Hawaii CPASS Summary | advancingstates.org

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"HICPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</EM></P> <H2 ALIGN=\"CENTER\">HAWAII</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>A complex and fragmented system, with more than 80 federal, state and local government programs offering direct or indirect assistance to persons with long-term care needs.</LI> <LI>Lack of capacity for some critical services is reflected in waiting lists.</LI> <LI>Hawaii lags behind many other states in maximizing use of federal programs that support special needs (e.g., federal housing dollars). Some persons end up in institutions due to Hawaii's high cost of housing and a shortage of low-cost and subsidized housing options.</LI> <LI>The default service approach for some populations remains institutional, rather than home and community services.</LI> <LI>Lack of awareness about available long-term care issues and service options.</LI> <LI>Hawaii's Developmental Disabilities Division self-determination law, Act 133, has yet to be fully implemented, and both public and private service system components lack experience in effectively supporting individual choice and self-determination.</LI> <LI>A worsening shortage of adequately trained personal assistance workers.</LI> <LI>The level of individual and family input into the policy process needs to be increased.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Committed leadership at the state level to implement systems change in keeping with the Olmstead Decision.</LI> <LI>Cross-disability consensus on the need for systems change as well as agreement that the LTC system should provide individual choice and self-determination.</LI> <LI>A number of family support training and advocacy programs have been implemented.</LI> <LI>Hawaii has been recognized for having the country's best state law regarding self-determination and self-directed supports.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Reallocate existing resources to support real choice and self determination while overcoming the shortage of skilled care support workers.</LI> <LI>Test the relationship between interventions in building community connections and the overall improvement in quality of life measures for persons in four target DD populations, including the elderly and persons with developmental disabilities, mental illness, and neurotrauma.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Support the state's ongoing statewide initiative to transform a fragmented system of long-term care services into an integrated system that honors the values of community access, choice and self-determination.</P> <P><STRONG>Goal.</STRONG> Involve all stakeholder groups and maximize individual participation in a collaborative community and systems change process.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Establish a consumer-majority Advisory Council, with additional members from human service organizations, social service organizations, and the Department of Health system. The Council will develop policies, procedures, and practices.</LI> <LI>Develop task groups and community interest groups to evaluate and discuss community needs and assets, collective visioning, and increased understanding and connection for project participants in the three demonstration sites.</LI> <LI>Develop "Kokua Circles" (Kokua is Hawaiian for "helping") or community councils for individuals participating in the project.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Increase the involvement and control of individuals in planning and evaluating their own personal supports, relationships and community connections.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Explore alternative models of teaching individualized person-directed planning, community development and individualized support models to the participating Department of Health systems, the community at large, individuals/participants and community organizations.</LI> <LI>Pilot and evaluate a new process of individualized person-centered planning, and community development.</LI> <LI>Institute and pilot mechanisms (Community Support Guides) for implementing person-directed plans by connecting participants to the community and personal assistants within models determined by each community demonstration.</LI> <LI>Use pilot results to develop policy recommendations and make waiver revisions to sustain the desired process of individualized person-centered planning in formal service delivery systems and the community at large.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Enhance the capacity of individuals to make informed choices about how the personal assistance services and supports specified in their individualized plans will be delivered and managed.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Explore alternative models of developing personal assistants, connecting community relationships and resources to individual-directed support brokering and coordination or cash and counseling models, and develop a process in which Department of Health systems can participate.</LI> <LI>Pilot and evaluate the use of Community Support Guides and other individually-directed, personal assistants models as determined within the demonstration sites.</LI> <LI>Use pilot results to develop recommendations to sustain the desired process of individual-directed personal assistants, support brokering and coordination (Community Support Guides and other models).</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Provide stakeholders with the attitudes, skills, and knowledge they need to effectively participate in the development and implementation of the project innovations.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Assess the training, technical assistance, and information needs of stakeholders, local community partners and agency personnel involved in developing and piloting individual-directed processes.</LI> <LI>Develop training, technical assistance, community collaboration, and information dissemination activities to meet identified needs.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Enhance the ability of individuals to communicate their visions of a high quality of life as the basis for more effective individualized person-centered planning and improved quality assurance at the individual consumer systems and the community levels.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Conduct evaluation activities to measure quality of life improvements of the project participants, given the models and activities demonstrated.</LI> <LI>Using a pre/post test design, assess changes in the participants' quality of life, as well as other aspects of their community living personal assistance. The interventions will focus upon individualized aspects of "cash and counseling" and fiscal intermediary models-specific components of each intervention will be determined within each demonstration community site.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Build community connections and improve the quality of life measures for persons in the four targeted DD populations through alternatives to paid support services<EM>,</EM>increased utilization of community resources, and the building of relationships and natural support services through community development activities.</LI> <LI>Develop three model demonstration sites in communities across the State of Hawaii for the provision of training, community assessment, community education, networking, and building of relationships for participants.</LI> <LI>Provide community outreach to ensure that all staff and volunteers involved with the CPASS Grant understand the tenets of self-determination and consumer choice in the determination and provision of personal assistant care services and supports.</LI> <LI>Develop and organize leadership by individual service recipients and their families to collaboratively guide project implementation and to institute similar innovations in policies, procedures, and practices within Department of Health (DOH) systems.</LI> </UL> </P> <H3>Consumer Partners</H3> <P>The Advisory Council includes service recipients and their families, and community groups, who bring expertise gained through personal experience and advocacy. <UL> <LI>The majority of consumer partners are family members of consumers or consumers of services themselves. A few may also represent the interest of an association or organization cited below, but they will participate on the Council as individuals.</LI> <LI>Key advocacy organization partners include, but are not limited to: Developmental Disabilities Council, Hawaii Centers for Independent Living, The ARC in Hawaii (formerly known as Association for Retarded Citizens), Hawaii Disability Rights Center, Mental Health Association of Hawaii, Special Parents Information Network (SPIN), Elder Law Program at the University of Hawaii's Richardson School of Law, and United Self-Help (consumer-run, non-profit agency for persons with serious disabling mental illness).</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>Early drafts of the grant application were circulated to both agency administrators and consumer representatives and revisions were made in response to their feedback.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>The Advisory Council, consisting of at least 51 percent consumers as well as heads and representatives of the key participating agencies and programs, will provide policy-level guidance on the implementation of all project activities.</LI> <LI>The Council will provide input on the development of all training and evaluation materials and instruments.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>The Department of Health's Adult Mental Health Division.</LI> <LI>The Department of Health's Executive Office on Aging.</LI> <LI>The Department of Human Services.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>ARC in Hawaii.</LI> <LI>ASSISTGUIDE Inc.</LI> <LI>National Center on Self-Determination.</LI> <LI>University of Hawaii at Manoa's Center on Disability Studies.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG></P> <P>Early drafts of the grant application were circulated to both agency administrators and consumer representatives and revisions were made in response to their feedback.</P> <P><STRONG>Private</STRONG> <UL> <LI>The Center on Disability Studies at the University of Hawaii at Manoa and the National Center on Self-Determination provided technical assistance in developing the grant application.</LI> <LI>ARC in Hawaii and other purchase of service (state contracted) providers in the community were consulted for input into the grant development process.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>The Department of Health (DOH) agencies will use their own resources and those of the Project to collaborate with consumer groups to plan the new system components of consumer-directed individual planning and budgets.</LI> <LI>The DOH staff will participate in education opportunities provided by the project staff, which will build capacity within the respective systems.</LI> <LI>The DOH agencies will develop and pilot the new system components of consumer-directed individual planning and budgets, and support brokering via the Community Support Guides and other fiscal intermediary models.</LI> <LI>The DOH agencies will conduct eligibility determinations, participate in individual planning, and contribute resources at the individual level, where applicable.</LI> <LI>DOH management staff will work with the Advisory Council on current practices that can be adapted in order to sustain project outcomes, including changes in policies, procedures and legislation.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>The University of Hawaii at Manoa'sCenter on Disability Studies will serve as the primary private partner in the project providing planning, training, technical assistance, and evaluation support to the project. This support will be coordinated closely with the needs of DOH staff and input from the project advisory board.</LI> <LI>ASSISTGUIDE Inc. of Honolulu, Hawaii will assist with web development activities related to the project.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>The Project will be coordinated with two ongoing statewide system improvement initiatives: (1) the statewide implementation of Act 133 of the Hawaii Revised Statues requiring consumer self-determination; and (2) a proposed new community-based Medicaid Waiver program. Currently, no activity is underway within these two system improvement initiativesit is expected that the PASS Grant will provide input to the direction these two initiatives should be taking in the state. Both initiatives will be impacted by the work of the Advisory Council and the proposed three demonstration community sites.</LI> <LI>The Real Choices Grant will develop and implement a cross-agency, cross-disability, Web-based single-entry point (SEP) system. The functions of the system will be specifically designed to support the implementation of the innovative models of individual budgeting, individualized planning, and support brokering and coordination that will be developed by the Hawaii PASS Project.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The Advisory Council, consisting of at least 51 percent consumers as well as heads and representatives of the key participating agencies and programs, will provide policy-level guidance on the implementation of all project activities. This body will provide broad consumer and cross-agency oversight to the project.</LI> <LI>Both the DOH-DDD (grantee) and the Center on Disability Studies at the University of Hawaii at Manoa will provide oversight on specific day to day grant activities and outputs.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>An approach called empowerment evaluation will be used to evaluate and revise the consumer-directed service models to be developed and piloted.</LI> <LI>Detailed annual work plans specifying objectives, activities, timelines, persons responsible, resources needed, and projected products and outcomes will be submitted to the Advisory Council for feedback.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>All grant activities are being implemented within the DOH-DDD and will yield policy and procedure recommendations for waiver and other changes thereby ensuring the sustainability of the grant activities.</LI> <LI>The University of Hawaii will provide training, technical assistance, and evaluation support, thus supplying faculty and staff with the necessary knowledge and skills to continue training cadres of personnel to further sustain the project outcomes.</LI> <LI>The proposed three demonstration communities will provide data and information that will be used to define system changes in the state waiver and other fiscal procedures to ensure continuation of practices found effective through the grant activities.</LI> <LI>A "train the trainer" program will assure that training activities supported by the grant will continue after it ends.</LI> <LI>The Department of Health agency staff, primarily case managers, will participate in community demonstration activities, working with community partners and supporting the community with available resources and linkages during the project duration. The projected system changes and the training and experience received by the staff will ensure readiness to continue innovations successfully demonstrated once the project is complete.</LI> <LI>Four different system-specific models of individualized planning and budgeting, and the role of Community Support Guides (i.e., support brokering and coordination) will establish the foundation for transforming each system into one that actualizes consumer self-determination.</LI> <LI>Consumers and agency personnel alike will better understand and honor the values of access, choice and self-determination, and will have greater capacity to translate those values into practice.</LI> <LI>Evaluation results of the pilots will be used to develop concrete recommendations and legislative proposals for expanding and sustaining program features shown to be effective.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Three targeted communities in the State of Hawaii.</P>