Goal A by vivi07

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									2005 Work Plan - Adult Community Services

A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A1 Levy funded Aging Case Management (CM) provided by Focal Point (FP) agencies. In 2003-04, a series of meetings were held with Case Mgmt POS agencies. For several reasons, they advocated that donations be pursued rather than fees. Four agencies volunteered for a donation pilot. One is implementing; three have dropped out. CM Audit recommends continued development of fee or donation model.

Chosen Target (Where do we want to be?)
For 2005, CM Audit recommends an expanded initiative to include a mix of three urban, rural and predominately minority service environments to measure results of a cost-share or fee-forservice or suggested donation model.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
(a) 2005 POS Agreements will include language requiring participation in the pilot. (b) Look to the AAA Board and Committees to define the design and scope of the initiative. (a) By February 28, 2005, the AAA Board will have approved the design and scope of the initiative. (b) By April 30, 2005, at least three Case Mgmt POS agencies will be participating in the pilot. (c) By September 30, 2005, AAA staff will provide a progress report to the AAA Board.

Lead Staff Responsible (Who? By when?)
Rita Odegaard is the lead staff. Directors of three POS agencies (or their designees) are responsible for pilot implementation at the local level.

Progress Dec. 2005
DCDHS staff, AAA Board and CM POS agencies put considerable effort into studying fee options. No pilot was initiated. DCDHS proposed a $5/month fee in its 2006 Budget Request. Municipalities, Aging POS agencies and others voiced concerns about the $5 fee, and the fee proposal was dropped from the 2006 budget. No further action planned by DCDHS.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A2 Improve Supports available for people with dementia and their caregivers: This initiative focuses on an area of rapidly growing service demand. Information packets continue to be mailed to caregivers and physicians. Focal Points and Long Term Support case managers are now receiving on-going case consultation and training from the Alzheimer's Association. Training is also being offered to adult day care centers and Adult Family Home providers. The Alzheimer's Family Caregiver Support Program (AFCSP) funds for caregivers is now being administered by the Alzheimer's Association.

Chosen Target (Where do we want to be?)
The goal is to: a) improve in-home support and resources, and b)provide on-going training and technical assistance to POS agencies and DCDHS case managers.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
To the extent possible, continue to fund in-home care services that give the caregivers more option for keeping the person with dementia in their home. •75 non-COP families receive support through AFCSP program. •A minimum of 20 consultation sessions and 4 trainings provided to DCDHS LTS case managers and POS agencies.

Lead Staff Responsible (Who? By when?)
Theresa Sanders is lead DCDHS. The South Central Alzheimer Association, the County's Long Term Support Unit and other POS agencies will play an important role in achieving the outcomes.

Progress Dec. 2005
This goal was successfully completed: 75 families received AFCSP funding; 15-20 consultation sessions were held with case managers; a quarterly newsletter issued; 4 trainings offered to both LTS and Aging Focal Points case managers - Feb, March, June and October 2005.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A3 Family Care Currently, the county administers the COP and Waiver programs for five target groups, developmentally disabled, frail elderly, persons with mental illness, AODA and physical disabilities. The funding source for each group is complex and implemented in a different manner. Also the intake point for services is quite different. Department staff serve as a member of the State's Long Term Care Reform Council and its Resource Center workgroup.

Chosen Target (Where do we want to be?)
There is a proposal in 20032005 State budget, for DHFS to investigate expanding Family Care to other counties. If the State pursues their plan, Dane County is interested in analyzing the pros and cons of becoming a Family Care agency for one or more target groups. The State received a 3 year start-up grant for development of five Resource Centers across the state. If the State has adequate funds to pursue this development, Dane County proposes to work with State staff to explore this option.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
•If State DHFS is permitted to investigate and fund expansion of Family Care to other counties Dane County will work with State staff to explore the potential for becoming a Family Care agency either as the Care Management Organization or Aging/Disabilities Resource Center(CMO/RC). •Determine the feasibility of this undertaking: poll existing family care counties, including Resource Centers, concerning program operations; analyzing data provided by State officials; financial analysis of funding trends between the current COP/Waiver program and Family Care's capitated payment; evaluate countyfunded resource capacity in the community to meet larger service demand; and explore where best the Resource Center structurally would fit, e.g. target groups, location, management. •DCDHS makes recommendation whether or not to participate as a pilot county and best structural options for CMO or RC.

Lead Staff Responsible (Who? By when?)
Fran Genter and Theresa Sanders are the lead staff.

Progress Dec. 2005
In Oct. 2005, the State issued a RFI/RFP to plan for or implement reform of long term care services, starting in 2006. DCDHS submitted a proposal for a strategic planning grant for DD adults and an implementation grant to develop a plan for moving COP/Waiver frail elderly and physical disabled individuals to a managed care model.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A4 SDS Initiative: This DD initiative has the dual goal of increasing consumer control of services and reducing the cost of services As of 12/31/03, the 729 individuals under spent their allocations by $776,000 and returned to the County.

Chosen Target (Where do we want to be?)
•By 04-30-05, all adults with developmental disabilities will have enrolled in SDS •Savings in 2004 will be $425,000

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
Continue to train brokers, providers, families, and consumers. Continue policy allowing consumers to bank a portion of under spending for future use. All adults will have transitioned to the SDS system by the end of the first quarter in 2005

Lead Staff Responsible (Who? By when?)
Dan Rossiter, DCDHS, is the lead staff for this initiative.

Progress Dec. 2005
All adults transitioned to Self-Directed Supports by the end of January, 2005. Per the Adopted 2005 budget, SDS consumer rates were reduced by $450,000. This was largely offset by Living Wage funds totaling $650,000 department wide. An additional $70,000 in GPR was returned at year end due to consumer under spending.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A5 Safe at Home: As of 12/31/03, 85 This DD initiative household were using will use remote Safe at Home/Sound monitoring Response. technology to reduce overnight awake staffing, reducing costs and increasing the privacy and independence of consumers.

Chosen Target (Where do we want to be?)
•Continue expansion of this program •12/31/04, 125 individuals will have enrolled. Cost saving of $120,000 in 2004.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
Using existing household, have open houses for demonstration purposes. Begin to mandate these types of supports as the current way of providing support. Consider expansion to North side and identify other potential uses for this technology.

Lead Staff Responsible (Who? By when?)

Progress Dec. 2005

Track the number, nature and outcome Monica Bear is the lead of incidents needing a response and DCDHS staff for this the resulting cost savings. initiative.

As of 12-5-06 106 households were enrolled in S.R. for a total of 154 individuals. Based on Lead role in day to day Waisman Center operation of Safe at Home is commissioned report provided under contract prepared by UW professor, with a POS agency. In David Rosenthal entitled 2004, that contract is with "An Investigation of the Waisman Center Training & Effectiveness of Sound Consultation Program. Response" SR saves an average of $19,136/yr per household (16 hours of pd staff time per week at $23/hr) less $8,087/yr in S.R. expenses/household equals savings of $1,171,184/yr. SR dispatched their staff to client homes 965 times in 2005. Nature of response included elopement, minor injuries, alarm sounding with no response from client, assistance toileting, requests to be repositioned in bed etc.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A6 Elder Services: Develop support and services to people with dual diagnosis of developmental disabilities and dementia/ Alzheimer’s. For DD individuals with dementia, the current system response is to provide 1:1 staff support. The original work group developed a series of recommendation for implementation of support to elders with developmental disabilities

Chosen Target (Where do we want to be?)
•All households with 1:1 support as a result of aging issues are identified •Develop alternative service models that provide the necessary support without the close staff to client ratios.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
Expand and explore current Alternative models of support that will trends in the aging system. meet the needs of this population are Adopt/adapt current trends to identified. meet the need of elders with developmental disabilities.

Lead Staff Responsible (Who? By when?)
Bill Huisheere, ACS, has lead coordination responsibility Sue Werner, ACS, Elder Services Committee Maya Fairchild, ACS, Health Care Committee

Progress Dec. 2005
•Collaborated with Elder Care Partnership Program and referred a small number of people to this program. Aging adults with DD tend to have higher supervision needs than the typical elderly person and thus are not able to be accepted into the program. •More frequent use of nursing homes for postsurgery/hospital rehab stays and for persons whose increased support needs are attributed to issues of aging vs. DD. An example that is becoming more common is when a person's dementia advances to the stage where the DD is no longer the primary issue. •Continue to identify individuals who live alone and encourage people to share supports and combine SDS budgets to meet increasing needs related to aging. Encourage use of home health agencies and other generic services when possible.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A7 Birth to Three Transition The University of Wisconsin’s Waisman Center has given notice of their intention not to provide Birth to Three services effective January 1, 2005. The Waisman Center program (titled The Bridges Program) currently provides services to approximately 600 families annually. A new provider will be identified, through a Request for Proposal process, by July 30, 2004.

Chosen Target (Where do we want to be?)
•Continue to provide Birth to Three services in Dane County without disruption in service •Smooth transition from the Waisman Center program to the new provider

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
The County will: -Ensure a strong, systematic transition to school process and methodology -Ensure the fulfillment of IFSPs during transition and beyond -Ensure that transition creates a minimal amount of work for families, such as paperwork, transitional program meetings, etc. -Cooperate with the Bridges program through transition and the Waisman Center on an ongoing basis -Provide regular communication and assurances to families

Lead Staff Responsible (Who? By when?)

Progress Dec. 2005
All children have transitioned from the Waisman Bridges program to the ICC Bridges program. A letter from the county went to all parents regarding the transition and identified a complaint process. There were 2 parent complaints submitted; both were responded to immediately and to the parents' satisfaction. A Parent Survey was not sent out in April. There was a change in the director of the ICC Bridges program, other issues needed attention. The survey is developed and parents will be surveyed in 12/05.

•All children will have transitioned from Donna Winnick, ACS, will the Waisman Center’s Bridges program have lead responsibility for to the new provider with a minimum of this initiative disruption (as identified by the families) by the end of the first quarter of 2005. A Satisfaction Survey of the transitioning families will be sent out by April 1st with results being made public.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A8 Mendota Mental Health Institute Inpatient Utilization: The goal of this MH initiative is to reduce inpatient utilization and expense. 2003 Data for involuntary placements of persons ages 22 -64: Admissions: 124 Days: 2,123 days Average Length of Stay (ALOS): 17.12 days

Chosen Target (Where do we want to be?)
Keep utilization from increasing and maximize collections.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
•ESU gate keeping will continue and community based alternatives will be implemented as quickly as possible in lieu of inpatient. •The County will continue to work closely with Fiscal Services to monitor timely collections for all payment sources. •Admissions will not exceed 124. •Total days will not exceed 2,123. •Average length of stay will be 15 days or less. •Improved collections vs. net payment from previous year •Number and percentage of people presenting for involuntary admission to MMHI for which ESU developed community based alternatives •Savings for community crisis stabilizations placements developed in lieu of ongoing inpatient placement at MMHI (Crisis Intervention [CI] placement costs vs. MMHI placement cost)

Lead Staff Responsible (Who? By when?)
•Roger Celusta is the lead staff at DCDHS for MMHI inpatient utilization. •Al Olson is the lead staff at the Mental Health Center of Dane County's Emergency Services Unit regarding admissions, discharges, and arranging for community alternatives. •Beth Lucht is the lead staff representing ESU in overseeing communitybased crisis stabilization placements in lieu of ongoing placement at MMHI.

Progress Dec. 2005
FFY05 (October 2004 September 2005): •153 Admissions. •2,772 inpatient days. •MMHI Budget was $1.19 million; expense was $1.51 million. •Average length of stay increased from 15 days to 18.1 days •Collections vs. net payments increased by 2% for admissions to AATU (total collected $483,570); Collections for GTU decreased by 14% (total collected $281,855). •223 of 475 requests for involuntary hospitalization were diverted •Diverting 223 persons saved approximately $733,677 in MMHI costs; the related CI expenses totaled $96,987 and were fully reimbursed by MA. Note: These numbers do not include savings from SOAR Case Management efforts nor Recovery House placements, both of which expedited discharges from MMHI.

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A8.5 SSI Managed Care - Planning & Potential Implementation DCDHS, Community Living Alliance, the Mental Health Center of Dane County, and WDHFS are discussing the possible development of a managed care model for Dane County residents who receive SSI benefits. Discussions are still in the early stages, as few decisions have been made and many issues are unresolved. DCDHS, MHC & CLA's interest is primarily based on improving services for people with mental health needs.

Chosen Target (Where do we want to be?)
The goal is to implement an SSI Managed Care model sometime during 2005 if the model (a) will increase access to health care, (b) is recovery based and consumer focused, (c) will improve service quality and flexibility, (d) is financially viable, (e) allows consumers to decide whether to participate, (f) does not undermine the service system for non-SSI consumers, and (g) is otherwise likely to succeed.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
DCDHS, CLA, MHCDC and WDHFS will continue an intensive planning and negotiation process that involves key stakeholders (consumers, families, advocates, POS agencies, etc.) at all points along the planning continuum. County oversight committees will receive briefings during 2004 & 2005. If negotiations prove favorable, Health & Human Needs Committee approval will be sought prior to implementation. Success is defined as being able to respond to key questions and issues, including but not limited to those listed under "Chosen Target", such that it is clear to DCDHS, CLA, MHCDC, Dane County elected officials and other stakeholders whether this model is worthy of implementation.

Lead Staff Responsible (Who? By when?)
David LeCount and Fran Genter are lead DCDHS staff. Directors and management staff at CLA and MHCDC play equally important roles in program planning, negotiation and implementation.

Progress Dec. 2005
SSI Managed Care Planning: CLA, MHCDC and DCDHS worked intensively throughout 2005. Due to unanticipated barriers, implementation was delayed. Implementation date is May 1, 2006. Program has been named "Health Advantage". Enrollment is voluntary. Educational town hall meetings for consumers and other interested parties set for Mar 7 and April 12. 2006 Adopted Budget includes "net out" of MA CSP and MA CM funds, with 5% savings to DCDHS

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2005 Work Plan - Adult Community Services
A. Develop innovative measures to reduce costs and redirect resources for the best results.
Initiative Area Current Status (Where are we now?)
A9 Maximizing Medical Assistance revenues through the new initiatives including Crisis Stabilization (HFS34), Crisis Intervention, CSDRB, & Comprehensive Community Services(CCS) (HFS-36). Crisis Intervention /Stabilization & CSDRB revenues in 2003 totaled: $1,893,887 CCS is slated to go into effect July 1st, 2004 so there is no revenue data available at this time.

Chosen Target (Where do we want to be?)
•The goal is to increase MA revenues by $500,000 in 2005.

Tactics to Close the Gap Measures of Success (How do we get there?) (How will we know we're there?)
1. Continue to expand crisis stabilization funding to LSS group homes & Off The Square Club and other applicable eligible people. 2. Have Yahara House (YH), SOAR, and Community Intervention Team (CIT) certified through HFS-36 and billing MA for Comprehensive Community Support services before the end of this year. •Expanding MA revenues by $500,000 through Crisis and CCS billing. •YH, SOAR, CIT certified and billing for CCS services.

Lead Staff Responsible (Who? By when?)
•David LeCount for DCDHS •Beth Lucht from the MHCDC for Crisis Stabilization. The goal will be met by the end of 2005.

Progress Dec. 2005
The system-wide implementation of HFS-34 (Crisis Stabilization) was extremely successful in 2005.Crisis Intervention/ Stabilization & CSDRB revenues for 2005 are projected to be $2,878,298 (based on YTD fiscal data through October). This represents a $712,795 increase (compared to 2004 crisis revenues). LSS group homes increased crisis stabilization funding by $126,806 (projected). DCDHS engaged in system and fiscal analysis of HFS36 (CCS) and concluded that it was not fiscally feasible to participate in this initiative at this time.

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2005 Work Plan - Adult Community Services
B. Assess performance and cost-effectiveness of services; and improve quality in those areas where quality measures are established.
Initiative Area
B1 Maintain Compliance with Wisconsin MA Personal Care regulations. This effort to comply with state regulations crosses multiple target groups.

Current Status (Where are we now?)
The nurse consultant developed guidelines and procedures for providing consistency among the county's POS agency for MA Personal Care (MAPC).

Chosen Target (Where do we want to be?)
Training and consultation to POS MAPC providers on required documentation to reduce errors identified in state audit of MAPC records.

Tactics to Close the Gap (How do we get there?)
Continue to monitor POS agencies MAPC records and clarifying any documentation issues.

Measures of Success (How will we know we're there?)

Lead Staff Responsible (Who? By when?)

Progress Dec. 2005
In 2005, the State requested one individual's care records for services provided in year 2002. To date, State officials have not released their audit findings.

Audit exceptions are held to a minimum Theresa Sanders, Doug Hunt of $5,000 (Total program is $7.9m) and the nurse consultant.

B2

Nursing Clinic: Develop a nursing clinic to provide nursing services to people with developmental disabilities

Dane County DD Nurse Association has developed a needs assessment to be completed to ascertain current needs and response. Currently the State Medicaid program funds independent nurse services but does not fund nurse clinics. A Health Care assessment was sent out to Support Brokers/Case Managers to ascertain the general health care of adults with disabilities. Approximately 950 of 1000 surveys were returned. The data has been entered into a database for analysis.

•State approval of nursing clinic services as a card covered service and a waiver covered service. MA card coverage is preferred as it would likely provide more revenue.

With a grant from the State of Wisconsin, verify the results of the survey (having a Registered Nurse [RN] verify a random sample of the returned surveys). Once the surveys are verified by the RN’s, it is anticipated the County will be able to predict the number of nursing hours needed by the current population; ascertain the number of nursing hours currently available; and identify the gap in hours, if one exists. If this analysis supports the development of a Nursing Clinic response, we will identify similar models in other states as well as pursue funding of this service as an MA card service, MA Waiver allowed service or seek RWJ grant to pilot the model.

•State approval as an MA card or MA waiver funded service •Alternatively, draft proposal submitted to RWJ to pilot the model.

Dan Rossiter and Sue Prodell, ACS are lead staff. Nancy Schook, RN, Waisman Center Training and Consulting, and Susan Heighway UW School of Nursing are lead consultant staff

•During 2004, an assessment tool was developed, validated and revised. A stratified random sample was completed in October 2004, and 176 people were invited to participate in the survey process. During 2005, a total of 156 surveys were completed and are currently being analyzed by a statistician. It is anticipated that this information will be the base for potential grant applications. This information may be used in a future RWJF grant application. •To date, we have not applied to the State for Medicaid funding.

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2005 Work Plan - Adult Community Services

Initiative Area
B3 Prader Willi Syndrome (PWS) support response

Current Status (Where are we now?)

Chosen Target (Where do we want to be?)

Tactics to Close the Gap (How do we get there?)
Develop a workgroup of parents, providers, advocates and County Staff. Examine state and national programs for adults with PWS. Consult with experts in the provision of therapeutic programs for individuals with PWS

Measures of Success (How will we know we're there?)
•Clear direction in the types of support desired, and •A single provider has been identified to provide those supports

Lead Staff Responsible (Who? By when?)
Monica Bear, ACS, has lead responsibility for this initiative. June 2005.

Progress Dec. 2005
•A workgroup of parents, brokers and county staff met several times Jan-Jun 2005, investigating state and national programs. Prader Willi Homes of Oconomowoc (PWHO) operates several homes using a cost-efficient model considered best practice for PW. PWHO was approached to expand into Dane County. They are unwilling at this time. Parent group felt strongly that they would prefer to purchase PWHO services in Oconomowoc rather than have an existing Dane County provider develop a similar model. •PWHO has been able to support Dane County residents at a lower cost than Dane Co providers. Consumers and families report better quality of life.

People with PWS have a Identify a therapeutic cost flaw in the part of their effective response to adults with brain (the hypothalamus) Prader Willi Syndrome. that determines hunger and satiety. These people never feel full enough, so they have a continuous urge to eat. To compound this problem, people with PWS need considerably fewer calories than normal to maintain an appropriate weight. The obesity that results is the major cause of illness and death in this disorder. As in the general population, obesity in PWS can cause high blood pressure, respiratory difficulties, diabetes and other problems. The diagnosis is rare, occurring 1:14,000 Currently, Dane County either send adults with PWS out of county for therapeutic services, or provides support 1:1 by various agencies within Dane County, without a universal approach.

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2005 Work Plan - Adult Community Services

Initiative Area
B4 Customized Employment

Current Status (Where are we now?)
Currently a significant number of adults with developmental disabilities who have been deemed inappropriate for community-based employment (e.g. unpredictable behaviors) and for facility-based employment (vulnerability of others attending the facility), and are supported in their residential program, typically at a 1:1 client staff ratio. Because these individuals do not have access to disposable income, they do not have any opportunity to participate in any activities outside their residences that requires spending money.

Chosen Target (Where do we want to be?)
Develop alternative sources of income for individuals who are not deemed appropriate for community-based or facilitybased employment that will allow these individuals to further participate in our community and do so in a more cost effective manner. These alternatives are typically self-employment opportunities (often called microenterprises), that generate somewhat small incomes for individuals.

Tactics to Close the Gap (How do we get there?)
Identify 6 to 8 adults with developmental disabilities who are not participating in community/facility-based employment. Bring together experts who have been assisting individuals in developing “customized employment” around the individuals capabilities (Employment Resources Inc., a Madison based agency who has been working with adults with physical disabilities around customized employment). Network with the State’s Division of Vocational Rehabilitation to secure funding for this initiative

Measures of Success (How will we know we're there?)
•6 to 8 individuals have participated in workshops to develop customized employment, and at least ½ will have begun an endeavor

Lead Staff Responsible (Who? By when?)
Doug Hunt, ACS, has lead responsibility, December 2005 Employment Resources Inc. will take provider lead

Progress Dec. 2005
Over the course of 2005, 3 grant funded selfemployment workshops were offered through the Income Links, LLC, a consulting firm from New Hampshire. 15 consumers/ teams were given the tools to plan their own microenterprise. Through our Self-Employment Pilot project with DVR, 6 of these individuals have received funding and technical support with 2 consumers successfully completing with DVR in "Supported Self-Employment" (one as a potter and the other as a watercolor artist) . This Pilot will continue in 2006.

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2005 Work Plan - Adult Community Services

Initiative Area
B5 ICF-MR Restructuring Initiative

Current Status (Where are we now?)
Beginning January 1, 2005, counties will receive the funding currently used to pay institutional care at Intermediate Care Facilities for the Mentally Retarded (ICF-MRs) and nursing homes for county residents with developmental disabilities. The current system creates a disincentive for counties to relocate persons to the community. If an individual is receiving long term care in an institution, all costs are paid by the state. However, counties often incur costs for serving people in the community due to limited state funding for waivers. This proposal helps eliminate that disincentive. This proposal provides more flexibility and more resources to counties to use for community-based care. Counties receive a pot of funding based on the costs of county residents currently in institutional settings. Counties can use this funding to relocate and fund care for these individuals in community

Chosen Target (Where do we want to be?)
•All Dane County residents with developmental disabilities residing in ICF-MRs or Nursing homes will be identified •Begin to move persons into the community with institutional funds and no increase cost to the levy.

Tactics to Close the Gap (How do we get there?)
Identify all Dane County residents who will be covered by the Restructuring Initiative. While the County tracks the number of residents in facilities, it is uncertain if this includes all Dane County residents, specifically those residents who were admitted at times that may pre-date Dane County records. Once all residents are identified, work with facilities to assure that relocation to the community is financially feasible. Once identified, begin the process of assessing community support needs if the individual(s) are to be brought back to their Dane County community.

Measures of Success (How will we know we're there?)
•By January 1, 2005, all ICF-MR and Nursing Homes have identified all Dane County residents •Assessments to identify what supports will need to be in place to have the individual(s) return home will be completed •By December 2005, some persons will be moved from institutional settings without added cost to levy

Lead Staff Responsible (Who? By when?)
Dan Rossiter, ACS, will have lead responsibility on financial feasibility. Joe Purcell and Bill Huisheere, ACS, will have lead responsibility on the relocation initiative.

Progress Dec. 2005
All residents of ICF-MRs and Nursing Homes have been identified and assessed; these assessments have been submitted to the Courts for disposition. As of December, 2005 three individuals have moved from ICF-MRs under this initiative. 16 individuals remain in ICF-MRs and nursing homes.

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2005 Work Plan - Adult Community Services

Initiative Area
B6 Analyze the new Jail AODA Treatment Pilot for outcome effectiveness and impact on diverting jail inmates from further substance abuse and criminal recidivism

Current Status (Where are we now?)
The AODA Jail Treatment Pilot program (Pathfinder) began in April, 2003. The program includes a public safety and AODA screening and assessment of jail Huber inmates and/or persons to be sentenced, voluntary program admission, 30 days of intensive AODA treatment while incarcerated followed by up to 6-9 months of treatment and support in the community. Participants will generally be on electronic monitoring under supervision of the Sheriff’s Office following release from jail. During the startup phase in 2003, 8 of 10 participants (80%) successfully completed the program (an additional 30+ referrals were made to the program but did not meet program eligibility requirements). Up to 50 persons will be served in 2004.

Chosen Target (Where do we want to be?)
Short Term Outcomes: •Inmates are engaged in treatment •Inmates do not recidivate or have other rules violations that result in program termination and/or return to the criminal justice system •Inmates discontinue AODA usage •Victims are aware of how the program operates and feel that the sentence/program is a just outcome •Increased participation by women and persons who have experienced trauma •Providers/criminal justice system staff are engaged in the program and feel that it is beneficial •Report to H&HN on progress every six months.

Tactics to Close the Gap (How do we get there?)
•Enhance effective screening and assessment procedures to select program participants •Continue an effective intensive in-jail and community-based treatment and case management program •Implement an effective electronic monitoring component to the program that assures community safety (sliding scale fee). •Monitor program effectiveness and pilot process outcomes continually

Measures of Success (How will we know we're there?)

Lead Staff Responsible (Who? By when?)

Progress Dec. 2005
•Input on process has lead to decision that the great majority of referrals be made through the sentencing process. •Collaboration and planning continues with the Sheriff’s Office, judiciary, private attorneys, Public Defender’s Office, Human Services. Regular updates and reviews are provided to the County Executive. •The successful outcome rate in 2005 was 76.2%. For 2005, 81% of people successfully discharged had full time employment and 71% had permanent housing (vs. 5% and 33% respectively at admission). Since inception, only 6% of those who have completed the program have committed a new crime.

The Pilot will continue to be evaluated John Borquist looking at three components: 1) process evaluation to describe and assess the fidelity of the program to the model, service utilization, and stakeholder perceptions; 2) impact evaluation of the service system to examine the partnerships/collaborations and service system changes; and 3) outcome evaluation. Primary outcome measures to be evaluated are reductions in jail days of incarceration, criminal recidivism and AODA use for offenders served in the program, Process evaluation and establishing and measuring baseline targets for the outcome evaluation will be continued in 2004. In addition to short-term evaluation, we will work to establish targets for intermediate and long-term outcomes during 2004 for 2005 and beyond.

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2005 Work Plan - Adult Community Services

Initiative Area
B7 Evaluation: System, Provider and consumer outcomes

Current Status (Where are we now?)
Many of the evaluation variables have been identified and are being tracked: System: •Hospital days •Court ordered services • People in paid work, hours work and amount paid • Supervised living arrangements being transitional, number of slots and the number of people served Program: • ESU, number of people presenting for inpatient and the number for which alternatives were arranged • Reduction in inpatient • People in paid work, hours worked and amount paid • CTA, reduction in jail days Consumer outcomes instrument to be developed by the State.

Chosen Target (Where do we want to be?)
The system and provider information will continue to be collated on an annual basis. A uniform consumer outcome instrument will be developed by the State this year. It will be implemented by paid consumers.

Tactics to Close the Gap (How do we get there?)
The system and provider outcome data will be collated at the County level annually. The uniform consumer outcome instrument will be developed in conjunction with the State and the County demonstration sites which includes Dane County.

Measures of Success (How will we know we're there?)
Outcome information will be collected annually for all three of these areas: System, Provider, and Consumer

Lead Staff Responsible (Who? By when?)
David LeCount, DCDHS Lynn Brady, Mental Health Center of Dane County

Progress Dec. 2005
System and provider variables continue to be tracked and collated annually at the county level (utilizing multiple data collection systems). Efforts during this reporting period have focused on problemsolving related to HSRS reporting. The state has not implemented a uniform consumer outcome instrument during 2005. The county will continue development of a centralized data system that will track outcome information. It is anticipated that this will be a multi-year effort.

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2005 Work Plan - Adult Community Services

Initiative Area
B8 Productive Work Models Increase paid work opportunities provided in integrated community work sites for people receiving services through core mental health programs who meet BRC I & II criteria.

Current Status (Where are we now?)
Some of the system's core mental health programs include work as part of the treatment. In 2004, we will begin collecting data on paid work for consumers in the following programs: •PACT •Gateway •Blacksmith •Cornerstone •Community Treatment Alternatives •Yahara House •Community Intervention Team •Chrysalis •Work Plus •Valley Packaging-Madison

Chosen Target (Where do we want to be?)
The goal over the next five years will be to have 50% of the people in paid work, making minimum wages or above, and working half time or longer.

Tactics to Close the Gap (How do we get there?)
•Work will continue to be emphasized and monitored as an important outcome measurement for all of the core contracted programs. •Progress will also be monitored through the Work Related Services committee and as a part of the implementation of the CCS-MA benefit - HFS-36.

Measures of Success (How will we know we're there?)
Within the next five years to have 50% of BRC I & II people working in community integrated work, working half time or longer, and making minimum wages or above.

Lead Staff Responsible (Who? By when?)
David LeCount with DCDHS and the Program Managers in all of the contracted core programs.

Progress Dec. 2005
Annualized work data for 2005 is drawn from programs in which work is an emphasis (Chrysalis, Valley Packaging, Work Plus,Yahara House, PACT, Blacksmith House,CIT, CTA). 31.4% of eligible consumers are reported to be in paid work settings (assuming an N of 900 eligible individuals). 90.8% of the consumers in paid work were making minimum wage or higher (average hourly wage was $2.61 higher than minimum wage). 26.5% were working half-time or more.

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2005 Work Plan - Adult Community Services

Initiative Area
B9 Fully implement the automated Functional Screen and the team case management concept.

Current Status (Where are we now?)
1. Mid-year 2003, the State introduced to counties a new automated functional screen for qualifying an individual for the COP and Waiver programs. During 2004, case managers for frail elderly and physical disabled were trained and certified to use the screen. 2. DCDHS contracted with a POS agency (South Madison Coalition of the Elderly) case management agency to hire a nurse to meet the State's staffing requirements for implementing the automated screen. Prior to 2004, only required a case manager. However, with the implementation of the new automated screen, the State is requiring counties to develop a team consisting of a nurse and case manager. 3. In 2005 it is anticipated that the State will require nonFamily Care Counties to change over to automated

Chosen Target (Where do we want to be?)

Tactics to Close the Gap (How do we get there?)

Measures of Success (How will we know we're there?)
By the end year 2005: a) DCDHS will contract with a POS physical disabilities case management agency, Community Living Alliance to hire one nurse b) Department hires or contracts with a nurse assigned to the Long Term Support Unit

Lead Staff Responsible (Who? By when?)
Theresa Sanders and Ann Wichmann, DCDHS; POS case management agencies, Kathleen Stoga, SMCE, Lalena Lampe, Tellurian CRX and Kelly Disch-Zolinski, CLA.

Progress Dec. 2005
Department staff applied for 2006 State COP Link grant to pilot nurse case management project and recently learned we received it.

1.Case Managers are fully trained 1. Develop a workgroup for on the electronic screening tool. implementing the team concept of a case manager 2.Pilot a nurse teamed up and nurse. with case managers to jointly 2. POS agency SMCE case complete the functional screen manager and nurse are both assessment, case plan and if assessing and developing an necessary, on-going case individual care plan, meeting management. the staffing requirements for administering the Functional Screen and Outcome tool.

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2005 Work Plan - Adult Community Services

Initiative Area
B10 Supportive Home Care ServicesPersonal Care and Chore

Current Status (Where are we now?)
For some years now, Supportive Home Care services have been provided under POS contract as well as purchased individually from companies and agencies. This model appears to have some inefficiencies with the cost for the same service ranging from $15 to $22 per hour.

Chosen Target (Where do we want to be?)
•Cost per hour is consistent for each Supportive Home Care service: Personal Care and Chore; •Consistent outcomes; and, •Maximize MA Personal Care revenue for personal care services.

Tactics to Close the Gap (How do we get there?)
a) develop contracts with agencies to provide SHCPersonal Care and Chore Services; b)develop a standard unit cost range up to 20%; c) eliminate the use of independent agencies as service providers; d)contract with a POS agency to submit MA Personal Care billing claims to the State Medicaid program.

Measures of Success (How will we know we're there?)

Lead Staff Responsible (Who? By when?)

Progress Dec. 2005
•Department staff were successful in keeping the variance within 20% for chore services. However, due to nurse requirements for billing MA Personal Care, nurse costs can be billed at a higher rate. •MA Personal Care for elderly individuals was implemented in CY2005. •A Providers workgroup has formed and with the assistance of the Planning Unit will develop quality care outcomes for SHC services. They are scheduled to start in January 2006.

1. Unit cost of similar services will have Theresa Sanders is the lead a variance not greater than 20% Dept. staff for this initiative. 2. Increase in MA Personal Care revenue POS 3. A workgroup will be formed to agencies, COP team and develop quality care outcomes. Aging Focal Points are actively involved. This is an on-going initiative through 2006.

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