Therap’s WHITE PAPERS:

Individual Access to Records in Therap

Therap is the industry leader in providing electronic records and documentation in services for people with intellectual/developmental and other disabilities. Therap is a web-based application suite that provides a comprehensive solution for the planning, documentation, reporting, communication and billing needs of organizations supporting people in home and community-based services and other settings. Using secure cloud technology, the Therap system helps agencies ensure high quality services and supports within day and residential programs, assisted living facilities, ICF/IID facilities, community support programs and state organizations. Daily communication and reporting between state agencies, program administrators, health care professionals, case managers, quality assurance teams and families becomes seamless.

Therap offers users a mature and stable automated system for electronic records. Therap users have access to a dedicated support team, multi-modal training and an array of local, state, regional, and national conferences and user groups.

The sole focus of the company’s work is to provide electronic documentation systems for those who provide services and supports to people in any setting. The system has been available as a commercial product since the company’s founding in 2003. This system was designed to be national in scope, compatible with any state I/DD system and other service and support systems, usable by multiple providers within a system, and usable by very small to very large providers and systems. Today, it used by providers in 49 states, by 13 state systems, and in ICF-IIDs throughout the country. More than 1,400 provider agencies, ICFs, and state agencies and other systems serving more than 210,000 individuals are Therap users.

Therap has a highly qualified staff of more than 150 employees with expertise in disabilities, service provision and management, person-centered services, information technology, systems operations, Medicaid, government, project management, and training and support.

Therap Services hosts data processing, storage, business continuity, and disaster recovery functions on its own servers providing a high level of state-of-the-art technology and system redundancy.

Therap Services LLC () is a Limited Liability Corporation registered in the state of Delaware. The home office is at 562 Watertown Avenue, Suite 3, Waterbury Connecticut 06708.

Self Advocacy

The idea of self advocacy for people with intellectual/developmental disabilities has been around for half a century. One of the first self advocacy group in the US was People First, organized in Oregon in the early 1970’s. The underlying philosophy was to change the paradigm from one of looking at a person’s disability first to one of looking at a person’s individuality first. Although deinstitutionalization was gaining momentum and had the potential to broaden the horizons of people with intellectual disabilities, decisions about the lives of these individuals remained almost completely in the hands of state systems that funded services and the evolving network of agencies that provided residential, vocational, and other program services. While the idea that people with intellectual disabilities could speak up for themselves and play the primary decision-making role in their own lives resonated with other civil rights movements, systems have been slow to make the changes that encourage elf-advocacy.

Good life decisions require access to information so an individual can understand options, ask questions, express doubts, and reach out for extra supports as needed. Attitudes have shifted to embrace the possibility that even significant disabilities, communications impairments and behavioral problems do not preclude a person’s desire to express opinions, have preferences, and make choices. But systems have been slow to provide access to information that an individual could use to make decisions about life choices.

Circles of Support

Some of the bright promise that accompanied deinstitutionalization has been elusive. Individuals with disabilities may live and work in community based settings but live lives in isolation. Their human relationships may be limited to those who are paid to provide care and services and other people with disabilities. Paid staff are often highly skilled empathic people who hold the best interests of those they care for in high regard. Still, traditional models of service provision have expected these staff people to make the best possible decisions for the people in their care, rather than to support those people in making those decisions for themselves.

The concept of circles of support evolved in the late twentieth century to address issues faced by other groups of people who were isolated from society. People leaving prison, for example, are often disconnected from friends, family, and community resources. The circle of support concept tries to assure that an individual has “a group of people such as family members, friends and others (resource people, staff) who come together to help a person to visualize express and accomplish his/her personal goals/valued outcomes.A circle of support assists the individual to make personalchoices and take charge of his life.” (NY OWPDD)

Knowledge is Power

The concepts of self-advocacy and person centered services are critical parts of the framework to assure that people with disabilities live meaningful and connected lives. Additional tools and resources are required before these ideas can change lives.

Traditionally, records about people receiving care from the state were kept for the benefit of the care providers and the care providing agencies. Staff people needed to communicate with each other about problems they encountered or incidents that occurred. Direct care people needed to inform health care personal about health and wellness issues. Record keeping requirements of funding sources needed to be met. All these functions are important for systems to run well, but they do not contribute to a person’s ability to make decisions about his or her life or for those people important in that life to help in the decision making process.

System centered thinking dictated that it was usually best to protect individuals and their friends and families from the content of records. The information in these records was often about things that went wrong and rarely contained any cause for celebration or acknowledgement of achievement. Inaccurate statements in records or descriptions of system lapses could be used against the agency. Privacy of individuals might be compromised. Access to records could cause undue stress or create bureaucratic or legal problems.

Even if records were available, individuals, family, or other support circle members faced many challenges. The reader had to go to where the record was stored, possibly within a limited time-frame. Records might have been incomplete or out of order. Much documentation was hand-written and hard to read and chances were slim that the person who created an illegible or confusing document would be available to the reader to answer questions. Correcting inaccuracies or amending records might have been technically possible, but in reality out of the question.

Electronic documentation

Electronic documentation is appealing for a wide variety of reasons. When documentation occurs as close as possible to the time and place of service delivery, accuracy and reliability of the information is enhanced. Documentation can occur and immediately become part of the record at any residential, vocational, community, or home setting. Information can be stored in such a way that it can be easily analyzed. Most demographic data needs to be entered just once, saving time and reducing the possibility of error. Coordinating data about the delivery of supports and services with billing, including billing multiple payment sources, can be achieved in an efficient manner. HIPAA compliance is enhanced and all records are easily auditable.

Therap has become the industry leader in electronic documentation for the developmental disabilities and related fields because its system is affordable, reliable, regularly updated, secure, and easy to use. Much of Therap’s popularity stems from the fact that user community has been integrated into the feedback loop of product development and enhancement. This has helped Therap to develop a very flexible suite of applications that can meet the needs of a broad variety of users.

Therap’s was founded by people with experience in the intellectual/developmental disabilities field who wanted to make a system that met the needs of providers, state agencies and individuals receiving supports and services. From the outset the system was designed to focus on the individual’s well-being. Therap’s system was designed with person centered services in mind. It is always up to date, accessible to everyone involved with a person’s well-being, and convenient to use wherever services and supports are delivered. This convenience and accessibility allows the person and anyone who is important them to be part of planning and articulating preferences in a meaningful and relevant way. Decision making can occur at a time and place that makes the most sense. Results of planning meetings are immediately available, even to those who were unable to attend.

Therap’s ISPmodule includes workflows that make it easy for a person, a case manager and/or other circle of support members to explore and record a person’s “dreams, interests, preferences, and strengths” (NY OPWDD) in advance of a planning meeting (Personal focus worksheet), and to expand on these ideas during the meeting itself (ISP Agenda and ISP Plan). This highly individualized approach inhibits the development of ‘cookie cutter’ goals, outcomes, or decisions made about the person based on system capacity rather than what is important to the individual. This format for person-centered planning strengthens the development and use of individualized supports. Underlying this process is the assumption of the basic human dignity of the individual that a person and those who know him or her outside of the context of being a “client” can bring to the planning and program implementation process.

Since individual information is stored in the cloud and is available in whole or in part to anyone who is granted access, there are no technical barriers to allowing people receiving supports and services and/or their family members and other member of their circles of support. Granting access fundamentally changes the relationship between the provider agency and the individual and those natural supports. The horizons of the planning process expand when these people have up to date information and the opportunity to communicate with other team members about the individual.

But this two way communication process contributes to individuals’ well-being at a more basic level. Family members and others have a context to integrate themselves into the life of the individual. They can have immediate information about incidents, who was involved, how people responded. They can offer suggestions to staff people based on the long term relationship they have had with the individual. The can learn, not only of planning meetings and agency business but about upcoming events that they may be able to encourage the individual to participate in or even join the individual at an event. Real two way communication between family members and program staff is a powerful tool. Family members can add depth and meaning to the basic demographic information collected at intake, can offer insights into why a person is drawn to some types of activities more than to others. Program staff can help families think about strategies to make visits or outing go more smoothly. Les tangibly, people who know one another and communicate regularly are more likely to celebrate successes and to problem solve together.

This partnership model does not stop with communication between the circle of support and the program or programs that support the individual, but can include that person as well.

While these opportunities to share access are consistent with evolving best practices in the field, there are many barriers to bringing them to reality. Staff are accustomed to writing about individual as if they and their families will never see what they wrote, and believe that it is important to communicate in this manner. People will read things that they won’t like to read, whether or not they are accurate or appropriate. People will try to communicate outside of the transparency of the formal record. While there is some truth to these concerns, their basis is primarily in fear of the unknown

At Therap, we recognize the huge potential the Therap system offers in nurturing person centered services though shared access with individuals and family members. Therap is actively helping agencies, family members and people receiving supports and services realize this potential and get past the myths and fears that stand in the way.

  • In 2014 Therap sponsored a two day conference for people with disabilities, their family members, and their circles of support in New Jersey. Participants at the conference had an opportunity to shift their perspectives from embracing individual’s access to their records as a program improvement strategy to considering that access as a right of anyone who ha a medical/clinical record.
  • Therap has two self advocates on the payroll who serve as liaisons to agencies that use Therap and to other self-advocate groups. They are part of the growing number of people who not only read their records on Therap, but also contribute to them. They have been attending various Therap conferences and are available to visit your agency.
  • You can learn more about our liaisons by visiting their blog at
  • Therap’s You Tube site includes videos featuring these liaisons, as well as videos about sharing data with family members and others.

Giving people access to their records is a big shift for any agency. Like any change, there is a learning process and it won’t all be perfect on day one. Therap’s person-centered philosophy, flexibility, security, and general ease of access make it an ideal system for sharing records. We know this has worked well in agencies that have been thoughtful about the process and taken it slowly. We also have support people, our liaisons, and contact at other agencies to help you plan and troubleshoot.

In the future, record sharing will become the norm. You have the opportunity to get ahead of the curve with Therap and begin to put the principles that underlie record sharing into practice. You will find that there are even more advantages to Therap’s totally integrated shared communication system than you ever imagined.Therap stand ready to help you move into the future.