IM4Q Signs of Quality: Reframing and Revisiting

1. IM4Q Signs of Quality: Reframing and Revisiting IM4Q AST 2019 Guy Caruso, IOD, IM4Q Technical Advisor Lee Stephens, ODP Central Office, IM4Q Lead

2. Definition of IM4Q Signs of Quality The intent of a Sign of Quality is for the IM4Q monitoring team to acknowledge something that they have witnessed or been made aware of during an interview that stands out as exemplary to them with regard to significantly improving the person’s life. A Sign of Quality denotes something in a person’s life that is far more than what is expected to allow the person to have an everyday life. It is something that someone else, such as a family member, a provider agency or a particular staff, a supports coordinator, or a member of the community, does or makes happen for the person.

3. Definition of IM4Q Signs of Quality A Sign of Quality is not something that would be expected to occur during the course of providing care or a service. For example, getting a wheelchair for a person or the person attending community activities are not signs of quality. However, ensuring that the wheelchair is customized for the person’s specific needs could be a Sign of Quality, as could having season tickets for a favorite sports team and participating in pre-game activities with other fans. In addition, it is not a Sign of Quality simply because there are no noted considerations.

4. Definition of IM4Q Signs of Quality When considering whether something is a Sign of Quality, monitoring teams should describe in detail why they believe that it is and bear in mind: • What has occurred? Is it something extraordinary and beyond what’s expected? • Did it require a great amount of effort or advocacy used to achieve it? • Did it require creative, “outside the box” proactive thinking used to achieve it? • Was a major positive change made in the person’s life because of it? If monitoring team members are unsure whether something is a Sign of Quality, then they should discuss it with their program coordinator. To record a Sign of Quality, an IM4Q program would submit it through HCSIS. It would be shared with the AE/SCO, but no follow-up would be required.

5. Strengths vs. Signs of Quality Strengths are different from Signs of Quality. A strength would be defined as a positive aspect of a person’s life provided by a family member, a provider agency or its staff, a supports coordinator, or member of the community. However, a strength would not be something that goes above and beyond most expectations. Strengths are not entered into HCSIS as are Signs of Quality. IM4Q programs can share strengths with providers and supports coordination organizations through separate documentation/reports.

6. Recorded as Signs of Quality, Yet They Are Not • A person received a new wheelchair and was very excited about it. • A young man, who is very independent, loves to work and keep busy. He is known for doing odd jobs around the house for his landlord. • A Lifesharing provider learned all she could about autism so that she would know how to best support the person living with her. • A person attends church in the community monthly. • Residential staff help a young lady and take her on walks, get her magazines, and take time to know her wants and needs. • A person has a communication device which allows for a lot of yes/no answers and for him to spell out answers. He also wanted to read some of the survey and point to the answers

7. Examples of Signs of Quality(New IM4Q Manual Appendix) • The 14 Consideration Theme areas can be used for such Signs of Quality using the five points listed above. The 14 themes that are listed below are taken from the 14 Themes for Considerations. Examples of Signs of Quality are listed under “Includes” in some of the theme areas and are only examples and are not meant to be all inclusive.

8. Examples of Signs of Quality 1. Adaptive Equipment: Summary: Staff/others have gone above and beyond regarding the importance of appropriate adaptive equipment to enhance a person’s life. • Highly specialized wheelchairs, other “state of the art” equipment that was not the “standard” chair people often receive. • Great effort was put forth to research, find, test, and then find funding for, the adaptive equipment to be used for a person • Note: Do not place communication devices here and place under Communication Needs/Device/Services. • Note: Any equipment that modifies the residence in any way is placed under another category, Residential – Building Adaptations/Modifications.

9. Examples of Signs of Quality 2. Communication Needs/Device/Services: Summary: Staff/others go above and beyond regarding the importance of communication for people with disabilities and go to great efforts to insure people have a meaningful way to communicate. Includes: • Person gets a highly specialized communication device which is used in all settings - at home, at work and in the community above what is “standard” fare. • Person’s staff/family receives extensive training on how to use the communication device and can assist the person in troubleshooting issues as they arise • Significant advocacy to support the funding of needed communication technology (e.g. IPad, Dynavox, etc.) again beyond what is typically offered by funders.

10. Examples of Signs of Quality 3. Community Presence and Participation: Summary: Here a team is looking for extensive and conscious efforts by others to provide a variety of meaningful and individually chosen activities/events in the community that occur very frequently for a person. These activities should not be with other people with disabilities. The activity should be primarily with community members without disabilities. Includes: • Any event/activity that takes place in the community (not a person’s home/place of residence/at work/school) and is driven by the person’s personal talents, interests, likes and NOT for the convenience of staff/family/others. Such as - • Civic/political groups (e.g., Neighborhood Watch; Political Party) • Social/racial/ethnic/fraternal/sorority/other groups (e.g., Knights of Columbus; Ukrainian Club) • Athletic/recreational/sporting event (e.g., attending a sporting event of one’s interest like, football, baseball, hockey and NOT being grouped with other spectators with disabilities who have donated section seating) • Joining athletic/recreational/sporting groups (e.g., softball league; cycling; kayaking; Booster Club; becoming a manager of a team)

11. Examples of Signs of Quality • Cultural/artistic (attending a play/symphony, joining an art/dance class; again NOT in a group section) • Associational groups (e.g., Rotary; Business Association; Elks; Moose. DAR; Grange) • Hobbyist (e.g., Stamp Collecting; Knitting; Collaging)) • Clubs, various organizations that meet in the community (e.g., Garden Club; Clean-up groups; librarian group) • Advocating for and obtaining any funds necessary to attend/join/participate in the event above and beyond what is typical and standard funding. • Note: Do not list the act of learning the skill/competence to participate in the event as this goes under Personal Competence, Enhancement and Growth. This theme area records presence and participation in the event that takes place in the community. • Note: Spirituality related presence and participations are recorded under Spiritual Life

12. Examples of Signs of Quality 4. Health/Well Being: Summary: Staff/others have gone the “extra mile” and have been very pro-active to address the health and well-being of a person. Staff/others do not exert unnecessary force/control over a person’s health/well-being decisions and instead work diligently to educate a person, as well as promote their self-determination and competence in making informed health/medical choices. Includes: • As a monitor you perceive some medical, psychological, health (e.g., weight/dietary/vision, hearing, smoking, alcoholic drinking other) concern and others who are with the person also see the need and have been addressing it in a proactive way with the person’s active participant (informed decision making versus Legal Guardian control). • A family/agency goes to great lengths to serve a person when they are very ill/dying, utilizing hospice/other supports to meet the wishes of the person (e.g. staying in one’s home with Hospice, support, versus forced to go a setting one does not want to be in) • Reproductive control (respecting desire to have children – or not; providing people with knowledge about sexuality in all its forms) • Community support groups (e.g. healthy lifestyles, smoking cessation, Weight Watchers, diabetes groups, parenting training, etc.)

13. Examples of Signs of Quality 5. Personal Rights, Competence Enhancement and Growth: Summary: Extraordinary efforts by others are put forth to increase the rights, competence and growth for a person beyond the expected. Includes: • Not only learning about and practicing one’s citizenship rights, but being supported to become active in politics/the electoral process • Engaging legal counsel if need be to guarantee personal rights • Being encouraged to choose a pet, take care of a pet, visit a veterinarian • Not only attending a meeting of/joining a self-advocacy group but being supported to be active, becoming an officer, recruiting others to join • Not only learning a skill (e.g., using a computer; learning to drive); craft (e.g., needlepoint, scrap booking); hobby (e.g., collecting sea shells; coins) actively using the skill • Major growth in independence, choice, control, decision making, and autonomy Being expected to be supported according to one’s chronological age and not imaged negatively or having limited expectations held for you, especially for individuals with more severe disabilities who are in greater jeopardy of negative imagery • Gaining athletic/recreational/sport skills (e.g., fishing; volleyball; baseball) and actively and regularly participating

14. Examples of Signs of Quality Note: This theme does include any issue of rights for a person, which is seen as increasing a person’s competence enhancement and growth. Note: A person’s choice for something (e.g. a pet) must take into consideration the rights of others, as well as any legitimate rules that apply to all citizens

15. Examples of Signs of Quality 6. Relationships/Friendships: Summary: Provider/others are highly conscious of the importance of friendships and relationships and bend over backwards to assist and support people to have meaningful friendships and relationships, especially with non-staff, non-consumer, and even beyond family ties with members of the community Includes: Family, Friend, Roommate, Neighbor, Social (boy-girl/friend) and other Non-Staff/Non Paid Relationships. These relationships and friendships could be at the person’s place of residence, work, school, worship, play, and in the community. Note: Does not include any paid staff relationships as these go under Residential/Living Situation Personal Change, Service System, or Work/Employment Related Consideration • Respecting people’s right to marry • Person indicates the need/desire to re-establish, renew, establish, seek out a relationship/friendship with any of the above listed groups of people and staff go to extraordinary efforts to achieve this • Person indicates an interest in or assistance with a boy/girlfriend relationship and staff go to extraordinary efforts to support a person in their interest (e.g. double dating; providing transportation) • Considerations concerning sexuality would be placed in this theme area and staff/others support a person in their sexuality by providing appropriate supports (e.g. sexual surrogate, etc.) • Staff/others work extraordinarily hard to improve communication among people by providing support through letters, email, telephone, skype, visits, attending important family/friend events (such as weddings, graduations, reunions, funerals); etc. Note: If the lack of, inconsistent, or inappropriate communication is between a family member and/or the person served with someone in the service system, then that is recorded under Service System and not here as it involves the service system

16. Examples of Signs of Quality 7. Residential/Living Situation Personal Change: Summary: Staff/others are consciously aware that individuals need to direct their own lives and do all they can to assist/support people to develop individualized living situations living with whom they would like to live. Includes: • Buying your own home • Family leaves their home to person and the people/staff around the person support them in living in their own home with support • Not letting level of disability be an obstacle to living where one wants to • Closing a group home for more individualized living

17. Examples of Signs of Quality 8. Residential – Building Adaptations/Modifications: Summary: Staff/others are keenly aware of the importance of appropriate building adaptations/modifications to enhance a person’s life and go to great efforts to address such issues. Includes: • A “smart house” is developed for a person utilizing technology to assist a person to have independence and a self-determined life • A house for a person with a physical disability is fully adapted so the person can live as independently as possible (e.g. ceiling fitted mounts for lifts, movement between rooms, adjustable counter tops, roll-under sinks, lower cabinets, fully accessible bathrooms)  • The person’s environment has been modified for the person’s maximum use of all areas of the house.

18. Examples of Signs of Quality 9. Safety: Summary: Staff/others are very aware of the importance of safety for the person and take extraordinary steps to educate the person, and to provide a safe environment/etc. Includes: • Person receives training/instruction that increases their safety such as assertiveness training, self-defense; becoming part of the neighborhood watch; using technology (cellphones) etc.

19. Examples of Signs of Quality 10. Service System: Summary: Supports Coordinators/staff/others know the individual, their history, and their needs/wants and address these in a very timely way showing the utmost respect for the person and their family and doing exemplary things for a person. Includes: • Supports Coordinator does extraordinary support/service for the individual (above and beyond the expectations to locate, coordinate and monitor) • Providing supports to a person who is hospitalized or in hospice, or incarcerated

20. Examples of Signs of Quality 11. Spiritual Life: Summary: Individuals interviewed are actively and fully supported by staff/others in their spiritual life and are active, contributing members of their faith. Includes: • Person is in a valued religious role, such as an usher, choir and/or Bible study member • Person is encouraged and participates in the rites of passage of one’s faith (e.g., Bar and Bat Mitzvah, confession, confirmation)

21. Examples of Signs of Quality 12. Transportation: Summary: Providers/others fully understand the importance of addressing and meeting people’s transportation needs so people can work, play, go to school, be in the community. Great effort is put forth to insure people have the transportation that they need to live a quality life. Includes: • Person is supported in learning to drive and maybe even in buying a car • Person carpools with co-workers to and from work or other activities (e.g. religious services) (staff may provide support) • People learn to safely use Uber, Lyft, other ride services

22. Examples of Signs of Quality 13. Work/Employment/Meaningful and Purposeful Activity:  Summary: Provider/others are consciously aware that people with disabilities want to work, be employed, want meaningful and purposeful activity during their day and assist/support people to have this need met in a timely way. Includes: • Promotion and not stagnation in a job • Full integration into the work setting such that individuals are included in work-related social activities (bowling leagues, happy hours, etc.) • Being provided opportunities to become a union member; join a trade association; participate in employee training/educational events; has full employee benefits; knows about and utilizes employee assistance program; etc. • Encouraged, supported, enabled to begin own business if so desired • Note: Workplace adaptations should be listed under Adaptive Equipment

23. Examples of Signs of Quality 14. Miscellaneous: Summary: Please make an effort to place Signs of Quality under one of the 13 above categories. If you have a Sign of Quality that does not fit above then use the miscellaneous theme category as a last resort.

24. Any Questions?