11 minutes
The path, and where people fall out of it Follow a person from first contact through assessment, eligibility, planning and services, and find the steps where people most often stop.
What you’ll be able to do Describe the main steps a person passes through to receive services and name at least three points where people commonly drop out and why. Compare the responses to this question and explain your choice: What is the most useful response? Document a next step for The path, and where people fall out of it: Find out, for one step you own, how many people who start it do not finish it, and whether anyone has asked why. The path, stated simply Strip away the variation between programs and a person's route looks like this. Someone makes first contact, usually with a county or Tribal lead agency, sometimes after being told to by a hospital, a school or a family member. An assessment of need is arranged and carried out. An eligibility determination follows, against the criteria of whichever program fits. If eligible, a service plan is developed and providers are selected. Services begin, and are reviewed on a cycle.
Each arrow between those steps is a place where a person can be lost, and the losses are not random. They cluster at the steps that ask the most of a person at the moment they have the least: the wait after first contact, the assessment appointment that requires transport and a whole morning, the eligibility letter written in a register most people do not read easily, the gap between an approved plan and a provider with capacity.
Where people fall out, and what is usually behind it Between first contact and assessment The wait. A person in crisis makes contact, is told an assessment will be arranged, and hears nothing for weeks. By the time it arrives the crisis has resolved itself in some other way, often worse. What helps: contact during the wait, even brief, and an honest estimate rather than silence.
At the assessment itself The appointment costs a morning, transport, and often a support person's time. People with fluctuating conditions may be assessed on a good day and recorded as needing less. What helps: flexibility on time and place, and a route to say the day was not representative.
At the eligibility decision The letter. A decision written for the file rather than the reader leaves a person unsure whether they were refused, delayed or approved, and unsure what to do next. What helps: plain wording, the reason, and the next step with a name attached.
Between approval and services starting Provider capacity. A person can be approved for a service that no available provider can staff, particularly in rural areas and particularly for specialized support. What helps: saying so early, and counting these people rather than recording them as served.
At review The retelling. A person recounts their whole history annually to establish something that has not changed. Some stop showing up. What helps: carrying forward what is stable and asking only about what moves.
Questions that find a drop-out point How many people start this step, and how many finish it?
What does this step require a person to have: transport, a phone, a morning, a support person, an address, reading in English?
How long does a person wait here, and what are they told during the wait?
What does the person receive in writing, and would it be clear to someone reading it alone, worried?
When someone stops here, what is recorded, and does anyone ask why?
Stop recording withdrawal as a decision What you can change You control the categories in your own reporting, and whether the record distinguishes a person who chose not to proceed from a person the process lost.
What to watch for Do not let withdrawn or declined stand as an explanation. It reads as the person's decision and hides the step that produced it.
Your next step Split one drop-out category into two — chose not to proceed, and stopped responding — and look at the second.
Carry this forward A person typically moves through first contact, an assessment of need, an eligibility determination, service planning, provider selection and then ongoing review — each a place where a person can be lost.
People rarely drop out because they stopped needing support; they drop out at the steps that require the most organization, the most waiting, or the most retelling of their story.
A system that records a drop-out as a person's choice learns nothing from it.
A scenario decision, an accordion of common drop-out points with causes, and a knowledge check.
Find out, for one step you own, how many people who start it do not finish it, and whether anyone has asked why.
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Previous lesson Next lesson Carry this into practice How the Division is organized, who it serves, what home and community-based services actually are, and what the most integrated setting requires of the people who administer them.
Return to the experience: What did you notice or try, whose perspective informed it, and what would you keep or adjust?
Participation and course completion in this program do not count toward DHS-required training credits unless management, a director, or DHS leadership expressly approves an exception.
