Independent Living Research Utilization

Facilitating Consumer Leadership in

Service Systems A Toolkit for Agency Implementation

© May 2007 by ILRU ILRU is a program of Memorial Hermann/TIRR (The Institute for Rehabilitation and Research) ILRU Program 2323 S. Shepherd, Suite 1000 Houston, TX 77019 713.520.0232 (Voice and TTY) 713.520.5785 (Fax) http://www.ilru.org Lex Frieden ILRU Director Richard Petty ILRU Program Director Editor: Darrell Jones Publications Staff: Sharon Finney, Marisa Demaya, and Marjorie Gordon Permission is granted for duplication of any portion of this publication, providing that the authors and ILRU are credited: Holt, J., Jones, D., Petty, R., [Others to be determined] (Authors). (2007). Facilitating Consumer Leadership in Service Systems: A Toolkit for Agency Implementation. Houston, Texas: ILRU. Support for development of this publication was provided by the Centers for Medicare and Medicaid Services under Grant No. 18-P-91554/2-01. No official endorsement of the funder should be inferred.

Facilitating Consumer Leadership in Service Systems

A Toolkit for Agency Implementation

Introduction

Much has been said and written about consumer-direction in services and systems which support community living for people with disabilities. However, although consumer-directed services are available in an increasing number of states and communities, the next step to consumer-directed service systems has yet to be systematically addressed. Many states have established consumer task forces or advisory boards that include consumers but very few have made systemic consumer direction a goal. Systemic consumer direction moves beyond an advisory board and it moves beyond service delivery which allows choice and control over one’s services. Its focus is a functional partnership between consumers and state agencies that exists throughout the processes, procedures, and policies that characterize service systems. Authentic partnership with consumers would occur at each step along the continuum including design, implementation, and evaluation. Consumers would be respected as leaders as well as service recipients.

The purpose of this Toolkit is to provide state agencies with an array of practical guidelines, recommendations, and checklists designed to enhance their capacity to create and sustain partnerships with individuals with disabilities to participate meaningfully in the decision-making process at the systems level.

State service systems are confronting enormous challenges in conceptualizing and creating sustainable programs that maximize the independence, real choices, rights, and integration of people with disabilities. This statement also reflects an underlying problem of considerable proportion: that is, service systems design and fund programs that address the needs, not of the designers and implementers themselves, but of another population---individuals with disabilities. In essence one group (with legal authority and funding responsibilities) is deciding what is best for another group who is fundamentally unrepresented in the decision-making process at the state level.

Individuals with disabilities have first hand knowledge of the supports they need and the barriers to obtaining these supports. Consumers intimately know what the difficulties are in programs designed to assist them and are painfully aware of the disincentives in existing systems that restrict their rights or impose segregation and isolation. On the other hand, the policymakers, legislators, and administrators know the governing statutory and regulatory requirements of such services and supports and the omnipresent funding limitations and restrictions.

These considerations make it clear that these two groups of people -- consumers and policymakers -- each bring valued expertise to the table and, working as partners, can more effectively address the crucial system change initiatives facing each state.

But the challenge of collaborative partnership is not just substituting old paternalistic words and phrases (safety, security, supervision) for newer ones (self-determination, choice, community participation). Nor is it expanding the number of individuals with disabilities serving on various committees, workgroups, etc. Authentic partnership can fundamentally change the roles and relationships of service systems and service users in the process of system transformation.

The challenges to this system transformation are formidable. In the midst of this change, it has become evident that the aspirations will not be met unless all constituencies come together as equal and contributing partners. A system cannot be transformed unless those who use and rely on it for key services and supports have a voice in shaping its new dimensions. Likewise, the new and dynamic system must have the input of those who know the legal, regulatory, and fiscal guidelines and constraints.

This Toolkit presents ideas, techniques, and mechanisms that may be useful to state policymakers in developing and establishing working partnerships with consumers that will allow the two groups to combine their areas of knowledge to maximize the efficiency and effectiveness of supports and services. The ultimate goal is increased independence, freedom, rights, and integration of individuals with disabilities. In order to accomplish this, each group in the partnership must learn how to communicate with one another, respect one another, and trust one another.

Audience

This paper is written primarily for executives, managers, and staffs of state agencies and service organizations involved in planning, administering, and delivering home- and community-based services. Much of the success of the HCBS initiative has resulted from the work of those managers, sometimes not at the executive level of their organizations, who have shown the commitment and skill required to navigate and influence change within their own organizations. Implementing consumer direction will require that same kind of commitment and skill and the authors of this paper trust that those managers can put to good use what is offered here, for much of what is presented has been drawn from what we have learned from many of those successful managers.

Consumer direction involves sharing power in a way that is uncommon for many organizations—many are struggling with how they will replace old autocratic management approaches with new approaches in which power and authority is shared more equitably within their organizations. Consumer direction calls

leaders to take even one more step toward new approaches: not only is power shared within an organization, but constituents from outside are brought to the table where decisions are made and those constituents come there as full partners. Successful managers will be challenged to garner the support of the highest level leadership within their organizations and they will also need to be constant promoters of the new concept with their peers and associates. The authors of this paper hope that we can offer tools, techniques and suggestions that will help managers pave the way for lasting change.

Part One: Consumer-directed Service Systems

Consumer leadership at the state systems level is the next logical step in the evolution of service systems. Every time a state agency engages in planning activities, proposes service configurations, reviews the status of services provided, monitors the effectiveness of the services, and evaluates programs and systems, the agency leaders should ask themselves the questions: “Have we involved recipients of service and other consumer advocates in this process?” and “Have they been engaged in a meaningful way?” Meaningful implies that the consumers were not token representatives of the disability community but rather had real power and authority in the decisions that were made. The means of involving/engaging consumer partners should occur through several different methods. A single method is unlikely to meet the myriad instances when it is critical to have consumer input. For instance, if state agencies limit themselves to just an advisory board, they will miss perspectives and consumers who may have some important things to say to them but don’t want to serve on a board.

For state agencies, the concept of consumer partnership provides a framework to always stop and ask, “Have we involved consumers?” “How can we involve consumers in innovative ways?” And “Do we really know what consumers are thinking about what we’re doing?”

For instance, here are some of the ways state agencies receive input and feedback. Are consumers fully included and engaged in meaningful roles and responsibilities in these activities?

• Planning and implementation boards • Strategic planning or visioning meetings which would involve a broader

array of constituencies than a board would (See http://www.hcbs.org/files/40/1979/findcomground-1.pdf as an example of an inclusive visioning meeting)

• Task forces focused on specific issues which may be time limited • Focus groups that are conducted following accepted procedures (See

Appendix X). • Roundtables at regional/national conferences (many consumer

organizations are open to considering proposals for a credible agency to offer a session at their conferences)

• Opinion surveys (something other than service satisfaction surveys)

• Paid consultants –as one method in a mix of avenues for input to ensure a broad spectrum of ideas and opinions.

Consumer partners in any of the venues listed above may be asked to review/give feedback on:

• Proposals • Policies • Programs/services • Progress • Barriers • Consumer satisfaction inquiries (reviewing it, not giving it) • Consumer outcomes • How the board/task force/focus group should be operating

In the following parts, much of the focus is on meaningful engagement of consumer partners in boards, committees, and workgroups. This does not imply that this type of partnership is the only method nor the best method. Agencies generally operate through groups and it seems reasonable to discuss how to support groups with members that include individuals with disabilities. The strategies to support members of groups can be readily applied to other methods of partnering with consumers at the state level.

Part Two: Preparing State Agencies and Service Organizations to Become True Partners

There are growing trends in business and the public sector to improve the quality of the goods and services they offer by gaining better and clearer perspectives on the needs and preferences of those who use those goods and services. Often, revenues and brand loyalty increase for business and public sector programs which in turn enhance success and improved customer satisfaction. Listening to customers—truly listening to, hearing them, and acting on what is learned—has been credited in corporate turnarounds such as Continental Airlines, DYNEGY Midstream, General Electric, and others. Home- and community-based service programs face challenges not unlike many businesses: they can benefit from the involvement of constituents, especially those who receive services, as they design and improve programs. As service systems undergo significant changes driven by changing demographics, funding trends, and pressure from more traditional institutional service systems, home- and community-based service programs will need the backing and strong support of constituents in state legislative processes. That strong support is more likely to occur if consumers have been fully engaged in program design and implementation as full partners.

Action Steps for Partnership Although there are no silver bullets that will make consumer direction happen magically, there are many strategies that, if combined and pursued with some determination, will make a measurable difference. The following are some steps that can be taken to create a foundation for consumer direction. They are described very briefly here, not as a comprehensive treatment of the subject, but rather as suggestions for getting practical results.

Strategies to Prepare for Consumer Direction at the Organizational level

A. Make Consumer Direction a Central Goal Articulating a goal of consumer direction at the top level of agency management and throughout all levels is an ideal approach to advance consumer direction, although managers at even a single level of the agency can do much to advance such a goal. Systems not designed with people-centered goals generally fail to promote consumer direction. Faithful and conscientious work toward a goal of consumer direction usually results in progress. B. Provide Opportunities for Service Users, Staff, Board, Funders, and

Others to Learn More about Self-Directed Services

Be intentional about the creation of "vision and people building" experiences to help all involved "stretch" their sense of the potential of consumer-directed services. Raising the bar can foster positive change. People respond to inspiring examples of what is possible - but they cannot implement visions that they have not yet had. C. Use Examples in a Positive Way to Foster Expansion of Consumer

Direction

As agencies advance consumer direction, there will be more and more examples of successes. Leaders can use these examples to show other leaders, funders, and legislators what might be possible with enhanced consumer direction.

Implementing any new system presents challenges for leaders. Consumer-directed service systems are no exception. Indeed, consumer direction may bring some additional challenges, since agencies and service delivery organizations are called to create management approaches in which service users and advocates have leadership roles. Leadership development must take place within the traditional structure of the agency or organization and outside it as users are supported in assuming leadership roles. D. Select Managers and Service Leaders Who Are Committed to Enhancing

Their Own Competencies in Consumer direction

To help consumers achieve self-direction, managers and service leaders must not only be committed to the concept, they must also possess competencies that are consistent with consumer direction. Service leaders should know, practice, and impart them all within the organization. Staff development activities should incorporate training that will help leaders and staff at all levels to develop these competencies. Individuals who have honed these skills should be appointed to key leadership roles. Naturally, service users will have their own instincts about who the most committed service leaders might be, so users should be included in the selection and supervision process. The following items are examples of these competencies. 1. Promoting Collaborative Leadership Approaches

Leaders capable of and willing to work in a collaborative framework, involving stakeholders within and outside their organizations, can do much to advance consumer direction. The complexity of managing any service system increases when those who are the recipients of services are involved in leadership. (There are also advantages for agencies in involving consumers, including having advocacy voices who can speak in support of the system and the agencies operating it.) Working collaboratively and in teams requires different skills from traditional "top down" management approaches. Relinquishing paternalism in favor of welcoming the contributions of others is significantly more enabling.

Agencies can select leaders with this competency and support leaders in acquiring it through training and adoption of team oriented management approaches throughout the agency. 2. Sharing Control and Authority

One meaningful way to share control is to establish a board or task force that includes a substantial number of service users and other advocates who have authentic power to influence policy, service delivery, and evaluation of services. Leaders can learn to share control by becoming more aware of how they monopolize control, power, and authority (albeit unconsciously and unintentionally). 3. Having a Level of Comfort with the Messiness of Participatory Processes

Once we open the door to participation, we begin to share the public space with others. People do not usually fit easily into someone else's preferences and notions of how participation ought to unfold. Conversely, by relaxing and accepting a more open-ended approach to how participation might take place, we can allow others to shape the experience and to make their own unique contributions.

4. Restraining Vested Interests That Might Limit Service Users' Potentials

When users of service have an authentic role in directing the systems that affect their lives, it is much more likely that the focus will remain on what is in the best interest of all concerned. In any service system, there are always opportunities and temptations for those involved to indulge their own vested interests, whether those interests are power, size, reputation, wealth, or any other largely self-serving aim. Service leaders must instead look for opportunities to defend, expand, and enrich the interests of people who are the recipients of the services offered.

Part Three: Considerations for Effective Partnerships

A common assumption is that everyone in a group or everyone who has similar interests (e.g. disability services) has similar knowledge and understanding of, and experience with the issues under consideration. In fact, this assumption often derails best efforts to partner with consumers. Acknowledgement of the differences actually strengthens and deepens the process. Consumers and state agencies each have a perspective of “reality” that is critical if system transformation is to occur in a meaningful way.

Just as the voices of the services users must be heard to help shape the transformed system, these voices can become valuable advocates with legislative bodies, the general public, and broader disability communities. Where state agency staff may be limited in their public discourse by lobbying constraints, advocates can step forward to educate, rebut, and push forward the vision of system transformation.

Recruiting and Identifying Consumer Partners The effort, time, and expense involved to build lasting, productive relationships should not be underestimated. If consumer partners are to become more than token members, both the state and consumer partners will have to recognize the value of full partnerships and be willing to commit to the process of developing and nurturing the partnership. Such institutional commitment must include development of supportive state level policies, training of state personnel, implementation of necessary procedures, and funding sufficient to support ongoing collaboration. This institutional commitment ensures that as state leadership positions change, the collaborative partnership and process is an accepted and expected part of how the agency does business.

A cautionary note: Although family members of individuals with disabilities, advocates for people with disabilities, and provider/state agency staff who have disabilities all bring important and useful perspectives to the state-level decision making process, they generally do not reflect the daily insights of a service user. The participation of those individuals is valuable, but to initiate change, those who are directly and immediately impacted by the system must have a voice and role in the change process.

Recruiting and identifying consumer partners needs to be done in a thoughtful and systematic manner and in consultation with the disability community.

• Recognize the importance of cross-disabilities, elders, and diversity. In an increasingly diverse society, these voices need to be heard.

• Look for consumers who have vested interest and new perspectives. Frequently, the same consumers are recruited to serve on many different committees for multiple terms or to participate in other feedback loops. It’s

important to seek out new faces with fresh ideas. Often agencies that considered certain problematic areas resolved are surprised to hear from new consumer partners that the solution has yet to be implemented. • A nominating or selection committee of consumer advocates should

recruit and select the consumers to serve. • The recruits should receive an orientation about the project and be

encouraged to ask questions about their role. Expectations for participation should be specified (committees, focus group, reviewer). A brief written or oral statement should also be requested from the recruit that indicates their interest and relevant experience, or an informal interview process could also be used if it is easier for the consumer.

Responsibilities and Authority of Consumer Partners

It is critical that consumer partners are members of groups, committees, subcommittees, or taskforces that have actual authority to change elements of the system. If the committee has limited or token authority, then the voices of consumer partners are of limited value. It is not reinforcing to participants to provide input when the impact is essentially meaningless. When this happens consumers may quit coming to meetings.

In the same sense, if consumer input has been obtained through focus groups, opinion surveys, roundtables at conferences, or other means, there needs to be a strong commitment from the agency to take recommendations seriously and to communicate back to the participants the results of their input.

With the assumption that the group has a specific charge to improve an aspect of the system and the authority to do so, then each member, including consumer partners, has a responsibility to assist in achieving the task of the group. There are several key expectations for consumer partners including:

• Attendance at meetings is a prerequisite for group membership (Strategies for supporting this will be discussed in the next section)

• Willingness to participate in meetings • Listening to other groups members and their perspectives

In Massachusetts, grant staff, state agency representatives, and consumer leaders agreed that they needed to set up the consumer committee. They asked participants to volunteer for a Nominating Committee and wanted to assure that this consumer group would have a meaningful role in the grant. They didn’t want a traditional advisory committee model.

• Contributing to the group discussion • Cooperating with other members • Compromising – the hallmark of groups • Collaborating to reach common goals

As the group reaches resolution on an issue, the consumer partners must have the same responsibilities for achieving the group’s task as any other member and should recognize and respect this responsibility.

A common challenge is having a consumer partner(s) who has had a past adversarial relationship with the agency. In this situation, the consumer partner must understand, and be willing to participate in the collaborative process without moving into an adversarial position. In a similar vein, the stage agency personnel must be willing to recognize that the voices of strong self-advocates can only help the system transformation process. Such advocates should not be ruled out as participants simply because they have made waves in the past.

To reinforce the role and responsibilities of consumer partners as well as the agency, it is sometimes useful to have a letter of understanding developed that specifies what both parties have committed to and the decision-making responsibilities of the group. Following are some suggested areas to be discussed and agreed upon prior to beginning the work of the committee, task force, etc.: State agencies can:

• Specify the desired outcome of the group process such as developing a new policy for using state funds for supported employment; revising the income limits for the Medicaid Work Incentive (buy-in); or developing compliance procedures for home- and community-based services.

• Explicitly state the type and amount of reimbursement (stipend, gift

certificate) that will be provided to the consumer; travel arrangements; and how lodging or meals will be handled.

• Determine if the consumer has ready access to a computer with an

Internet connection and, if not, how this can be provided by the agency. • Agree to have decision-makers at the table (no random-assignment of the

day representatives.) • Provide support (e.g. meeting space, telephone conference line) for the

consumer partners to meet separately when needed so they can better

understand each other’s disability perspective, discuss approaches, or develop consensus on “non-negotiables.”

Consumer Partners can:

• Agree to attend all committee meetings and any subcommittee meetings assigned. It is understood that there may be some occasions when attendance is not possible due to illness or family concerns.

• Agree to participate in the committee and provide input into the decisions. • Agree to read materials or do research assigned and be prepared to

discuss them. • Specify what accommodations are required

Reality Check

Developing a trusting relationship is the basis for a successful partnership. However, there are several serious considerations that need to be explicitly addressed. A framework for better understanding the concerns of consumers as partners is articulated in the findings of the Oklahoma New Freedom Initiative. Based on their successful efforts, consumer partners and state agency staff have determined that “. . . consumer partners often lack the skills, knowledge, tools, and financial resources to perform effectively. Public policy that is created out of groups involving consumers is often ineffectual because:

• Financial resources are limited. The lack of resources is the single biggest challenge facing consumer representatives. It is often difficult to find money and support for representatives who wish to participate fully in public policy development. Often, professional members can be involved as part of their job function, therefore receiving financial support for participation. The lack of resources for consumer representation has a direct effect on the availability and performance of consumer stakeholders and the development of informed and empowered consumers.

• There is a lack of system knowledge. Most public policy involves complex

system knowledge. It is a challenge for some consumer partners to communicate their viewpoint in this environment, as they may not have the full range of knowledge required to understand service system interrelatedness, terms, and complexity.

• Information exchange is limited among all stakeholders. The group

processes used must commit to careful thought and sufficient time and resources to support learning, and meaningful exchange of information

and ideas. When each person considers varied perspectives and engages in insightful dialogue, then new ideas emerge and build on one another, creating a powerful synergy.”

Strategies to address these concerns include four basic principles: 1. Open communication 2. Meaningful discussion of service system issues 3. Participants discovering each other’s knowledge and experience. 4. Understanding of differing perspectives around an issue.

The process must be interactive and iterative. Solutions are rarely identified through a linear process, but rather through a long, often circuitous, process that strengthens as it proceeds through enhanced trust and collaboration.

Part Four: Use of Facilitators

What is a Facilitator?

A facilitator is someone who accepts responsibility to help the group accomplish their common task in an effective manner while ensuring that all voices are heard and differing perspectives addressed in the decision-making process. The facilitator’s responsibility is to the group and its work not to individuals within the group.

Rationale for Using a Facilitator (Why)

It is important to have a successful partnership and using a facilitator to guide the group’s meetings indicates a real commitment to making the process equitable and inclusive. Successful partnerships take time and effort and there are numerous opportunities for misunderstandings to occur. Having a mutually agreed upon facilitator sends a powerful message that the agency is taking this process seriously and is also being responsive to the perceptions of the consumer partners. And finally, a facilitator can be extremely useful to keep the group on topic and accomplish its tasks in a timely and effective manner.

Identifying a Facilitator (Who)

An effective facilitator should have several key qualities. Several of these are listed below.

• Training in facilitating group meetings with a successful track record as a facilitator

• Acceptance by all members of the group including the consumer partners • Skills to cope with a variety of personalities • Ability to control dominating group members and bring quiet members out

in a non-intimidating manner thus establishing a sense of fairness of participation. This is important in any group, but especially in a group where the members have not yet developed a sense of trust with each other.

• A general knowledge of the issues that are the focus of the group’s tasks,

political issues, and sensitive areas • Availability over a period of time--at least a year • No conflict of interest in the outcome of the group’s decisions or strong

alliances with a group member

In each state, there are respected individuals who could fill this role--university faculty, individuals from the business sector who have been trained as facilitators and have experience in human services, or perhaps a nonprofit director who will not be affected by or benefit from the group’s decision. The facilitator should not be the agency administrator or staff to preclude any perception of bias in the issues being discussed.

What does a Facilitator Do?

A facilitator does not make decisions during the meeting for the group but rather helps each member of the group to recognize that they have a pivotal role in the group and ensure that each member is “heard” by other members. “Heard” implies not just the actual words spoken by a group member, but also that their perspectives and insights regarding the topic of discussion are not ignored by other group members. Often the group member to be “heard” may be a consumer partner and their opinions can be set aside as the more vocal members express their opinions. A facilitator can come back to member’s comments as the discussion continues and remind the group of them so they are not lost. In addition, the facilitator can provide a summary of all comments as part of the review process before moving to another topic, not just the prevailing opinion.

In addition, the facilitator needs to be aware of and responsive to: (1) both the energy level of the group and the overall emotional tone of the group and then take appropriate steps to address these concerns; (2) body language; (3) facial expressions; (4) side conversations; (5) members interrupting each other; and (6) members who are not following the conversation. Keeping the pace of the meeting deliberate, not rushed, and being able to stop for members to catch-up is crucial. It can also be effective for the facilitator to state what they have observed and possibly suggest something to do about it.

A facilitator can have several responsibilities in addition to facilitating the actual meetings including:

• Assisting with the preparation of the agenda to ensure both continuity and neutrality in how items are phrased.

• Conducting a quick evaluation at the end of each meeting to get a sense

of what worked and what didn’t in the process. (Do not evaluate the topic itself.)

• In some instances, agreeing to spend additional time before and/or after

the meeting to assist consumer partners in understanding the meeting process, any pre-meeting information, or post-meeting responsibilities.

Suggestions and cautions

In some instances, a facilitator over the course of several meetings may form an alliance with some members of the groups or may clearly prefer one position over another position on a topic. If this occurs, the agency representative should meet with the facilitator and discuss the concerns. If the facilitator cannot remain neutral, a new facilitator needs to be identified.

Historically consumers have not been part of the decision-making process for their own services or at the state-level. Given their possible inexperience, a consumer may not feel comfortable with making decisions and may defer to the opinions of agency personnel. A strong facilitator can use several strategies to address this including having consumers discuss an issue from their perspective before the full group discussion or providing opportunities for the consumer to discuss their perspectives during a pre-meeting orientation. Massachusetts e-mail communication—text box General source: “Reclaiming Meeting Facilitation – The No-Magic Method” by Berit Lakey

Part Five: Conducting Effective Meetings

Environmental and Materials Accessibility

The goal of meeting and materials accessibility is to ensure that everyone is on equal footing. Unequal access is one of the primary reasons why consumer partners often begin the meeting process in a secondary position. Although there are a number of accessibility concerns, the immediate physical environment and the materials used are two critical components. Environment - Prior to the meeting, take some time to visit the room where the meetings will be held to ascertain if it will meet the needs of your consumer partners. (Note: The consumers should have identified these needs as the Letter of Understanding is developed.)

Environmental questions to consider include:

Getting to the room ___Is the location of the meeting easily accessed by public transportation?

___Is adequate accessible parking available? ___Is the meeting room easily located within the building? ___Once inside the building, are there large signs available to direct people? ___Are the entrances to the room accessible? ___Have you disseminated readily understandable maps of the location of the building and the room? ___Do all contact information and directions include TTY or relay information? ___Are the restrooms accessible? The meeting room ___Is the room well ventilated, free of odors, and maintained at a comfortable temperature? ___Have meeting attendees been asked to refrain from the use of perfumes, hair sprays and other chemicals prior to the meeting? ___Has the room been cleaned with unscented products for at least 4 days prior

to the meeting? ___Does the room have good acoustics? ___Will the room be large enough for the group members and any additional staff, the facilitator, interpreters, service animals, and personal assistants or companions? ___Does the room have good lighting? ___Is carpeting low pile? ___Does the size and arrangement of space for meetings accommodate the stationing and flow of expected wheelchair users? ___Are additional chairs and tables removed from the room to allow wheelchair access? ___Are the tables and chairs in the room comfortable? ___Is the room large enough to arrange the tables and chairs in a configuration that encourages participation? ___Is there a room nearby that is quiet if consumer partners need a break? ___Does the room have a flip chart, microphones, and a screen for PowerPoints? ___Are visual or auditory distractions minimized? ___Are support staff available, friendly and identified with different colored name-tags or other means? Materials - It is imperative to give serious consideration to the preparation of materials for the meeting. Not having print materials available in the appropriate format for consumer partners indicates that you do not view them as authentic partners. The same level of consideration should be given to ensuring that the materials are understandable. Since each consumer partner will have individualized needs (don’t assume that all individuals who are blind want materials on a disk or that all individuals who are deaf prefer an ASL interpreter), you will need to visit with each consumer partner prior to the meeting to determine what type of alternate formats are preferred.

Materials & Other Considerations

___Are materials available, as needed, in Braille, large print, on discs, or on audio tape? ___Are items written on a flip chart or projected as they are developed by the group read aloud? ___Are videos that will be used captioned? ___Do videos that will be used have an audio description? ___Are assistive listening devices and qualified interpreters available? ___Are graphs, charts, tables, PowerPoints in accessible format? ___Are personal assistance services provided by your agency (if requested) or do you reimburse the participant’s own personal assistant? ___Are speech translators available for those whose speech is difficult to understand? ___Are the materials for all partners written in clear, easily understood language? ___Are the materials free of acronyms? ___Do the materials have phrases that may be readily understood by the agency representatives, but not by the consumer partners? For instance, many consumer partners will understand the phrase “institutional bias of Medicaid,” but may not understand “deficit reduction act.” ___Are materials culturally responsive? For instance, the term “undocumented immigrants” is less negative than “illegal immigrants.” ___Do you have name-tags and tent cards printed in large readable letters? ___If food is to be served, have you checked for special diets and utensils? ___Are refreshments reachable from a wheelchair? ___Are straws located at each table?

Other accommodations to consider - Supports always need to be individualized. Generally, accommodations have focused on individuals with physical or sensory impairments. However, consumer partners may have a variety of other impairments including traumatic brain injury, intellectual disabilities, mental illness, and neurological disorders. The following suggestions are not intended to be comprehensive, but may be considered as you plan accessible meetings. You should not determine the type of accommodations needed based on the type of disability. It is important to always ask the consumer partner what his/her needs are several days prior to the meeting to ensure that appropriate accommodations are made. It should be noted that many of the suggested accommodations listed below may be useful for all of the group members.

Other Accommodations

Environment ___Preferential seating – possibly near a door ___Consumer partner may participate in meetings by phone if needed ___Have stress reliever toys available on the table for individuals who want to use them during the meeting Before and during the meeting ___Prearranged or frequent breaks ___Option for note takers or tape recorders ___Advance copies of materials to be discussed ___Recognize that changes in room, routine, or personnel may be difficult and address them as early as possible Another consideration is that consumer partners may have had experiences with state agencies where requests for accommodations were either ignored or addressed minimally. For instance, a consumer partner who is blind and requires written information on a disk may have been told in the middle of a meeting that, “We will send you these handouts later” or “We will tell you the main points on the handout.” Due to this history, consumer partners may not be initially satisfied with the accommodations and request additional ones or “fine-tuning” current ones. The issue of having appropriate individualized accommodations is much more than just accessibility; it is an indication of the level of respect and attention given to meeting each member’s needs.

Comment [DLJ1]: ???

This section discussed environmental and materials accessibility in the context of group meetings. However, these suggestions are relevant for other types of consumer partnership activities. Whether engaging consumers in a group or individual setting, both environmental and materials accessibility remain a serious and important consideration.

Getting Started The following graphic is a simple description of a rather complex process. It is good to keep this in mind as you are getting started in the collaborative process. Consumer Experience and Knowledge---------Policymaker Experience and Knowledge I I I Sharing Knowledge, Information, and Ideas I I I Effective Public Policy

As noted earlier, the consumer partners may want to meet separately without state agency staff. This may be especially useful if the consumer partners are individuals with different disabilities. Having cross-disability consumer partners is valuable due to the breadth and depth of the cumulative experiences, but it also necessitates that the consumer partners have ample opportunity to understand the varying perspectives. Since individuals with physical disabilities have often been the most visible advocates, it is important that all consumer partners are comfortable expressing their opinions both to other consumer partners and state agency staff. With this foundation, consumer partners are more likely to feel comfortable engaging state agency staff in group discussions

Set realistic expectations – discuss ahead of time the process to be used and the extent of authority the group has been given. This is especially important for consumer partners because of the experience of many as a token member of a committee or in a group that has no real decision-making authority. Often individuals with disabilities are hesitant to commit their time and effort to a process that has generally not worked. Don’t overstate the power of the group, but describe it accurately.

A well-articulated expectation for the final product that is clearly accessible to the group will also serve to assist members of the group with their own individual expectations.

As a group, identify the vision and mission. A vision and mission statement of the agency may not be relevant and / or appropriate to the consumer partners in the group. In that case, the group members need to either develop their own

Comment [I2]: Will do flow chart here.

statements for the group and / or add language to the agency’s statements. The vision and mission statements are critical since they would articulate the goal that the group wants to attain and the purpose of the group. Buy-in at this point is essential. If any member of the group can’t accept the statements, continue discussion to develop consensus. Establish ground rules using the consensus method during the first meetings and publish those.

Place the vision and mission on a poster to be available during each meeting and refer to them in times of disagreement. Use the statements as the group touchstone. Meaningful vision and mission statements will enhance the group’s work and keep the group focused on their specific assignment.

During the process of developing or adapting a vision and mission statement, the expectations of the group members will probably emerge. If not, make this a specific activity prior to beginning the work of the group. Facilitate the process by specifying what a final product would look like. A vision and group mission, identified group expectations, and a defined end product form the foundation for the essential group activities.

In addition to the vision/mission, the guiding principles need to be stated explicitly. The group may develop the organizing principles, adopted from principles established by other successful collaborative groups such as:

• Effective public policy is born when it is created by a diverse group of stakeholders who: are committed to a shared vision, share knowledge, and become informed and active participants.

• Effective public policy considers and incorporates each stakeholder’s

experiences.

• Resources must be targeted to support and facilitate full participation and continual learning.

Another point that requires careful discussion is the process for making decisions. Again, consumer partners may have had experiences in which an agency already knew what they were going to do and the group process was merely rubberstamping the decision. It is important to discuss how decisions / recommendations will be made and to whom.

• Is the process one of democratic consensus? • To what extent will the membership influence decisions? Issue

recommendations?

Again, both advocates and agencies will need to look to the broader good rather than perpetuating old battles and defeats.

It is also critical to understand the political climate of the situation. A group that is examining an issue in the context of a budget surplus may differ from a group addressing the same issue in the context of a budget deficit or a court order. Given the political climate, is the group willing to examine the issue in the light of the vision/mission?

Structuring effective meetings - An effective meeting starts well before the actual meeting, often with the development of the agenda. It is best to have the group (or a specific subgroup) develop the agenda prior to the meeting. A call for agenda items should be made days or weeks before the meeting and the agenda should be finalized and sent to each member along with directions to the meeting location, time and estimated time to adjourn. The group will develop its own identity if properly supported.

Initial meeting activities include beginning the meeting with a summary of the last meeting (even when minutes are available). This will serve to refresh everyone’s memory and update those who could not attend. The next step is to read the agenda and ask for additions. Specify the amount of time spent by each agenda item. If more time is needed, negotiate this with the entire group or table until next time. It is preferable to address thoroughly a small number of items than try to push through a packed agenda with little time for real discussion. Also indicate on the agenda the person responsible for leading the discussion about that item.

Encouraging active participation during meetings - Room arrangement should be in a convivial manner – one that invites interaction. Circles are the best. Have note cards available for those who prefer to relay their comments or questions in writing. This is extremely important when individuals in the group are hesitant about making comments or posing questions to the entire group.

Another consideration in encouraging active participation during the meeting is the use of mentors or peers. A mentor or peer would be available to a group member to facilitate individual discussion and provide additional clarifications. The mentor might be useful to relay questions or areas of confusion. The mentor / peer could be available to the individual member during breaks and lunch to review the material discussed to ensure that the individual has 1) understood all that has transpired, and 2) relay the opinions or recommendations that they were uncomfortable discussing in group to the facilitator.

Often participation in meetings decreases over time. Although this may be due to several reasons, a common one is that the group or sponsoring agency only considers recommendations from certain members of the group or only reinforces one approach to solving a problem. In reality, there is rarely one solution to a problem. Encourage participants to be open to explore other options, even non-traditional ones. Debate and disagreement are part of a democratic process – encourage them, but always consider the common goal/vision that may be referred to on a flip chart during each meeting.

Comment [DLJ3]: A good place to talk about the Oklahoma example of members having homework assignments, giving reports, participating in sub-committees or in breakout groups during meetings to discuss details of a specific topic area to bring back to the larger group.

Important issues are often conveyed using examples and stories. Consumer partners may be more comfortable with this format.

Always have a flip chart available for “parking lot” issues that will need to be brought up again. If you reach an impasse, take a break or table the issue until next meeting.

If speakers are invited, make sure they know who the audience will be and what the audience expects. Be sure that invited speakers are knowledgeable about current best practice elements of the topic. Nothing can quell enthusiasm more than a speaker who is not in synch with the audience or is describing approaches that are a decade old. During question and answer period – be sure the presenter repeats the question in the simplest terms possible. Remember speakers and guests may need accommodations also.

In the same vein, video-audio presentation may be effective and hold the attention of the group members if they are relevant, well produced, and have the necessary accommodations to ensure that all group members benefit.

Closing the meeting effectively - How a meeting is closed can either renew the energy of the group or reinforce the concept that nothing will ever change. There are several strategies that can be used effectively including:

• At the end of the meeting, summarize what the meeting did and did not accomplish and have an open discussion on the agenda for the next meeting.

• Be sure to discuss the next meeting time (beginning and ending) and

location. • Ask participants to evaluate at the end of each meeting. The evaluation

should be simple and quick, but provide a way of checking on where group members are in this process.

• Read evaluation results (either individually or summarized) at the

beginning of the next meeting. This reinforces with each of the group members that their input is valued.

• End each meeting on an optimistic note and how the progress came

closer to meeting the vision.

Ensuring and Sustaining Attendance and Participation

Perhaps no other characteristic so defines a strong group member as regular attendance at meetings. Attendance often poses a considerable barrier for consumer partners. Described below are strategies that could be employed to address the barriers.

1. Typically at a meeting, everyone at the table, except consumer advocates and service users, are being paid by their agencies to be there. For a consumer partner to be able to regularly attend the group meetings as well as the sub-groups meetings, it is important to provide a stipend. The cash honorarium or stipend typically varies from $50 to $100 per meeting. However, the stipend may need to be increased if the consumer partner requires a Personal Care Assistant to also attend the meeting. If so, provide the cost of the additional hours. For those consumer partners who receive public assistance, a gift card may be a better choice since some partners must limit their income for continued benefit eligibility.

2. Funding strategies for consumer participation could include the lead agency providing the stipends from a line item in their budget. Community or advocacy groups might share the costs of participation or provide a co-share, or provide financial support for a group scholarship fund. Ideally, a legislative mandate could strengthen the financial support to convene and sustain participation in a formal sense. The legislature could issue direct funding as a separate line item.

3. Transportation also poses a significant barrier. Simply indicating to consumer

partners that their transportation costs will be reimbursed may not fully address the problem. If public or private transportation is not reliable or accessible, reimbursing travel costs may be a moot point. Hiring an accessible van to pick-up the consumers may be a more practical solution.

4. Often meetings start early or run into the evening. Consumer partners may

need to stay overnight so the cost of rooms and meals should also be paid by the agency. It is appropriate that accessible hotel rooms are available as well as accessible transportation to and from the hotel. Also remember that the consumer partners may not have and/or wish to use their personal credit cards so the agency may have to pay directly for the rooms.

5. Participation implies more than providing input at meetings. It also means that

each member has the computer capacity to respond to email, access online documents and respond, and enter into listserv conversations. Many consumer partners may not have readily available computer access. (Remember, saying that they can access computers at the library is neither reasonable nor feasible.) To ensure an equal playing field, your agency may want to provide computers for consumer partners. This may be difficult due to agency rules, but it may be critical to have full consumer participation. Paper and a printer may also be needed. See Appendix ? for a description of how a systems change grantee successfully addressed this.

6. If a consumer partner misses meetings, it is important to provide them not only

with the minutes of the meetings but also have follow-up discussion with them to ensure that they do not feel left out of the process.

Comment [DLJ4]: Do you know of a state that did this? NOPE

Comment [I5]: The Oklahoma approach description will be included in Appendix.

Part Six: Strengthening and Expanding the Partnership

Support Information and Education

A common assumption is that everyone in a group has a similar understanding of the issues to be considered. In fact, this assumption often derails best efforts to include consumer partners. A service user does not necessarily understand the policy that underlies the service or the guidelines for that service. Often the perspective of the service user is based on what agency/provider staff or other service users have told them. This should not be viewed as a deficit. Rather it is an opportunity to explore the policy and implementing guidelines from both a consumer and agency viewpoint. State agency staff may not realize how policies are being interpreted or misinterpreted in the field.

In providing background as well as ongoing information and education, it is helpful to remember that no one can assimilate all the relevant information about the topic in a single setting. Frequently, agency staff may feel that providing a single orientation session for consumer partners is all that is required. For effective education and information sharing, orientation activities need to be both incremental over time and interactive. As adult learners, we are much better at remembering what we hear if we can discuss it, get clarification, or have our questions answered. Orientation then becomes an ongoing process of providing information to consumer partners as needed. In fact, even for those who initially say that an orientation is not needed, they will often be open to education/information sharing sessions if asked again after a few months. Information and Education - The purpose of the information / education sessions is to provide individuals with the tools and resources they need to understand issues, develop strategies, and fully participate in the group. In developing and presenting these topics, use principles of adult learning. Appendix X contains a summary of these principles.

Topics

• Basic information about the political structure, system processes, funding sources, state organization, providers and advocacy groups relevant to the group’s charge and authority. Information for the sake of information is not beneficial. Provide only information that has direct relevancy to the subject and provide it in an impartial manner.

• Standard terminology. Agree on standard terms that will be used

consistently. For instance, the term “consumer-direction” is frequently used, but has multiple meanings. It could mean that a consumer can select from a set menu of services, determine the frequency of a particular service, decide whether to use a self-directed or agency model for

personal assistance services, or direct a care provider about what the individual would prefer to do that day. By clarifying the meaning of the term, it will save time, confusion, and backtracking by the group.

• Enhanced understanding of the concept of “consumer-direction.” Agency

staff need to understand the concept of consumer-direction as it applies to state policy, procedures, and regulations that guide the services and supports for individuals with disabilities.

• The nature of the policy change process. Discuss policy and identify what

can be changed and what cannot. Consider carefully, what can’t be changed. Sometimes things can be changed if the state is willing to consider innovative alternatives. If it cannot be changed, look for other options. Invariably there are some things that cannot be changed at this time. Accepting that fact will also facilitate the group process.

• State and federal commitments of accountability and responsibility.

Identify state and federal commitments of accountability and responsibility as public stewards. These should clearly reflect the intent of federal and state policy.

• Relevant Resources. Provide lists of relevant resources – people,

services, websites, etc. Strategies to strengthen the group process

• Provide a glossary of commonly used terms, phrases and definitions, and a list of acronyms and what they mean.

• Provide the group with a participant list that includes a “humanized” bio for

each participant as well as contact information. “Humanized” bios focus on the person more than academic achievements of organizational status.

• Create a level playing field through the exchange of information. It is

important to learn and respect each other’s languages. This facilitates a shared leaning experience. Story telling (reflecting the personal approach) is an excellent way to establish these personal understandings.

• Include strategies to enhance the development of personal skills in group

settings.

• Dedicate time to training as a protected part of each meeting and/or at another time. Education is an ongoing process that cannot be compressed into a one-time activity.

Other types of training that might be offered to various group members including how to successfully advocate, skills training on communication, and the sociopolitical concept of disabilities.

Leadership Development

One of the critical elements of achieving successful participation is state-level leadership – a person with decision making power that possess the position to influence others. The leader must clearly articulate a stated commitment to support meaningful participation. Leaders must understand the importance of the group process and pass it down as an expected behavior and an organization goal throughout the agency. Meaningful participation becomes the intended outcome. Leaders set the atmosphere, ensure the group vision is attainable and provides the resources to make involvement happen. Leaders make the decision for inclusion to happen.

As consumer partners are full members of decision-making groups and their experiences and insights are valued, they will continue to develop the skills and knowledge to become increasingly strong leaders. Other aspects of leadership development that occurs in the context of shared decision-making at the state level for consumer partners include:

• Improved understanding of cross-disability issues • Strategies for partnering across disabilities

• Improved understanding of the state’s rules and constraints • Better understanding of the complexity of developing state policy—what

rules are real (explicitly mandated by state of federal rule) and what may actually be changed

Evaluating Effectiveness of Consumer Participation and Direction

Evaluating the effectiveness of consumer participation can be conceptualized in several different ways. Some of the methods may be formal and others more informal. No single method of evaluation provides a complete picture. In addition, effectiveness needs to be considered across points in time. Effectiveness measured at the conclusion of a project may look quite different when measured 12 months after the project’s conclusion. “Effectiveness” of “consumer direction” and “participation” may also be defined in several ways. Given these variables – point in time of evaluation and definition of effectiveness, and the measurement strategies – formal and/or informal and point of view; the methods described below may serve as a starting point in conceptualizing both the evaluation questions and the methodology.

Informal - Sometimes the best evaluation of effectiveness is to examine the working relationship of state agency staff and consumer partners and advocates six months to a year after the conclusion of a specific project that had collaborative leadership (consumer partners and state agency staff). One might examine

• The consistency of participation including both attendance and contribution to doing research, homework, reports, etc. on the part of the members, both consumer partners and state agency staff.

• The number of collaborative presentations made at the state or national

level with consumer partners. Are consumer partners brought along for “show” or are they an integral part of the presentation?

• The type of interactions between consumer partners and state agency

staff in public meetings. Does there appear to be a greater understanding of each party’s perspectives? Has the state agency continued to support a collaborative process in the development of policy and programs?

• Have the recommendations from the group been implemented?

Formal - Formal evaluation methods generally include written surveys or structured interviews conducted in person, on the phone, by mail, or email/internet. Typically all members of collaborative groups participate with an external (independent) evaluator. The use of an external evaluator generally leads to more candid responses and impartial findings. Questions (whether structured interview or survey) generally examine one or more of the following:

• How did the consumer involvement process differ from other boards, work groups, committees, task forces, etc. that you had previously been a member of? What worked? What did not work? What have you learned? What would you change about the process?

• Was this a cross-disability initiative? Have you been involved in cross-

disability initiatives previously? How did this compare? What are the reasons to create cross-disability policy? What are the reasons not to? How could it have been done better?

• What was the recruitment and selection process for the consumer

partners? Who did it represent? Who was left out? What could have been done differently? Did your experience change over time? What was your experience with accessibility?

• Was this model of collaboration different? What were start-up challenges?

What were barriers to progress? What are some lessons learned?

Another approach would be to use some of the questions presented previously and rephrase them for responses on a Likert scale. If you need quantitative information, this approach may be useful.

Most evaluators would state that the use of focus groups often provides very rich information. As one member of the group responds to a question, others will expand and deepen the response. A caution on focus groups is the composition of the group. Consider carefully whether the group should be a mixed group or a group of only consumers or only state agency staff. Systemic - Another way of evaluating effectiveness of consumer participation and direction is to track changes in the state agency. The changes may be at the policy level, the program level, in the way the state agency does business, or in perceptions of consumers and advocates.

• Have recent system decisions on policy showed the impact of consumer involvement and perceptions?

• Are state programs making changes that support consumer direction?

• Is the state funding increasing for community supports?

• Is consumer direction becoming an accepted part of the agency’s policies

and programs?

• Do advocates and consumers see positive progress in the state’s policies and programs?

• Has the state continued to partner with consumers in ongoing as well as

time-limited committees, taskforces, work groups, etc.?

• Is a quality management system in place that heavily relies on a quality committee to provide feedback and recommendations to the entire quality management system?

Has a means of evaluating the community service experience been developed that utilizes consumers and service users? Is there a baseline by which to evaluate progress toward satisfaction, access, and services?

Sustainability: Spreading the Concept

A successful partnership of state agency staff and consumers forms the foundation for the state agency to consistently change how they do business. All members of the collaborative group should be dedicated to letting other constituencies (at both the state and community level) know about the process. State agencies can continue to use the same approach in multiple contexts and

settings. By repeatedly developing policies, procedures, and program guidelines with the full participation from consumer partners during the entire process, the state agency will be modeling the collaborative process for other state entities as well as community providers. A state agency that feels strongly about the efficacy and value of this collaborative partnership model can also strongly encourage (or even mandate) that community providers use the model.

Preparing a guidebook that describes the process is another useful sustainability method. The guidebook will be more relevant and acceptable if all members of the group have the opportunity to assist in the development, review, and approval process. By pairing the guidebook with training and technical assistance across the state, the concept will become part of the expectations for ongoing consumer partnerships.

In a similar manner, the consumer partners need to inform consumer groups and advocates about the successful group process. In doing so, they should emphasize both their responsibilities as well as what they learned about supporting an interactive learning process. It is important for state agencies to spread the word and continue to use the model, but consumer partners also have a responsibility to assist others in better understanding how they can be a contributing partner in this type of group. Being a partner in state level policy development requires all partners to learn, adjust, and adapt to a collegial model of joint responsibility. Key Strategies for Supporting Consumer Partners at the State Level in Providing Input

• Recruiting consumers through consumers • Environmental and materials accessibility • Setting clear expectations • Supporting participation

This could fit somewhere to try to sum up key points for other types of consumer partner input/interactions

Appendix X

Basic Principles of Adult Learning [Excerpts from ILRU-sponsored Teleconference on __________]

Kathleen McInnis-Dittrich, Ph.D.

Associate Professor of Social Work Boston College Graduate School of Social Work Chestnut Hill, MA 02467 mcinnikd@bc.edu Training both professionals and para-professionals involves a different kind of knowledge acquisition from that traditionally associated with children and teens. Adults are “selective learners.” They want to be respected for the experience and knowledge they bring to new learning and find ways to integrate what they already know with what is new to them. Adults sift through any new knowledge presented to them specifically for what is readily applicable to their training needs. “Telling” adults is not synonymous with “teaching.” This teleconference explores the basic principles of adult learning including the need for safety in a learning situation, the mutual relationship between teacher and learner, the significance of sequencing and reinforcing learning activities, and the importance of providing opportunities for both action and reflection. The teleconference will explore the connection between ideas, action, and feelings in adult learners, techniques for engaging the learner, and the importance of accountability for the materials learned.

Introduction to Adult Learning

• Adults learn within a specific contextual environment, based most often on need to learn rather than learning for its own sake.

• Adults’ motivation to learn is based on their interests not those of the

teacher.

• Adults need to be “doers” in the learning process rather than passive observers.

• Adults need to be able to apply new knowledge and skills immediately for

new information to be retained.

• Teachers and learners have a more “mutual” relationship than in traditional didactic learning.

Comment [DLJ6]: I don’t know if we need both Kathleen’s and the Vella material.

• Adults need to be respected for what they already know and how it relates to new information to be learned.

• The learning process for adults involves the interaction of ideas, feelings,

and actions.

Basic Principles of Adult Learning*

1. Needs assessments are crucial to identifying what adults need to learn and should precede the development of training/educational programs.

Ask directly. Helping adults to identify what they want to know as

well as what they need to know engages them in the learning process.

Observe directly. What have you observed as training or educational needs? Clarify whether adults have the information but are not applying it OR don’t have the information, therefore need to be trained.

2. Learning environments for adults need to be “safe.” If adults feel

threatened or embarrassed, the learning process is damaged.

Avoid excessive evaluation and testing as a means of accountability for new knowledge. It rekindles negative experiences from childhood.

Adopt the “there are no wrong answers or stupid questions” attitude.

3. Develop more “mutual” relationships between the learners and the

teachers. Develop and encourage learners to see themselves as part of both the teaching and learning process.

Ask for examples from adults in the learning context to supplement

your examples. Validate questions and comments from adult learners.

As teacher or presenter, emphasize mutual interests and concerns, de-emphasize “I know, you don’t know” perspective.

4. Learning activities must be sequenced and reinforced.

Break down new knowledge into a series of steps or tasks to be

presented beginning with simple tasks and proceeding to more complex ideas and tasks.

Help learners to master simple tasks and build upon them as materials becomes more difficult. This helps to build confidence and reduce anxiety.

5. The ability to act on new knowledge is based on having the time and the

opportunity to reflect on the new knowledge, to question and consider how this knowledge applies to them.

Encourage small group discussions whenever possible especially

when presenting controversial or difficult material. Ask small groups to directly answer the question of “how does this apply to you?”

Encourage constructive criticism of new material. It is easier to accept/retain materials you have questioned and then digested.

6. Adult learners must be respected as decision-makers.

Ask adult learners to respond to new material presented in a

decision-making capacity—i.e. How would you apply this information to what you do? When would this information be helpful? Not helpful?

Use exercises to demonstrate the decision-making process to clarify the complex process of making decisions based on what we do and don’t know.

7. Learning is a combined process of ideas, feelings, and action.

Adults receive new information within a learning context. The cognitive process evokes an emotional response. How the adult “feels” about what s/he has “thought” determines

how the new knowledge will be applied. Attitudes are caught not taught.

8. Adults need to see the immediate relevancy of the new knowledge

presented to them.

Training should be timed to be immediately applicable. Use examples, learning activities directly related to the situation in

which they will be applied. Make the connection and reinforce it!

9. Adults need to develop relationships with and “use” other learners in the

learning context as well as needing to feel they are contributing to others’ learning.

Infuse the learning context with opportunities to interact with other

adult learners.

Small learning groups may be helpful in providing support and safety to adult learners.

10. Actively engage adults in the learning process through “hands-on” and

participatory learning activities.

Provide ample opportunities for adults to “do something” with what they are learning.

Use creative, unusual experiences and don’t over-rely on role plays and question and answer format.

11. Learning is reinforced by accountability

Accountability applies both to the teacher and learner. Teacher should be evaluated by learners. Learners should be

evaluated by both self and the teacher. Build in small, non-threatening evaluation steps along the way but

don’t avoid evaluating out of fear of threatening safety.

*Source: Vella, J. (1994). Learning to listen, learning to teach: The power of dialogue in educating adults. San Francisco, CA: Jossey-Bass. For additional reading on adult learning… Canton, P. (1994). Understanding and promoting transformative learning. San Francisco, CA: Jossey-Bass. Galbraith, M. W. (Ed.) (1990). Adult learning methods: A guide for effective instruction. Malabar, FL: Krieger Publishing. Imel. S. (2000). Change: Connections to adult learning and education. ERIC Digest No.l 221. ED446252. Mezirow, J. (1996). Contemporary paradigms of learning. Adult Educational Quarterly, 46(3), 158-173. Vella, J. (1994). Learning to listen, learning to teach: The power of dialogue in educating adults. San Francisco, CA: Jossey-Bass. Vella, J. (2000). Taking learning to task: Creative strategies for teaching adults. San Francisco, CA: Jossey-Bass.