Community-Integrated Personal Assistance Services and Supports

LOUISIANA

Target Population

Persons with serious mental illness (SMI).

Geographic Focus

Statewide.

Primary Focus

• Enhance the infrastructure of the system of home and community services for adults with serious mental illness through identification and adoption of a successful model of personal assistance services (PAS) for this population.



• Equip consumers and providers with the skills necessary to assure that consumer-directed support services are delivered to adults with mental illness in a manner that enhances their participation, choice, and autonomy in community living. The State will incorporate consumer guidance into all aspects of the project.

Goals, Objectives, and Activities

Goal: Develop a common definition and service model of PAS for persons with serious mental illness for use by the Medicaid Agency, the Office of Mental Health (OMH), and service providers.

Objectives/Activities

• Identify best practices in providing PAS to persons with SMI and interviewing recipients.



• Conduct an analysis of current PAS and examine service models from other states.



• Examine various functional assessment tools that have proven effective in assessing persons with SMI.



• Adopt an appropriate assessment to become a part of the prior authorization process for the delivery of PAS to persons with SMI.



• Integrate the new service model definitions into service descriptions of existing programs.

Goal: Develop and implement a training curriculum for all personal assistance providers based on the service model developed and assure adequate consumer participation and sustainability of training efforts.

Objectives/Activities

• Develop or acquire a training curriculum for PAS for persons with SMI.



• Conduct training sessions with all service providers to incorporate the new service definitions and provider skills into each provider's ongoing staff development training and employee orientation training.



• Train consumers to conduct training in self-direction for consumers and providers.

Goal: Increase effectiveness of provider training and PAS through evaluation.

Objectives/Activities

• Develop and administer pre- and post-training evaluations to selected provider agencies to determine improvements in knowledge base and effectiveness of service delivery.



• Develop and administer consumer satisfaction evaluations with and effectiveness of PAS.

Goal: Develop and make available public education materials regarding consumer self-directed PAS.

Objectives/Activities

• Develop educational materials, including a brochure on consumer-directed PAS for persons with SMI.



• Develop a visual aid presentation on self-direction and post it on the web.

Key Activities and Products

• Develop a common definition and service model of PAS for persons with SMI.



• Develop an assessment tool, prior authorization processes, and other infrastructure supports.



• Develop training curricula for direct service workers, supervisors, and administrators using the train the trainer model.



• Train provider staff in the curricula and train consumers to conduct training in self-direction for consumers and providers.



• Conduct pre- and post-training evaluation of knowledge base and effectiveness of service delivery of the providers who serve SMI using outcome measures.



• Conduct pre- and post-consumer satisfaction evaluations with PAS consumers.



• Develop educational materials on consumer-directed PAS for persons with SMI and a visual aid presentation on self-direction.

Consumer Partners and their Involvement in Implementation Activities

• Consumer guidance will be incorporated into all aspects of the project. A nonprofit entity will train consumers who will then conduct trainings with providers, other consumers, and consumer groups on how to provide PAS to persons with SMI. Consumers of PAS will also participate in satisfaction surveys.



• The Disability Services and Supports System Consumer Task Force (DSSS-CTF), a Governor appointed cross-disability task force, is charged with the responsibility of making recommendations to the Department of Health and Hospitals (DHH) for long term care reform in Louisiana. This application is one that is approved and supported by this consumer group. A subcommittee of the DSSS-CTF, the Personal Assistance Self-Direction Project Steering Committee, once formed, will provide oversight and direction of grant activities. This subcommittee will comprise mental health consumers and stakeholders interested in supporting the development of PAS services for persons with SMI.



• Meaningful Minds of Louisiana, a grassroots consumer advocacy organization, comprises leaders of the mental health consumer community who represent all geographic regions of Louisiana. Members of the organization will serve on the project steering committee.

Public and Private Partners and their Involvement in Implementation Activities

Public Partners

The Bureau of Health Services Financing will collaborate with OMH (in DHH) to ensure that the Personal Assistant Services Employment Support option addresses the specific needs of persons with SMI who qualify for the option.

Private Partners

• The Louisiana Chapter of the National Alliance for the Mentally Ill has a Governor appointed representative on the DSSS-CTF and provides leadership to that group in the further development of a comprehensive system of community-based services to persons with SMI.



• The Louisiana chapter of the Mental Health Association (MHAL) works closely with the OMH on a plan to continue development of a comprehensive community system of care for mental health consumers. Currently, MHAL is working on a public education effort to promote the use of the new PAS Employment Support Option by persons with SMI.



• The Extra Mile, a group of nonprofit organizations around the State of Louisiana, were funded in 1990 by the DHH to support the efforts of DHH agencies to serve Louisiana citizens through the provision of volunteer support services. The Extra Mile is committed to assisting DHH to educate the consumer public about consumer-directed PAS.



• The Boston University Center for Psychiatric Rehabilitation will work with the State to develop or acquire a training curriculum for PAS for persons with SMI.



• The State will hire consultants to develop the service model, develop training, and evaluate the program.

Advisory Body, Committee, or Task Force

• A project steering committee, comprising consumers, family members, advocates, Medicaid, and OMH staff will oversee the project. The steering committee will serve as a subcommittee of the Consumer Task Force. This committee will have frequent and comprehensive oversight over the project and all decisions made as to model development and training will be approved by this body.



• The committee will make regular reports to the DSSS-CTF to assure that the project is in compliance with the task force's direction in its long term care reform plans and recommendations.

Formative/Process Evaluation Activities

• Consumer satisfaction and continuous monitoring of process and outcomes are integral to the project design.



• The project steering committee and grant staff will meet at least quarterly with the project evaluation staff to review project activities and progress. They will note deviations and discuss and assess possible impact to minimize potential problems. Staff will provide documentation of project activities to the evaluation staff to document implementation fidelity.



• Each component of the project will be monitored to assess the quality and efficiency of the grant activities. Staff will use a continuous improvement approach in order to provide feedback as quickly as possible so that changes can be made as needed to improve processes.



• A variety of data collection techniques may be employed here, including examination of meeting notes and minutes, evaluator observation of selected activities, focus groups with appropriate groups, quantitative evaluation of training and educational activities, and use of quantitative measures to assess satisfaction with the process.

Summative/Outcome Evaluation Activities

Boston University will conduct an outcome evaluation to assess the impact of grant activities on the service delivery system and the clients, including measuring outcomes as specified in the work plan and assessing sustainability of these outcomes as specified in the grant.

Strategies to Ensure Sustainability

• The OMH is committed to the further development of a comprehensive, home and community system of care that is sufficient to meet the needs of all who can benefit from this level of service. The development of a viable personal assistant service option for mental health consumers will erase a significant gap in service that currently results in unnecessarily lengthy hospital stays.



• The “train the trainer” model will assure sustainability of the training modules developed by this project. Staff will incorporate the modules into the employee orientation and annual training requirements that providers must follow in order to be reimbursed for PAS.