Emphasis on Client/Resident Outcomes
A notable distinction between the ICF/MR programs and the HCB waiver program that supports group homes is the level of oversight from federal and state agencies, which enforce regulations through a process known as “surveying.” Conducted annually, or as needed, a team of surveyors examines staff performance in achieving individual client goals and focus on the four core pillars of ICF/MR service:
1. Active Treatment
Active treatment is the cornerstone of the ICF/MR program. This treatment involves a team approach to teaching residents instrumental skills and socially responsible behaviors so that individuals can live a meaningful, happy and productive life. This approach helps individuals acquire the skills necessary to gain maximum independence, to maintain optimal functioning, or to prevent regression. Major components of an active treatment program include:
A) Admission and Assessment: Facilities conduct a pre-admission
evaluation, which includes background information and assessments of the
individual’s functional, developmental,
behavioral, social, health and nutritional status. Within 30 days of admission,
the facility’s interdisciplinary team performs a thorough assessment
to supplement the pre-admission evaluation. The assessment primarily identifies
a client’s:
- Strengths and developmental and behavioral management needs;
- Condition, disabilities, and their causes;
- Need for services and, as applicable, vocational skills.
B) Individualized Plan and Review: Clients and their families or representatives, along with the interdisciplinary team, develop an individualized plan that identifies goals. For example, goals can seek to improve or avoid loss of a particular skill or teach a person a new skill, such as, to manage their own bank account or bathe themselves. To be successful, and to enhance the client’s self-esteem, active treatment programs must be continuous and consistent. The individualized plan is reviewed at least annually and at benchmarks for the client such as completion of objectives or new interests arise. When appropriate, staff will develop a comprehensive discharge plan that assists clients in adjusting to a new living arrangement.
2. Client Rights
ICFs/MR promote the exercise of individual rights and rigorously uphold the rights of all clients, such as freedom from unnecessary drugs and physical restraints, freedom from abuse, and the provision of opportunities to participate in social, religious, and community activities. In essence, for many clients, ICF/MR staff act as frontline advocates ensuring and protecting client rights inside or outside the facility.
3. Client Behaviors and Facility Practice
Individual programs emphasize positive techniques to teach socially responsible behavior. However, facility practices are designed to protect the client and ensure that interventions to manage inappropriate behavior respect the safety, welfare, civil and human rights of every client.
4. Health Care Services
ICF/MR staff develops a medical care plan for clients who require one and physician services are accessible for those who need it. Other points include:
- Annual physical exams are provided.
- Staff and clients are trained in health and hygiene methods.
- Dental and pharmacy services plus systems for monitoring drug administration are arranged by the facility.
There is more to the survey process but these are its most client-centered components. Surveyors also inspect for compliance with life/safety codes, building cleanliness, etc.
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