Supporting People with Significant Needs to do Significant ......Building a Meaningful Life Start...

Sara Murphy, Kurt Smith & Jack Karner

WEBINAR SERIES,

OHIO EFSLMP 2018

Supporting People with Significant Needs to do Significant Things

Meaningful (adj.): full of meaning, significance, purpose, or value; purposeful; significant: a meaningful wink; a meaningful choice

- Dictionary.com

What Makes Life Meaningful for EVERYONE?

Family & friends

Employment (money & self-worth)

Engagement in community

A happy home, a sanctuary

Health

Choices/options

Freedom & Independence

Building a Meaningful Life

Start with the person’s goals, strengths and passions

Neighborhood/Homebase

Look at life domains and training needs

You are building a social/professional network. Who needs to be in it?

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Focus: Strengths not Deficits

You are assisting people to play a valued social role and develop an identity:

artist, sports enthusiast, dancer, volunteer, employee, etc.

What should this role/identity be?

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Positive Personal Profile

What are their dreams and goals? what do people WANT to do?

Assessment Tool for Community

Skills

What do people “need” to learn?

For people with significant disabilities

the goals are similar, but the “scale” may be

different

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For people with significant support

needs, “independence” may not be the goal.

Goals: Let’s Start Here…

Discovery/Exploration: Identify interests

Increase self-reliance

Endurance/stamina, range of motion, mobility

Communication

Where will we end up?

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Never Underestimate Anyone

Support everyone to achieve his/her full potential

We must give people the means to communicate --and learn to listen

Our job is to make

dreams happen!

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Sue Austin, Artist and Scuba Diver

Community-based Services for People with Significant Support Needs

LOTS OF THINGS TO CONSIDER

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Lots of Things to Consider

What is meaningful for the person?

What do people want to do?

What do people need to learn?

Physical stamina, endurance

Logistics

Safety & mitigating risks

Medical needs

Staff competencies and training

Resources and supports available

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Programmatic Changes

Make Community Inclusion a priority, an expectation

Map community resources, identify accessible, useable resources

Relocation? Large building? You want to be in the heart of the community- right in the middle of things.

Balance program enrollment: “1/3, 1/3, 1/3”

Community-based Staff

Key Characteristics:

• Teachers

• Networkers

• Problem solvers

• Resourceful, creative and unflappable

• Organized w/ a good sense of humor

Training:

• Positive instructional strategies

• Systematic instruction

• Discovery

• Person-centered training

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Get the right people on the bus.

A New “Mindset”

“My job is to be a connector, not caretaker.”

Promote “best practice”

Person-centered, out-come oriented services -not just filling time

Inclusion vs. Integration

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The “Change” ProcessNEW IDEA

(HOPE) CONFIDENCE

INSIGHT AND LEARNING

Courtesy of Tim Brown, IDEO

“Be Prepared”

Worst case scenario. What is your escape plan?• Emergency procedures- manual written

• Staff trained (annually)

• “Cavalry”- staff available to help when/where needed

• Access to medical information/releases

• Escape routes/quiet rooms

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Community-based Services

BUILDING CONNECTIONS AND CONFIDENCE

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Building Connections

Identify a person’s passions, interests, strengths

Target opportunities and community connections

Identify ways for person to actively participate

Create a consistent schedule, a daily/weekly opportunity to practice skills. Not just a field trip or outing

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Connecting to the World

Appearance, social skills and ability to communicate are critical

Help people develop their voice: choice making and self-advocacy

Physical stamina, endurance, mobility, range of motion

Update accommodations: power chairs, communication devices, i-pads, picture portfolios, transfer boards

Teach initiative, problem-solving and self-reliance (Stop staff from “over-helping”)

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Soft Skills

Teach greeting, manners, helping

Give people the means to communicate (technology, pictures, Dynavox, fist bump)

Appearance and hygiene

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Increase Stamina and Mobility

Walking (uneven ground, stairs, escalators)

Driving chair (onto bus, down curb cuts, crowded areas)

Range of motion (eating, pushing buttons in elevators, passing things to others)

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Systematic Instruction

Breaks down steps (task analysis)

Determines best way to teach a task (prompts, common language)

Creates a consistent approach

Documents level of instruction. See “small” progress

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Street Crossing Street Crossing- Lighted intersection Date 2/6 2/8 2/11 2/13 2/20

Stops at corner DV + + + +

Watches signal (Light and/or walk sign) DV/G IDV R + +

Identifies when signal changes to walk DV G G IDV IDV

Looks both ways- waits for cars to stop DV/G DV DV G G

When cars are stopped, makes eye contact with driver– “gives stop sign” M M DV IDV IDV

Crosses street in crosswalk + + + + +

Crosses street quickly- safely watching signal and for cars DV IDV G G +

Hurries if light changes yellow or signal flashes DV DV DV IDV IDV

Understands the dangers of Jaywalking, crosses only in crosswalks N/A DV DV N/A M

Looks for curb cuts- drives in middle DV DV G G +

Does not follow others into street before light changes DV DV DV IDV IDV

Level of Independence 10% 18% 18% 30% 45%

Prompts:P= Physical DV=Direct verbal

IDV=lndirect verbal M= Model G=GesturalR=Reinforced after performed+= completed independently

Start with Baby Steps

Identify person’s interests/goals – start with most motivating activity

Start with short, quick trips

Prep the individual (use pictures, videos,..)

Use “forgiving” community sites, at less crowded times

Bring person into an established group of “independent” peers

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Reticent or Scared?

Start with motivating activities, with favorite people, in forgiving environments

Preface trips with pictures, videos

Piano Lessons:

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Reticent or Scared?

Desensitize people:

Start with quick visits

Give person something to accomplish

Increase time and expectations

Grocery shopping:

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Reticent or Scared?

Give person a way to know when the job will be finished or to say “time to go”/“need a break”

Refuses to leave the facility? Don’t let them cross the threshold. Start the day in the community- donuts and cup of coffee at a café

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Logistics: Transportation

Independence/increased self-reliance is the goal- use personal and public resources whenever possible

Minimize need for transportation

centralized program site with satellite locations, develop accessible meeting spots, walkable locations in the person’s neighborhood

Cluster participants according to geographical locations

Tap personal resources (family, neighbors, residential staff, co-workers)

“I am 43 years old, I have never been in the front seat of a car”

Fleet of Small, Accessible Vehicles

Small, six passenger vehicles, Wheelchair

accessible

Participant,Franklin County Board of Developmental Disabilities

Managing Behavioral Needs

Behaviors are a form of communication- be sure you are listening- create ways to communicate in an appropriate way

Safety may require 1:1, double staffing

Develop an exit plan (prior to Day 1)

Quiet rooms located at community sites

How do you call in the Calvary?

Build a quick response team– family, friends and staff

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Managing Behavioral Needs (2)

Determine the individual’s interests (and triggers)

Structure, structure and more structure

Consistent, pre-determined schedules

Expectations are defined

Behavioral plans in place and training for staff

Communication tools (pictures? )

Self-monitoring, daily feedback mechanism in place (whiteboards? Checklists?)

Addressing Medical Needs

For medically fragile individuals: quick trips, partial days

Identify/Create “respite” locations:

Inventory community: Any natural places for people to rest/relax?

Small satellite “offices” throughout service area

Community rooms or church basements

Portable Massage tables for personal care

Create community-based, mobile nursing services

(hospice style nursing) Medical response vehicle

Be Sure to Share Successes

Look for small progress, post successes (we love WhatsApp)

Reward staff (developing the perfect site, problem-solving, powering through a difficult day)

A sense of humor is critical

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Franklin County BDD“MAKING IT HAPPEN”

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Why The Change?

CMS Settings rule

Privatization: Creating a “Move In Ready“ model

“It’s the right thing to do”

Where FCBDD Started

Mapped people served and community resources

Identified service areas and set up “Hubs”

Addressed mindset. Changed job descriptions- required community activities 1x wk for all staff- then increased it

Pilot with 91 individuals with complex needs

Integrated Community Employment & Discovery◦ Internship

◦ Volunteerism

Community Engagement◦ Based on Discovery themes and the Person Centered

Plan/Outcomes

FCBDD’s Transition To Community-Based Services

Shift from “contracts” to:• Person Centered Plans• Pathways to employment• Discovery (cornerstone)• “Community life engagement” • Change Job descriptions• Transportation, Transportation• Performance requirements• Measure what you value

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FCBDD shifted the data they collected – and posted it

Creativity is Key

Each person’s situation and resources will be different

Braiding services will be necessary

Work with support network in a collaborative way

Petition for rates that will support serving individuals with high support needs

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WC Lift

Track MountHoyer Lift

FoldingMat Table

SinkStorage

Personal Care Vehicle

Think Outside the Box

Lydia

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Volunteer

Margie

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Zumba Enthusiast

Justin & Jacobe

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Nissan Employees

Lot Technicians

Video Link goes here

It’s not that complex

Find places to belong

Never stop listening

Stay in the solution

Collaborate – “it takes a village”

Celebrate all successes and learn from non-successes

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Building Villages and Creating Pathways to Employment

Let’s get started making dreams

come true

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The greatest danger may not be that our aim is too high and we miss it, but rather that it is too low and we reach it.

- Michelangelo

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For More Information:

Sara Murphy

TransCen, Inc./WorkLink

785 Market Street, Suite 670

San Francisco, CA 94103

415.979.9520

smurphy@transcen.org

www.transcen.org

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For more information, contact:

Franklin County Board of Developmental

Disabilities/ARC Industries

Kurt Smith

(614) 342-5609

kurt.smith@fcbdd.org

Jack Karner

(614) 342-5091

jack.karner@fcbdd.org

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