The Division of DD has contracted with the University of Missouri Kansas City-Institute for Human Development to find out what great things providers, TCM's, and county boards are doing to promote self-determination and self-advocacy throughout the state of Missouri.

1. Missouri Support
Coordination
Capacity and
Innovation Project
(MOSCCIP)
George S. Gotto, Ph.D.,
Kelli N. Barton, Ph.D., &
William (Vim) Horn, M.P.A.
10/21/2016
1 MACCDDS – August 24, 2017

2. 2 MACCDDS – August 24, 2017
Agenda
• Project objectives and rationale
• Research process

3. 3 MACCDDS – August 24, 2017
Project Overview
• Objectives:
1. Develop an outcome measure that will serve as a
valuable tool to help enhance the capacity of the DDD
and SB40 Boards to develop policies and practices and
identify areas of need for support coordination; and
2. Validate the measure with a targeted sample of
individuals who receive support coordination services
and/or their family members
• In partnership with:
• MO Division of Developmental Disabilities (DDD)
• MO Association of County Developmental Disabilities
Services (MACDDS)
• MO Developmental Disabilities Council (MODDC)

4. 4 MACCDDS – August 24, 2017
Project Rationale
• To move beyond satisfaction measures by:
• Defining service expectations
• Standardizing the meaning of responses
• Assessing overall or general experience with SC and
whether needs are being met (less sensitive to
“recency bias”: satisfaction often fluctuates—can be
impacted by numerous factors and is subjective)
• To support statewide use, in order to:
• Identify effective policies/practices+ systemic barriers
• Build capacity of the system to meet future needs

5. Major Activities
MACCDDS – August 24, 2017 5

6. Advisory Committee
• Meet ~monthly
• Provide input on
content and
implementation
• Help guide
interpretation of
interview and focus
group data
• Assist with drafting and
editing survey
Organization Member Name
CHS Linda Holland
DD Council Sharon Williams
Rebecca Bax
Vicky Davidson
DDD Marcy Volner
Carrie Williams
EITAS, Jackson County SB40 Jake Jacobs
Greene County SB40 Jennifer Larson
Angela Tate
Jasper County SB40 Alecia Archer
MACDDS Les Wagner
Springfield Regional Office Cheryl Bruton
St. Charles DDRB Robyn Peyton
UMKC-IHD George Gotto
Vim Horn
Kelli Barton
MACCDDS – August 24, 2017 6

7. 7 MACCDDS – August 24, 2017
Research Process Rationale
• Systematic input from service system professionals,
individuals with IDD and their families
• Identify key issues/areas to evaluate
• Define service expectations
• “Learn the lingo”
• Cost of using poor measurement
• Places a limit on validity of conclusions we can reach
• Can lead to wrong decisions
• Can have too many or too few questions
• Too many: decreases response rate, however,
• Too few: provides too little information to determine what the
data mean
A reliable questionnaire completed by half of respondents yields more
information than an unreliable questionnaire completed by all respondents.

8. 8 MACCDDS – August 24, 2016
Online Responses: Overview
39.2%
48.0%
5.9% 7.0%
SC Service
Recip. (n=20)
or Family
(n=233)
Professionals
(n=310)
Both a
Professional &
Family
Member
(n=37)
Other (n=45)
• Focus on the online
questionnaire results:
large statewide
response
• Compared with
interview &
focus group data
• Presentation
highlights results
from SC service
recipients / their
families (n=253) &
professionals (n=310)
Who completed the online questionnaire?

9. 9 MACCDDS – August 24, 2017
Counties Represented
• Tot. counties named = 94 (82.5%)
• Some professionals responded: “too many to name”
• Not named: Audrain, Barry, Barton, Cedar, Dade, Daviess, Dent,
Gasconade, Henry, Howell, Lawrence, Lincoln, Marion, McDonald,
Mississippi, Montgomery, Newton, St. Francois, & Vernon
• Most represented counties
• SC service recipient / family: Clay (69, 27.3%);
Platte (34, 13.4%); Jackson (26, 10.3%);
Jasper (10, 4.0%); Buchanan (9, 3.6%)
• Professionals: Jackson (41); Clay (33);
St. Charles (21); Greene (19); Pettis (16)
• No % given because each pro. typically listed multiple counties

10. 10 MACCDDS – August 24, 2017
Indiv. / Family Responses (n=253)
Receiving paid disability
services? n %
Yes, receive paid disability
services AND support
coordination 120 47.4
Receive support
coordination / case
management ONLY 52 20.6
No, don't receive
paid disability services or
support coordination 28 11.1
Non-response 53 20.9
3.2%
20.9%
13.0%
38.7%
2.0%
22.1%
Age of SC Service Recipient
Under 5 6 to 17 18 to 21
22 to 60 Over 60 Non-response

11. 11 MACCDDS – August 24, 2017
Professionals Responses (n=310)
68%
32%
Response Type
Support Coordinator
Support Coordinator Supervisor /
Administrator
42.6%
21.6%
16.1%
19.7%
Organization Type

12. 12 MACCDDS – August 24, 2017
1.What do support coordinators do for you? / your family member
who receives SC services? / people with I/DD?
2.What personal characteristics do good support coordinators have?
3.What skills do good support coordinators have?
4.What system or organizational characteristics (policies/procedures)
make it possible for support coordinators to do a good job?
5.What barriers keep support coordinators from doing a good job?
Discussion Questions

13. 13 MACCDDS – August 24, 2017
1.Coded questionnaire responses for themes: Given discrete / specific
codes using respondents words
2.Categorized codes into broader domains
3.Organized domains
Questionnaire Data Analysis

14. 14 MACCDDS – August 24, 2017
Individual / Family Perspective (n=253)
Support Coordination
Outcomes
CharacteristicsSupport Coordinator SkillsFamily Support Activities
SC Characteristics
Barriers
Support Coordinator
Domain: Family Support (General)
Code:
 Family Support (0)
Domain: Finding (Linking)
Formal / Paid
Codes:
 Find Funds / Waivers /
Social Security (51)
 Find Employment
Opportunities /
Support (17)
 Find Respite (13)
 Find/Arrange Housing (12)
 Transportation (11)
 Find Behavior Support /
Counseling (10)
 Provide School-Related
Support (10)
 Find In-Home Support (9)
 Find Adaptive Equip. (9)
 Home Skills (7)
 Find/Provide Day Hab. (5)
 Find / Coordinate PAS (2)
 Find Training (0)
Domain: Communication
Domain: Planning (Person-Centered) &
Monitoring
Codes:
 Communicate (27)
 Advocate (23)
 Give General Advice /
Guidance (13)
 Answer Questions (10)
 Listen (3)
 Empower (0)
 Help Them Find a Voice (0)
Codes:
 Set Up/Coord. General Services Needed (40)
 ISP: Generate & Implement (31)
 Monitor Services (23)
 Documentation / Paperwork (21)
 Health & Safety, Welfare (21)
 Transition Planning (Adulthood, End-of-
Life) (9)
 Help with Self-Directed Services (5)
 Help with Budgets (2)
 Facilitate Meetings w/ Individuals, Families /
Guardians, & Providers (0)
 Help Individuals Live Independently (0)
Informal
General
Codes:
 Find / Provide
General Service
Info (84)
 Identify Needs
& Overcome
Barriers (0)
 Work with Other
Orgs (0)
Codes:
 Find Community
Activities /
Recreation (21)
 Find / Link to
Community
Resources,
Natural
Supports (18)
Domain:
Networking / Linking
Code:
 Networking Skills /
Connection to
Community / Linking (7)
Domain:
Knowledge &
Research /
Navigational Skills
Domain: Organizational / Planning Skills
Domain: People Skills
Domain:
CommunicationSkills
Domain:
Leadership
Skills
Domain: Problem
Solving Skills
Code:
 Organization (35)
 Multitasker / Efficient (10)
 Time Management (5)
 Paperwork / Case Noting (5)
 Detail/Task-Oriented (4)
 Planning / Scheduling Skills / Meet Deadlines (4)
 Ability to Coordinate Transitions (2)
 Ability to Prioritize (2)
 Attend IEP Meetings / Develop IEP (1)
Code:
 Knowledge of /
Research Skills
to Find
Resources (39)
 Educated on
Disabilities /
Medical
Conditions /
Medication (18)
 Understand / Meet
Needs of
Individual &
Support / Meet
Needs of
Families (15)
 Knowledge of the
System (13)
 Experience (5)
 (2): Safety / CPR;
Math / Accounting /
Budgeting Skills
Code:
 Communication (Verbal,
Written) (70)
 Listening Skills (34)
 Avail./Responsive (19)
 Advocate Effectively (11)
 Tech-Savvy, Computer (6)
Code:
 People Skills (7)
Code:
 Leadership Skills
/ Able to Work
Independently (5)
Code:
 Resourceful / Problem
Solving / Conflict
Resolution (18)
 Diplomacy / Negotiation
Skills (3)
 Navigate Politics /
Bureaucracy (2)
 Critical Thinking /
Decision Making Skills (0)
Organizational & Systemic Characteristics
Other
Domain: Professional /
Responsible
Domain: Flexible
Domain: Openness
Domain: Attentive /
Responsive
Domain:
Patience
Domain: Respectful
Domain: Personable /
Positive Attitude
Domain: Helpful
Domain: Caring
/ Empathy
Domain: Hard-Working /
Persistent
Domain: Intelligent
Code:
 Reliable / Prompt /
Punctual (15)
 Professional/Responsible (14)
 Dependable (3)
 (2) Effective; Experienced
Code:
 Creative / Think
“Outside the Box” (8)
 Team Player /
Cooperative (3)
 Flexible/Adaptable/
Willing to Learn (3)
Code:
 Patience (18)
 Calm (1)
Code:
 Respectful (5)
Code:
 Helpful (38)
 Supportive (8)
 Advocate (3)
Code:
 Knowledgeable /
Educated (46)
 Intuition/Insight (1)
Code:
 Understanding /
Empathy /
Compassion(74)
 Caring (34)
 Kind/Gentle (13)
 Loving (4)
 Concern (4)
 Sensitive (2)
 Passion (1)
Code:
 Persistent / Perseverance /
Tenacity (11)
 Hard-working / Good Work
Ethic (10)
 Dedicated (5)
 Strength / Resiliency (2)
 Determination (0)
Code:
 Friendly (33)
 Pos. Attitude/Personable (27)
 Humor (4)
 Motivated / Driven (4)
 Hopeful / Optimistic (3)
 Out-Going / Confident (3)
 Energetic / Enthusiastic (3)
Code:
 Honest / Trustworthy /
Honorable / Upstanding /
Integrity / Ethical (21)
 Tolerance / Open-Minded (5)
 Genuine/Sincere (5)
 Non-Judgmental (5)
 Humility (2)
 Fair (1)
Code:
 Attentive to / Knows Needs,
Person-Centered (28)
 Responsive (19)
 Accessible / Available (6)
 Check-In / Follow-Up (6)
 Detail-Oriented / Thorough (4)
 Observant (2)
Code:
 Lack of Flexibility (5)
 Lack of Quality Service Providers in Area (3)
 (1) Lack of Access to Plans and Budgets; Unrealistic /
Inflexible, High Need, or Dependent Family / Individual
 (0): Consumer Follow-Through; Freq. Crisis Situations
Code:
 Lack Passion for
Job/Not Caring (6)
 Lack of Understanding
about Disabilities (5)
 Lack of Patience / Neg.
Attitude (4)
 Lack of Organization /
Time Management (3)
 Personal Bias or
Hardships (3)
 Lack of Experience (2)
 Task-Oriented Instead
of Person-Oriented (1)
 Lack of Boundaries (0)
Code:
 Funding (34)
 Unmanageable Case Load (33)
 Lack of Training / Education / Knowledge ab Avail. Srvs
or Providers (26)
 Bureaucracy / Red Tape (20)
 Too Much Paperwrk/Logging & Lack of Admin. Support (9)
 Low Pay (8)
 Lack of Time (8)
 Lack of Support/Info from Upper Management (8)
 State / Local Medicaid Program Requirements (8)
 High Turnover & Shortage of Quality Staff (7)
 Lack of Respect/Support/Recognition (for staff) (6)
 Lack of Resources (4)
 Blanket Denials for Services/Care (3)
 (2): HIPPAA; Travel Time (Home to Home)
 (1): Lack of Written Reqs. / Guidelines; Paym’t to Providers
Slow / Complicated; Lack of Support from County; Issues w/
CIMOR/Technology; The System; Too Many Policies;
Waiver Restrictions; Meetings
 (0): Frequent System and/or Regulatory Changes (Often with
Little Notification); Utilization Review - Time Consuming &
Ineffective; Limited Transportation Options; Issues with
Providers (Not Implementing Plans, Not Doing Their Jobs,
etc.); Too Much Training; Unclear / Changing Expectations;
Unsupportive / Toxic Work Environment; Unrealistic
Timeframes, Processes, or Expectations; Micromanaging;
Stress / Pressure / Burnout
Communication
Code:
 Failure to get to Know
Family and Client / Lack
of Communication by
Coordinator (21)
 Lack of Communication
From Family (8)
 Lack of Timely Coord. /
Communication / Follow
Through Btwn Orgs (5)
 Miscommunication /
Inconsistencies / Unhelpful
Assistance (2)
 Delayed Communication
Btwn Different Entities (1)
 Language Barrier (0)
Code:
 Realistic Guidelines / Rules & Clear
Expectations, Reduced Red Tape, and Easily
Accessible Info (31)
 Available Resources / Tools for Staff (25)
 Adequate & Continuing Training (21)
 Supportive, Experienced Mgmnt (15)
 Available Resources for Families (13)
 Reg. Communication w/ Client, Fam. (13)
 Adequate Funding (12)
 Collab./Network w/ Other Agencies (11)
 Flexible (10)
 Team/Collaborative/Supportive Enviro. (9)
 Manageable case loads (9)
 Advocating/Support Choice/Pers-Ctrd (7)
 Annual, Statewide / Universal ISP (6)
 Open Communication (6)
 Reg. Office/SB40 Support/Consistency (5)
 Microsoft Cloud, SharePt, Outlook, Gonzo (5)
 Accountability (5)
 Recognition/Respect/Incentive/Time Off (4)
 (3): Allowing Autonomy; Forward Looking
/Vision; Adequate Compensation/Benefits
 Case Noting (2)
 Organized (1)
 (0): Transportation Provided; Provide Support
for Client Transitions; Service Monitoring;
Tracking / Review System or Personnel;
Quality / Timely UR
Organizational
& Systemic
Characteristics
Individual / Family Perspective (n=253)

15. Support Coordination Capacity
Building (SCCB) Survey
Developing a final Version
MACCDDS – August 24, 2017 15

16. 16 MACCDDS – August 24, 2017
• Demographic questions (8)
• SCCB Survey items / questions (12) related to:
• Knowledge
• Linking
• Planning / Monitoring
• Communication
• SCCB Survey feedback questions (2)
• Do you find the wording in any of the above items to be confusing or to not
accurately describe your experiences? If yes, please explain:
• Are there any areas of support coordination that were not asked about above
that you think should be included? If yes, please explain:
SCCB: Overview

17. Four Proposed Domains of the
SCCB Survey
MACCDDS – August 24, 2017
17

18. Item Level Structure
MACCDDS – August 24, 201718

19. Sampling
• Cluster sampling by
11 identified regions
• Samples randomly
selected
• 34,814 potential
respondents
Survey Response
Status n %
Mailed 2,100 -
Return to sender 148 -
Successfully
delivered 1,952 100.0
Completed* 240 12.3
Mail* 221 11.3
Online* 19 1.0
Requests no
contact* 4 0.2
No response* 1,708 87.5
*of those that were successfully delivered
MACCDDS – August 24, 2017 19

20. Response Rate by Region
Region Population % Sampled Sample Delivered Completed % Completed*
Albany 1,106 6.1 67 64 9 14.1
Central
Missouri
3,927 6.0 237 228 30 13.2
Hannibal 1,300 6.0 78 73 8 12.0
Joplin 1,793 6.0 108 100 9 9.0
Kansas City 5,630 6.0 340 312 27 8.7
Kirksville 890 6.0 53 53 3 5.7
Poplar Bluff 1,117 6.0 67 62 8 13.0
Rolla 2,239 6.1 136 125 21 16.8
Sikeston 1,213 6.0 73 66 7 10.6
Springfield 2,826 6.1 171 146 17 11.6
St Louis 12,773 6.0 770 723 101 14.1
Total 34,814 6.0 2,100 1,952 240 12.3
*of those that were successfully delivered
MACCDDS – August 24, 201720

21. Response Rate by Support Provider
Organization
Sampled Delivered Completed % Completed*
County office 1,374 1,270 150 11.8%
State office 726 682 90 13.2%
Total 2,100 1,952 240 12.3%
*of those that were successfully delivered
MACCDDS – August 24, 201721

22. 22 MACCDDS – August 24, 2017
Participant Characteristics
Variable n %
Sex
Female 125 54.4
Male 104 45.2
Missing 1 0.4
Age of respondent
≤5 8 3.5
6-17 54 23.5
18-21 21 9.1
22-60 130 56.5
> 60 12 5.2
Missing 5 2.2
Ethnicity
American Indian or Alaskan Native 1 0.4
Asian or Pacific Islander 4 1.7
Black, not of Hispanic origin 25 10.9
Hispanic/Latino 6 2.6
White, not of Hispanic origin 183 79.6
Other 10 4.4
Missing 1 0.4
Length of time with current provider organization
< 3 months 1 0.4
3-6 months 3 1.3
6-12 months 18 7.8
1-2 years 29 12.6
2-5 years 54 23.5
> 5 years 120 52.2
Missing 5 2.2
Length of time with current support coordinator
< 3 months 2 0.9
3-6 months 15 6.5
6-12 months 40 17.4
1-2 years 55 23.9
2-5 years 67 29.1
> 5 years 49 21.3

23. 23 MACCDDS – August 24, 2017
Person Completing the Survey
Completing survey n %
Person who receives support coordination services, with help 128 55.7
Person who receives support coordination services, without help 9 3.9
Other 89 38.7
Missing 4 1.7
Total 230 100

24. 24 MACCDDS – August 24, 2017
Relationship to the Individual
Receiving Services
61.5%
19.9%
7.7%
3.6% 2.7% 1.4% 0.9% 2.3%
0%
10%
20%
30%
40%
50%
60%
70%
Parent
(n=136)
Support Staff
(n=44)
Other
(n=17)
Sibling
(n=8)
Legal
Guardian
(n=6)
Friend
(n=3)
Grandparent
(n=2)
Missing
(n=5)
Percentage
Relationship
What is the relationship of this person to the individual who receives support
coordination services? (n = 221)

25. 25 MACCDDS – August 24, 2017
SCCB: Planning / Monitoring
3.5%
23.5%
9.1%
56.5%
5.2%
2.2%
0%
10%
20%
30%
40%
50%
60%
70%
≤5 (n=8) 6-17 (n=54) 18-21 (n=21) 22-60 (n=130) > 60 (n=12) Missing (n=5)
Percentage
Age Group
Age of person receiving services (n = 230)
3.5%
23.5%
9.1%
56.5%
5.2%
2.2%
0%
10%
20%
30%
40%
50%
60%
70%
≤5 (n=8) 6-17 (n=54) 18-21 (n=21) 22-60 (n=130) > 60 (n=12) Missing (n=5)
Percentage
Age Group
Age of person receiving services (n = 230)

26. 26 MACCDDS – August 24, 2017
Age of person Receiving Services
3.5%
23.5%
9.1%
56.5%
5.2%
2.2%
0%
10%
20%
30%
40%
50%
60%
70%
≤5 (n=8) 6-17 (n=54) 18-21
(n=21)
22-60
(n=130)
> 60 (n=12) Missing
(n=5)
Percentage
Age Group

27. 27 MACCDDS – August 24, 2017
Three Factor Item Structure