Rebalancing Initiative (REBAL)

VIRGINIA

Target Population

Individuals with mental retardation (MR), developmental disabilities (DD), and physical disabilities.

Geographic Focus

Statewide after piloting in three to five regions of the State.

Primary Focus

Increase access to and the availability and diversity of home and community-based long-term services and supports; maximize opportunities for consumers to choose, design, and manage community services and supports; and ensure that individuals can use funds in multiple settings and that quality assurance practices are incorporated into individual service plans.

Goals, Objectives, and Activities

Goal: Provide tools, information, and resources to individuals with disabilities, their families, case managers, and providers to assist them in designing person-centered service plans and to maximize informed choice in the selection of supports and services.

Objectives/Activities

• Implement a person-centered service planning awareness program to renew interest in and increase knowledge of person-centered planning principles and practices.
• Develop materials and training guides that explain person-centered service planning options and fully describes all available service options.
• Create a Web page on the Partnership for People with Disabilities Web site and post person-centered planning information and resource materials.
• Develop a rebalancing plan that details strategies to ensure growth in the systemic and systematic use of person-centered service planning and informed choice.
• Develop an implementation plan to incorporate successful practices into routine operations.

Goal: Maximize opportunities for individuals in State training centers and individuals currently on the statewide urgent waiting lists to choose, design, and manage needed community supports and services.

Objectives/Activities

• Provide information and resources on person-centered services planning, informed choice, and service options to individuals who will be returning to the community and individuals who will be moving from the urgent waiting list into slots in the MR Waiver.
• Provide assistance as needed in developing person-centered services and supports that are based on informed choice.
• Assess strengths and challenges of the pilot (including financing of services and quality management) and use results to refine materials and processes.
• Identify strategies to ensure that processes developed (including financing across settings and quality in all supports) are used with additional individuals who receive "slots" in waivers.
• Develop an implementation plan that ensures that processes are incorporated in policies and procedures of Community Service Boards (CSBs) and reinforced at the State level.

Goal: Develop definitions, processes, and procedures that can be used to identify additional services that can become consumer-directed within Virginia's MR/DD Waiver programs.

Objectives/Activities

• Identify the types of consumer-directed services available in other states, such as in-home services and supported employment, and determine if these services can become consumer directed in Virginia.
• Identify barriers that limit the number and types of consumer-directed services that are offered in the State and the strategies to overcome them.
• Develop definitions for additional consumer-directed services and identify strategies and processes for including the services in waivers.
• Develop a project rebalancing plan that describes strategies to increase consumer-directed services.
• Develop an implementation plan and share information with key stakeholders.

Key Activities and Products

• Prepare a report on findings of research from other states that outlines additional prospective consumer-directed services and definitions to include in Virginia's waivers.
• Prepare a report describing the pilot demonstration that provides information on the effectiveness of materials and resources, the tracking of financing of services, the quality practices, and the findings and results.
• Develop materials that explain the philosophy of person-centered planning and person-centered services in formats useful for individuals, family members, case managers, providers, and other supporters.
• Develop resource documents on the array of options for community support and service.
• Prepare a rebalancing and implementation plan that addresses how the State can integrate and continue the work of this initiative.

Consumer Partners and their Involvement in Implementation Activities

Consumers and family members will participate in the grant's advisory group and will assist in (1) developing materials; (2) providing guidance on person-centered planning and informed choice activities; (3) providing oversight in the examination of the expansion of consumer-directed services; and (4) developing implementation and sustainability plans.

Public and Private Partners and their Involvement in Implementation Activities

• The Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS), as members of the Training Advisory Team, will assist in the development of materials to ensure that the products will support the State's discharge planning process. The DMHMRSAS staff will also assist in identifying regulatory and practice barriers to consumer-directed services.
• The Department of Medical Assistance (DMAS) will participate in workgroups to develop materials and processes for person-centered planning and increased consumer choice; assist with the development of definitions for new or additional consumer-directed services; and provide feedback and input on all grant activities through membership in the advisory group.

Advisory Body, Committee, or Task Force

A Consumer and Agency Advisory Group, comprised of representatives from other systems change grants that are located at the Partnership for People with Disabilities and local staff members involved in the pilot, will work with project staff in all phases of the project to provide guidance and input to the development of materials and processes. Members will include individuals with disabilities, family members, agency, and provider representatives.

Formative/Process Evaluation Activities

• Project staff will monitor project activities and document the number and types of products disseminated, requests for technical assistance received and responses provided, numbers of participants at meetings or other group events, and utilization of materials.
• Project staff will pilot test materials for ease-of-use, content, and principles of universal design. Results from these pilot tests will guide modifications and refinements to materials.
• Participants in training events or those receiving technical assistance will complete evaluation forms that will measure changes in their knowledge and awareness, which will be used to assist staff with identifying pertinent follow-up activities as well as emerging needs.

Summative/Outcome Evaluation Activities

The State is not planning to conduct a formal summative evaluation of grant activities.

Strategies to Ensure Sustainability

• Project staff will work with DMAS, DMHMRSAS, and others to ensure that project activities have been institutionalized into State policies and practices.
• Grant staff will identify traditional and nontraditional sources of potential funding for the future support of project activities to continue beyond the grant.