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Page | 1 DRAFT –May 2017 - PPR Reporting Template Note: Section numbers and minor section title changes may occur
OVERVIEW:ThistemplateincorporatesnewinformationbeingrequestedaspartoftheProgramPerformanceReport(PPR)comprehensivereporting.Itincludesthefollowingsections:
Section AreaI. Identification
II. ComprehensiveReviewandAnalysis(CRA)
III. StatePlanImplementation
IV. ProgressReport
V. CouncilFinancialInformation
VI. MeasuresofCollaboration
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ANNUALPROGRAMPERFORMANCEREPORT(PPR)SECTIONI:IDENTIFICATIONPURPOSE:ToprovideidentifyinginformationofthereportingCouncil
1. State/Territory:2. FederalFiscalYearReporting:October1,20_throughSeptember30,20___3. ContactpersonregardingPPRinformation:4. Contactperson’sphonenumber:5. Contactperson’se‐mailaddress:
6. ExecutiveDirectorname(ifdifferentfromcontactperson):
7. ExecutiveDirector’sphonenumber:
8. ExecutiveDirector’semailaddress:
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SECTIONII:COMPREHENSIVEREVIEWANDANALYSISPURPOSE:ToprovideanupdatetotheComprehensiveReviewandAnalysis
ComprehensiveReviewandAnalysis‐Update‐[Section124(C)(3)]TheDDActrequiresthefollowingannualdescriptions:
adequacy of health care and other services, supports and assistance that individuals with developmental disabilities inIntermediateCareFacilities(ICF)receive;
adequacyof health care andother services, supports, and assistance that individualswithdevelopmental disabilities servedthroughhomeandcommunity‐basedwaiversreceive;
AIDDinterpretsthisasannualupdatesto: adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in
IntermediateCareFacilitiesreceive;(ICFupdates) adequacyof health care andother services, supports, and assistance that individualswithdevelopmental disabilities served
throughhomeandcommunity‐basedwaivers(HCBW)receive;(HCBWupdates) Andothersectionsthatapply(e.g.:stateinformation,portraitofstateservices,analysisofstateissuesandchallenges,rational
forgoalselection,collaboration). FederalandstateinitiativesimpactingpeoplewithDDandtheirfamiliesintheState/Territory
Note:(*)‐Adequacymaybedescribedintermsofqualityand/orpopulationsservedversusneed.
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SECTIONIII:STATEPLANIMPLEMENTATIONPURPOSE:ToprovidethecontextofwhatwillbereportedinthePPR.SectionIIIiscomprisedof3reportingareas:(A)Introduction;(B)evaluationofstateplanimplementation;(C)InputonNationalPriorities
A. Introduction Inthissectionprovideanexecutivesummarywithcohesiveinformationthatprovidesanoverviewofthereportincluding,butnotlimitedtothefollowing:(1)targetedareasofemphasis,(2)strategiesusedtoimplementactivities;(3)significantaccomplishmentsand/orbarrierstostateplanimplementation;(4)needsrequiringstateplanamendmentsNote:detailedinformationwillbeprovidedbelowinSectionIVCultural Diversity DescribetheCouncil’soveralleffortstoaddresstheneedsofindividualswithdevelopmentaldisabilitiesandtheirfamiliesofadiverseculturethroughitsstateplansupportedactivities.
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B. EvaluationofStatePlanImplementation[Section125(c)(5)and(c)(7)]Inthissectionreportontheevaluationactivitiesconductedandresults.Thereportshouldinclude:B1.EvaluationActivitiesDescribetheevaluationactivitiesundertakenduringthefiscalyearbeingreported,includingevaluationactivitiesconductedtostrategicallyassesstheoverallprogressanddirectionofthestateplanimplementationB2.EvaluationResultsReportthebroadresultsoftheevaluationactivitiesdescribedabove(B1),includingabroadassessmentoftheoverallprogressofCouncilsupportedactivities.B3.LessonsLearnedandFutureworkoftheCouncilReportonhowtheCouncilwilluselessonslearnedfromstateplanimplementationandthedatagatheredfromtheevaluationactivitiestomoveforwardtheworkoftheCouncil?
C. InputonNationalPriorities
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SECTIONIV:STATEPLANIMPLEMENTATIONPROGRESSREPORTSectionIV.A.DetailedProgressReportonGoalsGoal#1:GoalstatementwouldbetakendirectlyfromStatePlan Area(s)ofEmphasis:
AreaofEmphasis PlannedforthisgoalTakendirectlyfromStatePlan;areascheckedoff
AreasaddressedTobecompletedannually;CouncilchecksoffAreas
QualityAssurance
EducationandEarlyIntervention
ChildCare
HealthEmployment
Housing
Transportation
Recreation
FormalandInformalCommunitySupports
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Strategies:
**Strategies
**AsidentifiedinSection125(c)(5)(A‐L)oftheDevelopmentalDisabilitiesAssistanceandBillofRightsActof2000(PL106‐402)
PlannedforthisgoalTakendirectlyfromStatePlan;strategiescheckedoff
StrategiesUsedTobecompletedannually;CouncilchecksoffStrategiesUsed
Outreach Training TechnicalAssistance SupportingandEducatingCommunities InteragencyCollaborationandCoordination CoordinationwithRelatedCouncils,CommitteesandPrograms
BarrierElimination SystemsDesignandRedesign CoalitionDevelopmentandCitizenParticipation
InformingPolicymakers DemonstrationofNewApproachestoServicesandSupports
Demonstrationofprojectsandactivities OtherActivities
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Intermediaries/Collaborators:
Collaborators Definition of collaborator: someone who works with another person or group in order to achieve or do something
PlannedforthisgoalTakendirectlyfromStatePlan;Collaboratorscheckedoffasplanned
ActualTobecompletedannually;CouncilchecksoffplannedCollaboratorswhoactuallyparticipatedoraddscollaboratorsnotpreviouslyplanned.
StateProtectionandAdvocacySystem UniversityCenter(s) StateDDagency Other: Other: Other:
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1. Goal#1:2. StatePlanObjective1:
Checktheappropriateboxforeachofthequestionsbelow:
3. ThisObjectiveis:Individual&FamilyAdvocacy SystemChange CapacityBuilding
4. ThisObjectiveis:
New Ongoing Completed
5. ThisObjectiveis:a. FulfillingtheSelf‐AdvocacyDDActRequirement Yes Nob. TargetedDisparity Yes Noc. DDNetworkCollaboration Yes Nod. AdemonstrationprojectofNewApproachestoServicesandSupports Yes No,IfYes,Indicateprojectnameand
originalstartdateforthiseffort:nameofproject;mm/yye. Ademonstrationofprojectsoractivities Yes No,IfYes,indicateprojectoractivitynameandoriginalstartdateforthis
effort:nameofproject/mm/yy6. StageofImplementationforsystemschangeactivities:
planning implementation outcome/fullyintegrated
Background/Context7. Provideanoveralldescriptionofthisobjective:
Thedescriptionshouldataminimumprovidebackgroundinformationontheobjectivetoestablishacontextfortheactivities.
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Goal#1 Objective#1:
8. ExpectedOutputsListexpectedoutputsfromannualworkplan1.2.3.
9. OutputsAchievedListoutputsachieved1.2.3.
ProgressReport10. Thereportshouldincludethefollowing:
Anarrativeprogressreportthatcohesivelydescribestheactivitiesthatwereimplementedtowardachievingtheobjective,includinghowtheidentifiedstrategywasused,howtheactivitywasimplemented,challengestoachievingtheobjectiveandunexpectedbenefits.
Forsystemchangeactivities,includeadescriptionofthestageofimplementation(planning,initiation,implementation,outcome/fullyintegrated)ofthesystemchangeinitiative.
Allnarrativesmustdescribewhatnumbersmakeuptheperformancemeasuresnumberfortheactivitiesbeingreportedinthenarrative. Asummaryofevaluationactivitiestomonitorprogressandimpactofcouncilsupportedactivitiesfortheobjective;datacollectedduring
theyear,datasources,anddatacollectionmethods;(logicmodelandevaluationplanmaybeattachedtothereport).
11. ExpectedOutcomes(matchestheexpectedoutcomesfromtheannualworkplanasitrelatestotheobjective)Listtheexpectedoutcomesfortheactivitiesdescribedfortheobjectivefromtheannualworkplan
12. Outcomesachieved
13. Progresstowardsachievingoutcomesforoverallobjective:Theannualreportshouldincludeanassessmentastotheextenttowhichprogresswasmadeontheintendedoutcomesfortheobjective.
14. Additionally,includestoriesofculturallydiversepeoplewithdevelopmentaldisabilitieswhoselivesarebetterbecauseofCouncilworkonthisactivity(e.g.,becamebetteradvocatesforthemselvesandothers,becamemoreconnectedtothecommunity).StoriesofpolicyorlegislativechangesthathappenedasaresultofCouncilindividualadvocacyworkthatarelikelytopositivelyimpactthelivesofpeoplewithdevelopmentaldisabilitiesorthatwillpreventapotentialnegativeimpact(e.g.,createddeleted,refinedprogramsand/orlegislation,reallocateduseoffunds,organizationalsystemschangeasaresultofevidencebasedpractices).
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RepeatthispageforeachgoalandobjectivesasnecessaryfortheindividualCouncil’s5‐yearstateplan
2. Goal#NarrativeInthissection,foreachgoalreportedforthisreportingperiod,provideanoverallcohesivedescriptionof:
• theextenttowhichprogressisbeingmadeinachievingtheintendedoutcomesoftheGoalforthereportingyear;
• theextenttowhicheachgoalwasorwasnotachievedforthereportingyear;• whereapplicable,factorsthatimpededgoalachievementforthereportingyear• needsthatrequiresubstantivestateplanamendment(goalonly)
4YearOverview(FY2020)AdescriptionofhowtheCouncilwilluseandbuildfromknowledgegainedandprogressmadetomoveforwardinthenextstateplancycle(FY2022‐2026).5YearOverview(FY2021)ForthefinalPPR(FY2021)ofthisstateplancycle,provideanoverallanalysisoftheoutcomesachievedduringthefive‐yearstateplancycle.Thedescriptionshouldincludetheextenttowhichdiversestakeholdersaresatisfiedwithcouncilactivitiesthatpromoteself‐determinationandcommunityparticipationforindividualswithdisabilitiesandfamilies,resultsofothertypesofinformationgatheringsuchasfocusgroups,surveys,orotherfeedbackorinputmethodswithindividualswithdevelopmentaldisabilitiesandfamiliesandmajoraccomplishmentsandfactorsimpedinggoalachievement(ifapplicable)
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SectionIV.B.Individual&FamilyAdvocacyPerformanceMeasure(ByGOAL)IndividualResponses(individualswithDDandFamilymembersonly)
DemographicData****ThisisanaggregatednumberfromallindividualresponsescollectedforthereportingFFY
Race/Ethnicity # % Gender # %White,alone Female BlackorAfricanAmericanalone Male AmericanIndianandAlaskaNativealone
Other
Hispanic/Latino Asianalone NativeHawaiian&OtherPacificIslanderalone
Twoormoreraces Raceunknown
Category # %IndividualwithDD ThisisIFA1.1
FamilyMember ThisisIFA1.2
Geographical
Urban
Rural
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I. OutputMeasuresObjective# PerformanceMeasure
PerformanceMeasure
IFA1.1ThenumberofpeoplewithdevelopmentaldisabilitieswhoparticipatedinCouncilsupportedactivitiesdesignedtoincreasetheirknowledgeofhowtotakepartindecisionsthataffecttheirlives,thelivesofothers,and/orsystems
IFA1.2ThenumberoffamilymemberswhoparticipatedinCouncilsupportedinactivitiesdesignedtoincreasetheirknowledgeofhowtotakepartindecisionsthataffectthefamily,thelivesofothers,and/orsystems
1. SpecifyObjective#
2. SpecifyObjective#3. SpecifyObjective# 4. Addadditionallinesas
needed
Denominator:TOTAL#ofOutputRespondents:
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II. OutcomeMeasuresPerformanceMeasures Percent(%)IFA2.1AfterparticipationinCouncilsupportedactivities,thepercentofpeoplewithdevelopmentaldisabilitieswhoreportincreasingtheiradvocacyasaresultofCouncilwork.
IFA2.2AfterparticipationinCouncilsupportedactivities,thepercentoffamilieswhoreportincreasingtheiradvocacyasaresultofCouncilwork.
Sub‐OutcomeMeasures Projects
#Peoplewith
developmentaldisabilities
#FamilyMembers
Thenumber(#)ofpeoplewhoarebetterabletosaywhattheywant/saywhatisimportanttothem
1. SpecifyObjective# # #2. SpecifyObjective# # #
3. Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #
IFA2.3Thepercentofpeoplewhoarebetterabletosaywhattheywantorsaywhatservicesandsupportstheywantorsaywhatisimportanttothem
Totalsub‐outcome#/IFA1.1total=X%
Totalsub‐outcome#/IFA1.2total=X%
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Sub‐OutcomeMeasures Projects
#Peoplewith
developmentaldisabilities
#FamilyMembers
Thenumber(#)ofpeoplewhoareparticipatinginadvocacyactivities
1. SpecifyObjective# # #2. SpecifyObjective# # #
3. Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #
IFA2.4Thepercentage(%)ofpeoplewhoareparticipatingnowinadvocacyactivities
Totalsub‐outcome#/IFA1.1total=X%
Totalsub‐outcome#/IFA1.2total=X%
Sub‐OutcomeMeasures Projects
#Peoplewith
developmentaldisabilities
#FamilyMembers
Thenumber(#)ofpeoplewhoareon cross disability coalitions, policy boards, advisory boards, governing bodies and/or serving in leadership positions.
1. SpecifyObjective# # #2. SpecifyObjective# # #
3.Addadditionallinesasneeded # #Total#ofSub‐OutcomeRespondents: # #
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IFA3ThepercentofpeoplesatisfiedwithaprojectactivityIFA3.1Thepercentage(%)ofpeoplewithdevelopmentaldisabilitieswhoaresatisfiedwithaprojectactivity
IFA3.2Thepercentage(%)offamilymemberssatisfiedwithaprojectactivity
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SectionIV.C. SystemChangePerformanceMeasures(ByGoal)
SC1:OutputMeasuresThenumberofCouncileffortstotransformfragmentedapproachesintoacoordinatedandeffectivesystemthatassuresindividualswithdevelopmentaldisabilitiesandtheirfamiliesparticipateinthedesignofandhaveaccesstoneededcommunityservices,individualizedsupports,andotherformsofassistancethatpromoteself‐determination,independence,productivity,andintegrationandinclusioninallfacetsofcommunitylife.
Objective SC1.1Thenumberofpolicyand/orprocedurecreatedorchanged1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
Objective SC1.2Thenumberofstatuteand/orregulationscreatedorchanged1,SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
Objective SC1.3Thenumberofpromisingand/orbestpracticescreatedand/orsupported SC1.3.1Thenumberofpromisingpracticescreated SC1.3.2ThenumberofpromisingpracticessupportedthroughCouncilactivities
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SC1.3.3.Thenumberofbestpracticescreated SC1.3.4ThenumberofbestpracticessupportedthroughCouncilactivities
1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
Objective SC1.4ThenumberofpeopletrainedoreducatedthroughCouncilsystemicchangeinitiatives
1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
Objective SC1.5ThenumberofCouncilsupportedsystemschangeactivitieswithorganizationsactivelyinvolved
1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
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SystemsChangeSC2:OutcomeMeasures
OutcomeMeasures Number(#)SC2.1ThenumberofCouncileffortsthatledtothecreationorimprovementofbestorpromisingpractices,policies,procedures,statuteorregulationchanges.(sub‐measures2.1.1;2.1.3)
SC2.2ThenumberofCouncileffortsthatwereimplementedtotransformfragmentedapproachesintoacoordinatedandeffectivesystemthatassuresindividualswithdevelopmentaldisabilitiesandtheirfamiliesparticipateinthedesignofandhaveaccesstoneededcommunityservices,individualizedsupports,andotherformsofassistancethatpromoteself‐determination,independence,productivity,andintegrationandinclusioninallfacetsofcommunitylife.(sub‐measures2.1.2;2.14)
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III.Sub‐OutcomeMeasures Objective SC2:Suboutcomemeasures
SC2.1.1
#ofpolicy,procedure,statuteorregulationchangesimprovedasaresultofsystemschange.
SC2.1.2#Policy,procedure,statuteorregulationchangesimplemented.
1. SpecifyObjective# 2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
Objective SC2.1.3
#ofpromisingand/orbestpracticesimprovedasaresultofsystemschangeactivities.
SC2.1.4#ofpromisingand/orbestpracticesimplemented
1. SpecifyObjective#2. SpecifyObjective# 3. SpecifyObjective# 4. SpecifyObjective#
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Additionalgoal/objectivereportingfieldswouldbecreatedbasedontheindividualCouncil’s5‐yearstateplan.
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SECTIONV:COUNCILFinancialInformation[Section124(c)(5)(B)and125(c)(8)]CouncilisitsownDSA:____Yes ____No
FiscalInformationforProgrammaticPurposesONLY
Purpose:Inthissection,Councilsaretoidentifytheobligationandliquidationstatusforthe3FFYoffunds
1. FiscalYear YR2. ReportingPeriod MM/DD/YR‐MM/DD/YR3. TotalFederalFiscalAwardforReportingYear $4. StateFundsContributingtoCouncilStatePlanActivities $5. AdditionalCouncilFundsUsedforOtherActivities $6. FederalShareofExpenditures $7. FederalShareofUnliquidatedObligations $8. UnliquidatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–
FederalShareofexpenditures–FederalShareofunliquidatedobligations$
9. MatchRequired $10. MatchMet $11. MatchUnmet $
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Dollarsleveragedforthereportingyearbeingreported:$
1. FiscalYear YR2. ReportingPeriod MM/DD/YR‐MM/DD/YR3. TotalFederalFiscalAwardforReportingYear $4. StateFundsContributingtoCouncilStatePlanActivities $5. AdditionalCouncilFundsUsedforOtherActivities $6. FederalShareofExpenditures $7. FederalShareofUnliquidatedObligations $8. UnobligatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–
FederalShareofexpenditures–FederalShareofunliquidatedobligations)$
9. MatchRequired $10. MatchMet $11. MatchUnmet $
FiscalYear YR1. ReportingPeriod MM/DD/YR‐MM/DD/YR2. TotalFederalFiscalAwardforReportingYear $3. StateFundsContributingtoCouncilStatePlanActivities $4. AdditionalCouncilFundsUsedforOtherActivities $5. FederalShareofExpenditures $6. FederalShareofUnliquidatedObligations $7. UnobligatedBalanceofFederalFunds(=TotalFederalFiscalYearAward–
FederalShareofexpenditures–FederalShareofunliquidatedobligations)$
8. MatchRequired 9. MatchMet 10. MatchUnmet
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SECTIONVI:MEASURESOFCOLLABORATIONPurpose:Inthissection,CouncilsaretodiscusscollaborativeeffortswithspecificDDNetworkpartnersandothercollaboratorsseparatefromtheplannedDDNetworkCollaborationgoal/objective.1. Identifythecriticalissues/barriersaffectingindividualswithdevelopmentaldisabilitiesandtheirfamiliesinyourStatethatthe
CouncilandtheP&A,theCouncilandtheUCEDD,theCouncilandothercollaboratorsmayhaveworkedonduringthereportingperiod
2. IdentifytheAreaofEmphasiscollaborativelyaddressedbytheDDCouncilandCollaborators
AreaofEmphasis[CheckApplicablearea(s)] 8.Recreation
1.QualityAssurance 1. QualityofLife2.EducationandEarlyIntervention 2. Other‐AssistiveTechnology3.ChildCare 3. Other‐CulturalDiversity4.Health 4. Other‐Leadership5.Employment 5. Other‐pleasespecify6.Housing 14.Other‐pleasespecify
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7.Transportation 15.Other‐pleasespecify
ThereportshouldincludeanarrativeprogressreportthatcohesivelydescribestheactivitiesthatwereimplementedbytheCouncilandtheP&A,theCouncilandtheUCEDD,theCouncilandothercollaborators.DDNetwork.Foratleastoneoftheissues/barriersidentifiedabovedescribe:(a)theissue/barrier;(b)collaborativestrategiestoaddressissue/barrierandexpectedoutcome(s);(c)theDDC’sspecificroleandresponsibilitiesinthiscollaborativeeffort.IncludeanytechnicalassistanceexpertiseDDCouncilstaffcanprovidetootherStatesinthisarea;(d)brieflyidentifyproblemsencounteredasaresultofthiscollaboration,andtechnicalassistance,ifany,desired;and(e)anyunexpectedbenefitsofthiscollaborativeeffort.
