Research indicates the quality of services that people with disabilities receive has a direct impact on their quality of life and achievement of personal outcomes. According to research done by The Council on Quality and Leadership (CQL),
“People with intellectual and developmental disabilities (I/DD) who were served by higher quality providers had significantly more personal outcomes present, regardless of their demographics or complex support needs. While quality improvement initiatives may require a significant investment of both time and financial resources from providers, our findings suggest the efforts translate to improved personal outcomes among people with IDD. The quality of life of people with IDD demands quality person-centered services and supports. The ultimate goal of service providers should be improvement of quality of life among those they support.”

The Home and Community Based Services (HCBS) Settings Rule is a guide for promoting community integration, rights, and higher quality services for people with disabilities. The Settings Rule is an opportunity for agencies to go beyond traditional regulatory compliance related to health and safety by focusing on new definitions of quality based on principles of civil rights, self-determination, personal growth, and community-involvement.
The Living Well Grant supported pilot agencies to improve the quality of their Home and Community Based Services with a multipronged approach. The most effective strategies involved providing pilot sites with:

• Improved social networks;
• New information and tools for organizational self-assessment and quality improvement planning;
• Training and technical assistance for leadership and direct service professionals from Subject Matter Experts in the areas of person-centered services and community engagement; and
• Support to stay on track, reflect on lessons learned, and adjust plans as needed through regular check-ins and involvement in Learning Collaborative and Consortium meetings.

 Pilot site agencies completed an agency self-assessment developed by the grant team at three points during the 5-year period. The “Living Well Self-Assessment Summary” provides an analysis of agency self-assessments conducted across ten domain areas using Likert-scale questions. The self-assessments, completed by seven agencies at baseline (2019-2020), six at midpoint (2022), and seven at endpoint (2023), revealed improvements in most domain areas over time, with the largest gains in “Quality Assurance and Improvement” and “Person-Centered Planning.” Factors like agency growth, leadership changes, and external challenges, including the COVID pandemic and caregiver crisis, were cited as influences on the scores. Despite some variability in participation, the process was generally seen as beneficial for strategic planning and accountability. 

Quality improvement, particularly in the new areas of focus brought about by the HCBS Settings Rule, can seem daunting amid the competing day-to-day priorities and lean budgets of HCBS agencies. The Living Well pilot agencies implemented a manageable set of specific, proven strategies to achieve the greatest impact in the most cost-effective way. Their strategies primarily focused on regular self-assessment, action planning, learning from each other, training staff and people who receive support on rights and self-advocacy, and developing community connections.

Prioritize continuous quality improvement and foster a learning organization culture. 

• Learn how the Council on Quality and Leadership’s Basic Assurances® and Personal Outcome Measures® (POM) can be used to guide your quality improvement efforts. The Council on Quality and Leadership offers manuals and webinars on these tools for any provider. Agencies can also become accredited with Basic Assurances® and POM® certified.
• Use the Living Well Agency Self-Assessment to gain full understanding of your policies, procedures and practices related to providing high quality services. The self-assessment process will help you identify and prioritize areas of need. Continue to use this assessment tool to reassess your organization every 1-2 years.
• Engage management and direct service staff in action planning once you’ve identified your top priorities for improvement. Effective action planning involves 1) setting specific, measurable goals, 2) identifying critical activities that drive outcomes, 3) regularly tracking the impact of those activities, and 4) maintaining a cadence of accountability with staff through short, regular check in meetings review to activities and commit to next steps.
• Collaborate and learn from other providers. Ask other providers who are also striving to improve their services to form a Community of Practice or Learning Collaborative group. This can be done informally or through a provider association. Meet every 1-2 months and take turns sharing resources, successful strategies and solutions to challenges. 

Provide education and training for staff and people who receive support. 

• Subscribe to the Open Future Learning training platform. HCBS agencies have found Open Future Learning to be a cost-effective tool for shifting organizational culture and building staff capacity to provide person-centered, active support. Direct Support Professionals can also use OFL’s Side by Side modules with people they support to grow their understanding of person-centeredness, self-determination, safety and abuse awareness, relationships, employment and more.
• Teach your staff and the people you support about rights. This can be done using the Living Well Let’s Talk About Rights guides and video series. When people know about and use the rights that are important to them, they have better quality of life. People with disabilities are 27 times more likely to exercise their rights when organizations have supports in place to assess, educate, and support them to exercise their rights. Rights promotion should be a top priority for your organization.
• Teach people self-advocacy and plan ways to be healthy, safe and connected in the community. This can be done by facilitating Living Well Safe and Free meetings, using the Living Well Healthy, Safe, and Connected Toolkit and offering education about sexuality and healthy relationships. Studies about participating in self-advocacy opportunities show significant, positive impacts on the well-being of people with IDD.

Focus on community engagement. 

• Host Community Conversations to engage systems partners, families, self-advocates and community members to identify ways people can be safer and more connected in the community.
• Use the Friends: Connecting People with Disabilities and Community Members manual by Dr. Angela Amado to train and guide staff on how to create meaningful community connections.
• Learn about Asset Based Community Development (ABCD) strategies to leverage the assets of your community and build community partnerships.
• Intentionally use Community Mapping to identify connections you can make with the people you support. Keep a “database” or “inventory” of all the people, places, and activities you connect with. Some tech savvy agencies are using Google My Maps to create a catalogue of opportunities for staff or individuals to reference.
• Expand individualized and small group meaningful, community-based day services that focus on skill building, connecting to community members, volunteerism, and employment exploration. 

Basic Assurances – The Basic Assurances® is a tool developed by the Council on Quality and Leadership (CQL) to evaluate the essential, fundamental, and non-negotiable requirements of all human service organizations and system. The Basic Assurances® provide organizations with guidance for ensuring that systems translate into actual practices to positively impact the lives of people with intellectual and developmental disabilities, and psychiatric disabilities.

Personal Outcome Measures (POM) – The Personal Outcome Measures® (POM) is a person-centered discovery tool developed by CQL to explore the presence, importance, and achievement of personally-defined outcomes, along with the supports that help people attain their individual goals and dreams. 21 indicators are used to gain valuable insight into the lives of people with disabilities. The interview covers a variety of topics, including choice, health, safety, social capital, relationships, rights, employment, and more. For decades, the internationally recognized tool has been an effective data set for valid and reliable measurement of individual quality of life.

Living Well Agency Self-Assessment – This agency self-assessment from WI BPDD’s Living Well team provides an opportunity to gain full understanding of an agency’s policies, procedures and practices related to providing high quality HCBS. It focuses on ten domains and includes select factors and probes from the Council on Quality and Leadership’s (CQL) Basic Assurances. After completing this tool, choose your top three domains to focus your quality improvement work.

The 4 Disciplines of Execution: FranklinCovey’s The 4 Disciplines of Execution® methodology provides a framework for organizations seeking to increase strategic execution by creating a culture of high performance. It is a simple, repeatable 4 part formula for executing important priorities.

HCBS Business Acumen Toolkit: This toolkit was designed with grant funds from the US Administration on Community Living for community-based organizations serving people with disabilities. Strong business acumen is essential for growing and sustaining high quality services.

Open Future Learning – Open Future Learning is an affordable, effective online training platform designed exclusively for agencies supporting people with IDD. Open Future Learning has collaborated with revolutionary thinkers and leaders in the IDD field to create thought provoking, engaging training content for staff on a wide variety of topics.

Healthy, Safe and Connected Toolkit – People with disabilities need to be healthy, safe and connected. This toolkit was developed by WI BPDD’s Living Well Project team and self-advocates with People First Wisconsin. This toolkit can be used by agencies to give people ways they can be healthy, safe, and connected in their communities. It is written in plain language and has planning guides and worksheets.

Let’s Talk About Rights Guides and Videos – Rights are things that people can have or do. People with disabilities should be allowed to have and do all the same things as people without disabilities. When people understand their rights, they have better lives. These guides and videos from WI BPDD’s Living Well team can help agency staff, guardians and people who receive support learn about rights.

CQL Rights Conversation Cards – CQL’s Rights Conversation Cards can help agencies educate people about their rights. These playing cards provide a fun and engaging way to spark discussion about a variety of rights involving decision-making, due process, privacy, voting, healthcare, finances, accessibility, and so much more.

CQL Sex & Relationships Conversation Cards – produced by CQL | The Council on Quality and Leadership, help support staff and people receiving services to initiate conversations about sex and relationships. Through interactive card games, people receiving services can learn about sex and relationships, along with the array of rights and responsibilities involved, as well as supports that can help people along the way.

Safe and Free Meetings – WI BPDD’s Living Well’s Safe and Free meetings are designed to help youth and adults with Intellectual and Developmental Disabilities (I/DD) learn about important topics and skills for self-advocacy, safety, and independent living. A self-advocate leader and an agency staff should co-facilitate the meeting series. The topics include – Knowing Yourself, Being Part of Your Community, Rights, Voting, Problem Solving, Communication, Abuse Awareness, Safety at Home and in the Community, and Healthy Relationships. There is a facilitator guide, workbook, and PowerPoint for all twelve meetings in the series. There is facilitator guide to guide the series.

Elevatus Sexuality Education for People with Developmental Disabilities – This is curriculum was designed to teach people with developmental disabilities about sexuality and healthy relationships. This curriculum has been field tested by Elevatus and used by Living Well pilot sites with positive results and feedback.

Community Conversations – Community Conversations are a highly effective tool developed by the Waisman Center to bring people together to raise awareness and identify partnerships and solutions to issues affecting the lives of people with disabilities. Wisconsin has successfully used Community Conversations in Living Well and a number of other disability-focused projects, which have resulted in positive impacts on attitudes, engagement, and collaboration.

Asset Based Community Development – The ABCD Institute at DePaul University offers information, training, manuals and other resource guides on using Asset Based Community Development to leverage the gifts and mobilizing the assets of local communities. Faculty members Deb Wisniewski and Joe Erpenbeck both have experience providing training to HCBS providers.

Google Mapping – A tool that can assist in creating agency and individual maps Google my maps. The tool allows you to create a resource map of your area and can be personalized for the assets in your agencies area. The tool can also be used to build individual client maps.

Friends: Connecting People with Disabilities to Community Members – This manual by Angela Amado provides concrete, “how-to” strategies for supporting relationships between people with disabilities and other community members. It describes why such friendships are important to people with disabilities and why it is important to promote community belonging and membership. The manual includes specific activities to guide users in creating a plan for connecting people.

Building Full Lives Service Model – Building Full Lives (BFL) is an individualized community-based day service model that creates pathways to competitive integrated employment (CIE) by supporting people in small group activities, usually involving 3-4 people and one staff, to explore their communities, identify their preferences and goals, develop life skills and contribute to/be involved in their communities in meaningful ways. Check out the Building Full Lives Essential Elements and Agency Self-Assessment Tool in the BFL Model Toolkit in the Tools for Grantees section of the webpage.

A Framework for Community Engagement – An August 2022 brief paper by the U.S. Department of Education’s Office of Special Education and Rehabilitative Services, aimed at policymakers as well as service providers, presents a shared Federal vision for community engagement. Developed in partnership with ODEP and the U.S. Department of Health and Human Services’ Administration for Community Living as well as the Substance Abuse and Mental Health Services Administration, this paper explains why this vision is important and how it may lead to better employment outcomes, as well as identifies the types of supports required and available through multiple service systems to facilitate community engagement for individuals with disabilities, including youth.

Download the Reflection Activity to make your Quality Improvement Action Plan!