When it comes to Home and Community-Based Services (HCBS) for children, understanding the experiences of all children and their families who receive publicly funded services and supports is critical for addressing quality of life, program improvement, and equity. HCBS give families and children the option to receive person-centered care and support in their homes and communities to support children’s full potential without having to move to a facility or institutional setting.
Prior to 2022, Colorado—like many other states—took part in a child waiver survey aimed at gathering data from families of children with intellectual and developmental disabilities (IDD). However, the eligibility criteria for this survey created a gap, preventing the state from including families with children who had other conditions, such as life-limiting illnesses or physical disabilities. To gain a more comprehensive understanding of the satisfaction levels among children’s waiver members, the Colorado Department of Health Care Policy and Financing (HCPF) initiated the creation of a new Child Waiver Satisfaction Survey to capture the experiences of families whose children were enrolled in all of the state’s children’s HCBS waivers.
HCPF contracted with Vital Research, a national leader in HCBS quality measurement, to develop, test, launch, analyze, and report on the comprehensive Child Waiver Satisfaction Survey. The opportunity to compare experiences based on factors such as type of waiver, the region families lived in, and member demographics (e.g., age) was critical to deepening understanding of how services and supports were working for children and families throughout Colorado.
The Survey’s Broadened Scope
Vital Research’s survey development process was rooted in close collaboration with the HCPF team and drew on an extensive review of the existing research base and measurement tools as well as data from focus groups and interviews with parents whose children were members of the targeted waiver programs. The survey was also designed to align with the Quality Measure Set, a set of nationally standardized quality measures for Medicaid-funded HCBS, to create opportunities for comparisons with other datasets. The final survey consisted of 53 items, covering various key topic areas such as service planning, community inclusion, and case management. (For more information on the survey items and results, please view the final report.)
Turning Data into Quality Improvement
In 2023, Vital Research launched the survey statewide, making it available online and via mail to over 5,000 families in English and Spanish. Subsequent data analysis focused on understanding families’ satisfaction with the services and supports they received, challenges they experienced when getting services, and how family feedback varied based on which waiver program their child was on, where they lived (rural or urban areas), and their children’s age range. The second round of survey administration launched in March 2025, which allows for comparisons in results from 2023 to 2025.
HCPF is already leveraging survey results to design meaningful improvements in service delivery and ensure all children can thrive in their communities. By identifying areas of excellence and opportunities for enhancement, HCPF will strategically refine programs to better meet families’ needs. In addition, HCPF has used the survey results as a baseline measure from which to assess the impact of initiatives over time.
An Approach Other States Can Model
HCBS quality data must provide states with a complete picture of what is working well and what needs improvement for specific segments of the population. Current data collection protocols to assess children’s HCBS experiences may be leaving some populations of children out. As a result, data are not reflective of all aspects of states’ unique constellations of children’s services and supports. Thus, Colorado’s Child Waiver Satisfaction Survey fills a gap in the national HCBS quality measurement landscape to better capture the diverse needs and experiences of families and children receiving HCBS waiver services and supports.
The team at Vital Research is proud to work on this statewide initiative that amplifies the voices of families who are members of HCBS waiver programs. We look forward to the opportunity to implement similar work in other states in the future.
Working to improve Home and Community-Based Services (HCBS) for children? Interested in learning more about the research and evaluation services Vital offers? Please contact our Partner working in this area, Cathy Coddington, PhD.