DSHS Strategic Plan

The Department of Social and Health Services (DSHS) is Washington's largest state agency. In any given month, DSHS provides some type of shelter, care, protection and/or support to 2.4 million of our state's 7.1 million people.

Our goal and commitment is to be a national leader in every aspect of client service. The DSHS Strategic Plan is a roadmap that addresses our organization’s values, how well our organization is meeting its performance expectations and where we are going. They are used to guide our day-to-day decisions and focus our resources in the same direction. As a Department, the following mission, vision, and values tie us together.

service squares

Mission

Vision

Values

To transform lives

People are healthy

People are safe

People are supported

Taxpayer resources are guarded

Honesty and Integrity

Pursuit of Excellence

Open Communication

Diversity and Inclusion

Commitment to Service

 

DSHS Goals

Public TrustHealthProtection

Quality of LifeSafety

DSHS Strategic Priorities

Strategic chart

 

Secretary’s Priorities

Prepare for aging Washingtonians

Importance: DSHS must be ready for the explosive growth in the number of older adults who will need some type of assistance from us to stay in their home communities. Estimates from the state Office of Financial Management show the number of Washingtonians 65 and older will increase by 7 percent by 2040 (from 1.2 million to nearly 2 million people) and many will want to live in community-based settings. We must prepare our own staff to provide excellent services to this influx of clients and prepare family members and other providers to safely care for and support these individuals. [1]

 

Based on this, DSHS has established the following strategic objectives to support how we will prepare for aging Washingtonians.


 

Develop and expand approaches to serve adults who are older, Medicaid recipients and their caregivers.

Decision Package: 050 - ML - EG - Medicaid Transformation Waiver

 

Importance: Medicaid Transformation is a five-year project with the federal Centers for Medicare and Medicaid Services that provides federal dollars to test innovative, sustainable and systematic changes. As the population of adults who are older grows rapidly, states face budget challenges in paying for long-term services and supports (LTSS). The Transformation project looks at models that support individuals in meeting their needs while avoiding, delaying or lowering the use of traditional Medicaid services.

 

Expanding supports for informal, family caregivers and addressing social determinants of health, such as age, behavior and access to health services, for all high-risk adults are innovative approaches backed by a growing evidence base. Families and other informal support providers are integral to Washington’s LTSS system. Finding ways to support them while addressing the needs of the care receiver is an important Medicaid innovation.

 

Two new programs – Medicaid Alternative Care and Tailored Supports for Older Adults – have been in place since September 2017. Medicaid Alternative Care is available for people eligible for LTSS who choose to provide supports to their unpaid family caregiver. This is the first time federal Medicaid funds are available for this service in lieu of receiving other traditionally offered Medicaid long-term services and supports.  This program is built upon the successful state Family Caregiver Support Program. Tailored Services for Older Adults provides services and supports to help individuals avoid or delay the need for Medicaid-funded services. This is a new eligibility category and a limited benefit package for people financially “at risk” of future Medicaid LTSS use who are not currently financially eligible. Individuals can chose to provide supports to their unpaid family caregiver, or if no caregiver is available, they can receive services such as personal care, adult day care or home-delivered meals.

 

We are also testing foundational community supports, such as supported employment and supportive housing, for high-risk Medicaid populations. These services are necessary to improve health and quality of life and are available to clients who meet the criteria, as well as to individuals served by the Health Care Authority and the Behavioral Health Administration.

 

Success Measure: Implement Medicaid Alternative Care and Tailored Supports for Older Adults and attain an enrollment target of 7,000 individuals by June 2021.

 

See Chart AAH.14: Number of clients served in the Medicaid Alternative Care and Tailored Supports for Older Adults

 

Action Plan: 

  • Partner with Area Agencies on Aging to analyze and complete effective outreach to potential caregivers and clients and build sufficient provider networks.

  • Increase enrollment in both programs through training, systems and policy enhancements.

  • Evaluate the positive outcomes and cost-effectiveness for care recipients and caregivers.


Integrate statewide Medicare data into analysis of the clients we serve.

Importance: A substantial number of state hospital patients and persons referred to those hospitals for forensic competency evaluation have Medicare coverage. Access to Medicare data is needed to:

  • Better understand the patterns of state hospital use and forensic evaluation referrals of Medicare beneficiaries.

  • Better manage demand by Medicare beneficiaries for state hospital and forensic competency evaluation services.

  • Assess the potential for strategies to reduce Medicare beneficiary use of state hospital and forensic evaluation services and produce Medicare savings.

  • Design and evaluate intervention strategies to reduce or delay the need for personal care, community residential and institutional services.

  • Inform potential future negotiation for shared Medicare savings from the Centers for Medicare and Medicaid Services (CMS).

 

Success Measure:

  • Obtain resources necessary for data acquisition from CMS, establishing ongoing data interfaces, and meeting associated data security and privacy requirements by June 2019.

  • Complete funded high-priority data analyses, prioritized in collaboration with DSHS program partners, in fiscal years 2020 and 2021.

 

Action Plan: 

  • Integrate new data with existing data sources housed in DSHS’ Research, Data and Analysis division.

  • Collaborate with DSHS program partners to identify and conduct high-priority data analyses, such as patterns of state hospital use and forensic evaluation referrals of Medicare beneficiaries, to inform intervention strategies and business processes to better manage demand by Medicare beneficiaries for state hospital and forensic competency evaluation services.


Serve individuals in their homes or in community-based settings

Decision package: 050 - PL – EJ   - Targeted Vendor Rate Increase

 

Importance: The hallmark of Washington’s long-term services and supports (LTSS) system is that, whenever possible, individuals are given the opportunity to live and receive services in their own home or in a community setting. Developing home and community-based services has meant Washingtonians have a choice regarding where they receive care and has produced a more cost-effective method of delivering services. This results in better outcomes for clients in terms of their quality of life and the level of control and self-direction they exercise in their daily lives.

 

results wa logoSuccess Measure: Increase the percentage of LTSS clients served in home and community-based settings from 85.6 percent in July 2017 to 86.3 percent by June 2021.

 

See Chart AAH.1: Percent of Long-Term Services and Supports Clients Served in Home and Community-based Settings

 

Action Plan: 

  • Engage with nursing facilities, residents and families to facilitate successful relocations when it is the resident’s choice to live in a home or community-based setting.

  • Pursue innovations to serve specialized populations, individuals with complex needs and create new services, through Mental Health Transformation, Medicaid Transformation and development of specialized resources.

  • Work with hospitals and community providers to divert individuals from avoidable stays in institutional settings when preferred by the individual.

  • Request funding to increase certain provider contracted rates in order to maintain client access and choice and promote cost efficient delivery of care.


 

Complete 100 percent of the fiscal year 2020-21 projects as funded in the six-year plan. 

Decision Package: 000 – ML – WD - Facility One-Time Costs

 

Importance:  DSHS’ has 124 leased facilities that house 9,000 staff who provide services to 2.8 million DSHS clients statewide. Without office space, DSHS will not be able to accommodate the number of staff who will be needed to serve our clients statewide, including aging, disabled, and vulnerable Washingtonians. 

 

Success Measure: Complete 100 percent of the fiscal year 2020-21 projects as funded in the six year plan by the end of the biennium. This includes:

  • Lease renewals.
  • Downsizes.
  • Relocations.
  • New spaces.
  • Reconfigurations.

 

Action Plan: 

  • Hire two new senior facilities planners and a computer aided design coordinator by November 1, 2018.
  • Work with DSHS program staff to design office spaces and develop the space planning data forms (SPDS).
  • Distribute and analyze work pattern assessments surveys.
  • Submit modified pre-design and SPDS forms in a timely manner and obtain approval for projects through the state Office of Financial Management.
  • Work with Department of Enterprise Services and DSHS staff to manage and deliver office construction projects.

[1] Washington’s population is aging. This major demographic development will have important implications for policymaking and planning at all levels of government. In 2017, there are about 1,121,800 persons ages 65 and older, representing 15 percent of Washington’s total population. By 2040, the elderly population is forecasted to reach 1,997,600, representing 22 percent of the state’s total population.” Source: Forecast of the State Population, Forecasting & Research Division, Office of Financial Management June 2018.

 

Support people in our care and custody

Importance: We must provide top-notch care and supports for the people in our care and custody, whether they reside in a community-based setting or in one of our 11 residential facilities. Equally important is the safety of our employees who provide the care. Well-maintained facilities that have adequate space and staffing are another important element of the care and comfort of their residents.

Based on this, DSHS has established the following strategic objectives to support how we will care for those in our care.


QUALITY OF CARE 

Ensure clients receiving supported living, group home, and group training home services get regular medical and dental care and that health needs are identified and addressed.

Decision Packages: 040 – ML – DA - Utilization of Residential Services, 040 – ML – DM - Minimum Wage, 040 – ML – EE - Continue Consumer Directed Employer, 040 – PL – 4U - Aging Caregivers, 040 – PL – 4Y - Community Residential Rate Increase, 040 – PL – DP - Supported Living Investigators, 040 – PL – DX - Electronic Visit Verification, 040 – PL – ET - CARE Modernization

Importance: Regular medical and dental exams can help identify issues before they become more difficult to address. By getting the right health care services, preventative screenings and treatments, individuals who have regular medical exams have improved chances of living longer, healthier lives.

Success Measure: Increase the percentage of clients receiving certified residential services[2] who visit a doctor at least once a year from 73 percent in June 2018 to 86 percent by June 2019.

 

Action Plan: 

  • Provide case resource managers ongoing training and support to help them understand the value and importance of clients having regular medical exams.
  • Provide the regional leadership team with monthly report of clients in certified residential services who do not have a doctor visit recorded in the preceding 12 months of their annual assessment.
  • Review performance data quarterly with central office and regional executive management teams to ensure targets are being met and to note areas of concern.

 

Success Measure: Increase the percentage of clients receiving certified residential services who visit a dentist at least once a year from 74 percent in June 2018 to 86 percent by June 2019.

 

Action Plan: 

  • Provide case resource managers ongoing training and support to help them understand the value and importance of clients having regular dental exams.
  • Provide the regional leadership team with monthly report of clients in certified residential services who do not have a dental visit recorded in the preceding 12 months of their annual assessment.
  • Review performance data quarterly with central office and regional executive management teams to ensure targets are being met and to note areas of concern.

Expand the capacity of the treatment program addressing the security and clinical needs of highly aggressive youth.

 

Decision Package: 030 - PL - RD – CSTC New Cottage Operating Costs

 

Importance: Youth with violent, aggressive and destructive patient behaviors require a facility that meets a standard that withstands these types of behaviors. The newly constructed 18-bed Children’s Long-Term Inpatient Program facility on the Child Study and Treatment Center campus will allow DSHS to serve these patients.

 

Success Measure: Fully operate the newly constructed 18-bed Children’s Long-Term Inpatient Program by June 2019.

 

Action Plan:

  • Provide treatment to patients identified as having a high risk of violence with the goal of protecting other patients and staff.
  • Ensure access to a therapeutic and healing environment that will enable patients to focus on treatment plans developed to address their specific needs.

 

Build capacity to serve patients in severe psychiatric crisis.

Importance:  DSHS will maintain eight beds in the Psychiatric Intensive Care Unit at Eastern State Hospital and 12 such beds at Western State Hospital. These specialized units are designed to provide intensive treatment to patients in severe psychiatric crisis who have been identified as having a high risk of violence resulting from their mental illness. Referrals to the unit will be made with the goal of stabilizing aggressive behaviors or clarifying previous mental illness diagnoses, which would be the only services available in the state of Washington for this population. These beds provide DSHS’ best opportunity to support the needs of patients with severe mental illness who pose an extraordinary risk to themselves or others.

 

Success Measure:  Ensure the Psychiatric Intensive Care Units at Eastern State Hospital and Western State Hospital are fully operational by June 2019.

 

Action Plan: 

  • Hire staff for the Psychiatric Intensive Care Unit (PICU).
  • Move eligible patients into the Psychiatric Intensive Care units where they can access a therapeutic and healing environment that focuses on treatment plans developed to address each patient’s specific needs to transition to a less restrictive unit safely. 

 

Improve the Co-Occurring Disorder Treatment program in state hospitals to better serve patients receiving care for mental health disorders with co-occurring substance use disorder issues.

Decision Package: 030 - PL - RQ - Co-occurring Disorder Treatment - State Hospitals

 

Importance: Approximately 71 percent of patients at the state hospitals experience a co-occurring mental illness and substance use disorder. State law directs the hospitals to reduce recidivism through services targeted at substance use disorder.

 

Through effective treatment for co-occurring disorders, patients will improve their personal health and social functioning while reducing risks to public health and safety.  Patients will be better prepared to return home and be successful in the community. Once discharged from the hospital, patients will have the knowledge and necessary coping skills to help avoid relapse and readmission.

 

Success Measure: Based upon projected bed capacity at the state hospitals, increase the current ratio of substance use disorder professionals from 1:100 to 1:60 by end of fiscal year 2021.

 

Action Plan: 

  • Increase co-occurring disorder clinicians into treatment teams and provide co-occurring treatment services including assessments, individualized treatment planning and individual counseling.
  • Equip patients with skills to prevent relapse post-discharge.

 

Ensure timely admission of forensic mental health patients when mental illness arises, timely medical care and timely discharge when treatment and care is complete.

Decision Packages: 030 - PL - CM - 1N3 - Direct Care and Support Staff Backup, 030 - PL - CM - 3N3 - Direct Care and Support Staff Backup, 030 - PL - CS - Trueblood Lawsuit,030- PL -CB - Building 27 - RFT Staffing

 

Importance: State psychiatric hospitals are environments for patients’ treatment and recovery. Patients must be supported in attaining the highest possible quality of care to quickly restore and recover their mental health with the supports needed so they are able to leave the hospital in a timely manner.

 

Delays in admissions for forensic patients impede the ability of individuals with mental illness to access mental health treatment and the criminal justice system’s ability to process in a timely manner those patients for whom a court orders an inpatient competency evaluation and restoration treatment. In the Trueblood class action lawsuit, a federal Court found defendants cannot wait in jail for inpatient competency evaluation and competency restoration services for longer than seven days.

 

Success Measure:

  • Fully renovate and operate two new forensic wards at Eastern State Hospital by December 2019.
  • Fully renovate and operate Building 27 Competency and Restoration Facility Program at Western State Hospital by May 2019.

 

Action Plan:

  • Ensure timely admission for competency restoration patients.
  • Continue to build the Office of Forensic Mental Health Service’s capacity to effectively lead and manage Washington’s forensic mental health care system by holding at least one training for forensic evaluators per year, maintaining a near zero vacancy rate for all positions, ensuring adequate staffing and on-going communication with all key stakeholders.
  • Continue to collaborate with judges, counties, courts, prosecutors and defenders to streamline practices including diversion, triage, and access to evaluations in a jail setting.
  • Collaborate with the Office of Forensic Mental Health Services, the state hospitals and other community and government agencies to streamline practices including diversion strategies and triage.

 

Implement a functional and integrated electronic health records system at Western State Hospital, Eastern State Hospital, Child Study and Treatment Center, and the Building 27 Restoration Treatment facility at Western.

Importance: Electronic health records will play an important role in the health and safety of patients served at the state psychiatric hospitals by providing instant information required to provide consistent, high-quality care. This information will be used throughout the hospital system and to coordinate care with community providers.

 

Success Measure: Implement a fully integrated electronic health care record system.

 

Action Plan: 

  • Create a standard infrastructure across the state hospitals that can support the rollout and long-term success of the electronic health record system.
  • Employ experienced medical personnel to ensure that requirements unique to long-term psychiatric hospitals are met.
  • Implement strategies for successful practice changes that include staff engagement, readiness, training and developing rollout procedures.

 

Reduce the use of seclusion and restraints at the state psychiatric hospitals.

Importance: The reduction of seclusion and restraint is a nationwide priority of The Joint Commission, Centers for Medicare and Medicaid Services and patient advocacy groups. The use of these is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention.

 

The use of seclusion and restraints should be avoided. If restraints become necessary, they should be applied in the least restrictive manner and removed as soon as possible.

 

Success Measure: Monitor the rate of seclusion and restraints use, determine why their use occurs and develop appropriate action plans when the rate exceeds three percent.

 

Residential treatment facilities will monitor the rate of seclusion and restraint, determine why their use occurs and develop action plans to reduce seclusion and restraint if needed.

 

Action Plan:

  • Embrace therapeutic communication tools and reduce patient agitation through use of comfort rooms.
  • Analyze data on the causes of violence.

 

Provide evidence and research-based services so clients can successfully return to their community as engaged citizens.

Importance: Evidence and research-based rehabilitation and reentry services are proven to increase the success of returning home without any re-offenses. Any decrease in recidivism has significant impact on public safety. This is recognized by the Governor’s Results Washington measure and Reentry Executive Order.

 

results washingtonSuccess Measure: Decrease Juvenile Rehabilitation (JR) client recidivism rate from 54 percent in 2017 to 49 percent by December 2019.

 

See Chart JX18: Percent of JR Clients Recidivating within 18 Months of Release

 

Action Plan: 

  • Enhance behavioral treatment available for clients in JR residential programs and strengthen linkages to community-based alternatives upon release.
  • Provide all clients leaving JR with an individualized reentry plan and key documents such as transcripts, vocational certifications, resumes and identification cards that are critical for successful reentry.
  • Engage clients in job readiness and preparation, job skill acquisition, apprenticeships and targeted employment opportunities. Establish direct linkages with businesses supportive of reentry. Identify and establish partnerships with businesses willing to hire JR clients once they are ready to reenter their community and job market.
  • Collaborate with the Office of Superintendent of Public Instruction, local school districts, educational advocates, families and communities to emphasize and secure school enrollment upon release.
  • Ensure all eligible clients enroll in Medicaid pre-release according to agreements with community health partners.
  • Evaluate current parole supervision activities to improve practices that support rehabilitation.

 

SAFETY

 

Increase safety and high-quality care at state hospitals.

Decision Package: 030 - PL – RH Direct Care Nursing Staff Backup

 

Importance:  Behavioral Health Administration (BHA) recognizes that staff are our most valuable resource. It is vital that the state psychiatric hospitals and residential treatment facilities are safe workplaces and environments for patients’ treatment and recovery. A reduction in patient-to-staff and patient-to-patient assaults are key indicators of increased safety and well-being and quality of care and leads to fewer workplace-related injury claims. 

 

Success Measure: Decrease the number of patient-to-staff and patient-to-patient assault claims filed from at Eastern State Hospital, Western State Hospital and the Child Study and Treatment Center and residential treatment facilities by 5 percent by June 2021.

 

Action Plan: 

  • Implement training on treatment interventions that can help patients resolve situations that might otherwise lead to assaults.
  • Analyze assault-related data by days of the week and times of day within a safety committee structure to identify ways to decrease assault, and develop subsequent action plans.
  • Identify and reduce unsafe practices in the hospitals.

 

Increase public safety through coordinated rehabilitative services to residents at the Special Commitment Center (SCC).

Decision Package: 135 – PL – MZ - Quality of Care and Services

 

Importance: SCC residents are best prepared for successful community transition and reentry when engaged in comprehensive rehabilitative services. Connecting residents to treatment, habilitation and transition programs increases hope and a greater likelihood of achieving a successful transition to the community.

 

Success Measure: Increase the amount of hours per week treatment (core sex offender, habilitation and transition) is offered at SCC from 30 hours in 2017 to 65 hours in 2019.

 

See Chart SC2.2: SCC Treatment Hours Offered per Week

 

Action Plan:

  • Offer core sex offender treatment groups, habilitation groups and transition groups to residents at the SCC.
  • Track the number of sex offender, habilitation and transition hours offered to residents each week.

 

Provide a safe environment for staff and residents at the Special Commitment Center.

Decision Package: 135 - PL - M8 - Violence Prevention Training

 

Importance: Residents and staff thrive in a safe, healthy environment. For staff to be fully functional and effective in their job, they need to feel safe at work. Treatment for residents is ineffective if residents do not feel safe in the facility. Research shows as the use of confinement and segregation increases, the number of assaults increase at nearly the same rate.

 

Success Measure: Increase the percentage of staff at the Special Commitment Center who receive Psychiatric Emergency Response training (PERT) from 58 percent in 2018 to 90 percent by June 2019.

 

See Chart SC2.1: Percent of SCC staff with PERT Training

 

Action Plan:

  • Provide Psychiatric Emergency Response Training (PERT) to new hires during new employee orientation (NEO).
  • Continue scheduling existing staff into PERT during NEO until all staff are trained.

 

Success Measure: Decrease the use of isolation or room confinement in Juvenile Rehabilitation institutions from 5.2 hours per 100 days of confinement in 2018 to 3 hours by June 2019.

 

See Chart JX23: Juvenile Rehabilitation (JR) Time Spent in Isolation or Room Confinement

 

Action Plan:

  • Identify and implement the facility improvement reported through the national Performance Based Standards system to reduce the amount of time isolation and confinement are used.

 

Establish preventative maintenance programs at Rainier School, Fircrest School and Consolidated Support Services (CSS). 

Importance: Having an established preventative maintenance program that aligns with Center for Medicare and Medicaid Services (CMS) regulations will enable our larger facilities to provide safe living conditions for DSHS clients.

 

Success Measure: Increase the number of preventative maintenance work orders by 50 percent at each facility over the next fiscal year. 

 

Action Plan: 

  • Modify the Preventative Maintenance Project Module Worksheet that was used at Western State Hospital to use as the action planner for Rainier School, Fircrest School, and CSS.

 

Reduce the backlog of work orders that have been outstanding for 90 or more days at state facilities.

Decision Packages: 030 - 000 – ML – 8X - Maintain Safe Secure Facilities, 040 – 000 – ML – 8X – Maintain Safe Secure Facilities, 135 – 000 – ML – 8X – Maintain Safe Secure Facilities

 

Importance: Decreasing the number of work orders 90 days or older will help ensure a safe and satisfactory environment for residents of DSHS facilities, decrease overall maintenance costs and extend the life of building systems and equipment. Completing the work associated with the backlogged orders will help keep the environment of care at a satisfactory level, ensuring DSHS clients are well taken care of and have a safe residence in which to live.

 

Success Measure: Decrease outstanding 90-day-plus open work orders at each facility by 25 percent by December 2018. 

 

Action Plan: 

  • Request additional staff for the facilities.
  • Prioritize work orders.

 

Reduce workplace injuries at state hospitals.

Importance: The safety of our employees is necessary to meet our mission and to provide quality customer service to our clients.  Employee injury costs include Worker’s Compensation claims, assault benefits, training, overtime and backfilling while employees are on time loss.  DSHS has paid in excess of $50 million to Labor & Industries as of 2018, in worker’s compensation premiums.

 

Success Measure: Reduce the Occupational Safety and Health recordable overall injury rate by 10 percent which would reduce the injury rate from 6.31 in 2017 to 5.68 by December 2019.

 

Action Plan:

  • Partnering with facility and office safety staff to ensure safety programs are in place and effective.
  • Meet with leadership to garner support for a “tone at the top” approach.
  • Request two additional Safety Officer 3 positions to enhance safety awareness through consultation, training and annual safety program assessments.

 

Importance: Assaults/client related injuries make up approximately 45 percent of DSHS staff injuries. The greatest number of these injuries occur at Western State Hospital. Managing these types of incidents relies heavily on communication, training and staff skill development.  Shifting the culture of safety from a reactive approach to a preventive approach is key to an effective safety culture.

 

Success Measure: Reduce the number of assault/client related injuries from 2.38 in 2017 to 2.14 by December 2019, a reduction of 10 percent.

 

Action Plan:

  • Work with WSH leadership to create a “pilot project” at the hospital that includes training in three key areas: situational awareness, team building, and leadership development.
  • Deliver vicarious trauma training to identify key staff across the state who can be trained in the debriefing process.
  • Investigate assaults that lead to Occupational Safety and Health Administration recordable injuries and provide feedback to the Violence Reduction Team.
  • Provide assault data to the Violence Reduction Team.

 

Importance: Reducing the number and severity of injuries greatly reduces visible and unseen costs.

 

Success Measure: Reduce the days away, restricted (light duty) or transfer (change of position) by 1o percent which is a reduction from 5.34 in 2017 to 4.81 by December 2019.

 

Action Plan:

  • Identify causes and trends of injuries across the agency.
  • Based on trends, create action plans to reduce the number and severity of workplace injuries with the highest incident rates throughout DSHS.

 

Develop and implement staffing models for all institutions so that they can ensure client and staff safety, increase staff efficiency, performance and effectiveness and decrease staff overtime.

 

Importance:  Having an accurate staffing model will support getting the right number of the right kind of staff in our hospitals and institutions.  Accurate staffing models also support:

  • A safe and effective level of care for our clients. 
  • A reduction of assaults on staff.
  • A reduction in staff overtime expenses.

 

Success Measure: Implement staffing models for all institutions by August 2019.  This will ensure adequate staffing levels in order to support them. 

 

Action Plan: 

  • Complete the hospital staffing model and present to internal stakeholders (CBO Staff, Chief Financial Officer) by January 2018 (complete).
  • Present the hospital staffing model to Behavioral Health Administration and the financial managers by March 2018 (complete).
  • Present the hospital staffing model to the Office of Financial Management and legislative staff by May 2018 (complete).
  • Present the hospital staffing model to DSHS Cabinet in fall 2018.
  • Incorporate the hospital staffing model into the agency budget process.
  • Develop staffing model specifically for the RHCs by October 2018.
  • Present New RHC model to internal and external stakeholders in October and mid-November 2018.
  • Begin work on Special Commitment Center (SCC) staffing model by March 2019.

Certified residential includes supported living, group home and group training home services

Serve people in their home community

Importance: Studies show us that most people in rehabilitation and recovery do better when they live in their home communities. Our clients must be able to get the care and supports they need in the settings they need and want. The Governor’s Office, our agency and others are embarking on an ambitious Mental Health Transformation project to increase the availability of specialized supports in adult family homes and other facilities for individuals in recovery. We also are focused on developing more community living alternatives so people diagnosed with developmental disabilities so they can live, work and play closer to their families, friends and loved ones.

 

Based on this, DSHS has established the following strategic objectives to support how we will serve people in their home community.


MENTAL HEALTH TRANSFORMATION

 

Mental Health Transformation – provide new long-term services and supports for individuals transitioning from state psychiatric hospitals.

Decision Packages: 050 - ML - EF - Continue Discharge Placements, 050 - ML - EN - ESF - Capacity Mental Health

 

Importance: Washington has an identified gap in community options for individuals with behavioral challenges and personal care needs, particularly for those ready for discharge from the state psychiatric hospitals. Under a state law enacted in 2016, and as part of the Governor-directed Mental Health Transformation, the Aging and Long-Term Support Administration (ALTSA) received funding to increase community alternative options that prioritize the transition of those ready for discharge from state psychiatric hospitals who have long-term care needs. ALTSA’s success in meeting this objective and ensuring individuals receive the right array of services to meet their individual needs is a shared responsibility across DSHS administrations, including the Behavioral Health Administration. It will require extremely close coordination and a new level of collaboration between ALTSA, state hospitals, behavioral health organizations, managed care organizations, accountable communities of health and community providers.

 

Success Measures: Consistently achieve a quarterly average of 74 clients transitioning from state psychiatric hospitals into community settings by June 2019.

 

See Chart AAH.13: Number of individuals transitioning from state psychiatric hospitals into community settings

 

Action Plan: 

  • Increase types and capacity of specialized community options available to home and community-based clients, including Enhanced Services Facilities, Expanded Community Services, Specialized Behavior Support Adult Family Homes, and Supportive Housing by June 2023.
  • Work with local partners to address barriers and develop additional community providers who have the expertise and sufficient staffing levels to serve a high-needs population, reducing hospital readmissions.
  • Coordinate across agencies to successfully transition individuals from state and community psychiatric hospitals into community settings that are able to address the unique and complex needs using an individualized and person-centered approach, helping to ensure access to intensive care coordination.
  • Create a regulatory structure that supports providers willing to provide high-quality care to individuals with complex needs who are able to relocate out of institutional settings and proactively provide the necessary technical assistance and education that assists them in being successful in serving this population.

 

QUALITY OF LIFE

 

Support individuals with developmental disabilities to be able to receive services that support them in living in their own communities rather than in facility-based settings.

Decision Packages: 040 - PL - 4S - Community Transition Expansion, 040 - ML - DA - Utilization of Residential Services, 040 - ML - DH - Continue 47 SOLA Placements, 040 - ML - EF - Continue Discharge Placements, 040 - PL - 4S - Community Transition Expansion, 040 - PL - 4Y - Community Residential Rate Increase, 040 – ML – EF - Continue Discharge Placements

 

Importance: Individuals with developmental disabilities should have access to services and resources that meet their needs and promote activities, routines and relationships. This includes being able to live in communities, rather than in facility-based settings.

 

results washingtonSuccess Measure: Increase the percentage of Developmental Disabilities Administration (DDA) clients served in home and community-based settings from 97.4 percent in July 2017 to 97.6 percent by June 2019.

 

See Chart AD1.2: Percent of clients with developmental disabilities served in home and community-based settings

 

Action Plan:

  • Ensure all clients requesting services receive an assessment to determine eligibility for community-based services.

  • Provide Roads to Community Living funds to assist clients with their transition during the first 12 months after moving.

  • Conduct quarterly performance data reviews at the executive level to ensure targets are met.

 

Success Measure: Increase State Operated Living Alternative (SOLA) placements for 15 individuals who reside at Western and Eastern State Hospitals by June 2019.

 

See Chart ADX.37: Number of DDA State-Operated Living Alternative (SOLA) placements for DDA clients at Western and Eastern State hospitals

 

Action Plan:

  • Work with staff at Western and Eastern State hospitals to determine client discharge readiness.
  • Obtain homes in the community and recruit, hire and train staff to support clients in the SOLA program as funding becomes available and as clients are ready for discharge.
  • Conduct at least three quality assurance surveys during the first 12 months after a client has moved to ensure that service and support needs are being met. 

 

Ensure that services and supports provided to clients in certified residential settings meet regulatory requirements and quality of care standards.

Decision Packages: 040 – PL – DP - Supported Living Investigators, 040 – PL – 4Y -  Community Residential Rate Increase, 040 – PL – 4V - Critical Services and Supports, 040 – ML – DM - Minimum Wage

 

Importance: More than 4,200 individuals across the state receive community-based residential services from more than 135 contracted providers. Timely and consistent background checks for staff, routine community engagement for the individuals we support and quality support plans reflecting industry best practices are three key indicators of safe, integrated and quality service. 

 

Success Measure: Certified residential providers will receive fewer than four background-check-related citations each per quarter by June 2019.

 

Action Plan:

  • Provide certified residential service providers with training and technical assistance.
  • Give residential service providers the option of a background check tracking tool.
  • Review performance data quarterly with central office and regional executive management teams to ensure targets are met and to note any issues.

Success Measure: Certified residential service providers sampled will provide clients with at least 4.6 days of support in accessing community-based activities for three consecutive quarters during the 2017-19 biennium.

 

See Chart ADX.21: Average number of days in a seven-day period in which individuals in supported living programs accessed community-based activities

 

Action Plan: 

  • Share community activity data and promote residential providers’ support of community activities at regional provider meetings.
  • Follow up, involve case management and provide technical assistance as appropriate, for clients identified to have two or fewer community outings in sampled weeks.
  • Provide access to online training and encourage residential provider staff to support clients in accessing community-based activities.

 

Success Measure: 180 Developmental Disabilities Administration (DDA) employees or DSHS contractors will complete a standardized “functional assessments and positive behavior support plan” training by June 2019.

 

See Chart ADX.27: Number of employees who completed standardized “functional assessment and positive behavior support planning” training

 

Action Plan:

  • Promote training through the DDA website, GovDelivery and residential provider meetings.
  • Monitor regulatory compliance and encourage course completion for providers with citations related to behavior support planning.
  • Offer ongoing access to online training and provide at least one instructor-led training each quarter for employees of certified residential providers.

 

Conduct timely oversight and compliance activities of facilities and agencies providing residential care and supports.

Decision Package: 050 - PL - DP - Supported Living Investigators

 

Importance: This measure reflects the core work done by our licensors and surveyors regularly to ensure all long-term care facilities and services are following regulations and are providing quality care and those adults who are vulnerable are protected from abuse. This work is done on behalf of all residents of the state who might access these services, whether they pay for them privately or are DSHS clients. Requirements for on-site visits vary by setting.

 

Success Measure: Maintain the percentage of timely re-inspection at 99 percent or higher for nursing homes, and increase the percentage of timely re-inspection to 99 percent for assisted living facilities and adult family homes by June 2019.

 

See Chart AAR.1: Timely Licensing Re-inspections of Adult Family Homes, Assisted Living Facilities, and Nursing Homes

 

Action Plan: 

  • Optimize staffing through cross-training licensors among different settings and through recruitment and retention strategies.
  • Request funding for additional staffing to license and inspect assisted living facilities, the fastest growing provider type.
  • Develop and accept a Residential Care Services staffing workload model using key metrics such as facility and provider growth and changes.

 

Success Measure: Maintain timely quality assurance activities at 100 percent for services provided to people with developmental and intellectual disabilities.

 

See Chart AAR.2: Timely Quality Assurance for ICF/IID (Including Residential Habilitation Centers) and Supported Living Programs

 

Action Plan: 

  • Develop standard operating procedures for assuring quality for intermediate care facilities for individuals with intellectual disabilities (ICF/IID) in residential habilitation centers (RHCs) and for community ICF/IID.
  • Expand Residential Care Services staffing for supported living to allow for program-specific quality assurance and enforcement.

 

SAFETY

 

Complete abuse and neglect investigations timely and thoroughly.

Decision Package: 050 - PL - E7 - IT - Systems Modernization

 

Importance: Protection of adults who are vulnerable requires consistent and timely investigations and the offering of protective services and referrals for services and supports. Delays create a greater risk of harm to the alleged victim. Also, timely investigation means that a confirmed perpetrator can be listed on a statewide registry of people who are not allowed to work with vulnerable adults. Although there are no state or federal standards or guidelines for Adult Protective Services, the Aging and Long-Term Support Administration (ALTSA) mirrors the Child Protective Services 90-day standard for investigations. Performance on this item has improved due to increases in staffing funded by the Legislature to meet increased reports of abuse and neglect. 

 

results washingtonSuccess Measure: Increase the percentage of adult abuse and neglect investigations completed within 90 days (or remaining open for “good cause”) from 95.4 percent in calendar year 2016 to 97 percent by June 2019.

 

See Chart AAC.2: Adult Abuse and Neglect Investigations Completed Timely

 

Action Plan: 

  • Ensure focused monitoring of “good cause” delay reason codes, and analyze for process improvements.
  • Hire aggressively and improve retention to reduce staff vacancies and turnover.
  • Evaluate the results of dedicating staff for specialized investigations on financial exploitation allegations and self-neglect.

 

Investigate complaints regarding facilities in a timely manner.

Importance: Complaints in long-term care facilities are investigated to protect residents from abuse, neglect and exploitation; to ensure services provided meet the health and safety needs of residents; to evaluate whether provider practice meets regulatory requirements; and to make quality referrals to entities that help protect victims. The high volume of complaints and the resulting workload, coupled with limited investigative staff, has made it difficult to meet response time goals, especially for medium and low-priority complaints (non-immediate jeopardy complaints). The backlog has been reduced, but until staffing levels are stable and sufficient, this item remains a concern.

 

Success Measure: Reduce the long-term care facility complaint investigation backlog of non-immediate jeopardy complaints from 152 in June 2017 to 100 or fewer by June 2019.

 

See Chart AAR.7: Backlog of Facility Complaint Investigations

 

Action Plan: 

  • Hire aggressively, improve retention to reduce staff vacancies and turnover and cross-train for all facility types.
  • Continue to hire on-call staff to allow Residential Care Services to be more responsive to changing complaint volumes and staff availability.
  • Monitor complaint investigations for all regions, units, and facility types monthly.

 

INDIVIDUAL STRATEGIC OBJECTIVES

 

Prepare Special Commitment Center (SCC) residents who are reentering the community.

Decision Package: 135 – PL – M4 - Wraparound Reentry

 

Importance: Governor Inslee’s Executive Order on Reentry requires reentry plans for all people leaving a juvenile rehabilitation facility, and by extension, all individuals preparing for release from civil commitment. Supporting a successful reentry in clear and direct ways may make the difference between recidivism and successful transition to the community. Planning ahead of time for post-release helps address the many pervasive obstacles faced by youth and adults in areas relating to employment, education, housing, and social services and improves their long-term outcomes significantly.

 

Success Measure: Increase the percent of SCC residents conditionally released to Least Restrictive Alternative (LRA) placement who participate in vocational rehabilitation orientation prior to release from 44 percent in 2018 to 75 percent by 2019.

 

See Chart SC1.9: SCC Residents Conditionally Released Participating in Orientation

 

Action Plan: 

  • Collaborate with the Division of Vocational Rehabilitation to include orientation and eligibility determinations into SCC transition treatment groups for residents recommended for least restrictive alternative.
  • Residents who have or will have a court date for release will attend as part of overall transition program.

 

Consumer Directed Employer: Implement a new employment structure for in-home care providers that increases case management time available for clients and decreases administrative burden on the Department while maintaining consumer choice and consumer direction.

Importance: Over the years, managing the Individual Provider (IP) workforce has become increasingly complex due to the growth of the in-home caseload, the increased acuity of consumers and expanding demands brought on by new and changing state and federal requirements. Managing this workforce currently falls to DSHS and Area Agency on Aging (AAA) case management staff, which diverts their time away from working directly with consumers. Once implemented, the Consumer Directed Employer (CDE) will assume all administrative functions for the IP workforce including payroll, background check and training requirements, tax reporting, credentialing, electronic visit verification, etc. When the CDE is implemented, case managers will have more time for consumer assessments, service plan development and monitoring, addressing health and safety needs and other important case management activities.

 

Success Measure: Transition 100 percent of all personal care and respite hour authorizations formerly made to individual providers to the CDE by July 2020.

 

Action Plan:

  • Issue a request for proposal to procure a CDE vendor that includes input from tribes and stakeholders received through a statewide public process.
  • Successfully negotiate and sign a contract with up to two successful bidders to the CDE procurement.
  • Complete all staff, consumer and IP readiness activities needed to successfully transition the IP workforce to the CDE.

 

Process financial applications, complete new assessments and re-assessments and develop service plans for those who apply for services in a timely way so that individuals can be supported in the setting of their choice.

Decision Packages: 050 - PL - E7 - IT - Systems Modernization, 050 - ML - 93 - Mandatory Caseload Adjustments, 050 - ML - 94 - Mandatory Workload Adjustments

 

Importance: In order to receive long-term services and supports (LTSS), an individual must be functionally eligible (they require unmet assistance with activities of daily living) and financially eligible (their assets and income must be within limits). This is not only necessary for determining eligibility for Medicaid and LTSS services but also ensures federal funding can be used to pay for services. Delays in access to medical and support services can: leave families without support for their loved one; lead to gaps in housing; and/or result in unnecessary institutional placement.  Once approved for services, re-assessment occurs annually to determine continued eligibility.

 

Success Measure: Increase the percentage of timely financial eligibility determinations completed from 88 percent in June 2017 to 93 percent as of June 2019. (A financial eligibility determination is conducted timely when it is completed within 45 days from the date of intake or longer than 45 days if good cause exists.)

 

See Chart AAH.7: Financial Eligibility Determinations Processed Timely

 

Success Measure: Increase the percentage of initial functional assessments completed within 30 days of creation from 72 percent in June 2017 to 93 percent by June 2019. (Policy requires that assessments be completed within 30 days of when they are begun. Policy also requires an assessment be fully completed within 45 days of intake; data for this latter item is currently under development.)

 

See Chart AAH.5: Initial Functional Assessments Completed Timely

 

Success Measure: Increase the percentage of timely functional reassessments from 96.7 percent in June 2017 to 98 percent by June 2019. (A functional reassessment is timely when the case manager completes the annual reassessment within one year of the last assessment.)

 

See Chart AAH.12: Annual Function Re-Assessments Completed Timely (AAAs and HCS)

 

Action Plan: 

  • Monitor delay reason codes for initial and annual assessments to identify trends around delays resulting in assessment completion exceeding 30 days.
  • Analyze new reports related to intake, worker assignment, and assessment completion to identify trends and training opportunities to improve staff performance and consistency using updated policy and procedure that defines intake dates and timeliness.
  • Regional leadership will analyze staff performance based on new timeliness reports to identify areas of improvement or need for additional root cause analysis.

 

Build Department and partners’ expertise in working with Tribes as they develop capacity around government-to-government relations, especially around social services provision and contracting.

Importance: DSHS and its approach to government-to-government collaboration with tribes and Recognized American Indian Organizations (RAIOs) is recognized for its vision and leadership. Internally and with state departments, DSHS provides technical assistance and support to those seeking it. This has already taken place with the Department of Commerce and the former Department of Early Learning. Other noted work involves the recent expansion of the Indian Policy Advisory Committee meetings to include the Governor’s Office of Indian Affairs and various departments of state government.

 

The need for technical assistance is further demonstrated by the transition of the Department of Behavioral Health and Recovery to the Health Care Authority and the Department of Health, which will be working to create identified capacity by June 2019. An interagency memorandum of agreement among the three departments details the support the Office of Indian Policy will provide by continuing to manage contract consolidation and assisting with planning among tribes and departments involved.

 

Success Measure: Advance our government-to-government model within DSHS, Governor’s Office of Indian Affairs and other agencies to assist them in building needed and identified capacity. We will support our partners to achieve these goals by June 2019.

 

Action Plan: Coordinate collaboration and communication between the Office of Indian Policy, tribes, agencies and others including:

  • Maintain contracts and reporting activities.
  • Collaborate with tribes and departments to assist with continued planning activities.
  • Provide training to partners where needed.

 

Provide education and training to DSHS staff and providers to better serve residents and clients who are deaf or hard of hearing.

Importance: Providing training and education to service providers and DSHS staff on various communication modalities ensures that access points to critical services are well-equipped for effective communication. This is paramount in meeting the needs of individuals who are Deaf, Deafblind, Deaf Plus, Hard of Hearing, Late Deafened, or who have speech disabilities to support equal access to the benefits afforded to the rest of the community.

 

Success Measure: Increase the number of DSHS and service-provider sites where education and training in communication access modalities (methods) for people who are deaf and hard of hearing is provided from 25 to 50 by June 2019.

 

See Chart DH1.8: Number of Sites with Education and Training Provided

(DSHS and Service Provider sites, Training in Communication Access Modalities for the Deaf or Hard of Hearing)

 

Action Plan: 

  • Start education and training in communication access modalities at Home and Community Services and Residential Care Services offices.
  • Initiate an evaluation system for measuring client use and DSHS staff knowledge and application of communication modalities.
  • Conduct outreach and disseminate information on available communication access modalities.

 

Expand case management services for specialized populations.

Importance: Individuals who are Deaf, Deafblind, Deaf Plus, Hard of Hearing, Late Deafened, or who have speech disabilities, especially adults who are older, the underemployed and those with multiple disabilities, face barriers that affect access to communication, education, health care, employment, legal, housing, transportation, insurance, public assistance and other benefits. Case managers are available to assist these individuals in obtaining needed services by coordinating services, translating documents, advocating on their behalf and/or teaching new abilities and skills. These services are provided by eight contracted, non-profit Regional Service Centers throughout Washington.

 

Success Measure: Increase the number of clients served by the Regional Service Centers of the Deaf, Deafblind, Deaf Plus, hard of hearing and late deafened from 600 in June 2018 to 690 by June 2019.

 

See Chart DH2.1: Number of People Served by Case Management for the Deaf and Hard of Hearing at the Regional Service Centers

 

Action Plan:

  • Monitor each Regional Service Center’s total caseload and contract performance and implement corrective actions for under-performance as necessary.
  • Have new contracts in place with each center and contractors to reach out to a diverse communities.

 

Provide assistive communication technology services.

Importance: Many individuals with hearing loss depend on auditory supports and do not use sign language. Assistive communication technology, such as listening systems, aid in ensuring that effective communication occurs between people with hearing loss and employees or contractors providing DSHS services during in-person office visits. These assistive listening systems help clients access DSHS programs and services and include tools such as hearing induction loops and pocket talkers.

 

Success Measure: Increase the number of locations that serve the public and clients with assistive listening systems services from 263 locations to 363 locations by June 2019.

 

See Chart DH1.7: Number of DSHS and Contractor Sites with Assistive Listening Systems Services

 

Action Plan: 

  • Continue to distribute, install or maintain functionality of assistive listening technology including induction loops at the Legislature, Area Agencies on Aging, Home and Community Services Division and Residential Care Services offices statewide, including continuing training for DSHS staff.
  • Initiate an evaluation system for measuring client use and staff knowledge of assistive communication technology.
  • Install loop systems at residential facilities where individuals with hearing loss live.

 

Timely abuse and neglect investigations.

Decision Package: 050 - PL - E7 - IT - Systems Modernization

 

Importance: Adult Protective Services (APS) has two primary duties: offer protective services to vulnerable adults who are harmed and investigate allegations to determine if abuse occurred. Timely response is essential in order to protect health and safety, including providing protection orders and long-term services and supports. Investigations are categorized by priority. A high-priority investigation requires initiation within 24 hours of knowledge. A medium-priority investigation requires initiation within five working days, and a low-priority investigation requires initiation within 10 working days.

 

Success Measure: Increase timely initial response to investigations based on priority to 100 percent for high-priority investigations and maintain at 99 percent for medium and low-priority investigations by June 2019.

 

See Chart AAP.1: Adult Protective Services - Timely Initial Response

 

Action Plan:

  • Increase public awareness of the APS on-line reporting system.
  • Evaluate areas for improvement to ensure consistent intake decisions and timely assignment for investigation.
  • Monitor newly implemented phone technology across each of the three DSHS regions.

 

Support people to transition from nursing homes to care in their homes or communities.

Importance: The majority of individuals who require personal care services choose to receive these supports in their home or in other community-based setting. Some individuals stay in nursing homes because they do not realize they have other options, or because they entered some time ago when their needs were more intense, such as after hospitalization. Providing community resource education and assisting interested individuals to move from nursing homes into a community setting of their choice, increasing quality of life and contributing to the financial health of Washington.

 

Success Measure: Consistently achieve a quarterly average of 950 nursing facility-to-community setting transitions by June 2019.

 

See Chart AAH.2: Number of Relocations from Nursing Facilities to Home and Community-Based Settings  (Quarterly; Annuals Show Quarterly Average)

 

Action Plan: 

  • Provide staff with ongoing technical assistance, education, tools and resources to address the changing needs of clients.
  • Work collaboratively with nursing facilities, residents and families to improve their understanding of the resources and benefits of living in the community and to transition individuals who may prefer a community-based option.
  • Introduce and implement standards to improve quality outcomes and community stabilization for individuals choosing to relocate from nursing homes.
Provide a pathway out of poverty and become healthier

Importance: Whether people come to us for simple, short-term assistance or with more complex, long-term needs, we must be present to the whole person, offering the right benefits at the right time. Our participation in the Governor’s Poverty Reduction Workgroup and our own efforts to work with families to understand the cycle of intergenerational poverty will give us the tools we need to help individuals and families achieve economic stability.

 

Based on this, DSHS has established the following strategic objectives to support how we will provide a pathway out of poverty and becoming healthier.


REDUCE POVERTY

 

Provide assistance to the Governor’s Poverty Reduction workgroup.

Importance: DSHS and its approach to government-to-government collaboration with tribes and Recognized American Indian Organizations are recognized for knowledge of tribal governments and communities. The workgroup is charged with developing a strategic plan to reduce poverty, improve communities and make needed progress related to housing, health integration, employment and education systems.

 

Success Measure: Increase tribal participation to 100 percent, involving all 29 tribes and seven Recognized American Indian Organization’s (RAIOs) in the plan development, by June 2019.

 

Action Plan:  Assist with collaboration and communication activities between the Office of Indian Policy, tribes, agencies and others including:

  • Connect Department and other partners to tribal leadership, professionals, and communities around efforts to gather information and involve tribes in the initiative.
  • Facilitate meetings to involve tribes and communities as information-gathering efforts take place.
  • Provide assistance to the workgroup and tribes as meetings are scheduled to share the vision of the Poverty Reduction Workgroup project and collaborate with tribes and tribal communities to gather information and feedback.
  • Help implement the workgroup’s plan once it is developed.

 

Reduce poverty in the disability community in coordination with DSHS and workforce development partners.

Importance: Poverty affects the disability community at rates nearly double that of individuals without disabilities. While individuals with disabilities represent approximately 13 percent of the overall Washington working age population, they make up 26 percent of those living in poverty. DVR customers who obtain employment improve their economic circumstances and are less reliant on public benefits. However, only about 18 percent of DVR participants who are employed have incomes that equal or exceed 200 percent of the federal poverty level.

 

DVR provides access to services that support labor force participation and higher education and demand-driven job training that result in higher wages and financial independence. DVR also supports policy reforms to address barriers to economic success for Washingtonians with disabilities. These initiatives are carried out in collaboration with DSHS’ Economic Services Administration, WorkSource and workforce training programs, and community partners and advocates.

 

Success Measure: Increase the percentage of DVR participants who exit DVR services with incomes at or above 200 percent of federal poverty level from 18 percent to 25 percent by June 2020.

 

Action Plan:    

  • Educate customers about well-paying career options and encourage participation in educational and workforce training programs that prepare job-seekers for careers that pay a living wage.
  • Increase coordination and collaboration with DSHS, workforce development and community partners to develop integrated service delivery models, to expand access to services and to support customers’ need for job success.
  • Promote strategies to mitigate the potential loss of essential benefits and services to ensure that advancement in employment leads to upward financial mobility for people with disabilities.

 

Increase program exits to self-sufficiency

Importance: Increased exits from public assistance require employment in stable jobs with opportunities for increased wage progression.

 

results washington logoSuccess Measure: Increase the percentage of people who leave Temporary Assistance for Needy Families (TANF) due to increased income or at their request from 58 percent in March 2018 to 60 percent by June 2021.

 

See Chart E2.1: Percent and number of families who leave public assistance (TANF) due to increased income or at their request

 

Action Plan: 

  • Simplify and develop a “one program” concept to ensure seamless transitions for all customers from program to program (WorkFirst, Basic Food, Employment and Training, Workforce Innovation and Opportunity Act, colleges, etc.).
  • Develop a proposal for a refugee/immigrant pathway out of poverty pilot, including seeking additional resources.
  • Explore making more resources available to families by adding children to the Social Security Income facilitation group we serve.
  • Explore and develop data-gathering methods to ensure accurate measures of successful exits from public assistance.
  • Implement final, approved recommendations from Transforming Case Management, a multi-year project that will fundamentally change the way we work with customers; which includes expanding case management services, serving the whole family, strengthening our community partnerships and referrals to other resources, and coaching and evaluation strategies.

 

Prepare clients for reentry into the community.

 

Decision Package: 135 - PL- M4 - Wraparound Reentry

 

Importance: Governor Inslee’s Executive Order on Reentry requires reentry plans for all clients leaving a juvenile rehabilitation facility. Supporting a successful reentry in clear and direct ways makes the difference between recidivism and successful transition to the community. Planning ahead of time for post-release helps address the many pervasive obstacles faced by clients with employment, education, housing, and social services and improves their long-term outcomes significantly.

 

Success Measure: Increase the number of clients released from juvenile rehabilitation who have stable housing within six months of release from 83 percent in 2015 to 90 percent by June 2019. Note: Data from a DSHS Research and Data Analysis report on Housing Status of Youth Exiting Foster Care, Behavioral Health and Criminal Justice Systems provided yearly.

 

See Chart JX20: Juvenile Rehabilitation (JR) Clients Released into Stable Housing

 

Action Plan: 

  • Hold Reentry Team meetings upon intake to prepare clients and families for release.The meetings will address issues and risk factors that lead to housing instability.
  • Engage clients and families in actively planning for housing before release and document resources in service plan.
  • Connect clients and families with community resources and supports for housing upon release.

 

Seek external resources to expand capacity to evaluate poverty-related policies and intervention strategies.

Importance: Achieving this objective is aligned with the Governor’s initiative to reduce poverty, improve communities and make needed progress related to housing, health integration, employment and education. The recently established Governor’s Poverty Reduction Workgroup is co-led by the departments of Social and Health Services, Commerce and Employment Security.

 

Success Measure:

  • Obtain public or private resources to fund new poverty-focused, cross-agency data integration efforts by June 2020.
  • Complete in fiscal year 2021, funded poverty-focused policy analyses prioritized in collaboration with external agency partners to support initiatives to reduce poverty and/or mitigate the effects of poverty in Washington.

 

Action Plan: 

  • Identify staff responsible to seek and obtain public or private resources to support new poverty-focused, cross-agency data integration efforts.
  • With external public and private resources, enhance DSHS’ integrated client data environment with new and/or expanded data sources to support poverty-focused policy analysis.
  • Collaborate with Economic Services Administration (ESA), other DSHS program partners and external agency partners to identify and conduct high-priority analyses to support initiatives to reduce poverty and/or mitigate the effects of poverty in Washington.

 

SUPPORT TRANSITIONS TO THE WORKFORCE AND IMPROVE EMPLOYMENT OPPORTUNITIES FOR DISABLED INDIVIDUALS

 

Ensure successful transitions into the workforce for students with disabilities.

Importance: Students with disabilities often leave school without a path to further education or employment. Criteria for services change when youth reach adulthood and many support services are no longer available once they leave high school. Youth are often unprepared to navigate the complex array of services available to adults.

 

Comprehensive planning and coordination of school-based and vocational services help students acquire the knowledge, skills and supports they need to achieve their vocational goals and live as independently as possible after high school. The Division of Vocational Rehabilitation (DVR) collaborates with education and workforce development agencies to offer group services for students with disabilities so they can learn about the world of work, develop work-readiness skills and find employment. Eligible students also may receive individualized services from DVR.

 

Success Measure: Attain a 70 percent rate of entering post-secondary education or employment within one year of exiting secondary education for students with disabilities who are DVR customers.

 

Action Plan:   

  • Expand the scope and availability of pre-employment transition services through new and extended contracts with Washington’s community rehabilitation programs, Workforce Development Councils, community and technical colleges and educational service districts. Emphasize work-based learning experiences and work-based readiness training.
  • Increase collaboration and agreements with education officials, schools, and community partners to assess service needs, evaluate service delivery models and establish a seamless continuum of services for students with disabilities throughout Washington.
  • Ensure DVR staff are knowledgeable of and use transition planning and practices that best support positive post-secondary outcomes for youth.

 

Improve employment outcomes for individuals with disabilities.

Importance: Employment contributes to a person’s ability to live independently, attain a higher quality of life and participate fully in the community. People with disabilities who want to work can face substantial barriers to finding or keeping a job.

 

As a core program of Washington’s workforce development system, DVR promotes a healthier, more prosperous Washington through a dual-customer model, serving both individuals with disabilities and Washington’s businesses. DVR provides individualized services to people with disabilities, with priority for individuals with the most significant disabilities. These services are customer-driven and consistent with individuals’ unique strengths, abilities, interests and informed choice. Through business engagement, DVR and its partners work to close skill gaps, strengthen and diversify the workforce, and expand opportunities for people with disabilities in Washington.

 

Success Measure: Increase the percent of DVR participants who achieve successful employment outcomes from 55 percent in June 2018 to 65 percent by June 2020.

 

Action Plan:    

  • Strengthen vocational assessment practices as the foundation for individualized services that meet customer needs, identify and address barriers to employment and maximize outcomes.
  • Provide staff training and support to ensure that staff have the knowledge and skills needed to equitably deliver high-quality vocational rehabilitation services to customers with diverse needs, abilities and interests.
  • Increase business outreach and engagement to expand employment opportunities for individuals with disabilities, in collaboration with local Workforce Development Boards.

 

Increase the number of working-age adults with a developmental disability who are employed.

Decision Package: 040 – ML – DN - High School Transition Students

 

Importance: Developmental Disabilities Administration (DDA) is committed to providing employment support to all working-aged adult clients. Having a job and earning a wage are powerful achievements. Increasing access and opportunities for employment allows individuals to fully participate in their communities.

 

Success Measure: Increase the percentage of working-age adults with developmental disabilities receiving supported employment services who are employed from 66.2 percent in July 2017 to 67 percent by June 2019.

 

See Chart AD2.1: Percent of working-age adults with developmental disabilities receiving supported employment services who are earning a wage

 

Action Plan: 

  • Provide regional management teams and counties with quarterly data showing supported employment caseload and activities.
  • Use appropriated funding to expand capacity on the Basic Plus waiver for individuals who are age 21, graduating from high school, Medicaid-eligible and interested in pursuing supported employment services.
  • Seek technical assistance provided by the Centers for Medicare and Medicaid Services to evaluate “Value Based Purchasing” model. This may provide valuable information and options for financial and non-financial incentives to increase employment of clients with high-acuity needs.

 

INDIVIDUAL STRATEGIC OBJECTIVES

 

Increase cross-agency/cross-program services and supports for customers.

Decision Package: 060 – PL - Q2 – Partnership for Reemployment Backup

 

Importance: Economic Services Administration (ESA) can best accomplish its mission and unifying goal by developing, expanding and nurturing relationships with key state, federal, tribal and local partners that serve common customers. To the extent possible, it’s vital that we align or integrate service delivery models and services to provide the most effective supports.

 

Success Measure: The Solutions for Transitioning Parents[3] re-employment program is successfully implemented in King County by 2021.

 

Action Plan: 

  • Continue work to accomplish the objectives on the state’s Workforce Innovation and Opportunities Act plan to ensure integrated service delivery for our customers.
  • Collaborate with the Social Security Administration to shape the future of disability claim processing by continuing to be involved in planning, designing, and implementing a new nation-wide claims processing system Disability Case Processing System (DCPS)[4] through a pilot program.
  • Identify and pursue opportunities to integrate service delivery tailored to meet customer needs, either virtually through the use of innovative technology, in an ESA office location, or via out- stationing of our staff and resources.
  • Identify opportunities to partner through grant pilots
  • Expand Partnership for Re-Employment Project (PREP)[5] from locations in one region to locations in two regions by 2021.
  • Collaborate with the Governor’s Interagency Workgroup on Poverty Reduction to develop the framework for reducing intergenerational poverty.
  • Improve service alignment with the Department of Corrections for individuals leaving correctional facilities and re-entering local communities. 

Increase child support collections.

Decision Packages: 060 – PL – FX – Modernize SEMS, 060 – ML – FA- Families Forward Washington Grant, 060 – PL - Q2 – Partnership for Reemployment Backup, 060 – PL – QE – Contractor Reporting, 060 – PL – FE- Child Support Annual Fee Increase

 

Importance: Child support represents more than 40 percent of the income for very poor families. Consistent child support payments and resources for the whole family contribute to a family’s economic stability and their ability to exit the Temporary Assistance for Needy Families (TANF) program due to self-sufficiency.

 

Success Measure:

  • Increase current support collected from 66.8 percent in federal fiscal year 2017 to 70 percent by federal fiscal year 2021.
  • Increase the average “percent of increase” of current support paid by Partnership for Re-Employment Project (PREP)[6] participants from 26 percent as of February 2018 to 33 percent by June of 2021.
  • Increase the income and child support payments for 55 percent of Families Forward Washington (FFW)[7] participants between January 2019 and June 2021.

 

See Chart E1.3: Percent of current child support collected

 

Action Plan: 

  • Propose legislation to require contractor reporting of sub-contractors through the Washington State Support Registry.
  • Improve IT support for prosecuting attorneys to aid in child support establishments and modifications.
  • Provide opportunities to low-income non-custodial parents to increase earnings capacity, skills, and financial literacy and enable them to better support themselves and their families and result in more regular, consistent child support payments.
  • Propose legislation to reduce the threshold amount of “25 percent above or below” for modification review to allow more flexibility to change child support orders[8]

[3] Solutions for Transitioning Parents (STP) program is a collaboration with Washington’s Division of Child Support (DCS) Seattle Field Office and the South Seattle College Solutions for Transitioning Parents (STP) program and various other Local Community-Based Organizations and Partners to assist previously incarcerated adults living in King County to successfully transition back into the community. 

[4]  The Disability Case Processing System (DCPS) is a new, nation-wide claims processing system being developed to process SSA disability cases. WA DDS is involved in the beta testing and pilot project to roll out this system.

[5]  Partnership for Re-Employment Project (PREP) is a collaboration between Division of Child Support and Employment Security Department/WorkSource providing comprehensive training and employment services to parents who owe child support.

[6]  Partnership for Re-Employment Project (PREP) is a collaboration between Division of Child Support and Employment Security Department/WorkSource providing comprehensive training and employment services to parents who owe child support.

[7]  Families Forward Washington (FFW) is a grant project working with local service providers in Benton and Franklin counties.  The program will test new strategies to improve the earnings capacity, skills and financial literacy of low-income parents who owe child support but are unable to fully meet their obligations due to low earnings. 

[8] Current law provides that, in order for the Division of Child Support to file an action for modification or adjustment of an order, the child support order must be at least twenty-five percent above or below the appropriate child support amount.  This can be too restrictive in some cases and does not allow the department to pursue a modification or adjustment when the change would be beneficial for the family but does not meet the 25% threshold change.

Increase organizational efficiency, performance, and effectiveness

Importance: At DSHS, we strive every day to get even better at what we do, no matter how each of us contributes to our agency mission. If we are to continue transforming lives, an important piece of that is transforming ourselves. Our most important resource is our professional, caring, compassionate staff. We need to continue our efforts to be an employer of choice – recruiting and retaining individuals committed to a career in public service. We will keep a laser focus on equity, diversity and inclusion. Those values are foundational to every aspect of our work with clients and in our day-to-day interactions with each other. Data will be used to drive decisions that will ensure our work is effective, efficient and accurate.

 

Based on this, DSHS has established the following strategic objectives to support how we will increase organizational efficiency, performance and effectiveness.


 

CUSTOMER SERVICE

 

Ensure customers can easily access the DSHS website and that it is user friendly.

Importance: The DSHS website is the first place people go to find out information about our agency and our services. Our clients, employees, providers, members of the media and the public expect and deserve accurate, timely and easy-to-find materials. Readily available, well-organized and correct information will help accomplish all five of the Secretary’s goals.

 

Success Measure:

  • Ensure visitors to the DSHS website find current, accurate and easily navigable information 100 percent of the time by December 2019.
  • Reduce the number of calls to constituent services looking for information on the website by 5 percent by December 2019.

 

Action Plan:

  • Redesign website.
  • Upgrade to supported software.
  • Perform customer usability testing.
  • Measure monthly, comparing pre-redesign to post-redesign data:
    • Number of “hits” on DSHS website and sub-sites.
    • Number of visits to physical offices.
    • Number of queries to webmaster and constituent relations from people noting website issues (broken links, incorrect information, etc.

 

TIMELINESS FOR CLIENTS

 

Meet or exceed Social Security Administration (SSA) timeliness goals.

Importance: Social Security disability benefits are critical to individuals with disabilities to meet their basic needs, and timely processing is essential.

 

Success Measure: Meet or exceed the national average processing time[9] for initial disability determination of Social Security Disability Insurance (SSDI) and SSI from October 2019 to September 2021.

 

See Chart E1.7: The average time to process initial disability determinations for Social Security Disability Insurance cases (Title II-SSDI), and for Supplemental Security Income cases (Title XVI-SSI)

 

Action Plan: 

  • Continue working with the Pre-Development Unit (PDU)[10] to find efficiencies prior to sending to adjudicators.
  • Explore methods to increase information technology functionality as we transition to the new, nationwide Disability Case Processing System (DCPS)[11].
  • Explore ways to use customer feedback to improve business processes.
  • Engage support staff and examiners in streamlining disability case processing.
  • Continue working with DDS desk coverage adjudicators to find efficiencies in their business process.

CLIENT DATA

 

Proactively protect confidential client information and enhance data security

Success Measure: Confidentiality breaches remain under 45 each calendar year by December 2018.

 

See Chart OPR1.1: Number of reportable confidential data breaches per year

 

Action Plan:    

  • Train staff in the handling of confidential information.
  • Create mitigation plans and take required actions to reduce incidents and improve information security.

Success Measure:  Complete 100 percent of HIPAA risk assessments on DSHS information assets by July 2019.

 

Action Plan: 

  • Perform risk assessments on covered DSHS systems.
  • Conduct risk analyses on Department information assets.
  • Implement corrective actions that arise from risk analyses.

 

CLIENT INFORMATION TECHNOLOGY, SAFETY, and RISK MANAGEMENT

 

Ensure the protection of confidential client information and enhance data security.

Decision Package: 150 – PL – GE – Enterprise Security Modernization

 

Importance: DSHS manages many information technology systems that capture, store and provide access to data, including highly confidential and regulated information such as client and employee Social Security numbers and financial information, as well as medical and mental health information. DSHS must, by law, protect the confidentiality, integrity and availability of this data. Improving information security reduces risk to the agency and clients we serve, increases regulatory compliance, and supports the mission of transforming lives.

 

The following success measures and associated actions are dependent on funding for staff and technical resources. 

 

Success Measure: Implement data recovery services that give DSHS the ability to recover from catastrophic disaster or data corruption such as ransomware by June 2020.

 

Action Plan:  

  • Increase storage capacity at Quincy Data Center to improve disaster recovery capability.
  • Hire one Information Technology Specialist 5 for management of the CommVault backup solution.
  • Configure all remaining critical IT systems to back up databases and files to the CommVault solution at the Quincy Data Center to improve disaster recovery capability.
  • Develop and implement a testing plan to periodically ensure restoration of the data is functioning as intended.

 

Success Measure: Implement an enterprise information systems tool and resources to detect malicious or harmful activity on systems that comply with regulations and secure our systems more effectively by June 2020.

 

Action Plan:

  • Purchase licenses and hardware for a Security Information and Event Management (SIEM) tool.
  • Hire one IT Systems/App Specialist 6 to administer the SIEM tool.
  • Hire three IT Specialist 5s to analyze, validate, respond to alerts and events generated by the Security Information and Event Management tool, and backup the administrator function.

Success Measure: Implement a software inventory tool that will allow DSHS to delete unneeded software; ensure that only authorized software can run; and ensure all software is current, patched and licensed appropriately by June 2020.

 

Action Plan:

  • Procure software asset management tool.
  • Hire two IT Specialist 5 analysts to administer the system and act on the information provided by the tool.
  • Analyze agency software assets and validate license usage, identify insecure unauthorized software.
  • Close corrective action plans identified as being satisfied through this implementation.

Success Measure: Develop a segmented DSHS network that will meet federal guidelines and achieve compliance standards June 2020.

 

Action Plan:

  • Procure a micro-segmentation tool to help with security.
  • Use design and deployment services to architect the environment.
  • Implement segmentation based on design.

 

Increase the security of customer information.

Decision Package: 060 – PL - Q3 – Critical Systems Risk Mitigation

 

Importance: Federal and state laws and agency policy require the protection of sensitive customer data. Our customers also trust we will safeguard their personal information. This is a challenging task in an era in which individual identities and their associated information are marketable commodities. We must continually protect this information through constant vigilance, proactive measures and anticipation of future threats without limiting the ability to share data in the pursuit of customer service and department goals.

 

Success Measure: Implement 80 percent of the prioritized mitigation strategies to decrease the display and/or inappropriate disclosure of Social Security and bank account numbers by April 2020.

 

Action Plan: 

  • Continue to engage the interdisciplinary team and stakeholders to identify how to appropriately minimize the collection and exposure of sensitive customer data.
  • Continue to communicate and collaboratively work with Economic Services Administration (ESA) Security team, Enterprise Technology Security team, Washington Technology Solutions, Division of Child Support Security team, Health Benefit Exchange Security team and participate in the development of enterprise security initiatives.
  • Increase coordination with federal and state partners to maintain information security. In addition, regularly communicate with the Centers for Medicare and Medicaid Services Affordable Care Act Security team to ensure it is aware of project’s security initiatives and activities.

 

Protect sensitive client data.

Importance: DSHS integrates sensitive, identified client data from multiple DSHS and partner agency data systems. Federal and state laws and agency policies mandate protection of this data.

 

Success Measure: Ensure there are no breaches of client confidentiality in the operation of any data system or application containing sensitive client data each year.

 

Action Plan:

  • Follow policies and procedures that meet federal, state and agency data security and privacy requirements.
  • Prioritize and mitigate high-priority security gaps; timelines will be developed for addressing lower priority gaps.
  • Implement organizational changes in the handling of identified client data to use non-identified limited data sets for internal analyses not requiring access to direct client identifiers.

 

STAFF TIMEINESS

 

Conduct timely assessments to ensure that services authorized are adequate in supporting identified health and welfare needs.

Decision Packages: 040 – PL – ET - CARE Modernization, 040 – ML – OU - Forecast Cost-Utilization, 040 – ML – 93 - Mandatory Caseload Adjustments, 040 – ML – 94 - Mandatory Workload Adjustment, 040 – ML – DQ - RHC - Compliance, 040 – PL – 4A - Financial Eligibility Capacity, 040 – PL – 4V - Critical Services and Supports

 

Importance: Assessments are used to identify a person’s health and welfare needs, determine financial and functional eligibility and the service(s) a person is authorized to receive. It is important to complete assessments timely because they affect a person’s life and because it improves service delivery.

 

Success Measure: Maintain a 95 percent on-time completion rate of initial assessments by June 2019 to ensure support needs are evaluated timely.

 

See Chart ADX.24: Percent of initial assessments completed on-time for clients with developmental disabilities requesting services

 

Action Plan: 

  • Provide a monthly assessment timeliness report to regional leadership teams.
  • Review performance data quarterly with regional executive management teams.
  • Provide case resource managers training and ongoing support to better equip them with knowledge and skills to administer an assessment.

 

Success Measure: Maintain a 99 percent on-time completion rate of annual reassessments to review the effectiveness of authorized services and determine if support needs have changed by June 2019.

See Chart ADX.1: Percent of annual reassessments completed on-time for clients with developmental disabilities requesting services

 

Action Plan: 

  • Provide a monthly assessment timeliness report to regional leadership teams.
  • Review performance metric data quarterly with regional executive management teams.
  • Provide case resource managers training and ongoing support to better equip them with knowledge and skills to administer an assessment.

 

Success Measure: Maintain on-time completion of annual individual habilitation plans of individuals residing at a residential habilitation center at 95 percent or greater each quarter by June 2019.

 

Action Plan:

  • Provide a monthly report regarding timeliness of completing individual habilitation plans.
  • Quarterly review a sample of individual habilitation plans at each residential habilitation center to ensure they are updated within a year of the individual habilitation plans.
  • Provide residential habilitation centers with a quarterly report showing the trend of timeliness in completing individual habilitation plans.

 

Increase efficiency and timeliness of background check services through continuous improvement.

Importance: BCCU processes thousands of background checks daily.  Many background checks have associated forms, phone calls, emails, legal documents and research BCCU must process in conjunction with the Background Check Authorization Form to ensure the most thorough and accurate results are reported.  BCCU strives to apply continuous improvement principles and process improvement techniques to deliver the most effective and efficient customer service. It is also important that BCCU assist applicants in removing employment barriers that result from unclear or outdated criminal history information.    

 

Success Measure:

  • Decrease turnaround time for applicants submitting additional information (court documents and affidavits) from an average of three business days in June 2018 to two business days by June 2021.
  • Decrease the average number of days it takes to process general name and date of birth background checks from an average of five business days in June 2018 to two business days by June 2021.

 

Action Plan:    

  • Increase hours that processing staff are available to answer technical questions regarding court documents and applicant affidavits to four hours per day to decrease incorrect/incomplete records submitted and voicemails from applicants.
  • Monitor monthly the average numbers of days it takes for BCCU to process general name and date of birth background checks and additional information (court documents and affidavits). 
  • Hold stakeholder meetings with various programs to continually increase awareness of BCCU processes and identifying any impacts to both internal and external customers
  • Conduct internal and external customer outreach via surveys or other methods regarding the new online background check system to identify future enhancements to processes.

 

DATA

 

Strengthen and standardize behavioral health data collection and analysis to ensure consistent, reliable data reporting across the behavioral healthcare continuum.

Importance: By developing an integrated research, data and analysis process, Behavioral Health Administration (BHA) will improve accountability and increase transparency of information, management decisions and policy development. This effort also will strengthen the management of change, monitoring of service delivery quality and outcome analysis for the entire organization.

 

Success Measure: Implement standard and consistent processes for collecting and analyzing data across the behavioral health continuum by June 2019.

 

Action Plan:

The Behavioral Health Administration will work with DSHS divisions to:

  • Develop an inventory of performance monitoring and reporting within the system, and working with primary stakeholders, identify system-wide performance and reporting requirements.
  • Develop an overall accountability framework that outlines performance reporting requirements for key target audiences, including timing, indicators, and data collection responsibilities and creation of an action plan to implement the accountability framework and performance measurement system.

 

Budget requests will be increasingly informed by the use of analytics.

Importance: Decisions grounded in well-researched, professionally analyzed data help the Office of Financial Management (OFM) and legislative staff make the highest value funding decisions on behalf of the state when creating operating and capital budget proposals.

 

Success Measure: 100 percent of DSHS decision packages will have analytic-supported data by October 2019.

 

Action Plan: 

  • Align the capital budget process with the operating budget process to capture efficiencies, increase communication and leverage talent across the organizations starting in June 2018.
  • Integrate the Behavioral Health Administration’s fiscal and analytical team with the Financial Services Division, Central Budget Office and Research and Data Analysis Division (RDA) to inform decision-making, increase communication and leverage talent across the organizations starting October 2018.
  • Develop a vetting or review process for agency decision packages by January 2019.

 

Develop and implement business intelligence infrastructure to support data-driven decisions and provide program self-service.  

Importance: The ability for programs to have real-time, self-service access to critical data, with analytical support as needed, will strengthen data-driven decision-making throughout the organization. 

 

Success Measure:

  • Research and procure a business intelligence (BI) system that meets the needs of all user roles across the organization by August 2019.
  • Fully implement a BI system to include automated reporting functions by June 2021.

 

Action Plan: 

  • Establish a workgroup to research the functionality of available platforms and identify the needs of user roles across the organization, including technical/ security staff, report developers, and end users.
  • Procure and deploy enterprise BI software that meets the business requirements for Economic Services Administration (ESA).
  • Implement a data governance model to develop shared decision-making, define authority and management of shared data assets, and facilitate and support development of BI capacity at enterprise and division levels.
  • Establish a Business Intelligence User’s Group to promote skill development in business intelligence throughout ESA.

 

QUALITY ASSURANCE

 

Improve the behavioral health system through integration of health services and workforce development.

Decision Packages: 030 - PL - ESH/WSU - Psychiatric Residency Program, 030 - PL – RH Direct Care Nursing Staff Backup, 030 - PL - RW – Forensic Training Programs

 

Importance: Behavioral Health Administration (BHA) faces a shortage of medical professionals to ensure adequate and appropriate staffing, quality patient care, safety of patients and staff and staff retention.

 

Through residency programs, internships, fellowships and workforce development, BHA hopes to retain individuals when they complete these programs. Having had the opportunity to work for the units, new medical professionals will have a greater awareness of the work environment and the significance of the services they can provide.

 

Success Measure: Develop new and improve existing medical professional development internship and residency programs by June 2021.

 

Action Plan:

  • Retain the majority of graduates from a BHA internship or fellowship program that teaches the practice of forensic psychology.
  • Create a collaboration between Eastern State Hospital and Washington State University to create a psychiatric residency program.
  • Begin providing in-house preceptors for new and existing staff creating an opportunity for education, career growth, and job success at Western State Hospital.

 

Continually improve DSHS organizational performance through strong management practices and by building a DSHS quality management culture.

Importance: In September 2013, Governor Jay Inslee issued Executive Order 13-04 which stated, in part, that “Washington state and its public servants are committed to the continuous improvement of services, outcomes and performance of state government, to realize a safe, beautiful and healthy place to live and work.” 

 

Success Measure: By November 2019, maintain or improve DSHS performance by 2 percent on select DSHS Employee Survey questions.

 

Action Plan:

  • Implement new training to support DSHS staff and leaders in providing quality services.
  • Develop a graphic to include in the strategic plan, posters and other communication media to help DSHS staff understand how their work aligns with the agency’s and Governor’s goals. Publish this graphic on the DSHS main internal communications SharePoint site, Inside DSHS, in the Office of Communications’ This Week on Inside DSHS and on all administrations’ internal SharePoint sites.

 

Conduct quality assurance (QA) activities and comply with federal, state and program requirements.

Importance: Timely completion of quality assurance (QA) activities helps protect the health and safety of clients, secures federal funding and provides oversight of operations. Activities include completing QA reviews to ensure compliance with quality measures; data analysis to identify gaps in the processes being used based on QA review results; developing proficiency improvement plans using root cause analysis; and developing interventions/countermeasures to address the root cause using feedback from staff at all levels. Through this function, Aging and Long Term Support Administration (ALTSA) will get more predictable outcomes that will ensure access to client services is timely and responsive to assessed needs that providers and/or facilities are qualified to provide services, provider networks are adequate and federal assurances are met. Identified deficiencies are remediated and proficiency improvement plans are developed and monitored to ensure continuous quality improvement.

 

Success Measure: Maintain 100 percent completion of Home and Community Services Division case management, Adult Protective Services and financial eligibility compliance record reviews each calendar year.

 

See Chart AAH.9: Home and Community Services Quality Assurance – Timely Reviews

 

Action Plan: 

  • Provide consultation to, review and approve Home and Community Services and Area Agency on Aging (AAA) office-specific proficiency improvement plans. Address areas in which proficiency standards are not met.
  • Analyze statewide trends and adopt training, technical assistance, policy revisions or other action as necessary.
  • Gather and evaluate feedback from consumer surveys.

 

Success Measure: Achieve 100 percent completion, within 90 days of the monitoring exit interview, of all final reports for the AAAs during each calendar year by December 2018. Maintain perfect record through 2021.

 

See Chart AAH.10: Area Agencies on Aging Quality Assurance – Timely Completion

 

Action Plan: 

  • Streamline AAA monitoring activities, including early, consistent deadlines.
  • Coordinate with the DSHS Office of Indian Policy and follow all steps included in the Tribal Communications Protocol.

 

Success Measure: Increase the percentage of audited Nursing Home Statements of Deficiency sent to the facility within the federal regulatory standard to 95 percent by June 2019.

 

See Chart AAR.6: Residential Care Services Quality Assurance – Nursing Home Statements of Deficiencies Sent Timely

 

Action Plan: 

  • Use continuous quality improvement internal controls to track timeliness.
  • Request state funding to replace expiring federal funding and sustain the Residential Care Services quality assurance team.

 

EMPLOYEE ENGAGEMENT

 

Partner to provide expertise and resource hiring, developing and retaining knowledgeable and engaged employees and leaders.  

Decision Package: 110 – ML – KF – Rightsizing HR Services

 

Importance: Employees are the most valuable asset of the agency.  DSHS can’t fully achieve our goals or deliver quality services to our communities unless we have knowledgeable, engaged and dedicated employees.

 

Success Measure: Improve agency access to Human Resources (HR) staff resources. A new HR model – Transform HR – will be operational within current budgeted resources by June 2019 and fully operational by June 2020 with additional employees.

 

Action Plan: 

  • Design and implement Transform HR for increased efficiency, effectiveness and consistency to better align with DSHS’ business needs.
  • Expand strategic partnerships with administrations that allow for flexible service delivery to support changes in administrations and strengthen partnerships with customers across the agency.
  • Implement modern hiring/selection/and screening practices for expedited hire times, improved candidate quality and to ensure our clients are safe and well-served.
  • Create a culture of continuous learning by partnering with customers at all levels to provide quality learning experiences that prepare and cultivate skilled leaders for the agency.
  • Leverage HR technology solutions to automate processes and access to information/data for organizational effectiveness and sound business decisions.

 

Develop the DSHS infrastructure to support a modern and mobile work environment and create an organizational culture that empowers employees with choice, enables excellent performance and supports an environment of inclusion.

Importance: DSHS’ goal is to develop an organizational culture that supports the needs of employees, provides flexibility and mobility for staff, reduces impact on the environment, provides a supportive and productive work environment, attracts and retains talented employees and promotes work/life balance.

 

Success Measure: Design, develop and implement the modern and mobile work environment requirements in Governor’s Executive Order 16-07 and the Workplace Strategy Council no later than July 2019.

 

Action Plan:  

  • Determine positions eligible for teleworking and flexible work schedules.
  • Develop and implement plans to support a culture that enables a mobile workforce and creates a modern work environment.
  • Foster the culture of a mobile workforce and a modern work environment.
  • Services and Enterprise Support Administration (SESA) and Facilities, Finance and Analytics (FFA) will measure implementation of modern workplace strategies.

 

INFORMATION TECHNOLOGY, SAFETY, and RISK MANAGEMENT

 

Ensure investments in modernization are aligned with agency business objectives.

Decision Packages: 150 – PL – GE – Enterprise Security Modernization, 150 – PL – GD – Network Modernization

 

Importance:  The rapidly changing technological environment and our desire to provide client services at the point and time of need in a secure manner require strong, foundational IT governance. IT governance provides the processes, policies, measurement methods and communication to help DSHS meet federal and state regulatory requirements and align IT strategy with business objectives to ensure work efforts and investments deliver value.

 

Employing industry best practices through well-thought-out success measures will improve DSHS’ ability to ensure quality service delivery, control costs and increase transparency. The following success measures will continue to improve critical aspects of IT governance.

 

Success Measure: Expand IT portfolio management capabilities in a phased approach to encompass the entire DSHS enterprise to increase investment awareness, provide investment decision perspectives and to aid in translating DSHS IT strategy into prioritized programs and projects by June 2020.

 

Action Plan:  

  • Define, identify, and consolidate IT portfolios throughout DSHS.
  • Build and improve the DSHS IT Portfolio Management Program using industry best business practices and tools.
  • Institute a portfolio dashboard to accurately track assets and services.

 

Success Measure: Expand IT asset management capabilities and practices to effectively align fiscal, inventory and lifecycle components to enable investment decision-making by June 2020.

 

Action Plan:    

  • Build and improve the DSHS IT Asset Management Program using industry best business practices and tools.
  • Assess, select and implement a software asset management tool to improve licensing and budgeting, and to reduce compliance and security risks.
  • Publish a concise IT asset management process framework outlining how DSHS will track IT assets from requisition through retirement.

 

Success Measure: Improve the DSHS Enterprise Architecture Program to enable the agency to increase the pace of modernization and identify and communicate enterprise IT requirements aligned with business strategy by June 2019.

 

Action Plan:    

  • Complete the buildout of the DSHS current state architecture to visualize the administration’s lines of business, IT systems and the people who use them to assist in designing and building a future state.
  • Develop agency information systems and technology flows and functionality to assist in defining the program of works required to develop and deploy the future state architecture.
  • Build and foster an enterprise architecture community of practice that incorporates representatives from across the agency to improve collaboration, set realistic strategic goals and increase competencies.

 

Success Measure: Enable integration and improved interoperability between IT systems across DSHS by June 2019.

 

Action Plan: 

  • Analyze and better understand DSHS’ critical information technology systems and their connections to determine how to enable modernization, improve their usability, improve secure data integration and create reusable components.
  • Analyze and better understand how data flows through key DSHS information systems to identify opportunities to gain efficiencies and improve how systems integrate with each other.
  • Establish an information system integration modernization roadmap to lead DSHS to a future state integration framework which allows for real-time, interactive exchange of information in support of providing citizens who need services in a secure and timely manner.

 

Proactively improve network services and protect confidential data to achieve network and infrastructure modernization.

Decision Package: 150 – PL – GD – Network Modernization

 

Importance: The DSHS network and infrastructure provide access to confidential client, staff, and agency data. Modernizing the infrastructure will promote efficient and secure access to this data in support of DSHS clients, staff, and customers. This objective aligns multiple projects and allows actions to be prioritized in modules as staff and technical resources become available. 

 

Success Measure: Improve capacity, performance and security posture of the DSHS infrastructure by aligning with information technology best practices in the data center and remote site locations by June 2019. 

 

Action Plan:  

  • Develop and approve remote site and data center functionality and flows to include Internet Protocol Version six addressing for computers and networks and quality of service monitoring.
  • Begin phased implementation of approved communication platforms at remote sites and the data center.
  • Complete scheduled statewide network upgrades.

 

Success Measure: Modernize or replace statewide DSHS telephony platforms to use current, supported industry solutions, aligning with the statewide strategy to phase out 10 percent of digital services by June 2020.

 

Action Plan:    

  • Develop DSHS Voice over Internet Protocol (VoIP) and/or unified communications business strategy by June 2019.
  • Establish DSHS standards in alignment with proposed state Office of the Chief Information Officer strategy requiring all new purchases to be VoIP and/or unified communications by June 2019.

 

Success Measure: Plan and implement network modernization in support of business continuity/ disaster recovery at all DSHS critical remote sites by June 2019.

 

Action Plan:    

  • Develop implementation strategy for data center redundancy.
  • Build out the Quincy Data Center in phases to meet current and future DSHS disaster recovery requirements.
  • Design and install redundant connectivity solutions at DSHS critical sites.
  • Develop an agency technology roadmap of change initiatives that are required to achieve the future state.

 

Improve the ability to recover critical IT applications during an emergency event.

Decision Package: 110 – PL - KE - Cyber-Security & Modernization

 

Importance: The vast majority of services provided by Services and Enterprise Support Administration (SESA) and the Facilities, Finance and Analytics Administration (FFA) depend on reliable IT applications. A well-planned, well-tested disaster recovery plan for IT applications ensures SESA and FFA can continue to operate consistently, even during an emergency. Extended down-time for these IT applications affects SESA/FFA operations and consequently affects direct service delivery functions provided by SESA/FFA.  

 

Success Measure: Ensure that all disaster recovery plans for TSD-supported applications are up-to-date and tested by June 2019.

 

Action Plan:    

  • Complete SESA/FFA business operational impact analysis.
  • Complete disaster recovery plans for all TSD-supported applications
  • Conduct testing of all disaster recovery plans for all TSD-supported applications.

 

Meet or exceed federal and state program integrity standards.

Decision Package: 060 – ML - F8 – Meet or Exceed Integrity Standards

 

Importance: A strong, collaborative program integrity effort is vital for the public to have confidence that Economic Services Administration (ESA) programs, policies and processes work together to achieve accurate service delivery.

 

Success Measure: ESA and Office of Fraud and Accountability (OFA) Program Integrity teams will assess the action plan items and develop this measure by December 2019.

 

Action Plan: 

  • Increase capacity to conduct case reviews, targeted root cause analyses and resulting identification of program and policy integrity improvements.
  • Review program audit reports and other relevant information to assess risks, identify trends and create action plans.
  • Increase data and information sharing at national level and with other states.
  • Expand recipient integrity education initiatives to increase fraud prevention efforts across multiple public assistance programs.

 

Meet constantly changing business needs with modern technology/architecture.

Decision Packages: 060 – PL – FX - Modernize SEMS, 060 – PL - Q4 – Business and IT Transformation, 060 – PL - Q3 – Critical Systems Risk Mitigation, 060 – PL – FY Billing and Collections System

 

Importance: Our ability to provide superior customer service relies heavily on technology that is secure, responsive to business needs, user-friendly and available with minimal down time. The current Automated Client Eligibility System (ACES) complex and Support Enforcement Management System (SEMS) rely on old programming languages and time-intensive development processes, and each uses multiple system architectures. Economic Services Administration (ESA) is committed to meeting business needs while embracing the opportunity to create enterprise architecture shared among the state agencies providing health and human services.

 

Success Measure:

  • Establish a modern architecture for mission critical systems that is secure, responsive to business needs, user-friendly, and available with minimal down time by October 2025.
  • Complete mainframe re-hosting and begin use by June 2021.

 

Action Plan: 

  • Work with business and technical staff from the Washington state health and human services agencies to establish a clear vision of the scope of work and business processes we support in eligibility, payments and authorizations that must be integrated into successful enterprise architecture.


 

Develop tools to support staff’s core work and the service delivery system, including updates to technology, payment systems and improvements in applications and data analysis.

Decision Package: 050 - PL - E7 - IT - Systems Modernization

 

Importance: Developing tools for staff to do their jobs quickly and easily, with added value, supports employee engagement. It is also a type of continuous improvement that can result in better outcomes for clients and residents and better use of limited state and staff resources. This type of work is primarily the duty of the Management Services Division and other support staff throughout Aging and Long Term Support Administration (ALTSA).

 

Success Measure: Develop prioritized tools to support identified staff needs by June 2019.

 

Action Plan

  • Provide universal remote access and mobile IT tools to field staff in Residential Care Services and Home and Community Services.
  • Construct data marts for on-demand access to client demographic and service performance data.
  • Support the Medicaid Transformation Project.

 

Create a culture of risk awareness and mitigate identified high priority/serious exposure agency risks.

Importance: The Governor’s Executive Order 16-06 highlighted the need for all state employees to be aware of and know how to assess risk in their daily duties. DSHS is responsible for safeguarding state resources, most importantly client and employee welfare. It is necessary to assess potential risks to the quality of care for our clients and to our business operations. DSHS leaders must understand the most serious risks and make informed decisions about how to use resources mitigate them. In addition to preventing loss of life or assets and/or litigation, developing and sustaining a risk management framework throughout DSHS can lead to innovation in mitigating risk. DSHS’s risk management initiative is critical to comply with the executive order.    

 

Success Measure: DSHS supervisors, management staff and frontline staff will complete risk awareness and assessment training by June 2021.

 

Action Plan:

  • Advertise and promote risk awareness and assessment training to supervisors, managers and front line staff.

     

Success Measure: Communicate across the agency to raise risk awareness.

 

Action Plan:

  • Send a monthly communication about risk to all staff.

  • Publish 15 risk-related articles in DSHS’ internal communications options, Inside DSHS and This Week on Inside DSHS, by June 2019.

  • Make a series of videos available to all staff on basic elements of risk management and on mitigating risk.

 

Success Measure: Build a comprehensive process of identifying, organizing, prioritizing and mitigating risks.

 

Action Plan:

  • Develop a consolidated agencywide risk register by May 30 of each year.
  • Provide an up-to-date risk register to the Department of Enterprise Services by September 1 of each year.

 

Identify and prioritize contingency needs to address the continuity of all mission-essential functions.

 

Importance: DSHS must be prepared for an incident that necessitates the evacuation of any business office or residential program when transportation, relocation and staffing of mission-essential services is necessary. This is an especially challenging and high-risk undertaking for DSHS’ residential programs.

 

Federal funding requirements and state law stipulate development and maintenance of continuity plans, and training and exercises. When it is not in full compliance with these requirements, the department risks harm to clients and employees during emergencies, loss of federal funds, tort claims and lawsuits for failing to adequately plan for disruptions caused by emergencies.

 

Success Measure: Increase the percentage of administrations with complete and sufficient continuity plans approved by the responsible Assistant Secretaries and submitted to DSHS Emergency Management Services to 100 percent by June 2019.

 

Success Measure: Increase the percentage of complete and sufficient continuity plans approved by the responsible Superintendents or CEOs for DSHS-operated residential programs that are submitted to DSHS Emergency Management Services to 100 percent by June 2019.

 

Success Measure: Ensure all residential programs’ include a strategy reflected in their budget request around improving their ability to continue operations during a disaster. This strategy should be in their budgets by June 2019.

 

Action Plan: 

  • Ensure administrations and residential programs submit action plans addressing all of the above success measures to DSHS Emergency Management Services.
  • Ensure administrations and residential programs submit quarterly reports to DSHS Emergency Management Services describing outcomes related to continuity planning (including budget requests), training and exercises.

 

Update and enforce agencywide leased space standards.

Importance: Agencywide leased space standards support efficiencies of scale and cost-savings.

 

Success Measure: Complete agencywide leased space standards by September 2019.

 

Action Plan:

  • Create agencywide leased space standards for review by program Facility Coordinators by December 2018.
  • Schedule and hold stakeholder review meetings by June 2019.
  • Gain executive leadership support by September 2019.

 

EQUITY, DIVERSITY AND INCLUSION

 

Support and promote equity, diversity and inclusion (EDI) in the workplace through the increase of EDI competency.

Importance: Equity, diversity and inclusion are foundational and must be present in every aspect of our work at the Department of Social and Health Services. DSHS employees, whether working with clients or each other, must be constantly developing and practicing these core principles. This is the path forward for strengthening our effectiveness in helping those we serve and being in relationship with each other. A workplace environment of mutual respect and equal opportunity will lead to improved customer outcomes and a thriving organization.

 

Success Measure:  Ensure each administration fully integrates and uses performance-mapping to track progress on agencywide EDI initiatives by June 2019. These initiatives are:

  • A fully operational Equity, Diversity and Inclusion Council and fully developed EDI Communities of Practice focused on professional development and capacity-building.
  • Training and consultation for DSHS staff and external partners.
  • Business diversity.
  • Examining rules, compliance and reporting processes through an EDI lens.
  • Framing the DSHS organizational culture through an EDI lens.
  • Integrating EDI into policies, practices, legislation and budget.
  • Compliance with ADA, language and information technology access standards.

 

Action Plan: 

  • Provide performance-mapping training in each administration.
  • Identify measures to be used to track progress toward meeting DSHS’ key EDI goals in each administration. These goals are:
    • Be an EDI leader in workforce planning.
    • Be an inclusive workplace.
    • Promote business diversity/supplier participation.
    • Provide equitable access to services.
    • Champion EDI best practices.
    • Frame organizational culture through an EDI lens.
  • Compile and submit data quarterly and annually for each administration to use in reporting progress on their EDI initiatives.
  • Administrations will provide quarterly and annual reports to the DSHS Office of Equity, Diversity and Inclusion to determine which measures are being met and issues that need to be resolved.

  • Success Measure:  Use the Employee Diversity and Inclusion (EDI) Index[12] to create a baseline of employee attitudes and behaviors regarding EDI by December 2019.

 

Action Plan: 

  • Create and publish EDI Index baseline for DSHS.

  • Use the index to identify trends and measure progress against the baseline.

 

Success Measure:  Improve workplace and client service delivery by increasing certified diversity professionals (CDP) and executives (CDE) in identified roles by June 2019.

 

Action Plan: 

  • Identify essential positions that require certification.
  • Implement training for individuals to attain certification.
  • Further develop expectation for continuing education for those who achieve certification

 

Success Measure: Managers are well-versed in targeted recruitment strategies, reasonable accommodations, employee training and mentoring opportunities that foster a diverse and inclusive work environment.

 

Action plan:

  • The Office of Equity, Diversity and Inclusion will provide its expertise as recruitment, training and mentoring opportunities are developed.
  • Target recruitment efforts to diverse communities and organizations, job fairs, trade schools, colleges and universities and community organizations.

 

Advance equity, diversity and inclusion in our communities by increasing business opportunities for diverse suppliers and contractors.  

Success Measure:  Standardize how DSHS collects, formats and reports supplier diversity data in accordance with the Governor’s Subcabinet on Business Diversity recommendations.

 

Action Plan: 

  • Collect data from the Office of Minority and Women’s Business Enterprises (OMWBE) on DSHS vendor contracts.
  • Identify and consolidate DSHS supplier diversity data from multiple sources.

 

Success Measure: Increase expenditures* with:

  • Minority-owned (not including minority women) businesses from 2.61 percent (2018) to 4.75 percent by 2021.
  • Minority women-owned businesses from 1.46 percent (2018) to 3.25 percent by 2021
  • Women-owned (not including minority women) businesses from 1.65 percent (2018) to 3.5 percent by 2021.
  • Veteran-owned businesses from 2.6 percent (2018) to 5 percent by 2021.

 

*Only categories of spending that are included in OMWBE diversity participation reports will be included.

 

Action Plan:    

  • Increase outreach to diverse businesses.
  • Increase diverse business OMWBE/veteran certifications and Washington’s Electronic Business Solution (WEBS) registrations.
  • Collect feedback from the business community to address obstacles to doing business with DSHS.
  • Develop methods for forecasting expenditures with diverse businesses and contractors.
  • Provide administration-specific and department-wide reports on progress in meeting goals for contracting/spending with diverse businesses.

 


[9]  Economic Service Administration’s (ESA’s) processing time is compared to the national average published by the Social Security Administration on a continuous basis.

[10]  The Pre-Development Unit (PDU) develops claims by ordering medical records and sending out forms before being assigned to a claims examiner; which decreases processing times.

[11]  The Disability Case Processing System (DCPS) is a new, nation-wide claims processing system being developed to process SSA disability cases. WA DDS is involved in the beta testing and pilot project to roll out this system.

[12]  The EDI Index is a set of questions in the Employee Engagement Survey that reflect individual experiences related to diversity and inclusion.