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Odyssey Preconference WorkshopImplementing Sustainable Person-Centered and Positive
Support Strategies
Goals for Today
What This Presentation Will Address• Overview of Person-Centered Practices• Strategies for Expanding Person-Centered Practices With
Your Organization • Review Tools Your Organization Can Use to Move Create
Sustainable Changes
What We Will Not Address in Detail• Provide Detailed Training on Person-Centered Thinking or
Planning– How to Use Each Person-Centered Thinking Tool from
The Learning Community– Introduce Specific Lifecourse Tools
Agenda
• Positive Supports and Person-Centered Practices
• Integrating Practices Within Organizations• Team-Based Assessment and Action Planning
–Build on Strengths–Work Smarter Not Harder
• Using Data to Guide Implementation• How to Find Free Resources and Tools
Positive Supports Defined
Refers to All Practices that Include these Characteristics: 1) Person-Centered Interventions that Demonstrate Cultural
Competence and Respect for Human Dignity2) Emphasizes the Importance of Family-Centered and
Community-Centered Practices3) Evidence-Based and Promising Practices4) Strategies for Ongoing Assessment and Monitoring at
Individual and Organizational Levels5) Often Implemented in Combination with More than One
Practice
Positive Support Examples
• Person Centered Thinking/Planning – Foundational • Positive Behavior Support• Applied Behavior Analysis• Assertive Community Treatment• Cognitive Behavior Therapy• Motivational Interviewing• Systems of Care• Wraparound Planning• Trauma Informed Practices
Person Centered Practices & Planning
Organizational Workforce Development
Person Centered Practices & Planning
Positive Behavior Support
Tertiary Tier• In Depth Person Centered Plans• Integrated Plans (PCP, PBS, Trauma-
informed Therapy)• Teams Monitor Plan Progress
Primary Tier• Universal Person Centered Strategies:
Person Centered Thinking• Encourage Self Expression• Self-Determination and Choice Making• Meaningful Participation in the
Community
Secondary Tier• Monitor PCT Action Plans • Additional Quality of Life Strategies• Increase Strategies for Supporting Independence and
Community Involvement• Mental Health and Wellness Interventions
Use a Continuum of Intensity to Support Person-Centered Efforts
Positive Behavior Support
Organizational Workforce
SupportingStaff Behavior
SupportingAll People
PRACTICES
OUTCOMES
Improving Quality of Life
SupportingDecisionMaking
Avoiding the ”One-Shot Workshop” Approach to Training
Key Elements
• Importance of Balancing What is Important To and For a Person
• Increased Awareness of When We Engage in Power With Versus Power Over Another Person
• Being Open to Ongoing Learning About Cultural Differences and How These Differences Impact Our Behavior (Cultural Humility)
What Does “Person Centered” Mean?
To make a sincere effort to understand each unique person and act on their wishes in partnership with their team• Treat each person with dignity and respect• Build on person’s strengths and talents• Help people connect with their community and develop
relationships• Listen to and act on each person’s preferences• Listening to all the ways people communicate and express
themselves
Impact On Life TrajectoryIf We Collaborate to Provide Positive Supports and Choice Across the
Lifespan…
Adapted from Integration of LifeCourse Life Trajectory© andPerson Centered Thinking©
Achieve each person’s vision for a full life in
the community
… Instead of a life defined by …
[FILL IN THE BLANK]
Service Life Trajectory
EarlyChildhood
Birth
Transition
Adulthood
Aging
End of Life
School
Tools for Balancing Important to and Important ForFrom the Learning Community
Discovery/Learning Tools• Relationship Map• Routines and Rituals• Good Day/Bad Day• Communication• 2-Minute Drill• Reputation
Everyday Learning• Learning Log• Working/Not Working• 4+1 Tool
Management Tools• Donut• Matching
The Balance Between What is Important to and Important for
A PersonIMPORTANT TO SOMEONE
• MAKING CHOICES AND FEELING INDEPENDENT AND/OR INTERDEPENDENT
• FOLLOWING IMPORTANT RITUALS AND ROUTINES
• MAKING IMPORTANT SOCIALCONTRIBUTIONS
• FEELING VALUED AND APPRECIATED BY OTHERS
IMPORTANT FOR SOMEONE
• MAINTAINING GOOD HEALTH
• FEELING SAFE • PREVENTING TOOTH
DECAY• MANAGING MEDICATIONS• COMPLETING SCHOOL • FOLLOW COMMUNITY
RULES AND REGULATIONS
LIFE IS A BALANCE OF WHAT IS IMPORTANT TO AND FOR US
It is important to look for what is important to us when considering what is important for us
• Finishing school will help us find the job we want• Exercising regularly can become important to us when we are
planning to attend our high school reunion• Getting an entry level job helps us get started so that we can
apply for a more interesting position over time• Learning Spanish is more important when we are going to
Mexico on vacation
Five Valued Experiences
• Share ordinary places and activities• Make choices• Contribute• Be treated with respect and have valued social roles• Grow in relationships
-John and Connie O’Brien
Don’t Box in Dreams
Any changes an organization makes to its practices, structure or rules that result in positive differences in the lives of people. (Organization Level/Managers/Supervisors/CEO/Administrative Support).
Level 1
Level 2
Level 3
Any changes that results in a positive difference in the lives of people who use services or in your own work life.
Any change in practice, structure and rules made at the system level. These changes have an effect on many organizations, and therefore many peoples’ lives. (Larger State Level or National Organizational or Leadership Level Issues).
Levels of Change
© TLC-PCP 2012 TLCPCP.com
Being Person-Centered is Not Just About Some Tools
• Assess What Your Organization Does Well and What Can Improve
• Person-centered practices refers to more than some helpful tools
• Use a Variety of Strategies to Create a Person-Centered Context– Person-Centered Thinking Tools– Charting the Lifecourse– Teach & Promote Communication Skills– Use Motivational Interviewing
Building Relationships
Empathy & Culture
Mindfulness & Wellness
…..And Helps Us Build on the Inter-Related Features That Create
a Positive Community
Organizational Systems
Positive Social Strategies:
Tools and Strategies for Improving Social Interaction in
Person Centered Practices
Community Mapping
Social MatchingProblem
Solving
Conflict Resolution
Creating a Context for Positive Social Interactions
Embedding Cultural Awareness
Universal Stage• Using a Cultural Lens When Developing Policies • Recognizing Culture When Developing/Completing Job Descriptions and Performance Evaluations• Offering Culturally Relevant Trainings in New Orientation and Ongoing Instruction• Meaningful Data Collection-Collecting Data on Diversity to Guide Decision Making • Encourage Diverse Cultural Point of View• Encourage Self-Assessment• Varying Perspective and Interpretation of Self-Determination and Choice Making
Secondary Stage• Awareness of Cultural Bias and Norms when Monitoring and Early
Intervention • Training Targeted for Groups• Culturally Appropriate Targeted Strategies to Improve Specific
Settings • Simple Problem Solving for Challenging Situations That Occur in More
Than One Situation
Tertiary Stage• Tailor Problem Solving for Specific Problematic Situations Which
Incorporates Cultural Norms and Awareness• Individualize Training and Mentoring to Address Unique Settings
Where Problems Occur• Improve Supervision and Mentoring for Locations Experiencing
Challenges Which Include Cultural Responsiveness
Consider How We Address Culture Impacts How Person-Centered We Are
Activity: Write the Strengths of Your Organization and Work as it Relates to Person-Centered Practices and
Positive Supports at Each Tier
FBA/PBS Plan (Individualized intervention,
close monitoring of data)
Targeted intervention (small groups, certain areas/sites,
less individualized, increased monitoring of data from Tier
1)
Universal (everyone in organization, matrix(es), “big data” (e.g., incident reports),
QOL, workforce data (attrition, turnover, etc)
Tertiary Tier (3)
Secondary Tier (2)
Universal Tier (1)
“Letting it Happen”• Minimal Support for Translation to Practice• Practitioners Expected to Figure Out How to Proceed
“Helping it Happen”• Training Materials are Available to Practitioners• No Support for Problem Solving
“Making it Happen”• Implementation Team is Accountable for Developing Systems• Organizational Barriers are Identified and Systems Issues Resolved
http://implementation.fpg.unc.edu/module-3/topic-2
http://implementation.fpg.unc.edu/module-2/implementation-drivers
Formula for Success
Assumptions for Moving Forward
• Build on organizational STRENGTHS!• Identify a “do-able” list of tasks that can be achieved this year• Setting the pace
– Marathon, not a sprint– Changing everyday work routines– Work smarter not harder– Celebrate successes
Research-Based Findings to Promote Implementation
• Team-Based Approach • Active Administrator Involvement and Support• Champions at Different Levels of the Organization• Involvement of All Stakeholders in Implementation• Ongoing Coaching and Mentoring Systems Avoid the “One Shot Workshop” Approach Teaching Awareness and Creating Opportunities for
Reflection
Leadership Team
Visibility
Training Mentoring Evaluation
Active Coordination
Start Small And Build On Success
Organization and County Planning
Interagency & Natural Supports
PCT, PBS (Other PS) Expertise
FundingPolitical Support & Policy
Getting Started
• Form an organization-wide team that represents all stakeholders
• Assess readiness and buy in • Complete a self-assessment• Create an action plan • Use data for decision making• Make changes to improve outcomes
Team Members
• Core team representation (planning and coordination)• Administration• Management• Coaches• Key Contact• PBS Facilitators• PCT Trainers• Person Centered Planners
Expanding Input
Meeting 2-3 Times a Year• People Receiving Services• Family Members• Guardians• Case Managers• Community• Administration• Management• Coaches• Key Contact• Direct Support
County Communication for Team Implementation
Full Team Meeting
Administrative Meeting
Key Contact
Coaches Community of Practice
All Staff Community of Practice
Resiliency Committee
Cultural Diversity Initiative
Performance and Quality
Improvement Group
Community For All
Regional Quality Council
Create Strategies to Improve Communication
Identify Ways to Communicate
• Team Meetings• Staff Meetings• Trainings • Coach Meetings• Other Events• Newsletters• Website
* Build Into Existing Communication Whenever Possible
Getting Started
• Form an organization-wide team that represents all stakeholders
• Assess readiness and buy in • Complete a self-assessment• Create an action plan • Use data for decision making• Make changes to improve outcomes
You can’t change anyone else but people do change in relationship to your change. All relationships are a system, and when any one part of a system changes, it affects the other part-Jack Canfield
Systems Change
• Change occurs when everyone is actively involved in decision making
• Change is a personal experience• Mandates and directives can have negative
impact on morale
Assessing Interest & Commitment
• 80% Staff support for implementation• 3-Year Action Plan, progress occurs over time• Behavior is one of top three goals within organization• All staff agree to participate in implementation
– Encouraging and modeling social interactions– Building Person Centered values into everyday actions– Participating in decision making– Reinforcing and recognizing positive social interactions
Getting Started
• Form an organization-wide team that represents all stakeholders
• Assess readiness and buy in • Complete a self-assessment• Create an action plan • Use data for decision making• Make changes to improve outcomes
Assess Areas Where You Can Improve
There are many pockets of person
centeredness, but, as a whole,
our system doesn’t behave in
a person centered way
Self-Assessment:
• Organization Mission and Vision
• Policies for promoting quality of life, prevention of problem behavior, crisis response, etc.
• Procedures that might related to person-centered work
How Well Does Our Organization Reflect Important Values?
Provider Organization – Residential Supports
Now Future
Creating a Vision of What Services Look Like Now and What We Want for the Future
Now Future
Self-Assessment:
• Information related to onboarding, orientation, and in-service training– Policies– Training Materials
• Organizational surveys – Climate– Quality of life– Satisfaction
• Other documentation related to quality of life
• Information about other positive supports used in organization
How Well Does Our Organization Embed Person, Family, and Community Centered Values Into Systems?
Assessing Organizational Data
• Changes/Alignment of Organizational Policies • Orientation Staff Development & Performance• Surveys and Other Documentation Related to
– Quality of Life– Climate– Stress
• Information about Other Positive Supports Used in Organization• Quality of Life Evaluation• Incident Reports • Injuries, Sick Days, Workers Compensation, Staff Injury
The Person-Centered Organizational Development Tool is used by Teams to Engage in the Assessment and Action Planning Process
It is Available for Free at https://mnpsp.org/training-materials/
ActivityReview the Person-Centered Organizational
Development Tool
Write Down Where You Could Use This and When You Plan to Introduce it
Make a List of Things You Can Bring Back to Work
Actions for Implementing Person-
Centered PracticesWho Should be
Involved?Targeted Completion
Date
Getting Started
• Form an organization-wide team that represents all stakeholders
• Assess readiness and buy in • Complete a self-assessment• Create an action plan • Use data for decision making• Make changes to improve outcomes
Action Plan Implementation Examples
• Awareness Activities Around Jargon• Begin Using Person-Centered Language • Create One-Page Person-Centered Description for Adult
Services Units • Have All Employees Create One-Page Person-Centered
Descriptions• Integrate Coaches into Initiative Meetings• Develop Person-Centered Thinking Skills with Employees• All Employees will Complete the 2-day Person-Centered
Thinking Training (Or an Adapted Version)
Action Plan ExamplesOverall Management Activities Who By When Status Update
Last 30 minutes of Wednesday Meeting used for PC/PS Grant Discussion ALL Start 7/27/16
Achieved/In progress, 1/12/17 need to look at accomplishing one task at each meeting, setting assignments to comment next meeting, look at different meeting locations, flip charts/post it notes
Exit Interviews Anyone with Employees Start Friday 7/22/16
Completed- distributed to all supervisors/managers 7/26/16, 1/12/17 look at if these are being done
Pancake Breakfast, changed to staff role out pizza
Team Member Assistance 10/31/16
Picked dates of 11/11 and 11/18, need to work on agenda and get marketing about it out by 10/30/16
Completed both roll outs as of 1/12/17Staff matching pilot- determine plan for pilot and start system Key Contacts, 10/31/16
Will meet on 8/1/16 at 10:30am to develop action plan
Leadership training Team 12/31/16 In progress, completed, DP in progressMeet & Greet site visit with politician Steve, Anna, John 11/14/16 Nothing done as of 1/12/17
Police Department Outreach Lana, Steve 10/1/162 came to ice cream social First One completed 1/12/17
Booth at SLC Health & Human Services Conference Anna 7/1/17
Waiting for email response from Mary Bridget Lawson, missed out on 2016 conference, will look at attending 2017
Neighborhood gathering (Ice cream social Appreciation Event for police, fire department, etc) Lana, Bob, Rae 8/30/16 Completed, 2 police camePolicy language revision HR, Lana Monthly In progress
Team Activity – Integrating Cultural Awareness
Cultural Awareness Item Action Date Person Responsible
Assess diversity of organization and the local community
Review staff data from previous survey. 11/23/16 Dani
Work with staff to create strategies for increasing cultural awareness across the organization aligned to team’s outcome statements
Invite Diversity Action Team (DAT) to share information between both groups-share outcome areas with DAT.
10/27/16 Dani
Integrate cultural awareness into staff development and competency-based training
Provide training to org-wide team about cultural variety
Complete training throughout agency on PBS and Matrix (senior managers and supervisors
1/2017 Dani
Dani and Laura
Identify as a team the dominant cultures within the organization and whether there are subcultures that team needs to learn more about
Start survey with org wide team and develop questions for survey to assess current standing.
6/2017 Dani
Reach out to community members to increase natural supports, recruit diverse staff members, etc.
Autism respite grant connecting with tribal supportand NAACP to look at gaps analysis.
Team evaluates impact of cultural awareness (surveys, disparities related to incidents, 911 calls, diversity of staff, staff turnover, etc.)
Education on broadening cultural definition, noting variety of values as well as race and ethnicity.
Review bias in how people do there work with Decision Point Mapping – start in intake
Ongoing
End of 2017
All team
Easy Access to Person-Centered Tools
Annual Assessment – History Map
Community Outreach Example
Laura BirnbaumDani Dunphy
Saint Louis County
Universal Person-Centered Practice Examples
• Changing Documents and Reports– Edit of Language to be More Person-Centered– Paperwork/Documents Reflect Important To/For – Length of Report
• Implementing PCT Tools– 2-Day Training for Targeted Staff– Coaches Introduce Tools in Meetings– Included in Performance Evaluations– Tools Used While Supporting People– Coaches Support Staff
• Universal PCT For People We Support– Person-Centered Description for People Receiving Support – Action Plans Connected to Descriptions
• Integrating Person-Centered Approaches and Tools in Training – New Staff Orientation– Ongoing Mentoring
Universal Implementation Examples
• Team Data-Based Decision Making Using Organizational Information
• Align Person-Centered Practices and PBS by Integrating With– Position Descriptions– Training Materials– Job Hiring and Interviewing– Performance Reviews Teams
• Action Planning Based on Review of– Staff Climate/Satisfaction– Satisfaction of People Supported
• Regular Review of Policies and Procedures for – Alignment with Person-Centered Practices
Make a List of Things You Can Bring Back to Work
Actions for Implementing Person-
Centered PracticesWho Should be
Involved?Targeted Completion
Date
Getting Your Team Started
• Form an organization-wide team that represents all stakeholders
• Assess readiness and buy in • Complete a self-assessment• Create an action plan • Use data for decision making• Make changes to improve outcomes
Data-Driven Decision-Making
• Decide how you will know you are succeeding
• Find the right measure:– Focused on the right
things– Reliable/helpful– Do-able (not too
complex-just enough)• Use It to guide next steps
Examples of Evaluation Data Effort• Coaches, Key Contacts. PBS Facilitators• Homes, Areas of Organization (parameters)
Fidelity• Self-Assessment• Onsite Evaluation
Outcome• Quality of Life• Incident Reports • Injuries, Sick Days• Attrition/Retention, Workers Compensation
Impact on Workforce
After Implementing Coaching Model for The Tools of Choice (Universal Strategy)…Staff Turnover Rates Decreased:
• 2013 – 167%• 2014 – 70%• 2015 – 65%
• 2016 – year to date – 40%
Fidelity of Implementation: MN Team Checklist
White Form Team Implementation Across PositiveSupports
Blue FormPBS Subscale Items
Pink FormPerson-Centered Practice Items
Domains for Overall Fidelity• Team• Staff Commitment• Self-Assessment• Action Planning• Staff Development• Evaluation• Visibility
Scoring the MN Team Checklist
• Implementation Points– Achieved = 2 – In progress = 1 – Not Started = 0
• Percentage of Items Implemented – Overall Total✓Number of items scored as “Achieved” divided by
Total # of items– Subscale Scores✓Number of items in each subscale area scored as
“Achieved” divided by the number of items in that subscale area
Team Self-Assessment Example - Provider
0%
20%
40%
60%
80%
100%
Team StaffCommitment
Self-Assessment Action Planning StaffDevelopment
and Performance
Evaluation Visibility Total
Perc
ent I
mpl
emen
ted
Subscales
Minnesota Team Implementation ChecklistOverall Fidelity
6/10/2016
9/28/2016
1/17/2018
Activity: Review Items in Each Subscale on the
Checklist
Make a List of Things You Can Bring Back to Work
Actions for Implementing Person-
Centered PracticesWho Should be
Involved?Targeted Completion
Date
Free Resources - Visit MNPSP.ORG
Free Resources - Visit MNPSP.ORGThen Select Training Materials
Thank You for the Opportunity to Share Our Stories
Contact Information
Rachel Freeman
Email: [email protected]
Person-Centered Practice Resources
• Information About Person-Centered Practiceshttps://mnpsp.org/portfolio-items/person-centered-planning-big-picture/
• Person-Centered Thinking and Planning Trainers in Minnesotahttps://pctp.umn.edu
• The Learning Community https://tlcpcp.com
• Person-Centered Thinking Toolshttp://helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/
• Charting the Lifecoursehttps://www.lifecoursetools.com
Free Universal Resources
Social Skills Across the Life Spanhttps://mnpsp.org/portfolio-items/universal-social-skills-resources/
Positive Social Strategieshttps://mnpsp.org/portfolio-items/positive-social-strategies/
Intelligent Lives Videos - Transition Films Garrett’s Filmhttps://intelligentlives.org/transitionfilms
Sean’s Storyhttps://kstp.com/news/wyoming-police-department-to-pilot-growth-through-opportunity-program/4945439
Resources for Implementation
Implementation Examples• https://mnpsp.org/portfolio-items/implementation-examples/
Quality of the Social and Physical Environmenthttps://mnpsp.org/wp-content/uploads/2016/12/PBS-QOL-socialphysical-next-version9-11-17.pdf
Examples of Implementationhttps://mnpsp.org/wp-content/uploads/2016/12/example-of-provider-Implementation.pdf
https://mnpsp.org/wp-content/uploads/2017/02/Odyssey-Preconference5-18-1.pdf
https://mnpsp.org/wp-content/uploads/2017/02/Mental-Health-Orgwideexample4-26-17.pdf
Tools for Implementation
Overall MN Team Checklist• https://mnpsp.org/wp-content/uploads/2016/12/MN-team-checklist-OVERALL-FINAL.pdf
Person-Centered Subscale• https://mnpsp.org/wp-content/uploads/2017/06/MNTICPCPsubscale2-18-17-Next-
Version.pdf
PBS Subscale• https://mnpsp.org/wp-content/uploads/2016/12/Blue-MN-checklist-PBSNext-Version-
Minor-Edit.pdf
Direct Observation Tool• https://mnpsp.org/wp-content/uploads/2016/12/Observation-Tool-Definitions-FINAL.pdf
Definitions for Observations• https://mnpsp.org/wp-content/uploads/2016/12/Observation-Tool-and-Worksheet.-
7.31.17-js-3.pdf
http://rtc.umn.edu/docs/Friends_Connecting_people_with_disabilities_and_community_members.pdf
Making Community Connections
MNPSP.ORG• Training Materials • Universal Social Skills
New Mindfulness Studies in the Disability Field
Free Articles OnlineSingh N. N., Lancioni G. E., Karazsia B. T., Myers R. E. (2016b). Caregiver training in Mindfulness-Based Positive Behavior Supports (MBPBS): Effects on caregivers and adults with intellectual and developmental disabilities. Frontiers in Psychology, 7:98 10.3389/fpsyg.2016.00098https://www.frontiersin.org/articles/10.3389/fpsyg.2016.01549/full
Singh N.N., Lancioni GE, Karazsia BT, Chan J, Winton ASW. Effectiveness of caregiver training in mindfulness-based positive behavior supports (MBPBS) vs. training-as-usual (TAU): A randomized controlled trial. Frontiers in Psychology, 2016;7:1549https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053082/
Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Winton, A. S. W., Latham, L. L., et al. (2015). Effects of training staff in MBPBS on the use of physical restraints, staff stress and turnover, staff and peer injuries, and cost effectiveness in developmental disabilities. Mindfulness 6, 926–937. doi: 10.1007/s12671-014-0369-0https://link.springer.com/article/10.1007/s12671-014-0369-0
Examples - Short Videos for Staff Meetings
Empathy• https://www.newconversations.net/communication-skills-
workbook/listening/
Mindfulness• https://www.youtube.com/watch?v=o-kMJBWk9E0
Introversion Vs. Extroversion• https://www.youtube.com/watch?v=rUaj7rj6MI8&list=PLMo9v
qiZPs0RQa_kypIS3tchANZa-MJGO&index=17
Examples - Short Videos for Staff Meetings
Historical Trauma • https://www.youtube.com/watch?v=AWmK314NVrs
How People Experience Trauma• https://www.youtube.com/watch?v=sjJUQlodh0g
What is Cultural Healing• https://www.youtube.com/watch?v=l1o7ls7JnxA
Blame• https://www.youtube.com/watch?v=IL1JgIj3_fA
Resources From Dean Fixsen and Colleagues
Implementation Research: A Synthesis of the Literature• http://nirn.fpg.unc.edu/resources/implementation-
research-synthesis-literature
The National Implementation Research Networks’s Active Implementation Hub
• Home Page: http://implementation.fpg.unc.edu
• Modules and Lessons:• http://implementation.fpg.unc.edu/modules-and-lessons
Thank You!Preparation of this [presentation/report] was supported, in part, by
cooperative agreement JPK%50470 from the Minnesota Department of Human Services. The University of Minnesota undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore necessarily
represent official MN DHS policy.
