July 2010 State of Illinois Illinois Depart.docx

July 2010
State of Illinois
Illinois Department of Human Services
Division of Developmental Disabilities
STRATEGIC PLAN FY 2011–2017
July 2010
July 2010
Table of Contents
I.
Introduction…………………………………………………………
……………………………………………………………………...
3

II. Overview of the Division of Developmental
Disabilities……………………………………………………………
…… 4 – 5
III. Vision
…………………………………………………………………………
……………………………………………………………….. 5
IV. Mission
…………………………………………………………………………
………………………………………………………….…. 5
V. Guiding
Principles……………………………………………………………
………………………………………………………….. 6
VI. Summary of Strategic Priorities and Success
Indicators……………………………………………………………
…. 7 – 8
VII. Key Definitions, Strategic Priorities and
Goals…………………….……………………………………………
……….... 9 – 17
VIII. Glossary of
Terms…………………………………………………………………
…………………………………………………….. 18
IX.
Bibliography…………………………………………………………
……………………………………………………………………..
19

July 2010
3
I. Introduction
The Department of Human Services (DHS), Division of
Developmental Disabilities (the Division) is pleased to present
its strategic plan
for State of Illinois Fiscal Years 2011–2017. This plan has been
developed through a process designed to mine the wisdom of a
wide
array of stakeholders. It has also been developed in response to
several important environmental conditions: a recessionary state
economy; investigations by the U.S. Department of Justice at
Howe and Choate Developmental Centers; Olmstead related
litigation;
a growing waiting list for basic community services and the
recognition that Illinois must align its services for people with
developmental disabilities in accord with the preferences of
those we serve and nationally accepted practices. Current
practice calls
upon us to aggressively create a comprehensive and coordinated
person-centered service delivery system, rooted in community-
based structures, that appropriately supports individual
preferences, and which meets the needs of all individuals

regardless of
intensity or severity of need.
This strategic plan is bold and aims to substantively re-orient
Division priorities and resources to support a truly person-
centered
system of services for which there is a popular mandate;
however, this plan cannot be implemented with current funding
and
service structures and declining funding for services. While we
will do our part to ensure that new policies, procedures, and
strategies follow promising practices, are cost effective, and
responsive to individuals with developmental disabilities, the
allocation
of resources to support people with developmental disabilities
must accurately reflect service demand and be a priority at all
levels
of government and for the citizens of Illinois.
Some will ask, “How is this plan different from the last one?”
Our answer is that the majority of goals can be directly tied to
research
and recommendations made by a wide range of internal and
external stakeholders. The Division met with a group of
advocates that
represent all aspects of the service delivery system—self-

advocates, family members, provider agencies, union
representatives, and
others—and reached consensus on the Strategic Priorities
addressed in this plan. In addition, readers will see many of our
strategies
are drawn from the policy recommendations of our stakeholder
groups and from literature in the field that reflects generally
accepted best practice. These documents are acknowledged in
the bibliography.
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II. Overview of the Division of Developmental Disabilities
The Division of Developmental Disabilities has oversight for
the Illinois system of programs and services specifically
designed for
individuals with developmental disabilities. The Division
provides direct services and funds services provided by private
facilities and
local, community agencies. It works as a partner with many
local entities statewide to offer an extensive array of services,
which
enable persons with developmental disabilities to reside with
their families or in other integrated living situations, to ensure
their

health and welfare and achieve their personal goals.
Community services funded through Medicaid waivers for
children and adults are provided through about 350 agencies
and, for
Home-based Services, through 4,100 employees that are directly
hired by the person served. These services vary from 24-hour
residential services to specialized therapies, personal support
services, day programs, Individual Service and Support
Advocacy
(ISSA), and respite. Medicaid waiver services are to be
provided in integrated community settings. Currently, over
16,500 people are
served through the Division’s Medicaid waiver program.
The Division has administrative oversight of about 300 private
Intermediate Care Facilities for Individuals with Development
Disabilities (ICFs/DD) and Skilled Nursing Facilities for
Pediatrics (SNFs/Ped). These residential settings vary in size
and location and
provide a continuous program of specialized and generic
training, treatment, health services, and related services that are
directed
toward the acquisition of the behaviors necessary for the
individual to function with as much self-determination and
independence

as possible and toward the prevention or deceleration of
regression or loss of current optimal functional status (also
known as active
treatment). There are currently 6,530 people living in private
ICF/DD and similar type settings in Illinois.
The Division also manages the operations of residential services
to 2,100 individuals with developmental disabilities who reside
in
eight state-operated developmental centers (SODCs). SODCs
provide similar services to ICFs/DD—an array of services and
supports
that provide training and services to ensure the person is able to
function with as much self-determination and independence as
July 2010
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possible. They also provide residential services to persons with
developmental disabilities who may have a higher level of need
or to
individuals in crisis.
In past years, the Division has supported nearly 15,000 children
and adults with developmental disabilities through a wide-range
of

non-Medicaid grant programs offered through 160 community
agencies. These programs are unique to the specific needs of the
local community and the people served. Many of the people
served through these grants, for example, people with mild
intellectual disability and a co-occurring mental illness or
people with an Autism Spectrum Disorder, need services to
achieve
personal goals and live successfully in their local community,
but may not meet the federal Medicaid eligibility requirements.
The
continued erosion of this funding will have a far-reaching,
negative impact on those receiving services, their families, the
local
agencies and, ultimately, the entire community.
III. Vision
All children and adults with developmental disabilities living in
Illinois receive high quality services guided by a person-
centered plan
that maximizes individual choice and flexibility in the most
integrated setting possible. All areas of the State have available
a full
array of services that meet the needs of children and adults with
developmental disabilities living in their local communities
regardless of intensity or severity of need. There is no waiting

list for services.
IV. Mission
The Illinois Department of Human Services, Division of
Developmental Disabilities provides leadership for the effective
management
of the design and delivery of quality outcome-based, person-
centered services and supports for individuals who have
developmental
disabilities. These services and supports will be appropriate to
their needs, gifts, talents and strengths; accessible; life-
spanning;
based on informed choice; and monitored to ensure individual
progress, quality of life, and safety.
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V. Guiding Principles
The Division of Developmental Disabilities will move forward
responsibly with its strategic objective to improve access to

person-
centered services in community settings. We must recognize
and involve a wide variety of stakeholders: self-advocates,
families
and guardians, providers, legislators, and other advocates. In
order to ensure both progress and the overall health and well-
being
of those we serve, the Division commits to the following
guiding principles:
1) People with developmental disabilities will be actively
involved in policy discussions and decisions and will be
respected as
partners in the process, making informed choices and decisions
in order to support productive and fulfilling lives;
2) Families and guardians will be listened to and respected, and
we will strive to earn and keep their trust along with the trust
of the public;
3) As small, home and community-based options are increased
and enhanced, we will look at new and creative ways to utilize
resources across the service delivery system;
4) Public resources will be used effectively and efficiently to
help those we serve achieve their goals;

5) The integration of habilitation, social, and clinical supports
will be considered paramount when enhancing and developing
services throughout the delivery system; and
6) We will establish goals, monitor our progress, and assure
quality for those we serve.
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VI. Summary of Strategic Priorities and Success Indicators
Summary of Strategic Priorities Critical Success Indicators
By 2017…
1. Create person-centered services aligned and strengthened
across the developmental disabilities system, such that they
are provided in the most integrated setting appropriate to the
needs of the individual throughout the lifespan, regardless of
intensity or severity of need.1
are driven by
a person-centered plan that accurately reflects their needs,
personal
goals, and objectives.

-based
model for service
delivery that improves the coordination and integration of
habilitation,
social and clinical care for people with developmental
disabilities.
settings will
achieve parity with the national utilization rates.2 3
would need
to increase this option at a rate of 5.5% on average, annually, to
achieve parity with the national average by 2017.4
private ICFs/DD: Illinois
would need to
serve an average of 2.7% fewer individuals per year
(compounding)
to achieve parity with the national average by 2017.5
serve an
average of 8.9% fewer individuals per year in state
Developmental
1 The definitions of “person-centered services” and “person-
centered organizational change process” were developed by a
group of developmental disability
agencies, self-advocates, and parents in collaboration with the
Division of Developmental Disabilities in the fall of 2008.
2 Smith, Agosta, & Daignault, 2008, pp. 15–17. The national

utilization rate as of 2007 was 12.6 individual per 100,000
living in large facilities. Illinois’ rate is
21.0 individual per 100,000.
3 Smith, Melda, & Agosta, 2010.
4 Smith, 2010, Topic 3, p.4.
5 Smith, 2010, Topic 6, p.7.
6 Smith, 2010, Topic 7, p.8.
7 Smith, 2010, Topic 8, p.9.
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Centers (compounding) to achieve parity with the national
average
by 2017.6
services:
Illinois would need to serve an average of 20.5% more
individuals
per year in integrated employment services (compounding) to
2. Restructure financing and rates to encourage high quality
person-centered services.
realigned to reflect
the Strategic Priorities and benchmarks identified in this plan.
3. Expand system capacity to accommodate increasing demand.

-funded Home and
Community
Based Services (HCBS) will achieve parity with national
utilization rates.
individuals
receiving Medicaid-funded services per year (compounding) to
individuals
receiving HCBS Waiver Services per year (compounding) to
achieve
parity with national average by 2017.9
4. Actively build a strong, compassionate, and professionally
trained work force.
employees and
community-based direct service professionals will be reduced.
5. Continue our commitment to measure system performance
and engage in continuous quality improvement.
management
system that captures, aggregates, and analyzes data from
various
sources, allowing timely analysis of service processes and
outcomes.
8 Smith, 2010, Topic 1, p.2.

9 Smith, 2010, Topic 2, p.3.
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VI. Key Definitions, Strategic Priorities and Goals
Person-centered
thinking
Person-centered
practices,
services and
supports
Person-centered
philosophy
Person-centered
planning
Person-centered
happiness and

achievements
The
Person
Person-Centered Services:
Services and supports
characterized by a
comprehensive understanding of
individuals' strengths, desires,
hopes, and aspirations and
provided in a manner that
reflects a sincere commitment to
maximizing opportunities for
individuals to function with as
much independence and self-
determination as possible.
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10

A person-centered
organizational change process
requires a systematic review
of all policy, procedure, and
program design to align with
new service model.
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Strategic Priority #1: Create person-centered services aligned
and strengthened across the developmental
disabilities system, such that they are provided in the most
integrated setting appropriate to the needs of the
individual throughout the lifespan, regardless of intensity or
severity of need.10
Statement of Current Reality: Individuals with developmental
disabilities and their families are more often than not

frustrated by the current system of care and its philosophical
underpinnings which seem to favor a rigid, bureaucratic
approach to service delivery that puts the interests of rules and
regulations ahead of the individual’s. Instead, they would
like to see a person-centered service system that provides
services and supports characterized by a comprehensive
understanding of individuals' strengths, desires, hopes, and
aspirations, and provided in a manner that reflects a sincere
commitment to maximizing opportunities for individuals to
function with as much independence and self-determination
as possible.
Key Intent: This priority represents a substantial departure
from past Division practice, reorienting services such that
they are philosophically and operationally designed to achieve
person-centered services, provided in the most integrated
setting. Policy, procedure, practice, and system of services will
be realigned to support person-centered service planning
in a rational, incremental process to take place over the next
seven years. Our intent is that this transition is accomplished
in a thoughtful manner that does not jeopardize current services
to individuals and grows capacity in our system. We will
partner with those we serve and provider agencies to ensure
organizations providing person-centered, quality service,

10 The definitions of “person-centered services” and “person-
centered organizational change process” were developed by a
group of developmental disability
agencies, self-advocates, and parents in collaboration with the
Division of Developmental Disabilities in the fall of 2008.
July 2010
12
remain stable and viable. We recognize that in some cases state
and federal policy must be changed to accommodate
this new emphasis and will work toward those adjustments. It
is also important to note that Misericordia, a high quality,
large private campus with historical importance and broad-
based community support, will maintain significance in our
system.
Goals
1.1. Establish a Person-Centered Service Plan and planning
process that is driven by the individual and is philosophically
committed to
services and supports that are provided in the most integrated
setting. The planning process will encourage development of
plans

that include a wide range of supports both paid and unpaid, and
will include but not be limited to: assessment of living
situation,
family situation, and urgency of need, personal goals, clinical
needs, and preferred service types.
1.2. Strengthen the Point of Entry System for people with
developmental disabilities such that it is widely known to the
broader
community, performs system intake, pre-admissions screening,
and appropriate referral to service agencies using consistent and
uniform protocols.
1.3. Strengthen and adequately fund the independent service
coordination function, making the service coordination and
advocacy
function more robust. Service coordinators will work with
individuals and families to develop the person-centered plan,
assist
them in locating service providers, perform periodic monitoring
of service plan implementation, and provide a foundation for a
sound quality assurance system.
1.4. Conduct a geographic analysis of supports and services;
identify gaps between required supports and services within
region and
person-centered requirements. Continually review data and
analyze the environment creating a feedback loop.
1.5. Ensure an inclusive continuum of care in which all
individuals are appropriately served, regardless of intensity or

severity of need.
1.6. Align Division policy, practice, procedure with a person-
centered organizational structure and service system.
1.7. Restructure community services funding along person-
centered lines to promote flexibility in service plan design and
portability.
1.8. Increase availability and usage of self-directed services.
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1.9. Define and align roles of current institutional and
community services to ensure they fit the person-centered
model.
1.10. Better coordinate service delivery among key state
agencies.
1.11. Adopt policies that encourage downsizing of SODCs and
ICFs/DD to support the transition of individuals to the most
integrated
setting.

1.12. Adopt policies that support the transition of people that
live in private ICFs/DD to the most integrated setting.
1.13. Preserve safety net services for people with extreme
needs.
1.14. Ensure people with significant medical and/or behavioral
needs and those with dual diagnosis (DD/MI) have access to
person-
centered supports and services that meet their needs in
community settings.
Strategic Priority #2: Restructure financing and rates to
encourage high-quality, person-centered services.
Statement of Current Reality: Illinois’ funding of developmental
disability services is low compared to other states. Residential
care for people with developmental disabilities is
disproportionately delivered through a system of State Operated
Developmental
Centers (SODCs) and large congregate care facilities rather than
in small, integrated community settings. The state’s rate
structure
is largely a prospective reimbursement system and generally
does not reimburse agencies for the full cost of services
rendered.

Our current funding models are based on beds and “slots” and
are not truly person-centered. This limits flexibility and forces
people into rigid programs, rather than shaping services around
a person’s specific needs and personal goals. As a result, there
is
not always a strong correlation between a person’s level of need
and the funding he or she receives from the Division.
Key Intent: Every individual has a person-centered plan. This
plan will be supported by an equitable budget amount or rate for
services determined and recorded during plan development. The
person chooses a service model (traditional provider budget
option, self-directed budget option, or a mix) and subsequent
services are determined by the person, his or her guardian, and
his
or her Individual Support Team. Services are realigned across
the system such that there is adequate reimbursement, and there
is
July 2010
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a strong correlation between level of need and level of funding.
As discussed earlier, the Division has authority over some, but
not
all, funding policies, and we recognize that changes in funding

mechanisms may require legislative or administrative action by
state
and federal entities.
Goals
2.1. Define an “adequate” rate for residential, day, and
employment services.
2.2. Restructure funding models so that the service plan is tied
to a Person-Centered Budget Allocation that adequately
supports high-
quality, outcome-based services delivered by all providers along
the service continuum.
2.3. Institute global budgeting that combines waiver and
ICF/DD funding into one line.
2.4. Obtain adequate appropriations to fund services in a timely
fashion, eliminating the need for any payment cycle (i.e.,
payment delay).
2.5. Invest in information technology that supports budget
development for person-centered planning.
2.6. Restructure funding models to support people with
significant medical and behavior needs in community settings.
2.7. Enhance mechanisms for funding to essentially follow
people who transition from SODCs and private ICFs/DD to
integrated community
settings.

Strategic Priority # 3: Expand system capacity to accommodate
increasing demand.
Statement of Current Reality: Illinois has not kept up with
demand for developmental disabilities services. In August
2007, 35% of
emergency and critical service needs, as reflected on the
Prioritization of Urgency of Needs (PUNS) system, were unmet
and
estimates are that this number will double by 2014.11 The
PUNS system serves as the Division’s waiting list for services,
tracks
demand, and provides data to inform decissions about system-
wide service needs. Only those people in significant crisis are
able to
receive community-based, waiver services without waiting. Our
ability to meet demand and eliminate the waiting list is
dependent
11 Smith, Agosta, & Daignault, 2008, pp. 29–32.
July 2010
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on increased flexibility and realignment of current funding
structures, and adequate funding for outcome-driven services

and
supports.
Key Intent: Reduce the time people must wait to access
necessary services state-wide. Increased community capacity
will include
habilitation, day, and employment services provided in the most
integrated setting, and will also include access to appropriate
nursing, medical, dental, behavioral health and other clinical
services. We will increase our ability to meet a broad and deep
range
of needs across the state.
Goals
3.1. Increase Home and Community Based service system
capacity such that we will achieve parity with national
utilization rates for these
services.
3.2. Develop a robust and statewide clinical services network
for people with developmental disabilities that includes
university,
community service providers, and state employees in
community offices and/or a select number of SODCs.
3.3. Scale up use of self-direction system-wide.
3.4. Support and encourage development of system capacity in

underserved areas.
3.5. Reduce the amount of time adults and children in non-crisis
situations must wait for services.
3.6. Develop a community economic impact statement that
quantifies such benefits as job creation and well-being (report
card).
Strategic Priority #4: Actively build a strong, compassionate,
and professionally trained work force.
Statement of Current Reality: A number of reports have
established that direct service professionals in the
developmental
disability service system are in short supply, underpaid, and
over-worked. Turn-over rates are high and cost the system
dearly. If
the system is to deliver quality services, achieve successful
outcomes for individuals with developmental disabilities, and
grow in
professionalism, then action must be taken to attract and retain
highly qualified workers to the field. This outcome requires
July 2010
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increased career development opportunities, as well as improved

working conditions, wages, and benefits across the system.
Key Intent: Substantially improve training, recruitment,
retention, wages, and benefits for direct service professionals
throughout
the system. This effort will significantly improve the lives of
individuals with developmental disabilities by ensuring their
care is
entrusted to professionals that are well qualified, appropriately
trained and adequately paid.
Goals
4.1. Conduct a full-scale, system-wide study of direct service
professionals’ wages, benefits, and hours of work, etc.
4.2. Boost and realign funding for community services, so that
community agencies can attract and retain competent direct
service
professionals by paying competitive wages with solid benefits.
Reduce the disparity between wages paid to state employees and
community direct service staff.
4.3. Reduce annual turnover and vacancy rates for direct service
professionals.12
4.4. Adequately staff all services, so that reliance on over-time
is reduced and staff burnout is eliminated.13
4.5. Create supports and incentives for effective training,
recruitment, and retention of direct-service professionals by

providers
throughout the developmental disabilities system (e.g.,
increased training to prevent and manage difficult behaviors,
on-call capacity
to provide technical assistance to providers/direct-service
professionals facing challenging conditions).
4.6. Partner with institutions of higher education (e.g., Illinois
Community College Board) to create career pathways supported
by
certification and degree programs.
4.7. Provide incentives for current direct services professionals
to seek additional education and credentialing.
4.8. Develop an orderly, supportive, and phased process for
transitioning displaced state employees into comparable
positions in
community-based services.
12 Powers, Powers, & Merriman, 2007, pp. 53–54.
13 AFSCME Council 31, 2007, pp. 10–12.
July 2010
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Strategic Priority # 5: Continue our commitment to measure
system performance and engage in continuous quality
improvement.

Statement of Current Reality: A serious shift to a person-
centered system requires the development of benchmarks
aligned with
person-centered goals and outcomes. Statutes, rules, and
regulations were established over a decade ago and have not
kept pace
with emerging or generally accepted standards in the field. In
general, the existing rules and regulations should be updated to
strengthen and expand the emphasis on goals and outcomes of
the individual, rather than on buildings and structures. In
addition,
information management systems are disparate and aging. It is
becoming increasingly difficult to track quality assurance data
in a
manner that produces useful information to guide policy and
quality of care decisions.
Key Intent: Clearly define person-centered quality measures,
monitor performance, and use data and lessons learned to
inform
future policies and procedures. Use information gathered
through this effort to strengthen the quality assurance feedback
loop,
ensuring a systematic, on-going process for review and
improvement of rules, regulations, policies and procedures.
Goals

5.1. Define quality indicators and assurance processes so that
they are aligned with person-centered principles and
requirements of state
and federal oversight entities.
5.2. Measure performance and engage in continuous quality
improvement to guide better system performance and ensure
better
outcomes for people with developmental disabilities.
5.3. Enhance IT capacity to clearly and consistently measure
system performance.
5.4. Adequately fund the Division’s infrastructure to effectively
monitor and assure quality standards.
5.5. Institute performance-based contracts.
5.6. Realign current licensure and certification processes with
person-centered, outcome-based quality objectives.
July 2010
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VII. Glossary of Terms
Adequate Funding: Funding for services that reasonably covers
the cost of providing services that are high in quality,
appropriate to the person’s needs,
equitable for all people with similar needs, and ensures
government funding is used in an efficient and responsible

manner.
Integrated Employment: Jobs held by people with
developmental disabilities that are paid at minimum wage, or
preferably higher, and occur in an
integrated work environment.
Person-Centered Services: Services and supports characterized
by a comprehensive understanding of individuals' strengths,
desires, hopes, and aspirations
and provided in a manner that reflects a sincere commitment to
maximizing opportunities for individuals to function with as
much independence and self-
determination as possible.
Person-Centered Budget: A budget allocation identified for
each person served through standard assessment and review of a
person-centered plan, that
ensures adequate funding is available to meet the persons
specific medical, clinical and habilitation needs, and achieves
their identified goals. Funding may
be used by the person and their Individualized Support Team to
purchase self-directed services, services offered through a
provider agency or a combination
of both, based on the needs and goals of the person served.
Integrated Community Setting: A home (house or apartment) or
place of employment that is integrated into a local
neighborhood, among similar homes or
places of business where people with and without
developmental disabilities live, work, and play.
Most Integrated Setting: “The most integrated setting
appropriate to the needs of qualified individuals with
disabilities” to mean “a setting that enables

individuals with disabilities to interact with non-disabled
persons to the fullest extent possible.” (28 CFR pt. 35, App. A,
p. 450 Americans with Disabilities Act
(ADA) regulations, 1998).
Clinical Service Network: A statewide network of clinical
service providers in a specific region or area of the state, who
work in partnership with each other,
with people with developmental disabilities, their families and
guardians, provider agencies, and the State to meet the clinical
needs of people with
developmental disabilities living in the region.
Money Follows the Person: A mechanism by which funding for
services “follow” a person from one setting to another. It is
generally used to describe a
mechanism for funding to follow a person from an institutional
setting into an integrated community setting. For purposes of
this plan, it does not mean that
the exact amount of funding available to a person in an
institutional setting is available for services in the integrated,
community setting.
Self-Directed Services: A service model by which people with
developmental disabilities are empowered to direct the nature
and duration of services they
receive and are able to directly manage their personal support
staff.
July 2010
19

VIII. Bibliography
AFSCME. (2010). Trends in Developmental Disablity Services.
Washington, D.C.
AFSCME Council 31. (2007). Beyond the Breaking Point:
Illinois State Services in Crisis. Chicago, Illinois.
Braddock, D., and R. Hemp. (2008). Services and Funding for
Services for People with Disabilities in Illinois: A Multi-state
Comparative Analysis.
Illinois: Illinois Council on Developmental Disabilities.
Burke, R. (2009). Vision for the Future of Department of
Human Services Division of Developmental Disabilities.
Chicago, Illinois: unpublished
paper.
Institute on Community Integration, University of Minnesota.
(2008). Final Report: The Illinois Comprehensive Workforce
Development Initiative
to achieve improved indivdual outcomes for citizens with
intellectural and developmental disabilities. Illinois: Illinois
Council on
Developmental Disabilities.
Navigant Consulting, Inc. (2006). Report of the Community
Integrated Living Arrangement Nursing Services
Reimbursement Work Group to the
Secretatry of the Department of Human Services and the
Honorable Rod R. Blagojevich, Governor, in Response to

Senate Resolution 514.
Springfield, Illinois.
Navigant Consulting, Inc. (2007). Division of Developmental
Disabilities 2007–2011 Strategic Plan. Springfield, Illinois:
Illinois Department of
Human Services Division of Developmental Disabilities.
Paceley, S. (2009). The Model Service Delivery System for
Illinois Citizens with Disabilities or What we'd like our servcies
to look like input from
self-advoacates/Illinois Voices. Springfield, Illinois:
unpublished paper.
Pennhurst Group, LLC, and H&W Independent
Solution
s. (2008). State Operated Developmental Centers Consulting
Services Final Report.
Springfield, Illinois: Illinois Department of Human Services
Division of Developmental Disabilities.
Powers, E. T., N. J. Powers, and D. Merriman. (2007). State
Funding of Communtiy Agencies for Services Provided to
Illinois Residents with

Mental Illness and/or Developmental Disabilities. Springfield,
Illinois: University of Illinois Institute of Government and
Public Affairs.
Smith, D. K. Melda, and J. Agosta. (2010). Data Report: Trends
in Services for Individuals with Intellectual & Developmental
Disabilities in Illinois
and the United States. Tualatin: Human Services Research
Institute.
Smith, G., J. M. Agosta, and J. Daignault. (2008). Blueprint for
System Redesign in Illinois. Portland: Human Services Research
Institute.
1
8
Assignment: Addressing Patient Safety and Quality of Care

through Policy
NURS 4105: Advocacy through Healthcare Policy
Maria Pribe
Walden University
September 15, 2019
Addressing Patient Safety and Quality of Care through Policy
The legalization of the policy relating to the use of Marijuana in
Michigan for adults aged 21 years and older removes criminal
and monetary penalties for the possession, use, and supply of
the drug for recreational purposes (Todd, 2018). The Michigan
Medical Marihuana Act legalized the growth, possession, and
use of marijuana. A 21 year and older will be allowed to possess
2.5 ounces of marijuana and grow up to 12 plants in an enclosed
area (Michigan Regulation and Taxation of Marihuana Act,
Initiated Law 1, 2018). The aim of writing this paper is to
address patient safety and quality of care through policy.
Ways that the Policy Addresses Safety, Quality, and its
Implications Triple Aim Initiative
Medical cannabis products acquired from dispensaries and state
programs follow the specified Michigan requirements of
growing, formulation, manufacturing, marketing, and
distribution (Thomas & ElSohly, 2016). In the United States
(US), there is an increase in errors in the chemical content and
inaccuracies in the labeling of products purchased from medical

cannabis markets. According to Thomas and ElSohly (2016), an
analysis of the tetrahydrocannabinol (THC) content on 75
products from 47 brands indicated that 17% were accurately
labeled, 23% had inadequate descriptions, and 60% had an
increase in classifications. Additionally, the FDA reported that
in the US, firms were marketing cannabidiol-containing drugs
that had not been approved thus indicating a decrease in quality
control measures. Also, edibles that resemble sugars may
increase intoxication or unintentional consumption. Therefore,
the risk of overdosing is exacerbated by the absence of
appropriate labeling and the lack of an FDA-approved
antagonist that reverses the effects of the drug (Thomas &
ElSohly, 2016).
States that have legalized the use of marijuana have laws
requiring product safety testing for contaminants, pesticides,
and cannabinoids before selling (Klieger et al., 2017).
Consequently, the labeling rules outline the need to indicate the
health risks, the strain of marijuana used, product potency, and
proof of contaminant testing. Due to the concerns of accidental
ingestions of edibles by children, manufacturers are required to
have child-resistant packaging and labeling (Pacula & Smart,
2017).
To address safety and quality, the state of Michigan has
regulations that outline the standards of testing, packaging, and
labeling of products (Michigan Regulation and Taxation of

Marihuana Act, Initiated Law 1, 2018). It is also a requirement
that for marihuana-infused products, the maximum level of THC
and the amount of marihuana concentrate is specified on the
product label. Also, a sample of the product needs to be tested
by a marihuana safety compliance facility before distribution
(Michigan Regulation and Taxation of Marihuana Act, Initiated
Law 1, 2018). Consequently, restrictions have been made on
advertising, marketing, and display of marihuana to protect
adolescents and children from early exposure to the drug.
The Institute for Healthcare Improvement (IHI) developed a
framework that illustrates the efficient approach to optimizing
health system performance (The IHI Triple Aim Initiative, n.d.).
The objective of IHI Triple Aim is to improve the quality and
experience of care offered to the patient, enhance the health of
the population, and reduce the per capita cost of accessing
health care. Communities that accomplish the Triple Aim have
populations with improved health because of designing policies
that identify healthcare problems and provide solutions to them.
The medical cannabis programs achieve the objectives of the
IHI Triple Aim because the interdisciplinary services of medical
cannabis programs improve the patient healthcare experience.
Furthermore, medical cannabis was found to be effective in
managing cancer and opioid addiction, therefore, it improves

the health of the population because patients are offered
coordinated care that decreases the illness (The IHI Triple Aim
Initiative, n.d.). Additionally, economic benefits have been
observed in states with medical cannabis programs such as
reduced Medicare Part D spending and increased taxation
profits. Hence, a reduction in the per capita cost of care for
populations reduces publicly funded health care budgets.
The Effectiveness of the Policy on Improved Outcomes of Care
for Patients
States that have legalized the use of medical marijuana to treat
chronic pain have reduced opioid overdose deaths and untreated
use disorder (Lucas & Walsh, 2017; Todd, 2018). In states that
have legalized medical marijuana, the overdose death rates
reduced by 25%. Legal access to marijuana has also caused a
reduction in opioids dependence or hospitalization because of
abusing the drug by 23% (Todd, 2018). Studies show that
patients use marijuana to reduce the use of opioids for mental
health and pain-related conditions (Todd, 2018). The increased
rate of substitution for prescription drugs among the patients
suggests that medical cannabis may be an effective treatment
for the conditions (Lucas & Walsh, 2017).
Cannabinoids regulate crucial cell signaling pathways that are
involved in its survival, angiogenesis, invasion, and metastasis.
A research conducted by Orellana-Serradell et al. (2015)
detected the presence of cannabinoid receptors on prostatic

cancer and then assessed the effects of the in vitro use of
synthetic cannabis analogs. The study established that there is a
presence of a dose-dependent inhibitory effect that included an
increase in the levels of activated caspase-3 and a decrease of
Bcl-2, confirming the activation of apoptosis. The researchers
also observed an endocannabinoid-modulated activation of the
ERK path-way and a concurrent reduction in the AKT pathway
activation. This observation suggests that endocannabinoids
may impact the treatment of prostate cancer (Orellana-Serradell,
2015).
Role of the Nurse in Addressing the Quality and Safety
Standards within the Policy
In the United States, the federal government classifies cannabis
as a schedule 1 controlled substance with increased chances for
abuse and no accepted medical value. Nurses are important in
providing quality care in the health care system because of their
frequent interactions with patients (Mason, Gardner, Outlaw, &
O’Grady, 2016). Therefore, nurses may influence practice
standards and processes to ensure the quality of care through
policy work. Nurses are required to have practical information
to effectively care for the increasing number of patients using
cannabis through the medical marijuana program and those who
self-administer the drug for recreational purposes or treatment
of different conditions (National Council of State Boards of

Nursing [NCSBN], 2018).
A nurse requires to know the current state of legalization and
the jurisdiction of medical and recreational cannabis (NCSBN,
2018). An understanding of the endocannabinoid system,
cannabinoid receptors, pharmacology, and the research
associated with the medical use of cannabis. Additionally,
nurses need to identify the safety considerations for patient use
of cannabis to treat the patient without judging their choice of
treatment (NCSBN, 2018). These principles provide the nurse
with the essential knowledge for providing safety and quality
care for the patients using medical or recreational marijuana.
Opinion about the Policy
I support the policy on the legalization of Marijuana in
Michigan state for adults 21 years and older because of its
therapeutic benefits. Studies show that cannabinoid-based
medications are effective in the treatment and management of
chronic pain and cancer (Orellana-Serradell, 2015; Lucas &
Walsh, 2017). However, nurses lack evidence-based resources
when caring for patients who use medical or recreational
marijuana because of its classification as a schedule 1
controlled substance (NCSBN, 2018).
References
Klieger, S. B., Gutman, A., Allen, L., Pacula, R. L., Ibrahim, J.
K., & Burris, S. (2017). Mapping medical marijuana: State laws

regulating patients, product safety, supply chains and
dispensaries. Addiction, 112(12), 2206–2216.
doi:10.1111/add.13910
Lucas, P., & Walsh, Z. (2017). Medical cannabis access, use,
and substitution for prescription opioids and other substances:
A survey of authorized medical cannabis patients. International
Journal of Drug Policy, 42, 30–35.
doi:10.1016/j.drugpo.2017.01.011
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T.
(2016). Policy & politics in nursing and health care (7th ed.).
St. Louis, MO: Elsevier.
Michigan Regulation and Taxation of Marihuana Act, Initiated
Law 1 (2018). Retrieved from
https://www.legislature.mi.gov/(S(r03jnxzfjaqkfrcvnkpajhxx))/d
ocuments/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf
National Council of State Boards of Nursing (2018). The
NCSBN national nursing guidelines for medical marijuana.
Journal of Nursing Regulation, 9(2). Retrieved from
https://www.ncsbn.org/The_NCSBN_National_Nursing_Guideli
nes_for_Medical_Marijuana_JNR_July_2018.pdf
Orellana-Serradell, O., Poblete, C. E., Sanchez, C., Castellón,
E. A., Gallegos, I., Huidobro, C., . . . Contreras, H. R. (2015).
Proapoptotic effect of endocannabinoids in prostate cancer

cells. Oncology Reports, 33(4), 1599–1608.
doi:10.3892/or.2015.3746
Pacula, R. L., & Smart, R. (2017). Medical marijuana and
marijuana legalization. Annual Review of Clinical Psychology,
13(1), 397–419. doi:10.1146/annurev-clinpsy-032816-045128
Institute for Healthcare Improvement. (n.d.). Retrieved from
http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.a
spx
Thomas, B. F., & ElSohly, M. A. (2016). The Analytical
Chemistry of Cannabis: Quality Assessment, Assurance, and
Regulation of Medicinal Marijuana and Cannabinoid
Preparations (pp.83–99). St. Louis, MO: Elsevier.
http://dx.doi.org/10.1016/B978-0-12-804646-3.00005-9
Todd, T. (2018). The benefits of marijuana legalization and
regulation. Berkeley Journal of Criminal Law, 23(1), Article 6.
https://doi.org/10.15779/Z38NK3652D
1
PAGE

7
Assignment: The Cost of Health Care
NURS 4105: Advocacy through Healthcare Policy
Name: Maria Pribe
Walden University
Instructor: Dr. Dorothy Roberts
September 8, 2019
The Cost of Health Care
Cannabis is an illicit drug that is frequently cultivated,
trafficked, and abused worldwide. According to the world health
organization (WHO), the consumption of cannabis has an annual
prevalence rate of 2.5% of the global population (Bridgeman &
Abazia, 2017). The legalization of the use of medical marijuana
has a significant impact on the cost, access, and quality of
health care. A study conducted on conditions that medical
marijuana is considered an alternative treatment method showed
that states with active cannabis policies had fewer drug
prescriptions (Bradford & Bradford, 2016). A reduced number
of drug prescriptions cause a decrease in Medicare Part D and
enrollee spending. Hence, the use of medical marijuana is cost-
effective (Lear-Phillips, 2018). The aim of writing this paper is
to analyze the impact of financing and budgetary issues
associated with the legalization of medical marijuana in

Michigan State.
Funding and Annual Costs of Continuing of the Policy for the
Last Year
Health care systems may be financed using government funding,
taxation, donations, private insurance, and voluntary aid. The
state of Michigan created a marihuana regulation fund in the
state treasury to fund the legalization of the use of medical
cannabis (Michigan Regulation and Taxation of Marihuana Act,
Initiated Law 1, 2018). The initial funding of the policy will be
appropriated from a general fund, however, proceeds from the
fund would be used to repay any amount allocated. According to
Wolfram (2016), the medical marijuana industry generates
$44.3 million a year based on the current patient population.
Financial and Budgetary Efforts Developed to Contain Costs.
The state of Michigan passed legislation that allows limited sale
and purchase of marijuana by individuals with certified
licenses. Michigan’s regulatory agency, the Department of
Licensing and Regulatory Affairs, has imposed a 10% excise tax
on all marijuana sales, minimum levels of insurance for
individuals with licenses, and provide for the levy and
collection of fines for violations of the act or rules (Wolfram,
2016). These legislations will create a transparent, licensed,
and regulated medical marijuana industry in Michigan causing
the collection of revenue to be consistent and businesses to

operate under established rules, hence, promoting competition.
Current Cost-Containment Strategies
Public health and safety policies on medical cannabis are
modified and changed to adapt to new regulations, restrictions,
and penalties (Cornett, 2018). States that have permitted the use
of medicinal cannabis have established laws that regulate its
sale (Bridgeman & Abazia, 2017). The Michigan Medical
Marihuana Act legalized the growth, possession, and use of
marijuana to treat debilitating conditions such as neuropathic
pain, spasticity in multiple sclerosis, and nausea because of
chemotherapy. The law allows Michigan residents to be given
permits by the department of licensing and regulatory affairs
after a recommendation by a certified doctor. Therefore, a 21
year and older will be allowed to possess 2.5 ounces of
marijuana and grow up to 12 plants in an enclosed area
(Wolfram, 2016). However, government medical assistance
programs and private health insurers do not provide
reimbursement of medical cannabis expenses. The schedule 1
classification of cannabis causes hospitals and other care
settings that receive Medicare reimbursement or federal grants
to consider the potential loss of the funds. The loss of funds
may occur if the government penalizes hospitals because of
permitting the use of marijuana therapy in their facilities
(Bridgeman & Abazia, 2017). In March 2019, Gov. Gretchen
Whitmer approved the establishment of the Marijuana

Regulatory Agency within the Michigan Department of
Licensing and Regulatory Affairs (LARA). The new agency
released regulations on the implementation process of the 2018
voter-approved law that legalized marijuana for adults 21 and
older (Marijuana Policy Project, 2019). The guidelines outline
the role of the agency in promoting the communities’
participation in the cannabis industry. Also, the rules included
the provision of licenses that permit the use of cannabis for
temporary events. The regulations by LARA provide license
renewal fees that are triple-tiered based on the gross weight of
products transferred the previous year by the individual,
therefore, this will increase the revenue collection (Marijuana
Policy Project, 2019). The use of medical marijuana under a
strict regulatory framework will allow patients to have
increased access to safe medicine. Additionally, the sale and
production of the drug through a licensed and accountable
system will enhance the growth of the business and promote
competition, therefore, impacting the economy of Michigan
(Wolfram, 2016).
Health Outcomes of Financing the Policy and the Role of the
Nurse in the Workplace
In the United States (US), approximately 3.1 million individuals
use marijuana daily (Wilkinson, Yarnell, Radhakrishnan, Ball,
& D’Souza, 2016). Thirty states in the US have legalized the

use of cannabis for medicinal and recreational purposes.
However, the legalization of marijuana for medical use occurs
by popular vote and this differs from the approval of
medications by the U.S. Food and Drug Administration (FDA)
that requires an intensified standard of evidence for both
efficacy and safety (Wilkinson et al., 2016). Financing the use
of medical marijuana will provide the state the ability to
regulate its use causing safer use of cannabis. Consequently,
there will be a decline in the prevalence of marijuana use among
individuals (Wilkinson et al., 2016). However, the presence of
operating medical marijuana dispensaries in certain
municipalities may cause an increase in the use of the drug.
Shih (2019) noted that young adults living near medical
marijuana dispensaries had an increased rate of using the drug
and this exposes them to the risk of developing mental and
physical health problems.
The use of prescription opioids for patients with chronic pain
may lead to an overdose. A research conducted on states having
medical cannabis laws established that there was a reduced
annual rate of opioid overdose and death by 24.8% (Cornett,
2018). Hence, an increase in the prescription of medical
cannabis for health conditions such as cancer and chronic pain
may reduce Medicare spending and private insurance costs
(Lear-Phillips, 2018).

The role of a health care practitioner is to advocate for the
patients’ rights and needs (Lear-Phillips, 2018). Medical
marijuana applies to the future roles of nurses because they may
encounter a patient with a prescription of the drug. It is the
responsibility of the practitioner to ensure a patient acquires
quality care in their institution. Therefore, the role of the nurse
is critical in the provision of care because a provider may
advise them to administer medical marijuana to patients with
chronic pain before a therapy session (Lear-Philips, 2018).
Additionally, the nurse is required to counsel the patient about
safety to avoid developing health outcomes such as addiction to
the drug.
References
Bradford, A. C., & Bradford, W. D. (2016). Medical marijuana
laws reduce prescription medication use in Medicare part D.
Health Affairs, 35(7), 1230-1236.
doi:10.1377/hlthaff.2015.1661
Bridgeman, M. B., & Abazia, D. T. (2017). Medicinal cannabis:
History, pharmacology, and implications for the acute care
setting. Pharmacy and Therapeutics, 42(3), 180-188. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
Cornett, L. N. (2018). Legalization of medical cannabis and
potential implications for healthcare delivery in the United

States. Kentucky Journal of Undergraduate Scholarship, 2(1),
Article 2. Retrieved from
https://pdfs.semanticscholar.org/d398/14ec2f6c8dca93ca50468c
21b78ab2049415.pdf
Lear-Phillips, J. T. (2018). Medical marijuana and the
healthcare system. Kentucky Journal of Undergraduate
Scholarship, 2(1), Article 4. Retrieved from
https://pdfs.semanticscholar.org/d0cd/bb93fa304207554ff46bb4
559911d623b807.pdf
Marijuana Policy Project. (2019). Marijuana regulatory agency
publishes emergency rules to implement legalization. Retrieved
from https://www.mpp.org/states/michigan/
Michigan Regulation and Taxation of Marihuana Act, Initiated
Law 1 (2018). Retrieved from
https://www.legislature.mi.gov/(S(r03jnxzfjaqkfrcvnkpajhxx))/d
ocuments/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf
Shih, R. A. (2019). Young adults who live near medical
marijuana dispensaries use marijuana more often, have more-
positive views. Retrieved from
https://www.rand.org/news/press/2019/06/17.html
Wilkinson, S. T., Yarnell, S., Radhakrishnan, R., Ball, S. A., &

D’Souza, D. C. (2016). Marijuana legalization: Impact on
physicians and public health. Annual Review of Medicine,
67(1), 453–466. doi:10.1146/annurev-med-050214-013454
Wolfram, G. (2016). The economic impact of a strong
regulatory framework for medical marijuana in Michigan.
Retrieved from
http://www.mml.org/pdf/resources/Economic%20Report_Gary%
20Wolfram.pdf
YORK COUNTY
TRUANCY PREVENTION INITIATIVE

Strategic Plan
2013-2015
Vision Statement
All York County students who are subject to compulsory
attendance requirements attend school
every day
Mission Statement
Reduce Truancy in York County

United Way of York County’s Core Values
Integrity
Our relationships with each other and the greater community are
based on honesty and respect,
as we conduct ourselves with the highest ethical standards. Our
work is guided by our
organization’s stated mission and values.
Accountability
We are prudent stewards of United Way of York County’s
resources, responsible to our donors,
member organizations and community. Our financial and
outcome reporting meet or exceed
operational and governance standards and enhance transparency
to the donors and communities

we serve.
Operational Excellence
Our high standards of performance and commitment to
continuous improvement enable us to
provide effective, efficient, and quality services.
Inclusiveness
We value difference and strive for inclusion. We act in ways
that respect the dignity, uniqueness
and intrinsic worth of every person.
Collaboration
Within United Way of York County, we work as a team for the
good of the organization and the
community. We partner with other organizations and individuals

to leverage our talents and
resources for greater community impact.
Making a Difference
We mobilize the community to improve people’s lives. We
make a positive and lasting impact in
our community.
Guiding Principles
The work of the Truancy Prevention Initiative will be guided by
the following principles/beliefs:
1. Truancy is multi-faceted and is a result of numerous factors.

2. Reducing truancy in York County requires a collaborative
effort between a number of
countywide entities to help them identify and promote best
practices.
3. The work of the Truancy Prevention Initiative is to facilitate
communication and
partnerships between countywide entities.
4. Rather than implement programs, the role of the Truancy
Prevention Initiative is to
provide technical assistance and consultation to determine and
encourage the
implementation of appropriate evidence-based truancy
prevention and intervention
programs for York County.
5. To continue to serve the future needs of the community, the
Truancy Prevention Initiative

must actively seek out opportunities for sustainability.
6. The Truancy Prevention Initiative must continue to focus its
resources on public
advocacy efforts.
Framework
Reduce truancy in York County by collecting and analyzing
countywide data to:
1. Demonstrate the impact of truancy on the community;
2. Illustrate the impact of truancy prevention programs on
truancy rates;
3. Focus education and outreach efforts that inform
communication and enhance
connections among stakeholder groups;

4. Facilitate technical assistance efforts to stakeholders;
5. Pursue funding opportunities for TPI’s sustainability; and
6. Advocate for policy changes.
Strategic Imperatives, Goals, Objectives
Consistent and relevant data
Goal #1
Collaborate with key stakeholders to collect and analyze data
that gauges the truancy
climate in York County.

Objective #1.1
Examine current data collected and determine ways to
incorporate improvements
Objective #1.2
Assess and analyze the current status of truancy in York
County. This includes,
but is not limited to, the collection and analysis of the following
data:
t truancy rates

Objective #1.3
Evaluate how other stakeholders’ truancy data might better
inform or improve the
truancy “picture”
Objective #1.4
Develop a partnership structure that facilitates shared data
collection and analysis
to answer the following:

ata collected?
Goal #2
Use data as a means to examine program effectiveness, build
partnerships, and develop
future plans.
Objective #2.1
Collect data on the status and progress of truancy intervention
programs in York
County
Objective #2.2
Share the data with stakeholders

Objective #2.3
Prepare year-end data reports to share with the larger York
County community,
stakeholders, and potential funders.
Education and Outreach
Goal #3
Focus education and outreach efforts on enhancing connections
among stakeholders
Objective #3.1
Share information on current partnerships and programs in the

County4
Objective #3.2
Establish a clearinghouse of countywide truancy prevention and
intervention
programs
Objective #3.3
Make existing partnership and program information available to
stakeholders
considering truancy prevention and intervention programs
Technical Assistance
Goal #4
Facilitate technical assistance efforts to stakeholders

Objective # 4.1
Work with stakeholders to determine what areas of technical
assistance are
needed. Stakeholders include, but are not limited to:
Objective #4.2

Incorporate truancy in the current plans Local Education
Agencies create for
students, both school-wide and district-wide
Objective #4.3
Contact other providers who currently provide technical
assistance and training to
determine best strategies to incorporate truancy education
Objective #4.4
Enhance the use of technology to reach a broader audience in a
more time

efficient manner, with capability to assist on demand via the
website
Objective #4.5
Follow-up with the technical assistance requests to track
progress in connections
made
Sustainability
Goal #5
Pursue funding opportunities for TPI’s sustainability, focusing
particularly on three main
sources for support: school districts, businesses and
government.

Objective #5.1
Develop a “Case for Support” for each of the three potential
sources of funding
Objective #5.2
Apply for funding from each of the three potential sources of
funding on an
annual basis.
Objective #5.3
Explore fee-for-service options
Objective #5.4
Seek opportunities for government and foundation funding
opportunities
Advocacy

Goal #6
Advocate for policy changes by illustrating the impact of
truancy.
Objective #6.1
Use data to improve state leadership knowledge on the impact
of truancy
Objective #6.2
Use data to influence legislatives changes around truancy
Objective #6.3
Remain active on the Statewide Truancy Workgroup

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