ISP Monitoring 2014 - Lesson 5 Printable Version PD · ISP Monitoring 2014 - Lesson 5 6. Thanks, Sonya. As we get started, I want to let you know that I’ll be referring to ODP Bulletin

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Course Number: 005-15-05

1ISP Monitoring 2014 - Lesson 5

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For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test.



Hello, my name is Sonya Hipple, Supports Coordination Organization (SCO) Lead for the Office of Developmental Programs. Welcome to Lesson 5 of ISP Monitoring 2014.



During February 2014, ODP hosted conference calls and invited SCOs to attend and answer questions about how they effectively meet monitoring requirements. ODP thanks each SCO that took time to participate and share what works for them. This part of the webcast will include practices SCOs put forward that help to meet requirements in the Waivers. I’ve talked about some of the practices in previous lessons, but there are a few more that we’d like to share. Although there was a great deal of commonality in general approaches to meeting monitoring requirements, the calls showed that SCOs have developed their own specific tools and practices.



For each practice we talk about, we’ll begin by naming the ODP expectation, followed by methods that SCOs have created to meet it. While the expectations must be met, the specific practices of individual organizations are offered as examples as a means to meet the expectation. SCOs are encouraged to use them if they will be helpful, improve on them, and create new methods to meet requirements.

Here’s an example: ODP expects that SCOs have processes in place to make sure SCs are meeting requirements for frequency and location of monitoring, but SCOs use similar processes in different ways. Other examples are the various ways SCOs ask SCs to prepare for monitoring visits –information, good scheduling habits – and practices SCOs, AEs, and Providers have put in place to resolve issues and address trends.

The final part of this lesson will be addressed to SC Supervisors and SCO Administrators as it contains information SCOs shared during the conference calls about providing guidance and oversight in meeting monitoring requirements.

Amy Hines from the Office of Developmental Programs Consulting System will be your narrator.



Thanks, Sonya.

As we get started, I want to let you know that I’ll be referring to ODP Bulletin #00‐10‐06, Supports Coordination Services in this webcast. You can find a link to it in the Resources section of the course. I also recommend that you have a copy of the Annotated ISP Monitoring Tool in hand during the webcast – you may want to take notes on it for your reference later.



We’re going to start with how frequency and location of monitoring is tracked to ensure requirements are met. Again, we’re talking not only about what the SC does to ensure requirements are met, but also the oversight that SC Supervisors and SCO Administration provide in ensuring the organization is in compliance with requirements.

ODP expects that SCOs have processes in place to make sure SCs are meeting requirements for frequency and location of monitoring. Almost all SCOs have developed some internal tracking form or method – spreadsheets or charts ‐ for monitoring visits. ODP does not require a specific spreadsheet or document to track and project monitoring visits, but SCOs must demonstrate that they have a method that includes each individual, the waiver they are enrolled in, and living situation, in order to ensure waiver compliance.

During the conference calls, SCOs talked about the different ways they use the tracking methods to ensure they meet requirements, including during regular discussion between SCs and SC Supervisors.

Whether they use paper or electronic tracking methods, most SCOs ensure the actual spreadsheet or chart is stored in a central place that is always available to the SC and SC Supervisor.

One SCO reported they use one common Outlook calendar to record an appointment for all monitoring visits so all SCs and SC Supervisors have access to real‐time information. They felt this helped them be aware of schedules across the agency and to plan for coverage, if needed.



Most SCOs use a tracking form in two ways: as a method to review whether requirements have been met which is a helpful tool for SC Supervisor; and some SC Supervisors have SCs submit tracking with projected monitoring visits for the next month, so they have time to make adjustments, if needed.



All SCOs also use tracking methods to review location and ensure that monitoring visits vary according to the specific requirements in each waiver. Tracking monitoring is also useful to ensure that monitoring visits occur evenly over time and are not all scheduled very close together.



Some SCOs reported they find it helpful to use HCSIS reports, such as the pending monitoring report, in conjunction with their own internal tools.



One method to meet ODP’s requirement that monitoring is thorough and contains complete information is by preparing for the visit in advance: knowing what the individual’s current circumstances are and being aware if there are issues that need to be addressed before even going to the location of the monitoring visit.

Although SCOs have various methods for SCs to prepare for monitoring visits, there is a great deal of agreement about the documentation that can help the SC be prepared to conduct the monitoring. First, of course, is the ISP itself. In order to answer monitoring questions about the individual’s current situation, SCs prepare by reviewing the outcome section of the ISP: outcome statements, the frequency and duration of services and what the team expected to see if progress toward the outcome statement was being made. What does the individual hope to achieve as reflected in outcome statements – what does the SC expect to see occurring that will show that outcome statements are being achieved? Other sections of the ISP that are pertinent to monitoring are Health Promotions, the Health and Safety Focus areas (especially if issues have been identified in the past), medications, health evaluations and appointments, behavioral supports plans and mental health care, and staffing levels.



The SC should always review the ISP and previous monitoring documentation to be current on the major issues in the individual’s life and what areas need follow up in the upcoming monitoring visit. One of the most important issues in monitoring is to check on the current status of incident corrective action plans during monitoring visits to ensure they are continuing or completed and having the intended effect of addressing the cause of the incident. For example, if an individual has had incidents of unplanned hospitalizations, the SC might need to prepare for the monitoring visit with questions about what’s happening with follow‐up instructions, new or changed medications and potential side effects, and medical appointments.

Being prepared to talk knowledgeably about each individual’s unique benefit structure may mean reviewing the information prior to the visit and preparing questions or areas of discussion.

Many SCs use a review of documents that providers routinely send as one way to review status and progress and prepare for monitoring.

Finally, SCOs also talked about ways they use scheduling to help other team members prepare for monitoring visits: as an opportunity to remind individuals, caregivers and providers of documents that will need to be available.



This information is not an all‐inclusive list of all the sources of information that SCOs felt could be reviewed to prepare for monitoring. Yet, it is fairly comprehensive and all this information may be daunting for an SC to remember when heading to a monitoring visit.

A number of SCOs have solved this by asking SCs to record information on one document that captures reminders for the SC about important issues, as well as questions the SC plans to ask the provider or caregiver. Some SCOs have developed their own forms for SCs to use in order to prepare with specific topics that need to be covered, based on each individual’s unique circumstances – in order to meet ODP’s expectation that Monitoring is thorough and contains complete information.



Earlier in the webcast, we talked about ODP’s expectation that every issue identified in ISP Monitoring is acted on and resolved. This is the central purpose of monitoring.

Some SCOs have found it effective to write a plan to address the issue with the provider or caregiver before ending the monitoring visit. This ensures everyone understands what they need to do to resolve the issue. A number of SCOs leave a copy of the plan to resolve the issue with the provider or caregiver, while others ask for everyone present to sign the plan to show their commitment to act on resolving the issue. Some SCOs have printed blank copies of the concern sheet in HCSIS to take with them to monitoring visits while others have developed their own documents.

ODP does not mandate a specific method for documenting a plan to resolve issues, but each SCO must demonstrate they have a clear process in place to do so – this makes it more likely that follow‐up actions will be implemented.

Remember when there are issues of imminent risk, immediate action for safety is the priority.



SCOs have created practices around supporting SCs to conduct effective monitoring , we want to share a few examples now.

Many SCOs noted that tracking methods to determine if monitoring is occurring at the required frequency and duration must be used proactively to be efficient. In other words, when an SC and his or her supervisor meet, looking ahead a month or even two months can help to avoid problems. SC Supervisors can find this particularly useful when helping to plan for coverage during staff time off or busy times.

The SC Services Bulletin that we have used as a reference throughout this training stipulates that SCOs must have processes in place to provide oversight and guidance around issues. Many SCOs reported they expect SC Supervisors to meet with each SC at least monthly and use that time to review progress toward resolving issues. Some SC Supervisors are in the practice of reviewing documentation of follow‐up with the SC to ensure that it is timely and clear. The nature of the issue may necessitate more frequent interaction between the SC and SC Supervisor as plans are being developed and implemented to address the issues.

Some SCOs sample monitoring periodically to assess quality of each SC’s monitoring and to help point out opportunities for improvement in monitoring for the organization. One SCO in particular emphasized that it’s important to have a plan to randomly sample monitoring across all SCs in the organization over time in order to get a full picture of the quality of monitoring and to ensure consistent practices.



During the February 2014 conference calls, SCO Administrators and supervisors talked about strategies they use to support monitoring that meets requirements and that make it effective.

Many SCOs make it a point to ensure that SCs are able to explain monitoring requirements to individuals, families, and providers so they understand their obligations in the monitoring process. Some SCOs have written materials that SCs use to inform individuals, families, and providers of monitoring requirements. Other SCOs talked about meetings with providers to regularly review monitoring expectations and findings.

SCOs have now been through several years of SCO monitoring and some reported using questions in the SCO Monitoring Guidelines to identify opportunities for improvement as they prepare for monitoring.



Some SCOs identified that they have regular meetings with providers to review monitoring expectations and findings. This is a support to SCs because it makes it more likely that they and providers will be able to collaborate because they have a common understanding of monitoring and how to address issues.

When providing guidance to SCs in resolving issues, some SCOs have adopted the practice of having regular meetings of supervisors and administrators to review critical situations. Smaller SCOs have said that they have similar processes, but that review may happen in a less structured way.

Because of the role of the AE in the monitoring process, many SCOs and AEs have established regular meetings to review practice and resolution of issues. These can be very useful over timein identifying trends across programs and resolution of issues that need to be addressed, or even in finding and promoting practices that the AE and SCO want others to use.



We’ll conclude this training by emphasizing the person who has the most important perspective in the ISP monitoring process: the individual.

Even if monitoring reveals that there are no issues, that the ISP is being implemented as outlined and services and supports are being delivered in accordance with the service definitions and at the correct frequency and duration ‐ it does not necessarily mean that the individual is satisfied. Satisfaction is subjective to each of us as individuals and our feeling about services is directly tied to whether or not they are effective for our needs – as we perceive them.

When the SC learns that the individual desires a change whether through his or her words or actions; the question becomes, is the individual aware that he or she has the authority to request changes? If yes ‐ does the individual know how to change the ISP? Does he or she understand the obligation of the team to support his or her authority to request change?

If changes are proposed to services or supports, does the individual understand and know how to exercise the right to appeal?



Throughout these five lessons in this course, we have talked about the need for monitoring to be done correctly so that requirements are met. However, monitoring is about more than meeting requirements. It’s important to think about the process of Individual Support Plan monitoring as an opportunity to support the individual in having a voice about what’s happening in his or her life. No matter what role each person performs in the monitoring process – conducting visits as an SC, as a provider working with the team to resolve issues, as an AE or ODP staff supporting teams as they look for solutions – the results impact the individual and the life he or she wants to live.



This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs.

Thank you for participating in this lesson.



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ISP Monitoring 2014 - Lesson 5 Printable Version PD · ISP Monitoring 2014 - Lesson 5 6. Thanks, Sonya. As we get started, I want to let you know that I’ll be referring to ODP Bulletin