Pennsylvania Office of Developmental Programs

Pennsylvania Office of Developmental Programs

Quality Assessment & Improvement (QA&I) Interview Questions Tool

Overview of the Quality Assessment & Improvement Process

The mission of the Office of Developmental Programs (ODP) is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives.ODP’s vision is to continuously improve an effective system of accessible services and supports that are flexible, innovative and person-centered.The QA&I Processis a way for ODP to evaluate the service delivery system. Individual interviews are an integral part of QA&I to identify ways to improve supports for all individuals.

QuestionPro Completion Tips and Successful Interview Strategies

The following guidelines are intended to help the Interviewercomplete this tool successfully.

1. Interviews should focus on the individual’s overall experience and not be specific to one service or support.
2. Interviews should be conversational and as relaxed as possible. There are no right or wrong answers.
3. The individual’s response should be prioritized over that of a proxy, guardian, family member, team member, etc. If someone other than the individual answers the question, use the appropriate section in this tool to indicate who answered the question.
4. Use the comment section to provide additional information about the individual’s answer and/or record answers by staff or family that differ from, supplement or augment the answer of the individual, where appropriate.
5. Any identification of health and safety issues should be immediately reported per ODP regulations and/or IM4Q policy.
6. ODP staff conducting interviews should communicate reports of dissatisfaction, issues and/or concerns by individuals interviewed from the Core Sample to the QA&I Regional Coordinator. IM4Q staff conducting interviews should document dissatisfaction, issues and/or concerns by individuals in the comment field under the question that initiated the report of dissatisfaction, issue and/or concern. AEs should address dissatisfaction, issues or concerns with the SCO and Provider. Identified issues and resolution are to be documented in the individual’s service notes by the SCO.
7. All answers should be recorded and then entered and submitted via QuestionPro within seven (7) days of the interview.The same QuestionPro link can be used for each interview.
8. Answers using the response option “Don’t know, no response, unclear response or individual does not communicate using words. Describe:” should include specification about which one occurred (e.g., individual did not know, there was no response, etc.).

Name & MCI # of Interviewee

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Date

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Name of Interviewer

# / Question / Who is asked the question / Core Sample Guidance
to assist the interviewer with question purpose and interpretation in order to obtain the information in lieu of simply asking the question.
Additional AE Provider Review Guidance / Response, Respondent and Comments
DEMOGRAPHIC INFORMATION
1. / Where did the interview take place? / Observation / The intent of the question is to record the location of the interview. This is an observation question and can be answered prior to the interview based on the location that the interview will be conducted.
AE GUIDANCE- The interviewer should list provider site/address if appropriate / Home
Work
School
Provider site/address: ______
Other place, please describe:______
Comment:
OBSERVATIONS
2. / Is the individual's preferred mode of communication used? / Observation / The intent of the question is to determine if the individual’s preferred mode of communication is used during the interview. Th interviewer should check the pre-survey or ISP, as appropriate,prior to the interview to compare the preferred mode of communication documented to what is used during the interview. The interviewer should observe if the preferred mode of communication is used during the interview and record it. If a device is present but not in working order, the interviewer should indicate such in the Comment section.
AE GUIDANCE: The interviewer should check the ISP prior to the interview to note the preferred mode of communication. / Yes
No. Why? ______
NA, no system is in place or none is needed
Comment:
3. / If the individual uses mobility equipment and other assistive equipment, is it:

• Available?
• In good working order?
• Clean?
• In good repair and free from hazards?

/ Observation / The intent of the question is to determine if the individual uses mobility equipment or assistance equipment and, if so, that it is maintained, in working order, clean, in good repair and free from hazards. The interviewer should observe and record the information. If an equipment need or use is not obvious, the interviewer should ask the individual if s/he recently got new equipment or if there is a need that has not yet been addressed. / Yes, the equipment is maintained, is in working order, is clean, is in good repair and is free from hazards.
No,the equipment is needed, not maintained, not in working order, not clean, not in good repair and/or is not free from hazards. Describe:
______
NA, there is no mobility equipment
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
INTERVIEW QUESTIONS
4. / Who usually helps you in your day to day life? / Individual / The intent of the question is to establish an understanding of the supports the individual receives. This question can be used as a tool for the remainder of the interview but is options. If chosen, the interviewer should record the individual’s answers – name and role or relationship - and use the information as part of the interview conversation. / Name & Role/Relationship:
1.
2.
3.
4.
Comment:
5. / Do you get to decide what your day is like? / Individual / The intent of the question is to determine if the individual has choice about his/her daily routine. The interviewer can use prompts such as does the individual have choice about when to get up, what to do each day, when to go sleep, etc. / Yes, the individual has total control of the daily routine
Yes, but the individual receives support to determine the daily routine
No, someone else decides the daily routine
Don’t know, no response, unclear response or individual does not communicate using words. Describe:______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
6. / Do you choose what you do? Do you decide where you go? Do you choose when you do things? / Individual / The intent of the series of questions is to determine if the individual has choice, control and freedom. Questions can be asked separately to achieve an overall answer about choice and control.The interviewer should discuss with the individual where and when s/he receives supports; whats/he likes or doesn’t like; and if there is opportunity for choice and control. / Yes, the individual makes his/her own choices and has control
Yes, but the individual is supported by family and/or staff to make choices
No,choices are made for the individual by family and/or staff
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
7. / Do you use your mode of communication everywhere you go, such as when you are at home, at work, at school and in your community? / Individual / The intent of this question is to determine the individual’s impression of continual use of his/her preferred mode of communication in all aspects of life. The interviewer should ask if the individual is able to use the preferred mode of communication everywhere s/he goes. / Yes, the preferred mode of communication is used everywhereNo, the preferred mode of communication is used only in some places and settings. Describe: ______
No, the preferred mode of communication is not used at all
NA, no system is in place or none is needed
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
8. / What do you like to do for fun or to relax? / Individual / The intent of this question is to learn the type of things the individual enjoys doing for leisure. The interviewer can guidance the discussion by asking questions such as "What do you do when you are not at work?", "Do you have a hobby?", "I see these items in your home (pictures, etc.) can you tell me a little more?” The interviewer should use answers to this question to support conversation in the remainder of the interview. / Record the important things:
1.
2.
3.
Don’t know, no response, unclear response. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
9. / Do you get to do these things as much as you like? / Individual / The intent of this question is to determine if the individual is able to participate in his/her favorite activities as much as possible. The interviewer should refer to information gathered in question #8. / Yes, the individual enjoys his/her favorite activities as often as s/he likes.
Sometimes the individual enjoys his/her favorite activities as often as s/he likes. Why? ______
No, the individual does not enjoy his/her favorite activities as often as s/he likes. Why?______
Never. Why?______
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
10. / Do you get support to do these things? / Individual / The intent of this question is to determine if the individual receives the necessary supports participate in his/her favorite activities. The interviewer should refer to information gathered in questions #8 and #9. / Yes, the individual receives support to participate in favorite activities.
Sometimes, the individual receives support to participate in favorite activities. Why? ______
No, the individual does not receive support to participate in favorite activities. Why?______
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
11. / Does your vision, hearing or how you get around make it hard for you to go places and do the things you want to do? / Individual / The intent of this question is to know if the individual’s vision, hearing or mobility needs may limit access to activities and if these limitations have been considered in how the individual is supported and/or can be better supported. The interviewer should provide examples or use observation based on the vision, hearing or mobility needs for the individual. / Yes, the individual is challenged to participate in activities due to vision, hearing or mobility and needs more or different supports. Describe: ______
Sometimes the individual is challenged to participate in activities due to vision, hearing or mobility and needs more or different supports. Describe: ______
No, the individual is not challenged to participate in activities due to vision, hearing or mobility
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
12. / Are any changes needed to improve where you spend the most time, so you are comfortable and can easily get around? / Individual / The intent of the question is to determine if adaptive changes are needed in the individual’s typical environment. The interviewer should explore if adaptations are required, such as counters lowered, ramps installed, closets adapted, light switches lowered, etc. / Yes, the individual needs adaptations. Describe:
______
No, the individual does not need adaptations.
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
13. / When you go outside your home to do things like play sports or have a meal at a restaurant, who do you go with? / Individual / The intent of the question is to determine if the individual has connection to friends/unpaid supports, as well as paid supports. The interviewer should find out whether the individual goes out with friends, family, paid staff, alone or does not go out into the community at all. The interviewer should record all applicable answers. / Check all that apply:
the individual goes out alone
The individual goes out with friends
The individual goes out with family
The individual goes out with staff
NA, the individual does not go out into the community
Don’t know, no response, unclear response or individual does not communicate using words.Describe:______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
14. / Do you have friends you like to do things with, such as go to the movies, hang out, watch TV, go out to eator play sports? / Individual / The intent of the question is to find out if there are friendships beyond relationships with staff and family. / Yes, the individual has friends who are not staff or family
No, all friends are staff or family
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
15. / Do you have time or space to be alone if you need or want it? / Individual / The intent of the question is to determine if the individual can have privacy if s/he so chooses. The question is not intended to capture issues related to supervision and the capability of being alone.
The interviewer should be aware of creating tension in a family situation by asking this question and skip the question if appropriate or necessary.The interviewer should use the comment box to indicate reasons why anindividual should not be alone. / Yes, the individual can be alone when and where s/he chooses
No, the individual can’t be alone when and where desired.
NA,the individual lives alone
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Question skipped
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
16. / Did you help decide the services and supports you get? / Individual / The intent of the question is to determine if the individual took part in making decisions about his/her services and supports. / Yes, the individual chose his/her services and supports
Yes, the individual chose some of his/her services and supports, with help
No, the individual made no choices about his/her services and supports
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
17. / Do you get help when you need it? / Individual / The intent of this question is to determine if the individual is receiving supports when needed. This is an opportunity to determine if staff are timely or if there are unmet needs not addressed via the ISP. It may also indicate if the individual is listened to and understood if the individual has requested help. / Yes, the individual receives all services and supports when needed.
Sometimes the individual receives services and supports, when needed. Why? ______
No, the individual does not receive services and supports when needed. Why? ______
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
18. / How happy are you with your services and supports overall? / Individual / The intent of the question is to gain an overall sense of the individual’s satisfaction with services and supports. The interviewer should use information gained throughout the interview about supports the individual receives.
AE Guidance: The interviewer should answer this question related to all services not just those rendered by the provider that is being monitored. However, if feedback is specific to this Provider, the AE should make note in the Comment section and also document it in the Comprehensive Report. / The individual is happy with supports overall
The individual is somewhat happy with supports overall
The individual is somewhat unhappy with supports overall
The individual is unhappy with supports overall
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
19. / When you have changes in the people who help you, did you know they were leaving and did you meet the newsupport person before s/he helped you? / Individual / The intent of the question is to determine if the individual is aware of and receives communication about staff changes. The interviewer should use the comment section to capture whether the individual took part in making decisions about new staff. / Yes, the individual knew the support person was changing and met the new support person ahead of time.
No, the individual knew the support person was leaving and didn’t meet the new support person ahead of time.
No, the individual didn’t know the support person was leaving, but did meet the new support person ahead of time.
No, the individual didn’t know the support person was leaving and did not meet the new support person ahead of time.
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______
Who answered the question?
Individual
Family, list: ______
Staff, list: ______
Other, list: ______
Comment:
20. / Do you feel that people listen to you and understand you? / Individual / The intent of this question is to determine if the individualexperiences an Everyday Life (EDL). This question relates to EDL values such as stability, communication, relationships, partnership, etc. / Yes, the individual always feels listened to and understood
Yes, the individualsometimes feels listened to and understood
No, the individual doesn’tusually feel listened to and understood
No,the individual never feels listened to and understood
Don’t know, no response, unclear response or individual does not communicate using words. Describe: ______