The Vermont Division of Mental Retardation (DMR) has issued new Guidelines for Quality Services. These guidelines are directly linked to DMR's overall mission statement and goals emphasize the goal of achieving key outcomes based on quality of life principles.

Vermont's Goals

1.People with disabilities are treated with respect and dignity.
2.People are supported in their own families, in their own homes, in local neighborhoods and communities.
3.People and their families and guardians have opportunities to make meaningful choices.
4.Services foster the development of personal relationships with other community members.
5.Services support people in regular jobs and/or activities of their choice.
6.Services foster the development of practical life skills.
7.Services are supported and managed in a manner which ensures the fiscal stability of the system.
8.Services are designed to enhance the varying abilities of people to communicate and are responsive to their needs.
9.All staff and contracted people are properly trained and competent in performing their work.
10.The safety and health of people are valued and promoted.

DMR's "quality management activities focus on goals and outcomes which integrate evaluation and monitoring systems designed to improve the quality and quantity of services in the State of Vermont. The goals and outcomes identified ... reflect on the quality of life, health, safety, and civil and human rights of people supported by the mental retardation service system." System goals are driven by four key principles: (a) personal choice and participation; (b) community membership; (c) personalization; and, (d) relevance.

Vermont's new guidelines incorporate desired outcomes that tie directly to each of the ten system goals that have been adopted. Please see the chart below for examples of these outcome statements.

Quality Goals and Outcomes

Goal 2: People are supported in their own families, in their own homes, in local neighborhoods and communities.

OUTCOMES
2.1 People have a sense of belonging, inclusion and membership within their communities.
2.2 Opportunities which include variety and choice are provided for community membership based on the interests of the person.
2.3 People receive the necessary supports to live with their family when desired.
2.4 No people are admitted to institutional settings in or out of state.
2.5 Homes for people receiving residential services are suited to the person.
2.6 Services are available and provided for people requesting and needing those services.

Goal 10: The safety and health of people are valued and promoted.

OUTCOMES
10.1 People have access to support and services which promote their physical and emotional well-being.
10.2 People receive training and support to be safe in their daily lives.
10.3 People live in homes which meet applicable standards for fire safety and accessibility.
10.4 People receive medical and dental services in a manner consistent with those available to all community members.
10.5 Medical services are provided for people receiving residential services in accordance with the Medical Guidelines.

These outcome statements were developed in collaboration with Vermont's network of private service providers and families. Agency performance is assessed through annual provider reviews that take an in-depth look at the services and supports being received by one-half of the individuals served by the agency. The review is conducted by a team comprised of DMR staff at least one individual who receives services through another community agency, and a staff member from a peer provider agency. [N.B., These agency reviews are supplemented by a variety of other quality management activities, including facility safety reviews, fiscal audits, supported employment site reviews, and a periodic systems review through which DMR asks provider agencies, other organizations, people with mental retardation and family members to rate an agency's performance against the aims set forth in its mission statement.]

DMR officials point out that many of the newly adopted outcomes involve more subjectively assessments of an agency's performance than was the case when more process-oriented standards were used. As a consequence, "[r]eviewers will use specific examples to back up their conclusions and work with agencies to reach consensus." The first reviews using the new guidelines have been completed and "are being well received by all concerned." State officials also report that "[b]roadening the focus to quality of life issues from quality of tooth brushing (for example) has changed the focus of muck of our interaction with service providers in a very positive way."

The implementation of these new guidelines is in a trial phase to work out the rough spots. However, DMR officials note that, since these guidelines were developed jointly with community agencies and families, there is a shared commitment to making them work. FMI: Charles Moseley, Director, Division of Mental Retardation, Department of Mental Health and Mental Retardation, 103 South Main Street.　Waterbury, VT 05671-1601.

Readers interested in learning more about changes that are occurring in other states will find several such initiatives profiled in Reinventing Quality: A Sourcebook of Innovative Programs for Quality Assurance and Service Improvement in Community Settings, available (Price: $8) from the Publications Office, Institute on Community Integration, University of Minnesota, 109 Pattee Hall, 150
Pillsbury Drive SE, Minneapolis, MN 55455 (tel 612/624-4512).

More Thoughts on Quality….

The Center on Human Policy at Syracuse University has released two publications that explore fundamental questions in safeguarding people with developmental disabilities who are living in the community while adhering to fundamental values in supporting such individuals. Assistance with Integrity: The Search for Accountability and the Lives of People with Developmental Disabilities by John O'Brien and Connie Lyle O'Brien is the product of a series of conferences and meetings with key stakeholders in Wisconsin, New Hampshire, and Colorado. Conventional regulatory quality assurance approaches and methods are criticized as "activity traps that threaten the developments most necessary to improve the quality of community life for people with developmental disabilities." Such approaches, the authors suggest, have created a "crisis of accountability." The paper then goes on to explore alternative approaches that build "safer, more just, more inclusive communities in company with people with developmental disabilities." This is a lively, insightful paper that challenges the premises of conventional program regulation while acknowledging that people with lifelong disabilities need effective safeguards.

Safeguards is the theme of the Center's Policy Bulletin No. 3. This bulletin contains papers that discuss various approaches to building effective safeguards for people with developmental disabilities in the context of individualized, person-centered services. In the Paradox of Regulation, Steve Taylor identifies the shortcomings and counterproductive effects of conventional regulatory schemes and argues for the adoption of alternative approaches that offer potentially better opportunities for achieving high quality. Other papers by John O'Brien and Connie Lyle O'Brien provide thoughtful perspectives on replacing traditional quality assurance methods with new approaches. Both of these publications can be ordered (charge applies) by contacting: Rachael A. Zubal, Publications Coordinator, Research and Training Center on Community Integration, The Center on Human Policy, Syracuse University, 200 Huntington Hall, Syracuse, NY 13244-2340 (tel 315/443-3851 -- fax 315/443-4338).