QIDP Roles and Functions
A large portion of being a QIDP on a daily basis is to insure that each resident is provided with good, consistent, active treatment.
Active treatment in ICF-DD settings
Active treatment, also called developmental programming, is both a concept and a formal procedure with specific parameters and guidelines as specificities in the regulations. As a concept, active treatment is the skill-training residents receive to help them become as independent as possible. Active treatment per regulations is the aggressive and organized effort to reach each resident's fullest functional capacity.
Human beings tend to grow and progress in a sequential, orderly and predictable manner from the fact that the rate and direction of development can be influenced by systematic opportunities for learning.
Each individual has his own rate of development, so the goals that should be set for them depend upon the particular developmental skills that they already have and their specific developmental needs. Each resident will have developed for them an individually tailored program specifically directed to achieving developmental objectives called an Individual Service Plan or ISP.
Interdisciplinary Team/ ISP Meetings
During an Individual Service Plan meeting also called an Interdisciplinary team (or ID team) of professional consultants in various skill areas (ex: Occupational therapist, Physical therapist, Recreation therapist, Speech therapist, Psychologist, Dietitian, Registered Nurse) gathers with the resident, family members or conservators, a day program representative and a Regional Center caseworker and the QIDP for a formal meeting twice a year. As well as discussing generally how a resident is doing, we discuss what progress has been made with current formal plans and objectives and where we want to go from here. Each consultant develops an updated formal written assessment of the resident, which is presented to the team. The QIDP may also have assessments depending on structure of the meetings. The QIDP coordinates all services and follows up plans and writes the Individual Service Plan. The QIDP also coordinates formal trainings goal and objectives and writes the Individual Program Plan. The QIDP also in-services direct care staff on how to implement the written and informal plans decided on by the team to be priorities and writes monthly and quarterly reports demonstrating progress made on those objectives. There are specific rules involved in writing assessments, plans, objectives, Individual Service Plans (more general) and Individual Program plans (specific to training program) reports, reviews and data sheets that we will not go into here.
ID teams are not technically limited to a bi-yearly meeting (one on the residents birthday month and one 6 months after). As a resident's needs change, perhaps due to illness, a significant change in medications, behavior changes or maturity so does the need to alter their treatment plan. This may include a new or temporary nursing care plan, changes in skill training programs coordination with doctors, treatment centers, day programs. It may also require coordinating an interim staffing with the ID team. Any member of the team may call together a meeting at any time through out the year.
Measurable Goals and Objectives
Effective training requires the development of specific goals and objectives for each resident. Goals are the broad term that we are aiming for, for example, 'to improve self feeding skills' or 'to improve dressing skills' or 'to improve behavioral skills'.
The objectives are more specific and detailed. They must be expressed in simple observable/measurable terms so that competent observers can know what the objectives are and can agree on whether or not they have been accomplished or 'met'.
Observation in this context may be taken to refer to any apparent activity displayed by a learner. If the activity is not apparent, observers will likely be unable to agree about it. For example, 'Jane will develop good eating skills' is too general and is not an objective expressed in measurable terms, because observers may differ widely on just what good eating skills are and how one knows when such good eating skills have been achieved. Objectives that contain words like "to know", "to understand", "to enjoy", etc., are also unacceptable because such words are subject to a wide range of interpretation.
New and revised goals and objectives often emerge from previous ones, so that overall, an active treatment plan is actually a long series of short range, time-limited goals, which converge on long-term goals. The observer should be able to follow a developmental sequence. Now it is possible to measure specific objectives in the eating process that are specific, measurable, prioritized and sequential steps in ability the individual can achieve.
Goal: To improve self feeding skills
Objective: Jane will set her glass on the table after drinking without spilling 3 out of 5 trials with verbal prompts to 30% success for 4 consecutive months or John will take his plate to the sink after eating with continual guiding to 20 out of 30 times for 2 consecutive months. (Specifics in writing good measurable objectives will not be covered here) Objectives need to be included in the resident's individual daily schedule for consistency.
In addition to including a statement of specific, precise, and measurable objectives, each training program for a resident must incorporate a clear plan describing the step-by-step techniques or methods to be used to achieve those objectives. Such a plan is necessary to ensure that all staff that must implement the training program does so the same way each time. Each plan must have a form of data collection that unambiguously reflects the resident's level of achievement or progress toward meeting the objective. The plans need to be written in simple strait forward language that the direct care staff can follow daily. It is the QIDP's responsibility to insure that the staff carries out the plans correctly and revise the plan as needed.
Monthly and Quarterly ISP Reviews
The QIDP is responsible for taking the data collected by staff and incorporating it into a review monthly. There are specific guidelines to data collection and reviews that will not be covered here. Each resident will have their progress (or lack of progress) noted compared to the last months progress (Quarterlies look at the past 3 months together). As a result of the review, the QIDP may need to in-service staff on the data collection and/or implementation of a plan, revise a plan or go back to ID Team (interim staffing) and re-evaluate an objective. The reviews address more than just the specific objectives progress; they also address health concerns, day program contact, and use of trust account money, family/social involvement, rights, and community integration. This information collected and processed will then be presented to the ID team at the next review meeting. And then the process starts all over again.