integrated settings-strategies and...
TRANSCRIPT
Integrated
Settings-Strategies
and OpportunitiesLISA MATHIS, OPRA
SCOTT MARKS, OACB
Why are we here?
And what are we doing?
Integrated Settings Rule Review
Service Transition Overview
Strategies and Opportunities
Questions and Discussion
The Big Question
Some Things We Know….
What Else We Know…
Question:
Does the regulation prohibit facility-based or site-based settings?
Answer:
No. The regulation requires that all settings, including facility or site-
based settings, must demonstrate the qualities of HCB settings, ensure
the individual’s experience is HCB and not institutional in nature, and
does not isolate the individual from the broader community. In
particular, if the setting is designed specifically for people with
disabilities, and/or individuals in the setting are primarily or exclusively
people with disabilities and on-site staff provides many services to them, the setting may be isolating unless the setting facilitates people going out into the broader community.
Access
“The setting is integrated in and
supports full access of individuals
receiving Medicaid HCBS to the greater community, including
opportunities to seek
employment and work in
competitive integrated settings,
engage in community life,
control personal resources, and
receive services in the
community, to the same degree of access as individuals not
receiving Medicaid HCBS.”
Options
“The setting is selected by the individual from among setting options
including non-disability specific settings and an option for a private
unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on
the individual’s needs, preferences, and, for residential settings,
resources available for room and board.”
Dignity
“Ensures an individual's rights of privacy, dignity and respect, and
freedom from coercion and restraint.”
Autonomy
“Optimizes, but does not
regiment, individual initiative,
autonomy, and independence in making life
choices, including but not
limited to, daily activities,
physical environment, and
with whom to interact.”
Choice
“Facilitates individual choice regarding services and supports, and who provides them.”
Access
Meaningful non-work activities
A say in the scheduling of preferred activities.
Knowledge- of activities, employment opportunities,
etc…
Freedom- to move about setting without restriction.
Service Location- among other residential, business,
community, etc…
Access (Continued)
Greater Community- Encourage visitors at regular
intervals.
Transportation- access to and training on public
transportation or other resources.
Financial- Access to and/or control of funds.
Age-appropriate activities.
Physically Accessible- access to bathrooms and break
rooms. Environmental adaptions.
Options
Settings based on individual needs and preferences.
Volunteering Opportunities.
Recreation Opportunities.
Service Combination- The ability utilize multiple HCB
services any given day/week.
Dignity
Confidentiality/Privacy
Personal Appearance- Assistance provided to
help desired personal appearance.
Respect- Interactions and communications from
staff.
Behavior Support- Individualized and specific.
Secured Personal Storage
Autonomy
Barriers- Gates, fences, locked doors restricting settings?
Variety- Activities responsive to goals, interests and
needs?
Peers- Choice of people to interact with?
Meals- Schedule, location and choice of where/when to
eat and with whom to eat with.
Age-appropriate- Tasks and activities matched to skills,
abilities and desires.
Rights- Info provided on individual rights.
Choice
Service- Choice of providers, setting and service and
understanding of options.
Change- ability to update and periodically change
preferences.
Support- To make decisions and exercise autonomy.
Plans- Development that supports interests, needs,
capabilities and preferences.
Information- about requesting additional or changing
HCBS.
What We Can Do
These CMS considerations can be broken into 3 main
areas of development for providers of HCBS services.
Logistics
Culture
Policy
Logistics
Day to Day operations
Scheduling
Business Model
Hiring/HR
Transportation
Culture
Staff Development
Organizational culture
Interpersonal Relationships
Respectful interactions
New mental models for service delivery
Policy
What state/federal policies are in place to support the
changes?
Does My Mission and Vision Support integrated supports?
Do Individual Service Plans support individual needs,
preferences, desires, growth, etc?
Barriers
Transportation
Health and Safety
Resources
Community “readiness”
Lack of Employment/Community Options
And more….
Reasons for Change?
So, do we have a plan?
New vs Existing Settings
Existing settings have time (2019 or 2022) to
develop and implement plan for integrated
settings.
Any NEW settings must be integrated upon
opening. Plans for new services should be
shared with county boards for service
authorization. OPSR visit within 12-18 months.
Heightened Scrutiny may be requested for
settings with “presumed institutional qualities”.
Questions we Ask…
Do you have a system, process, or regularly occurring way that people know about things going on in the community? (events, volunteering, recreation, art etc…)
Do you have any programming, partnerships, agreements or contracts that promote the “greater community” into the space?
Is transportation available for people seeking employment or participation in the community?
Are community and facility-based activities age-appropriate and matched to individual interests and/or working towards someone’s desired service outcome?
Are people able to set their own schedule to the extent most possible, including when/where to eat meals and with whom they can interact with?
More Questions….
Are you able to provide community-based vocational habilitation
experiences in small groups?
Do you have facility-based programming that supports the needs of people so they can be successful in community life?
Do you have staff that are committed to coordinating and providing
community-based services? (Community Connectors, Community
specialists, etc..)
How well does your mission/vision align with providing inclusive,
integrated supports?
Are people with the most significant disabilities afforded
opportunities to engage in the community?
And More…..
Do you have community partners with whom you can collaborate
for opportunities for service provision? (Volunteering, Recreational,
Vocational, Advocacy, etc…)
Do you have any means of documenting or determining your
agency’s move towards integration and/or the person’s
achievements towards their desired service outcome?
Do you have a method/process for how you organize groups for
community experiences?
Culture – Service Transition Models
Meet Liz Weintraub:
The Dignity of Risk
Liz Weintraub has a long history of leadership in
self advocacy, and has held many board and
advisory positions at state and national
organizations. In addition to her part-time
position with AUCD, Liz also works for the
Council on Quality & Leadership (CQL) and consults for National Children's Center in
Washington, DC. Her work with both of these
organizations focuses on improving quality of
life for people with disabilities.
Liz is the immediate past chair of the Maryland
Developmental Disabilities Council. Liz a faculty member of The National Leadership Consortium
on Developmental Disabilities at the University
of Delaware and is the President of the Board of Directors for Shared Support Maryland, a
progressive provider organization.
Moving From Caregiving towards
Mentoring & Teaching
It’s a cultural change …..
telling versus asking
Telling We act as parents
Creates dependency
Prevents individuals from learning to
keep themselves safe
Takes a way power and control
Can cause aggressive behavior or a
culture of helplessness
Asking We act as mentors
Creates independence
Individuals can learn to keep
themselves safe
Gives back power and control
Decreases aggressive behavior or a
culture of helpplessness
are you Really helping people to
be more independent? really????
But what about health and safety ???
Identify risk (Risk Assessment)
Prioritize risk - what is REALLY important?
Create a risk plan that minimizes risk through
building independence
Utilize informed consents that list the benefits
and risks of being part of the community
But what about getting individuals with
the most significant disabilities out in
the community?
Start the process in your facility by :
Opening the classroom doors – see
where they go!
Let individuals form relationships
organically with others in the program
Train, train, and train again on safety
Strategies and Opportunities
Logistics
Hiring Practices/HR
Community Connectors
Logistics: Do you have staff that are committed to
coordinating and providing community-based
services?
We are looking for a dynamic community builder who enjoys meeting people and building connections in neighborhoods to be a part of our community development team.
Responsibilities:
Ability to facilitate relationships and connections and to connect people of diverse backgrounds.
Ability to identify and connect people and assets in neighborhoods and associations.
Ability to work as part of a team with emphasis on relationships, outcomes, maturity and tact.
A strong commitment to community and relationship building and inclusion of all people.
Logistics: Do you have staff that are committed to
coordinating and providing community-based
services?
Qualifications:
Excellent listening and relationship building skills.
Strong interest in community development.
Excellent communication and problem solving skills, initiative, good
judgment and extreme reliability.
Knowledge of computers and good writing skills.
Work flexible schedule.
What to look for?
Flexible, flexible, flexible!
People who are already connected to the community.
People who have creative, advocacy, volunteering interests they
are willing to share.
Networking, communication skills- a good face for your agency.
Driver requirements.
Business Plan- Maximize Units?
New budgets allow for 260 days of service, or
more importantly 6500 Units of service/year.
Utilization data suggests opportunity for
additional support, evening/weekend services.
Longer days/shorter weeks for staff?
Maximize revenue while increasing opportunity
to connect to community activity.
Business Plan- Diversify Services
Adoption of ADS, Career Planning and Individual
Employment Supports.
“Do Discovery”- Formal process that is now billable for
providers and will provide great information for
employment and community supports.
Opportunity to provide service while closing
revenue/utilization disparity.
Any billable services that are inherently community-
based
Do you have facility-based programming that supports the
needs of people so they can be successful in community
life?
AdultDay
Program
VolunteerOptions Recreation
CommunitySkill
Instruction
ArtsJobClub
Advocacy
LifeSkills
Culture-Some Potential for Change
Getting Started
Start Small
Begin with finding one staff member to be your
“community specialist”. This should be someone who is
outgoing, interested or active in the community and
someone you trust to represent your agency in the
community.
Then find one small group of people you support who
you know might be interested in trying something new.
This group will be your “pioneers”.
Start Small-The Pioneers
Allow your “pioneer” group to discuss a place in the community
they would like to go or something they would like to do.
Go out and do it! Bring a camera!
Come back and share!
Pictures and experiences are helpful to reflect on the events of the
day and to share experience with others.
Provide the stories for others and for family members.
Show safety and success!
Use “Hub” time to build on success and skills in community and life.
Example
Participants have grown from 4 to 8, and in February and March to
16 people. Here are some of the ways in which people are getting
to know their neighborhoods, and in doing so, make new acquaintances and meet old friends, creating new opportunities for
themselves while directing and living their lives:
TC and her friend NB have been taking Zumba classes at a local
church where they have been meeting new people. The Pastor and
his wife have befriended them. They plan on asking the Pastor and
his wife to dinner at their house. They have been going to silent
dinner and meeting new friends and old friends they haven’t seen in
a few years. TC wants to participate in the Deaf Ministry at church. NB, after her bowling league is over, plans to keep in touch with the people on her team and their families.
Example
CK, after stating that her favorite thing was to go home after work
and watch television, has been going to sewing class and has sold
some of the items she has made to others at work. She presented one of the purses she had made at a recent Project Circles Focus
Group Meeting and spoke about her skills.
RT has been going to Michaels for craft classes and is beginning to
speak with people in her class attempting to get to know them.
MB is taking cookies or a cake to her neighbor one time each
month. Her neighbor is always alone and very quiet. They talk
longer each time she goes over. She continues volunteering at a day care where the Director says the children love having her there.
Additionally MB attends church with her friends.
A-HA Moments…
Staff with longevity needed additional support implementing
community connecting.
Staff takes pride and enjoys assisting Individuals to live their lives fully in the community.
Staff may have to advocate professionally on behalf of an Individual
when the community is resistive.
Families and Guardians need additional support as their family
member enjoys new opportunities.
Individuals have grown and are ready to take on new opportunities, if supported.
Do you have a system, process, or regularly occurring way that
people know about things going on in the community? (events,
volunteering, recreation, art etc…)
Do you have a system, process, or regularly occurring way
that people know about things going on in the community?
(events, volunteering, recreation, art etc…)
Even More…
Some other points….
Individuals should be invited or expected to add events to the
calendar that they pick/want to do.
Small groups can go on trips into the community specifically to find events for a calendar. (Searching bulletin boards, public spaces,
etc…)
Sometimes you have to “field of dreams” it. If you build it, they will
come! Providers and individuals can develop and share community
events.
Follow Everything!
Follow Everything!
There’s a group for that!
E3 Method
Experience
Engage
Expand
Experience
Experience
Who have I worked/collaborated/partnered with
before?
Who have I shared a positive experience?
Who do I share a belief, point of view, interest, gift,
interest, talent?
Who could I potentially share an experience?
Businesses? Community Groups? Recreational groups?
Social Media groups, other local associations?
Engagement
Engagement
How can we continue to work together or share
our gifts?
On what other projects or activities can we
collaborate?
What other opportunities are there?
Where do our strengths complement each
other?
How do we mutually address barriers?
Expansion
Expansion
How does our collaboration/relationship attract
others?
Who are the connections of my connections?
Who else do we need to complement our
efforts?
Who else would benefit from our gifts?
How can we develop more gifts to share?
Policy- What do we need?
Strategic Plan?
Training Plan
Business Plan
Community Outreach Plan
Or
Remediation Plan
Training Plan
DODD- Community Integration Training- Whether or not agency is
planning to use add-ons.
Loop Ohio- Every Staff (or at least community staff) register for Loop and read X number of posts per/week.
BrownBags/Webinars- Ensure agency and staff are on listservs and
registered to receive updates and training opportunities.
Inquire with your friendly, neighborhood trade association.
Lay out benchmarks and/or training requirements as part of plan.
Organizational Shift
TableOfOrganization-Mid-SizeFacilitytoCommunity(1yearPlan)
ExecutiveDirector/CEO
CommunityDirector
SeniorAdministrator
CommunityConnectionSpecialist(4)
JobPlacementSpecialists(2)
OperationManager
LifeCoach EmploymentAdministrator
JobCoach(4) HabilitationSpecialists(4)
ProductionSupervisors(2)
StorefrontManager
Transportation(Driver)
Community Mapping
Do you have community partners with whom you can
collaborate for opportunities for service provision?
Community/ Organizational Asset IdentificationTools
Appendix C - Blank Community Asset ProfileTool
Asset BasedCommunityDevelopment
Asset Mapping
Appendix A:
Community Asset Profile Template
Page 14 of 17
Do you have community partners with whom you can
collaborate for opportunities for service provision?
Resource Exercise
Place that is most welcoming Place where I am a regular
Place for a cheap drink Place where best Connector is at
Place that makes me happy
Best place to go on a Saturday
A place I’ve always wanted to go
A place that sparks your creativityPlace where I have learned something
Place I take visitors
Best place to meet new people
A place that is part of a tradition
Best place to meet new people
Place to spend time outdoors Joe Erpenbeck
ABCD in Life and at Work
www.joeerpenbeck.com
Association Mapping Animals: Cat and Dog Shelters, Clubs: The Scratching Post, Save
The Animals Foundation, Peppermint Pig Thrift Shop
Artistic: Music, writing, craft and art groups: Women Writing For a
Change, Thunder Sky Art Studio, Happen Inc.
Business: Chamber of Commerce, Business groups: Strathcona
Business Improvement Association, Northside Business Council, Mt
Pleasant Non Profit Group
Charitable: fund raisers, events and faith based: Food banks,
Walnut Hills Anti-Drug Coalition, Madisonville Educational and
Assistance Center
Civic: Neighborhood groups, committees and events: Westwood
Works, Block Party Planning, Block Clubs, Mt Pleasant
Neighbourhood House, A Small Group,
Association Mapping
Education: Meet-ups, library and clubs: Local book clubs, Free
Geeks, Vancouver Social Innovation Group, Trade School series,
Innovation groups
Environmental: Concern and event groups: Community gardens, Astronomy, Green committees
Ethnic: Clubs and events: Sons of Norway, Germania Club,
Vancouver Italian Cultural Centre
Faith: Congregations and small groups: Church choir, Hospitality
committee, Free Store
Health and Fitness: Sports and exercise: Flying Pig Half Marathon training groups, yoga, and walking groups
Association Mapping Hobby: around any kind of hobby: Lots of Funky Knots
Knitting Club, Writing groups, scrap booking, Card
games, drumming circles.
School: Committees and events: Westwood PTA, School
Festival Planning, Chase School Coats Collection
Campaign
Self Help: From health to speciality areas: AA, Vancouver
Tool Exchange, Madison Time Bank
Social Service: Events, Boards and causes: Canticle
Café, My Neighbor’s Place, Seniors Center
Sports: Supporters and events: Friends of Cornwall Park
Disc Golf, Packers Fan Club, Rosie Reds
Youth: Activity and support: Summer Arts Camp, Scouts,
And one more….
Example- Settings Plan The following plan outlines the step to be taken by Adult Day Service
agency over the next 2 years (2017-18). Listed are the plans and actions already in progress as well as the strategies to be implemented over the coming years. The intent of this plan is to bring the agency into compliance with the HCBS Integrated Settings rule as well as provide the most inclusive services for the people supported by this agency. This plan will address strategies to better collaborate with the community, provide services that promote relationship-building, independence and community living skills, and offer supports in a true community setting.
1. Institutional Qualities
A. The agency is centrally located in the community, walking distance from several restaurants and other frequented community locations. The “disability-specific” signage has been removed and there is little to distinguish the agency from other community locations.
B. The agency has engaged a 2 year plan to address certain institutional qualities within the setting. This includes a partnerships with local thrift stores for furniture and art/decoration exchanges for the purpose of creating an atmosphere that is less institutional and more closely aligned with a home or club.
Example-Settings Plan
2. Transportation
A. Currently, our agency does not provide NMT or transportation services, those services being performed by the county board, or other agency or independent providers. We are currently in the process of getting certified for NMT and will be purchasing two minivans by June 30th, 2018. This will allow us flexibility to provide Transportation to supports in the community as well as transporting to employment sites.
B. Our agency has also begun talks with the Area Agency for Aging on collaboration for transportation needs, hoping to coordinate a “shared ride” model for participants, maximizing the transportation resources available in the county.
C. We currently work closely with individual providers and families to ensure the scheduling of transportation for those who need to arrange to get to work from our service setting. In times of extreme need, staff will provide transportation in their private vehicles at no charge.
Example-Settings Plan
3. Integrated Services
This section of the plan specifically addresses the ways in which the agency will further expand the provision of supports that are person-centered, matched to individual interests and designed to support the identified goals of the Individual Service Plan.
A. We have begun the development of a new, informal, person-centered discovery tool to complement the ISP and help expand on the goals and outcomes already identified. This tool, which is still in development, will use person-centered language and communication that will help identify areas of interest and further exploration. This tool will help direct community-based activities and will be shared with the team as one of the methods for the agency to support ISP goals. This tool will be used within the first 30 days of referral to our agency and be revisited regularly as interests change and areas of exploration are further developed.
B. Our agency has been regularly “getting people out” of the facility for several years. We currently use tools such as community calendars and schedules of community events to promote decision-making and provide informed choice of what is currently available in the community.
Example-Settings Plan
C. Direct Service Staff have received initial training on Asset-Based Community Development techniques and begun to parlay them to the coordination of community events. These tools, including gift-discovery, social role expanders, and connective communication skills are being applied to facility-based exploration in order to create new opportunities for community supports and find welcoming places for people to connect.
D. Agency is looking to implement a FANs network and “Give-Back Crew” style program, allowing further community connections and resource sharing for people served and staff. This opportunity, which we hope to realize by the end of 2017, will allow us to garner new resources and meet unmet needs, while also promoting further opportunities for people served to volunteer and give back to their communities in new and creative ways.
Example-Settings Plan
4. Community Partnerships
A. In April of 2017, we will engage in a community asset-mapping process, designed to fully recognize the potential partnerships to be found in the community. This process will include discovery of local associations and institutions as well as the connections the agency already has through staff, board members , families and people served. This process will help inform our strategic plans for ongoing partnerships as well as potential for community-based opportunities with local associations.
B. We are partnering with City Council to hold 2017’s Bike-a-thon. This popular community event has not been held for the past 4 years, and we wanted to take the lead in coordinating this community building event, the proceeds of which go to other local charities.
Example-Settings Plan
C. We have begun to hold community classes out of our center to promote collaboration and foster connections. Utilizing the talents of our certified Art instructor staff member, we have begun to hold Mommy and Me Art classes as well as “Draw and Sip” type events, all of which are also open to the people we serve.
D. We are engaged in long-term talks with our local hospital to open a community recreation center, which this community is in need of. There is currently no community center or place/location that offers community classes, recreation activities, or local events.
E. We are expanding our “Next-Chapter” Book club, by opening 2 new chapters in July of 2017. We will be looking for community volunteers to be book club facilitators and members.
F. We have created 2 new positions for “Community Connections Coordinators”, specifically to find community opportunities and lead integrated services in the community. These positions are currently posted.
Remediation Template
http://dodd.ohio.gov/OurFuture/Document
s/HCBS%20Remediation%20Plan%20Templat
e.pdf
Thank [email protected]