Community Participation Program

Intensive Behavioral Supports

Older Adult Program

Production Center

Residential Services

Supported Employment Services

Community Participation Program
(CARF: Personal and Social Services)

Program Description:

ARC Broward, Inc. provides specialized supports to individuals who display deficits in basic personal hygiene skills and who lack the ability or interest to prepare for integrated community employment. The purpose of this program is to provide the participants with needed assistance and support and greater skills and competencies in order to optimize adaptive functioning and enhance opportunities for social integration. Supports are provided in community-integrated settings that support individuals in valued roles in the community, are age and culturally appropriate, increase the individuals ability to control their environment, encourage the development of friendships and emphasize community inclusion.

The program operates during the weekdays between the hours of 8:30am and 3:30pm. Staff to client ratios do not exceed those dictated in the Medicaid Waiver Core Assurances. Support staff include nursing, social service specialists, behavior specialists and a Certified Behavior Analyst. Treatment is provided within the context of structured and meaningful daytime activity aimed at maximization of optimal social and behavioral functioning.

Within the first thirty days of enrollment, each individual receives an initial comprehensive functional assessment of skills and behaviors and participates as a key member of the Support Team in the development of a Person-Centered Plan that includes the identification of goals and objectives. Every year thereafter, assessments are conducted and Individual Program Plans are reviewed. Treatment Plans addressing the formal objectives are reviewed, analyzed and modified, if needed, at least monthly.

Individuals are presented with a "menu" of service alternatives and are assisted by their support teams to "design" their supports by selecting desired services/activities. Several activities are offered concurrently to allow for individual choice. Services offered include the following categories with activities in each reflecting those most requested and those with highest overall reported satisfaction and may include but not be limited to the following:

Community Inclusion

Physical Exercise

Socialization/Interaction

Personal Care/Grooming

Recreation/Leisure

Nutrition/Meal Time Activity

Communication

Volunteer Activities

Outcome Management System:

Effectiveness Indicators:

	a) Maximize the percentage of individuals served who have demonstrated progress on at least 50% of their objectives/strategies identified in individualized plan.
	Target: 80% of individuals Measurement Tool: Objectives: Graphic Displays of Data (Individualized per child per behavioral objective) Strategies: Quarterly Progress Reports Reporting Period: October 1 through September 30

Each October, Team Leaders will evaluate annual progress by analyzing graphic displays for increasing trends (objectives) and reviewing statement of progress (strategies). For each individual served, team leaders will divide the total number of objectives/strategies in which progress was demonstrated by the total number of objectives/strategies and multiply by 100 to determine percentage of objectives/strategies in which progress was demonstrated for each person. Subsequently, team leaders will divide the total number of individuals who demonstrated progress on 50% or more of their objectives/strategies by the total number of individuals and multiply by 100 to determine the percentage of individuals who demonstrated progress on at least 50% of their objectives.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Maximize the percentage of individuals served who participate in 12 or more community activities per month.
	Target: 80% of individuals served Measurement Tool: Recreation Tracking Sheet Reporting Period: October 1 through September 30

Each October, the Activity Specialist will calculate the percentage of individuals who participated in 12 or more activities per month by dividing the total number of individuals in each program (separately) who participated in 12 or more activities per month by the total number of individuals in each program and multiplying by 100.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicators:

	a) Minimize average annual cost of care of persons receiving services/supports
	Target: 5% below budgeted cost of care (based on cost of care from previous year) Measurement Tool: Financial Database/Expenditure Reports Reporting Period: October 1 through September 30

Each October the Coordinator of Quality Assurance or designee will determine average cost of care per person receiving services/supports by dividing the total budgeted operating expenses by the projected annual census. Subsequently, the Coordinator of Quality Assurance will compare the average annual cost of care for the ending fiscal year to the budgeted cost of care to determine the percentage of increase or decrease from the previous year.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicators:

	a) Maximize consumer satisfaction scores for persons receiving services/supports.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

Data will be calculated for each service area by dividing the number of individuals who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of individuals who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Community Participation Program

Analysis of Findings:

A review of the data of the 16 individuals who are enrolled in the Community Participation program reveals that 9 individuals demonstrated progress on 50% or more of their objectives during the past year (56% of the individuals served). This is below the targeted outcome of 80%. However, significant variables over the past year may be correlated with this performance including renovation to the facility, which resulted in relocating individuals to a different area of the facility and caused disruption in continuity and stability; high rates of staff turn-over which resulted in inconsistency in treatment implementation; and missing/lost data during the packing/moving phase of the renovation. Additionally, supervision, training and monitoring of the Community Participation staff members were the responsibility of person-centered team leaders who were often not on-site due to oversight responsibilities of a number of off-site programs, including group homes, supported living, supported employment and day programs as well as direct responsibility for behavioral treatment for all individuals on their teams. These findings resulted in the assembling of a project team to conduct an overall evaluation of the Adult Services Division's structure and service delivery. Recommendations generated from this evaluation team resulted in some restructuring of the division whereby the Community Participation program and staff have been shifted to the leadership of a Day Program Manager who reports to an on-site Program Coordinator. Additionally, the team's recommendations contributed to the establishment of the Facility Based Behavioral Services Team, which has been added to the Behavioral and Psychological Health Care Division. This team will provide direct support, including training and monitoring, in the areas of functional analysis and behavioral plan development, implementation and analysis of progress.

Ninety-two percent (92%) of the individuals served participated in 12 or more activities per month during the reporting period. This exceeds the targeted outcome of 80%. It is recommended that the team evaluate the outcome indicator for modification by either increasing the target or redefining the measure to examine the type of activities in relation to the mission of the program.

Performance on the efficiency indicator slightly exceed the targeted outcome. Analysis of budget and expenditure report data reveals that Community Participation expenditures were 10.7% below budgeted costs.

Consumer Satisfaction surveys conducted with the participants of the program or individual's family member or other designated persons on behalf of the participant revealed that 90% of the respondents reported overall satisfaction with services received. Social Service Specialists attempted to survey all sixteen participants or representatives through interviews, but were only able to obtain responses from ten individuals. Nine of the ten reported overall satisfaction. The descriptive feedback provided by the respondents included the following statements:

	Need more security and supervision
	Supervision is poor
	Communication is good
	[Participants are] not engaged in any activity
	[Participants are] not learning anything
	Vans do not appear safe

It is noteworthy that the majority of the statements were reported by one individual. However, the input is significant and will continue to be addressed by the Adult Services Team who will develop strategies to evaluate and, where necessary, improve upon the identified areas. The changes in the structure, as well as the appointment of a new Activity Specialist are expected to yield significant improvement in many of these areas. Additionally, internal quality assurance activities will include a focus upon these areas through further participant interviews, formal observation and record reviews.

The second effectiveness measure, maximizing the percentage of individuals served who participate in 12 or more community activities per month, will be enhanced to participate in 12 or more community activities that are consistent with program's mission per month. The existing tool to collect this data will be revised accordingly. The target of 80% will remain the same for the next reporting period.

Program Description:

ARC Broward provides specialized day treatment to individuals who display severe behavior problems that result in harm or potential harm to self, others or property; interfere with adaptive functioning; interfere with social acceptance; and/or significantly deviate from a known standard or norm. Priority for placement is given to individuals whose behaviors pose the greatest danger to self or others. The purpose of this program is to provide the participants with greater skills and competencies and control or eliminate problem behaviors in order to optimize adaptive functioning and enhance opportunities for social and vocational integration.

The program provides day treatment during the weekdays between the hours of 8:30am and 3:30pm. Staff ratios do not exceed six participants per staff member. Support staff include on-site nursing, social service specialists, behavior specialists and certified behavior analysts. Treatment is provided within the context of structured and meaningful daytime activities aimed at maximization of optimal social, behavioral and mental functioning.

Within the first thirty days of enrollment in the program, each individual receives an initial comprehensive functional assessment of skills and behaviors and participates as a key member of the Interdisciplinary Treatment Team in the development of a Person-Centered Program Plan that includes the identification of goals and objectives. Each objective is addressed through formal behavior programs utilizing behavior analysis techniques and procedures. Every year thereafter, assessments are conducted and Person-Centered Plans are reviewed. Short-term treatment programs addressing formal objectives are reviewed, analyzed and modified, if needed, at least monthly.

In addition to treatment plan implementation, each individual will engage in a structured daily schedule that includes a selection of activities from each of the following areas:

Pre-Vocational Training or Personal and Social Skills Training

Physical Exercise

Socialization

Communication/Alternative Communication Strategies

Anger Management

Relaxation Therapy

Conflict Resolution

Outcome Management System:

Effectiveness Indicators:

	a) Maximize the percentage of individuals served who have demonstrated progress on at least 50% of their objectives/strategies identified in individualized plan.
	Target: 80% of individuals Measurement Tool: Objectives: Graphic Displays of Data (Individualized per child per behavioral objective) Strategies: Quarterly Progress Reports Reporting Period: October 1 through September 30

Each October, Team Leaders will evaluate annual progress by analyzing graphic displays for increasing trends (objectives) and reviewing statement of progress (strategies). For each individual served, team leaders will divide the total number of objectives/strategies in which progress was demonstrated by the total number of objectives/strategies and multiply by 100 to determine percentage of objectives/strategies in which progress was demonstrated for each person. Subsequently, team leaders will divide the total number of individuals who demonstrated progress on 50% or more of their objectives/strategies by the total number of individuals and multiply by 100 to determine the percentage of individuals who demonstrated progress on at least 50% of their objectives.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicators:

	a) Minimize average annual cost of care of persons receiving services/supports
	Target: 5% below budgeted cost of care (based on cost of care from previous year) Measurement Tool: Financial Database/Expenditure Reports Reporting Period: October 1 through September 30

Each October the Coordinator of Quality Assurance or designee will determine average cost of care per person receiving services/supports by dividing the total budgeted operating expenses by the projected annual census. Subsequently, the Coordinator of Quality Assurance will compare the average annual cost of care for the ending fiscal year to the budgeted cost of care to determine the percentage of increase or decrease from the previous year.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicators:

	a) Maximize consumer satisfaction scores for persons receiving services/supports.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

Data will be calculated for each service area by dividing the number of individuals who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of individuals who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Intensive Behavioral Support

Analysis of Findings:

A review of the data of the 22 individuals who have been enrolled in the Community Participation program between October 1999 and September 2000 reveals that 16 individuals demonstrated progress on 50% or more of their objectives (73% of the individuals). This is below the targeted outcome of 80%. However, significant variables over the past year may be correlated with this performance including renovation to the facility, which resulted in relocating individuals to a different area of the facility and caused disruption in continuity and stability; high rates of staff turn-over which resulted in inconsistency in treatment implementation; and missing/lost data during the packing/moving phase of the renovation. Additionally, supervision, training and monitoring of the Community Participation staff members were the responsibility of person-centered team leaders who were often not on-site due to oversight responsibilities of a number of off-site programs, including group homes, supported living, supported employment and day programs as well as direct responsibility for behavioral treatment for all individuals on their teams. These findings have resulted in the assembling of a team to conduct an overall evaluation of the Adult Services Division's structure and service delivery. Recommendations generated from this evaluation team resulted in some restructuring of the division whereby the Community Participation program and staff have been shifted to the leadership of a Day Program Manager who reports to an on-site program coordinator. Additionally, the team's recommendations contributed to the establishment of the Behavioral Services Team, which has been added to the Behavioral and Psychological Health Care Division. This team will provide direct support, including training and monitoring, in the areas of functional analysis and behavioral plan development, implementation and analysis of progress.

Performance on the efficiency indicator did not meet the targeted outcome of 5%. Analysis of budget and expenditure report data reveals that Intensive Behavioral Services expenditures were 0.7% below budgeted costs. Unanticipated severe staff shortages resulted in additional expenses for temporary agency personnel. Additional recruitment efforts are expected to minimize this. Additionally, increased personnel costs were factored into the budget for the upcoming reporting year.

Consumer Satisfaction surveys conducted with the participants of the program or individual's family member or other designated persons on behalf of the participant revealed that 97% of the respondents reported overall satisfaction with services received. Social Service Specialists attempted to survey all forty-nine (49) of the participants or representatives through interviews, but were only able to obtain responses from thirty-three (33) individuals. Thirty-two (32) of the thirty-three (33) reported overall satisfaction. The descriptive feedback provided by the respondents included the following statements:

	"Provide more social activities"
	"It is a God send to be open 5 days"
	"[There is] no stability in the classroom"
	"Quicken the process of hiring…"
	"[I am not satisfied with] employees that are not appropriate for job. Also, the long wait to get services."
	"I want to go out on trips and make more money"
	"I have a lot of work to do everyday and I like the kind of work I do"
	"I like the concern that staff gives to [my son]. He has really grown up and likes to make money."
	"I don't like my class. It is too noisy. I like the workshop."

Despite the high satisfaction rate, the narrative input is significant and will continue to be addressed by the Adult Services Team who will develop strategies to evaluate and, where necessary, improve upon the identified areas. The changes in the structure, addition of the Behavioral Team, and the appointment of a new Activity Specialist are expected to yield significant improvement in many of these areas. Additionally, ARC Broward has added a Recruiter to assist in the timely hiring of qualified employees. Finally, internal quality assurance activities will include a focus upon these areas through further participant interviews, formal observation and record reviews.

The current measures and goals will remain the same for the next reporting year.

Program Description:

ARC Broward provides specialized supports to individuals with developmental disabilities who are over the age of 55 or who suffer from precocious aging. The program operates from 8:30am to 3:30pm Monday through Friday. Staff to client ratios do not exceed those dictated in the Medicaid Waiver Core Assurances. Support staff includes nursing, social service specialists and behavior specialists, as needed.

The purpose of the Older Adults Program is to provide individuals with retirement choices/options so that they will have an opportunity to enjoy a rich, satisfying and meaningful quality of life as they are aging. Supports are provided in community-integrated settings that support individuals in valued roles in the community, are age and culturally appropriate, increase the individuals' ability to control their environment, encourage the development of friendships and emphasize community inclusion.

Supports are person-centered based upon individual choices, preferences, interests, abilities and needs. Each individual receives an initial and subsequent annual assessment of his/her preferences, interests, abilities and needs. The individual participates as a key member of his/her interdisciplinary team to develop yearly Person Centered Plans that include goals and objectives for the upcoming year. Individualized active treatment plans are developed and implemented to optimize adaptive functioning and maintenance of skills. Psychiatric care plans are implemented, as necessary, to promote safety, comfort and stability of individuals' mental health. Additionally, assistance is provided as needed for self-care activities (e.g. toileting, feeding, and medication administration).

Individuals are presented with a "menu" of service alternatives and are assisted by their support teams to "design" their supports by selecting desired services/activities. Several activities are offered concurrently to allow for individual choice. Services offered include the following categories with activities in each reflecting those most requested and those with highest overall reported satisfaction and may include but not be limited to the following:

Leisure Activities

Socialization/Interaction/Cognitive Growth and Maintenance

Personal Growth and Development

Supported Retirement

Volunteer Activities

Consumer Empowerment

Outcome Management System:

Effectiveness Indicators:

	a) Maximize the percentage of individuals served who have demonstrated progress on at least 50% of their objectives/strategies identified in individualized plan.
	Target: 80% of individuals Measurement Tool: Objectives: Graphic Displays of Data (Individualized per child per behavioral objective) Strategies: Quarterly Progress Reports Reporting Period: October 1 through September 30

Each October, Team Leaders will evaluate annual progress by analyzing graphic displays for increasing trends (objectives) and reviewing statement of progress (strategies). For each individual served, team leaders will divide the total number of objectives/strategies in which progress was demonstrated by the total number of objectives/strategies and multiply by 100 to determine percentage of objectives/strategies in which progress was demonstrated for each person. Subsequently, team leaders will divide the total number of individuals who demonstrated progress on 50% or more of their objectives/strategies by the total number of individuals and multiply by 100 to determine the percentage of individuals who demonstrated progress on at least 50% of their objectives.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Maximize the percentage of individuals served who participate in 12 or more community activities per month.
	Target: 80% of individuals served Measurement Tool: Recreation Tracking Sheet Reporting Period: October 1 through September 30

Each October, the Activity Specialist will calculate the percentage of individuals who participated in 12 or more activities per month by dividing the total number of individuals in each program (separately) who participated in 12 or more activities per month by the total number of individuals in each program and multiplying by 100.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicators:

	a) Minimize average annual cost of care of persons receiving services/supports
	Target: 5% below budgeted cost of care (based on cost of care from previous year) Measurement Tool: Financial Database/Expenditure Reports Reporting Period: October 1 through September 30

Each October the Coordinator of Quality Assurance or designee will determine average cost of care per person receiving services/supports by dividing the total budgeted operating expenses by the projected annual census. Subsequently, the Coordinator of Quality Assurance will compare the average annual cost of care for the ending fiscal year to the budgeted cost of care to determine the percentage of increase or decrease from the previous year.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicators:

	a) Maximize consumer satisfaction scores for persons receiving services/supports.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

Data will be calculated for each service area by dividing the number of individuals who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of individuals who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Older Adult Program

Analysis of Findings:

A review of the data of the 25 individuals who are enrolled in the Community Participation program reveals that 10 individuals demonstrated progress on 50% or more of their objectives during the past year (40%). This is below the targeted outcome of 80%. However, significant variables over the past year may be correlated with this performance including renovation to the facility, which resulted in relocating individuals to a different area of the facility and caused disruption in continuity and stability; high rates of staff turn-over which resulted in inconsistency in treatment implementation; and missing/lost data during the packing/moving phase of the renovation. Additionally, supervision, training and monitoring of the Community Participation staff members were the responsibility of person-centered team leaders who were often not on-site due to oversight responsibilities of a number of off-site programs, including group homes, supported living, supported employment and day programs as well as direct responsibility for behavioral treatment for all individuals on their teams. These findings have resulted in the assembling of a team to conduct an overall evaluation of the Adult Services Division's structure and service delivery. Recommendations generated from this evaluation team resulted in some restructuring of the division whereby the Community Participation program and staff have been shifted to the leadership of a Day Program Manager who reports to an on-site program coordinator. Additionally, the team's recommendations contributed to the establishment of the Behavioral Services Team, which has been added to the Behavioral and Psychological Health Care Division. This team will provide direct support, including training and monitoring, in the areas of functional analysis and behavioral plan development, implementation and analysis of progress.

One hundred percent (100%) of the individuals served participated in 12 or more activities per month during the reporting period. This exceeds the targeted outcome of 80%. It is recommended that the team evaluate the outcome indicator for modification by either increasing the target or redefining the measure to examine the type of activities in relation to the mission of the program.

Performance on the efficiency indicator did not meet the targeted outcome of 5%. Analysis of budget and expenditure report data reveals that Intensive Behavioral Services expenditures were 1.9% below budgeted costs. Unanticipated under-enrollment resulted in this variance outcome. However, the expenditures were consistent with budgeted costs.

Consumer Satisfaction surveys conducted with the participants of the program or individual's family member or other designated persons on behalf of the participant revealed that 100% of the respondents reported overall satisfaction with services received. Social Service Specialists attempted to survey all twenty-five participants or representatives through interviews, but were only able to obtain responses from twenty-one (21) individuals. The descriptive feedback provided by the respondents included the following statements:

	"[I like] the outings"
	"[I like] seeing my friends"
	"They [staff] try to work with you and make changes, if requested"
	"I love to go to ARC"
	"Provide the opportunity to cook"

Despite the high satisfaction rate, the narrative input is significant and will continue to be addressed by the Adult Services Team who will develop strategies to evaluate and, where necessary, improve upon the identified areas. The changes in the structure, addition of the Behavioral Team, and the appointment of a new Activity Specialist are expected to yield significant improvement. Additionally, ARC Broward has added a Recruiter to assist in the timely hiring of qualified employees. Finally, internal quality assurance activities will include a focus upon these areas through further participant interviews, formal observation and record reviews.

The second effectiveness measure, maximizing the percentage of individuals served who participate in 12 or more community activities per month, will be enhanced to participate in 12 or more community activities that are consistent with program's mission per month. The existing tool to collect this data will be revised accordingly. The target of 80% will remain the same for the next reporting period.

Program Description:

ARC Broward, Inc. provides vocational training to individuals with Developmental Disabilities who are either preparing for integrated community employment or, for various reasons, are not currently interested in or able to pursue community employment but desire opportunities for vocational training, experience and monetary compensation. Individuals perform vocational tasks including but not limited to assembling, packaging, sorting, collating, and labeling for businesses in the community who contract with the Production Center at ARC Broward. Individuals work both independently and as members of an assembly team and are paid for the work that they perform. The purpose of this program is to provide the participants with training to develop vocational competencies and social skills that promote success in the work place.

The program operates during the weekdays between the hours of 8:30am and 3:30pm.

Within the first thirty days of enrollment, each individual receives an initial comprehensive functional assessment of skills and behaviors and participates as a key member of the Support Team in the development of a Person-Centered Plan that includes the identification of goals and objectives. Every year thereafter, assessments are conducted and Individual Program Plans are updated and modified.

Outcome Management System:

Effectiveness Indicator:

	Maximize the percentage of individuals whose efficiency ratings improve by at least 3% each year.
	Target: 75% of individuals Measurement Tool: Monthly Efficiency Reports Reporting Period: October 1 - September 30

Each October, the Production Department Head will calculate data by comparing the previous twelve-month average efficiency rating to the twelve-month average for the year prior to such for each individual. For individuals who have been enrolled for less than 24 months, but at least 12 months, the final nine-month average will be compared to the initial 3-month average. The total number of individuals whose average efficiency rating has improved by 3 percentage points or more over the previous twelve month period will be divided by the total number of individuals in the sample and multiplied by 100 to obtain the percentage of individuals who have demonstrated improvement of 3 % or greater. The sample will only include individuals who have been enrolled in the Production Program for the previous 12-month period.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicators:

	Minimize average annual cost of care of persons receiving services/supports
	Target: 5% below budgeted cost of care (based on cost of care from previous year) Measurement Tool: Financial Database/Expenditure Reports Reporting Period: October 1 through September 30

Each October the Coordinator of Quality Assurance or designee will determine average cost of care per person receiving services/supports by dividing the total budgeted operating expenses by the projected annual census. Subsequently, the Coordinator of Quality Assurance will compare the average annual cost of care for the ending fiscal year to the budgeted cost of care to determine the percentage of increase or decrease from the previous year.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicators:

	a) Maximize consumer satisfaction scores for persons receiving supports/services.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

Data will be calculated for each service area by dividing the number of individuals who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of individuals who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Maximize stakeholder satisfaction scores.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

The Coordinator of Support Services will generate surveys to the businesses that contract with the Production Center and obtain and compile results each September.

Data will be calculated by dividing the number of stakeholders who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of stakeholders who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Director of Program Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Production Center

Analysis of Findings:

Performance on the effectiveness measure did not meet the targeted outcome. Many variables appear to correlate with this outcome including the reconstruction of the production center during which time production was disrupted by ongoing construction in the environment, the new work environment provides less space than the former environment and increased age of the individuals which appears to correlate with decreased motor skills and speed. Additionally, sixteen new jobs have been added to the Production Center workload. This affects efficiency of the individuals because the learning curve on a new job ranges from two weeks to three months, many of the new jobs include new tools and machines to acquire utilization skills for, product size on several new jobs were awkward to handle and nearly all new jobs contained multiple steps. Another factor related to lower efficiency and progress of individuals is the new configuration of the Production Center in which multiple jobs are now handled on each production line. Finally, there has been more work and less downtime; hence, individuals have not had as much time to rest between jobs. Plans to address these variables include ensuring more stability in the Production Center, limiting the number of new jobs in a manner that allows the individuals to thoroughly learn the steps before another job is added and building in structured non-work tome to alleviate fatigue.

Performance on the efficiency indicator exceeded the targeted outcome of 5%. Analysis of budget and expenditure report data reveals that Production Center Services expenditures were 11% below budgeted costs.

Consumer Satisfaction surveys conducted with the participants of the program or individual's family member or other designated persons on behalf of the participant revealed that 96% of the respondents reported overall satisfaction with services received. Social Service Specialists attempted to survey all one hundred and thirty (130) participants or representatives through interviews, but were only able to obtain responses from one hundred and twelve (112) individuals. The descriptive feedback provided by the respondents included the following statements:

	"I like getting my paycheck"
	"I feel like I am accomplishing things"
	"Everyone is nice to me"
	"Staff are nice and concerned about me"
	"I like the way I am notified if there is something wrong. [Staff] respect my input on behalf of my children."
	"[I like the] nurse best."
	"It is too noisy."
	"I want a job in the community."
	"I want more work"
	"I would like to see more family involvement."
	"[I am not satisfied with] staff turnover."
	"[I want] speech therapy for adults."
	"I want to make more money"
	"I do not like having to wait for work from my instructor. I would like to be a self starter."

Despite the high satisfaction rate, the narrative input is significant and will continue to be addressed by the Adult Services Team who will develop strategies to evaluate and, where necessary, improve upon the identified areas. The changes in the structure, addition of the Behavioral Team, and the appointment of a new Activity Specialist are expected to yield significant improvement. Additionally, ARC Broward has added a Recruiter to assist in the timely hiring of qualified employees. Finally, internal quality assurance activities will include a focus upon these areas through further participant interviews, formal observation and record reviews.

Surveys were mailed to twenty-two companies that contract with the Production Center. Five surveys were returned of which four indicated overall satisfaction. Descriptive responses to questions asked included the following:

	The quality of work completed is excellent
	More pick up and deliveries would be beneficial
	The quality of the work was poor. We didn't give you the opportunity to fix the problems, as, in our opinion, realigning the grooves would have been impossible for your people…"

Since the response rate for the return of completed surveys was so low, it is difficult to determine whether the results are representative. The Coordinator of Business Enterprises will continue to request feedback from companies who contract with the Production Center in efforts for overall improvement and high satisfaction. All measures will remain the same for the next reporting period. The target for the effectiveness indicator of maximizing the percentage of individuals whose efficiency ratings improve by at least 3% each year will be reduced from 75% to 60% due to the variables described in the above analysis.

Program Description:

ARC Broward, Inc. provides residential supports and services, including an Intermediate Care Facility, group homes and Supported Independent Living, to individuals throughout Broward County. The varying degrees of supports and services allows individuals to select the type and intensity of services and supports that meet their unique needs.

The Intermediate Care Facility, BARC Housing, is located in Davie, Florida. It provides a comprehensive array of intensive specialized services, including but not limited to nursing, dietary, pharmacological, psychiatric, psychological, behavioral therapy, physical therapy, occupational therapy and speech therapy to thirty-six (36) individuals with developmental disabilities who also have severe behavioral challenges, psychiatric disorders and/or significant functional skill impairments. Additionally, individuals receive training, assistance, supervision or support in areas such as health, social, leisure, recreation, personal care, transportation, finances and homemaking to ensure that all of their needs are met 24 hours per day seven days per week. Staff to resident ratios do not exceed one staff member to four residents during waking hours.

ARC Broward, Inc. operates small group homes in single-family neighborhoods throughout the Broward County area. Individuals are provided with room and board and residential habilitation (training and education). ARC provides constant supervision to the residents of the homes 24 hours per day, 7 day per week. Examples of the services, training, assistance and supervision provided to the individuals who reside at the group homes include medical/health care, active treatment/residential habilitation, social/recreation/leisure, financial management, transportation, personal care, homemaking and case management/social services.

ARC Broward's Supported Independent Living Program provides individualized supports to assist adults to live in their own homes in communities of their choice throughout Broward County. Staff members provide training, assistance or support coordination in all areas of independent living, including but not limited to home and community safety, medical/health care, personal care, homemaking, financial management, community mobility, social, recreation and leisure and case management. Staff members also provide emergency on-call services 24 hours per day, 7 days per week.

Residential Services support staff include nursing, social service specialists, behavior specialists and a Certified Behavior Analyst.

Within the first thirty days of enrollment, each individual receives an initial comprehensive functional assessment of skills and behaviors and participates as a key member of the Support Team in the development of a Person-Centered Plan that includes the identification of goals and objectives. Every year thereafter, assessments are conducted and Individual Program Plans are reviewed. Treatment Plans addressing the formal objectives are reviewed, analyzed and modified, if needed, at least monthly.

Outcome Management System:

Effectiveness Indicators:

	a) Maximize the percentage of individuals served who have demonstrated progress on at least 50 % of their objectives/strategies identified in individualized plan.
	Target: 80% of individuals Measurement Tool: Objectives: Graphic Displays of Data (Individualized per child per behavioral objective) Strategies: Quarterly Progress Reports Reporting Period: October 1 through September 30

Each October, Team Leaders will evaluate annual progress by analyzing graphic displays for increasing trends (objectives) and reviewing statement of progress (strategies). For each individual served, team leaders will divide the total number of objectives/strategies in which progress was demonstrated by the total number of objectives/strategies and multiply by 100 to determine percentage of objectives/strategies in which progress was demonstrated for each person. Subsequently, team leaders will divide the total number of individuals who demonstrated progress on 50% or more of their objectives/strategies by the total number of individuals and multiply by 100 to determine the percentage of individuals who demonstrated progress on at least 50% of their objectives.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicators:

	a) sMinimize average annual cost of care of persons receiving services/supports
	Target: 5% below budgeted cost of care (based on cost of care from previous year) Measurement Tool: Financial Database/Expenditure Reports Reporting Period: October 1 through September 30

Each October the Coordinator of Quality Assurance or designee will determine average cost of care per person receiving services/supports by dividing the total budgeted operating expenses by the projected annual census. Subsequently, the Coordinator of Quality Assurance will compare the average annual cost of care for the ending fiscal year to the budgeted cost of care to determine the percentage of increase or decrease from the previous year.

The analysis will include statement of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. The report will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicators:

	a) Maximize consumer satisfaction scores for persons receiving services/supports.
	Target: 90% of the individuals will report overall satisfaction Measurement Tool: Satisfaction Survey Reporting Period: October 1 - September 30

Data will be calculated for each service area by dividing the number of individuals who report satisfaction by the total number of survey respondents and multiplying by 100 to obtain the percentage of individuals who report overall satisfaction.

The analysis will include an examination of performance in relation to targeted outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining action steps for improved performance, where indicated. Responses to survey questions will be examined to obtain specific input that will be directly applied to the quality improvement plan. The reports will be submitted to the Associate Director of Adult Services annually by November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Residential Services

Analysis of Findings:

Data findings during the reporting period of October 1, 1999 through September 30, 2000 reveal that fifty out of sixty-six individuals (83%) demonstrated progress on 50% or more of their targeted objectives. This performance slightly exceeds the targeted outcome of 80%. However, Supported Independent Living outcomes were not included in the analysis because evaluation of the information revealed that the determinations of progress were subjective and could not be empirically validated. Additionally, while four of the residential sites met or exceeded the outcome, three did not achieve it. The breakdown is as follows:

Aspen House: 100%

BARC Housing: 82%

Capri House: 50%

Lakes House: 60%

Riviera House: 40%

Santa Fe House: 80%

Venice House: 100%

The three sites that did not meet the targeted outcome had staff shortages in key positions included Instructors and Instructional Associates for significant time periods. Additionally, Riviera House and Lakes House both experienced increases in medical conditions and degeneration associated with aging, which appears to correlate with the individual's inability to demonstrate progress. Finally, many formal programs were revised at Capri House and Santa Fe House this reporting period, which may have impacted individuals' progress. The teams will implement objective and measurable indicators of progress in the Supported Living Program and will include data in the next reporting period. Additionally, a staff recruiter position has been added to facilitate hiring of qualified employees in a timely manner. Finally, the Staff Recruitment and Retention Project Team continues to propose and implement strategies to increase employee moral and retention.

Performance on the efficiency indicator slightly exceeded the targeted outcome. Analysis of budget and expenditure report data reveals that residential services expenditures were 5.9% below budgeted costs. Expenditures at Lakes House were higher than budgeted costs due to significantly increasing needs of the residents associated with severe medical and degenerative conditions that require increased staffing which were not anticipated. The additional costs have been factored in to the budget for FY2000 - 01.

Social Service Specialists administered satisfaction surveys to seventy-eight (78) individuals who receive residential services out of a possible ninety-six individuals. Eighteen individuals chose not to participate in the survey process. Of the individuals surveyed, seventy-seven reported overall satisfaction (99%). This satisfaction rate far exceeds the targeted outcome of 90%. Only one individual reported dissatisfaction with residential services, simply stating, "I do not like living in a group home." The individual did not expand on his response by providing areas of dissatisfaction or suggestions for improvement. The descriptive feedback provided by the respondents included the following statements:

BARC Housing Residents:
	"Would like more sports offered."
	"I don't like some house-jobs."
	"[Staff] treat me nicely."
	"[I like] the exercise program and the activities."
	"I love it! My new roommate…"
	"[I like] the activities - fun. [I don't like] noisy people I live with."
	"I like the staff. I like to help out the cook. They help me with my feelings."
	"Too much noise at BARC."
	"Staff are very nice. Treat me nice."
	"Teach me and take me out of this place."
	"Help me move to a smaller group home."
Group Home Residents:
	"I want to go to the beach and go swimming in the ocean."
	"I want more friends."
	"I am happy. This is my house, Lakes House. I live there."
	"I think Norma is the best cook."
	"I like my friends."
	"I like the food. I like feeling safe. I would like to have a computer."