DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES

FAMILY SUPPORT
ANNUAL REPORT

July 1, 2010 - June 30, 2011

DIVISION OF DEVELOPMENTAL DISABILITIES
CREDO
To support the choices of individuals with disabilities and their families by promoting and
providing within communities, flexible, quality, consumer-driven services and supports.
Individuals with developmental disabilities are valued members of their communities and are
involved and participating based on their own choices.
VALUES
We Value:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Healthy relationships with people;
Individual and family priorities and choices;
Equal access to quality services and supports for all individuals and families;
Partnerships and ongoing communication with individuals, family members,
advocates, providers, and community members;
Developmental approaches – changing conditions that affect people rather than
changing people who are affected by conditions;
Individual freedom from abuse, neglect and exploitation with a balance between
the right to make choices and experience life and individual safety;
A diverse workforce that is motivated, skilled and knowledgeable of and uses
the most effective practices known;
An environment rich in diversity in which each person is respected and has the
opportunity to reach their optimal potential;
An individual’s right to choose to participate in and contribute to all aspects of
home and community life; and
A system of services and supports which are:
Responsive – timely and flexible responses to internal and external
customers;
Strength based – recognizing people’s strengths, promoting self-reliance,
enhancing confidence and building on community assets;
Effective – ongoing identification of effective methods and practices and
incorporation of those practices into operations; and
Accountable – to our customers and to the taxpayers.
THE KEY TO OUR SUCCESS
EXCEEDING THE EXPECTATIONS OF OUR CUSTOMERS

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

I.

Introduction

In 1993, Family Support Legislation was passed that defined a family support program for people
with developmental disabilities and their families, subject to funding appropriations. This
legislation was a result of collaboration with families, advocacy organizations, providers of
services, and the Division of Developmental Disabilities (Division) in recognition of the
significance of family support as a national initiative. While there is no appropriated funding for
a family support program in Arizona, the Division integrates the philosophy of the legislation
into its activities as indicated in its Credo and Values. This Annual Report highlights initiatives
and systems successfully implemented, and describes the ways in which individuals and families
are supported through the Division and its many collaborators.
Family support is defined as services, supports and other assistance provided to families with
members who have a developmental disability and that are designed to:






II.

Strengthen the family’s role as a primary caregiver;
Prevent inappropriate out-of-home placement;
Maintain family unity;
Reunite families with members who have been placed out of home; and
Include respite care, assistive technology, appropriate personal assistance services, parent
training and counseling, home modifications and assistance with extraordinary expenses
associated with the needs of a person with a developmental disability.

Overview of the Division of Developmental Disabilities

The Division of Developmental Disabilities within the Arizona Department of Economic
Security provides services and programs to 31,320 people with developmental disabilities as of
June 30, 2011. The Division believes that people can best be supported in integrated community
settings and the majority of the Division’s programs and services are tailored to meet the
individual needs of individuals and their families at home and in community-based settings.
The Division coordinates services and resources through central administrative offices, district
offices and local offices located in communities throughout Arizona. These district and local
offices promote the use of existing community resources and program flexibility to meet the
needs of individuals with developmental disabilities and their families. While a few services are
delivered directly by the state, most services and supports are delivered through a network of
individual and agency providers throughout Arizona.

2 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

To be eligible for Division services a person must have a chronic disability that is manifested
before the age of 18 and is attributable to a cognitive disability, cerebral palsy, epilepsy or
autism. The disability must also result in substantial functional limitations in three or more of
the following areas of major life activities:








Self care: needing help with eating, hygiene, etc.
Receptive and expressive language: needing help with communicating with others.
Learning: needing help with acquiring and processing new information.
Mobility: needing help with moving from place to place.
Self direction: needing help with managing personal finances or making decisions.
Capacity for independent living: needing supervision or assistance on a daily basis.
Economic self sufficiency: not being financially independent.

Infants and toddlers under the age of three years may be eligible for services if they exhibit a
significant delay in one or more areas of development or, for children under the age of six, are
determined to be at risk of having a developmental disability without services. The following
chart shows the breakdown of eligible individuals by primary disability as of June 30, 2011:

3 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

The Division supports people of all ages. The following chart shows the breakdown of
eligible individuals by age as of June 30, 2011:

The Division provides services through two primary funding sources: State funded services and
the Arizona Long Term Care System.
State funded services cover individuals who meet the statutory criteria described above. State
funded services for individuals over the age of three can only be provided up to the Division’s
legislative budget appropriation. There is a waiting list to receive these services after the age of
three; the types of services provided are listed in Section III of this report.
Individuals with developmental disabilities who qualify for services through the Division may
also be eligible for services through the Arizona Long Term Care System (ALTCS). The
Arizona Long Term Care System provides long term and acute care services to individuals with
developmental disabilities who are at risk of institutionalization. The Arizona Long Term Care
System is the Medicaid Title XIX program for persons with developmental disabilities who meet
the ALTCS eligibility criteria. The Arizona Health Care Cost Containment System (AHCCCS)
determines eligibility for Long Term Care Services through a review of the person’s functional
needs and financial eligibility. It is a research and demonstration program approved through the
Federal Centers for Medicare and Medicaid Services and is intended to illustrate that home and
community-based services and a managed care approach are more cost effective than
institutionalization. Long term and acute care services are bundled to coordinate and enhance
service delivery under a single system of support managed by the Division.

4 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

The following chart shows the breakdown of eligible individuals by funding source as of June
30, 2011:

The Division provides most of its services through a statewide network of profit and non-profit
agencies (Qualified Vendors) and individual providers. Services are provided based on the
person’s identified needs, state and/or federal guidelines and, when applicable, the availability of
funds. See Section VI for the number of providers.

III. Services and Supports
People receive assistance from a support coordinator (case manager) in determining eligibility,
assessing needs, and obtaining services and supports. Support coordinators:
 Gather information to help determine eligibility;
 Develop, with ideas and suggestions from the person and his/her family, an Individual
Service/Support Plan that identifies the supports and services needed;
 Assist the person and family in obtaining the needed services and supports;
 Monitor the provision and effectiveness of services; and
 Provide information about services available from other state and community agencies as
well as from private organizations.

5 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

Targeted Support Coordination is an option for people who are eligible for Medicaid/Title XIX
health care through the Arizona Health Care Cost Containment System (AHCCCS), but are not
eligible for ALTCS. This option allows the individual/responsible person to determine the
frequency and type of contact he/she wants from the support coordinator. This program does not
provide for the other services covered by Long Term Care such as respite, habilitation, etc.
People who are eligible for Medicaid but not eligible for Long Term Care are eligible for
Targeted Support Coordination.
The Arizona Long Term Care System provides funding for many services based on assessed
need. Based on the availability of state funding, the Developmental Disabilities (DD) statefunded program offers essentially the same services as does the Arizona Long Term Care
program except for acute and behavioral health services. An asterisk (*) indicates services that
are available for Arizona Long Term Care members only.
 Augmentative Communication Devices (devices that help a person communicate, such as a
notebook, communication board, or computer system. Each device is individualized to a
person’s specific needs and strengths).*
 Attendant Care (help with personal care and housekeeping).
 Behavioral Health (care and treatment for people with behavioral health needs such as crisis
services, evaluation and diagnosis, counseling, behavioral health rehabilitation,
transportation, respite, medication, psychiatric medication adjustment and monitoring or inpatient hospital services).*
 Day Treatment and Training (training, supervision, therapeutic activities, and support to
promote skill development in independent living, self care, communication, and social
relationships. Services can be provided in both congregate and individual community
settings).
 Early Periodic Screening, Diagnosis and Treatment Services (EPSDT).*
 Employment Services (center based employment, group supported employment, and
individual supported employment).
 Environmental modifications (building modifications to allow an individual to function as
independently as possible in their own home). *
 Habilitation (interventions such as habilitative therapies, special developmental skills,
behavioral intervention, sensory-motor development designed to increase the person’s skills
and functioning).
 Health Plan Services (acute care).*
 Homemaker (help with housekeeping).
 Home Health Aide (health maintenance, continued treatment or monitoring of a health
condition and supportive care with activities of daily living).*
 Home Health Nurse (skilled nursing services).*
 Hospice (care for individuals who are terminally ill).*
 Residential Services (see Section IV).
 Therapies (Occupational, Physical, and Speech).
 Transportation (to ALTCS covered services).
 Respite Care (short term care and supervision to provide relief to the caregiver).
Information about children’s services can be found in Section VII.
6 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

IV.

Residential Options

The Division provides services in a variety of living environments, the vast majority of which are
community based. Most services are provided in the family or person’s home. Opportunities are
provided for people to choose a place to live, with necessary supports, within their communities
such as receiving supports to live within the family home; living in one’s own home or
apartment; living in an adult developmental or child developmental home or residing in a small
group home. When residential services are needed, the following options are available:
Individually Designed Living Arrangement - This service provides for an alternative, nonlicensed living situation for consumers to choose where and with whom he/she will live and
assume all responsibility for his/her residence. Generally, one or more consumers reside
together in a private residence that is leased or owned by the consumer(s) and/or the
consumer(s) representative(s). The focus of this service is to provide teaching supports
(habilitation) to individuals based on the collective need for support to eligible consumers
who have chosen to reside together and share their resources.
Adult Developmental Home - A residential setting for adults that is licensed to provide room,
board, supervision, and teaching (habilitation) for up to three people.
Child Developmental Home - A residential setting for up to three children that is licensed to
provide supervision, teaching (habilitation) and room and board for children. This includes
children who have been adjudicated dependent by the court as well as children who can
benefit from temporarily living away from home. The long-term goal is to move the children
out of foster care into a permanent home.
Group Home - A community residential setting for up to six people that provides supervision,
habilitation, and room and board. The group home provides a safe and homelike atmosphere,
which meets the needs of individuals who cannot physically or functionally live
independently in the community.
Rarely does a person need a more intensive residential setting.
following facilities may be accessed:

For those individuals, the

Nursing Facility - A Medicaid certified facility, which provides inpatient room, board and
nursing services to individuals who need them on a continuous basis but do not require
hospital care or direct daily care from a physician.
Intermediate Care Facility for Persons with Intellectual Disabilities - A facility whose
primary purpose is to provide health, habilitative, and rehabilitative services to people who
require them on a continuous basis.

7 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

The following chart shows the breakdown of eligible individuals by residence as of June
30, 2011:

V.

Employment Options

The Division offers a variety of employment services. The Division works in
coordination with the Rehabilitation Services Administration to obtain appropriate
services and supports and where necessary provides supports beyond those available
through the Vocational Rehabilitation program. Based on a person’s needs and interests,
the following options are available:
Individual Supported Employment – This service provides job development,
assistance in matching the individual with an integrated competitive job and
intensive time-limited supports to an employed individual once placed. This
time-limited service provides regular contacts at an individual job site with the
employed person and/or with the employer. This service is intended to help the
person develop the specific on-the-job skills necessary for successful employment
and may also include job search when such services are not available through the
Rehabilitation Services Administration/Vocational Rehabilitation Program.
Employment Support Aide – This service provides people with the one-to-one
supports needed for the person to remain in his/her employment. These supports
could include one or more of the following three options: personal care services,
behavioral supports and/or follow-along supports needed to maintain stable
employment. The actual supports provided will be dependent upon the person’s
need, however, it is the Division’s expectation that this service will primarily be
used to provide on-the-job follow-along supports for people in competitive
employment.
8 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

Group Supported Employment – This service provides long-term, ongoing support
services for a person who is employed. This group service provides people with
an on-site supervised work environment in a community employment setting.
People are paid by a Qualified Vendor or employer for work performed in
accordance with state and federal laws.
Center-Based Employment – This service provides a controlled work
environment, additional supervision and other supports for people engaged in
remunerative work either in a sheltered workshop or in the community. This
service provides people with a supervised work environment. The Qualified
Vendor pays people in accordance with state and federal laws for the work the
person performs.
VI.

Provider Network

The Division provides most of its services through a statewide network of for-profit and nonprofit agencies (Qualified Vendors) and individual providers.
The Division contracts with agencies through the Qualified Vendor Application process. This is
an electronic process that is open and continuous. This means the Division accepts applications
at any time.
In order to support choice, individuals/families have a variety of providers from which to choose.
Individuals/families can recruit someone through the local school, neighborhood, spiritual
community, family, etc. These potential providers can either work for an agency or be an
individual provider.
Individual providers receive training and must be certified prior to service provision. These
individual providers are employees of the person or family and are paid through a fiscal
intermediary. The fiscal intermediary for the Division is Public Partners Limited.
Home and Community-Based Providers
Agencies (Qualified Vendors)
Individual Providers

# of Contracts
551
2,533

VII. Additional Services for Children
Children from birth to three years of age, who have a developmental delay and who are eligible
for services though the Division, may also be eligible for services through the Arizona Early
Intervention Program (AzEIP) and the Arizona Long Term Care System. The Division works in
concert with AzEIP, which is the statewide coordinating agency for Part C of the Individuals
with Disabilities Education Act, to provide services designed to support growth and development
for infants and toddlers. An individual and family support plan is developed to enhance the
child’s development and the capacity of the family. Division funded services may include special
instruction, therapies, service coordination, health services, or assistive technology devices. As
9 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

of June 30, 2011, 3,223 children are eligible for services through the Arizona Early Intervention
Program.

VIII. Acute Care Health Plan Services
The Arizona Long Term Care System (ALTCS) is unique in the nation in that it has always
followed a managed care model. A managed care approach has proved cost effective over many
years in Arizona. It is also the first program of its kind to bundle acute and long term care
services under a single program contractor. The system is designed to maximize choices in
service providers as well as service settings. Services and supports are available to all eligible
people when they need them and without delay. Streamlined administration makes the system
more transparent to eligible individuals.
The Division currently holds contracts with four health plans that provide acute care services to
Arizona Long Term Care System members residing in every Arizona county. The health plans
are responsible to assign or allow choice of a primary care provider to each person who is
enrolled. The health plans are:





Arizona Physicians Independent Physician Association (APIPA)
Mercy Care
Capstone
Care First

The Division also coordinates with Indian Health Services for children and adults who are tribal
members.

IX.

Other Division Activities that Support Arizona’s Families

In addition to the supports and services noted above, the Division strives to provide other
supports to consumers and families. Some of these include:
 The Division’s website provides information to consumers and families about the Qualified
Vendor program (how the Division contracts for services), the Fiscal Intermediary program
(the network of independent providers) and how to work with providers. It includes links to
Division laws, rules, policies, and forms; and links to many of the Division’s publications
such as Navigating the System (a handbook for consumers and families), the ALTCS
Member Handbook, DDD Working with You and others. The website also has a referral
feature for people to apply for eligibility determination.
 The Division supports councils and family groups.
Some of these include the
Developmental Disabilities Advisory Council (a governor appointed Council that is advisory
to the assistant director), FACT groups (Families Actively Communicating Together – a
parent driven group that provides support and learning opportunities) and specialized groups
10 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

for autism, Down syndrome and groups for families who speak Spanish. There are groups
all over the state.
 The Division has a policy review group that provides input on all policy revisions. These
revisions are then presented to the Developmental Disabilities Advisory Council as well as
families, people with disabilities and other stakeholders, so they can provide input in policy
development and/or revision.
 All new support coordinators go through Core Training that teaches support coordinators the
philosophy of the Division and provides the foundation for further on-the-job training.
 The Division provides support to Human Rights Committees organized with each District
across the state. These committees are comprised of local volunteers who provide
independent oversight in matters related to the rights of people with developmental
disabilities, such as incidents of abuse, neglect, or exploitation.
 The Division provides support to Program Review Committees across the state. These
volunteer committees review every proposed behavior plan to make sure they are properly
written, include positive strategies and do not violate people’s rights.
 The Division’s quality management system includes the Risk Incident Management System
which is the automated system for incident reporting. The purpose of incident management
is to assist in promoting the health, safety, and welfare of people with developmental
disabilities through active reporting, investigating, tracking and trending of incidents and the
implementation of both individual-specific and systemic corrective actions and prevention
strategies. It also includes residential monitoring of roughly 1,000 group homes every six
months for compliance with programmatic standards. The Consumer Resolution Tracking
System is an automated system used to track consumer concerns and complaints and to
describe the resolution of the issue. Staff is able to look for patterns of concerns so there can
be systemic resolution. Activities of the Office of Compliance and Review, which include
appeals and hearings, are also reviewed for trends and areas for improvement. Quality
Management staff gathers information to support the Division’s Credentialing process of
Qualified Vendors. Staff also coordinates the gathering of data, analysis and responses to
Quality of Care concerns. The Division holds monthly meetings to analyze a variety of data
to use in its performance improvement plan. This plan includes a description of all planned
activities/tasks for both clinical care and other covered services, targeted implementation
and completion dates for measurable objectives and activities, methodologies to accomplish
goals and objectives and identifies staff responsible and accountable for meeting established
goals and objectives. The statewide Quality Management Committee prioritizes, monitors
and coordinates all organization wide quality/performance improvement activities in
accordance with the quality management plan. Its monitoring activities include utilization
review data analysis, member and provider satisfaction survey data review, quality of care
concerns, performance improvement plans, corrective action plans, etc.
 The Division, in partnership with the Arizona Early Intervention Program (AzEIP), is
implementing a team based model of service to improve service delivery to infants and
11 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

toddlers. In team-based early intervention services, a team lead is the primary partner with
the family in the provision of services. The team lead has expertise relevant to the child’s
needs and the outcomes on the Individualized Family Service Plan (IFSP). The team lead’s
focus is on collaborative coaching of families as the primary intervention strategy to
implement jointly-developed, functional IFSP outcomes in natural environments with
ongoing coaching and support from other team members. The team lead does not meet all
the service needs of the child. The other team members support the team lead, through
regular team meetings and joint visits with the family. Families participate in the team
meetings through in-person attendance, calling-in to the meeting, or asking the team lead to
share their questions/concerns.

X.

A Snapshot of 2011 Accomplishments

In partnership with consumers, families, and community stakeholders, the Division continues to
support innovations and improvements. Some of achievements are as follows:
 The Division partners with the Sonoran University Center of Excellence in Developmental
Disabilities (UCEDD) on a project to describe and address barriers to effective late life
transitions for aging caregivers of adults with developmental disabilities. The project also
promotes effective late life transitions for people with developmental disabilities as well as
improving aging related and end of life care for people with developmental disabilities.
 The Division is a partner in Arizona’s Aging and Disability Resource Center whose goal is
to create a coordinated system of information, assistance and access for all people seeking
long term care services. This system, known as AzLinks, includes a web site
(www.azlinks.gov) that provides links to federal, state, and other agencies, integrating
resources on a variety of relevant topics. AzLinks also has a reference manual for people
who do not have access to the internet.
 The Division continues to participate in the National Core Indicators Project a project that
has outlined approximately 100 consumer, family, systemic, cost and health and safety
outcomes. A variety of tools including consumer surveys measure areas such as the
satisfaction with supports and services provided to people with developmental disabilities
and their families. Preliminary data for fiscal year 2011 show a consistent level of
satisfaction since 2000. Based on the information generated by this survey, the Division is
focusing on alleviating loneliness through increasing self-advocacy. Each District has a
Consumer Advisory Council which will advise the District on ways to assist consumers in
becoming self-determined advocates.
 The Division participates in the Department’s Faith Based Initiative. This initiative seeks to
form cohesive partnerships with other government entities and faith based organizations to
improve access to community and government services and supports.
 The Department of Economic Security commissioned the Arizona Sustainability and
Innovation Work Group which was formed in response to the economic downturn the
12 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

country has been experiencing over the last several years. This workgroup was diverse and
composed of contracted agency providers, AHCCCS representatives, family members,
individual providers, state staff, self-advocates and others. The work group analyzed
reliable sources of information to determine how Arizona compared with other states on key
measures then issued a report making recommendations in a variety of areas such as home
based and residential services, employment, therapies, case management and other ideas to
explore for potential changes and innovations.
 From a National Comparison:
o Arizona ranks very high in the number of citizens with developmental disabilities
it serves as a percentage of the general population.
o Arizona ranks very high in the number of individuals served in the most integrated
setting.
o Arizona ranks very high in the percentage of people who receive services living
with their family.
o Arizona ranks very high in the percentage of people living in their own homes or
settings of six or less.
o Arizona is one of the most cost effective programs in the country as evidenced by
its overall per capita funding of $29,958 per person. Only one state in the nation
spends less per capita per person than Arizona.
o The fact that everyone is in service, there are no waiting lists, and per capita costs
on a general population basis are among the nation’s lowest is further evidence
leading to the conclusion that Arizona’s program is highly cost effective.
o Arizona’s expenditures per person are lower than states of similar size.
 The State serves more individuals per 100 thousand population than all but six other
states, continues to expand the number of individuals served each year and has no waiting
list attributable to budget concerns for ALTCS services. The percentage of people living
in settings of six or fewer and the significant percent of people living in their own or their
family’s home further demonstrate the State’s commitment to consumer choice,
community inclusion and support for families. Arizona is one of the most cost effective
programs in the country, with only one state in the nation spending less per capita due to
people living at home with their families or on their own.
 The Division partners with Pilot Parents of Southern Arizona to provide Partners in
Policymaking. Partners in Policymaking is an innovative leadership training program that
teaches people to be community leaders, and to affect systems and policy change at the
local, state and national levels. The program is designed for individuals who have a
disability and for parents raising children with a disability. Partners provides the most
current information and education about disability policy, the legislative process, and
local, state and national issues that affect individuals with disabilities. Partners
participants are people who are ready to work for long-term systems change and for
change in public policy. The overall goal of the program is to foster a partnership between
people who need and use services for disabilities, and those who determine public policy.
13 of 14

Department of Economic Security/Division of Developmental Disabilities
Family Support Annual Report, July 1, 2010 – June 30, 2011

Partners graduates gain the abilities to teach policymakers a new way of thinking about
people with disabilities.
 The Division contracts with Raising Special Kids and Pilot Parents of Southern Arizona
to provide peer counseling which provides self-help opportunities through education,
training, information, encouragement and support to individuals, families and other
caregivers. This service also communicates with professionals in fields such as
education, healthcare, child protection and law enforcement to increase awareness and
understanding of developmental disabilities.
X.

Conclusion

The Division is proud to be a leader for its support of individuals and families and continuously
seeks to improve its system of supports for consumers and families. Staff will be updating the
Qualified Vendor System, including revising the service descriptions and expectations of the
services. The Division will engage consumers and families to provide valuable ideas on how
services should look. With the Developmental Disabilities Advisory Council, the Division will
explore new ways to receive input from people with developmental disabilities and their
families on how to improve the service delivery system. The Division will actively pursue
additional employment opportunities for people with developmental disabilities.
The Division looks forward to collaborating with the community, stakeholders and other entities
to continue providing quality supports and services in the most inclusive ways and settings.

14 of 14