Rebalancing Initiative (REBAL)

LOUISIANA

Target Population

People with developmental disabilities living in Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) with 16 or more beds.

Geographic Focus

Statewide

Primary Focus

Develop a system to ensure that people with developmental disabilities have increased opportunities to transition from institutional settings to community-based living and increased access to self-directed, community-based long-term care services and supports; and develop ways to measure the quality of supports and services provided to consumers who have transitioned to the community.

Goals, Objectives, and Activities

Goal: Develop a transition plan to increase the number of individuals with developmental disabilities transitioning to the community though rebalancing of the State's long-term care services programs.

Objectives/Activities

• Identify states with successful rebalancing initiatives and review their programs to identify best practices.
• Identify agency needs and develop an action plan to accomplish the rebalancing goal.
• Prepare fiscal impact statements in conjunction with legislative initiatives to project funding required to ensure the sustainability of the grant initiatives and submit them for inclusion in the State budgetary process.
• Develop the formative evaluation plan to measure project progress and design a project Web site that will be used to post project materials and reports.
• Conduct project evaluation, compile results, and make recommendations for change to the transition plan based on evaluation results.
• Develop a comprehensive transition plan, including policies and procedures necessary to implement the plan.

Goal: Enhance community services and supports for persons with developmental disabilities by providing education to providers and consumers on available community options.

Objectives/Activities

• Develop community resource books that identify existing medical, dental, behavioral, housing, and transportation resources available to persons with developmental disabilities within each county and distribute them to appropriate public and private organizations.
• Develop a training curriculum for people with developmental disabilities and their families on available community living options.
• Develop a training curriculum for providers that focus on best practices for transitioning individuals from institutions to community living options.
• Develop a training curriculum on best practices for working with, treating, and responding to the needs of individuals with developmental disabilities for medical providers, psychiatric providers, dentists, and other community professionals.
• Conduct interviews with consumers and families of consumers with developmental disabilities to identify and develop guidance and best practices for determining transition and support needs that must be met when a person with developmental disabilities transitions from an institutional setting to the community.

Goal: Transition at least 270 individuals with disabilities living in large ICFs/MR to community living options by the end of the grant period.

Objectives/Activities

• Implement a procedure to identify and update the list of consumers interested in transitioning from ICFs/MR to community-based living options.
• Develop a linkage plan to transition consumers with developmental disabilities to the community.
• Develop and implement a process that enables providers and State agency staff to identify supports and interventions necessary for a person with developmental disabilities to transition to and remain in the community.

Goal: Improve the quality of supports and services included in the transition plan.

Objectives/Activities

• Develop a process for measuring the quality of services and supports to be used by agency staff.
• Create tools (e.g., data reports, satisfaction and outcome surveys) to measure the quality of supports and services included in the transition plan.
• Establish a network of accredited providers or community entities to provide the necessary services and supports for people who transition.
• Review and revise licensing requirements for community providers.
• Conduct consumer and provider satisfaction surveys and make changes to processes and services based on results.

Key Activities and Products

• Develop a framework for increasing consumer-directed, community-based services and supports.
• Develop a transition manual to help identify needed transition services together with a plan for transitioning consumers from institutional settings to community-based living arrangements.
• Develop a training curriculum on best practices for transitioning, working with, treating, and responding to the needs of individuals with developmental disabilities for medical providers, psychiatric providers, dentists, and other community professionals.
• Develop a list of minimum needs that must be met when a person with developmental disabilities transitions from an institutional setting to the community.
• Develop a flowchart of steps necessary to transition consumers to the community.
• Create tools (e.g., satisfaction and outcome surveys) to measure the quality of supports and services included in the transition plan.

Consumer Partners and their Involvement in Implementation Activities

Consumers and their families will participate on the Advisory Board, as will several advocacy groups, such as the Alliance of Developmental Center Parents, Developmental Disabilities Council, the ARC of Louisiana, People First, and Families Helping Families. As members of the Advisory Board, consumers will be involved in monitoring grant activities and progress, participating in formative evaluation activities, and recommending program and policy changes.

Public and Private Partners and their Involvement in Implementation Activities

• Members of several organizations will serve on the Advisory Board, including the Bureau of Community Supports and Services, Bureau of Health Services Financing, Louisiana Rehabilitation Services, Disabilities Services and Supports Systems, Office of Mental Health, the Governor's Office of Disability Affairs, and the Advocacy Center. These organizations will provide information on current practices, participate in regional workgroups, and assist in the development and implementation of system reforms.
• The State will hire an outside consultant to identify states with promising rebalancing initiatives and assist in the development of a rebalancing action plan. The consultant will create a project Web site, develop the formative and summative evaluation instruments, and assist in the education of agency staff, consumers, advocates, and other stakeholders about the range of community options available.

Advisory Body, Committee, or Task Force

• An Advisory Board that includes persons with developmental disabilities and their family members will monitor project progress, review all project reports, and make recommendations to address infrastructure problems and improve the effectiveness of community-based services.
• The Advisory Board will provide direction, feedback, and guidance to ensure that project activities are consumer directed and person centered. Additionally, members of the Advisory Board will participate in the formulation of recommendations for programmatic and policy changes.

Formative/Process Evaluation Activities

• The Advisory Board and project staff will meet quarterly to track project activities and assure they are implemented according to the grant plans. Reasons for deviations from the grant plans will be documented, and impacts of these deviations will be addressed.
• Various methods such as a review of meeting notes and minutes, focus groups, and evaluations of training and educational activities will be used to monitor and assess the quality and efficiency of activities.

Summative/Outcome Evaluation Activities

Grant staff plan to conduct an outcome evaluation focusing on the impact of grant activities on consumers and the service delivery system using consumer and provider satisfaction surveys and a series of forums coordinated by the project manager. The outcome evaluation design and process will be determined by the regional workgroups and the Advisory Board.

Strategies to Ensure Sustainability

• Policies and procedures implemented during the grant period will continue after the grant ends and will assist the State in its efforts to move from reliance on ICFs/MR to community living options for persons with developmental disabilities.
• Training curricula developed under the project will focus on transitioning to community living and will continue to be an integral part of future trainings with consumers, families, and providers.
• Community resource booklets will be routinely updated after the project ends and encourage community inclusion for individuals with developmental disabilities.
• Initiatives developed and implemented under the grant will be part of an integrated State plan to assure that people with developmental disabilities and their families have increased choices and opportunities to move from institutions to community-based living options.