PAULA MCELWEE: Now we have
spent quite a bit of time

on these first items just
for the purpose of

sorting through this concept of
how you can use compliance

information to help you set up
quality standards, or quality

outcomes that you are going to 
look at for your organization.

So lets just kind of hit real quickly
what some of the other items are.

Yes, TDD does still show 
up in the checklist.

So, this is communication access.

And onsite the checklist 
actually says TDD, TTY,

picture communication 
for non readers, 
video interpreter access,

texting, use of relay, etc.

Actually, I added a 
couple of those.

Interpreters, so they are 
going to be looking at 
equal access in the same way.

I am just going to flip through 
these real quick because we

have got an exercise that I want to do.

So they are going to look at physical access.

They are going to look at all 
the ADA stuff that hopefully your

center knows and applies 
elsewhere and has already

applied at your center, 
which is not always the 
case when we go in.

I notice door knobs cause I have 
real bad arthritis in my right hand,

and if I have to open the door 
with my left hand, it reminds me

that whoops they don't have this 
access piece straightened out yet, right.

So physical access, 
reasonable accommodations,

and who can do a review for 
access if you get -- if there

isn't access I really question 
the centers skills to do that.

But even if your center 
is very skilled at doing it,

you sometimes do not 
see the thing that you

walk past every signle 
day and so is there

somebody you can trade an annual 
review with and you can do an

access review -- we aren't 
going to go into a discussion 
on these.

We're just going to flip 
through them real quick.

Advocates for and conducts 
activities that promote

equal access and this is one 
things that you do as a center

under advocacy that would not 
require that there be a CSR,

but you use, the services 
you use in the community,

are they all accessible, 
and we need to have the

highest standard on this.

We really do need to be the example, 
and if we are going

to hold a meeting in our town, 
we are going to go to the hotel

and I know this is what ILRU 
does and NCIL, when we work

together on this so when 
you are coming to a hotel,

we try to really know the 
accessibility in that hotel.

And if there is some part 
of it that we don't see,

we will advocate with that hotel 
and we won't contract with them

until we know that we can 
have the thing that we need, 
whatever it is.

We should take the same 
stance, don't you think,

in our communities, that we 
are going to really make sure

that we only use accessible 
facilities and resources, 
whether public or private.

Doesn't matter.

We are going to make sure 
those things are in place.

Sometimes here the question 
comes up around faith-based

organizations and I think that 
the decision on the part of the

center has got to be, if that's 
where the community meets and we

are going to have something in 
the church hall or whatever,

we still need to 
look at accessibility.

We aren't talking about at this 
point just who is under ADA.

We are talking at this point 
about facilities we use in

the community and they 
should be accessible.

So regardless of other 
considerations.

Under provision of services -- this 
is the second evaluation standard.

There are six.

This is where we look at a lot 
of those items around the CSR,

and we look at your outreach 
to unserved and underserved

populations as defined in 
your SPIL or your own plan.

It can go either way.

Your SPIL may or may not 
be representative of what 
you are doing.

A SPIL is Statewide Plan for 
Independent Living that is

created by the state every 
three years and updated.

The most recent one was this past 
year that just went into effect

so you can take 
a look at that.

But we are looking at 
cross disabilities,

significant range 
of disabilities,

eligibility determination 
as we mentioned and

that everything you do is 
cross disabilities, so it 
goes across all areas.

Evaluation standard 3 is around 
independent living goals and we

looked there at how we facilitate 
the development and achievement

of independent living goals 
and I think we've had some nice

discussions about how that 
leads to good quality measures,

the goal accomplishment is 
still a foundation for who 
we are, right.

So you can look through your notes 
on some more specifics around

that and around those
independent living plans.

We are not going to go into 
detail on that right now.

We also look at 
community options.

We looked there at, again, 
increasing the capacity of

your community to be accessed 
by persons with disabilities

so we will look at 
activities around that.

And that is not going 
to be measured in a CSR.

Now we are back to the kinds 
of things that you will set an

outcome for in your work 
plan and you are going to 
work for in your community.

It's going to be different 
from what happens on an 
individual basis.

Sometimes it is individual 
but often it is community wide.

We look at all of the different 
things that you do in your community

in order to do that would be 
areas where you may want to 
measure your performance.

We look at the core services.

Of course we think a best 
practice is for all new

staff to complete the core service 
training that we have at ILRU.org.

The Rapid Courses are 
online and they can even print 
you certificate of completion.

There is actually a training 
plan for all staff that we've

used the requirements 
of services, is a

requirement that RSA will 
be looking for when you're

on site so how do you do 
your training.

Then the final evaluation 
standard is resource 
development activities.

So as you know, you are 
required to raise money

somehow and a best practice we 
see is the board members are all

donors or that they give or 
raise a certain/specific amount of

money and there are 
probably other ideas that

you can sort out in your table 
in this next little group.

So here is the 
next conversation.

Now that you have a little bit 
of familiarity with what that

checklist content is and how 
you can look at the compliance

and already know that there is 
some areas for improvement that

you might want to track, 
how can you do that?

So at your table, 
in your groups,

ask how can you apply 
the checklist at your CIL.

Is it something you
feel is doable?

If not, why not?

What are the barriers 
to doing that?

And do you -- is it -- can 
you see a path to taking it 
beyond compliance?

And I don't want you 
to just say yes here.

I want you to say how.

How can you use the 
checklist back home.

So these questions are to try 
to get to that basic question,

how can you use the checklist 
when you go back home.

So what are you thinking about 
the use of this checklist and

how useful and 
functional it will be?

Does anybody have an 
exciting revelation to 
present to the group?

Raise your hand so 
I can call on you.

Over here we've got 
an exciting -- exciting.

AUDIENCE MEMBER: Yeah.

Since we went through our 
site visit just about a year,

year and a half ago, 
we actually just got 
the report within

the last six weeks, 
what we're doing is,

we're in the process of 
documenting our strategic plan,

and what we've done is embedded 
some of the key aspects into the

strategic plan, and that would 
include, for instance, I have put

together a cross functional team 
to monitor CSRs both for the

completeness of the reports 
and the consumer notes,

as well as all forms and 
documentation within 
all of the CSRs.

So that's something that's 
in the works right now.

PAULA MCELWEE: Okay.

Any other ideas or comments?

AUDIENCE MEMBER: Hello.

We talked about similar compliance 
committee comprising it of a

board member, 
executive director, 
staff, consumer,

and possibly stakeholder, 
just to kind of get them

together to do input feed, 
go over the checklist,

make sure everything 
is being adhered to.

PAULA MCELWEE: Good.

Any other comments or 
questions about this?

Think about it and if you want 
to raise your hand in a minute,

I'm going to draw a 
little picture here.

I'm going to draw a circle.

Circles are great, aren't they?

So one of the things you're going 
to do is set some measures.

Right?

You need to decide what 
you want to measure.

I heard you say embedded 
in the -- embedded in the plan.

Planning.
Right?

You embed it in your plan.

So what you decide you need to 
improve, informs what's in your

plan, which informs, lets make sure 
the arrows are going the right way,

which results in a report of outcomes,

which leads you to set new measures, 
which leads you to embed that in your

plan and your activities, 
and there's a continuous 
cycle of improvement

that can happen. 
So quality is not 
a one-time thing.

Setting up a way to measure 
your quality to set standards for

yourself and to move forward 
as a center to get a hold of

quality and make it 
happen is continual.

Does that make sense?

So it's a continual 
quality process.

It isn't just one thing.

Other comments, anybody 
has other comments or questions?

Then there's one more area that 
I'd like to cover with you 
before I'm done with you today.

We asked you to -- in your last 
conversations around the table,

tell how you can see the checklist 
can take you beyond compliance and

help you to formulate desired 
outcomes for your center.

I assume then you 
did talk about that,

but I would like to 
ask you this question.

How can you cause this to happen?

And we may have either questions 
or comments at this point,

but I want you to think for a minute, 
okay, we're going to

take some of this information home, 
and we're going to talk

about how to reach some 
quality outcomes.

How will you make that 
happen in your organization?

What are the steps that 
you're going to take?

Think about that 
with me for a minute.

We'd like to take any comments 
or questions around that part.

How will you apply this at home?

How will you get it to be implemented?

There's more still to learn.

We're going to talk about 
how to define those outcomes,

we're going to talk about 
different ways that you can

assess things to find where 
you need to make changes,

but big scope, how do you 
convince the group at home,

who do you convince, how does 
the conversation take place?

What do you see happening next 
as a result of this training?

So when you get home and you have 
some ideas, then what will happen?

And I have hand here.

AUDIENCE MEMBER: Maybe 
we can add to that, 
if people could identify

barriers that they think 
they're going through.

PAULA MCELWEE: Bill hasn't 
found you yet.

Raise your hand.

AUDIENCE MEMBER: Maybe 
along with that, 
if we could think --

people could -- if they're already 
thinking, oh, this is all great,

but, and they've got some of 
those buts right off the bat,

if we could start 
hearing some of those --

PAULA MCELWEE: Okay.

I'm seeing some nods.

So what are the buts?

He had a comment.

AUDIENCE MEMBER: I think one 
of the things that we have

to do is get our folks 
to see the bigger picture.

For instance, we're working on 
having them understand our

financial condition because 
everyone is part of the 
same organization.

So if we don't understand 
where we are financially,

then we don't understand why 
we're doing what we're doing.

And so compliance is merely 
a way to help us drive towards

our ultimate goals and to see it 
not as a stick, but as a carrot,

to do something better and to get 
them invigorated in that direction.

PAULA MCELWEE: Stick or carrot, huh.

AUDIENCE MEMBER: My name 
is Leah Gray and I am from

Tri-County Patriots for Independent 
Living Pennsylvania.

And we've already -- I've already 
started implementing a lot of this

over the last couple of years 
since I've been there,

and I will tell you what happens.

We have several staff people that 
have been there for ten, fifteen years.

They're all in the process 
of resigning because they do

not want to do all this paperwork 
or all the compliance.

I'm not sure what they've been 
doing for the last 15, 
20 years that the CIL has been

in existence, but now that we're 
actually going back and checking

files and seeing what they haven't 
done, they're very, very reluctant 
to want to make those changes.

I have lost several staff people.

But to me, that is okay because 
now I have been able to bring

in people that want to do this 
work the way it needs to be 
done to keep us moving forward.

PAULA MCELWEE: There's a book about 
quality called "From Good to Great."

And the first -- I think it's the 
very first chapter is about getting

the right people – 
the wrong people off the bus 
and the right people on the bus.

Sounds like what you're talking about.

Yeah.

AUDIENCE MEMBER: I think we 
should set up a support 
group for people that are going

through that --
[Laughter].

PAULA MCELWEE: Peer support.

Here we are.

AUDIENCE MEMBER: I'm 
a change agent.

I've been there a year and 
a half, and I've had six people 
leave under my reign.

So, yeah.

PAULA MCELWEE: That's funny.

Okay.

Right here.

AUDIENCE MEMBER: On the 
other side of that,

there are some of us that
have been really trying to get

someone to force us to 
retire for several years.

[Laughter].

PAULA MCELWEE: So this 
is a retirement plan.

Okay.

AUDIENCE MEMBER: We've been 
through a lot of that –

somebody was talking about 
being a change agent.

We're just finishing up that process.

And so we use the tool to start 
really taking a look at what

we're doing, how we're doing, 
and we're starting to talk to

staff about it, and that this 
is something that, you know,

at some point we're going to be 
audited, these are the types

of things they're going to look for, 
and basically not to be afraid of it,

but show what you've done, 
and try and make it positive.

We have one person that's
kind of ... about it, and, you know, 
we expect that, but the other

thing that just coming here has gotten 
both Lisa's and my brains going,

and so we're -- we've already 
been in touch with our exec.

We'll be meeting and just kind 
of plotting and planning and

then bringing it to our exec, 
then from there bringing it to the 
leadership team and the board.

PAULA MCELWEE: I will 
piggyback on what you said 
because this is so important.

At the beginning I said to you
part of your resource is the 
people in this room, right?

Another part of this resource that 
you have available to you as you go

through this process is not just the 
people in the room but also being

able to sit down and recall what 
we have done and we have those
resources for you, too.

It's going to be all available to you.

What you don't have in your hand, you 
will have online and you can call us.

Every one of the presenters has 
their information at the end of 
their presentation.

Email or phone, depending on who it is, 
sometimes, well, continue to make this

a viable process that you are going to 
actually do, because otherwise coming

here was a vacation in Austin and 
I don't think they really wanted 
to pay for that for you.

But if you -- if you think in terms 
of how can you make it happen,

you have some resources 
available to you in this room,

in the presentations we are giving 
you and after we are done that can

make all of this a little bit easier.

It isn't simple, no matter what we do.
It isn't magic, no matter what we do.

It is hard work.

But it's so worth the work and I don't 
know -- Maureen and Anne have been 
doing this a while and they will be

talking about this tomorrow, 
but if you want to jump in or anybody

else who have had this experience 
of applying these measures.

Is it worth the work?

Why?
Why is it worth the work?

Does it change what happens at home?

AUDIENCE MEMBER: Yes, 
because it makes us better

at what we do and makes 
us more responsive to the

community needs and consumer 
needs and what they need.

PAULA MCELWEE: Responsive on an 
individual basis and community wide,

because you notice you've got both 
focuses going all the way through this, 
right?

What happens in a person's life and 
what happens in the life of the larger 
community.

Both of those are happening 
all the way through.