Core Services “Thinks Outside of the Box” in Northeast Tennessee

Posted on April 2, 1999

By Jaqueline Cooper, CQL Quality Enhancement Specialist

Core Services of Northeast Tennessee is a human services organization dedicated to enhancing the lives of people with intellectual and developmental disabilities. The organization operates with a person-centered approach, ensuring that the people they support have control over their lives, including choosing their staff and living arrangements. Core Services is known for its creative and diligent problem-solving strategies, always striving to design solutions that meet the specific needs of those they support. They are not afraid to innovate, adapt, and change course as necessary (as well as communicate “the why” behind it), demonstrating a strong commitment to continuous improvement.

One of the organization’s key priorities is advocacy, empowering people to understand their rights and speak up for themselves. Through communicating, educating, and hosting workshops for staff, Core Services educates and encourages self-advocacy among the people they support. By fostering a culture of learning and confidence, the organization helps people become strong advocates for their own well-being. This focus on advocacy ensures that every person has the tools and support they need to lead a fulfilling and independent life.

Innovation and community involvement are at the heart of Core Services, fostering community engagement through activities such as a weekly book club at a local Barnes & Noble and the iCan Fitness Program, which provides personalized, adaptive, and inclusive training for all in the community. These initiatives help connect people and encourage meaningful participation in the community, reinforcing Core Services’ commitment to inclusion. Activities people participate in are based on personal choice and interest, as well as their personal goals. Tools such as relationship mapping, Charting the Life Course, and Personal Outcome Measure® (POM) interviews are instrumental in building bridges and providing support for a personalized and meaningful community life for all.

Technology plays a crucial role in the organization’s efforts to support independence and self-determination. As a SHIFT-accredited Technology First Organization, Core Services integrates enabling technology into their programs to enhance the lives of the people they support. Currently, 50% of the people they serve use technology to assist with daily tasks such as medication self-administration, while 25% use technology to improve their independence and reduce their reliance on support staff. These advancements highlight Core Services’ dedication to utilizing cutting-edge solutions to foster autonomy.

Throughout the CQL Accreditation journey and focus groups, Core Services emphasizes the importance of growth and development of its employees, recognizing that a well-trained and motivated workforce is essential to delivering high-quality support. Over half of the staff hold nationally recognized credentials, and all employees participate in ongoing training to enhance their skills. The organization’s investment in staff development has led to reduced turnover and a unified vision among employees. Susan Arwood, who served as Core Services’ Executive Director during the accreditation cycle but has since retired, emphasizes the importance of supporting both the people served and the staff, ensuring that everyone involved in the organization is empowered to succeed.

With strong values centered on inclusion, innovation, and empowerment, Core Services continues to lead the way in providing exceptional support for people with intellectual and developmental disabilities.

“Our agency would not be where it is if not for CQL Accreditation. It drives us to always move forward and reach for what seems impossible. Our experience has been that what seems impossible at the beginning of an accreditation cycle is achievable by the end. When that repeats for 8 years in a row it is amazing how lives improve.” 

Susan Arwood, Former Core Services of Northeast Tennessee Executive Director

About Core Services of Northeast Tennessee

Core Services of Northeast Tennessee has been providing services since the 1960s and are committed to empowering people with intellectual disabilities to live a shared vision of a valued life in connection with family, friends, and community life. They provide diverse services to meet a variety of needs of people in their community including supported living, employment, technology, respite, personal assistance, funds management, nursing, and more! The vision of Core Services is that people with intellectual disabilities participate in, contribute to, and are valued members of their chosen community and are continually innovating and creating programs as a response to the ever-evolving needs and goals of the people they serve.

This organization has a longstanding commitment to excellence with CQL, having achieved Person-Centered Excellence, With Distinction accreditation in 2021 and maintaining that accreditation ever since. In 2017, Core Services of Northeast Tennessee was a CQL Award of Excellence recipient, and later Susan Arwood received the first-ever CQL President’s Award. Core Services was also honored with the Moving Mountains Award in 2022, recognizing best practices in direct support workforce development. The Moving Mountains Award is presented annually by the Institute on Community Integration, NADSP, and ANCOR.

The agency has also completed the Tennessee Department of Disability and Aging (DDA) requirements for designation as a ‘Person-Centered Organization‘, as well as becoming an ‘Enabling Technology Transformation Agency’ and a provider mentor through the DDA Tennessee Employment First Leadership Initiative (TEFLI). 

Core Services of Northeast Tennessee recently achieved re-accreditation for Person-Centered Excellence, with Distinction. We asked Susan Arwood a series of questions about who they are as an organization, along with their experience with the CQL Accreditation process.

What are some notable changes in your organization over recent years?

There are many notable changes in our organization. The agency has become more adept at involving stakeholders in agency planning. The Core Council is a successful concept that resulted from this effort. The Core Council is a group of DSPs who meet without management present to discuss issues and make policy recommendations. The Self-Advocate Council is a group with a similar function, composed of people supported by the agency. Through groups such as these, and an extensive use of surveys, everyone within and outside of the agency can easily give feedback. 

As a result of this feedback, numerous positions have been established that improve agency supports and provide promotional opportunities for staff. These include Remote Support Specialist, Night Monitor, Community Integration Specialist, Community Engagement Specialist, Employee Support Specialist, Enabling Technology Coordinator, Financial Independence Liaison, MAPs Coordinator, Pre-ETS Coordinator, Workforce Development Specialist and Grief Coach.

The positive improvements in programs have also resolved DSP workforce issues. The agency has less than a 4% DSP vacancy rate and an average DSP tenure of 7.2 years. Over 55% of all employees hold professional certification through organizations such as NADSP and SHIFT. Almost 50% of people supported by the agency are able to choose the type of support they want (DSP vs Remote) for more independence. The entire agency, from persons supported to leaders, has a sense of ownership, pride, and accomplishment as a result of achievement in recent years.

What are your goals as an organization?

We want to expand our current employment program into a more person-centered model where anyone who wants to work can choose and pursue a career. We want everyone we support to choose when and how they want supports delivered as we expand our enabling technology efforts.

We want everyone who is employed by our agency to complete 2-day person-centered thinking training, a Personal Outcome Measures® Workshop and seek a professional credential through organizations such as NADSP, CESP, SHIFT and others.

What organizational values or practices are you most proud of?

We are very proud of our employee retention initiatives and the culture we have built with our employees. By recognizing that the quality of agency supports is dependent on the quality of the workforce, we have made this a priority. Our goal is to have employees who are happy, supported, and empowered just like the people we support. Efforts do seem to be paying off. 

For the past 10+ years, employees with less than 5 years of tenure with the company were the majority. In 2017, only 27% of the DSP workforce had more than 5 years of tenure. In 2024, 51% of the Core Services workforce had over 5 years of tenure. The average tenure of a Core Services DSP in 2024 was 7.2 years. In addition, the DSP vacancy rate has continued to decline with a 3.2% DSP vacancy rate in 2024.

Why did you decide to pursue CQL Accreditation?

We first decided to pursue CQL Accreditation in 2016 when we were looking for a roadmap to help guide conformity with the Home and Community Based Services (HCBS) Settings Rule. We decided early on that we wanted to go beyond compliance to actually live the ideals of HCBS. CQL’s Basic Assurances® and Person-Centered Excellence Accreditation was ideal for that purpose. This year marks our third round of accreditation. 

Our agency would not be where it is if it not for CQL Accreditation. It drives us to always move forward and reach for what seems impossible. Our experience has been that what seems impossible at the beginning of an accreditation cycle is achievable by the end. When that repeats for 8 years in a row it is amazing how lives improve.

What is one specific aspect or area of your organization that has improved as a result of your accreditation? How has it improved?

There have been many aspects of our company that have changed for the good, as a result of accreditation. One that stands out is effective use of data. Prior to our organization’s involvement with CQL, we kept the minimum amount of data to meet licensing requirements. Data was not used for driving program improvements. We rarely thought about the why, who, what, and how of collecting data and a lot of what we collected was not useful. 

Through our accreditation process we learned that effective use of data helps you know exactly where you’re at, what your strengths are, and where your opportunities lie. We currently have a robust system of collecting and analyzing data that continuously drives quality improvement.

What is the impact of accreditation on your organization as a whole?

Accreditation has had a substantial impact on the health and well-being of not only the people supported but our entire organization, employees included. Over the past 9+ years we have worked diligently to improve our supports using CQL principles as our roadmap. People supported by Core Services have happy and involved lives. 30% of people are employed. 53% of people choose the type of support they want for increased independence (DSP vs. Remote). 31% of people participate in self-administration of medications through the use of a medication dispenser.

What is the impact of accreditation on the people you support?

There are so many things that impact quality of life that were not even on our radar until we began our CQL journey. At the start of our transformation journey, most of the people we support lived in segregation. They attended a segregated day program and did not have meaningful involvement in their communities. Today, people have jobs, friends, volunteer opportunities, vacations and busy, exciting lives.

How have the Personal Outcome Measures® (POM) affected person-centeredness at your organization?

There is a tendency for systems to not have the most person-centered annual planning process. At Core Services, Personal Outcome Measures® was the key to putting people back into the driver’s seat for their own planning. The agency has a certified POM interviewer/trainer and a goal of everyone having a POM interview at least every two years. In addition, the agency believes so strongly in the benefits of Personal Outcome Measures® that 70% of employees have attended a Personal Outcome Measures® Workshop. Information learned during POM interviews has resulted in many positive life changes for people including jobs, vacations, housemate changes, and other areas.

How do you envision the future of your partnership with CQL?

I see us continuing to lean on CQL for education and direction on best possible supports. Before our involvement with CQL we did not know what we didn’t know. 

The partnership has been very beneficial. It is motivation to continuously strive to be better and provide the best possible supports. In the 9+ years that we have enjoyed a relationship with CQL, we have continuously grown and improved. We hope that our story can motivate other provider agencies.

Have questions about CQL Accreditation?

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Since 1969, CQL | The Council on Quality and Leadership has been a leader in working with human service organizations and systems to continuously define, measure, and improve quality of life and quality of services for youth, adults, and older adults with intellectual and developmental disabilities, and psychiatric disabilities. CQL offers accreditation, training, certification, research, and consultation services to agencies that share our vision of dignity, opportunity, and community for all people.