Oklahoma joins a growing list of states to adopt SIS to determine services for people with intellectual disabilities

Debbie Pumphrey of Oklahoma’s Developmental Disabilities Division explains the state’s decision to adopt SIS, its outreach to families, the importance of SIS training, and more.

AAIDD: What prompted Oklahoma to adopt SIS?
Pumphrey: Oklahoma was interested in the Supports Intensity Scale because it focused on objectively identifying current support needs and included information regarding employment support needs. The focus was on using the results of the SIS assessments to assist in individual planning for services and supports.

AAIDD: What assessment instrument did your state use before SIS? And how in your opinion does the Supports Intensity Scale bring something new to the developmental disability services arena?
Pumphrey: Oklahoma did not use a formal instrument prior to SIS. In two of our waivers, a locally developed checklist was used to identify support needs and in the other two waivers, a person-centered planning process in conjunction with a health related assessment was used.

The SIS will provide standardized information related to the acuity of support needs. Previously, Oklahoma had very limited capability to provide and use this type data. We eventually hope the data will provide a stronger foundation for predicting the support needs and related costs for people on the waiting list. The community of states who have adopted the SIS also appears to offer opportunity for growth and learning. While we have only participated in two SIS teleconferences and one leadership forum since initiating the contract to use the Scale, it appears this provides a great opportunity to network and learn from other states.

AAIDD: Can you discuss with us, your plans for a phased-in implememtation of the Suppots Intensity Scale over three years?
Pumphrey: Sure. Oklahoma’s Developmental Disabilities Services Division operates 4 HCBS waivers. Implementation of the Supports Intensity Scale in the In-home Supports Waivers (IHSW) will require minimal changes in the assessment and plan development process. The SIS will replace the Needs Assessment checklist that was previously used. Since the current SIS is normed for adults, we will start with the Adult IHSW. The Children’s IHSW will wait until the SIS for children is available for use. The initial implementation numbers are based on the number of case managers who provide services to adults in the IHSW, as well as the number of service recipients. Implementation in the other waivers will require modification to the planning processes used in those waivers. Case management experiences using the Supports Intensity Scale in conjunction with planning in the IHSW will provide a foundation for making these modifications. We also anticipate using SIS to identify the support needs of people on the waiting list. Use of SIS will be expanded to include those receiving services in other waivers.

AAIDD: What has the initial reaction been from case managers and families about the adoption of SIS? Are there any special plans to introduce providers and families to SIS?
Pumphrey: Some case managers and families expressed concerns about adopting the Supports Intensity Scale. Much of the concern expressed by families was related to whether SIS would be used to deny services, whether the Scale would be scored without talking to those who know the person best, whether the score would be “locked In” and whether the score would be tied to funding. This was based on information they obtained from families in other states where the SIS was being used. I met with them to discuss our intent to use SIS for individual planning, not for individual budget development and assure them that respondents would include the people who know the person best. Case managers were concerned about the amount of time it would take to administer the Scale on top of the duties they already had, as well as inter-rater reliability. I met with the advisory council regarding plans to replace other processes with SIS and develop an individual planning module in the case management software which would provide guidance to case management in the planning process and reduce the writing requirements for individual planning in the Community Waiver. We are currently planning a handbook for families, as well as a letter to families and providers regarding the Supports Intensity Scale.

AAIDD: On the technical end, I believe you are trying to integrate SISOnline into your case management system. What prompted this decision and how does it make your work more efficient?
Pumphrey: SISOnline was a natural extension of our CCM software and will be linked with it. This ability to integrate the two was a critical factor in the final decision to use the Supports Intensity Scale. This allows the case manager to complete documentation in the field, rather than returning to the office to enter them. We are able to incorporate our business rules into the software for the case management system which helps case managers effectively provide services in an individualized and extremely complex service delivery system.

AAIDD: In terms of Oklahoma’s use of SIS, how important do you consider training on SIS?
Pumphrey: Training is critical to ensure uniform administration of SIS. As you know, the Supports Intensity Scale will be administered by state-employed case managers as part of the preparation for the annual plan. AAIDD trainers will train 8 Oklahoma trainers who will train case managers to administer the Scale. Once the case manager is trained, they will administer SIS to each person on their caseload who receives services through the Adult IHSW. In subsequent years, additional case managers will be trained until all are trained.