Oregon after the pilot-find out lessons learned and plans for full implementation of SIS this fall

Oregon established a discrete assessment unit and reinstated quality assurance and reliability procedures through training, as the state moves ahead with full scale implementation of SIS. This comes after conducting a pilot study with SIS last year. Jan Morgan from Oregon’s Restructuring Budgets, Assessments and Rates project tells us more.

AAIDD: As Oregon prepares to implement the Supports Intensity Scale statewide, can you comment on your general experience with SIS so far? What are the major lessons learned from the pilot that will inform your full roll out of the Scale?
Morgan: We were pleased overall with the use of the Supports Intensity Scale in our pilot results from the summer of 2007. In terms of major lessons learned, there were many. We realized the significant impact on workload in the area of scheduling interviews. Interviews can take anywhere from 1 ½ -4 hours. The realistic number of assessments per day for interviewers is no more than 2 (although we did manage to accomplish 3 in many instances). We recognized the need for us to develop an assessment unit to address the training and administration of the assessments, as well as regular inter-rater reliability checks and on-going training of interviewers. Regarding the technical aspects, we learned that SISOnline storage capabilities provided data on all assessments for us, allowing us to establish a new database. However, we needed the demographic data on the consumer to be pre-populated to minimize errors. Talking about consumers, another major lesson learned was the need for a preliminary orientation of the Supports Intensity Scale for respondents and consumers before attending the interview. In the same vein, we recognized the merit in the consumer meeting the interviewer, even if he/she can’t stay for it. There is no doubt that excellent information coming from the SIS interview can be used for ISP planning purposes, although we felt that the SIS questions did not entirely capture all the supports some of our consumers need.

AAIDD: Can you elaborate on the new assessment unit developed by the state?
Morgan: Our existing case managers have very high caseloads. We want to ensure that consistency is maintained and controlled statewide, not only in administration, but also in on-going training. Case managers in Oregon are employees of individual counties, not the state, and this would create difficulty in maintaining this kind of consistency for hundreds of interviewers for whom this is not their main activity. Hence the decision to establish a separate assessment unit.

AAIDD: Clearly, you have spent considerable resources and time on organizing the pilot project with SIS, and it looks like it was a helpful endeavor. Would you also recommend a pilot as a strategy to other states and large entities before fully implementing SIS?
Morgan: Absolutely. It allowed us to learn what the issues would be on a small scale so that we could adjust our procedures without adversely affecting current systems. We were interested in testing the elements of organizing, coordinating, and scheduling interviews. We also wanted to obtain participant feedback about the process from counties, providers, consumers, and AAIDD interviewers. Finally, since we want to develop an Individual Budgeted Amount Model for the consumers with 24-hour residential, supported living, employment/inclusion services, we needed to collect data to use for that model.

AAIDD: Oregon will be one of the first states to implement many follow up and proactive checks with training to ensure quality in your assessment work. Training in Oregon will include inter rater reliability checks, quarterly meetings between AAIDD and state trainers, and conference calls. How do you hope this process will contribute to the Restructuring Budgets, Assessments and Rates project and families?
Morgan: Since funding will be tied in part to SIS scores, it is imperative that we ensure that the assessments are being done consistently and accurately statewide. The intent is that the inter-rater reliability checks, quarterly meetings, conference calls, etc. will allow us to have the best reliability and accuracy possible on an on-going basis. AAIDD will be training our Senior Assessment Specialists who will then train others as needed.

AAIDD: I believe you are also revising supplemental questions on SIS as part of the full scale roll out of SIS. What prompted this move?
Morgan: We are still studying this aspect to decide exactly what we will do. We have determined that there are a small number of targeted areas in regard to medical and behavioral issues where additional information seems to be useful. We want to make sure we have these kinds of questions included so that we can continue to study them for their usefulness as we have more SIS results to consider. The contractor helping us with this, Human Services Research Institute, has also identified a small number of SIS and Supplemental Question items which can be used to “flag” individuals who might need individual review for exceptional supports beyond the standard model.

AAIDD: In the final analysis, what do you hope to achieve for your developmental disability system and people served by investing in the Supports Intensity Scale system?
Morgan: We believe that the Supports Intensity Scale will help Oregon determine and meet the needs of consumers of comprehensive waiver services (24-hour residential, supported living, and employment/inclusion) more effectively and in a more standardized way. We also believe that SIS will help distribute resources fairly and equitably statewide by using the assessment scores to help develop an Individual Budgeted Amount model. We hope then to establish a database of consumers’ needs and available supports.

AAIDD: What in your opinion can AAIDD do more to enhance its support to your state?
Morgan: Continue to work productively with us as we move forward, including training of our interviewers and assisting with quality assurance on an ongoing basis.