Environmental Scan of Measures for Medicaid Title XIX Home and Community-Based Services Measure Scan as of July 5, 2007

Appendix III: Compendium of Measures and Tools Identified Through the Medicaid Home and Community-Based Services Measure Scan as of July 5, 2007

Appendix III (continued)

Colorado

Tool or Measure Set: Colorado Department of Human Services Children's Extensive Support (CES) Family Satisfaction Survey
Data Source: Surveys
Respondent: Families with children on CES waiver
Mode of Data Collection: Mail
Total Items/indicators: 14
HCBS MS Domains: Unmet Need, Qualified Providers, Person Centeredness/Autonomy, Quality of Life, Access
Populations: Children with developmental disabilities or delays who also have significant medical and/or behavioral issues
Developer: Division for Developmental Disabilities
Use history: The Division conducted the survey initially in 2000 and again in 2004. In 2004 the survey was sent to 200 families receiving CES services.
States Currently Using: Colorado
Psychometric Testing: Unknown
Summary: The purpose of this tool is to assess families' satisfaction with the CES waiver program; specifically, were services working well and how could they be improved? Families are asked to rate their satisfaction using a 5-point Likert scale in ten areas related to the program.

Tool or Measure Set: Gauging How Well Colorado Supports Its Citizens with Developmental Disabilities
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 73
HCBS MS Domains: Health and Welfare, Safety, Access, Equity, Administrative Oversight, Person Centeredness/Autonomy, Unmet Need
Populations: Adults with intellectual disabilities (MRDD)
Developer: Human Services Research Institute (HSRI)
Use history: In 1997 the Division of Developmental Disabilities conducted stakeholder focus groups to obtain input on developing performance measures. Later in 2003 as part of its evaluation of the Colorado Systems Change Project, HSRI was asked to make recommendations regarding a comprehensive set of performance measures for developmental disabilities services.
States Currently Using: Colorado
Psychometric Testing: Not specified
Summary: In its recommendations HSRI includes some of the performance measures from the State's 1997 set and others that are more robust than what the State has been measuring. The Division uses performance measures to track broad system performance, not necessarily to build waiver-specific quality improvement plans. Measures are organized according to six focus areas: (1) Personal Outcomes, (2) Satisfaction, (3) Quality, Health and Safety, (4) Accessibility, (5) Efficiency, (6) Agency Strength.

Tool or Measure Set: Colorado Department of Health Care Policy and Financing Case Management Client Satisfaction Survey Project
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Mail
Total Items/indicators: 17
HCBS MS Domains: Timeliness
Populations: Adults with HIV/AIDS, Adults with acquired brain injuries, Adults with mental illness, Elderly with physical disabilities
Developer: Revisions to the Department's previous client satisfaction survey were made by staff from the Community Based Long Term Care section, with substantial input from long term care clients, family members, advocates, single entry point case management administrators, and other stakeholders.
Use history: As part of its 2005 CMS Systems Change for Real Choices grant the Department developed and tested a revised client satisfaction survey instrument for its 23 single entry point case management agencies. This revised instrument was used to conduct a one-time survey of a 10% random sample of clients from all agencies. A total of 3, 389 surveys were sent out. While case management agencies had been conducting client surveys for years, the Department identified limitations in the survey's design and administration that necessitated the revisions.
States Currently Using: Colorado
Psychometric Testing: Stakeholder input for content validity, other testing
Summary: The purpose of the revised survey is to help improve communication between clients and case managers. Consumers rated their satisfaction with their case managers on a 5-point Likert scale.

Tool or Measure Set: Colorado Division of Developmental Disabilities, Key Indicators of Program Performance
Data Source: Multiple, including NCI Consumer Survey, program monitoring, billing data, and wage and turnover surveys.
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 15
HCBS MS Domains: Person Centeredness/Autonomy, Quality of Life, Timeliness, Equity, Qualified Providers, Health and Welfare
Populations: Individuals with intellectual disabilities
Developer: Colorado Division of Developmental Disabilities, in response to legislative mandate
Use history: The key indicators are a short list of measures, drawn from the longer list the State tracks, that are designed to provide an overall picture of the health of the system of services for people with developmental disabilities.
States Currently Using: Colorado
Psychometric Testing: NCI measures have been tested, unclear if others have been
Summary: Focus areas are effectiveness and outcomes, standards of care, contract performance standards and outcomes, accessibility to services and resources, and organizational stability. Whenever possible, the State tried to maintain consistency between its measure definitions and those used by NASDDDS.

Tool or Measure Set: Colorado Transition Satisfaction Survey
Data Source: Consumer survey
Respondent: Consumers who have recently transitioned from a nursing home
Mode of Data Collection: Mail survey
Total Items/indicators: 10 items: 5 close-ended and 5 open-ended
HCBS MS Domains: Quality of Life, Unmet Need, Timeliness
Populations: People who have moved out of a nursing home within the last two years
Developer:
Use history: Instructions note that "It will help us to help other people who will move from a nursing home soon. Your answers will not affect your benefits."
States Currently Using: Colorado
Psychometric Testing: Not specified
Summary: Very simple survey which queries who assisted with transition (agency and individual), satisfaction with current situation, and whether current services are adequate.

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Connecticut

Tool or Measure Set: Connecticut Home Care Program for Elders Client Satisfaction Survey
Data Source: Consumer survey
Respondent: Consumer or proxy
Mode of Data Collection: Mail survey
Total Items/indicators: 13 items
HCBS MS Domains: Unmet Need
Populations: Elders with physical and cognitive disabilities
Developer: Connecticut Department of Social Services
Use history: Survey is mailed out annually to a random sample of waiver participants.
States Currently Using: Connecticut
Psychometric Testing: No
Summary: Mail-out survey which primarily queries which categories of services recipient receives (e.g., homemaker, skilled nursing, meals on wheels, adult day, etc. ) and whether s/he is satisfied with them, along with items to determine if all services are received and ability to get by without them. State staff will sometimes follow up on responses with a phone call.

Tool or Measure Set: The Connecticut Real Choice System Change Community Inclusion Assessment
Data Source: Consumer Survey
Respondent: Consumer or Proxy
Mode of Data Collection: Choice of Telephone Interview or Online Survey
Total Items/indicators: Unknown
HCBS MS Domains: Access, Person Centeredness/Autonomy, Efficiency, Unmet Need, Equity, and Quality of Life
Populations: Adults or children with mental retardation or developmental disabilities
Developer: A.J. Pappanikou Center for Developmental Disabilities at the University of Connecticut
Use history: Administered as part of the Connecticut 2002 Real Choice Systems Change grant.
States Currently Using: Unclear if still used by Connecticut
Psychometric Testing: Unknown, some items adapted from existing tools which may have been evaluated.
Summary: The Connecticut Real Choice Systems Change Community Inclusion Assessment was not available at the time this summary was written. The tool was developed to determine the level and quality of community inclusion within Connecticut communities for people with developmental disabilities in order to build support for informed decisionmaking, independent living, and meaningful quality of life. The survey includes basic demographic questions as well as items pertaining to education, employment, community accessibility, transportation, voting, community participation, and preferences. Some of the measures are adapted from the Harris Interactive and National Organization on Disability "Community Participation" survey (2000).

Tool or Measure Set: Connecticut Department of Mental Retardation Quality Service Review Tool
Data Source: Multiple: consumer survey (National Core Indictors, modified), support person interview, observation, safety checklist and document/record review
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 55 indicators in master tool; different vendors and programs use subsets of the indicators in the master tool
HCBS MS Domains: Health and Welfare, Safety, Person Centeredness/Autonomy, Administrative Oversight, Timeliness, Coordination of Long-Term Care and Other Services
Populations: Individuals with intellectual disabilities
Developer: Connecticut Department of Mental Retardation (DMR)
Use history: Service review tool published in December 2006, and is designed for use with all DMR vendors
States Currently Using: Connecticut
Psychometric Testing: Reliability and validity of National Core Indicators established through studies with partnering States. Content validity established via stakeholder input
Summary: Review tool measure individuals' experiences with services and supports, along with the vendor and DMR's effectiveness in supporting individuals to achieve positive outcomes. Indicators are calculated as present or absent based multiple data sources, and are organized in eight broad areas: planning and personal achievement; relationships and community inclusion; choice and control; rights, respect, and dignity; safety; health and wellness; satisfaction; and administration. Review tool incorporates relevant CMS expectations, as well as DMR's regulatory and legislative requirements, and was developed with consumer and family input.

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Delaware

Tool or Measure Set: Delaware Passport to Independence Survey
Data Source: Consumer Survey
Respondent: Consumer or Proxy
Mode of Data Collection: Telephone Interview
Total Items/indicators: 56 close-ended items, 27 open-ended questions, and 8 demographic questions
HCBS MS Domains: Access, Person Centeredness/Autonomy, Efficiency, Unmet Need, Equity, and Quality of Life
Populations: Elders with physical or cognitive disabilities, and adults with physical disabilities and/or chronic conditions
Developer: Center for State Health Policy at Rutgers University
Use history: Tool developed in 2003 and study took place in Delaware from 2003 to 2005.
States Currently Using: Study is completed
Psychometric Testing: Unknown
Summary: Survey administered to individuals who were discharged from Delaware nursing homes. Survey administration took place immediately after the transition and again within six months. Interviews were conducted in approximately forty minutes. Survey addressed the type of counseling and support received when the individual was leaving the nursing home, barriers leaving the nursing home, current living environment, quality of life, socialization, support with activities of daily living and instrumental activities of daily living, as well as health and welfare.

Tool or Measure Set: Delaware Division of Developmental Disabilities Draft Performance Measures
Data Source: Multiple: Case management checklist, licensure review, National Core Indicators (NCI) consumer survey, facility reviews, provider reviews
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 8 draft indicators
HCBS MS Domains: Safety, Health and Welfare, Unmet Need, Qualified Providers
Populations: Individuals with intellectual disabilities
Developer: Human Services Research Institute (HSRI), under contract to the Division of Developmental Disabilities
Use history: Measures are currently being pilot tested
States Currently Using: Delaware
Psychometric Testing: Testing ongoing
Summary: Using CMS Real Choice Systems Change grant funds, Delaware contracted with HSRI to assist with developing performance measures for its Medicaid HCBS program. Currently 8 measures, from a draft list of 160, are being tested for review by the State. These measures have specified numerators, denominators, sources, exclusions, etc., and Division hopes to expand to a prioritized list of 30 soon. Delaware has also participated in the NCI project since 2001, and conducts the NCI consumer survey annually with about 400 individuals of a universe of approximately 1800 program participants. The measures are: substantiated abuse and neglect; compliance in safety items; compliance with emergency/disaster standards; medication error follow-up; individualized care plans; percent of specified services implemented; provider compliance with standards; and provider timely completion of compliance plans.

Tool or Measure Set: Delaware Division of Developmental Disabilities Contracting Performance Measures
Data Source: Providers supply data to the State
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 20 total (8 for day service providers and 12 for residential service providers)
HCBS MS Domains: Person Centeredness/Autonomy, Qualified Providers, Safety, Health and Welfare
Populations: Individuals with intellectual disabilities
Developer: Delaware Division of Developmental Disabilities
Use history: Required of all contracting service providers
States Currently Using: Delaware
Psychometric Testing: Not specified
Summary: These performance measure matrices specify performance standards for providers, including benchmarks and data sources. Focus areas include staff training and background checks, consumer involvement and satisfaction, development of internal quality management systems, and compliance with program policies and procedures.

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Florida

Tool or Measure Set: Indicators for Florida's Developmental Disabilities Program
Data Source: Administrative data and consumer survey
Respondent: Consumer (for interview)
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 8 indicators for community residents
HCBS MS Domains: Access, Quality of Life, Person Centeredness/Autonomy
Populations: Adults and children with developmental disabilities
Developer: Indicators compiled by the Florida Agency for Persons with Disabilities, consumer survey is the Personal Outcomes Measure tool, developed by The Council for Leadership and Quality
Use history: Used for all developmental disability services
States Currently Using: Florida
Psychometric Testing: Reliability and Validity of consumer survey tool has been established, indicator matrix provides information on reliability and validity of each measures
Summary: Measures examine service penetration (numbers served by different provider types) as well as improved quality of life, as measured by the Personal Outcome Measures.

Tool or Measure Set: HCBS Monitoring Review Tool for Florida's Alzheimer's Waiver
Data Source: Data gathered during onsite provider reviews
Respondent: N/A
Mode of Data Collection: In person
Total Items/indicators: 12 indicators
HCBS MS Domains: Person Centeredness/Autonomy, Qualified Providers, Health and Welfare
Populations: Adults with Alzheimer's
Developer: Florida Agency for Healthcare Administration
Use history: Used with one waiver
States Currently Using: Florida
Psychometric Testing: No
Summary: Indicators are aligned with the CMS subassurances and are organized into four groups: level of care, plan of care, qualified providers, and health and welfare. Reviewers determine if the outcome specified, e.g., "Participants are afforded choice between waiver services and institutional care," is met based on provider documentation.

Tool or Measure Set: Florida's Channeling Waiver Beneficiary Survey
Data Source: Consumer Survey
Respondent: Consumer
Mode of Data Collection: Responses are collected face to face during home visits by reviews. A telephone survey may be substituted if necessary.
Total Items/indicators: 9 close-ended items, 2 open responses
HCBS MS Domains: Access, Coordination of Long-Term Care and Other Services, Effectiveness, Person Centeredness/Autonomy
Populations: Elders with physical and cognitive disabilities
Developer: Florida Agency for Healthcare Administration
Use history: Used during quality review process for one waiver
States Currently Using: Florida
Psychometric Testing: No
Summary: The beneficiary survey is one component of the review process for the waiver, which also includes case record review, home visits, and review of provider documentation. Sample size is very small; providers are only required to conduct 3 interviews per provider. During the interview the reviewer also verifies receipt of the services in the service plan and notes the reasons for any discrepancies.

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Georgia

Tool or Measure Set: Georgia Office of Developmental Disabilities Regional/State Individual Service Plan Quality Assurance Checklist
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 22
HCBS MS Domains: Quality of Life, Person Centeredness/Autonomy, Health and Welfare
Populations: Adults with intellectual disabilities (MR/DD)
Developer: Office of Developmental Disabilities, Division of Mental Health, Developmental Disabilities, and Addictive Diseases, Georgia Department of Human Resources
Use history: Staff in the Office of DD conduct quarterly "look behind" reviews on a 5% sample of individuals' service plans that the Department's Regional Offices reviewed. The same process is used for both of the State's waivers for people with MR/DD.
States Currently Using: Georgia
Psychometric Testing: Not specified
Summary: The Office uses data from aggregated checklists to identify trends in the processes used to administer and assure quality in the waiver, such as whether assessments are completed according to timeframes, whether assessed needs are addressed in service plans, and whether objectives and goals are consumer focused and measurable.

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Idaho

Tool or Measure Set: Performance Measures for the Idaho Developmental Disabilities HCBS-Self-Direction Option
Data Source: Administrative data and consumer survey data
Respondent: Consumer or proxy
Mode of Data Collection: Face-to-face structured interview
Total Items/indicators: 59 measures
HCBS MS Domains: Access, Person Centeredness/Autonomy, Timeliness, Unmet Need, Health and Welfare
Populations: Adults with developmental disabilities
Developer: Idaho Department of Health and Welfare
Use history: Developed for new self-direction option under Idaho's developmental disabilities waiver. These measures will serve as a template for oversight of the State's other HCBS waivers.
States Currently Using: Idaho
Psychometric Testing: Tools still under development
Summary: The self-direction option for developmental disabilities waiver participants is new, and the State is still developing some of the data collection tools that will support the review process. A central tool will be a modified version of the Participant Experience Survey, MRDD version. The State has added several items to this tool, specific to self-direction, that align with the goals and performance measures articulated for the program. Overall, the performance measures are organized along 7 major program goals, and cross-reference the relevant CMS HCBS Quality Framework Areas.

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Illinois

Tool or Measure Set: Performance Measures for Illinois HCBS Waiver for Persons with Brain Injury
Data Source: Administrative data gathered during provider reviews
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 25 measures (excluding those related to Level of Care and Financial Oversight)
HCBS MS Domains: Qualified Providers, Health and Welfare, Person Centeredness/Autonomy, Unmet Need, Coordination of Long-Term Care and Other Services
Populations: Adults with acquired brain injuries
Developer: Illinois Bureau of Interagency Coordination, Healthcare and Family Services
Use history: Measures are reported annually to CMS as part of the waiver's evidentiary report
States Currently Using: Illinois
Psychometric Testing: Not specified
Summary: These measures were drawn from the evidentiary report submitted to CMS by the State. They are aligned with the assurances-trend data are reported for several years.

Tool or Measure Set: Parent Surveys for Illinois' Medically Fragile Children's Waivers
Data Source: Consumer survey
Respondent: Parent or guardian of consumer
Mode of Data Collection: Telephone interview
Total Items/indicators: Home medical equipment survey: 19 items
Nursing survey: 16 items
Care Coordination survey: 16 items
HCBS MS Domains: Access, Health and Welfare, Safety, Timeliness
Populations: Medically fragile children
Developer: Illinois Bureau of Interagency Coordination, Healthcare and Family Services
Use history: Current version was last revised in 2004. Used with one waiver.
States Currently Using: Illinois
Psychometric Testing: Not specified
Summary: Surveys contain general satisfaction questions related to program responsiveness, access to services, receipt of services, care coordination and language barriers.

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Iowa

Tool or Measure Set: Iowa HCBS Waiver Provider Self-Assessment Checklist
Data Source: Self-reported data from providers
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 62 items on checklist (excluding financial accountability)
HCBS MS Domains: Qualified Providers, Health and Welfare, Safety, Person Centeredness/Autonomy
Populations: Elders with physical and cognitive disabilities, adults with physical disabilities, adults with intellectual disabilities, children with mental health disabilities, adults with AIDS/HIV
Developer: Iowa Department of Human Services
Use history: This draft document is part of a brand new quality monitoring strategy for all of seven of Iowa's waivers.
States Currently Using: Iowa (planned)
Psychometric Testing: Tool still under development
Summary: Self-assessment data will be collated by Iowa State University employees (Iowa Medicaid Enterprise-Foundation for Medical Care), who have been contracted by the State to perform all QA functions for the waivers. This is just one component of the four-pronged approach to monitoring the waivers. Other methodologies included periodic, indepth reviews of randomly selected quality focus areas, review of incidents, complaints and death logs, and a full onsite review every five years. These new processes replace a previous system that was very labor intensive and involved indepth, lengthy interviews with program participants. In addition, the State has been using the Participant Experience Survey, E/D version, and has plans to modify the tool to additionally address health and welfare and self-direction concerns.

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Kansas

Tool or Measure Set: Kansas Department on Aging, Frail/Elderly Case File Quality Review Protocol
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 21
HCBS MS Domains: Timeliness, Person Centeredness/Autonomy, Other: Coordination With Health Services, Health and Welfare
Populations: Elderly with physical disabilities
Developer: Kansas Department of Aging developed tool and University of Kansas did reliability testing on it.
Use history: Tool has been used at least since 1998 and has undergone several iterations to keep current with CMS's latest guidelines and policy interpretations. Tool is used to conduct quarterly reviews on a stratified sample of consumers receiving services from each of the Department's programs: 1) Older Americans Act HCBS (approximately 1800 consumers in State fiscal year (SFY) 2006); 2) Senior Care Act State-funded HCBS (approximately 6300 consumers); and 3) Frail/Elderly Medicaid HCBS waiver (approximately 7900 consumers in SFY 2006).
States Currently Using: Kansas
Psychometric Testing: Not specified
Summary: The Department publishes quarterly reports of statewide averages and compliance trends over a six year period by indicator to assess their service delivery performance. It publishes separate reports for each of the three programs.

Tool or Measure Set: Kansas Department on Aging, Frail/Elderly Consumer Interview Protocol
Data Source: Consumer survey
Respondent: Consumer
Mode of Data Collection: Face-to-face interviews
Total Items/indicators: 33
HCBS MS Domains: Timeliness, Safety, Person Centeredness/Autonomy, Health and Welfare, Effectiveness
Populations: Elderly with physical disabilities
Developer: Kansas Department of Aging developed tool, in collaboration with the University of Kansas.
Use history: Tool has been used at least since 1998 and has undergone several iterations to keep current with CMS's latest guidelines and policy interpretations. The State's Area Agencies on Aging use this tool to conduct quarterly interviews on a stratified sample of consumers receiving services from each of the Department's programs: 1) Older Americans Act HCBS (approximately 1800 consumers in SFY 2006); 2) Senior Care Act State-funded HCBS (approximately 6300 consumers); and 3) Frail/Elderly Medicaid HCBS waiver (approximately 7900 consumers in SFY 2006).
States Currently Using: Kansas
Psychometric Testing: Reliability testing conducted by the University of Kansas.
Summary: The Department uses collected data to assess quality of services by publishing quarterly reports of standards met/not met by area agencies on aging (AAAs) and following up with AAAs that have not met standards. It publishes separate reports for each of the three programs.

Tool or Measure Set: Kansas Summary Data on Children with Severe Emotional Disorders
Data Source: Administrative data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 8 sets of statistics related to children with severe emotional illnesses
HCBS MS Domains: Health and Welfare, Safety, Quality of Life
Populations: Children with severe and persistent mental illness
Developer: Kansas Department of Social and Rehabilitation Services
Use history: The Department uses quarterly statistics on children receiving services through the State's Medicaid waiver for kids with severe emotional illnesses to assess the impact of waiver services.
States Currently Using: Kansas
Psychometric Testing: Not specified
Summary: On an annual basis the Department collects statistics on 18 indicators that are organized according to five major focus areas: 1) children's residential living status (home versus institutional), 2) incidents of children arrests/interactions with law enforcement, 3) delinquent behavior, 4) academic performance, and 5) exiting from continued case management services.

Tool or Measure Set: Kansas Mental Health Prepaid Ambulatory Health Plan Performance Indicators for July 1, 2007 to June 30, 2008
Data Source: Provider data
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 47
HCBS MS Domains: Health and Welfare, Access, Timeliness, Unmet Need, Quality of Life, Efficiency
Populations: Adults with severe and persistent mental illness (Medicaid waiver and nonwaiver services)
Developer: Kansas Department of Social and Rehabilitation Services developed indicators based on the Substance Abuse Mental Health Services Administration's National Outcomes Measures for Co-Existing Disorders.
Use history: Draft indicators to be effective July 2007 for use in the State's proposed 1915b/c waiver.
States Currently Using: Kansas (proposed)
Psychometric Testing: Based on existing national measure set
Summary: All performance indicators are measured quarterly and contractor financial penalties are applicable for unmet standards. Standardized penalties increase with each failure to comply with the minimum performance level.

Tool or Measure Set: Kansas Family Satisfaction Survey
Data Source: Consumer Satisfaction Survey
Respondent: Parents/guardians
Mode of Data Collection: Telephone interview. Families that could not be reached received a mail survey
Total Items/indicators: 75
HCBS MS Domains: Access, Health and Welfare, Timeliness, Quality of Life, Effectiveness, Other: Coordination With Other Services
Populations: Other: Parents/Stepparents/Grandparents of children with severe emotional/behavioral disorders who received services from a County Mental Health Clinic
Developer: University of Kansas School of Social Welfare, with input from county mental health clinic personnel, parents, and youth.
Use history: Survey instrument was developed in 1996 in response to a legislative request and has been conducted annually since 1997 with revisions to the survey tool itself and the process for disseminating result reports to county mental health centers.
States Currently Using: Kansas
Psychometric Testing: Stakeholder involvement to assure content validity; other testing not specified
Summary: 22 indicators are based on questions that use a 5-point Likert scale for responses and focus on these four areas: 1) Convenience of Services; 2) Full Range of Services; 3) Quality and Appropriateness; and 4) Cultural Competency and Responsiveness. 53 indicators are based on questions regarding the effectiveness of services in the child's service plan. Responses options are yes/no/NA. Survey utilizes a convenience sampling approach so the ability to generalize findings to parents who did not complete the survey is limited.

Tool or Measure Set: Kansas Youth Satisfaction Survey
Data Source: Consumer survey
Respondent: Consumers aged 12 and older
Mode of Data Collection: Telephone interview; children that could not be reached received a mail survey
Total Items/indicators: 47
HCBS MS Domains: Safety, Quality of Life, Access, Health and Welfare
Populations: Children with severe emotional/behavioral disorders
Developer: University of Kansas School of Social Welfare with input from county mental health clinic personnel, parents, and youth.
Use history: Survey instrument was developed in 1996 in response to a legislative request and has been conducted annually since 1997 with revisions to the survey tool itself and the process for disseminating result reports to county mental health centers.
States Currently Using: Kansas
Psychometric Testing: Stakeholder involvement to assure content validity; other testing not specified
Summary: Survey instrument asks respondents to: 1) Think of one worker they were dissatisfied with and answer 18 questions (with a 4-point Likert response scale) about that worker's behavior; 2) Assign grades (A-F) to services that the consumer has received from the mental health center; and 3) Using a 5-point Likert scale indicate the degree to which they are receiving benefits due to services received. The survey instrument utilizes a convenience sampling approach so the ability to generalize findings to consumers who did not complete the tool is limited.

Tool or Measure Set: Quality Indicators for Self-Directed Services
Data Source: Multiple
Respondent: N/A
Mode of Data Collection: N/A
Total Items/indicators: 10 concepts/indicators
HCBS MS Domains: Safety, Person Centeredness/Autonomy, Timeliness, Equity, Access, Qualified Providers, Health and Welfare, and Quality of Life
Populations: Elders with physical or cognitive disabilities, adults or children with mental retardation or developmental disabilities, children with physical, cognitive, or mental health disabilities, adults with severe and persistent mental illness, adults with acquired brain injuries, and adults with physical disabilities and/or chronic conditions
Developer: Topeka Independent Living Center
Use history: Developed in 2005 for Kansas Self-Directed Programs
States Currently Using: Kansas
Psychometric Testing: Concepts not always fully developed as indicators
Summary: Concepts/indicators address individual control in hiring and managing workers, access to paid workers, flexibility in location in which services are provided, training for workers, payment and benefits of workers, risk, and safeguards.

Tool or Measure Set: Kansas Lifestyle Outcomes
Data Source: Interviews with consumers and proxies, if appropriate/necessary
Respondent: Consumer or proxy
Mode of Data Collection: In-person
Total Items/indicators: Four broad outcomes, comprising multiple sub-areas
HCBS MS Domains: Health and Safety, Person Centeredness/Autonomy
Populations: Individuals with intellectual disabilities
Developer:
Use history: Version 2. 0 dated May, 2001
States Currently Using: Kansas (unclear if still in use)
Psychometric Testing: Not specified
Summary: The four broad outcomes are:

• Opportunities of Choice to Support and Increase Independence, Productivity, Integration and Inclusion; Effective Access Maintained
• Individual Rights and Responsibilities Reported
• Personal Health and Safety Maintained
• Use of Psychotropic Medicines or Restrictive Practices Safeguarded

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