Posted on March 31, 2020

By Katherine Dunbar, CQL Vice President of Accreditation

Hundreds of human service organizations around the world turn to the Basic Assurances® to evaluate the effectiveness of their systems or policies, and assess if they are having the intended result on the lives of people with disabilities. This tool explores essential, fundamental, and non-negotiable requirements involving the health, safety, and human security of people receiving services, as well as areas such as natural supports, social networks, employment, and more.

By using 10 factors, 46 indicators, and hundreds of probes, the Basic Assurances® is a robust approach to measuring quality in human services, and its tenets have been a staple of CQL Accreditation for decades. Considering the vigorous methodology of the Basic Assurances®, there is a natural need among human service organizations for additional guidance and support in better understanding and utilizing the tool.

Webinar Series: Inside The Basic Assurances®

To highlight important components and explore common challenges involving the Basic Assurances®, CQL conducted a 10-part webinar series, looking at the tool factor by factor. During the series, which spanned over the course of nearly a year, CQL’s Quality Enhancement Specialists provided expert insight into the crucial information that organizations need to know about what the factor entails and how its associated indicators and probes are evaluated during the CQL Accreditation process. More than 1,200 people attended the various sessions to improve their knowledge about how the Basic Assurances® will strengthen quality in their supports and services.

Below you will find the video recordings of the webinar sessions for each factor, along with some ‘Top Tips,’ shared by the Quality Enhancement Specialists who presented on each Basic Assurances® factor.

Factor 1 Top Tips

By Michael Clausen, CQL Quality Enhancement Specialist

• A rights assessment allows organizations to capture the extent to which people are able to exercise their rights and identify needed supports to overcome challenges.
• An effective Human Rights Committee is a foundational element to supporting, upholding, and maintaining Rights Protection and Promotion at all organizations. There are lots of great resources available, including CQL’s webinar ‘A Working and Effective Human Rights Committee,’ and the book Human Rights Committees: Staying on Course with Services and Supports for People with Intellectual Disabilities.
• Organizations are encouraged to not only develop rights training, but also build a rights culture. Consider the formal inclusion of people receiving supports and self-advocacy groups as a fundamental part of this effort.

Factor 2 Top Tips

By Jennifer Quigley

• Organizations should have a comprehensive procedure for complaints and grievances, with related data being collected and analyzed. People supported, staff, family members, guardians, and other stakeholders should be made aware of the procedure.
• Organizations should orient new employees and provide ongoing staff development about person-first language, the idea of supporting over ‘care-giving,’ informed choice, and promoting dignity and respect.
• People must be supported to have integrated community jobs that are based on their interests, skills, and abilities, along with pay that is at or above minimum wage. While organizations do not need to be the provider of employment services, they should be supporting people to access these resources as desired.
• We recognize that not everyone wants a competitive job so agencies should also provide supports for volunteering, retirement, establishing community routines (gyms, restaurants, shopping, visiting friends and neighbors, etc.) to help ensure people have meaningful days.

Factor 3 Top Tips

By Elizabeth Sites, CQL Quality Enhancement Specialist

• Your Natural Supports policy should not just list statements, but clearly describe how people will be supported to develop, maintain, and enhance relationships of all kinds.
• Before you can help a person build support networks, you must first identify individual desires for natural support connections.
• People receiving services should be supported to develop connections through the use of technology in the same way that all people use technology to connect with others.

Factor 4 Top Tips

By Elizabeth Sites, CQL Quality Enhancement Specialist

• There are many actions in supports and services that might involve abuse, neglect, mistreatment, and exploitation, yet are not externally reportable. Regardless of whether they are externally reportable, your ANME policy should include all actions that do not align with the values of your organization.
• Abusive acts between people receiving services should be viewed and handled in the same manner as abusive acts by staff, families, and others.
• Results of investigations should be shared with the victim so that the proper supports can be put in place as determined by the person.

Factor 5 Top Tips

By Kendra Julius, CQL Quality Enhancement Specialist

• People should have individualized education about their health concerns and treatment options, and the support to make informed healthcare decisions.
• Agencies should support people to choose their healthcare practitioners, schedule their own appointments, and be actively involved in healthcare decision making.
• Policies should include guidelines for obtaining all recommended preventative screenings and routine healthcare evaluations consistent with national standards.
• Staff and people should have education to recognize and respond to acute health changes and medical emergencies, and the supplies available to do so.

Factor 6 Top Tips

By Elizabeth Sites, CQL Quality Enhancement Specialist

• Accessibility modifications do not always have to be complex and expensive. They can be very simple, such as placing a coffee maker or microwave in a lower position.
• While there should be organization-wide protocols, there should also be protocols specific to program locations/homes and as needed for each individual person.
• You should have a system for completing internal inspections that includes who is responsible, what happens to the documentation, who reviews it, and how necessary follow-up is completed. People conducting these inspections should include DSPs and people receiving services.

Factor 7 Top Tips

By Betsy Burns, CQL Quality Enhancement Specialist

• An organization’s hiring plan should be developed and implemented based on analysis of turnover, availability of qualified candidates, supports needed by people, and other relevant data, such as the length of time it takes to hire staff, and results of satisfaction surveys or focus groups.
• Orientation for new employees needs to integrate an organization’s philosophy, vision, mission, beliefs, goals, programs, and practices.
• People receiving services should be involved in all aspects of the employment process including hiring, matching, evaluation, recognition, and staff incentives.
• Organizations should have an influential culture based on their philosophy, vision, and mission, which can help inform employee performance evaluations. Staff incentive programs also need to include both tangible and intangible rewards that are meaningful to direct support staff, which enhance their professional and personal growth.

Factor 8 Top Tips

By Jennifer Quigley

• People supported should direct the planning, development, and implementation of person-centered plans with support as needed. This plan defines the interactions with the person and supports the attainment of personal outcomes.
• People’s preferences around supports must be honored, and informed consent has to be received for person-centered plans and behavior support plans.
• Organizations should implement Positive Behavior supports that include plans for teaching replacement behaviors, alternative communication, and coping strategies rather than relying on restriction and punishment.
• Unnecessary, intrusive interventions must be prohibited by organizations. Focusing on positive behavior supports will guide an agency away from intrusive interventions such as floor restraints, rights restrictions, seclusion, and denial of food.
• Organizations need to treat psychoactive medications for mental health issues as having the potential of being intrusive. They must be reviewed on a regular basis, based on a specific psychiatric diagnosis, and people should be monitored regularly for side effects.

Factor 9 Top Tips

By Betsy Burns, CQL Quality Enhancement Specialist

• People supported should help shape the organization’s philosophy, vision, mission, beliefs, policies and procedures, and daily routines that promote the attainment of personal outcomes.
• Organizations need to use a budgeting and accounting system to plan and implement strategies that promote personal outcomes and have clear, understandable policies and procedures to assist people with managing their money.
• There must be specialized supports for people, including adaptive, therapeutic, corrective, prosthetic, orthotic, and mobility devices. The organization should also have effective systems for researching and implementing augmentative communication options.
• Organizations should ensure people and their legally authorized representative(s) decide when to share personal information, have access to, use, and contribute to the information that is in their records.

Factor 10 Top Tips

By Michael Clausen, CQL Quality Enhancement Specialist

• The strategy (policy/procedure) should detail the structure of an organization’s plan, including what Basic Assurances®-related data will be collected, who is accountable for collecting and analyzing it, associated timelines, information-sharing tactics, and a values statement.
• The system, which can be a dashboard, report, etc., should be inclusive of data and vital information that is accessible to all stakeholders – not just administrators. Expectations for capacity and expertise of analysis varies based on organizational size, resources, etc.
• A good system will allow you to identify correlations between what is happening in different programs and systems
• Begin with the data that you have right now and allow your plan to evolve based on identified strengths and opportunities.
• Organizations should have a mechanism – often a diverse committee – that is responsible for collection, analysis and action.