Changing Vocational Rehabilitation Systems through Quality Assurance
Presenter: Joe Mathews
Event ID: 1322386
Event Started: 5/19/2009 2:46:03 PM ET

Okay. Hi everybody. I want to welcome you to the program evaluation summit group's first summit Webinar. My name is Scott 15 billa, I'm with the region 8 TACE center at the university of northern Colorado. I've give you a background about this Webinar series before we begin. Last year we had a first annual program evaluation in quality assurance summit. That was held in Salt Lake City, Utah. The impetus for the summit came from the office of rehabilitation that is looking at their program evaluation and their Executive Director and their director of program services Kyle Walker. They gave some direction to their new program evaluation specialists, which was Michael shoe maker. Who started making contacts with some other program evaluators around the country. They were seeing a trend -- from federal and state governments. They wanted to put an event together which would allow program evaluation specialists to have a forum for discussing common issues and challenges. The program evaluation quality assurance was born of that. As we learned at the summit there's many new program evaluators and quality assurance specialists who are dealing with common challenges and starting up quality assurance systems and policies and practices. So from this community program evaluator from the summit, we've started a community of practice, which we've been sharing information, resources over the past year. We put together a planning team which has tried to organize this community. The main ways we kept this community going is for one, planning a second annual program evaluation quality assurance summit, which will be held this September 16th and 17th in Denver, Colorado. Talk about that at the end of this talk. Secondly, we set up a learning community web page -- that's our host for today's Webinar. The learning community planning team came up with an idea to host a series of online trainings for program evaluators and wear envisioning 8 Webinars that will cover a variety of topics important in program evaluation and quality assurance. These are sort of brief sections approximately 30 minutes each. Will be recorded. You can watch them later because they'll be posted on the national clearinghouse website under the program evaluation web page this. Is the first in our series and meant to be an introduction to the series in a discussion of changing VR systems through quality assurance. We're very pleased to have Joe Matthews as our speaker for this introductory Webinar. Joe is a technical assistance advisor for the TACE region 8. Leadership and experience. Served as the administrator of disability services division for the state of Montana, which included being the director of vocation rehabilitation for 18 years. Vocational rehabilitation counselor before that. We're very happy to have him on our team at the TACE region 8. Turn the raining over to Joe. 

thanks very much Scott and thank you Mike for setting up this Webinar. First time I had the experience of doing this. I hope it works well. 

I come to you today with a short presentation that really comes from the perspective of a state VR director and some of the experiences that I had wheel working -- while working as the Montana director both with quality assurance and lately with RSA as they came in and worked with our state with regard to federal review. I'm assuming that many of you on this call have been through a federal review. If you haven't, you will be shortly. I fond this topic of quality assurance quite timely based some on the experiences that we had just in running our agency and then also with what I think is a real renewed emphasis from the rehab services administration regarding quality assurance. 

I want to just say at the outset I certainly don't speak for RSA, but I am offering perspectives based on some experience in working with the team that came in and worked with my state. 

As Scott mentioned, this subject is attracting great attention. I'm really pleased to see that our region, region 8 and other regions are designing community practice around quality assurance. It's a hard sunt to entirely get your arms around because there are many, many diverse components to it. Quality assurance in one state may not necessarily look like quality assurance in another state. Every agency has it's own political entity and operates a little bit differently. Hopefully some of these perspectives that I'll share with you are unique to all of us who work in the vocational rehabilitation field. 

So what is this thing called quality assurance? 

I did a little bit of research and have talked to a number of people an I think there is some confusion out there, not only within our community, but within the quality assurance community in general as to exactly what it means. I kind of came up with three definitions here that you can see on your screen. It's any systematic process of checking to see whether a service or product is meeting specified requirements. It's designed to increase customer confidence in an organization's ability to improve work processes and efficiencies in allowing an organization to better compete with others and provide the highest quality services. Quality assurance has been around for a long time in a lot of different ways. It was primarily used by the military in World War II with regard to keeping track of such things as musician anythings and -- munitions and equipment. It's become more pref planted to allowing organizations to keep better track of the things they're doing to improve quality in the processes that lead to quality. 

What's the big deal about quality assurance and why now? 

Certainly from any experience and my -- my experience and my perspective, the United States congress and our own State legislatures are required specific goals and outcomes for all programs that are funded with public money. In this economic uncertainty and with the federal deficit, I think anybody that's involved in keeping track of public dollars, wants to make sure that the programs they fund are accountable, that they're doing what they're supposed to do and that they can demonstrate that the outcomes they're generating are transparent and done with the most efficiency possible. 

Certainly, my experience with our own legislation here in Montana -- assume that many of you have been through this -- it needs to be open and transparent. Our legislators are really on this bandwagon as well as I think congress itself. They want evidence-based research and data. We'll talk a little more about evidence-based later. These things are essential to ensure quality outcomes in the agency's performance. I think it's certainly no secret or doesn't come as a shock to anybody on this call that utilization of good data does become a foundation for future decision-making. Many of you on this call are real experts in that area in putting good data together and that work in VR has not gone unnoticed by congress and our funders. Certainly, a comprehensive quality assurance system reinforces and continues improvement that we're all looking for. 

I can remember being at a conference or it might have been a council state administrators meeting a year or two ago. We were listening to folk from the general accounting office. They were talking about the VR program in particular. I was taken by a phrase that they used, which said that VR was very data rich, but somewhat knowledge poor. Meaning that from their perspective, we're an agency, the public VR program that generate as lot of data. We keep track of a whole myriad of things but perhaps not enough effort has been made in demonstrating what knowledge we learn from all the data we keep and how we can use that knowledge to promote a quality assurance system that get us to ever increasing improvement. 

I think also in the evolution of this quality assurance thing, United States Congress several years ago developed a report card of federal agencies so that any federal program that had oversite of federal dollars much like RSA does was reviewed. There was a report card created that identified at least to Congress whether or not these federal agencies were meeting the necessary requirements and insuring that these dollars were well spent. There was more too it than that. I kind of believe that some of that led to the evolution of why we hear quality assurance so much these days. Why it's become so important to RSA and thus to the states. They were rated and one of the things that was found is that RSA, at that time, was not doing a good enough job in monitoring the state's activities an quality assurance and that they needed to develop more comprehensive procedures for making sure that quality assurance was taking place. So that kind of led to the popularity of this. So in some respects it's always been there. 

Some of the general concepts around quality assurance and I mentioned some of these already. You'll hear some repeats in here. These are some areas that I think are important. I want to reinforce them. Anything we do around this subject revolving around open and transparent government. We need to identify it to see it, to goat our: -- get our arms around it. Quality assurance needs to identify specific goals and outcomes. In our federal law and the he habilitation act is there through standards and indicators. Continuous improvement is expected. The goal here is to reduce waste and inefferentcy. As I functioned -- efficiency. We have identified process for quality improvement in our agencies, that is assistance parent, efficient and timely. That we're using evidence-based research, data and service delivery because that's critical to assure quality outcomes in our performance. That it provides the state agency a real process that has methods behind it to insure documentation in the areas of program improvement. One of the things that kind of surprised me when Montana weren't through it's federal review, was the effort that our state RSA team, the team that came in to review us, put forth in identifying or helping us identify that method call process. They set up a number of questions to ask us, to ask our staff members, to ask the consumers that we serve, other partners and ancillary programs, regarding kind of a cycle of how we do things. We were caught a little bit by surprise, not that those things weren't in place, but that RSA really did put an emphasis in the review and it's something to pay real close attention to. They were looking for the evidence-based research and evidence-based outcomes that we had. Wanted us to show why the things we were doing worked an they wanted to be able to see it. They wanted it to be transparent. 

Some of the building blocks that go toward putting a quality assurance system together, at least some of the things I think are important from a state director's perspective are to really go back to the precept and mission language of the the Rehabilitation Act. New things are put in, older things are taken out but it really does define the process by which the public vocation hall rehabilitation program is designed to work through the eyes of the con grandchildren of the United States based on feedback that they get. Proponent of going back periodically, as afternoon as necessary and making sure that staff understand that language, that they review it periodically to make sure it aligns with the mission and the strategies that the state is putting forth. Of course, we have the standards and indicators. They represent the central focus of the federal monitoring process of the states and our service production. We've seen those things be reviewed in their entirety. Lots of data surrounds that. There's an indication that these standards an indicators may change. I happen to believe they will at some point. There may be some things added and things taken away, by that whole standards and indicators process, does indicate the importance of outcome data and making sure that we're able to provide that to the people who want to look at it. 

Next, the state strategic plan and I recognize some states may not have what they call strategic plans, but sometimes states will have a plan in addition to their state plan that helps connect the dimensions of what the community is telling the states, what their con Tish wents are telling the states and how that can interact with the VR quality assurancesystems. Driven by agency mission, vision and values. Those in turn will drive how the organization operates. A lot of the services that the agency provides then are tied to these goals which are tied to the mission. Again, I just want to emphasize that at this point and demonstrating this to RSA seemed real important to them hundred they reviewed our state an I would expect that many of you who have been through those reviews would have a similar experience. 

Again, some of the essential come points that goes -- components that go into the quality assurance. Most of you on this call will relate to these. These will by no means all inclusive but some of the things that I thought of as a former state director that you'll want to pay attention to. Your federal monitoring report when you get it. Two pieces that can be attached to that, one is corrective action plans. Those as we understand from RSA deal more with any area where state may be determined to be out of compliance with the federal law. We're hopeful that not a lot of state agency haves to deal with corrective action plans, but if you do, that's a very essential component to get back in with the laws. Program improvement plans are you're going to see those a lot when you go through a review. The quality assurance piece that comes into that will be very important. Most any state that goes through a federal monitoring report will have a program improvement plan. These are things that are designed not only by RSA in reviewing the state but also from the state itself in trying to demonstrate that it is continually improving in it's efforts to serve individuals with disabilities and also in it's outcomes. They -- its outcomes.rating improvement plans designed to help them improve. Standers and indicators. We talked about that. Obviously going to remain important. How well you meet those standers and what you -- -- your state plan's the assurances you make to the federal government that you're operating in compliance with the law and the regulations. If you do a strategic plan or if you name it something else, is designed around how you're going to achieve the outcomes that you want, what things you're going to want to put in place and be able to document and demonstrate that get you to continuous quality improvement. All the federal reporting that states do, the different reports that are shared with RSA, those need to be in place and obviously need to be accurate and timely. 

If you do public hearings that all of us do in one way or another, focus forums, the idea here is to generate input from the consumers, people we serve from our ancillary partners, other programs that are involved with vocational rehabilitation. Any reports that states do to the governor as part of your state plan and any specific reports that state DOS to their own -- states do to their own legislature which are legislature designated once you get through the session that you are involved with. 

Some more essential components, any case management, fiscal and data systems that you have set up. Making sure those are transparent. Making sure those are producing the demonstrated outcomes that you want in terms of quality data. Agency case reviews that are done. I would have to say I was somewhat surprised when the federal government or when RSA reviewed us, that there wasn't more emphasis placed on reviews. There seems to be a de-emphasis on actual case review and more of an emphasis on processes with regard to quality assurance. 

Obviously your comprehensive system of personnel development will be important. Your turnover in staff and how to demonstrate how you're doing training and bringing staff up to speed. The input you receive from your key partners, your ancillary programs and VR. The end men didn't living. -- independent living. AmericanIndian rehabilitation programs will be key to these programs as well. You'll want to be evaluating your service delivery periodically. I know we all do that. To be able to document and demonstrate that through RSA I think is a really important component of quality assurance. Certainly the role and advise that you get from your -- advice that you get from your state rehabilitation council. To provide guidance to the state agency. 

Most states have a structured cycle of events. This needs to be done in a regular cycle.? Montana we call it the cycle of service. It sounds more imposing than it is. A cycle of service is just a process. It's a process that begins and ends and is done over and over again. It's a process for receiving meaningful input. Once you receive that input, you develop strategies around how to deal with that input. How to implement it. Then you do implement those processes in the service delivery system. You continue to collect data around those processes. You evaluate that data and then you act upon what is learned from that data. 

Some of the con Septembers behind cycle of service is that it's continually repeated. You align it with your state agency business cycles. Remember, that we talked before about state agency business cycles are different from one agency to another, depending upon your location and state government when your legislature meets, when you do the public hearings, when you do the focus forums, other things like that. Some of the things will always be the same like when you submit your state plan, when you submit your reports to the govern nor etc. -- governor etc. Whatever cycle states decide upon the transparent and disciplined. You want to make sure to stay on track with your cycle. There are always windows of opportunity for individuals with business abilities, particularly with disabilities particularly about what the agency is doing well and what it can improve upon. Those windows when they are open they need to be acknowledged, need to be transparent so that the real input that comes from people can actually be incorporated into your state plan, the strategic plan and be used to improve your quality. This public service cycle is necessarily different in distinct from say a commercial private sector model where they're really trying to sell something in the private sector, where as we're designed to always look at refreshing the definition of quality, which comes in direct response to our consumers and partners. Obviously to the funders of our program. Congress, our own legislative folks who are interested in what we're doing. 

Lastly, in these concepts, to make sure that we offer full inclusion and consensus, the process should involve ouren tire agency staff, they need to know about this. The key stakeholders that we work with and our state rehabilitation council. 

So in conclusion, I just wanted to give you those perspectives. I think this whole issue of quality assurance is probably going to get bigger. We're going to learn more. The idea of communities of practice where we can share information back and forth between states and between the professionals that do this work. I think we'll be critical. This will become more refooned. It -- refined. It's part of the trend of accountability and continuous improvement. I don't think that's going away. I think there will be a greater emphasis on justifying the things we do by developing a good cycle of service or continuous improvement model, you are also setting yourself up to really be well prepared to work with RSA when they do a review of their program. The information is there. They need to be sure that they can see the path or the road that you got there. We in Montana, when we did this, we did have a cycle set up, I certainly don't think it was perfect. It had a lot of jump starts and we ran into some brick walls trying to make sure it was continue yous and that it was transparent but the feds did kill us that they were able to trace it back. They were able to demonstrate where we got a lot of the information. We were able to demonstrate through our strategic planning that we did have goals and we had outcomes and that we revisited it regularly, that we updated it. That we involved our stake holders. From that they designated us as a best practice state in terms of being able to really show the kind of work that we were doing in a way that they were able to recognize. So that was very helpful to us. I'm sure that's helpful to you as well. I don't think we're going be backing off a lot from the push from state an federal agencies toward program evaluation and quality assistance -- continuing to improve we'll do nothing but benefit state agencies. Both in terms of the funding they receive from the federal government and the quality of services that they provide to the folks that we serve. So I would like to thank you for your time and attention. I hope I introduced this topic for much more conversation in the future. I'd like to thank the clearinghouse and Mike and I will turn this back over to Scott so that we can end this particular Webinar. Thanks all very much. 

Scott, are you there? 

I am. Thanks Joe. I am. Are there any questions for Joe? We probably have time for a couple of questions. 

Scott, this is Jane Macintosh from alas contact, I want to thank Joe for his presentation and I want to know how fast this will be on the clearinghouse website for other people to hear it? 

I can answer that question. This is Mike. The recording will take about an hour before I get it back and probably two more hours of just putting it up. So it will be up this afternoon before I leave. 

Thank you. 

Are there any other questions for Joe? I actually -- I do have a couple closing comments to make before we go, but if anyone else has a question for Joe? 

thank you very much Joe, we appreciate that. I just wanted to briefly talk about the community of practice that we're building and how you can help be part of this community. As I mentioned in the opening, we have a learning community that's grown out of our first program evaluation summit last September. Community of practice is a group of people with similar goals who get together and build networks an they interact and they contribute. Just by engaging in this community process of mutual learning happenings where we can share information and experiences and tools and resources. With today's technology, we don't have to be in the same place at the same time for this to occur. We can network through calls and in person events and email and other online events like this Webinar. Now we brought together professionals from the regional TACE centers in this community. Hosting today's talk. The disability stats RTC at Hunter college and a number of vocational -- state vocational rehabilitation agencies including the Utah state rehabilitation and the Colorado division of vocational rehabilitation which is cohosting this years summit. You are the network and contributors who give and take from the community who give it purpose. Now, we have a couple of things that we are doing to keep this community alive and number one is the program evaluation page at the national clearinghouse. You can go to HTTP:NCRTM.org or Google for that. Some things that are on the clearinghouse evaluation page are the Utah state quality assurance manual. They developed a full manual about quality assurance in a number of states are kind of in development with that. We have examples of 33 different consumer satisfaction surveys as well as an analysis of those surveys. We have conference call transcripts talking about quality assurance between the Utah state rehabilitation and other state agencies. There's Power Points and notes from last years summit. The Webinar training sessions like what we did today will be posted on there. We are -- like I mentioned before -- we're thinking that we'll have 8 of these live Webinars. They'll all be posted on the website. We're scheduling our second Webinar for July 21st, the tentative speaker is Darlene groom and the topic is comprehensive needs assessment which they conducted for the Michigan -- we'll be holding the second annual program summit on September 16 and 17th in Denver, Colorado. It's cohosted by Colorado DVR and TACE region 8. So some of the speakers and topics for that summit, these are still tentative but Dr. Sander good from Hunter college will be talking about performance management. A representative come out to talk about the quality assurance survey that was sent around last year to the state agencies. Results from that. We're also looking -- many of you are probably aware there's a new comprehensive needs guide that RSA contracted that's going to come out soon and we'll hopefully have a representative from that contracting agency coming out to answer questions about that comprehensive needs assessment guide. 

Michael shoe maker from state disdoes his experiences with construction of the quality assurance manual. Have a session on survey building an analysis Likely a session on the dash board concept, sandy Adams from Washington state. Hoping to have a session where we can share tools as well that we used in program evaluation in quality assurance. Kind of a session where we share what tools we're using. What people are using in different states. Those are some of the tentative topics and we hope that you'll join us in cement. There's no -- September. There's no registration fee so you'll have to pay for travel, lodging and per diem. You can do to the TACE region 8 website for more information. The registration is likely to go up June 16th. It's not up yet but there's information on that website and the registration will be going through the TACE region 8. 

In closing, thank you very much for attending today. Thanks very much to the national clearinghouse and Michael Millington for attending Thanks all for participating. 

[ Event Concluded ]