EXECUTIVE SUMMARY

Overall Comments:

ARC Broward's Outcomes Management System is the heart of the organization's customer driven quality improvement efforts. This system has evolved from a program evaluation system into one which attempts to involve the persons receiving services and other stakeholders with goals and measures based upon their input and expectations.

The purpose of this report is to summarize and analyze data to identify needed areas of improvement. The report will demonstrate the organization's use of stakeholder input to direct its ongoing process of quality improvement by first detailing changes that have occurred to date based upon such and subsequently by outlining an activity/implementation plan for additional quality improvement efforts. This information will used to assist the organization in a various decision making circumstances, including but not limited to, the development of the strategic plan and the development of the budget. You will note throughout the analyses of the specific program areas that suggestions for quality improvement are noted. Never the less, it is important to detail overall trends, comments and concerns which require additional follow-up and consideration by the organization in its effort to develop and implement a system which truly promotes quality improvement efforts.

Organizational Changes Resulting From Stakeholder Input:

	1)	In response to feedback from support coordinators and in an effort to improve overall communication with support coordinators, ARC Broward has instituted and hosts ongoing monthly meetings/forums. The agenda includes information exchange, problem identification and solution generation and topics of current issue. Additionally, these meetings appear to have reportedly resulted in a generalization effect and improved regular communication and information exchanges and rapport. Additionally, the Director of Adult Services has formally and informally provided training, support and monitoring to ensure professional, timely and accurate communication by agency personnel in response to input from support coordinators.
	2)	In response to feedback from consumers, family members, staff members and support coordinators, many changes have been made to the design of the organizational structure, including: • Although individuals receiving services remain on person-centered teams and receive person-centered supports from the teams, Supported Employment Services have been separated from the person-centered teams and centralized under the supervision of a Supported Employment Manager. Community Supports Specialists no longer provide coaching services to individuals receiving both employment and supported living services. Employment Specialists now provide employment development, coaching and follow along services and Supported Living Specialists provide transitional and coaching services to individuals receiving Supported Living Services. • Although individuals receiving only day program services (i.e. Community Participation, Intensive Behavioral Supports, Older Adult Program) remain on person-centered teams, a Day Program Manager position has been created to provide centralized, consistent daily supervision, structure and support. • The Activity Specialist position has been evaluated and restructured. The individual in this position has been reassigned to provide intensive supports for day program services with a great emphasis on meaningful, functional and age-appropriate activities which promote opportunities for skill development, enhanced interests and hobbies, contribution to community through volunteer efforts and establishment of relationships and natural supports. • The Facility Based Behavioral Support Team has been established to provide sophisticated and comprehensive behavioral services to all individuals receiving services by the agency. This team functions under the leadership of a Certified Associate Behavior Analyst and a PhD level Psychologist Certified by the National Board for Behavior Analysis. Behavior Specialists are assigned to provide behavioral services according to consumer needs. At least two behavior specialists are assigned to each program division.
	3)	In response to input from consumers, families and support coordinators, the following changes have taken place: • Computers have been installed for service recipients to receive computer training. • A food service training program has opened to provide opportunities for trainees to experience the food service industry, including cashier, food preparation, cooking, stocking and janitorial functions. Individuals are provided with an opportunity for increased earnings in conjunction with the training and exposure (not to mention all the benefits to the consumers of the food service!)
	4)	In response to information regarding service needs provided by the Department of Children and Families and their request of ARC Broward to provide such, the following service and support expansion has occurred: • The Therapeutic Intervention Program (TIP) has been acquired. This program provides education, after-school, caregiver training, mental health, behavioral, occupational, speech/language and physical therapy services to children with autism and their families. The acquisition of the TIP Program necessitated extensive reconstruction of the facility and playground area to accommodate the environmental needs of the program. Feedback received indicates that this program has resulted in improved behavioral stability and family supports. • Several new group homes for adults have opened, including Santa Fe House and Malibu House. • A group home for children with severe behavioral disorders (Club House) opened. • The Alternative Behavioral Learning Environment (ABLE) After Care and Home/School Behavioral Services Program was established to serve children with severe behavioral disorders and their families. Feedback received from families indicates that this program has provided respite and family support and ability for caregivers to enter/reenter the work force and/or spend more time with siblings of child in the ABLE Program.
	5)	The Deaf and Hard of Hearing Mental Health program was established to address a severe service gap for this population.
	6)	In response to input received from Mental Health Service Recipients and the Consulting Psychiatrist, pharmacy services are provided to individuals at no cost through the State of Florida's Indigent Pharmaceuticals Program.
	7)	In response to feedback from the District Behavior Analyst/Senior Psychologist regarding local and statewide shortage of Certified Behavior Analysts, ARC Broward has instituted a state approved 90 hour Applied Behavior Analysis Course with opportunity for required supplemental supervision. Successful completion of this course and supervision hours establishes eligibility for students to sit for the state Applied Behavior Analysis Certification Examination. This course and supervision is offered to qualified applicants throughout the state. Additionally, ARC Broward has become the host site for the University of Nevada's Master's Program in Applied Behavior Analysis. Both of these efforts expect to yield improvements in the quantity and quality of behavior analysts in the geographic area.
	8)	In response to feedback from program and leadership staff regarding correct and consistent behavior program development and implementation, the Behavioral and Psychological Services Division has established and instituted the following: • An Internal Behavior Program Review Committee: The Committee meets quarterly to evaluate behaviors, treatment procedures and data findings. The Committee is comprised of a multi-disciplinary board that includes Psychologists, Social Workers, Behavior Analysts and Behavior Specialists. It provides a learning environment in addition to improving quality of behavioral service delivery. • Weekly Interdisciplinary Meetings: Direct Care and Support Professionals meet regularly to discuss specific behavioral services and address ongoing consumer needs regarding such. This process improves quality services by providing a comprehensive, multi-disciplinary evaluation of concerns and outcomes in a qualitative and interactive forum.
	9)	In response to feedback from support coordinators, funders and staff regarding staff recruitment and retention, the following measures have been taken: • The establishment of a recruiter to assist in the timely and appropriate hiring of qualified employees. • The ongoing efforts of the Staff Recruitment and Retention Project Team to increase incentives, rewards and longevity of employees.

Activity/Implementation Plan for Organizational Change Based Upon Stakeholder Input:

	1)	Although ARC Broward has established measures for the majority of the services and supports provided by the organization, it would benefit from developing efficiency, effectiveness and satisfaction measures for the following services/supports: Developmental Preschool Therapeutic Intervention Program (TIP) Community Based Behavioral Support Rehabilitative Services (OT, PT and Speech Therapy) The establishment of such measures will be completed by April 1, 2000.
	2)	Although ARC Broward has established measures for programs provided to individuals receiving services, it would benefit from developing efficiency, effectiveness and satisfaction measures for the following administrative support areas: Employee Development/Staff Training Human Resources (e.g. reducing turnover, effectively recruiting and job matching applicants, etc.) Marketing/Development/Fundraising (e.g. increasing foundation support, etc) Fiscal (e.g. reducing aged receivables, maximizing billing, etc) Operations The establishment of such measures will be completed by July 1, 2001.
	3)	ARC Broward routinely participates in statewide and local activities related to strategic planning. Several years ago, the organization received a grant from the University of Tennessee for inclusion in its regional "Organizational Change Mentoring" project, which consisted primarily of customized on-site technical assistance. The one-year technical assistance process included "whole systems" approach to establish our future direction, strategic planning, organizational restructuring and tools and strategies for change. The outcome resulted in a commitment from the organization to continue its on going strategic growth and direction and become an organization which is customer driven, person centered and flexible to respond to the on-going changes occurring in the rehabilitation field. In order to continue to assess ARC Broward's current position, the following information gathering tools need to be updated: Facilitation of Focus Groups with: • Consumers • Families • Cross Representatives from direct care, support, supervisory and administrative staff • Interested Stakeholders • Independent Support Coordinators • Funding Sources • Board of Directors Completion of the "Achievement and Rehabilitation Centers, Strategic Planning Survey" by family members and all agency staff. This survey assesses service trends and population trends. Continued participation at both Statewide and District Provider meetings which routinely share trend information from interested stakeholders (e.g. consumers, families, providers, etc.) for the purpose of increasing provider capacity and consumer accessibility of services. Completion of "Organizational Assessment" and "Organizational Norms" surveys by all staff members. This instrument assesses the current culture of the organization. Completion of an environmental SWOT Analysis (strengths, weaknesses, opportunities and threats).
		ARC Broward has contacted the University of Tennessee and has scheduled a meeting with their consultant on March 14, 2001. During that meeting, the organization will develop a "Strategic Planning" schedule which will detail the time frames required for completing the required actions identified above. It is recommended that the Strategic Plan be updated by June 1, 2001.
	4)	Over the past several years, ARC Broward has upgraded its computer capabilities significantly. Throughout these efforts, the organization has ensured that the system has the eventual capability to operate an integrated data management system which would facilitate the periodic review and analysis of client demographics, characteristics of persons receiving services and personal outcome measures for individual consumers. It is the intent of the organization to also coordinate the management of client demographics to relevant and critical census management, attendance and billing functions. Over the past several years, ARC Broward has investigated the option of purchasing existing software related to the above. In the end, the exercise demonstrated that the existing software packages currently available on the market were both cost prohibitive and programmatically limited. As a result, the organization has determined that a more effective and efficient route would be to investigate the feasibility of creating a system through ACCESS software. It is recommended that this investigation be conducted over the next several months and that decisions related to both cost and implementation and design of such be completed by September 30, 2001.
	5)	As reflected in the analysis of the futures planning assessment, several planning activities are essential to address the needs identified. It is recommended that educational and planning sessions that include the following topics be coordinated by the Adult Services Support Team Leader and offered to families by September 30, 2001: • Informed Planning for Individual's Living Arrangements • Financial Planning for Individual's Future including Trusts • Information Regarding Guardianship • Planning for Individual's Health Care including Health Care Surrogacy and Advance Directives It is also recommended that strategic planning include evaluation of the expansion of agency service and supports in the following areas by November 2001: • Increased Respite Care Services • Transitional Services to Prepare Relatives for Future Caregiver Roles A survey to assess individual and family interest in additional respite and recreational services will be developed, disseminated and analyzed by May 1, 2001.