Department of Economic Security Division of Developmental Disabilities FAMILY SUPPORT ANNUAL REPORT July 1, 2011 - June 30, 2012 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, 2011 – June 30, 2012 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 32,354 people with developmental disabilities as of June 30, 2012. 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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/intellectual 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; and/or 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, 2012: 3 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 The Division supports people of all ages. The following chart shows the breakdown of eligible individuals by age as of June 30, 2012: The Division provides services through two primary funding sources: State funded services and the Arizona Long Term Care System (ALTCS). 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 (3); 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 ALTCS. ALTCS provides long-term and acute care services to individuals with developmental disabilities who are at risk of institutionalization. ALTCS 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. The Arizona Medicaid waiver is a research and demonstration program approved through the Federal Centers for Medicare and Medicaid Services (CMS) 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 The following chart shows the breakdown of eligible individuals by funding source as of June 30, 2012: The Division provides most of its services through a statewide network of profit and non-profit agencies (Qualified Vendors) and independent 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 Targeted Support Coordination is an option for people who are eligible for Medicaid/Title XIX health care through 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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 individuals to choose where and with whom he/she will live and assume all responsibility for his/her residence. Generally, one or more individuals reside together in a private residence that is leased or owned by the consumer(s) and/or the individual(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 individuals who have chosen to reside together and share their resources. Adult Developmental Home – A licensed, private home of an individual contracted to provide room and board, supervision, and teaching (habilitation) for up to three adults. Child Developmental Home – A licensed, private home of an individual contracted to provide supervision, teaching (habilitation) and room and board for up to three 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. 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 residential care, supervision, and skilled nursing services to individuals who need them on a continuous basis but who 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 The following chart shows the breakdown of eligible individuals by residence as of June 30, 2012: V. Employment Options The Division offers a variety of employment services. The Division works in coordination with the Rehabilitation Services Administration/Vocational Rehabilitation Program 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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 601 2,524 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 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 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 of June 30, 2012, 3,229 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 Division currently holds contracts with four health plans to provide acute medical care services to Arizona Long Term Care System members residing in every Arizona county. The health plans are responsible to allow each person who is enrolled a choice of a primary care provider. The health plans are:     Arizona Physicians Independent Physician Association (APIPA) Capstone (thru September 30, 2012) Care First Mercy Care 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 individuals and families. Some of these include:  The Division’s website provides information about the Qualified Vendor program (how the Division contracts for services), the Fiscal Intermediary program (the network of individual 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 people with developmental disabilities and families), the ALTCS Member Handbook, DDD Working with You and others. The website also has a referral feature for people to make a referral for an 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 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 10 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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 within 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 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.  The Division’s Quality Management System also conducts residential monitoring of roughly 900 group homes once to twice a year for compliance with programmatic standards.  The Division’s Consumer Resolution System is an automated system used to track member, provider, and community 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 and the Office of Administrative Review, which include hardship reductions, Notices of Action appeals and hearings, are also reviewed for trends and areas for improvement.  Quality Management staff gather 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, 11 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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 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 2012 Accomplishments In partnership with consumers, families, and community stakeholders, the Division continues to support innovations and improvements. Some achievements are as follows:  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 one-hundred (100) individual(s), family, systemic, cost and health and safety outcomes. A variety of tools including 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 2012 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.  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 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 12 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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. The Division is working to implement some of the recommendations from the group.  The Division became a member of the State Employment Leadership Network (SELN) in January 2012. The SELN is a joint initiative of the National Association of State Directors of Developmental Disabilities Services and the Institute for Community Inclusion (ICI) at the University of Massachusetts, Boston. The SELN supports states in their efforts to improve integrated employment outcomes for their constituents. The Division of Developmental Disabilities (DDD) has since completed a comprehensive self-evaluation and distributed a Strategic Employment Assessment Supplemental Survey to a wide range of Division staff, consumers, family members, advocates, other state agency representatives and stakeholders. DDD, with its SELN Project Team, conducted two (2) days of focus groups with Division leadership, field employment staff, a newly created DDD Employment Leadership Committee, family members, self-advocates, and providers of employment services. The Division will use the information generated by the above activities and Project Team’s findings, observations and recommendations to develop a detailed work plan including the key outcomes, goals and action strategies to be pursued over the next several years to improve the employment outcomes for its program participants. DDD, with its Employment Leadership Committee, will have the rich technical support and assistance from the SELN membership at large, an unbelievably rich resource of other states, researchers, and policy makers with experience in creating systems change at the state level.  The Division is an active member of the Arizona Community of Practice on Transition (AzCOPT) and currently chairs the Executive Committee. As a “community of practice,” AzCOPT is a collaborative of state agencies and stakeholder groups who have come together around the shared interest of improving school and post-school outcomes for youth and young adults with disabilities. Community members meet to address issues including meaningful youth involvement during transition, increasing post-secondary education options and successes including higher education and competitive/integrated employment, outreach to child welfare, juvenile justice, behavioral health systems and supports, healthcare, transportation and other issues that impact a successful transition from school to adult life. The AzCOPT Leadership Team includes the following members: Division of Developmental Disabilities; Arizona Department of Education Exceptional Student Services; DES Rehabilitation Services Administration/Vocational Rehabilitation; Arizona Department of Health Services (DHS) Office for Children with Special Health Care Needs; DHS Behavioral Health Services; Youth Action Council of Arizona family support services; and the Tribal 121 Vocational Rehabilitation programs. The overall purpose is to facilitate collaboration among the various supports and services available to students and young adults as they move into their adult lives. More specifically, AzCOPT provides guidance to all staff across the collaborative working with transitioning students to better create “linkages” through and after 13 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 transition, and also introduce parents and students to what they might expect during and after transition. AzCOPT has developed a training curriculum titled “A vision of Coordination and Collaboration” intended to give trainees an awareness of key supports and services available both during secondary education and after a student exits high school, describing the roles of the school as well as the child and adult service agencies. The statewide group has supported the development of two local communities of practice and hopes to support more across the state. The group has begun to look at the state’s Indicator 14, Post-School Outcome (PSO) data to determine barriers to better outcomes and assist local groups in examining the same at their local level. The Arizona Community of Practice is a member of the National Community of Practice on Transition, supported by the IDEA Partnership and the National Secondary Transition Technical Assistance Center (NSTTAC). As a member DDD has access to the promising practices (and lessons learned) of other state groups also dealing with improving the postsecondary outcomes for students with disabilities.  From a national comparison:        Arizona ranks very high in the number of citizens with developmental disabilities it serves as a percentage of the general population. Arizona ranks very high in the number of individuals served in the most integrated setting. Arizona ranks very high in the percentage of people who receive services living with their family. Arizona ranks very high in the percentage of people living in their own homes or settings of six or less. Arizona’s expenditures per person are lower than states of similar size. Arizona is one of the most cost effective programs in the country as evidenced by its overall per capita funding of $28,861 per person. Only one state in the nation spends less per capita per individual receiving services than Arizona. 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. The State serves more individuals per one-hundred thousand (100,000) 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 individual choice, community inclusion and support for families.  The Division partners with Pilot Parents of Southern Arizona to provide Partners in Policymaking. Partners in Policymaking is an innovative leadership training program that 14 of 15 Department of Economic Security, Division of Developmental Disabilities Family Support Annual Report, July 1, 2011 – June 30, 2012 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. 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.  The Division has updated the Individual Support Plan (ISP), the ISP process, and ISP training. The training has rolled out; two Districts are currently trained and implementing the revised ISP planning process. The remaining three Districts are being trained with full implementation statewide targeted for October 1, 2012. XI. Conclusion The Division is proud to be a leader for its support of individuals and families and continuously seeks to improve its system of family and individual supports. Staff is updating the Qualified Vendor System, including revising the service descriptions and expectations for the services. The Division continues to engage consumers and families to provide valuable ideas on how services should be provided. With the Developmental Disabilities Advisory Council, the Division continues to explore new ways to receive input from people with developmental disabilities and their families on how to improve the service delivery system. The Division actively pursues additional employment opportunities for people with developmental disabilities. The Division looks forward to continuing collaboration with the community, stakeholders and other entities to provide quality supports and services in the most inclusive ways and settings. 15 of 15