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Camino Real Community Services

IDD LOCAL SERVICE AREA PLAN


Services to Intellectually and Developmentally Disabled Persons

FY 20011 – FY 2012


___________________________________________

Comments or inquiries regarding this document
may be addressed to the
Executive Director
at
Camino Real Community Services
P.O. Box 725
Lytle, Texas 78052
Phone: (210) 357- 0310
FAX: (210) 357- 0456
Email: emmag@caminorealcs.org
____________________________________________


This Local Service Area Plan is the product and property of: Camino Real Community Services








Table of Contents

I. MISSION AND VALUES

Executive Summary...................................................................................................2

Vision Statement.......................................................................................................3

Mission Statement.....................................................................................................3

Philosophy................................................................................................................3

II. LOCAL SERVICE AREA PLANNING PROCESS

Data Gathering Processes..........................................................................................4

Local Service Area Plan Review...................................................................................4

III. EXTERNAL/INTERNAL ASSESSMENT

External Assessment.................................................................................................5

Internal Assessment...................................................................................................5

IV. LOCAL AUTHORITY ASSESSMENT COMPONENTS

Population.................................................................................................................6

Services and Supports................................................................................................6

Collaboration..............................................................................................................7

Resource Development and Allocation..........................................................................7

Review of Goals from Previous Local Service Area Plan..................................................9

Survey Data Collection................................................................................................9

Local Service Area Priorities........................................................................................9

Impact of Key Forces.................................................................................................10

VI GOALS FOR FY 2010 AND FY 2011.......................................................................11




I. MISSION AND VALUES

Camino Real is a Texas Community Center as established by its sponsoring governmental agencies, County Commissioners' courts, and through inter-local governmental agreements beginning September 1, 2000. Previously state-operated, it is now considered to be a unit of local government, although not a government agency. This distinction as a local governmental entity provides for immunity from certain liabilities, and makes possible the local Mental Health and Intellectual and Developmental Disability Local Authority roles that enable the Center to act on behalf of the state of Texas to deliver services and to determine other providers of state funded services. Camino Real provides services in nine counties under the oversight of a nine member Board of Trustees appointed by the local county judges.

The services provided by Camino Real Community Services are predicated on the performance contracts with The Texas Department of State Health Services, The Texas Department of Assistive and Rehabilitative Services and The Texas Department of Aging and Disability Services. Persons with mental illness, intellectual and developmental disabilities (IDD), and children with severe emotional problems and/or developmental disabilities meeting eligibility criteria for services comprise the priority population. Funding for these services are made up of local, state and federal funds, with the majority of the funds being local revenues. The general revenue state funds are allocated by the Texas legislature through the above state agencies.
Camino Real is the Local Mental Health Authority (LMHA) and the Intellectual and Developmental Disability (IDD) Local Authority (LA) for the following counties: Atascosa, Dimmit, Frio, Karnes, LaSalle, Maverick, McMullen, Wilson and Zavala. Early Childhood Intervention (ECI) services are also provided in Atascosa, Bee, Dimmit, Frio, Gonzales, Guadalupe, LaSalle, Live Oak, McMullen, Maverick, Wilson and Zavala counties.

It is the intent of Camino Real to ensure the highest quality of services is provided in the most efficient manner to eligible consumers while being good stewards of the public dollar. It is also the intent of Camino Real to assure accountability for: cost-effectiveness of and the relative value of service delivery options; to ensure a client with intellectual disabilities lives in the least restrictive environment appropriate to the person's care; to ensure that all potential and incoming consumers are aware of the availability of community living options as well as institutional options; to support children through Permanency Planning to live in a family or family-like setting; to divert consumers of services from the criminal justice system; to ensure that a child with intellectual disabilities remains with the child's parent or guardian as appropriate; and to look for opportunities for innovation in services and service delivery. Camino Real supports Promoting Independence initiatives that enhance the current system to give individuals with disabilities choices in living in the most integrated setting. The responsibility for Camino Real to work in partnership with consumers and the community to accomplish this intent is reflected in the vision, mission and philosophy of the Center. Developing the vision, mission and philosophy was a multifaceted effort that included input from consumers, community and staff.





VISION

As a thriving center, Camino Real, in partnership with consumers, families, communities, service providers, and policy makers envisions:
  • Quality customer--driven services;
  • Accessible, innovative and culturally sensitive services;
  • Communities which embrace and support persons with mental illness, mental retardation, and developmental disabilities (IDD);
  • Consumers achieving their individual dreams and;
  • A great place to work

Camino Real shall serve each consumer of the Center with a comprehensive, individualized plan that enhances the consumer's ability to function successfully in the community, or other least restrictive environment. Camino Real shall provide the highest quality mental health and IDD services in a safe and humane environment with absolute respect of the consumers' rights.

MISSION

Abriendo Puertas...

...opening doors through choice, dignity and respect.


PHILOSOPHY

Camino Real values:

INDIVIDUAL WORTH -- We affirm that the individuals we serve share with us common human needs, rights, desires and strengths. We celebrate our cultural diversity and individual uniqueness and commit ourselves to support and enable each person's choices and preferences.

QUALITY -- We commit ourselves to the pursuit of excellence in everything we do.

INTEGRITY -- We believe that our personal and professional integrity is the basis of public trust.

DEDICATION -- We take pride in our commitment to public service and to the support of the people we are privileged to serve.

INNOVATION -- We are committed to developing an environment which inspires and promotes innovation, fosters dynamic leadership and rewards creativity among our staff, volunteers and the people we serve.

PARTNERSHIPS -- We believe that our vision and values are best realized when individuals working in teams achieve positive outcomes.



II. LOCAL SERVICE AREA PLANNING PROCESS

The approach to planning at Camino Real Community Services is based on the gathering of information internally, as well as from stakeholder issues of concern, and identifying those outside forces which impact center operations. Factors impacting planning include the organizational mandates attached to the various funding streams used to finance services, waiting lists, as well as the changing demographics of the nine-county area served by the IDD program.

OVERVIEW OF DATA GATHERING PROCESSES

Camino Real Community Services gathers data internally on the local Center level from which regional and clinical managers plan day-to-day activities. The Anasazi database, from which productivity reports are generated, is used to make decisions about objectives to accomplish as well as how best to manage personnel to achieve those objectives. Information about these reports and objectives is then taken to program management meetings where it is refined and reviewed against Center objectives. All information is funneled through the Executive Council with feedback provided at program manager's meetings and Center administrative staff meetings. The Executive Director is the conduit for information getting to the Board of Trustees for approval on a policy level.

The Local Service Area Plan is devised to achieve the Center vision using both the data gathered from annual reviews and the ongoing, day-to-day Center processes. The Local Service Area Plan is considered to be a fluid document that must respond to the changing landscape of legislative directives and business realities. This requires the ongoing review and updating of Center strategies at all levels of management.

Camino Real Community Services has many committees and councils that provide ongoing input concerning services. Some groups are composed solely of personnel, internal to Camino Real, but many include participation by stakeholders from outside the Center. These committees include the Planning and Network Advisory Committee (PNAC). Membership of this committee includes consumers, family members, community members, and staff from other agencies from various counties served by Camino Real. Meetings are held as necessary to ensure this committee is up to date on agency, community, and state issues. This group is also the driver behind the local community needs assessment surveys to identify local needs and priorities and strategies to address them. Many of the members are also members of their respective county's local Advisory Councils and bring local issues of concern for consideration as a possible Center-wide concern that may need to be addressed.

LOCAL SERVICE AREA PLAN REVIEW

Review of the Local Service Area Plan will be done every two years at a minimum or more often if necessary. It is reviewed by the Planning and Network Advisory Committee to ensure stakeholder input and review. The Executive Council is the body ultimately responsible for making changes based on recommendations, findings, etc. of various survey processes or Performance Contract and rule changes. The Executive Council will recommend changes to the Board of Trustees for final approval. Goals and objectives that are part of action plans generated by specific committees are routed to the Executive Council for final approval. All planning committees must be making recommendations in line with the Center vision, mission and values, and it is up to the Executive Council to review all plans for improvement against these criteria. This is not just a rubber-stamping process, but a concerted effort being made to assure we are "pointing all the arrows in the same direction". This is an ongoing, day-to-day process to ensure that Camino Real is responding to the needs of its consumers.



III. EXTERNAL / INTERNAL ASSESSMENT

Camino Real has a comprehensive methodology for gathering information to assess key factors that influence the Center's effort in meeting its stated vision, mission, and goals

EXTERNAL ASSESSMENT

External assessment of service delivery is mostly provided by the Department of Aging and Disability Services (DADS) through their oversight of performance contract expectations. The following external methodologies are utilized to gather information regarding the many facets of service delivery and business practices in IDD services:

DADS Reviews

  • Home and Community Based Waiver Services (HCS);
  • Texas Home Living Waiver Services (TxHmL) Provider Services;
  • HCS, Texas Home Living and Quality Assurance Authority Review;
  • Data Verification Reviews;
  • Budget and Cost Reports; and
  • Intellectual Disabilities and Behavioral Health Outpatient Data Warehouse (MBOW).
  • CARE
  • IDD Financial Audit every two years
  • Audit of HCS and TxHmL billing every two years

Other Reviews

  • Annual Fiscal Audit by External Auditor; and
  • Building Safety Inspection by Texas Risk Management Council

INTERNAL ASSESSMENT

Internal assessment of service delivery and business practices are generally done through internal reviews and audits, satisfaction surveys, and community needs assessment surveys. The following is a general list of those internal review processes:

  • HCS and TxHmL and GR Satisfaction Survey;
  • Quarterly Consumer Advisory Committee meetings for HCS, TxHmL, Authority, and GR consumers;
  • Corporate Compliance/Quality Management Audit;
  • Bi-Annual Community Needs Assessment;
  • Utilization Management Reviews of MBOW Data;
  • Review of Performance Accountability Measures.



IV. LOCAL AUTHORITY ASSESSMENT COMPONENTS

POPULATION

Priority Population Description for Intellectual and Developmentally Disabled Services: The priority population for IDD services consists of: persons with an intellectual disability, as defined by Texas Health and Safety Code §591.003; individuals with a pervasive developmental disorder (including autism) or autism spectrum disorder, as defined in the Diagnostic and Statistical Manual Of Mental Disorders; individuals with a related condition, who are eligible for and enrolling in services in the ICF/IID Program, Home and Community-based Services (HCS) Program or the Texas Home Living (TxHmL) Program; children who are eligible for Early Childhood Intervention services through the Department of Assistive and Rehabilitative Services (DARS); and nursing facility residents who are eligible for specialized services for intellectual disability or a related condition pursuant to Section 1919(e)(7) of the Social Security Act.

SERVICES AND SUPPORTS

The Center provides the following services through its IDD Services division:

  • Eligibility Determination: An assessment or endorsement conducted in accordance with the Texas Health and Safety Code, 593.005 and 25 TAC Chapter 415, Subchapter D to determine if an individual has an intellectual disability or is a member of the DADS priority population.
  • Service Coordination: Assistance in accessing medical, social, educational and other appropriate services and supports to help an individual achieve quality of life and community participation acceptable to the individual.
  • Continuity of Services: Assistance in placement into or out of a state facility, enrollment or transfers into the HCS or ICF/MR program, or assistance in maintaining an individual's placement or developing another placement for the person.
  • Service Authorization and Monitoring: Service Coordination provided to an individual who is assessed as having a single need.
  • Respite: Support Services provided to the consumer in or out of the home to give the family or primary care givers temporary relief.
  • Employment Assistance: Assistance in helping a participant locate paid employment in the community by assisting the participant to identify his or her employment preferences, his or her job skills, his or her requirements for work setting and work conditions, and prospective employers offering employment comparative with the participant's identified preferences, skills, and requirements.
  • Supported Employment: Supports provided to an individual to assist them in maintaining their job in the community.
  • Vocational Services: Services provided away from an individual's home to help the individual develop and refine skills necessary to live and work in the community.
  • Day Habilitation: Assistance with acquiring, retaining, or improving self-help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life.
  • Community Supports: Services and supports provided to an individual in the individual's home or community that are necessary to achieve outcomes in the Person Directed Plan.
  • Foster Care Services: Services provided to individuals who are in need of a residential setting and are eligible for HCS.
  • Special Therapies-OT, PT, Speech, audiologists, and dietary services provided to individuals who have been identified with a need and participate in a Medicaid waiver.
  • Behavioral Support: Provides specialized interventions that assist a participant to increase adaptive behaviors to replace or modify maladaptive behavior that prevent or interfere with the participant's inclusion in home and family life or community life.
  • Nursing: This service includes treatment and monitoring of health care procedures prescribed by a physician/medical practitioner and/or required by standards of professional practice or state law to be performed by licensed nursing personnel.
  • Permanency Planning: This service is for persons under age 22 enrolled in or in the process of being enrolled into an Intermediate Care Facility or HCS residential setting. Camino Real conducts permanency planning every 180 days to assist the person in moving toward residence with either their natural family or a family based alternative.

Collaboration

Camino Real is firmly integrated into the community and collaborates with various agencies and local systems in order to provide comprehensive supports to consumers while avoiding duplication of effort. Examples of these collaborative efforts include but are not limited to:

  • State Supported Living Centers: The Center works closely with the State Supported Living Centers to facilitate placements in the community once consumers are identified as needing placement. Collaboration with the admissions department occurs when community-based consumers are in need of facility placement.
  • Community Resource Coordination Groups (CRCG's): Camino Real assigns staff to participate in local CRCG's to assist in planning for consumers that are served by multiple providers..
  • Local School Districts: Collaboration occurs with transition into and out of the school system. Supports are provided to school aged children who meet priority population criteria..
  • Counties: Camino Real works closely with the local governance entities that are the sponsoring agencies for the Center. Routinely provide minutes from Board meetings and presentations made to Commissioners courts regarding Center business and needs. Several counties provide physical locations for the Center operations. Staff routinely works closely with county judges, area schools, local medical service providers, local law enforcement, and other social service providers to meet consumer needs.
  • Community Centers: Camino Real is a member of the Texas Council of Community Centers, Inc. through which efforts for collaboration are facilitated. Visits to other Centers, sharing of information, and identification of opportunities for efficiencies are just a few examples of the communication and cooperation between Centers.
  • Area Law Enforcement and Judicial Officials: The Center collaborates with area judicial officials in developing and implementing strategies for the treatment and diversion of persons with mental disabilities who interface with law enforcement.
  • DADS Partners: A formalized collaborative relationship among Camino Real Community Center, Alamo Area Agency on Aging, Middle Rio Grande Area Agency on Aging, Hill Country Community Center, and DADS Regional and Local Services. These community partners provide access to the Department of Aging and Disabilities Services (DADS) system and through cross training are able to improve and streamline services.

Camino Real employs staff that is reflective of the community they serve so that services are delivered in a culturally sensitive manner. For example, while over 66% of Camino Real staff are fully bilingual, over 95% of the IDD staff who serve the border counties area are bilingual where the predominant language spoken in homes is Spanish.

RESOURCE DEVELOPMENT AND ALLOCATION

It is the philosophy of Camino Real Community Services to maximize its resources through conservative and responsible expenditure of funds while maintaining a viable service delivery system. Simultaneously, the Center leadership maintains awareness of new and developing funding, both in public as well as private sources.

Resource development and allocation activities involve adding more support through the accrual of new resources and by increasing service efficiencies.

Resource allocation involves reviewing and analyzing current methods of service delivery as well as the organization's current overall strategies. The Center pursues increases in resources via fund-raising activities, increased volunteer activities, donations, maximization of Medicaid and Medicare revenues, retention of profitable sheltered workshop contracts, and finally, by assuring that all funding sources (including local, state and federal) to which the Center has rights, are sought after and obtained.

The resource goals of the Center are:

  • Ensure existing resources continue to be available;
  • Create opportunities to maximize existing resources (e.g., making organizational or programmatic changes, applying for program or staff certification, training staff and/or providers, performing cost-benefit analysis of current and new resource-generating programs);
  • Identify (through research or business contact) additional sources of funds which may be available;
  • Create opportunities to obtain additional resources (e.g., grant writing, contracting); and
  • Identify federal, state or local programs (public and private) in which to participate.

In general, funding for Camino Real Community Services comes from local, state, and federal sources. Very little, if any, funding is available for "discretionary" spending (i.e. providing new services for programs or enhancing the number of persons receiving services). Camino Real is always faced with the potential for reduced general revenue dollars and reduced Medicaid reimbursement rates based on legislative activity. Given this state of funding, the Center will be engaging in activities to increase the number of resources and funding sources to maintain the current level of services being provided, and when possible, provide additional needed services and supports.

Strategies to Maximize Funding Resources and Their Use

  • Implementation of strategies to increase the number of Medicaid eligible service recipients;
  • Implement a more refined training and processing system that will ensure retainment of earned revenues and prevent and/or eliminate paybacks;
  • Implement management system which maximizes medication revenues and minimizes costs. This system, at a minimum, would include maximization of Medicaid funds;
  • Explore grant opportunities;
  • Explore fund raising activities;
  • Collaboration with other Centers to achieve administrative efficiencies;
  • Continued monitoring of Performance Accountability Measures to increase service efficiencies;
  • Identify and eliminate inefficiencies, clarify staff roles and activities;
  • Utilization Management techniques will be continued to do an analysis of appropriate cost to service ratios as well as acceptable levels of service delivery;
  • Refine internal information systems and standardized reports that can be provided to managers; and their staff related to performance as well as budgetary measures.




V. COMMUNITY NEEDS AND PRIORITIES

REVIEW OF GOALS FROM PREVIOUS LOCAL SERVICE AREA PLAN

Previous goals

  1. Camino Real Community Services will increase public awareness of the services it provides.
    Camino Real has continued its marketing efforts throughout the service area by participating in various provider groups to collaborate to meet community needs. In addition, regular newspaper ads in local papers educate the public as to available services. A new brochure was designed and is distributed at the various health fairs at which Camino Real participates as well as at open houses and other activities held during IDD Awareness month.
  2. Camino Real Community Services will ensure a solid network of providers.
    Camino Real continues its efforts to recruit and maintain qualified internal and external providers. In IDD services Camino Real contracts with providers for day habilitation and SHL services as well as provides services coordination for consumers in the Texas Home Living and HCS waiver programs who are served by other providers.
  3. Camino Real Community Services will improve family support services.
    Camino Real administrates an active respite program to meet family needs. In addition, newly enrolled waiver consumers are encouraged to recruit their own providers with whom they are comfortable. These providers are then screened for employment by Camino Real and given the required training to do the job.

FY 2008 Survey Data Collection

The Community Needs Assessment Survey is the major venue for gathering information about those issues that are of foremost concern to the stakeholders of Camino Real. In May 2008, the Community Needs Assessment Survey was distributed to consumers of Camino Real. Surveys were also distributed to other community stakeholders such as local community leaders and other service providers. Many survey participants took the survey with them to complete and return at a later date so an exact percentage of return is difficult to calculate. However, 292 Consumer/Family surveys and 113 Other Stakeholder surveys were received. This represents a significant increase in the number of stakeholder surveys received compared to previous planning efforts. Eighty three percent (83%) of Consumer/Family respondents noted that they were satisfied with services. The following table shows the results to other important questions asked:

LOCAL SERVICE PRIORITIES

What Services are most Important to Your Community? Consumer/Family Responses Other Stakeholder Responses Total
Training in Life Skills 64 40 104
Psychology/Behavioral Services 47 49 96
Work Center Training 55 29 84
Community Support Services 48 23 71
Screening for Eligibility 25 34 59
Help to Find and Keep a Job 25 26 51
Nursing Services 34 15 49
Respite Services 38 10 48
Help to Find Alternate Living Arrangements 23 12 35
Foster Care Providers 20 14 34

Three areas were cited as gaps in services. Transportation is always a concern. In addition the local availability of psychological and nursing services was mentioned. Camino Real provides psychological and nursing services; however, the area is designated as medically underserved with a severe shortage of health care professionals, especially a lack of licensed medical staff and licensed counselors. This makes having a provider available locally in each area a challenge at best. These findings are in line with previous assessment/survey results and are still valid for the service area.

IMPACT OF KEY FORCES

The strengths, weaknesses, opportunities, and threats to Camino Real are derived from the surveys and assessments completed as well as management meetings.

Strengths

  • Committed staff with strong technical and clinical expertise;
  • Experienced management team;
  • Strong community involvement demonstrated by the local advisory councils, involvement of county judges, and PNAC;
  • Active and committed Board of Trustees;
  • Good procedures in place to identify financial information and maximize all potential revenue streams;
  • Access to “state of the art” technology (i.e., video conferencing);
  • Low staff turnover rate;
  • Cooperation and good relations with local school districts;
  • Good internal auditing process especially related to Medicaid compliance;
  • Good Customer Services based on current and historical feedback;
  • Consumer focused;
  • Strong work center programs that provide local funds to the Center and real, meaningful work activity to the consumer;
  • Bilingual services are provided (English/Spanish); and
  • Marketing and educating the communities at large regarding all program services.

Weakness

  • Underfunded system - Not enough general revenue to meet the demand for services and a lack of financial resources at the local level;
  • Large geographical service area;
  • Legislative mandates that limit who can be served while the community identifies a broader base of persons in need of services; and
  • Significant lack of local community resources to address the local demand for social services.

Opportunities

  • Exploration of additional grant opportunities for expanding or enhancing services;
  • Continue to enhance strong work center programs where consumers experience real, meaningful work activity while the Center benefits from generated revenues; and
  • Challenge of expanding authority processes for oversight of a growing network of external providers.
  • Seeking funding through the 1115 Waiver program to provide additional services for individuals with IDD/Autism.

Threats

  • Legislative momentum toward privatization of services;
  • Lack of sufficient General Revenue Funding to meet need for services and all the administrative requirements related to service delivery;
  • Texas has poorly funded human services— one of the lowest in the nation;
  • Poor economy in the areas served by Camino Real which directly impact services;
  • Difficulty in recruiting and maintaining experienced and qualified staff in the rural areas;
  • Increase in Health Care costs/fringe benefit package without corresponding funding to offset the increase;
  • Continual changes within the state system pertaining to funding streams, policies, etc. that prevent stability and development of expertise with requirements;
  • Rapid outdating of technology and ongoing costs;
  • Rising fuel costs to serve a large service area; and
  • Large percentage of population lives under poverty level and large percentage is uninsured.

Gaps

  • Lack of community resources for referrals;
  • A waiting list for IDD services
  • No public transportation systems in the entire area; and
  • High unemployment rate severely limits opportunities for employment for persons with disabilities.


VI. GOALS FOR FY 2014 and FY 2015

Goal 1: Camino Real will work to ensure a solid network of providers in the service area.

  • Camino Real will work with local area providers to ensure quality services by providing oversight through Service Coordination and assisting as needed to ensure consumer needs are met.
  • Camino Real will offer choice of providers during waiver enrollments and complete them on a timely basis.

Goal 2: Camino Real will emphasize consumer choice and consumer control in the array of services offered.

  • Information such as brochures on qualified providers will be offered to consumers enrolling into a Medicaid waiver program to assist in making informed choices.
  • Consumers new to the service system will be assisted to identify services that meet their needs and preferences.
  • Consumers will be informed of the Consumer Directed Services Option and the benefits of this program.
  • Consumers will be offered choice of internal providers within Camino Real as capacity and staff availability allows.

Goal 3: Camino Real will ensure consumers receive services in the least restrictive environment appropriate to the person's care.

  • Consumers will receive education on all service options including those available at the most local state supported living center, small group homes and within their own family home.

Goal 4: Camino Real will successfully provide service coordination services to all persons receiving Medicaid waiver services within the service area.

  • Consumers will be assisted to access waiver services that meet their preferences for personal growth and development that will allow them to fulfill their personal dreams.
  • Service Coordination will be provided to individuals who reside in nursing facilities who have an Intellectual Disability or a Related Condition.





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