               91 Serious Mental Illness Treatment
                       Unknown                                       General Mental Health
                                                                     Co-Occurring disorder (SA/MH)
TOTAL           102 TOTAL                                     102 TOTAL                                102


II. DATA RESULTS - Please attach actual total numerical results on outcome evaluation form.

       SCORE:          115.4

III. NARRATIVE REATIONALE - Please attach reationales which are relavant to data above, if possible.

IV. RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES - Attach, if
    applicable.

V. RECOMMENDATIONS FOR PROGRAM CHANGES TO ASSIST IN MEETING OUTCOME
   EVALUATION OBJECTIVES - Attach, if applicable.

Submitted By: Holly Collins                                                                          Executive Vice President, CLS/CSS


President & CEO: Randall L. Gray                                                                      Date: September 1, 2009



Community Living Services                                  Page 1 of 12                                                      FY2008-2009
Community Living Services
                                                           MARC CENTER
                                                     QUALITY MANAGEMENT PLAN
                                                                AND
                                                 ASSESSMENT OF CONSUMER OUTCOMES

                                                        COMMUNITY LIVING SERVICES
                                           TIME OF          DATA         OBTAINED            EXPECTANCIES       RELATIVE                        LAST
              PRIMARY OBJECTIVE            MEASURE         SOURCE           BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ASTONISHMENT
1. a. Percent of consumers/                Annually       Consumer       Support
       family members who indicate                       Satisfaction   Coordinator
       the program exceeds their                           Survey
       expectations in the following
       assessment areas:
          * Convienience of Location                                                   60         70      80       1        100       1.4         98
          * Cleanliness/Safety                                                         60         70      80       1        100       1.4        100
          * Transportation                                                             60         70      80       1        100       1.4        100
          * Community Activities                                                       60         70      80       1        100       1.4        100
   b. Offers choices and a variety                                                     80         90     100       1         99       1.1         99
       of meaningful activities.
   c. Responsive to concerns                                                           80         90     100       1        100       1.1        100
   d. Friendly, courteous, caring                                                      80         90     100       1        100       1.1        100
   e. Communication                                                                    80         90     100       1        100       1.1        100
   f. Professional Conduct                                                             80         90     100       1        100       1.1        100
   g. Ability to provide resources                                                     80         90     100       1        100       1.1        100
       and information
   h. Satisfied with services received                                                 80         90     100       1        100       1.1        100
   i. Do services meet your                                                            80         90     100       1        100       1.1         99
       expectations?
   j. Are services effective and                                                       80         90     100       1        100       1.1        100
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals who              Semi-             ISP           Support     50         75     100       8         99      10.6        95
   experience a progressive move         Annually                        Coordinator
   or maintain residency in the most
   optimal setting during the program
   year.

2. Percent of individuals whose            Annually          ISP         Support       50         75     100       7         97       9.1        100
   individual program plan indicates                                    Coordinator
   identification of behavioral
   intervention strategies and timely
   modification which assure
   appropriateness of service delivery.

3. Percent of individuals who               Semi-           Skills      Group Home     50         75     100       5         94       6.3        89
   maintain or increase skill levels in    Annually      Assessment      Supervisor
   major goal domains.

4. Percent of individuals who achieve       Semi-         Previous        Support      50         75     100       5         94       6.3        91
   at least 50% of ISP objectives within   Annually       Objective     Coordinator/
   he goal attainment timeframe.                          Summary       Group Home
                                                                         Supervisor

5. Percent of individuals who express       Semi-         Discharge      Director/     50         75     100       5        100       6.7        100
   at discharge and during follow-up       Annually       Follow-up      Support
   intervals that services provided                        Contact      Coordinator
   facilitated community integration                      Summary
   and/or self-sufficiency.




Community Living Services                                               Page 2 of 12                                                        FY2008-2009
                                      TIME OF        DATA          OBTAINED            EXPECTANCIES       RELATIVE                        LAST
           PRIMARY OBJECTIVE          MEASURE       SOURCE            BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
EFFECTIVENESS
1. Percent of compliance to Arizona   Annually      Arizona        Director/
   Department of Division of                      Department       Program
   Developmental Disabilities Group                    of          Manager
   Home monitoring requirements:                   Division of
     11th Place                                  Developmental                   90         95     100       1         92       1.0         97
     26th Street                                   Disabilities                  90         95     100       1         93       1.0         99
     Alamo                                                                       90         95     100       1        100       1.1        100
     Cabana                                                                      90         95     100       1        100       1.1        100
     Rutledge                                                                    90         95     100       1         94       1.0         99
     Garnett                                                                     90         95     100       1        100       1.1        100
     Evergreen                                                                   90         95     100       1         96       1.0         97
     Brae Voe                                                                    90         95     100       1         98       1.0        100
     Halifax                                                                     90         95     100       1         94       1.0        100
     Hope                                                                        90         95     100       1         96       1.0         98
     Hunter                                                                      90         95     100       1         97       1.0         95
     Juanita                                                                     90         95     100       1         98       1.0         99
     McLellan                                                                    90         95     100       1        100       1.1        100
     Nassau                                                                      90         95     100       1         93       1.0        100
     Covina                                                                      90         95     100       1         99       1.0         99
     Redmon                                                                      90         95     100       1         97       1.0        100
     Sesame                                                                      90         95     100       1        100       1.1        100
     Signal Butte                                                                90         95     100       1        100       1.1         99
     Spencer                                                                     90         95     100       1         98       1.0        100
     Stetson                                                                     90         95     100       1        100       1.1        100
     White Hall                                                                  90         95     100       1         97       1.0        100
     Tremaine                                                                    90         95     100       1         90       0.9         99
     Granite Reef                                                                90         95     100       1         75       0.8          0

1. Percent of compliance to Arizona   Annually     Arizona         Director/
   Department of Division of                      Department       Program
   Developmental Disabilities Group                   of           Manager
   Home licensure requirements:                     Health
     11th Place                                    Services                      90         95     100       1        100       1.1        100
     26th Street                                                                 90         95     100       1        100       1.1        100
     Alamo                                                                       90         95     100       1        100       1.1        100
     Cabana                                                                      90         95     100       1        100       1.1        100
     Rutledge                                                                    90         95     100       1        100       1.1        100
     Garnett                                                                     90         95     100       1        100       1.1        100
     Evergreen                                                                   90         95     100       1        100       1.1        100
     Brae Voe                                                                    90         95     100       1        100       1.1        100
     Halifax                                                                     90         95     100       1        100       1.1        100
     Hope                                                                        90         95     100       1        100       1.1        100
     Hunter                                                                      90         95     100       1        100       1.1        100
     Juanita                                                                     90         95     100       1        100       1.1        100
     McLellan                                                                    90         95     100       1        100       1.1        100
     Nassau                                                                      90         95     100       1        100       1.1        100
     Covina                                                                      90         95     100       1        100       1.1        100
     Redmon                                                                      90         95     100       1        100       1.1        100
     Sesame                                                                      90         95     100       1        100       1.1        100
     Signal Butte                                                                90         95     100       1        100       1.1        100
     Spencer                                                                     90         95     100       1        100       1.1        100
     Stetson                                                                     90         95     100       1        100       1.1        100
     White Hall                                                                  90         95     100       1        100       1.1        100
     Tremaine                                                                    90         95     100       1        100       1.1        100
     Granite Reef                                                                90         95     100       1        100       1.1        100




Community Living Services                                         Page 3 of 12                                                        FY2008-2009
                                         TIME OF       DATA          OBTAINED            EXPECTANCIES       RELATIVE                         LAST
            PRIMARY OBJECTIVE            MEASURE      SOURCE            BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
EFFICIENCY
1. Comparative cost by percentage of     Annually     Medicare        Director     60         70      80       3         70       3.0         65
   habilitation program to state                       Cost of
   hospitalization.                                 Effectiveness
                                                       Report

2. Percent of positive variance of       Annually     Budget          Director      5         3       1        3        3.75      3.8         3.5
   actual year-end budget to projected               Variance
   budget.                                            Report

ACCESS TO SERVICE/CARE
1. Percent of placements made            Annually      Intake        Director/     50         75     100       5        100       6.7         100
   within 30 days of referral.                        Service        Program
                                                      Inquiry        Manager

TOTAL                                                                                                        100.0               115.4




Community Living Services                                           Page 4 of 12                                                         FY2008-2009
                                          FY2008-2009
                                   QUALITY MANAGEMENT PLAN
                                              AND
                               ASSESSMENT OF CONSUMER OUTCOMES

                                     COMMUNITY LIVING SERVICES

NARRATIVE RATIONALE

This report summarizes measures of efficiency, effectiveness, performance, access to service and
satisfaction for Marc Center’s Community Living Services.

Marc Center’s Consumer/Family Quality of Services/Astonishment survey was designed by those
we serve and/or their families. They offered what criteria define quality and service for them in
the survey’s design. The survey is completed at the consumer’s annual service plan meeting and is
available on Marc Center’s website throughout the year soliciting customer satisfaction information
to support Marc Center’s belief in continuous quality improvement. Marc Center also added a
quality assurance hotline, called Silent Whistle, as part of their belief in continuous quality and
service improvement.

Fiscal Year 2008-2009 Summary

Community Living Services (CLS) served 102 individuals during fiscal year 2008-2009, a net in-
crease of five over last fiscal year. Cost per individual served in a supervised living site in Arizo-
na was $46,048 1 annually. This is in comparison to the cost in Arizona of a state-run ICF/MR facil-
ity which is $117,713 2 annually. By providing care, daily living skills training and a stable home
for our residents, it can be stated that Marc Center’s CLS program saved taxpayers more than
$7,964,490 in one year alone. Arizona ranks ninth in the nation for highest cost per individual
served in supported living/personal assistance arrangements behind Alaska, Louisiana, Maine,
New Mexico, Oklahoma, Rhode Island, Tennessee and Wyoming. 3

Waiver spending per participant in Arizona as a whole has continued to decrease since a high of
$28,800 experienced in 1996. Recent data shows that spending in Arizona has fallen to $25,300
per participant in 2006 as DDD continues to attempt to serve more individuals with limited avail-
able funds. However, this by no means covers the average cost per individual served as noted
above. One can theorize that many individuals in Arizona are receiving nominal services in order
for the state to accommodate higher numbers; additionally, this allows funding sources to serve
others in higher cost arrangements better suited to their needs.

The demographics of our program indicate that 65% of those served are male residents, which is
disproportionate to the national population. This trend is expected to continue during FY2009-
2010. CLS relocated the last of our rented group homes and purchased a new home in
Scottsdale. Opting to own the homes rather than lease provides an opportunity to provide more

1
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)
2
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)
3
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Community Living Services                          Page 5 of 12                                       FY2008-2009
stability for these consumers. Home modifications for roll-in showers, ramps, grab bars and zero
threshold clearance is much easier when the home is owned, than negotiating with a property
owner. Additionally, Marc Center personnel maintain the exterior appearance of the homes. Two
of the purchased homes relocated several residents back to Pinal County, their home county. Also,
during this economic downturn, this was an opportune time for Marc Center to purchase and se-
cure low-interest mortgages as a means of owning all group homes.

In addition, Marc Center’s CLS program embarked on a pet visiting program to provide pet ther-
apy for all appropriate and doctor-approved residents. This program has proven to be successful
in lowering maladaptive behaviors in our most challenging individuals. The activity participation
level and facial expressions of those participating in the pet therapy/visiting program says it all.

During fiscal year 2008-2009, the Community Living Services department decreased total over-
time hours by 31,745.5 for the year resulting in an average of 1,380.25 hours per setting per
year when compared to fiscal year 2007-2008. This represents a decrease in overtime of 23.5%
over last fiscal year. Recruitment remains challenging, but is has been minimized by the state job-
less rate associated with the economic downturn. Human Resources hired 73 staff during this re-
porting period; 19% of those hired turned over in the first 60 days and 37% termed within 180
days. CLS management and Human Resources continue to meet on a monthly basis to discuss
strategies to lower the turnover rate for this department and increase recruitment ideas and ef-
forts. This is critical, given the national tenure averages of three to six months employment within
residential settings. In addition to the CLS Mentoring program, the Human Resources department
has also designated one trainer for coaching follow-up with all new hires at the 30-, 60- and 90-
day review time periods. The focus of this follow-up is to ensure that new hires are getting what
they need, have access to their supervisor promptly, and to answer any questions that may have
arisen after the employee left basic orientation training. We will continue to work closely with
Human Resources to promote ongoing recruitment and retention efforts.

The Division of Developmental Disabilities (DDD) conducted monitoring visits of all 23 group
homes during this reporting period. The Community Living Services Department remains in high
compliance with all applied rules and statutes, receiving an overall 96% compliance ratio. Posi-
tive comments received during this review include: “documentation submitted by the agency de-
monstrates that the agency is training beyond the minimum training requirements outlined by the
Division of Developmental Disabilities; we commend Marc Center for the investment in regards to
the training of their staff; and, the agency provides a wide variety of activities for the residents.”
The individuals are able to make choices both in activities and in their homes. The monitors felt
that the settings they visited were clean, home-like and well maintained. They also noted that
there was a high level of personalization in both the common areas and in the bedrooms. Staff
communications with the residents are respectful and friendly, providing a natural atmosphere.
The staff on duty is to be commended for the calm and positive manner in which they interacted
with the residents throughout the course of the visit and for their ability to answer all questions
posed in an appropriate manner. It is clear that everyone takes great pride in the residents’ ac-
complishments, living conditions and community integration. Overall and as reflected by monitor-
ing reports, Marc Center is doing a commendable job working with residents in their homes. The
most recent monitoring review yielded no systemic findings and determined that the agency is op-
erating within the full compliance range. The systems in place to ensure quality programming ap-
pear to be working well and the staff has done a commendable job implementing these systems.
There is an appropriate level of oversight and internal assessment. No systemic concerns were



Community Living Services                     Page 6 of 12                                 FY2008-2009
noted at this time, and it is recommended that the Marc Center continue to work within their own
Quality Management Plan.

The Department of Health Services conducted a compliance/licensure review of all 23 group
homes during this reporting period and Marc Center received 23 two-year full compliance li-
censes to conduct group home services within Maricopa County.

The Community Living Services department was successful in submitting for and acquiring one new
group home during this reporting period. The CLS department now provides services in four Mari-
copa County metropolitan cities, including Mesa, Tempe, Gilbert, and Scottsdale. The Granite
Reef group home, our most recent residence, serves four individuals in a co-ed setting in a gated
community in Scottsdale.

Marc Center will continue to review requests for proposals (RFP) for new growth in the future. Re-
search has shown that more than 15,923 4 individuals in Arizona with developmental disabilities
are living with caregivers over the age of sixty. Many of these dependents do not receive any
services outside their home. As the aging caregiver approaches their 80s and 90s, it is feasible
that they will struggle to care for their loved ones. Many of these individuals will seek community
living services for their family member. Marc Center will need to be prepared to handle an influx
of individuals who have never lived away from home and who very well may have their aging
issues already present.




4
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Community Living Services                          Page 7 of 12                                       FY2008-2009
ASTONISHMENT

Objective #1 – Percent of Those Served Expressing Astonishment




                                                    Chart 1

Again, this year overall comments received on the surveys were positive and indicated that de-
partmental and agency-wide systems are in place and functional, and that our stakeholders are
satisfied with services. Marc Center should focus on continuing to meet the expectations of those
we serve. Further clarification of our abilities to meet expectations may be needed, as well as
more thorough communication. Also, information gathering may be warranted in order to achieve
this goal.

Met Life’s 2008 nursing home statistics remain unchanged since 2007. These numbers indicate that
the cost of a room per day in a nursing home averages $213 ($213 x 102 x 365 = $7,929,990)
compared to Marc Center’s cost per day of $150. Marc Center continues to save Medi-
care/Medicaid more than $2,437,470 annually on the 102 individuals served in our community
living program. 5 This data will be utilized when looking for alternative funding sources for the el-


5
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Community Living Services                          Page 8 of 12                                       FY2008-2009
derly population in the Phoenix Metro Area as we look for our program venue to expand and
offer alternatives to nursing homes for this population.
Staff acknowledges and continues to monitor closely the nationwide shortage of direct support
providers. Marc Center respects the dedication of our Direct Support Providers (DSP) who are
willing to commit to working in positions where traditionally low pay and high expectations are
required. Marc Center continues to put effort and resources toward enhancing pay, benefits and
additional recognition programs to support our existing workforce, as they are critical to the on-
going quality service provision for which Marc Center is so well known.


PERFORMANCE

Objective #1 – Percent of Individuals Served Experiencing Progressive Moves
Objective #2 – Percent of those who Increased Skill Level
Objective #3 – Percent of those who Achieved 50% of their ISP Goals




                                             Chart 2

The percentage of individuals who experienced a progressive move or maintained residency in
the most optimal setting during the program year was 99%. This represents a 1% decrease from
the last reporting period due to a consumer who experienced a decompensation in his health sta-
tus and now requires an increased staffing pattern to meet his health and safety needs.

The average profile of referral indicates that service provision continues to evolve toward a med-
ical and/or high-level behavioral model. Additional specific training, supervision and monitoring
requirements have been necessary to ensure that services provided are appropriate and of bene-
fit to the individual.


Community Living Services                   Page 9 of 12                                FY2008-2009
Being mindful of this trend, the CLS department is making every effort to interface with funding
source personnel, as well as internal Marc Center departments, to assure that required modifica-
tions to our program structure, systems, training and sites/facilities are accomplished to meet the
needs of current individuals served and to be better prepared for the increased needs of individ-
uals referred. Marc Center will continue this focus with regard to strategic planning objectives.
When looking for new homes or living settings, Marc Center will need to be mindful of the needs
of our future population. More creative home modifications, such as lower countertops and cabi-
nets, pull-down closet rods, zero thresholds in flooring and swing grab bars will be implemented
where needed to better serve this population with accommodations that still allow for maximum
independence.


ACCESS TO SERVICE/CARE
Objective #1 – Average number of days between the date of referral and the date of program
               placement.
Objective #2 – Percent of individuals referred for alternative services when needs cannot be
               met by Marc Center.




                                             Chart 3

The Community Living Services department has used the guideline of placements typically taking
a minimum of 30 days to complete, which coincides with funding source requirements in most cas-
es. Unlike prior years, CLS staff has not been challenged by the number of vacancies and have
remained dedicated to extensively reviewing placement profiles to offer the most appropriate
placement.



Community Living Services                   Page 10 of 12                                FY2008-2009
As the CLS department pursues expansion opportunities and diversification of programming to fill
identified service gaps, we feel that our ability to identify, secure and actively place individuals
in the most appropriate placement available or to work with the individual and his/her ISP team
to design/create a placement within 30 days continues to be a challenge. However, Marc Center
remains committed to securing placement within the designated timelines of 30 days or less.

During this reporting period CLS worked closely with the funding source staff to identify and se-
cure temporary emergency placements for individuals from other agencies who were not able to
continue in their placement. In order to ensure the health and safety of the individual, Marc Center
CLS assisted with these emergencies, housing many individuals pending appropriate future
placement through the state when it became available. Several of these temporary individuals
became permanent Marc Center placements.

Conclusion
As the Community Living Services pursues expansion opportunities and diversification of pro-
gramming to fill vacancies and identified service gaps, we feel that our ability to identify, secure
and actively place individuals in the most appropriate placement available or to work with the
individual and his/her ISP team to design/create a placement continues to be a challenge. How-
ever, Marc Center remains committed to securing placement and filling vacancies wherever they
exist.




Community Living Services                   Page 11 of 12                                 FY2008-2009
RECOMMENDATIONS FOR CHANGE IN OUTCOME EVALUATION OBJECTIVES:

There are no recommendations for change.


RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clear-
ly present results, using various types of performance analysis tools and processes. Specifically,
the research study generated metrics such as:
    • Return-On-Investment (ROI);
    • Output and Outcome Trends and Comparisons; and,
    • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax
        dollar spent for Marc Center’s services, $1.57 of actual value was delivered to the com-
        munity.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple
different types of services will allow Marc Center to more specifically highlight areas of efficiency
performance, and to analyze results that clearly show the operating trends of the organization.
This information has been integrated into the outcome evaluation system and enables various
funders and donors to more easily determine the effectiveness of their respective donations and
support.

As a means of providing more efficient adjustments in the program throughout the year, man-
agement will continue the implementation of a scorecard system to track outcomes on a monthly
basis within our outcome evaluation system. Such an approach allows for the measurement and
assessment of other pertinent criteria as determined by respective department management.




Community Living Services                    Page 12 of 12                                 FY2008-2009
                                                         MARC CENTER
                                                   QUALITY MANAGEMENT PLAN
                                                              AND
                                               ASSESSMENT OF CONSUMER OUTCOMES

Date:          September 1, 2009                                                    Reporting Period: July 1, 2008 to June 30, 2009

Completed by:            Janey Durham                                                      Department: Employment Related Services


I.      INDIVIDUAL CHARACTERISTICS

                 Total Number Served: 1151                                       Total Daily Capacity:             500

E GROUP               RACE BACKGROUND                   CITY                         DISABILITY               PRESENT LIVING
SITUATION
       0 -3            White                   948  Chandler          19   Cognitive Disability              258Parent's Home           325
      4 - 12           Black                   38   Tempe            23    Cerebral Palsy                      3Foster Home/ADH/CDH      35
     13 - 17           Asian                    2   Gilbert           18   Epilepsy                            8Adoptive Home
     18 - 21     7     American Indian/         1   Mesa             624   Autism Spectrum                     5Grandparent's Home        1
     22 - 30    297    Alaskan Native           1   Queen Creek        7   Multiple Disabilities              39Group Home              219
     31 - 44    535    Native Hawaiian/Other        Scottsdale         7   Dually Diagnosed (DD/MH)           20Rent                    517
     45 - 55    286    Pacific Islander             Apache Jct.       39   Developmental Delay                  Own Home                 10
     56 - 65     26    Other/Multi Racial       161 Phoenix          414   Physical Disability               23 Other                    44
       66+             Unknown                      Other:                 Depression/Depressed Mood               TOTAL               1151
TOTAL   1151 TOTAL                             1151 TOTAL           1151 Anxiety/Stress
   GENDER                         ETHNICITY BACKGROUND                     Substance Abuse
Male            613    Hispanic                                      193 Psychotic/Schizophrenic
Female          538    Not Hispanic                                  958 Serious Mental Illness Treatment    750
                       Unknown                                             General Mental Health
                                                                           Co-Occurring disorder (SA/MH)     45
TOTAL          1151 TOTAL                                           1151 TOTAL                              1151


II. DATA RESULTS - Please attach actual total numerical results on outcome evaluation form.

        SCORES:                                 EDS: 102.0            OE: 97.6                               CE: 95.7

III. NARRATIVE RATIONALE - Please attach rationales which are relevant to data above, if possible.

IV. RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES - Attach, if
    applicable.

V. RECOMMENDATIONS FOR PROGRAM CHANGES TO ASSIST IN MEETING OUTCOME
   EVALUATION OBJECTIVES - Attach, if applicable.

Submitted By:          Janey Durham                                                                            Executive Vice President, ERS


President & CEO: Randall L. Gray                                                                            Date: September 1, 2009



Employment Related Services                                       Page 1 of 17                                                    FY2008-2009
                                                           MARC CENTER
                                                     QUALITY MANAGEMENT PLAN
                                                                AND
                                                 ASSESSMENT OF CONSUMER OUTCOMES

                                                       EMPLOYMENT RELATED SERVICES
                                                        (Employee Development Services)
                                           TIME OF          DATA         OBTAINED              EXPECTANCIES       RELATIVE                        LAST
              PRIMARY OBJECTIVE            MEASURE         SOURCE           BY           MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ASTONISHMENT
1. a. Percent of consumers/                 Annually     Satisfaction     Support
       family members who indicate                         Survey        Coordinator
       the program exceeds their
       expectations in the following
       assessment areas:                                                                 60         70      80       5         91       6.5        78
          * Convienience of Location                                                     60         70      80       2         88       2.5        71
          * Cleanliness/Safety                                                           60         70      80       5         77       5.5        73
          * Transportation                                                               60         70      80       2         83       2.4        76
          * Community Activities
   b. Offers choices and a variety                                                       80         90     100       3         97       3.2        96
       of meaningful activities.                                                         80         90     100       2         93       2.1        91
   c. Responsive to concerns                                                             80         90     100       2         99       2.2        97
   d. Friendly, courteous, caring                                                        80         90     100       2         91       2.0        89
   e. Communication                                                                      80         90     100       2         90       2.0        91
   f. Professional Conduct                                                               80         90     100       2         90       2.0        88
   g. Ability to provide resources
       and information                                                                   80         90     100       2         98       2.2        96
   h. Satisfied with services received                                                   80         90     100       2         98       2.2        98
   i. Do services meet your
       expectations?                                                                     80         90     100       2         98       2.2        96
   j. Are services effective and
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals who              Semi-            ISPP           Program       40         75     100      10         78      10.4        77
   accomplish 65% of their               annually         Summary        Manager or
   ISPP objectives.                                                        Program
                                                                         Coordinator

2. Percent of placements                   Quarterly      Quarterly     Vice President   75         90     100      10         90      10.0        91
   with the individual's placement                         Reports            or
   plan goal.                                                              Program
                                                                          Manager

3. Percent of individuals who                Semi-          ISPP          Program        60         75      80      10         92      12.3        88
   experience a progressive move            annually      Summary/        Manager
   during the program year.                                Monthly
                                                           Reports

EFFECTIVENESS
1. Percent of individuals who                Semi-          ISPP          Program        65         80      90      10         78       9.8        78
   advanced to independent                  annually      Summary/        Manager
   status on work related skill                            Monthly
   assessments.                                            Reports

2. Percent of individuals who               Monthly        Monthly        Program        65         80      90      10         80      10.0        76
   achieved increased production                           Report         Manager
   rates and pay.

EFFICIENCY
1. Percent of positive variance of          Monthly        Monthly      Vice President   10         25      50       5         0        0.0         0
   actual year-end production                              Budget
   revenue to consumer wages.                              Report



ERS - Employee Development Services                                     Page 2 of 17                                                          FY2008-2009
                                      TIME OF    DATA      OBTAINED            EXPECTANCIES       RELATIVE                         LAST
            PRIMARY OBJECTIVE         MEASURE   SOURCE        BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
ACCESS TO SERVICE/CARE
1. Percent of individuals who         Monthly   Monthly    Program       80         90     100       4         96       4.3         98
   participate in an Intake within              Report     Manager
   15 days of the initial referral.



2. Percent of individuals who         Monthly   Monthly    Program       80         90     100       4         96       4.3         97
   receive services within 30 days              Report     Manager
   of Intake.

3. Percent of individuals referred    Monthly   Monthly    Program       80         90     100       4         93       4.1         92
   and accepted that meet                       Report     Manager
   eligibility criteria.

TOTAL                                                                                               100                102.0




ERS - Employee Development Services                       Page 3 of 17                                                         FY2008-2009
                                                           MARC CENTER
                                                     QUALITY MANAGEMENT PLAN
                                                                AND
                                                 ASSESSMENT OF CONSUMER OUTCOMES

                                                       EMPLOYMENT RELATED SERVICES
                                                           (Organizational Employment)
                                           TIME OF          DATA         OBTAINED              EXPECTANCIES       RELATIVE                        LAST
              PRIMARY OBJECTIVE            MEASURE         SOURCE           BY           MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ASTONISHMENT
1. a. Percent of consumers/                 Annually     Satisfaction     Support
       family members who indicate                         Survey        Coordinator
       the program exceeds their
       expectations in the following
       assessment areas:
          * Convienience of Location                                                     60         70      80       4         91       5.2        78
          * Cleanliness/Safety                                                           60         70      80       2         88       2.5        71
          * Transportation                                                               60         70      80       2         77       2.2        73
          * Community Activities                                                         60         70      80       2         83       2.4        76
   b. Offers choices and a variety                                                       80         90     100       2         97       2.2        96
       of meaningful activities.
   c. Responsive to concerns                                                             80         90     100       2         93       2.1        91
   d. Friendly, courteous, caring                                                        80         90     100       2         99       2.2        97
   e. Communication                                                                      80         90     100       2         91       2.0        89
   f. Professional Conduct                                                               80         90     100       2         90       2.0        91
   g. Ability to provide resources                                                       80         90     100       2         90       2.0        88
       and information
   h. Satisfied with services received                                                   80         90     100       2         98       2.2        96
   i. Do services meet your                                                              80         90     100       2         98       2.2        98
       expectations?
   j. Are services effective and                                                         80         90     100       2         98       2.2        96
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals who              Semi-            ISPP           Program       40         75     100      12         72      11.5        69
   accomplish 65% of their               annually         Summary        Manager or
   ISPP objectives.                                                        Program
                                                                         Coordinator

2. Percent of placements                   Quarterly      Quarterly       Director       75         90     100      10         85       9.4        81
   with the individual's placement                         Reports           or
   plan goal.                                                             Program
                                                                          Manager

3. Percent of individuals who                Semi-          ISPP          Program        60         75      80      10         81      10.8        78
   experience a progressive move            annually      Summary/        Manager
   during the program year.                                Monthly
                                                           Reports

EFFECTIVENESS
1. Percent of individuals who                Semi-          ISPP          Program        65         80      90      10         72       9.0        68
   advanced to independent                  annually      Summary/        Manager
   status on work related skill                            Monthly
   assessments.                                            Reports

2. Percent of individuals who               Monthly        Monthly        Program        65         80      90      10         77       9.6        74
   achieved increased                                      Report         Manager
   production rates and pay.

EFFICIENCY
1. Percent of positive variance of          Monthly        Monthly      Vice President   10         25      50       5         0        0.0         0
   actual year-end production                              Budget
   revenue to consumer wages.                              Report



ERS - Organizational Employment                                         Page 4 of 17                                                          FY2008-2009
                                        TIME OF    DATA      OBTAINED            EXPECTANCIES       RELATIVE                        LAST
            PRIMARY OBJECTIVE           MEASURE   SOURCE        BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ACCESS TO SERVICE/CARE
1. Percent of individuals who           Monthly   Monthly    Program       80         90     100       5         96       5.3        98
   participate in an Intake within                Report     Manager
   15 days of the initial referral.



2. Percent of individuals who           Monthly   Monthly    Program       80         90     100       5         96       5.4        98
   receive services within 30                     Report     Manager
   days of Intake.

3. Percent of individuals referred      Monthly   Monthly    Program       80         90     100       5         93       5.2        93
   and accepted that meet eligibility             Report     Manager
   criteria.

TOTAL                                                                                                 100                97.6




ERS - Organizational Employment                             Page 5 of 17                                                        FY2008-2009
                                                           MARC CENTER
                                                     QUALITY MANAGEMENT PLAN
                                                                AND
                                                 ASSESSMENT OF CONSUMER OUTCOMES

                                                       EMPLOYMENT RELATED SERVICES
                                                              (Community Employment)
                                           TIME OF          DATA         OBTAINED              EXPECTANCIES       RELATIVE                        LAST
              PRIMARY OBJECTIVE            MEASURE         SOURCE           BY           MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
ASTONISHMENT
1. a. Percent of consumers/                 Annually     Satisfaction     Support
       family members who indicate                         Survey        Coordinator
       the program exceeds their
       expectations in the following
       assessment areas:
          * Convienience of Location                                                     60         70      80       2         91       2.6        78
          * Cleanliness/Safety                                                           60         70      80       2         88       2.5        71
          * Transportation                                                               60         70      80       2         77       2.2        73
          * Community Activities                                                         60         70      80       2         83       2.4        76
   b. Offers choices and a variety                                                       80         90     100       2         97       2.2        96
       of meaningful activities.
   c. Responsive to concerns                                                             80         90     100       2         93       2.1        91
   d. Friendly, courteous, caring                                                        80         90     100       2         99       2.2        97
   e. Communication                                                                      80         90     100       2         91       2.0        89
   f. Professional Conduct                                                               80         90     100       2         90       2.0        91
   g. Ability to provide resources                                                       80         90     100       2         90       2.0        88
       and information
   h. Satisfied with services received                                                   80         90     100       2         98       2.2        96
   i. Do services meet your                                                              80         90     100       2         98       2.2        98
       expectations?
   j. Are services effective and                                                         80         90     100       2         98       2.2        96
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals who              Semi-            ISPP           Program       40         75     100      10         82      10.9        86
   accomplish 65% of their               annually         Summary        Manager or
   SIP objectives.                                                         Program
                                                                         Coordinator

2. Percent of placements consistent        Quarterly      Quarterly     Vice President   75         90     100      10         84       9.3        88
   with the individual's placement                         Reports            or
   plan goal.                                                              Program
                                                                          Manager

3. Percent of individuals who                Semi-          ISPP          Program        60         75      80      10         67       8.9        77
   experience a progressive move            annually      Summary/        Manager
   during the program year.                                Monthly
                                                           Reports

EFFECTIVENESS
1. Percent of individuals placed in        Annually       Individual      Program        40         75     100       5         68       4.5        76
   competitive or supported                 and/or        Work Plan      Manager/
   employment who retain their             Quarterly         and            Job
   jobs for 90 days or more.                               Monthly      Development
                                                            Report       Specialist

2. Percent of individuals who               Monthly        Monthly        Program        65         80      90       5         58       3.6        77
   achieved an increase in wages.                          Report         Manager

3. Percent of individuals who transition    Monthly        Monthly        Program        20         30      40      10         23       7.7        27
   to community employment.                                Report         Manager




ERS - Community Employment                                              Page 6 of 17                                                          FY2008-2009
                                     TIME OF    DATA      OBTAINED            EXPECTANCIES       RELATIVE                        LAST
            PRIMARY OBJECTIVE        MEASURE   SOURCE        BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
EFFICIENCY
1. Percent of individuals placed     Monthly   Monthly       Job        80         90     100      10         67       7.4        70
   competitively whose                         Report    Development
   placement cost is within the                           Specialist
   national average of $,2500.

ACCESS TO SERVICE/CARE
1. Percent of individuals who        Monthly   Monthly    Program       80         90     100       5         96       5.3        96
   participate in an Intake                    Report     Manager
   within 15 days of the initial
   referral.

2. Percent of individuals who        Monthly   Monthly    Program       80         90     100       5         97       5.4        96
   receive services within 30                  Report     Manager
   days of Intake.

3. Percent of individuals referred   Monthly   Monthly    Program       80         90     100       4         87       3.9        89
   and accepted that meet                      Report     Manager
   eligibility criteria.

TOTAL                                                                                              100                95.7




ERS - Community Employment                               Page 7 of 17                                                        FY2008-2009
                                         FY2008-2009
                                  QUALITY MANAGEMENT PLAN
                                             AND
                              ASSESSMENT OF CONSUMER OUTCOMES

                                  EMPLOYMENT RELATED SERVICES
                                    SUPPLEMENTAL MEASURES

SUPPLEMENTAL MEASURE                                                              RESULTS
     1. Number of referrals from State Health Care Programs                          51
     2. Percentage of individuals who obtained employment outcomes with access
                                                                                    69%
        to medical insurance plans/benefits.
     3. Number of contacts made inquiring about employment opportunities in the
                                                                                   17,039
        local job market.
     4. Number of individuals placed competitively or into supported employ-
                                                                                    118
        ment.
     5. Percent of recidivists.                                                     43%
     6. Average number of weeks worked in the workshop.                           49 weeks
     7. Number of Subcontractors/Corporations that provide a variety of “real
                                                                                     61
        work” for ERS individuals/trainees.
     8. Average number of weeks worked in the community.                          51 weeks
     9. Average number of hours worked per week in the workshop.                   28.75
  10. Average number of hours worked weekly in the community.                      15-20
  11. Average activity stipend/individual/two week period.                         $78.37
  12. Average wage for community based employment.                                $9.05/hr
  13. Number of incident reports.                                                   107
  14. Length of time to pay back the cost of program, relative to taxes paid,
                                                                                  24 months
      once employed.
  15. Number of referrals for Computer Lab and Clerical Training positions.         265
  16. Number of graduates/successful participants in Computer Lab and Cleri-
                                                                                    167
      cal Training positions.
  17. Number of trainees who are on a community enclave.                             76
  18. Number of community enclaves added this past year.                              2




Employment Related Services                 Page 8 of 17                            FY2008-2009
                                         FY2008-2009
                                  QUALITY MANAGEMENT PLAN
                                             AND
                              ASSESSMENT OF CONSUMER OUTCOMES

                                EMPLOYMENT RELATED SERVICES

                                    NARRATIVE RATIONALE

The outcome management report encompasses the programmatic year beginning July 1, 2008
and ending June 30, 2009. This report summarizes measures of efficiency, effectiveness, access to
service and astonishment for all primary and supplemental measures.

This year, no new astonishment measures were added and no changes have been recommended.
It is noteworthy that ERS not only tracks satisfaction of all ERS consumers, but the system allows
each discrete program to monitor specific measures in all other primary objective categories. In
reviewing outcomes, Sheltered Employment relates to Organizational Employment; Work Adjust-
ment relates to Employee Development Services; and Job Placement relates to Community Em-
ployment.

Fiscal Year 2008-2009 Summary

In 2008, Marc Center’s employment programs were awarded excellent scores in monitoring from
the Division of Developmental Disabilities, Rehabilitation Services Administration, and from Magel-
lan, the Regional Behavioral Health Authority that contracts with ADHS, for the provision of beha-
vioral health services in Maricopa County. The audit findings recorded minimal recommendations
for improvement. In fact, numerous commendations acknowledged tenured staff commitment, com-
prehensive/complete consumer files, and the availability/variety of work that enabled staff to
more adequately assess consumer vocational interests and aptitudes. During fiscal year 2008-
2009, two new community enclaves were developed to serve a minimum of 12 individuals. The
additional community work environments included Nite Sweeps and Bashas’. Employment Related
Services staff will continue to work diligently next year to develop additional enclaves that offer
extended job opportunities for persons served. Marc Center is one of the few agencies in Arizona
hat has consistently offered subcontract work for persons served on a fulltime basis. The economic
downturn has resulted in many agencies extending months of downtime, not only because of dimi-
nished subcontract work, but because of eliminated community enclaves. During this time period,
Marc Center’s vocational training program has 350 consumers fulltime paid training with minimal
downtime.

Community Employment Services has experienced an increase in referrals from Magellan this past
year. This is due to co-locating at two East Mesa area behavioral health clinics where employment
specialists provide immediate employment options for new and current clinic referrals. Employ-
ment specialists served 55 to 60 individuals per month during fiscal year 2008-2009 with pre-
employment classes, resume writing, job search skills, interviewing skills/practice, job development
and job placement. This partnership between Magellan and Marc Center should continue and
should also contribute to future co-location at other clinics.

Last year, Marc Center began a work stipend for participants who desired daily pay for daily
work. This cash stipend reinforced self-esteem and confidence for all participating individuals. It


Employment Related Services                  Page 9 of 17                                 FY2008-2009
was evident that, for many individuals referred with behavioral health challenges, this program
has been extremely successful in building soft and hard work skills. An average of 28 to 30 con-
sumers received daily pay for work activities. The program has been successful in helping consum-
ers determine if they are interested in working and furthering their vocational training or if they
are not ready for work at this time in their life. Employment services has been faced with the chal-
lenge that, while the number of individuals served with behavioral health disabilities has in-
creased and consumer satisfaction is at an all-time high, Marc Center has lost $160,000 per
month in un-encountered units of services billed to Magellan over the past year. The economic
downturn, state budget cuts, and lack of sufficient funds from Magellan has forced us to reassess
the daily work for daily pay concept, resulting in the suspension of hourly daily paid activities.
However, these consumers will be offered the opportunity to participate in paid training where
they can complete piece work. Last year, individuals referred through SCAN and Mercy Care re-
sulted in more than $700,000 additional revenue to Marc Center. Unfortunately, significant cuts in
funding with Mercy Care this year have resulted in a decrease of approximately $350,000 to
$400,000 per year. The cut would have been larger, but we were able to negotiate and work
with Mercy Care on grandfathering in twenty-three participants that will allow this targeted pop-
ulation long-term funding to participate in Marc Center employment programs.

Employment Related Services negotiated and worked with Safeway in the development of a Sa-
feway training store at our Extension facility. The unique 500 sq. ft. store is the largest one within
Arizona and provides training opportunities with stocking, day porter, courtesy clerks and display
marketers. Operating as a simulated store identical in setup to any other Safeway store, this set-
ting is equipped with aisles, display cases and freezers. The store was originally scheduled to
open in December 2008; however, the economy and other mitigating factors delayed the store
opening until June 2009. Referrals are on an accelerated pace, most originating from students
who are transitioning from Mesa Public Schools. Clearly, this site will become a promising referral
source for this unique training program. Marc Center has duplicated this concept and presented it
to Walgreen’s Company. Walgreen’s is also very interested; however, as a direct result of the
economy, they want to delay the development of the training store. Walgreen’s did utilize our
employment program for specialty jobs at the Tempe Medication Distribution Center. Approx-
imately 30 client referrals and three staff worked on a variety of jobs, including scanning, pulling
old prescriptions for destruction, and some basic data entry. Walgreen’s is doubling the size of
the Tempe Distribution Center over the next 18 months and has expressed an interest to fill some
of their internal positions with our client referrals. At some point in the near future, we will have
the opportunity to develop an enclave, as well as to provide job placement and supported ser-
vices for Walgreen’s.

As noted in last year’s outcome report, Marc Center’s Freestone Rehabilitation Center again was
filled to capacity, requiring a waiting list for this location. To minimize the impact caused by the
waiting list, Marc Center purchased three acres at Signal Butte Road and Main Street in east Me-
sa to develop a new Marc East location. Architectural plans have been created and submitted to
the City of Mesa for approval for several small offices and a workshop that will serve up to 100
individuals. However; and again attributed to the economic downturn and reduction in state con-
tracts, this project will be put on hold for at least 18 to 24 months. Another reason for the delay in
construction is that, while the original cost of the new facility was estimated at $1.7 million, that
cost has now increased to $3.1 million given the growing demands in the East Valley. To compen-
sate for the increased referrals, staff has worked with families and a group of individuals are
now being transported daily to our Mesa Extension facility and a new Bashas’ enclave in the East
Valley. Currently we are looking for alternative rental space to accommodate the remaining ERS


Employment Related Services                  Page 10 of 17                                 FY2008-2009
consumers at Freestone during the construction of the Village at Oasis Park, an alternative living
arrangement for the elderly and those with disabilities in need of supported apartment living.

Currently, Americans with disabilities represent one eighth of the working age population; yet less
than 17% of these individuals are employed outside the home. 1 Nationally, in 2006, the propor-
tion of supported and competitive employment participants dropped to 21.5%, the lowest level in
eight years. During this same year, Arizona, as one of the few states to do so, increased its
spending on supported employment by more than 18%. This should result in an increase in the use
of Medicaid funds for prevocational and vocational services, even though Rehabilitation Services
Administration (RSA) referrals held constant or slightly declined during the last year. Of the 8,249
individuals served during fiscal year 2006 in Arizona, 1,138 participated in sup-
ported/community employment. In 2008/2009, Marc Center served 1,151 individuals in all four
work programs, with 118 placements at an average wage of $9.05 per hour. This equates to a
14.4% participant rate for community employment; however, it is below the national average of
21.5%, but above Arizona’s average of 13.8%.




1
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Employment Related Services                        Page 11 of 17                                      FY2008-2009
ASTONISHMENT

Addresses: Employee Development, Organizational Employment and Community Employment.

OBJECTIVE #1 – Percent of Consumers/Families Astonished




                                              Chart 1

The percent of stakeholders who expressed overall astonishment (satisfaction) in all employment
programs was 92% for FY2008-2009. This is a nominal increase from last year’s 91% overall
score. The lowest scores noted with astonishment addressed the areas of cleanliness/safety of fa-
cilities, transportation and community activities. Feedback relative to cleanliness/safety and
transportation related to our Freestone facility where families continue to express their ongoing
concerns about congestion and overcrowding, that has contributed to an un-kept appearance. A
lack of storage space could contribute to an unsafe work environment. Again, this has been re-
solved by working with families and referring some consumers to our Mesa Extension facility and
to a new Bashas’ store in the East Valley. In addition, we have rented a semi-truck for storage
purposes to create a safer work environment. The transportation concerns were about the length
of time some consumers would be in a van if they came from Queen Creek to Freestone and from
Freestone to our Extension facility, since some individuals could be in route two and a half hours a
day. In addition, referrals from Queen Creek remain at the Freestone site to reduce their transit
time. The low score related to community activities was not a direct result of anything Marc Center
implemented; families were extremely supportive last year when we had added six new commu-
nity enclaves. However, the economic downturn did result in the loss of three enclaves which had
provided as stable work for families/consumers and Marc Center. ERS staff continues to seek new


Employment Related Services                 Page 12 of 17                                 FY2008-2009
community employment opportunities, but have faced many challenges as a result of the economy.
Employment Related Services will continue efforts this next year on increasing the astonishment
scores.

During the past year, the Maricopa County economy and labor market experienced unemploy-
ment rates of approximately 9.5%, which is elevated from 5.5% last year. The increase demon-
strates a significant slowing in the Arizona economy. Arizona led the nation in job growth in fiscal
year 2007 and now has begun to elevate toward the top of the list for job loss. Positions remain
vacant in retail, custodian service, landscaping and other less skilled positions/industries; however,
many of our referrals are looking for jobs outside the typical industry placement opportunity. RSA
has also slowed the rate of referral to all organizations offering community employment services
since their budgets have been reduced. The Division of Developmental Disabilities (DDD) and the
Regional Behavior Health Authority (RBHA) continue to make steady referrals to our employment
programs; however, we anticipate that this could be compromised in the next year with a reduc-
tion in the number of authorized units of service per individual being reduced, as a result of the
declining state economy.

Individuals placed in community positions began their jobs earning an average of $9.05 per hour.
This is a decrease of 93¢ from last year’s average. Many of these placements were for part-time
employment and, therefore, did not include medical benefits. Arizona’s current economy has
caused many placements to experience reduced hours of employment compared with previous
years. The state of the economy has also contributed to fewer placements in the general popula-
tion, as well as with our consumers. Staff continues to work with current placements and encourag-
es individuals to obtain more hours as a means of achieving full-time employment.


Employee Development Services

OBJECTIVE #2 – Percent of Those Served Who Made Progressive Moves
OBJECTIVE #3 – Percent of Those Whose Placement is Consistent with Plan
OBJECTIVE #4 – Percent of Those who Completed 65% of their ISP Goals

Acronyms defined:             EDS = Employee Development Services
                              OE = Organizational Employment
                              CE = Community Employment

Employee Development and Community Employment Services experienced a rate of 90% and
84% respectively of those served obtaining a placement consistent with their plan. Organizational
Employment demonstrated a rate of 85% in obtaining placement consistent with the individual’s
plan. These results parallel last year’s scores of 91%, 88% and 91% respectively; however, we
did experience a slight decrease because of the economy forcing consumers to take jobs availa-
ble rather than waiting for a job of their preference. We have seen this more with consumers who
live on their own and who are confronted with financial obligations that must be met. These indi-
viduals often times cannot wait for the ideal job that is commensurate with their interests and apti-
tudes. The consumer and job developer will continue to identify multiple job choices that broaden
the possibility of placement. Choices offered are comparable to job availability in the current lo-
cal job market.




Employment Related Services                     Page 13 of 17                              FY2008-2009
Progressive moves for fiscal year 2008-2009 for Employment Related Services were: Community
Employment (CE) 67%, Employee Development Services (EDS) 92% and Organizational Employ-
ment (OE) 81%. OE increased from 78%, CE decreased from 77% and EDS increased from 88%
in fiscal year 2007-2008. The 10% decrease in Community Employment (CE) is a direct result of
the poor economy. In addition, consumers employed in the community have experienced reduction
in hours worked. The reduction in hourly wages and job loss with recidivism peaked at an all time
high of 43%. Slight increases were noted from last year for persons served completing at least
65% of their ISP goals.




                                            Chart 2a




                                            Chart 2b



Employment Related Services                Page 14 of 17                               FY2008-2009
                                                     Chart 2c

Conclusion

Arizona will be facing tougher economic times during the next two years, as one of three states hit
hardest by the downturn in the economy. For Marc Center work programs, this will mean more
competition for community employment jobs, making placement much more challenging. In addi-
tion, the more than $3 billion state budget deficit could result in cuts to services for persons
served. The deleterious effect of these funding reductions could contribute to many individuals not
receiving adequate long-term supports necessary for community employment retention. Given the
status of our economy, ERS has been successful in keeping more than 300 individuals actively in-
volved in daily with minimal downtime.

Production contracts and enclaves are also likely to experience more competition with other ser-
vice providers and from the contracted company itself, as each company attempts to preserve
their own workforce relative to declining sales/production. Many enclaves that Marc Center
would typically secure may be kept in-house by those companies to retain their own employees
and keep their costs low, if appropriate. The management of the employment services programs
will seek to become more innovative in its contract approach, as well as looking for unique oppor-
tunities that allow us to surpass like-industry competition.

Placing individuals at or above a livable wage in the Phoenix metro area will continue to be a
challenge for the employment services program. Livable wage in the metro area for FY2006 was
$12.46 per hour in order to afford a one-bedroom apartment. With the average one-bedroom
apartment rent at $603 per month, an individual would have to spend 107.5% of their income
just to maintain housing – an impossibility. 2 Minimum wage increased in Arizona in January 2009;


2
 SLHI Staff, “Gray Land, Housing for People with Serious Mental Illness in Maricopa County,” Arizona Health Futures,
January 15, 2008. September 4, 2008 < http://arizonahealthfutures.org/?m=200801 >
<http://www.slhi.org/publications/issue_briefs/pdfs/ib-2008-January.pdf>


Employment Related Services                         Page 15 of 17                                        FY2008-2009
however, the average rent per apartment has increased, leaving individuals struggling still to find
jobs that pay above $12.46/hour.




Employment Related Services                 Page 16 of 17                                FY2008-2009
RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES:

There are no recommendations for change.


 RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clear-
ly present results, using various types of performance analysis tools and processes. Specifically,
the research study generated metrics such as:
    • Return-On-Investment (ROI);
    • Output and Outcome Trends and Comparisons; and,
    • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax
        dollar spent for Marc Center’s services, $1.57 of actual value was delivered to the com-
        munity.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple
different types of services will allow Marc Center to more specifically highlight areas of efficiency
performance, and to analyze results that clearly show the operating trends of the organization.
This information has been integrated into the outcome evaluation system and enables various
funders and donors to more easily determine the effectiveness of their respective donations and
support.

As a means of providing more efficient adjustments in the program throughout the year, man-
agement will continue the implementation of a scorecard system to track outcomes on a monthly
basis within our outcome evaluation system. Such an approach allows for the measurement and
assessment of other pertinent criteria as determined by respective department management.




Employment Related Services                  Page 17 of 17                                 FY2008-2009
                                                          MARC CENTER
                                                    QUALITY MANAGEMENT PLAN
                                                               AND
                                                ASSESSMENT OF CONSUMER OUTCOMES

Date:       September 1, 2009                                                     Reporting Period: July 1, 2008 to June 30, 2009

Completed by:                Michael Franczak, Ph.D.                                      Department: Behavioral Health Services


I.       INDIVIDUAL CHARACTERISTICS

                  Total Number Served: 1755                                  Total Daily Capacity:               361

      AGE GROUP               RACE BACKGROUND              CITY                        DISABILITY                      PRESENT LIVING
  0 -3           0      White                   939  Chandler      86    Cognitive Disability               34   Parent's Home          106
 4 - 12          0      Black                   115  Tempe        52     Cerebral Palsy                      1   Foster Home/ADH/CDH       3
 13 - 17         0      Asian                    15  Gilbert      204    Epilepsy                            2   Adoptive Home            0
 18 - 21       113      American Indian/         21  Mesa        904     Autism Spectrum                    13   Grandparent's Home        3
 22 - 30       436      Alaskan Native               Queen Creek 70      Multiple Disabilities              16   Group Home               98
 31 - 44       583      Native Hawaiian/Other     4  Scottsdale   55     Dually Diagnosed (DD/MH)           16   Rent                   860
 45 - 55       393      Pacific Islander             Apache Jct.  42     Developmental Delay                45   Own Home                 57
 56 - 65       190      Other/Multi Racial       366 Phoenix     226     Physical Disability                35   Other/ Home w/family    628
  66+           40      Unknown                  295 Other:      116     Depression/Depressed Mood         990   TOTAL                  1755
TOTAL         1755      TOTAL                   1755 TOTAL       1755    Anxiety/Stress                    589
   GENDER                          ETHNICITY BACKGROUND                  Substance Abuse                   394
Male           774      Hispanic                                  366 Psychotic/Schizophrenic              235
Female         981      Not Hispanic                              1094 Serious Mental Illness Treatment    634
                        Unknown                                   295 General Mental Health               1056
                                                                         Co-Occurring disorder (SA/MH)     504
TOTAL         1755      TOTAL                                     1755


II.      DATA RESULTS - Please attach actual total numerical results on outcome evaluation form.

         SCORE:         104.0

III.     NARRATIVE RATIONALE - Please attach rationales which are relevant to data above, if possible.

IV.      RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES - Attach, if
         applicable.

V.       RECOMMENDATIONS FOR PROGRAM CHANGES TO ASSIST IN MEETING OUTCOME
         EVALUATION OBJECTIVES - Attach, if applicable.

Submitted By:           Michael Franczak, Ph.D.                                                             Chief Operations Officer, BHS


President & CEO: Randall L. Gray                                                                          Date: September 1, 2009



Behavioral Health Services                                    Page 1 of 13                                                        FY2008-2009
                                                           MARC CENTER
                                                     QUALITY MANAGEMENT PLAN
                                                                AND
                                                 ASSESSMENT OF CONSUMER OUTCOMES

                                                        BEHAVIORAL HEALTH SERVICES
                                            TIME OF         DATA          OBTAINED            EXPECTANCIES       RELATIVE   FY2009              FY2008
              PRIMARY OBJECTIVE             MEASURE        SOURCE            BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE     RESULTS
ASTONISHMENT
1. a. Percent of consumer/family            Annually      Satisfaction    Support
       members who indicate the                             Survey       Coordinator
       program exceeds their
       expectations in the following
       assessment areas:
          * Convienience of Location                                                    60         70      80       1         98       1.4         98
          * Cleanliness/Safety                                                          60         70      80       1         99       1.4        100
          * Transportation                                                              60         70      80       1        100       1.4        100
          * Community Activities                                                        60         70      80       1         98       1.4        100
   b. Offers choices and a variety                                                      80         90     100       1         98       1.1         99
       of meaningful activities.
   c. Responsive to concerns                                                            80         90     100       1         99       1.1        100
   d. Friendly, courteous, caring                                                       80         90     100       1        100       1.1        100
   e. Communication                                                                     80         90     100       1        100       1.1        100
   f. Professional Conduct                                                              80         90     100       1         99       1.1        100
   g. Ability to provide resources                                                      80         90     100       1         99       1.1        100
       and information
   h. Satisfied with services received                                                  80         90     100       1        100       1.1        100
   i. Do services meet your                                                             80         90     100       1        100       1.1         99
       expectations?
   j. Are services effective and                                                        80         90     100       1        100       1.1        100
       helpful?

PERFORMANCE: indicators comparing progress from entry to intervals to end of service
1. Percent of individuals              At Discharge      Discharge       Specialists/
   discharged to:                                         Summary          Clinical
   a. the same or lower level of care                                   Coordinators    80         85      90      10         85      10.0        93
   b. a higher level of care due to                                                     17         15      10      10         15      10.0        7
      psychiatric decompensation

2. Percent of individuals who                Semi-        Assessment     Specialists/   80         85      90      10         43       5.1        53
   achieved 50% or more of their            annually       Summary:        Clinical
   treatment goals at discharge.                           Functional    Coordinators
                                                          Assessment,
                                                           GAF and
                                                             ALFA

EFFECTIVENESS
1. Percent of individuals who                Semi-          Global       Specialists/   80         85      90      15         94      16.6        92
   maintained or increased skill            annually       Fcuntional      Clinical
   levels in major goal domains                           Assesssment    Coordinators
   (individuals improve functional                           (GAF)
   abilities).

EFFICIENCY
1. Percent of positive variance             Annually        Expense       Director/      7         5       3       10         5       10.0         5
   of actual year-end budget to                              Report         CFO
   projected budget.

2. Comparative percentage cost of           Annually        Budget        Director/     40         50      60      12         60      14.4        66
   clinical program to state                               Variance         CFO
   hospitalization.                                         Report




Behavioral Health Services                                               Page 2 of 13                                                        FY2008-2009
                                    TIME OF    DATA       OBTAINED            EXPECTANCIES       RELATIVE                         LAST
           PRIMARY OBJECTIVE        MEASURE   SOURCE         BY         MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
ACCESS TO SERVICE/CARE
1. Seven days from referral to      Monthly   Referral     Intake       75         85      95      10         96      11.3         99
   intake assessment.                           Log       Personnel

2. Twenty-three days from intake    Monthly   Referral     Intake       75         85      95      10         94      11.1         99
   assessment to first behavioral               Log       Personnel
   health service.

TOTAL                                                                                              100                104.0




Behavioral Health Services                               Page 3 of 13                                                         FY2008-2009
                                          MARC CENTER
                                 QUALITY MANAGEMENT PLAN
                                            AND
                             ASSESSMENT OF CONSUMER OUTCOMES

                                 BEHAVIORAL HEALTH SERVICES
                                   SUPPLEMENTAL MEASURES

SUPPLEMENTAL MEASURE                                                              RESULTS
1. Percent of consumers who live in residential or housing programs or the Vil-   50.1%
   lage program who are involved in meaningful day activities or vocational
   services as a result of support services received.
2. Number of adults receiving In-Home Support services.                             10
3. Number of consumers served attending the Village program.                       294
4. Number of consumers served in Independent Housing services.                      50
5. Number of consumers served in Level II residential programs.                     33
6. Number of consumers receiving services through the Outpatient Clinic.           1368
7. Percent of individuals who transition to more independent settings.            71.5%




Behavioral Health Services                  Page 4 of 13                           FY2008-2009
                                        FY2008-2009
                                 QUALITY MANAGEMENT PLAN
                                            AND
                             ASSESSMENT OF CONSUMER OUTCOMES

                                BEHAVIORAL HEALTH SERVICES

NARRATIVE RATIONALE:

This report summarizes measures of efficiency, effectiveness, access to service and astonishment
for all primary and supplemental measures.

This year Marc Center’s Behavioral Health Services continued to provide effective and efficient
care while expanding our service array by adding nine co-located counselors, four of whom pro-
vide Dialectical Behavioral Therapy, a specialty counseling service that meets a large need in the
Maricopa County behavioral health system. The co-located counselors work directly in clinics for
individuals with a serious mental illness. Behavioral Health Services also added four independent
housing units and is in the process of final refurbishing of five other units. BHS was able to add a
full-time Clinical Director to the team, thereby strengthening the clinical supervision process.

Fiscal Year 2008-2009 Summary

Behavioral Health Services (BHS) began implementation of the electronic record system (PACE+)
and by June, the system was in operation in 80% of the behavioral health programs. This means
that all of the housing, outpatient clinic and co-located counselors are able to access the person’s
clinical record from their work sites and complete treatment plans, progress notes and encounters
for billing. The remaining 20% of the programs will be using the electronic record by September
1, 2009. Obviously, this automated system frees up clinical time for staff to meet more community
needs.

Marc Center’s BHS participated in, and in many cases led the effort to obtain Magellan operated
clinics for individuals with a serious mental illness. Due to the fact that Magellan would not allow
individual providers to operate clinics, a limited liability partnership with Recovery Innovations of
Arizona and Jewish Family and Children’s Services was formed to compete for five clinics. We
were successful and have started the transition of clinics in June with the complete transition ex-
pected by mid-August 2009.

Marc Center’s East and West Village programs continue to draw attention from referral sources
and were instrumental in organizing the Maricopa County Consumer Recovery Center’s efforts to
sponsor a wellness event that included more than 250 participants with a serious mental illness.
These participants competed in a day-long kick ball event which was the talk of the behavioral
community for months afterward. Many participants reported that it was one of their best days in
memory because they had the opportunity to perform as athletes and participate as fans instead
of being recognized as patients. We intend to continue this effort with a bowling tournament this
summer and another kickball event this fall.




Behavioral Health Services                   Page 5 of 13                                  FY2008-2009
ASTONISHMENT
OBJECTIVE #1 – Consumer Astonishment




                                             Chart 1

Service Delivery

The consumer’s perception of service delivery measures whether Marc Center delivers what it
records in the treatment planning process. The survey results revealed that consumers reported a
significant improvement in service delivery over the past five-year period of measurement. The
rate in FY2005 was 81%, which increased to 94% in FY2006, 95% astonishment rate in FY2007,
94% in FY2008 and 98.6% in FY2009. Over this five-year time period, this represents a 17.6%
increase. The significant improvement over the past five years is directly due to the enhanced
structures and processes that have been implemented to be more responsive to the consumer’s
needs and the implementation of a recovery-oriented system of care. These changes included ad-
ditional staff training, supervision and closer monitoring of outcomes. Marc Center staff continues
to be committed to providing consumers with the quality care that is the agency’s hallmark. This
objective will continue to be monitored to ensure that changes in the regional behavioral health
system or reductions in funding do not affect the positive outcomes that Marc Center’s service de-
livery has been able to achieve.




Behavioral Health Services                  Page 6 of 13                                 FY2008-2009
Overall Astonishment

Marc Center continues to promote family participation in the care of their loved ones. The Beha-
vioral Health Services department has created systems and processes that encourage families to
participate in care on an ongoing basis. The system implementation and the genuine compassion
that staff possesses for the consumers they serve is evident. All surveys obtained from family
members indicated a 100% level of astonishment. This percentage has been consistently main-
tained over the previous four years. This year, we partnered with Southeast Valley NAMI to con-
duct Family to Family Training Sessions that were well attended. This objective will be monitored
during the upcoming year and reported during the next reporting period.


PERFORMANCE

Objective #1 – Discharged to lower level of care




                                              Chart 2

Consumers who meet their goals and objectives move through the continuum of care to indepen-
dence. This measure tracks the percent of consumers who require less care based on progress. The
percentage of individuals discharged to a lower level of care was 85% during FY2009. While
this number represents a decrease from the previous year, the current percentage is commenda-
ble and continues to support the fact that programs and activities result in sustained functional im-
provements which allow people to increase their independence. One reason for the slight de-
crease is that over the past year Marc Center has accepting more challenging consumers – many
of whom are referred directly from hospitals, following court-ordered treatment. When these in-



Behavioral Health Services                   Page 7 of 13                                  FY2008-2009
dividuals transition to the community, there is an increased potential that they need to return to
the hospital for readmission, if they are unable to make a successful adjustment. The current result
indicates that the programs at Marc Center provide efficient care, since the costs of higher level
of care are substantial. This objective will be monitored during the upcoming year and reported
during the next reporting period.

The continuum of care also provides for consumers who require additional care due to lack of
progress or worsening of symptoms. The rate for FY09 is 15%. Consumers who are referred to a
higher level of care are usually referred because they require inpatient services that cannot be
provided in the environments available at Marc Center. In most of these cases, the individuals
were discharged from inpatient services to Marc Center and were not stable when they were dis-
charged. The pattern of more challenging discharges is likely to continue over the next several
years as hospital admissions throughout the system have increased substantially over the past two
years. This objective will be monitored during the upcoming year and reported during the next
reporting period.


EFFECTIVENESS

Objective #1 – Individuals who Maintain or Increase Skill Levels




                                              Chart 3

Effectiveness of treatment and services is determined by measuring the skill levels of consumers,
using the Global Assessment of Functioning (GAF). This year’s score of 94% represents improve-
ment over FY2006-2008’s score and exceeds the minimum goal expectancy. The reasons for this
improvement are likely due to the implementation of strengths-based programs, implementation
of client-directed outcome-informed approach, increased utilization of peer support staff, and
enhanced training and supervision for all staff.




Behavioral Health Services                   Page 8 of 13                                 FY2008-2009
EFFICIENCY

Objective #1 – Budget Variance




                                               Chart 4a

Developing and following an accurate budget is a critical administrative function. Marc Center’s
Behavioral Health Services demonstrated a positive budget variance of 95% for fiscal year
2008-2009. The positive variance is indicative of the infrastructure put into effect to address the
objectives measured above.

     •     Marc Center implemented a direct support staffing ratio that is clinically appropriate to
           the needs of the consumers.

     •     A co-located counselor program was funded in the past year.

     •     Monthly controllable expenditures are closely monitored to ensure expenses are appro-
           priate for program operations.




Behavioral Health Services                     Page 9 of 13                               FY2008-2009
Objective #2 – Comparative Cost of Clinical Program




                                             Chart 4b

Maricopa County service costs and efficiency are an important consideration. Costs cannot be ex-
amined alone but must be matched to outcomes. Services that produce good outcomes at reason-
able costs continue to reflect Marc Center’s goal.

The costs for room and board services in a hospital environment have increased to $1,106 per
day according to the AHCCCS fee-for-service rates included in the Covered Behavioral Health
Services Guide as published by the Arizona Department of Health Services Division of Behavioral
Health Services. Additional expenses based for inpatient care also include physician and profes-
sional expenses that would increase this daily cost substantially.

The cost for services in Marc Center’s Independent Living program is $364 per day and includes
24-hour supervision, counseling, therapeutic services and room and board. This represents a $742
cost per day savings compared to inpatient hospitalization.

The outpatient support services costs are approximately $4,380 per year per person, or $12 per
day per person for outpatient services. Compared to inpatient services, this represents a cost sav-
ings of over $524,000/year. There is usually a significant difference between the acuity of con-
sumers in outpatient and inpatient treatment making comparison inequitable.

As noted by the analysis above, Marc Center offers cost effective services for a wide range of
consumers. When the entire outcomes report including astonishment and outcomes ore considered,
Marc Center is achieving its goal of quality outcomes at an efficient cost.



Behavioral Health Services                  Page 10 of 13                                FY2008-2009
ACCESS TO SERVICE/CARE




                                               Chart 5

Objective #1 – Seven Days from First Referral to First Available Appointment

When individuals request care in the behavioral health system, their need for services is usually
urgent. The appointment time offered for an initial intake assessment must be within seven days of
the referral or request for routine behavioral health services. In FY09, 96% of individuals who
were referred for a routine assessment were offered an appointment within the 7-day timeframe.
This score is better than the expected outcome rate and elevates Marc Center above most pro-
viders in its ability to provide rapid access to care. Behavioral Health Services at Marc Center
made a concerted effort to raise the percentage of those treated within seven days. The favora-
ble rate that we are achieving today is attributed to the following factors:

     •     Tracking systems have been enhanced to review performance on an ongoing basis
           throughout the month.

     •     Appointment scheduling procedures have been enhanced.

     •     A clarification in policy was achieved to define that the assessment requirements have
           been met as long as the intake appointment is offered to the consumer within the manda-
           tory timeframe even if the consumer requests a date longer than the 7-day interval.




Behavioral Health Services                    Page 11 of 13                             FY2008-2009
Objective #2 – Twenty-three Days from First Referral to First Actual Appointment

After people receive their initial assessment, their next appointment must be set within a reasona-
ble timeframe. The first behavioral health service provided following the initial assessment is
mandated to occur within 23 days of the initial assessment. As indicated in the above chart, data
gathered during FY09 are all above the contract threshold of 85%. While this year’s rate is
slightly below the previous year’s rate, there has been a substantial increase in the number of in-
take referrals making it more difficult to schedule the next appointment within 23 days. Stated
differently, there are a finite number of open appointments each month, and if they are filled by
intakes, they cannot be filled by second appointments. Our capacity to allocate staff time more
appropriately continues to positively impact the results. This data is collected at the Outpatient
Clinic site that is responsible for all intakes. Procedures have been implemented to closely track
this important treatment factor. This objective will be monitored during the upcoming year and
reported during the next reporting period.


Conclusion
It is recommended that the BHS Department continue in its efforts to position itself within the com-
munity to be responsive in meeting the needs of consumers by providing a continuum of services.
This includes working with the funding sources and exploring alternative funding sources in an ef-
fort to maintain and/or expand current services, as well as identifying additional services that
may be offered. It is further recommended that the department continue to enhance and refine its
structure, systems and procedures to assure compliance to contractual, licensure and accreditation
requirements.




Behavioral Health Services                  Page 12 of 13                                 FY2008-2009
RECOMMENDATION FOR CHANGE IN OUTCOME EVALUATION OBJECTIVES:

There are no recommendations for change.


RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clear-
ly present results, using various types of performance analysis tools and processes. Specifically,
the research study generated metrics such as:
    • Return-On-Investment (ROI);
    • Output and Outcome Trends and Comparisons; and,
    • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax
        dollar spent for Marc Center’s services, $1.57 of actual value was delivered to the com-
        munity.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple
different types of services will allow Marc Center to more specifically highlight areas of efficiency
performance, and to analyze results that clearly show the operating trends of the organization.
This information has been integrated into the outcome evaluation system and enables various
funders and donors to more easily determine the effectiveness of their respective donations and
support.

As a means of providing more efficient adjustments in the program throughout the year, man-
agement will continue the implementation of a scorecard system to track outcomes on a monthly
basis within our outcome evaluation system. Such an approach allows for the measurement and
assessment of other pertinent criteria as determined by respective department management.




Behavioral Health Services                   Page 13 of 13                                 FY2008-2009
                                                      MARC CENTER
                                                QUALITY MANAGEMENT PLAN
                                                           AND
                                            ASSESSMENT OF CONSUMER OUTCOMES

                                               ADMINISTRATIVE/SUPPORT SERVICES
                                        TIME OF       DATA         OBTAINED            EXPECTANCIES       RELATIVE                        LAST
           PRIMARY OBJCETIVE            MEASURE     SOURCE             BY        MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE      YEAR
1. Percent of staff who have            Annually    Peronnel        Human
   retained employment for at least:               and payroll     Resources
   a. 1 year +                                       records        Director      20        40      60       5         75       9.4        69
   b. 2 years +                                                                   25        45      65       5         40       4.4        48
   c. 3 years +                                                                   25        45      65       5         33       3.7        38

2. Percent of employees receiving       Annually    Personnel       Human         50        75     100      10         44       5.9        58
   wage increases or one-time                      and Payroll     Resources
   bonuses.                                          Records        Director

3. Number of reported accidents         Annually    Workers         Human         15        30      45      14         52      24.3        45
   and Workers Compensation                           Comp         Resources
   claims.                                           Report/        Director
                                                    Accident
                                                      Forms,
                                                    Personnel
                                                       Files

4. Percent of employees who             Annually   Satisfaction     Human
   express satisfaction in each of                   Survey        Resources
   the following areas:                                             Director
   a. Orientation/in-service                                                      80        90     100       2         76       1.7        72
      training
   b. Benefits                                                                    80        90     100       2         51       1.1        63
   c. Employees are appreciated                                                   80        90     100       2         67       1.5        63
      and respected
   d. Prompt feedback                                                             80        90     100       2         67       1.5        68
   e. Good working environment                                                    80        90     100       2         80       1.8        78
   f. Promotions                                                                  80        90     100       2         65       1.4        35
   g. Positive and fair discipline                                                80        90     100       2         55       1.2        43
      system
   h. Satisfactory salary                                                         80        90     100       2         42       0.9        33

5. Number of media releases             Annually    Media         Management      90       100     110       5        141       7.1        148
   published or telecast that                       Records          Team
   highlight Marc Center programs
   and activities.

6. Number of people impacted            Annually    Community     Management     2,200    2,400   2,600      5       2,800      5.8       2,750
   by tours or outside speaking                    Involvement       Team
   engagements related to Marc                       File and
   programs.                                        Tour Forms

7. Percent of increase in operational   Annually   Operating      Management
   dollars generated from:                          Budget/          Team
   a. Service contract grants                        Needs                        3         4       7        5         0        0.0         3
   b. Fundraising and private                      Assessment                     4         7       10       5         1        0.7         4
      sources
   c. Other sources necessary to                                                  5         10      15       5         2        1.0         4
      provide services to
      disabled children/adults.




Administrative/Support Services                                   Page 1 of 22                                                        FY2008-2009
                                  TIME OF       DATA       OBTAINED             EXPECTANCIES       RELATIVE                         LAST
          PRIMARY OBJCETIVE       MEASURE      SOURCE         BY          MIN       GOAL     MAX   WEIGHT     RESULTS   SCORE       YEAR
8. Number of persons receiving:   Annually   Individual/   Department
   b. CDS Services                             Records                     95       110    125        4        124      4.5          122
   c. ERS Services                                                        1000      1100   1300       4       1,151     4.2         1,101
   d. CLS Services                                                         95       100    105        4        102      4.1           97
   e. CSS Services                                                         100      125    150        4        109      3.5          173
   f. BHS Services                                                         350      400    500        4       1,755     17.6        1,687

TOTAL                                                                                                100                107.2




Administrative/Support Services                            Page 2 of 22                                                         FY2008-2009
                                             FY2008-2009
                                      QUALITY MANAGEMENT PLAN
                                                 AND
                                  ASSESSMENT OF CONSUMER OUTCOMES

                                   ADMINISTRATIVE SUPPORT SERVICES

NARRATIVE RATIONALE

“Excellence is to do a common thing in an uncommon way.” Booker T. Washington

Human Resources (HR) Summary

During FY2008-2009, Marc Center made several adjustments and improvements in its recruiting, hir-
ing, interviewing, training and follow-up systems. Due to the current rise in unemployment, coupled
with layoffs from competing agencies, Marc Center was able to attract and retain more quality staff
with less recruitment outreach. In the last year, Marc Center was confronted the challenge of laying
off a small number of employees, as well as restructuring departments to adjust for state funding cuts.
While most competing agencies have reduced salaries across the board, Marc Center only had to
freeze employee raises for the upcoming fiscal year.

Increased emphasis on supervisory training was a key component of FY 2008-2009. Supervisory staff
was trained in leadership and supervision by our CEO. Other first time classes included: recognizing
drug abuse in the workplace and successfully conducting annual employee evaluations. The training
department has also added a key new curriculum, “Principals of Caregiving” which has been very
well received.

During FY2008-2009, all departments continued the practice of awarding monetary Spot Awards
when we “catch someone doing something extraordinary” and/or an employee contributes in a signif-
icant manner. The Spot Awards have also proven to be such a successful endeavor, as it highlights
employees’ value and increases retention in the first year of employment, that administration will pro-
vide more awards across all programs and support departments this coming year. Indeed, the feed-
back from employees regarding these awards has been very positive, despite a salary freeze. Su-
pervisors are encouraged to utilize the spot award program for qualified employees. Employees who
receive these awards are featured in the monthly HR newsletter which is posted on Marc’s website.




Administrative/Support Services                Page 3 of 22                                   FY008-2009
Objective #1 – Percent of staff who retain employment for at least 1 year, 2 years and 3 years.




                                              Chart 1a

Significant changes in employee retention from FY2008-2009 are noted in these results and can be
tied directly back to changes made regarding compensation, reward programs, and changes in the
paid time off incentives, as well as changes in the economic climate.

When comparing the number of active employees who have been employed for more than one year,
we see a value of 75% for FY2009 versus 69% for FY2008. This represents an increase in the volun-
tary retention in this area of over 8%. For active employees who have been with Marc Center two
years, we see a decrease, from 48% to 40%. We saw a small drop in employees with over three
years of service, going from 38% to 33%. It should be noted that the two and three year retention
numbers reflect the retention rate over the entire two and three year periods respectively.

The FY2007-2008 voluntary turnover rate for Marc Center was approximately 32 %. As of June 30,
2008, Marc Center employees totaled 489, while on July 1, 2009, that number increased to 508.
During the last year, HR hired 268 new employees and 249 employees were terminated with a net
increase of 19 employees.

While specifically included in the outcome assessment, Marc Center pays careful attention to its work-
force demographics. Chart 1b, on the next page, offers a picture of the culturally diverse staff.




Administrative/Support Services               Page 4 of 22                                   FY008-2009
                                              Chart 1b

During FY2008-2009, the diversity of Marc Center’s employees was:
       Caucasian – 63.73%                          African-American – 18.24%
       Hispanic – 13.53%                           Pacific Islander/Hawaiian – 1.96%
       Asian – 1.57%                               Native American – 0.78
       Two or more Races/Other – 0.20%

The diversity during this same fiscal year for individuals served by all programs within Marc Center
was:
       Caucasian – 69%                                 African-American – 5%
       Hispanic – 24%                                  Pacific Islander – less than 2%

To promote cultural awareness and increase further understanding of cultural differences, Marc Cen-
ter offers all new employees initial training and annual classes on cultural differences/awareness.
Marc Center, recognizing the critical importance of a workforce mirroring those we serve and a work-
force that possesses an understanding of different cultures, has adopted a philosophy of embracing
cultural differences.

In adherence to EEOC requirements, Marc Center submits all necessary reports to regulatory bodies
regarding ethnicity. This process keeps us abreast of the cultural composition of our employees as it
relates to those we serve. Marc Center remains within 10% of our population served in nearly all eth-
nic origins, with the exception of African-Americans. Wherever possible, those served help select their
staff and make this selection based on their preferences.




Administrative/Support Services               Page 5 of 22                                    FY008-2009
Objective #2 – Percentage of Employees Receiving a Wage Increase




                                              Chart 2

Marc Center experienced a decrease in the number of employees receiving a wage increase above
their base salary from FY2008 to FY2009. During FY2008, 58% of employees received a wage in-
crease, while in FY2009, 44% of employees received a wage increase. This change correlates to the
turnover rate during FY2009, the increase in employees due to growth, as well as a continued freeze
in salaries for management.

The point-in-time survey reflects those employees who were still active as of July 1, 2009 and were
also employed as of June 30, 2008. These results do not reflect any increases due to bonuses or spot
awards.




Administrative/Support Services              Page 6 of 22                                  FY008-2009
Objective #3 – Number of Reported Accidents and Workers Compensation Reports




                                              Chart 3a

Marc Center experienced a total of 45 accidents and injuries in FY2007-2008 and 51 accidents and
injuries in FY2008-2009. These figures include non-medical injuries and injuries requiring professional
medical attention and Workers Compensation filings. One of the reasons for the increase is a focused
effort that was begun to ensure that all incidents are properly recorded and tracked. A large in-
crease in caused injuries on staff was also noted. The total number of non medical injuries increased
from 28 to 30.

Chart 3b, on the next page, reveals an increase in the number of accidents and injuries in the BHS,
CDS and CLS program area from FY2008 to FY2009. The ERS department decreased from eight to
five injuries, and the CDS, HCBS and BHS departments each had one more injury than in the prior
year. The majority of associated expenses originated from one outstanding injury in the CSS depart-
ment.




Administrative/Support Services               Page 7 of 22                                    FY008-2009
                                                Chart 3b


               Cost of Injuries by Department         FY2007-2008   FY2008-2009
               Behavioral Health Services                $2,000        $4,268
               Community Day Services                    $3,284        $5,331
               Community Living Services                 $2,000        $3,106
               Employment Related Services               $6,932        $2,906
               Community Support Services                    $0       $20,032
               Support                                       $0            $0




Administrative/Support Services                 Page 8 of 22                      FY008-2009
Objective #4 – Percentage of Employees Who Express Astonishment




                                             Chart 4a

In FY2009, Marc Center expanded its web-based survey instrument to collect more information, as
well as provide a more accessible and confidential platform for feedback. As a result of these im-
provements, the number of respondents increased significantly from last year’s survey.

During FY2008-2009, the agency gauged the astonishment of the organization as a whole on 30
questions regarding employees’ experiences at Marc Center. In addition, several essay questions
were asked which allowed employees to opine on what they liked best about their job, least about
their job, what can be done to make their jobs more satisfying, and what they would change about
their job. Every question had a comment field so that employees could expand upon their answers.
Marc Center strives in its efforts to be responsive to the concerns, needs and desires of employees.
Currently, an aggregate average of 63% of the employees across all areas of the organization is
astonished with their relationship with the organization. This increase in score from last year’s em-
ployee survey (59%) can be traced to increased communications with staff, increased usage of the
employee spot award programs, as well as the current economic and funding climate experienced by
the organization. For the prior year, 118 employees responded to the survey; this year that number
increased to 167.




Administrative/Support Services              Page 9 of 22                                   FY008-2009
                                             Chart 4b

The areas where there are high satisfaction rates include: Orientation and Initial Training (76%, up
4%), Respect and Appreciation (67 up 4%) Working Environment (80%, up 2%), Feedback from Su-
pervisors (67%, down 1%). The areas of low satisfaction rate are: Salary (42%, up 9%), Discipline
System (55%, up 12%), Benefits (51%, down 12%). It should be noted that the largest percentage
increase from last year focuses on Salary Adjustments/Promotions, which increased from 30% to
65%. This is attributed to the continued use of the spot award program, as well as the new employee
evaluation program. Results from the survey will be published in the employee newsletter.

Nationally, starting wages for residential direct-support employees average $12.20 per hour, and
day/work programs average starting wages of $10.56 per hour. Currently, Marc Center’s starting
wages for residential DD is $8.75 per hour and for day/work programs is $8.50 per hour. For BHS,
the starting wage is $10.00 per hour. Incentive wages are offered in more challenging group homes
to ease overtime and the difficulty in hiring for these homes. While Marc Center’s starting wages are
lower than national averages, they are competitive with Arizona providers.




Administrative/Support Services              Page 10 of 22                                  FY008-2009
Tenure of Executive Staff

Marc Center administration is committed to providing a work atmosphere that promotes employee
retention. It has had a long-standing policy of encouraging internal promotions, when appropriate, as
proudly demonstrated by the composition of the executive and administrative branches, many of
whom have grown professionally with the company. The table on the next page indicates the tenure
of these staff – an average of 14 years.

                                                                                     NUMBER OF
       EMPLOYEE                        TITLE                                           YEARS
       Randy Gray                      President & CEO                                   34
       Mark Tompert                    Facilities Director                               29
       Laura Gruner                    CLS Director                                      27
       Holly Collins                   Executive Vice President, DD                      25
       Janey Durham                    Executive Vice President, ERS                     24
       Fran Foglesong                  Assistant HRD Director                            23
       Adalesa Meek                    BHS Clinical Director of Counseling               18
       Barbara J. Smith-Odum           Executive Assistant                               9
       John Moore                      Chief Financial Officer                           9
       Norm Duve                       IT Director                                       8
       Steve Hilger                    BHS Director of Outpatient Services               6
       Michael Franczak, Ph.D.         Chief Operations Officer, BHS                     4
       Ramsey Riddell                  BHS Director of Quality Management                4
       Pat Gilbert                     Chief Administrative Officer                      3
       Neil Bourque                    HRD Director                                      3
       Kay Moore                       Chief Operations Officer DD                       2

Training Recap

As an example of the increasingly rich and diverse trainings, all Marc Center employees responsible
for managing and evaluating others attended a two-day training for supervisors. In partnership with
Arizona State University’s Center for Nonprofit Leadership and Management, Marc Center again
trained approximately 75 supervisors in conducting performance evaluations. The new performance
evaluation from this training will provide supervisory staff with a more stringent and consistent tool for
objectively evaluating employees. The scoring system uses a formula yielding a score that corres-
ponds to a rate increase percent. It is anticipated that wage increases will become more uniform as
the performance evaluation format conforms across all departments. Staff members gave the training
high marks with positive feedback. In addition, Marc Center CEO began training all Marc Center su-
pervisory staff on the topic of Supervisory Leadership Training. This training is meant to be mandato-
ry for all employees who serve in a supervisory role and for any newly promoted supervisor. The cur-
ricula consist of: teambuilding, leader performance, continuous improvement, conflict resolution, and
effecting change.

For the last three fiscal years, Marc Center’s tuition reimbursement benefit has been directed at en-
couraging continuing education and professionalism. Marc Center recognizes that the agency’s ability
to meet its performance expectations and to grow depends on its workforce. Accordingly, the agency


Administrative/Support Services                Page 11 of 22                                    FY008-2009
is acutely aware of the need for and benefit from these educational and professional initiatives. In
addition, Marc Center’s senior behavioral health staff has taken responsibility for not only the basics
of professionalism and education among its workforce; but also for more complex, cutting-edge initia-
tives and treatment protocols current to their field, including visiting other leading service providers to
gain insight into their “best practices” so that Marc Center could gain from this as well.

Conclusion

In 2001, the Bureau of Labor Statistics projected a 63% increase in demand for direct-support pro-
viders (DSP) through the year 2010, based in part on the number of aging caregivers. This is twice
the projected demand for fast-food and nursing aides in the same time period. Three prime areas
are noted with the difficulty in recruitment of DSPs: rapidly increasing insurance premiums, growing
demand in competing industries and the advantage that private businesses have over human services
organizations with supply and demand/sales. 1 Marc Center continues to keep medical insurance costs
for employees minimal when possible. In addition, the slowing of Arizona’s economy may provide
some relief in recruiting challenges with a larger pool of available employees as other layoffs occur
in the valley.

Arizona’s downturn in its economy has meant that the Human Resources department and Marc Center
need to implement more efficient and effective recruitment and hiring practices in the future. As with
any slowdown in the local economy, the number of individuals seeking positions will increase making
recruitment more fruitful. Indeed, Marc Center has hired many employees who were laid off, or were
not satisfied with working at previous providers. However, many of these individuals will not be look-
ing to make a career change, but seeking a stop gap income to hold them over until their preferred
field returns to hiring again. Marc Center will make a concerted effort in our industry to devise higher
starting wages and more lucrative benefits for direct-support providers than our competitors. Marc
Center was able to increase the retention of its newest employees and looks to stabilize its retention
for the entire workforce in the future.


Objective #5 – Number of Media Events

A total of 115 articles were released during FY2008-2009, compared to 120 articles during FY
2007-2008 and 117 articles during FY2006-2007. Publications were attributed to coverage of Marc
Center’s dedication for the new vocational training facility, legislation regarding specific bills and
funding appropriations and human interest stories printed in relation to our programs. In addition,
there were numerous special features that profiled special events, the financial impact of legislative
recommendations, and external forces/trends that could potentially impact our service delivery sys-
tem, related to the economic downturn. Of particular emphasis is the number of articles published on
the editorial page, the most widely read page in newspapers. Valley newspapers carried 21 articles
related to Marc Center on the editorial page. Of the 115 articles published this year, approximately
one half were feature stories regarding Marc Center. These articles are maintained in our master files
and are used as resources for the following: new Board member orientation; interns; visitors to the
Center; new staff; people with disabilities; and, grant requests. This information is invaluable as we

1
  David Braddock, Richard Hemp and Mary C. Rizzolo, The State of the States in Developmental Disabilities 2008
(Boulder: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, 2008)


Administrative/Support Services                    Page 12 of 22                                       FY008-2009
strive to gain community support. Two job magazines, Job Examiner and The Employment Guide have
also provided coverage of Marc Center’s services and have become very effective resources in re-
cruiting prospective employees. One article per month is included in each publication.

Print coverage generally occurs in the following publications: East Valley Tribune, Arizona Republic,
Mesa Independent, Apache Junction Independent, local municipal papers, and various magazines and
newsletters. Newspaper coverage included the following feature stories:

     •     Marc Center Programs
     •     In-Home Support Services, including Respite
     •     Efforts to Pursue Alternative Fund Sources
     •     Legislative Issues/Appropriations
     •     Board Member Accomplishments/Achievements
     •     New Building Construction
     •     Grand Openings for New Buildings/Program Expansion

Our local independent station, as well as the local affiliate stations for ABC, NBC and CBS, have also
aired coverage related to Marc Center initiatives, particularly in the area of legislative advocacy.
AZjobworks.com has also become a great source of job applicants and provides an opportunity for
Marc Center to publicize its programs. Valley radio and television stations continue to carry PSAs and
some coverage of service programs. Our local independent station, Channel 3, covered most of the
feature stories related to legislative appropriations; Channel 11, the City of Mesa channel, provided
coverage of multiple City Council hearings that involved Marc Center presentations regarding the
CDBG program and City of Mesa funding from the Human Services Advisory Board. All the network
stations covered live testimony of our CEO from the Legislature regarding the need for additional
funds to support community services for people with disabilities. In addition, KTAR and KFYI radio car-
ried several announcements related to program initiatives. Marc Center continues to foster a good
rapport with media sources to increase the general public’s awareness and support of programs for
children and adults with disabilities. As a result of the economic recession and severe cuts in contracts,
Marc Center severed its contract with outside sources to assist with our public relation efforts. This will
require administrative staff and board members to assume more responsibility relative to these public
relations and marketing efforts. While broadcast coverage, including PSAs, has diminished over the
past few years, we have received outstanding primetime coverage on issues of significance, especial-
ly on the editorial pages of local newspapers. The reduction is attributed to less emphasis on PSAs,
which generally are released during non-primetime when viewers and listeners are not tuned in. It is
noteworthy that most of the articles published relative to Marc Center’s programs were carried as
feature stories on the front sections of newspapers.

The chart at the top of the next page profiles the frequency of media coverage Marc Center has re-
ceived this past year.




Administrative/Support Services                 Page 13 of 22                                    FY008-2009
                                               Chart 5a




                                               Chart 5b

Objective #6 – Number of People impacted by Tours or Outside Speaking Engagements

Approximately 800 people toured the agency this year or attended grand openings. Approximately
70 groups generated these turnouts. 50 tours were provided of the day treatment and training pro-
grams for approximately 225 people. The balance of tours was attributed to the dedication ceremo-
nies for the new vocational training facility and the grand openings of our outpatient clinics. In addi-
tion, numerous foundations and benefactors have toured the vocational program. Most of the individ-
uals who tour represent students from Mesa Community College and Arizona State University; loaned
executives from local businesses on behalf of Mesa United Way; representatives from local service
clubs; donors and benefactors; interested citizens touring various program components; and, families
involved in the intake process. This past year, by design and structure, Marc Center has experienced
an approximate 7% increase in the number of people touring our main campus site as a result of ex-
pansion plans and the dedication of the new vocational facility. Tours and public exposure to our
main campus site have enhanced community awareness of Marc Center programs, especially our day


Administrative/Support Services               Page 14 of 22                                   FY008-2009
treatment and training facilities. This has resulted in increased public exposure relative to print and
broadcast media. However, it has been noted that we need to make more of a concerted effort to
provide alternative tours of satellite sites located throughout the community, including our residential
sites. For example, as part of orientation, new board members tour a random sampling of sites
throughout Maricopa County. Indeed, given the program emphasis on choice and options, fami-
lies/individuals and funding sources are always interested in site tours of Marc Center programs.

During this last year, we reached approximately 2,000 people through numerous presentations to
businesses, school groups, service clubs, the legislature and other community organizations – the same
number as the preceding year. Board members and staff represented the agency at more than 30
community activities. Many of these activities were related to Marc Center’s dedication ceremonies
and promotion of consumer advocacy.

One of the objectives established through our marketing plan focuses on a proactive approach to
public education and awareness. Through a designed program of tours and speaking engagements,
we have been able to reach a more significant sector of the community, informing them of our service
programs. The significance of this is supported by editorial page coverage in various newspapers. It
is apparent from a review of the files that track community involvement (tours and speaking engage-
ments) that staff needs to do a better job of tracking and recording the engagements on appropriate
forms. To ensure that we are tracking accurate data, the Executive Assistant will continue to remind
key staff to complete these forms at management meetings. Given the amount of time and resources
invested in these public relation activities, it also is very important for management to assess the add-
ed value impact of tours and presentations prior to their occurrence.

This past year, the volunteer program logged approximately 1,500 hours of volunteer service, using
the donated time of over 165 volunteers. Hours of volunteer service, as well as the number of volun-
teers have diminished as a result of the excessive rules and regulations (e.g., fingerprint clearance)
imposed by funding agencies related to training, medical clearance, etc. reduced this year since the
capital campaign drive for the new day treatment and training facility was successfully completed.
Volunteer activity encompasses time donated by Board members, self advocate sponsors, and com-
munity volunteers.




                                               Chart 6a


Administrative/Support Services                Page 15 of 22                                   FY008-2009
                                                Chart 6b

Objective #7 – Percent of Operational Dollars Generated

Contrary to previous years, Marc Center negotiated revenue neutral contracts for existing services
with the Department of Economic Security and the Regional Behavioral Health Authority, Magellan,
for DHS/BHS. Stated differently, this amounted to a “freeze” on approximately 95% of Marc Cen-
ter’s existing revenues. Therefore, it is evident that we must pursue and promote growth/expansion of
existing service programs, recognizing that state revenues, at best, will be neutral over the next
couple of years. Growth will help Marc Center absorb the inflationary increases in operational ex-
penses, especially those associated with transportation, utilities, food and insurance costs. In fact, the
last quarter of FY08-09, existing state contracts were reduced by approximately 10% with DES
sources and 4% with BHS sources. Overall state revenues had diminished by 30%, resulting in these
adjustments to contracts with provider agencies.

Despite our strong legislative advocacy, and a suit filed by our statewide provider association, the
federal DDD long-term care program was reduced by $1.1 million and Magellan by approximately
$400,000. While behavioral health funding appears to be capped at last year’s rates, we did expe-
rience a reduction in state-only funding in these contracts. There is allowance for growth and expan-
sion in other program areas, including new program initiatives. In summary, service providers across
the state experienced a 10% reduction in unit rates for all contracts with DDD and an average 4%
reduction in lump sum funding from Magellan. While this will result in an annualized reduction of $1.5
million in total contract dollars from these two funding sources, diminished revenues are offset by in-
creased referrals from the Division and program expansion in the Behavioral Health division. Stated
differently, reductions and increases result in an approximate revenue neutral budget projected for
FY09-10. As demonstrated by the positive consumer outcomes, we have been able to preserve quali-
ty services and maintain a positive net excess in revenue over expenses. Within the past five years,
behavioral health revenue has increased in excess of 2,500%, while DES revenues have increased at
approximately 3% per year up until this year. It is very clear that Marc Center must position itself for
steady growth in response to community need. Placing emphasis on the services to be provided, ra-
ther than the target populations to be served, will assist us in our program initiatives relative to


Administrative/Support Services                Page 16 of 22                                    FY008-2009
growth. This approach will also broaden our marketing niche and help us to offset fixed overhead
expenses, while making available critical funding for unfunded/under-funded services.

Clearly, our challenge this year and in the near future is to identify alternative funding streams and
to generate additional revenue that helps us offset the dramatic increases in cost associated with all
insurances, housing, transportation and other consumer price index items. We have embraced this ap-
proach by aggressively pursuing third-party private insurance carriers and self-referrals who have
the capacity to pay for the service. There is recognition that state and federal funds are not sufficient
to offset all of the costs associated with delivering quality responsive services. This past year, we es-
tablished TechMarc and a subsidiary known as ProMarc that will allow Marc Center to generate ad-
ditional revenues as a property management company. Additionally, we have negotiated a contract
with Banner Health to provide food services at its corporate headquarters site. We have also re-
ceived approval from Magellan for the establishment of an LLC known as Partners In Recovery, a col-
laborative behavioral health initiative valued at approximately $17.7 million to accommodate Beha-
vioral Health outpatient clinic rollouts, of which $6.8 million will be allocated to Marc Center for the
operation of three clinics. Finally, Marc Center has been aggressive in pursuing Neighborhood Stabi-
lization Project 1 and 2 funding for the acquisition of additional homes and to increase our financial
portfolio. These are but a few of the examples of how we have diversified our funding base in order
to assure the continuance of quality services to persons served. Clearly, as the financial squeeze tigh-
tens, especially in this economic downturn, we must turn to untraditional revenue sources in response to
community need.

Even though the negotiated rates for existing contracts have been reduced, these alternative revenue
streams have positioned Marc Center for another year of excess revenues above expenses. The per-
cent of increase from private donations/contributions includes the dollar value of equipment and
capital items that benefit our service programs. Some of these sources, including United Way, dimi-
nished as much as 33%, but increased in other new sources of revenue by 100%. Also included in this
category are unsolicited donations. Marc Center realized another reduction in private dona-
tions/pledges, again because of the economic recession – especially as related to United Way in-
come. Last year we generated a 4% increase in this category. This year, we generated a 2% overall
increase, largely as a result of capital campaign pledges. The new program initiatives detailed pre-
viously should begin to generate revenue, based upon proforma analysis, within nine months. The de-
crease in fundraising and private sources is directly attributed to the economic downturn, as well as
the competing need of other agencies for their social services. To counter this trend, Marc Center will
place more emphasis on what distinguishes us from other providers in the area of quality services,
and place a greater emphasis that demonstrates a return on investment relative to do-
nated/contracted dollars.

To date, Marc Center has raised $2.6 million towards its capital campaign goal of $5 million for the
vocational building. It is noteworthy that we have received approval for tax exempt bond funding
that will allow Marc Center to consolidate approximately $7.5 million of debt into a fixed 10-year
loan at 4.77% interest. Also, an additional $1.6 million of bond funding will help finance additional
capital construction and renovation projects. This bond will save Marc Center approximately $20,000
per month in interest payments. One of the keys to Marc’s financial solvency is embraced by a corpo-
rate pursuit of property ownership rather than leased facilities. Over the past few years, working
with the City of Mesa and Maricopa County Board of Supervisors, we have been able to acquire title



Administrative/Support Services                Page 17 of 22                                   FY008-2009
to both our main campus site at 924 North Country Club and our East Valley site at Oasis Park. This
has dramatically increased our corporate worth enabling us to leverage these properties in pursuit of
additional growth and expansion. With a positive cash flow and an asset-to-liability ratio that ex-
ceeds 5 to 1, we are able to more adequately respond to the needs of our community. We have also
capitalized on the housing market decline and purchased rather than leased the remaining group
homes during FY08-09.

Fund raising endeavors including those conducted by various Knights of Columbus chapters have to-
taled approximately $15,000. Marc Center has established a fundraising plan that encompasses
special events, endowments, foundations, corporate giving and individual contributions. However, we
have not implemented the plan relative to income, given Marc Center’s established position within our
community.

Other sources of revenue include the City of Mesa, production and miscellaneous sources. These reve-
nue streams have decreased over this past two years, given the state of the economy. Production has
increased slightly. The following chart portrays Marc Center’s operating budget growth over the past
25 years. It would appear that Marc Center will be level funded from major funding sources, necessi-
tating an aggressive approach in the area of program expansion. In other words, rates of reim-
bursement will hold steady, even though expenses have increased.




                                              Chart 7a

Objective #8 – Number of Persons Served

Marc Center continues to serve unfunded/under-funded individuals with disabilities with excess, car-
ryover revenues and United Way funding. City of Mesa funds also enabled Marc Center to serve
additional adults enrolled in vocational training programs. In addition, Marc Center has always pro-
vided more service and encountered more billable units than the reimbursement we receive from our
contracts. Even though most contracts with major funding sources were diminished from 4% to 10%,
the total number of persons served this past year has increased slightly (by 2%), and units of services
per individual have increased substantially, especially within the CSS division. It is also noteworthy
that we continue to operate an extended employment program that allows eligible, community-based


Administrative/Support Services               Page 18 of 22                                   FY008-2009
adults to be served on a sliding fee basis. Marc Center does continue to serve children through other
program options, including Community Support Services, even though we no longer operate an Early
Intervention Services component.

1,151 adults were served in our Employment Related Services (ERS) program, representing an ap-
proximate 5% increase during the past year. This is a significant increase, given that vocational re-
habilitation referrals have diminished for all contracting agencies. Also, as reported last year, state
VR is in the third year of a pilot demonstration program emphasizing the Milestone model of reim-
bursement that has drastically reduced referrals. 1,755 individuals were served in our Behavioral
Health programs, which include the outpatient clinic, community housing, Level II housing, the Village
programs and in-home supports. Within this count, the largest number of individuals (1,368) was
served by our outpatient clinic. 294 individuals were served in the Village programs, the comprehen-
sive one-stop centers that offer a multitude of self-directed services including recreation/leisure, activ-
ities of daily living and vocational services. 102 adults were served in 23 DD residential group
homes. This past year, Marc Center did add one additional group home. Even though Community
Support Services (CSS) experienced a reduction in individuals/ families served this past year, units of
services increased substantially, based upon need. This correlates with referrals for people with more
challenging needs. This past year 102 individuals/families were served. Finally, our Community Day
program (CDS) offered services to 135 individuals in four sites.

The vocational training program was able to increase its numbers and demonstrated the 5% growth
as a result of contracts with third-party insurance carriers, including Mercy Care, SCAN and Evercare.
In addition, our outcomes relative to community training and competitive job placements have culmi-
nated in a steady increase of referrals from multiple sources, including Magellan. We do project a
decrease in referrals for the coming year as the economic downturn and reductions in contract funding
levels require Marc Center not to exceed authorized units of service.

Behavioral Health referrals and numbers served have increased from 1,687 to 1,755. Again, this is
attributed to the outpatient clinics and exceeding authorized levels of service delivery within the vo-
cational training program. Over the past five years Marc Center has realized a 430% increase in
referrals.

Community Living sites and numbers served have remained constant over the past ten years, with the
exception of one new site in Scottsdale. In addition, while we have increased the number of Communi-
ty Day Services sites, the total number of persons served has also remained relatively steady. Rela-
tive to Community Day Services, the trend seems to support smaller settings closer to the community in
which the family lives. With the internal reorganization of our DD services, we are focusing renewed
effort on the growth and expansion of our DD services in the three discrete program areas (Communi-
ty Living, CSS and Community Day Services). Staff is pursuing these growth initiatives with contract
negotiations occurring in state Districts III and V. It is noteworthy that we have successfully negotiated
the operation of an additional Community Day Services program with the Cortney’s Foundation, a
nonprofit organization that is committed to fundraising and augmenting the existing services provided
by the Division of Developmental Disabilities. Referrals are beginning to increase to the Cortney’s
Foundation. At capacity, the site will provide services to approximately 15 individuals. The largest
growth in our programs occurred in the areas of outpatient clinics and vocational training. We are
projecting future growth in CSS for the coming year.



Administrative/Support Services                 Page 19 of 22                                    FY008-2009
 Over the last ten years, Marc Center has increased the number of persons served from 1,500 to
 3,252, a 161% increase. All programs have experienced an increase in referral of people with more
 challenging behavioral and medical needs. It is evident that the economic downturn and the state’s
 inability to maintain current service rates may challenge Marc Center’s efforts to continue meeting
 community needs. However, incorporating a revenue-neutral budget – by expanding services and
 introducing alternative revenue initiatives – Marc Center has been able to introduce growth initiatives
 that increase the number of persons served by 2%. The following chart summarizes over the past six
 years the number of persons served by department.

Department              FY 03-04   FY 04-05     FY2005-06       FY2006-07     FY2007-08       FY2008-09
EIS                         205      166            158            148            n/a             n/a
ERS                        1180     1184            1170          1028           1101            1151
CDS                         129      134            129            111            122             135
CSS                         100       57             70            77             173             109
CLS                          97       99             98            98             97              102
BHS                         897     1005            1506          1768           1687            1755
TOTAL                      2608     2645            3131          3230           3180            3252
                                                Chart 8a

 The following chart summarizes the growth in number of people served since 1980.




                                                Chart 8b

 Marc Center continues to receive increased referrals diagnosed with more medical and behavioral
 needs. This coincides with a state-wide and national trend and is contributing to the revision of eligi-
 bility criteria to serve people with more challenging needs. The impact of this trend will require levels
 of supervision at a higher ratio than we are currently experiencing, as well as more professionally-
 trained staff.



 Administrative/Support Services                Page 20 of 22                                   FY008-2009
Despite the increased transition of Community Day Services clients to part-time or full-time employ-
ment, the department has shown a small increase in number served. We are projecting future growth
as many smaller organizations will be unable to preserve existing services as a result of cuts in con-
tract rates.

We anticipate a continued steady growth in CSS as well as referrals to our vocational training pro-
gram. In addition, we have established strategic plan initiatives to expand Community Day Services
and Behavioral Health Services. The fact that contracting providers are receiving no increase in rates
for current services, it is essential that Marc Center expand existing services and pursue new program
initiatives to offset inflationary adjustments incurred in delivery of existing programs.




Administrative/Support Services              Page 21 of 22                                   FY008-2009
RECOMMENDATIONS FOR CHANGE OF OUTCOME EVALUATION OBJECTIVES:

There are no recommendations for changes.


RECOMMENDATIONS FOR PROGRAM CHANGES:

Marc Center has participated in a national research study in conjunction with CARF to more clearly
present results, using various types of performance analysis tools and processes. Specifically, the re-
search study generated metrics such as:
   • Return-On-Investment (ROI);
   • Output and Outcome Trends and Comparisons; and,
   • Efficiency Measures and Projections.

For the year ended June 30, 2009, the results of the study demonstrated:
    • The taxpayer return on investment for Marc Center is 157% - meaning that for every tax dol-
        lar spent for Marc Center’s services, $1.57 of actual value was delivered to the community.
    • Taxpayer return on investment for CSS was 158%.
    • Taxpayer return on investment for Employment Related Services was 201%.
    • Taxpayer return on investment for Behavioral Health Services was 128%.
    • State and federal resources only funded 90.2% of resources need for these services.

In normal financial analysis, Marc Center recognizes return on investment as the ratio of money
gained or lost relative to the money invested.

The approach of user-based evaluations to measure the perceived delivered value of multiple differ-
ent types of services will allow Marc Center to more specifically highlight areas of efficiency perfor-
mance, and to analyze results that clearly show the operating trends of the organization. This infor-
mation has been integrated into the outcome evaluation system and enables various funders and do-
nors to more easily determine the effectiveness of their respective donations and support.

As a means of providing more efficient adjustments in the program throughout the year, management
will continue the implementation of a scorecard system to track outcomes on a monthly basis within our
outcome evaluation system. Such an approach allows for the measurement and assessment of other
pertinent criteria as determined by respective department management.




Administrative/Support Services               Page 22 of 22                                   FY008-2009

				
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