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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
www.transcen.org
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For more information, contact:
Franklin County Board of Developmental
Disabilities/ARC Industries
Kurt Smith
(614) 342-5609
Jack Karner
(614) 342-5091
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