Texas RCSC Summary | advancingstates.org

<A NAME=\"TXRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">TEXAS</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>There are long waiting lists and a lack of coordination among social service personnel regarding alternative services.</LI> <LI>Texas continues to have one of the largest institutionalized populations in the nation.</LI> <LI>Numerous restrictive funding streams and lack of comprehensive case management across agencies results in a loose collection of service "silos."</LI> <LI>For mental health consumers the lack of community support services may result in repeated unnecessary institutionalization.</LI> <LI>There is a lack of capacity in critical areas such as affordable, accessible, integrated housing and personal attendant care.</LI> <LI>Changing benefits in public programs, expansion of service options, and lack of a cohesive access system contribute to a confusing system for consumers, especially those who are in a crisis situation.</LI> <LI>Texas has implemented various improvements to and increased the capacity of long-term services and supports over the last decade, yet the system remains fragmented and difficult to access.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>The Texas Health and Human Services Commission exists to provide the leadership and innovation necessary to administer the state's Health and Human Services (HHS) system. Under this structure, Texas is in a good position to make meaningful changes in its long-term care system across the HHS enterprise.</LI> <LI>Thanks to strong and committed consumer participation, Texas is becoming more focused in its statewide vision for improving access to services and supports for persons of all ages with disabilities.</LI> <LI>Texas has 25 Area Information Centers, 28 area agencies on aging, and 11 Independent Living Centers (ILCs), providing a range of services, including information, referral and assessment services, benefits counseling, family caregiver initiatives, nutritional support, and guardianship services.</LI> <LI>Texas has one of the most effective Home of Your Own coalitions in the nation, sponsored by United Cerebral Palsy of Texas, working to foster home rental and ownership.</LI> <LI>Nonprofit organizations provide a wide variety of volunteer services to people with disabilities of all ages.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Improve system coordination and access to long-term care services by developing and implementing one or two access models in pilot demonstrations to be tested in urban, rural and culturally diverse settings.</LI> <LI>Coordinate and integrate the model(s) with other existing access systems or projects in the community that have similar goals.</LI> <LI>Develop and implement a client-tracking mechanism and methods for gauging consumer satisfaction.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Create a fundamental, system-altering shift in the way consumers access the state's long-term care services and supports.</P> <P><STRONG>Goal.</STRONG> Develop and implement a "system navigator function" at the community level using one or both of two access models.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop state guidelines for two local models.</LI> <LI>Issue guidelines for system navigator function, with consideration given to the recommendations from regional access planning groups.</LI> <LI>Issue request for proposal for demonstration sites.</LI> <LI>Activate demonstration sites.</LI> <LI>Develop training program for system navigators and family/person-directed planners.</LI> <LI>Develop common intake, referral, assessment and follow-up protocols.</LI> <LI>Complete operational features of demonstration sites.</LI> <LI>Provide state technical assistance and program evaluation.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Evaluate the effectiveness of the navigator function by tracking the number of persons successfully diverted or transitioned from institutions into the community, and by gauging consumer satisfaction regarding accessibility of the system.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop valid client-tracking mechanism.</LI> <LI>Identify valid methods for gauging consumer satisfaction.</LI> <LI>Develop consumer satisfaction tool(s).</LI> <LI>Implement consumer satisfaction tool(s).</LI> <LI>Implement client-tracking mechanism.</LI> <LI>Develop method for, and evaluate personal outcomes.</LI> <LI>Develop method for, and evaluate system outcomes.</LI> <LI>Make adjustments to system design according to evaluation results.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Functional framework for and definition of the role of system navigators.</LI> <LI>Effective use of system navigators within two local access models.</LI> <LI>Two demonstration sites selected in regions of the state where local access planning is actively underway and where a commitment to community collaboration to reach across all ages and population groups is clearly evident.</LI> <LI>System-wide training in family/person-directed planning for system navigators and case workers working in the demonstration sites.</LI> <LI>An evaluation that addresses both process and outcomes.</LI> <LI>Project status reports submitted on monthly, quarterly, and annual basis.</LI> <LI>Ongoing state-level technical assistance and program coordination.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The Texas Health and Human Services Commission (HHSC), the lead agency for this grant application, developed a Consumer Task Force after an initial stakeholders' meeting was held to determine the direction and focus for the project.</LI> <LI>The Consumer Task Force includes consumers from ADAPT, the aging community, a parent of a child with mental retardation and autism, an adult with a physical disability, a representative of an ILC, and a representative from the Association for Retarded Citizens (ARC).</LI> <LI>The members each represent different geographic regions of the state and are known in their communities as aging and disability advocates. Many have been involved in the local Texas Long-Term Care Access projects and are very familiar with the issues and proposed solutions.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>The State elicited consumer participation in the development of its response to the Olmstead Decision through an advisory board, which assisted in the development of the state's Promoting Independence Plan. The access recommendations in the Plan provided the initial foundation for the changes the state is seeking to make as described in this application.</LI> <LI>The Consumer Task Force (CTF) was convened to participate in the development and writing of the grant application, the pilot site selection criteria, and to review the final application.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>After receiving the award from CMS the CTF reconvened to assist HHSC with the development and review of the request for proposals and then again to help finalize the selection of the demonstration sites. The CTF will continue to provide state-level input and feedback throughout the duration of the grant.</LI> <LI>The CTF will work with the HHSC management team to develop the navigator role.</LI> <LI>The CTF will assist in the evaluation process by participating in evaluation interviews with a sample of access recipients, and through the solicitation of feedback via public hearings.</LI> <LI>The project team will partner with various consumer organizations including the Children's Policy Council, Independent Living Centers, the Association for Retarded Citizens, the National Alliance for Mental Illness, the Coalition of Texans with Disabilities, ADAPT, the Texas Mental Health Consumers, and the Texas Disability Policy Consortium for technical assistance regarding specialty issues. These issues may range from identifying best practices in outreach and support development for specific populations to developing local chapters and providing assistance in community coalition building.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Texas Department of Human Services.</LI> <LI>Texas Department of Mental Health and Mental Retardation.</LI> <LI>Texas Department on Aging.</LI> <LI>Texas Department of Housing and Community Affairs.</LI> <LI>Area Agencies on Aging.</LI> <LI>Texas Information and Referral Network and Area Information Centers.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>ADAPT (nongovernmental, nonprofit advocacy group).</LI> <LI>Businesses involved in developing transportation, attendant care and housing.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public Partners</STRONG></P> <P>The Texas Department of Health, Texas Department of Human Services, Texas Department of Mental Health and Mental Retardation, and the Texas Department on Aging all provided staff resources during CTF meetings. Staff provided input for the grant's goals and objectives and offered suggestions for the overall functional requirements of the system navigator, as it was to be later laid out in the HHSC request for proposals.</P> <P><STRONG>Private Partners</STRONG></P> <P>ADAPT has a representative on the CTF who has been very active throughout the submission of the grant application.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P> <UL> <LI>The HHSC will work with state agency partners to develop standardized intake, screening, and information forms.</LI> <LI>Technical collaboration will occur with the Texas Department of Human Services to coordinate with its Texas Integrated Eligibility Redesign System (TIERS), and a specific component of that project known as the State of Texas Assistance and Referral System (STARS) "self-screener." STARS is a Web-based prescreening tool that consumers can use to see for themselves which benefits, services and programs they are potentially eligible.</LI> <LI>Collaboration with the Texas Department of Human Services, the Department of Mental Health and Mental Retardation, the Texas Department on Aging, AAAs, and other entities is critical to this project in order to identify and assess individuals in nursing facilities and other institutions who want community services (see second goal above).</LI> <LI>The Texas Information and Referral Network (TIRN) systems design will interface with the Real Choice project in the implementation of the pilot demonstration. The HHSC and the TIRN has received legislative support to implement a 211 telephone system in selected areas of the state. This, along with their comprehensive I&R Website, <A HREF=\"http://www.helpintexas.com/\">FindingHelpinTexas.com</A>, will be key components in the overall design of the two access models at the local level.</LI> </UL> </P> <P><STRONG>Private Partners</STRONG> <UL> <LI>ADAPT has a representative on the CTF who has been very active throughout the dissemination of the RFP and selection of the demonstration sites.</LI> <LI>Business/industry partners are represented on both the local projects' newly-formed advisory committees, and their contributions will be described in the projects' next reports to the HHSC.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>HHSC has made access planning a priority across the health and human services enterprise, urging partner HHS agencies to require interagency support of project activities at the local level. One of the selected demonstration sites has utilized this mechanism to elicit the support of local DHS and MHMR agencies and others, specifically in the area of designating "navigator liaisons" within their agencies to be the contact point and expediter of services for consumers referred to them by the system navigators.</LI> <LI>ADAPT has acquired funding from Volunteers in Service to America to hire and train personnel to implement identification and assessment initiatives in one area of the state.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The two demonstration sites will have a project director and a local advisory committee, which will include local agency representatives and cross-disability consumer representatives. The project director provides reports, updates, etc. to the project coordinator at HHSC.</LI> <LI>The Promoting Independence Plan and the SB 367 Task Force on Care Settings for Persons with Disabilities work will be used to provide input to the HHSC Project Team for oversight of the project.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>Evaluate pilot project using a set of core consumer-specific results. Monitoring will include site visits by the project director to the pilot site(s) and review of all deliverables.</LI> <LI>Quarterly reporting and the monitoring visits will provide timely feedback. Both the process outcomes and personal outcomes measures will provide insight into operational issues highlighting indications for remedial activities.</LI> <LI>Monitoring of the development of the system navigator function will include interviews with the individuals selected for the positions and agency personnel.</LI> <LI>Additional outcomes to be monitored include the development of standardized forms, protocol, and databases. The successful utilization of standardized forms to be shared across numerous programs and services is expected to be a significant challenge for both demonstration projects. Many aspects of information sharing, technology requirements, confidentiality, etc., will have to be understood, processed carefully, and agreed upon by all partners involved. It is anticipated that these processes will evolve and require fine-tuning over time in order to be formed into the desired products.</LI> <LI>The CTF will assist in the evaluation process by participating in interviews with a sample of access recipients, and through the solicitation of feedback via public hearings.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The use of a fully developed navigator function, a comprehensively tested local system of access, and a stringent evaluation plan for both system and consumer-directed outcomes, will create a fundamental change in the way individuals access long-term care services and supports.</LI> <LI>Demonstration sites will be selected based in part on their commitment to making a permanent change in their infrastructure dealing with access to information and services, their willingness to maintain and upgrade network technology as needed, and their willingness to invest in development of the access system with or without state resources. RFP applicants are required to match the requested grant funds at 5 percent.</LI> <LI>Local councils of governments have already committed resources to the project and are expected to continue this support.</LI> <LI>The state will continue to use the navigator system, the standardized screening and assessment forms, and the integrated database after the grant period ends. Formal agreements among network partners will assure that data is updated as needed to maintain the database.</LI> <LI>Building on success with the pilot communities, the state will implement strategic directives and priorities that empower other communities across the state to replicate these models.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide, including urban, rural and culturally diverse settings.</P>