Posted on November 28, 2023

By Michael Clausen and Rebecca Kasey, CQL Director of Personal Outcome Measures®

Organizations that achieve Person-Centered Excellence Accreditation, With Distinction are not only good at what they do, but they are also recognized as leaders in our field. This high standard is achieved only through a commitment to innovative practices, community partnerships, promotion of rights for every person, and putting people receiving supports at the forefront of everything they do. In this Capstone, CQL is featuring several of the organizations that have achieved Person-Centered Excellence Accreditation, With Distinction, and sharing examples of some of the best practices they have implemented. 

Thank you to CQL’s partner organizations that contributed to this article: 

• Karen Hirschfeld, Director Compass/QI, Anne Miller RN, Director of Quality Assurance, Christine Schulte PHD, Vice President of Psychology Services, Colleen Tapia, Compass/QI Administrator and Nicole Zerillo, Director of Strategic Communications & Marketing, AHRC Nassau and Citizens Options Unlimited, Inc. (New York) 
• Josephine Bailey, Division Director of Day, Community, QA Supports and Corporate Compliance Officer, The Arc Lexington (New York) 
• Susan Arwood, Executive Director, Core Services of Northeast Tennessee 
• Beth Garretson, Director of Policy and Quality Management, Opportunities for Positive Growth, Inc. (Indiana) 
• Georgia Kuss, Director of Quality Enhancement and Training, St. Louis Arc (Missouri) 
• Sally Ritchey, Director of IT, Trinity Services, Inc. (Illinois) 

Community Building & Partnerships

The Arc Lexington

We have been successful in engaging local businesses to open up employment opportunities to people with disabilities. We partner with local colleges to develop certificate programs for people we support as well as our staff. We worked with the Rotary and Salvation Army to create a community garden and give the produce to the local food pantry. The Arc Lexington also partnered with Capital District Physicians’ Health Plan, Inc. (CDPHP) to develop an Autism Resource Center and worked collaboratively with the Mayo Clinic to bring an Engaged and Empowered Curriculum to the Day Habilitation program. 

Opportunities for Positive Growth, Inc. (OPG)

We engage with local government to advocate for/with people with disabilities. We work with a variety of local businesses who employ some of the people we support. We partner with other providers in the community to provide support to people where they are. We partner with local schools, community based social groups, and other local civic and non-profit groups.

AHRC Nassau and Citizens Options Unlimited, Inc.

The Thomas S. Gulotta Wheatley Farms & Arts Center is a “first-of-its-kind” program in Nassau County, Long Island, centered on the arts, nature, and wellness. This accessible community center re-sets the focus by attracting people through its doors based on shared interests, who are then welcomed into a fully inclusive experience for all people.

Inclusive Practices

Core Services of Northeast Tennessee

We developed a “Core Council,” which is a group of six Direct Support Professionals (DSPs) who meet monthly without the presence of management to ensure that the perspective of DSPs is present in all facets of agency operations. The group governs itself, choosing members, rules, agendas, and meeting frequency. This group of key employees has been responsible for changes in benefits, policies, holiday gifts, and other important issues. The trust and transparency established has resulted in a spirit of problem-solving and goodwill that has produced many positive outcomes. 

The Self-Advocate Council is a similar group comprised of people supported. The Self-Advocate Council identifies their own pertinent issues in addition to giving input to matters reviewed by the Core Council. 

St. Louis Arc

The St. Louis Arc’s READI Committee (Race, Equity, Access, Diversity, and Inclusion) has existed in various iterations over the past decade. The work is data-driven, focusing on results from staff surveys as well as known best practices in the field of social justice. We engage in training, education, and “listening sessions” for staff, on topics like racial justice, LGBTQIA+ identity, gender expansiveness, religion/spirituality, and invisible disabilities. We help host events for celebrations like Juneteenth, Pride Month, and a local “Festability – A Celebration of Disabilities.” We created a Common Language Guide to help provide baseline definitions for common DEI terms. We implemented a third-party system (Syntrio Lighthouse) for staff to report discrimination anonymously. We also evaluate policies from a DEI lens, send staff to conferences and workshops, and work to make the Arc a trauma-informed agency.  

Trinity Services, Inc.

There are a number of family members involved in governance as Board members, along with a person who receives supports from the organization. This adds a richness to the organization’s activities that might not be easily gained any other way. Additionally, several people receiving supports regularly participate in employee interviews and give feedback to the hiring manager. Finally, people receiving supports from the organization are valued members of the Human Rights Committee, as well as other committees that contribute to the organization. 

Opportunities for Positive Growth, Inc.

Our organization established Factor Champion Groups about a year before our last CQL Accreditation visit to begin the Basic Assurances^® self-assessment process. These groups were composed of employees at all levels of the organization. Many groups included people we support or community members. This process was beneficial in a variety of ways. It made preparing for our accreditation visit relatively easy – the workload was dispersed across about 40 people over the course of a year. It also helped those who participated learn about and buy into the process and to the Basic Assurances^®, which they then passed on to other employees. After our accreditation, the members of these groups worked with organizational leadership to create our Basic Assurances^® plan, and they continue to be engaged in our quality management planning and processes on an ongoing basis. 

Rights Protection and Promotion

Opportunities for Positive Growth, Inc.

Last year we created a position that is solely focused on protecting and promoting human rights. The Human Rights Committee Facilitator is responsible for coordinating our Human Rights Committee and also has responsibilities related to educating and supporting employees and the people we support about human rights, restrictions, and HCBS expectations. 

AHRC Nassau and Citizens Options Unlimited, Inc.

We acknowledge that people in home and community-based services are often prescribed psychotropic medications more frequently than people who do not receive services. Because of this, AHRC Nassau and Citizens have instituted a process to safeguard people from receiving unnecessary psychiatric medications. We use a system called “The Psychiatric Screening Questionnaire” to investigate potential environmental and medical factors that may cause change in a person’s behavior. Prior to referring a person for psychiatric services, the person – along with their support team – will meet and ensure that a behavior support plan has been in place for no less than three months. Another part of the process is that a Personal Outcome Measures^® interview (within the last 12 months) was completed. This happens prior to scheduling a meeting for additional information into the person’s need/desire for psychiatric services and alternate interventions. 

St. Louis Arc

The St. Louis Arc believes that people with disabilities have a right to Due Process review if they have been prescribed even one behavior-modifying medication, not just five or more, as the state of Missouri mandates. Our internal committees are also divided into two groups, one of which reviews “standard” rights restrictions and another that examines these restrictions from a holistic aging lens, taking into account the complexities that accompany this stage of life. 

Trinity Services Inc.

Our organization uses a Listening Ear hotline system so that people can report concerns. The typical/traditional methods of reporting issues are also available, but Listening Ear offers a direct line to leave a message received by the chair of the Human Rights Committee. Recently, one person became aware of a concern that a peer had, but the peer didn’t feel comfortable reporting it. The person was able to contact the Listening Ear on that peer’s behalf and help them get the problem addressed.  

Person-Centered Supports

The Arc Lexington

Lexington is an innovative agency that constantly monitors the services we provide to find gaps or areas in need of improvement. For example, when it came to our attention that there was a gap in supports for students and young adults with learning differences who were aging out of high school, CEO Shaloni Winston founded Transitions, a post-secondary program designed to support teens and young adults with college, career, and life. Students learn life skills that include self-advocacy, employment advancement, and social skills, all while gaining real-life experience and/or earning a degree.  

Trinity Services, Inc.

The organization has created a Flourish planning process that focuses on helping people to identify and achieve personal goals, with an annual celebration of what the person has been involved in. This process exists outside the (often-bureaucratic) state-required personal planning process and involves all the people who are close to the person in creating a person-centered plan with them. Trinity has created the ‘My Plan To Flourish’ app that supports Flourish, designed to help track progress and provide a place for the person to create to-do lists, add photos, update and maintain the plan on a continuous basis, all on a personal device.  

Integrated Quality Management Systems

Core Services of Northeast Tennessee

During Core Services’ transformation to a person-centered agency/technology-first agency, it was apparent from observations that people were happier and perhaps safer. However, what proof did we have of this beyond observations? What data could we show a funding source or a family member to demonstrate what is actually a best practice? We realized that our agency’s data collection habits were based on meeting state regulations but did not always address what really matters. For example, data collected was heavily focused on safety and compliance and was not measuring the person’s view of the quality of their life. Today, a system of data collection is in place that is constantly evolving based on what matters most to people supported, their family, the agency, our employees, and other stakeholders. 

Opportunities for Positive Growth, Inc.

Opportunities for Positive Growth, Inc. offered the following tips: 

• Engage as many levels of the organization as possible in identifying quality measures that really matter
• Be transparent about how these measures relate to improved outcomes for people supported
• Provide updates to the organization about where quality initiatives stand
• Be explicit about how assessments lead to change for each person or the organization as a whole
• Make sure that you are checking in on the integrated quality management system (IQMS) regularly and changing it when the needs of the organization change; it should be a living document 

Positive Culture

Core Services of Northeast Tennessee

One of Core Services’ best practices is the DSP Retention Initiative. As Core Services transformed to a true person-centered agency it became clear that happier people created happier staff. This was evidenced by reduced turnover rates and a sharp increase in applicants for employment who were referred by employees. An “ah-ha” moment was when we asked, “what would happen if we applied the same person-centered practices to our HR practices?” The Core Services’ DSP Retention Initiative is founded on philosophies of person-centered support. Developing DSPs and empowering them to use their skills to improve the lives of people supported will maintain a virtuous cycle that benefits employees, people supported, and the overall health of the agency.  

The Arc Lexington

The Arc Lexington developed a Nurturing Environment Program to prevent abuse and neglect and monitor staff morale. A monthly meeting is held for all employees as well as people we support. It provides a forum to share information, from any challenging situations and incidents to accomplishments and milestones. Everyone works together to brainstorm resolutions to continue to improve supports and services. We have established a culture where all stakeholders are involved to make every day the best it can be at The Arc Lexington.

The State and National Advocacy

AHRC Nassau and Citizens Options Unlimited, Inc.

Stanfort J. Perry, CEO of AHRC Nassau, emphasized that “being ready, willing, and empowered to share key advocacy messages with government officials and legislators is a priority for both AHRC Nassau and Citizens Options Unlimited. Advocates across our community are ready to not only share the issues impacting the safety, independence, and inclusion of people with disabilities, but also how the county, state, and federal levels of government can offer meaningful support.”  

Centering advocacy approaches on the lived experiences and perspectives of people with intellectual and developmental disabilities, their families, and staff, is how AHRC Nassau and Citizens Options Unlimited continue to evolve our approaches and move forward toward a more equitable future. 

Opportunities for Positive Growth, Inc.

We are active in professional organizations for each of the services we offer, such as the Indiana Association of Behavioral Consultants (INABC), the Association for Indiana Music Therapy (AIMT), and the Indiana Association of People Supporting Employment First (INAPSE). OPG employees hold leadership positions in many of these organizations. OPG employees have engaged in advocacy at the state and federal levels for improved pay and professional treatment for providers. For instance, we participated in the DSP Workforce Strategy Session. We partner with Help Over Hurdles, a non-profit that offers support to DSPs. We are participating in the BDDS Innovative Pilot Projects (IPP) program to improve support options for people with disabilities. Our employees are also active in advocacy related to Employee Stock Ownership Plans (ESOPs). 

St. Louis Arc

The Arc maintains representation across several local and national committees, including ANCOR Government Relations, The Arc of the United States – National Council of Executives, Missouri Association of County Developmental Disability Services (MACDDS) Legislative Community, and the legislative committees for the St. Louis and St. Charles Provider Coalitions. The St. Louis Arc works to engage people in advocacy efforts through the St. Louis Advocates, which is comprised of individuals with developmental disabilities and their allies. 

Trinity Services, Inc.

Trinity is heavily involved in advocating for DSP wages and for adjustments to the state’s payment system that would better support people in growing and flourishing. The organization is a founding member of an advocacy organization for DSP wages called “They Deserve More.” Membership on key state committees is critical, as is involvement with state and national trade associations that help drive legislative action agendas. The organization also seeks out innovative opportunities available through demonstration grants, pilot projects, or municipal funding, that create new service options for people. 

Making Your Practices More ‘Distinct’

Great human service agencies know that continuous improvement and quality enhancement are integral for providing the best possible services. A special thanks to each of the organizations that contributed to this Capstone to provide real examples of best practices in action. These organizations have been diligent in creating better and more person-centered services, especially by improving the areas of community building and partnerships, inclusive practices, rights protection and promotion, person-centered supports, integrated quality management systems, a positive culture, and state and national advocacy.