National Core Indicators Tell How Well States Serve People with IDD; Providers’ Surveys Vital
By Robin Wilmoth and Janet Shouse
About the Author
Robin Wilmoth is the director of Innovative Programs with the Department of Intellectual and Developmental Disabilities. Robin has 30 years of experience serving as a direct support professional, employment specialist, independent support coordinator, quality assurance director and residential director with provider agencies in Tennessee. Prior to coming to DIDD and working in the provider field, she was with the Middle Tennessee Human Rights Committee for 10 years. As director of Innovative Programs, Robin assists with accreditation efforts, person centered practices, DIDD Policy Committees and Councils. She also provides training across the state as well as working directly with persons served in focus groups.
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Our aim today is twofold. One, we want to help make people aware of the National Core Indicators, and two, we want to encourage community provider agencies to tackle the time-consuming task of completing their National Core Indicators surveys.
So, what are the National Core Indicators? And why should you care?
National Core Indicators (NCI)™ is a voluntary effort by public developmental disabilities agencies to measure and track their own performance. While many of you may not yet be receiving any developmental disabilities services, the chances are that you or your loved one will at some point. And the National Core Indicators can help you evaluate how your state is doing. You can also see how other states measure up against Tennessee.
National Core Indicators is a collaborative effort between the National Association of State Directors of Developmental Disabilities Services and the Human Services Research Institute. (Both sites have great information.) The purpose of the program, which began in 1997, is to support NASDDDS member agencies to gather a standard set of performance and outcome measures that can be used to track their own performance over time, to compare results across states, and to establish national benchmarks. A majority of states contribute data.
The NCI data reflects efforts funded by Medicaid dollars. Medicaid affects many of us– children and adults with disabilities, people who are aging, those with limited incomes, and many who experience the unexpected. It is a critical safety net.
The National Core Indicators look at five major categories and how developmental disabilities service systems perform, although not all states participate in all measures:
- Individual Outcomes– Individual outcome indicators address how well the public system aids adults with developmental disabilities to work, participate in their communities, have friends and sustain relationships, and exercise choice and self-determination. Other indicators in this domain probe how satisfied individuals are with services and supports.
- Health, Welfare and Rights– These indicators address safety and personal security; health and wellness; and protection of and respect for individual rights
- System Performance– The system performance indicators address service coordination; family and individual participation in provider-level decisions; the utilization of and outlays for various types of services and supports; cultural competency; and access to services.
- Staff Stability– These indicators address provider staff stability and competence of direct contact staff.
- Family Indicators– The family indicators address how well the public system assists children and adults with developmental disabilities, and their families, to exercise choice and control in their decision-making, participate in their communities, and maintain family relationships. Additional indicators probe how satisfied families are with services and supports they receive, and how supports have affected their lives.
The Tennessee Department of Intellectual and Developmental Disabilities would like to share information about the two National Core Indicator Surveys that are currently being completed by providers who use Medicaid funds to support people with intellectual and developmental disabilities. The 2016/2017 National Core Indicators Adult Consumer Surveys and the 2017 NCI Staff Stability Survey.\
As it has for the past two years, DIDD utilizes the National Core Indicators because it is recognized nationally as a standardized way to look at information across states. This information helps states identify where they need to improve services.
DIDD recognizes the time and effort that providers take to complete these surveys. This information, in turn, helps DIDD identify ways to improve services for people supported and the direct support professionals that support them. We, as advocates, appreciate the information that is available to us as a state because of Tennessee providers’ commitment to providing this information.
1) Currently, 77% of the 2016/2017 NCI Adult Consumer Surveys have been completed and returned to DIDD. Providers only have to provide the background information that allows the supported individual to participate in the interview at his or her convenience. Without the remaining 33%, we may not understand fully the quality of the services that people in our state receive.
The Adult Consumer Surveys core indicators (really just questions asked of the individual and those who know he or she well) used across 42 states to assess the outcomes of services provided to people supported by the state. Indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.
2) Currently, just 10% of the 2017 NCI Staff Stability Surveys have been completed and returned to DIDD. The surveys are due June 30, 2017. These surveys provide data that can drive decisions of policymakers and funding.
The Staff Survey core indicators are used across 42 states to assess the average length of service for all direct contact staff who left their jobs or who were terminated in the past year, and to describe the situation of all currently employed direct contact staff.
Addressed are the crude separation rate, which is the proportion of direct contact staff separated (no longer employed, either by employee decision to leave or agency decision to terminate) in the past year, and the vacancy rate, which is defined as the proportion of direct contact positions that were vacant as of a specified date. Direct contact staff salaries, bonuses, and benefits packages are also requested for this survey, in an effort to develop a comprehensive report.
Using standard measures across states allows a picture to develop of what is happening not only in Tennessee, but in other states also. While we hear many providers complaining about staff turnover and difficulty finding quality employees, documenting these issues using the 2017 NCI Staff Stability Surveys, could be a powerful tool in making a case for needed changes in the industry.
Information from these two surveys contributes to The Case for Inclusion, a yearly report presented by United Cerebral Palsy, an international advocate, educating and providing support services for children and adults with a spectrum of disabilities through an affiliate network. The Case for Inclusion is an annual ranking of how well state Medicaid programs serve Americans with intellectual and developmental disabilities. Individuals with IDD, including the aging, want and deserve the same freedoms and quality of life as all Americans.
These surveys will enable Tennessee to move forward with having comprehensive reports to present and use for:
- Informing policy and program development regarding direct support professional workforce improvement initiatives
- Monitor and evaluate the impact of workforce initiatives
- Compare state workforce outcomes with those of other states
- Provide context for consumer outcomes
- Build systems to more effectively collect, analyze, and use workforce data