Five Star Quality Defined

Derrick Dufresne

Mike Mayer

Senior Partners
CRA: Community Resource Alliance
October, 2008

To help provide further definition, this is a follow-up to Beyond Accreditation Five Star Quality (doc), the first article we wrote on the Five-Star Quality Philosophy. In the Five-Star Quality model there are several key elements that must be clearly understood in order to accurately describe the degree of quality that exists.

At the same time, it is not our intent to come up with a chart that details percentages, logarithms, or can be scientifically proven. There are many ways to accomplish the different levels of quality. It is not possible or necessary to describe every way that these things can be done. It is far more important that we have a clear understanding of what the outcomes are for each level.

We hope to provide information that will help the reader to better understand and be able to identify the levels of quality by the outcomes evident. Thus, this is a system that is not about “paper compliance” or abstract policies and procedures, but rather something that we will be able to define by what we see when we see it.

As can be seen by looking at the accompanying chart, the first and greatest distinction is about what is above or below the line. This is the key line of demarcation that needs to be described and evaluated. As is clear: One, Two, and Three-Star Quality fall below the line. Four and Five-Star Quality sit above the line. The distinction between below and above the line is most important.

We also find it is often the least understood distinction. In particular, we find that human service agencies continue to ask (or even assert) that people can have Four or Five-Star experiences within their programs. The Five-Star Quality model does not support that framework of thought. This is not a model of quality where the agency tallies up enough “experiences” to qualify as having reached a certain level.

In addition, we find that many agencies often mistake what is actually, at most, a Three-Star experience with what they perceive to be Four or Five-Star experience. It is this misperception that we would like to address and, hopefully, clear up now:

As long as a person’s experience is contained within the “Disability Bubble” (meaning as part of a program that is operated by an agency for people who have disabilities) it can never be better than Three-Star Quality.

Another key element of the evaluation process is the determination as to whose name is found on the “marquee” of the operation, even if it is held in a generic community setting. If the program, business, letterhead or marquee (sign) has the name of the human service/disability agency at the top, it can never be more than Three-Star Quality.

Having said this, we want to emphasize that Three-Star Quality is very good – it is the best of what traditional service systems have available. In comparison to much of what we see currently in operation – even after 58 years of community services (within the Disability Bubble), Three-Star Quality could be considered great quality (but only within the Disability Bubble).

Most typical accreditation services would consider this level of service to be worthy of their highest evaluation. Three-Star Quality means that an agency has at least crossed the point of no longer seeing that all supports for people with disabilities need to be self-contained – meaning that they understand that not all services and supports must be provided within the walls of the agency, by agency employees or volunteers. Most importantly, it means that the agency helps people enrolled in their services not to just “be in the community” but to become truly participating members of their community.

This, frankly, contrasts with Two-Star Quality situations we see still incredibly prevalent in human service today. Any type of sheltered employment, group home, or other operation that can be distinguished as self-contained, is clearly Two-Star Quality. These operations may meet all of the licensure requirements, have great health and safety records, hold multiple accreditations and have community outings on a regular basis, but they are still only Two-Star programs in the Five-Star Quality Model.

Some human service agencies, despite what they believe are their many efforts and innovations, are increasingly upset and disappointed that we consider them below the line. They desperately seek (and rightly so) to have their efforts acknowledged; for someone to recognize the risks that they have taken (often with little to no funding support). They believe they must be doing Four or Five-Star Quality work because, a) it is so much different than that which they used to do and, b) the lives of the people they work with have improved (at least from their perspective).

Further, we have had people point out to us their organization’s awards, accreditations, positive publicity and/or accolades received. We’ve even been in some situations where the agency has pointed out partnerships with communities and with generic community services that believe that this must certainly be evidence of Four or Five-Star Quality.

Unfortunately, we beg to differ. While efforts like these above are valuable and should be a part of the lives of people who have disabilities, the truth regarding the march toward Five-Star Quality is that a service or support can only be above the line if it is not only community–based but community led. This means that a generic, non-disability specific community organization, business, or group of citizens must be at the forefront of the community effort while the human service agency, if it needs provide any support at all, provides that support behind the scenes.

The biggest hurdle, unfortunately, which disability-focused human service agencies can never overcome on their own, is that the name on the marquee, the ownership of, or the leadership for the program, service or activity offered, must come from a non-disability focused organization. The name on the marquee must be a community-identified and a community-owned venture.

The implications for disability-specific human service organizations are obviously huge. It means that their name goes from the top of the letterhead (or marquee) to the bottom. It means now that the tag-line is likely to read “with the generous support of XYZ Human Services”. The disability agency has to become an invisible support to the community effort rather than its primary mover.

Thus, the agency becomes a support for building community competency – so that the community can help people who have disabilities become functioning citizens –with the least amount of specialized support from the human services agency as possible.

This mindset represents a paradigm shift. Success can no longer be measured by the number of employees, the size of the budget, the number of programs that it operates, awards, accreditation, or how well it is known in the community. If an agency is to embrace this clear redefinition of success, it will obviously require a significant transformation by the organization as a whole.

The organization moves to the background, and the community, along with the people who receive support, move to the foreground. Rather than continue to be identified as a “client” of a disability-focused agency, the new identification for this person receiving support will be as an employee, a member of the (non-disability specific) community organization, a team member of the event, or a full citizen participant of the community opportunity.

Far less important, is whether or not the agency is Four or Five-Star Quality. These concepts will coalesce as the agencies and their communities continue to develop. This can be debated, discussed, and resolved as we move forward.

For now and for the immediate future, Four-Star Quality is defined as when an organization begins a project, such as a supported employment project within a factory, but then turns it over to the management of the factory, providing support to the various departments of the factory so they are able to meet the needs of the individual employees with disabilities.

Another example could be the dance that was always sponsored by the disability-related organization and that others in the community were invited to attend. To reach Four-Star status, the agency turns over the dance planning and execution to the local Elks Club and the agency’s name now is only identified as “with support from”, as is the local radio station that promoted it, the grocery store that provided food and decorations at cost, etc. The agency’s role becomes that of invisible support as trainers, consultants, greeters, clean-up staff, etc. They do not present themselves as “obvious staff”.

An example of how one agency demonstrated Five-Star Quality may help here:

The adult services division of Sor County Board of MR/DD was spun off to become a free standing non‐profit organization – First Consideration, Inc. (FCI). Initially, FCI only served people who had developmental disabilities but they were doing so in a public venue that was not identified as specific to people who had disabilities – as the County Board-owned and operated workshop had been. (One-Star becoming Two-Star)

FCI began providing supported employment services for a small group of individuals who had disabilities at local businesses. (Three-Star)

FCI worked with one of the employers, Daem, Inc., to take over the job-coaching duties for people employed at the employer’s place of business with the promise of being immediately available if needed. FCI worked with HR, employee assistance programs, and the co-workers of the individuals who had disabilities at Daem until they felt confident managing the situation. (Four-Star)

FCI eventually spun-off their supported employment services into another nonprofit – Work Placement Services (WPS), which operated out of a storefront business in the downtown area. WPS was actively involved in helping people who needed work – people who did and did not have obvious disabilities. WPS did not advertise themselves as being for people who had disabilities but rather as a community resource.

When Daem downsized their local operations, WPS got the contract to assist those employees who had been laid-off from Daem. Some of the people who did not have obvious disabilities were trained how to be job coaches to assist people who did have disabilities to get and maintain successful community employment – meeting a need of both local businesses (who needed good employees) and FCI who needed to have individuals with disabilities be successful in community employment.

Further, Daem was pleased that at least some of their former employees had found employment locally while, concurrently, Daem’s outplacement and unemployment costs had been effectively managed. (Five-Star)

To use the dance example to cover all of the categories:

One‐Star: A dance for people with disabilities that is sponsored by the human services/disability organization held at the sheltered workshop. (The person is absent from the community).

Two‐Star: A dance for people with disabilities held at the local YMCA that is sponsored by the human services/disability organization. People with disabilities are “the audience” even though some people who do not have disabilities may attend. (The person is “in” the community)

Three‐Star: A dance for the general community is held at the local YMCA sponsored by the human services/disability organization in partnership with the YMCA and other organizations. People with disabilities from that agency and possibly others are in attendance. (The person is a participant with the community).

Four‐Star: A dance for the community held at the local YMCA and sponsored by the YMCA and other community groups and the human services/disability organization provides “invisible” (not publicly recognized) supports to the YMCA and the rest of the community to enable people with disabilities to fully participate as anyone else would. People with disabilities from throughout the community are clearly welcomed and may or may not have paid supporters assisting them. (The person is a member of their community).

Five‐Star: A dance for the community held at the local YMCA and sponsored by the YMCA and other community groups. People with disabilities from throughout the community are clearly welcomed and may or may not have paid supporters assisting them.

The human services/disability organization is not obviously a part of the dance planning, coordination, etc., but rather acts as consultants and trainers to the sponsoring organizations to help them have the capacity to support people with disabilities fully to participate as anyone else would. The human services/disability agency personnel are “invisible” but remain “on‐call” for the sponsoring organizations. (The person is “of” their community – meaning the community has the ability to meet any immediate needs of the individuals who have disabilities).

In closing, what must become increasingly clear is the difference between One, Two and Three Star Quality and everything above the line. This is the line of demarcation that, for some, will either be raising the bar to new heights, as an exciting prospect, or a bridge too far, whose cost, with all the implications that might follow, is just too great to the organizational identity.

If indeed it is a bridge too far, our only hope is that we can be honest enough to discuss the reasons and the rationales for the decision looming, with the hope that we can find solutions. We hope that the discussion does not turn to “the community is not ready” or “we’d never be able to raise any more money” or “that’s just not realistic”.

We know, for some, it will be a bridge too far. For others, it will be a chance to move from clienthood to citizenship. We believe that all people, including people with disabilities, deserve Five Star Quality and, through full participation in truly inclusive programming, to be “of” their community.