CMHW Outcome-based Standards for Rights and Dignity

General Provider RequirementsOutcome-based StandardsThe Six OutcomesQuality Assurance Reviews

General Provider Standards• Iowa Administrative Code (IAC) Chapter 441—

77.46(1)c(1) states all providers of the Children’s Mental Health wavier services shall implement the following outcome-based standards for rights and dignity for children with serious emotional disturbance(SED):1. Consumers are valued2. Consumers are part of community life3. Consumers develop meaningful goals4. Consumers maintain physical and mental health5. Consumers are safe6. Consumers and their families have an impact on the

services received

Outcome-based Standards• Outcome-based reviews look at two components:

– Outcomes – these are measures of the quality of life that a consumer has. Outcomes belong to the individual. For example, does the childfeel staff treat him or her with respect? Does the consumer access the community? Under the CMHW, there are 6 outcome areas.

– Processes – these are the agency supports to assist the consumer in meeting the outcome. For example, if the outcome is for the consumer to be valued, the agency supports this by through staff training on the individual’s issues, insuring the staff interactions are respectful, etc.

• Each outcome has indicators to assist in determining if the consumer has the outcome and the agency has a process for that outcome.

Outcome #1• Consumers are valued

– This outcome addresses some of the following:• Are staff interactions with consumers respectful?• Does the child feel they are treated age appropriately?• Does the child feel staff is supportive?• Does the family/guardian feel the child is valued?

– The agency processes to meet this outcome could include the following:

• Staff is trained on the individual’s culture, values, and needs• The agency responds appropriately when the child is mistreated

during service delivery.• Staff have an understanding of the consumer’s values and culture,

and are respectful of both. • Staff descriptions of the child are respectful. Narrative also is

respectful.

Outcome #2• Consumers are part of community life

– To measure this outcome, the following questions are part of the review:

• Does the consumer have access to the community they live in?• Do they participate in community activities they enjoy and have an

interest in?• Are they aware of community resources and memberships?

– To have the process, the agency would need, at a minimum, the following:

• Staff are aware of the consumer’s interests and match community activities to those interests

• Staff know and share information with the consumer and/or family on community activities and memberships

• Staff assist the consumer in participating in community activities and groups.

Outcome #3• Consumers develop meaningful goals.

– This outcome reviews skill development and supports based on the consumer’s needs and desires. The following are examples of questions for this outcome:

• Is the consumer working on goals that are important to him or her?• Is the consumer making progress and does narrative show progress?• Do the consumer’s goals and skill development supports match what

has been identified by interdisciplinary team and written in the case manager’s plan?

– For the process, the following is an example of what may be reviewed:

• The agency is aware of and responsive to the individual’s desires and needs.

• Staff is trained on Medicaid narrative requirements and does existing narrative meet those requirements.

Outcome #4• Consumers maintain physical and mental health.

– This outcome addresses health and welfare issues of the child. These are some of the questions used to determine this outcome:

• Does the child have health (physical or mental) issues? If so, is staff aware of these and trained to effectively address the issue(s)?

• Does the child have access to outside, professional supports for these identified issues?

• Does the child feel his or her health issues are adequately addressed? Does the family agree?

– The process would include some of the following:• Staff is trained on the specific health/welfare issues of the child.• The agency request updated information regarding these issues.• If health supports are needed during service delivery, staff provide

those supports accordingly.

Outcome #5• Consumers are safe

– For this outcome, the child’s safety in the home and community are reviewed. Questions used to determine this outcome include:

• Does the child/family identify any safety issues?• Are those issues being addressed?• Is there a formal or informal plan identifying the safety issues, who is

responsible for addressing those concerns, and how the concerns will be addressed?

– The following are examples of how an agency could support have a process for this area:

• Staff are aware and trained on the child’s safety issues.• Service provision addresses safety issues, as directed in the case

manager’s plan.• When staff identify a safety issue, that information in provided to the

interdisciplinary team.

Outcome #6• Consumers and their families have an impact on

services they receive.– This outcome addressed the child and his or her family’s

input on service delivery at all agency levels. Examples of measuring this outcome are:

• Is the child and/or the family involved in the hiring, firing, and evaluation of staff?

• Does the child and/or family asked about the overall service delivery of the agency?

• Does the child and/or family feel they have input on services and that input is used to change service provision as needed?

– For the process, the agency review could include:• Consumers are included in hiring new staff.• Consumers and/or families are asked annually in evaluate current

staff.• The agency informs the child and/or family on the grievance process.• Changes in service delivery to the child have occurred because of

input from the child and/or family.

Quality Assurance Reviews• According to IAC 441– 77.46(1)c(2-5), the Department of

Human Services’ Bureau of Long-term Care shall conduct random quality assurance reviews. The six outcome previously identified will be utilized for these reviews.

• Interviews will occur with the child and the child’s parent(s) or legal guardian(s), and with informed consent, the targeted case manager.

• Interviews may also include provider staff.• Reviews of case files, staff training records, and general

compliance issue could also be a part of this QA process. • Based on the review, corrective actions may be required of the

provider.• Results of outcome-based QA reviews shall be forwarded to the

certifying or accrediting entity. • For more information, contact your local HCBS Specialist.