DIVISION OF DEVELOPMENTAL DISABILITIES

FAMILY SUPPORT ANNUAL REPORT

July 1, 2015 – June 30, 2016

DEPARTMENT OF ECONOMIC SECURITY

Our Mission:
The Arizona Department of Economic Security makes Arizona stronger by helping Arizonans
reach their potential through temporary assistance for those in need, and care for the vulnerable.
Our Values:
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Teamwork – We collaborate with humility, and partner with kindness.
Respect – We appreciate each other, and value those we serve.
Integrity – We never lie, cheat, steal, bully or harass – nor tolerate those who do.
Accountability – We commit to excellence, innovation and transparency.
Diversity – We respect all Arizonans, and honor those in need.

Our Vision:
Opportunity, assistance and care for Arizonans in need.

Our Goals:
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Serve Arizonans with integrity, humility and kindness.
Support Arizonans to reach their potential through social services that train, rehabilitate,
and connect them with job creators.
Provide temporary assistance to Arizonans in need while they work toward greater selfsufficiency.
Provide children with food, health care, and parental financial support; provide services
to individuals with disabilities; and protect the vulnerable by investigating allegations of
abuse, neglect, and exploitation.

DIVISION OF DEVELOPMENTAL DISABILITIES
Mission:
To provide to individuals with developmental disabilities and their families, the necessary
services and supports that are flexible, high quality, and member-driven. To afford individuals
the opportunities to exercise their rights and responsibilities of independent decision-making and
engagement in the community.

Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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 or DDD) in recognition of the
significance of family support as a national initiative. The Division integrates the philosophy of
the legislation into all of its programs and activities. 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 are designed to:
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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 the 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

As of June 30, 2016, The Division of Developmental Disabilities within the Arizona Department
of Economic Security provides services and programs to 37,076 people with developmental
disabilities. The Division believes that people can best be supported in integrated community
settings. The majority of the Division’s programs and services are tailored to meet the 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. There are five (5) districts
statewide. They include: District Central, District East, District North, District South, and
District West. 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.
Division Eligibility Criteria: To qualify for supports and services through the Division, an
individual must:
1. Voluntarily apply;
2. Be an Arizona resident and lawfully in the United States;
3. Have been diagnosed with autism, cerebral palsy, epilepsy, or an intellectual disability
which manifested before the age of eighteen and is likely to continue indefinitely; and,
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

4. Have substantial functional limitations in three or more of the following life areas that are
directly attributable to the qualifying diagnosis:
a.
b.
c.
d.

Self-care: Needing help with eating, hygiene, dressing, using the bathroom, etc.
Receptive and expressive language: Communicating with others.
Learning: Acquiring and processing new information.
Mobility: The skill necessary to move safely and efficiently from one location to
another within the person’s home, neighborhood, and community.
e. Self-direction: Managing personal finances, protecting self-interest or making
independent decisions which may affect the individual’s well-being.
f. Capacity for independent living: Needing supervision or assistance on a daily
basis.
g. Economic self-sufficiency: Being financially independent.
Children under the age of six may be eligible for services when they are determined to be at risk
for a developmental disability if services and supports are not provided.
The following chart shows the breakdown of eligible individuals by primary disability as of June
30, 2016:

People Served by Primary Disability
AUTISM, 8,368 , 22%

AT RISK, 8,456 , 23%

CEREBRAL PALSY,
3,254 , 9%

EPILEPSY, 1,559 , 4%

COGNITIVE
DISABILITY, 15,439 ,
42%

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

The Division supports people of all ages. The following chart shows the breakdown of eligible
individuals, by age, as of June 30, 2016:

Ages of People Served
55+, 2,016 , 5%
0 - 5, 7,264 , 20%

22 - 54, 11,594 ,
31%

18 - 21, 2,469 , 7%

6 - 17, 13,733 , 37%

The Division provides services through two primary funding sources: state general fund and
Medicaid.
The Division provides services to three eligibility categories or populations: (1) state-only
funded members, (2) Arizona Long Term Care System (ALTCS) members, and (3) Targeted
Support Coordination (TSC) members.
Individuals who meet the Division’s eligibility criteria, described above, receive state-funded
services not-to-exceed the Division’s legislative budget appropriation. Children under the age of
three receive state-funded services in accordance with the Individuals with Disabilities Education
Act (IDEA) Part C requirements. The types of state-funded 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 care services,
behavioral health services, and acute care services to individuals with developmental disabilities
who are at risk of institutionalization. Arizona Health Care Cost Containment System
(AHCCCS) staff determines eligibility for ALTCS through a review of the person’s functional
needs and financial eligibility. AHCCCS is the Arizona Single State Medicaid Agency and
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

oversees the Medicaid program. In Arizona, the Medicaid program is a research and
demonstration waiver approved through the Federal Centers for Medicare and Medicaid Services
(CMS), and is intended to demonstrate that home and community-based services and a managed
care approach are more cost effective than institutionalization. Long term care, behavioral
health, and acute care services are bundled to improve care coordination and enhance service
delivery under a single system of support managed by the Division.
Targeted Support Coordination (TSC) is an option for people who qualify for services through
the Division and who are also eligible for Medicaid acute care through AHCCCS, but are not
eligible for ALTCS. AHCCCS determines if an individual is eligible for the TSC program. This
option allows the individual/responsible person to determine the frequency and type of contact
he/she wants from the Support Coordinator. TSC provides support to the individual by assisting
in identifying community resources and helping to coordinate acute care services provided by
Medicaid. These individuals may also receive state-funded services not to exceed the Division’s
legislative budget appropriation. For persons under age 21, Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) services are covered.
The following chart shows the breakdown of eligible individuals by funding source as of
June 30, 2016:

People Eligible by Funding Source
TSC, 4,356
12%

NON-ALTCS, 3,337,
9%

ALTCS, 29,383,
79%

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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 assessing needs and
obtaining services and supports. The role of the Support Coordinator may include:
 Facilitator – leading the team that develops and implements an Individual Support Plan.
 Advocate – advocating for the needs of the person as identified by the person and family.
 Teacher/modeler – helping a person gain self-advocacy skills.
 Coordinator – coordinating supports and assessing for medically necessary services.
 Mediator – assisting with communication between a person, family, and other systems,
with a focus on working together.
 Information source – knowing about community supports, other systems, and supports
from the Division.
 Monitor – monitoring the plan to ensure quality of supports and services, as well as
progress towards reaching the individual’s goal.
ALTCS provides funding for many services based on assessed need. Based on the availability of
State funding, the Division’s state-only funded program offers essentially the same services as
does ALTCS except for acute and behavioral health services. An asterisk (*) indicates services
that are available for ALTCS members only.
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Augmentative Communication Devices (devices that help a person communicate, such as
a tablet, 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
in-patient 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 (transition to employment, center-based employment, groupsupported employment, individual-supported employment and employment-related
transportation).
Environmental modifications (building modifications to allow an individual to function
as independently as possible in their own home).*

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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Habilitation (interventions such as habilitative therapies, special developmental skills,
behavioral intervention and sensory-motor development designed to increase the
individual’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.
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:
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Individually Designed Living Arrangement – This service provides for an alternative,
non-licensed 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
individual(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.

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Adult Developmental Home – A licensed, private home contracted to provide room and
board, supervision, and teaching (habilitation) for a group of siblings or up to three adults
with developmental disabilities.

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Child Developmental Home – A licensed, private home contracted to provide
supervision, teaching (habilitation) and room and board for a group of siblings or up to
three children with developmental disabilities. This includes children who have been
determined (adjudicated) dependent by the court as well as children who can benefit from
temporarily living away from home.

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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Group Home – A residential setting in the community for up to six people with
developmental disabilities 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

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Assisted Living Centers (ALCs) – The facility provides resident rooms or residential units
to eleven or more residents. Assisted Living Centers may be licensed to provide one of
three levels of care listed below, as defined by the Arizona Department of Health
Services:
o “Supervisory Care Services” means general supervision, including daily
awareness of resident functioning and continuing needs, the ability to intervene in
a crisis and assistance in the self-administration of prescribed medications.
o “Direct Care Services” means programs and services, including personal care
services provided to persons who are incapable of recognizing danger,
summoning assistance, expressing need or making basic care decisions.
o “Personal Care Services” means assistance with activities of daily living that can
be performed by persons without professional skills or professional training and
includes the coordination or provision of intermittent nursing services and the
administration of medication and treatments by a nurse who is licensed.

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Assisted Living Homes (ALHs) - The facility provides resident rooms and services to ten
or fewer residents.

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Nursing Facility – This is a Medicaid-certified facility. This service provides skilled
nursing care, residential care, and supervision to persons who need nursing services on a
24-hour basis, but who do not require hospital care under the daily direction of a
physician.

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Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) – A
facility whose primary purpose is to provide health, habilitative and rehabilitative
services to people who require them on a continuous basis.

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

The following chart shows the breakdown of eligible individuals by residence as of
June 30, 2016:

People Served by Residence*
INSTITUTION
0.5%
GROUP HOME
7.61%

ADULT DEV HOME
3.24%
CHILD DEV HOME
0.68%
HOME 87.94%

*Behavioral Health Residential Facility, .02% and Assisted Living Center, .01% are not included in the graph
above.

V.

Employment Options

The Division offers a variety of employment services. As needed, the Division also coordinates
services with the Department of Economic Security, Division of Employment and Rehabilitative
Services, Vocational Rehabilitation (VR) to ensure the Division member is receiving every
opportunity available to assist in their successful employment. Based on a person’s needs and
interests, the following options are available:
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Individual Supported Employment – This service provides Job Coaching and/or Job
Search for eligible Division members. Job Coaching is a time-limited service that
provides regular contacts with the employed person and/or with their employer. This
service is intended to help the person develop the specific on-the-job skills necessary for
successful employment. Job Search may be provided when it is not available through
VR. Job Search includes job development and assistance in matching the individual with
a community-integrated competitive job.

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

VI.

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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: limited personal-care services, behavioral
supports and/or follow-along supports needed to maintain stable employment. The actual
supports provided will depend 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.

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Group-Supported Employment – This group service provides people with an on-site
supervised work environment in a community integrated employment setting. Members
are provided the opportunity to work in an environment that allows for maximum
interaction with other co-workers or the community at large. People are paid by a
Qualified Vendor for work performed in accordance with state and federal laws.

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Center-Based Employment – This service is provided in a Qualified Vendor owned or
operated setting where participants are engaged in paid work and work-related activities
with little or no interaction with the general community. People are supported in
developing the skills, abilities and behaviors that will enable them to realize their
vocational goals, including transition to a more integrated setting. The Qualified Vendor
pays people in accordance with state and federal laws for the work the person performs.

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Transition to Employment – This service is a curriculum-based service that provides a
Division member with individualized instruction, training and supports to promote skill
development for integrated and competitive employment. In addition to employmentrelated skill development, the service may also assist a member in obtaining unpaid work
exploration such as a volunteer job and job shadowing experiences.
Provider Network

The Division provides most of its services through a statewide network of for-profit and nonprofit agencies (Qualified Vendors) and independent providers.
The Division contracts with agencies and professional providers 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.
Providers either work for an agency or are listed as an independent provider based on the need in
a specific geographic area.
Independent providers receive training and must be certified prior to service provision. These
independent providers are employees of the person or family and are paid through a fiscal
intermediary. The fiscal intermediary for the Division is Public Partnership Limited (PPL).

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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

Home and Community-Based Providers
Agencies (Qualified Vendors)
Independent Providers

# of Contracts
598
1,544

VII. Services for Children
Children from birth to three years of age who have a developmental delay and who are eligible
for services though Arizona Early Intervention Program (AzEIP) may also be eligible for
services through the Division and/or the Arizona Schools for the Deaf and the Blind (ASDB),
and ALTCS. The Division works with AzEIP, which is the lead agency for IDEA Part C, to
provide services designed to support parents and other caregivers to increase their child’s
engagement and participation in everyday routines and activities. An Individualized Family
Service Plan (IFSP) is developed to enhance the child’s development and the capacity of the
family. AzEIP providers utilize teaming, coaching and natural learning opportunities to support
families. Division funded services may include special instruction, therapies, service
coordination, health services, or assistive technology devices. As of June 30, 2016, 3,039 DDD
children are currently eligible for services through AzEIP.
VIII. Acute Care Health Plan Services
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 ALTCS guiding principles include a member-centered
approach. The member, and family/significant others as appropriate, are the active participants
in the planning for and the evaluation of services provided to them.
The Division currently holds contracts with three health plans to provide acute medical care
services to ALTCS members served by the Division residing across every Arizona county. The
health plans allow each person who is enrolled a choice of a primary care provider. The
Division’s contracted health plans are:
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United Health Care Community Plan
Care 1st Health Plan
Mercy Care Plan

The Division also collaborates with the American Indian Health Program (AIHP) for children
and adults who are tribal members.
IX.

Behavioral Health Services

The Division delegates the scope of responsibility for the provision and oversight of behavioral
health services to ALTCS-eligible members through its Interagency Service Agreement (ISA)
with the Arizona Department of Health Services/Division of Behavioral Health Services
(ADHS/DBHS). ADHS/DBHS, either directly or through subcontractors, is responsible for the
provision of all medically necessary covered behavioral health services.
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

As of October 1, 2015 ADHS/DBHS subcontracts for the delivery of behavioral health services
through three Regional Behavioral Health Authorities (RBHAs): Cenpatico Integrated Care,
Health Choice Integrated Care, and Mercy Maricopa Integrated Care and five Tribal RBHAs:
Colorado River, Gila River, Navajo Nation, Pascua Yaqui, and the White Mountain Apache
Tribe.
The Division coordinates resolution of member specific quality of care concerns, identifies
systemic issues with behavioral health service coordination, participates in system improvement
efforts, and provides training and technical assistance to the Division’s district personnel in
addressing the complex needs of its dually diagnosed members. As of June 30, 2016, the ISA
between the Division and ADHS/DBHS expired due to the integration of behavioral health
services under the oversight and monitoring of AHCCCS.
Other Division Activities that Support Arizona’s Families

X.

Providing timely, current supports and services to individuals and families is very important to
the Division. In addition to the supports and services listed above, the following are some
examples of how the Division serves as a leader for individuals and families:
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The Division’s This Is MY Life contracts with ABILITY360 and DIRECT to provide
curriculum development and training to assist individuals in learning self-determination
and self-advocacy principles. Self-determination promotes learning all types of decisionmaking skills to apply in everyday life. Project objectives included focusing on abilities,
developing a self-determination community, member-controlled provider contracts,
member budget control, promoting programs that support inclusion, and improving
operating efficiencies within DDD.

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The DES website, including the Division’s web pages, provides a significant resource for
the community. This past year, the DES website was redesigned to be more userfriendly. As a result, the Division’s resources for individuals and families as well as
providers are easier to access and locate. Included on the website are links to important
publications such as Navigating the System (a handbook for individuals and families), the
DDD Member Update Newsletter, and the ALTCS Member Handbook. Other examples
include frequently asked questions, eligibility referral and a provider search. On the
“Help for Providers” page, the most current Rate Book is available, the Provider Manual,
billing information, Qualified Vendor announcements, and many other resources to
support providers.

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Recognizing the challenges members have when navigating between multiple health care
services, the Division began the process of addressing the integration of physical and
behavioral health services for its ALTCS-eligible members through a single entity: the
member’s health plan. The Division held more than 14 stakeholder and colleague
meetings that gathered comments from Division personnel along with community input
to support a transparent and thoughtful process in the development of contractor
requirements. Over 971 comments were received during these “listening sessions” and
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

provided opportunities to hear firsthand what concerns Division colleagues and
community members had regarding services. The Division solicited input on topics that
included the benefits of combining behavioral health and physical health care services
under one contractor, determining what behavioral health services are most important,
how the system can be improved to receive those services, and how to improve transition
from child to adult services.
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The Division’s Behavioral Health Administration partnered with the Arizona Department
of Health Services on a grant funded through the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the University of Arizona Campus Health
Services to identify skills-based and culturally competent workshop and training
opportunities focused on adolescents and transition-aged youth. Other areas that were
identified for improvement and intervention included adolescent development, brain
development and treatment implications; cultural competency and the engagement and
retention of youth and families from diverse cultures; intermediate-level trauma-informed
care, including historical and intergenerational trauma. The feedback provided by the
Division’s Behavioral Health Administration was added to other responses received from
a large population of statewide stakeholders and families. This information was then
utilized to provide free trainings on the above identified subject areas. Two main training
sessions were conducted in April 2016, with a follow-up session held in May 2016.

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The Division implemented the AHCCCS High Need/High Cost (HNHC) Program
specific to ALTCS-eligible members who met criteria for high utilization of medical and
behavioral health emergency department visits; inpatient admissions; inpatient
readmissions within 30 days, or a total cost of $50,000 or more, inclusive of medical,
behavioral health, and long term care costs. As part of this program, implementation of
the Division’s Behavioral Health Administration facilitates monthly multi-disciplinary
staffings for program members with each of the RBHAs, Children’s Rehabilitative
Services (CRS), the Division’s subcontracted health plans and Division nursing staff
where individualized medical, behavioral health, and long term care needs, treatment
interventions, and service delivery are discussed and documented. These multidisciplinary staffings also include the Division’s District Behavioral Health Specialists
who involve the members’ Support Coordination planning team in the provision of
information including treatment interventions to address medical, behavioral health,
environmental, and psychosocial needs, identification of barriers to improvement and
additional resources needed, as well as changes to any treatment goals. As part of these
multi-disciplinary staffings intervention action steps are identified, the appropriate
providers under medical, behavioral health and long term care services are involved in
addressing the members’ needs based on the relevant service delivery system.



The Division supports councils and family groups. Some of these include the
Developmental Disabilities Advisory Council or DDAC (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. These groups are located throughout the state.
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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The Division has a Policy Review Team (PRT) that meets monthly. The PRT is
responsible for the annual policy review, policy approvals and policy clarifications.
New policies or major policy revisions are shared with the DDAC.



The Division provides updates to policy via an Opt In list. Families, members and
community stakeholders submit their contact information to the DDD Policy Unit so that
they can receive email updates when there are changes to policy. There are currently
over 240 individuals on the Opt In list.

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The Division’s policy manual was divided into five different manuals. The five manuals
include the Operations, Medical, Eligibility, Behavior Supports, and Provider Policy
Manuals.



All new support coordinators complete over 100 hours of initial training upon hire that
teaches them the philosophy of the Division and provides the foundation for further onthe-job training.



The Division’s Office of Family and Community Resources provides support to Human
Rights Committees (HRCs) 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. Committees usually meet once a month to:
o Review any incidents that may have involved neglect, abuse or denial of rights to
members receiving services.
o Review behavior programs which involve the use of behavior modifying
medications or aversive techniques.
o Review any proposed research involving members receiving services.
o Make recommendations to DDD about changes needed to protect the rights of
members receiving services.

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The Division provides support to Program Review Committees (PRCs) across the state.
These volunteer committees review every proposed behavior plan to make sure the plan
is properly written, includes positive strategies and does not violate people’s rights.



The Division’s Quality Management System includes the Incident Management System
(IMS) 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.

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The Division’s Quality Management Staff also conducts residential monitoring of
approximately 900 group homes each year for compliance with programmatic standards.
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

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The Division’s Resolution System is an automated system used to track member,
provider, and community concerns and complaints, and to describe the resolution of the
issue. This allows for the ability to identify patterns of concern to ensure systemic
identification and resolution. During this time period, the Division responded to 1292
complaints.

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Activities of the Office of Compliance and Review, which include Notice of Action
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.

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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 AzEIP, uses a Team-Based approach to support
families receiving Early Intervention services for their children. In Team-Based Early
Intervention, every family has a team that works together to enhance a child’s learning
and development within everyday activities. Early Intervention teams were selected to
attend a two-day Master Teams Institute in October and December 2015. This institute
provided teams the opportunity to build relationships and focus on evidence-based
practices. Teams also gained a deeper understanding of natural learning environments,
coaching and teaming practices. In addition to the two-day Master Teams Institute, the
Master Coach Institute was held in December 2015. For individuals that completed the
Master Teams Institute, this one-day Master Coach Institute provided them the
opportunity to shine as leaders and further infuse the Team-Based Early Intervention
Services approach into every aspect of the program.



The Division has established measured Performance Measures for care and service and
must show demonstrable and sustained improvement toward meeting Performance
Standards. Statistically significant improvement in measured rates is expected and
decreases may result in corrective action plans, service caps, up to sanctions. These
Performance Standards established by the Centers for Medicare and Medicaid Services
(CMS) Core Sets and utilizing the National Committee for Quality Assurance (NCQA)
Healthcare Effectiveness Data and Information Set (HEDIS) technical specifications are
national measured medical outcomes that support state and national quality comparisons.
The Division is committed to ensure coordination of member needs across an ever
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Family Support Annual Report, July 1, 2015 – June 30, 2016

expanding continuum of medical identified health risk factors to meet special health care
needs.
XI.

A Snapshot of 2016 Accomplishments

In an effort to support members and their families, the Division engages in continuous
improvement opportunities and actively collaborates with its community partners and
stakeholders. Some examples include:


The Division’s Office of Licensing, Certification, and Regulation streamlined it processes for
issuing developmental home licenses to providers of residential services to children and
adults with disabilities. The office has reduced the time to issue initial licenses from
approximately six months to approximately 20 days.



The Division is actively moving forward with implementation of affordable housing for
members of the Division. Last year, the Arizona Department of Housing (ADOH)
announced that their joint competitive application for the Section 811 Project Rental
Assistance program (PRA) was approved and will be operated by the Division. The Section
811 PRA program enables persons with disabilities who are income-eligible to live in
integrated, affordable housing. Arizona received $2,950,000 for the Section 811 PRA
program.
Additionally, in a joint project with the Housing Authority of Maricopa County, the Division
was allotted 27 apartments that are currently in the process of being renovated. Once
completed, the Division will begin a phased move-in process to allow for the most
integration possible in the apartment complex. This process is slated to begin in early 2017.
To ensure success, the Division has begun to work with Support Coordinators to identify
potential residents.



Arizona has participated for over a decade in the Residential Information Systems Project
(RISP) and the Supporting Individuals and Families Information Systems Project (FISP).
This is done in collaboration with the University of Minnesota’s Institute on Community
Integration and the National Association of State Directors of Developmental Disabilities
Services (NASDDDS). Arizona has 86 percent of persons with intellectual/developmental
disabilities living in their family home. The next closest state was South Carolina which has
71 percent living in their family home. The national aim is 90 percent and the Division is
committed to assisting our members in exceeding this goal.



Creating a “Picture of Life”, a key collaboration with the Division, the University of Arizona
Sonoran Center for Excellence in Developmental Disabilities (UCEDD), and the Arizona
Developmental Disabilities Planning Council, was launched in 2012 as a statewide project to
improve outcomes for foster youth with developmental disabilities. The goal of the project is
to prepare those youth who are about to exit foster care to exercise choice, promote the use of
informal and community supports and to make knowledgeable decisions on community
living and work. In doing so, the project intends to improve transition outcomes for these
youth, which include the following desired outcomes: a safe and stable home, selfPage 16 of 21

Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

determination and self-advocacy, framing a vision for their future, a support system to help
with decision making, an ongoing circle of natural/informal support, and employment
exploration and opportunities. Ultimately, this model project will help to improve services
for individuals with developmental disabilities exiting foster care in Arizona by offering a
mechanism for youth to exercise meaningful choice about their living arrangements, work
life, social networks and services.


The Division continues to participate in the National Core Indicators Project, a project that
has outlined approximately 100 individual, family, systemic, cost, and health and safety
outcomes. Surveys measure areas such as the satisfaction with supports and services
provided to people with developmental disabilities and their families. The Division
continues to show areas of strength and areas where improvement is needed. Following each
survey completion, the Division identifies strategies to improve priority areas.



The Division offered 861 in-person training class sessions to its employees. An additional 20
computer-based courses were offered. There were over 12,723 combined attendees who
successfully completed these trainings.



The Division offers free statewide Article 9: “Managing Inappropriate Behaviors” Instructor
Clinics throughout the year. 153 instructors from the provider community completed the
Instructor Certification process for Article 9.



The Division offers free statewide Prevention and Support Instructor Clinic throughout the
year. Five (5) New Instructor Clinics had 36 participants. Ten re-certification clinics were
held for existing Prevention and Support instructors, with 50 participants.



Over the past year, the Division has continued its efforts to prioritize integrated employment
as the primary consideration for adults of working age.
o The Division continues to hold a leadership role as Co-Chairperson of the broadlybased statewide Arizona Employment First. The Planning Committee has met
monthly since January 2014 and published its statewide Strategic Plan in August
2015. A formal Memorandum of Understanding (MOU) has been written and is
being finalized. The Division is a signatory on the MOU. Standing committees are
being created to implement the Key Directions and Strategies identified in the
Strategic Plan. The Division is amending relevant policy to reflect its commitment to
the concept of Employment First.
o The Division has continued its membership in the national State Employment
Leadership Network (SELN). The SELN is a network of State Developmental
Disability Agencies committed to improving integrated employment outcomes for
their program members. The Division participates in monthly webinars held with all
state members on a variety of issues that impact the ongoing work of state agencies
on behalf of their membership. Just a few of the issues addressed include national
Employment First initiatives; recent Department of Justice enforcement and related
settlement actions related to integration of services; CMS rules affecting waiver
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

services for eligible Medicaid service recipients; the new Workforce Innovation and
Opportunity Act (WIOA) requirements impacting state DDD agencies and other
stakeholders with reciprocal responsibilities and services; and family involvement
that is so critical in supporting their family members’ successful employment
outcomes. The Division is a standing member of the SELN Data Committee
benefitting from best and promising practice of other states as it considers
enhancements to its own processes.
o The Division continues to prioritize efforts directed toward enhancing the successful
transition of young adults with intellectual disabilities from school to work. There is
an active state level Community of Practice on Transition (CoPT) that meets monthly
and supports local CoPTs with training and technical assistance. The Division cosponsored the 15th Arizona Transition Conference, drawing over 880 participants.
The Division regularly presents at the Conference and has been consistently asked to
present a session that features Division members telling their own stories of
successful employment.
o The Division’s nine District Employment Specialists regularly participate in local
high school transition fairs, job fairs, and other events highlighting employment.
Division leadership likewise collaborated with the Arizona Department of
Education/Exceptional Student Services (ADE/ESS) program in the development of
key goals and actions for their annual state plan. This collaboration is intended to
likewise enhance students’ successful transition from school to employment. The
Division is a member of the ADE/ESS Core Team advising them on the
implementation of their newly awarded Intensive Technical Assistance Grant (ITA)
from the National Technical Assistance Center on Transition (NTACT). Among the
goals of the ITA Grant is the development of evidence-based and promising practices
to improve employment outcomes for students with intellectual/developmental
disabilities.
o Related to successful transition to adult life, the Division has continued its joint
project with the VR program. Through a Memorandum of Understanding, the
Division provides matching funds to allow the VR program to obtain additional
federal monies and hire dedicated staff to work with Division-eligible youth in the
foster care system. The project established a system of coordinated planning and
service provision for youth beginning at age 14 to better ensure their successful
transition to meaningful and sustained employment, education and community living.
o Additionally, the Division is broadening internal awareness of the value of
employment for individuals with intellectual disabilities. The Division requires
intensive Support Coordination training on the full array of employment services and
supports available to members through the Division. The day long training also
outlines the Division’s relationship with VR in the provision of employment services.
In addition to this day long training, a computer-based training curriculum is being
finalized. It will be available for Support Coordination staff, including supervisors, to
take soon after hire and provide a short overview of the Division’s employment
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

services as a precursor to the day-long training. It will also be required as one of
DDD’s staff annual training requirements. The Division is conducting a series of
“listening sessions” with DDD Support Coordination staff and with members’
families and caregivers to assess the need and preferred format for the development
of transition related resource materials.


The Division is a member of the Arizona Leadership Team implementing the federal
PROMISE (Promoting Readiness of Minors in Supplemental Security Income) grant.
Arizona, as part of a six state consortium that includes Colorado, Montana, North Dakota,
South Dakota and Utah, received one of the five-year federal study grants designed to fill
gaps in services, remove barriers to successful transition from high school to adult life for
young adults on SSI, and increase the self-sufficiency of these young adults. Youth 14-16
years of age who are receiving SSI benefits, and their families, will be eligible to participate
in this study. The project Arizona is part of has been titled ASPIRE (Achieving Success by
Promoting Readiness for Education and Employment) and has engaged over 1,000 teenagers
and their families as of June 2016.



The Division partners with Pilot Parents of Southern Arizona to provide Partners in
Leadership. Partners in Leadership 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. 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’s Office of Family and Community Resources delivered 41 presentations
during this fiscal year providing outreach to 3,334 people. Attendees included stakeholders,
community partners, emergency-management teams, school districts, family groups, Division
staff, various community fair attendees, and health and wellness event attendees.



The Division, along with its community partners, sponsored the Twelfth Annual Direct
Support Professionals Recognition event on Thursday, September 24, 2015 at the Disability
Empowerment Center. These outstanding individuals were honored for their superior service
in working with individuals with developmental disabilities. There were 12 awardees which
included ten Direct Support Professionals and two Direct Care Supervisors.
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016



The Division piloted a New Parent Orientation, with over 30 family members participating in
the three sessions. The goal of the orientation is to give families an overview of the Division,
including increasing confidence when advocating for an eligible family member.
Communication strategies are discussed, potential resources are reviewed, and families have
the opportunity to have questions answered.



The Division engaged in a strategic planning process. The Division held more than 40 inperson, statewide Listening Sessions for members, families, providers, Division staff and
other stakeholders. In addition, the Division conducted a web-based Strategic Plan Survey,
in which more than 600 respondents (members, parents/guardians, Division staff, providers
and others) participated.
Subject Matter Expert (SME) Teams met from September through December 2015 to further
consider the steering team’s recommended goals and objectives. When stakeholder
comments became available, comments provided by stakeholders were categorized and
provided to SME teams for their consideration and incorporation into their action plans. The
SME Teams determined the targeted outcomes that would be used to measure progress on
each of the objectives.
The four goals that serve as a frame work for the Strategic Plan are included below:
 Goal 1: Opportunities. Support opportunities for member’s choices and quality of
life.
 Goal 2: Value. Ensure that members get the best possible support for the money
spent.
 Goal 3: Communication. Achieve open, ongoing, clear communications among
members, families, providers, stakeholders and DDD staff.
 Goal 4: Environment. Make DDD a place where people love to work and grow
professionally.
Each of the goals listed above have one or more sub teams. The sub teams have been meeting
to begin work on the action plan. The Division will periodically provide updates as to
progress in meeting these goals.

XII. Conclusion
Under the leadership of the New DES, the Division has continued to grow and prosper. During
this past year, the Division has been reinvigorated with excitement and passion. The Division is
working diligently on the Strategic Plan goals and objectives, viewing it as the guide for the next
five years. This excitement has permeated the Division and it is recognized in the work the
Division is doing. The Division’s member, family, stakeholder and provider communities feel
this excitement and are joining DDD on this empowering journey.
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Department of Economic Security, Division of Developmental Disabilities
Family Support Annual Report, July 1, 2015 – June 30, 2016

The Division is committed in continuing to lead the nation in including individuals with
disabilities in the community. With the affordable housing efforts, the options for inclusion
continue to increase and expand.
The Division looks forward to continuous input, transparency and change as DDD embarks on
fulfilling the goals and objective outlined in the Strategic Plan.

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