1. Respite, Habilitation, and Attendant Care
Bees Knees, LLC
Respite, Habilitation, and Attendant Care
“Bee Exceptional”
Phone:
Fax:

2. Habilitation Training
Bees Knees, LLC
Part III:
Habilitation Training

3. Congratulations On Your Position As A Habilitation Provider!
As a Habilitation Provider, you are a teacher, a role model, and a friend. This portion of the training will teach you how to find the outcomes for your client’s goals, write teaching strategies, and complete a habilitation report. Estimated Completion Time: 1.5 hours

4. What Is Habilitation?
Habilitation is a services that teaches children with special needs communication, social, motor, and cognitive skills to aid in the development of goals set forth by the individual’s parents, therapists, and support coordinator.
Habilitation providers are required to take a Skill Building/ISP training course, which explains the above information in greater detail.
As a habilitation provider, you are qualified to also provide respite and attendant care. Keep in mind that the pay rate for these services differ from your habilitation pay rate.

5. What is My Job as a Habilitation Provider?
As a habilitation provider, you will be working on specific goals which are outlined in your client’s ISP. This service uses a variety of methods designed to maximize the person’s abilities, such as:
Habilitative Therapies-
therapies designed to teach a person new skills and maximize functioning. Some examples of habilitative therapies are speech, music, physical, and occupational therapies.
Special Developmental Skill Instruction-
focuses on how to teach adaptive skills to individuals with disabilities.
Behavior Intervention-
utilizes techniques to correct behaviors.
Sensory-motor development-
focuses on the interaction of sensation and movement.

6. How Do I Determine What Goals To Work On?
The goals you work on MUST be included in your client’s ISP. You will need to sit down with the parents and go over the HAH goals in the ISP. All of the HAH goals MUST be worked on and documented. If you are the only HAH provider for your client, you will need to work on and document EACH HAH goal listed in the ISP. If your client has multiple HAH providers, you may divide the goals between each provider. You will need to communicate with parents and other providers for the client to coordinate this.

7. What if the Parents Want Me to Work on Goals That are NOT Listed in the ISP?
You need to work on goals that are listed in the ISP. If the parents would like to add a goal to the ISP, they just need to contact their support coordinator to have this information added. If the information is added to the ISP, you can establish this as a goal, but it needs to be an official goal from the ISP.

8. How Are Goals Established?
The goals are established through the ISP process by the ISP team. This could include the individual, the parents, support coordinator, and other therapists or providers working with the individual. You may end up being a part of your client’s ISP team. The team has put a great deal of thought into establishing goals that they feel are important for the client. These are the goals that you will need to work on.

9. What Are Some Examples of Goals?
There are many different goals that your clients may have. The goals are determined based on the individual’s needs. Some examples could be:
Brush teeth
Wash clothes
Increase social skills
Plan a nutritional meal
walk
Use a potty chair
Tie shoes
Increase fine motor skills
Behavior issues
These are just a few of many possible goals.

10. What Is An Outcome?
An outcome is a more specific description of the goal and goes into greater detail about how , when, and why the goal will be achieved.
The term “outcome” and “objective” are used interchangeably. From this point on, I will use the term “outcome”. Just note that if you see the term “objective”, it means the same thing as “outcome”.
Outcomes are:
developed by the individual’s team during meetings and documented in the individual’s plan.
a written plan, laying out the steps we take to help the client achieve their goals.
very specific, written in overt language, and include the person’s name, what they are going to achieve, to what extent are they hoping to achieve it, and a deadline for the outcome. Outcomes should be person-centered and written in measurable family-friendly terms.

11. The Difference Between the Goal and the Outcome
The goal defines the individual’s ultimate and broad accomplishment they want to achieve.
The outcome explains in overt and specific language:
How- how often the outcome will be run
Who- the individual’s name
What- what skill is being worked on. This should be observable and measurable
Where- where the outcome will be implemented. Sometimes this is not specified (considered optional) because the outcome may be implemented in various locations
Why- the reason the individual is working on this skill
When- the expected completion date of the outcome

12. Goal: Outcome: Cindy will make her bed each day.
Each morning, to increase her independence, Cindy will make her bed, by October 2012.
Note the detailed information included in the outcome.

13. Where Do I Find My Clients Outcomes?
Your client’s outcomes are listed in their ISP on the Action Plan- Part I page. These are listed under OUTCOMES (Objectives). This page also lists the Person Responsible for each outcome and the Time Frames- start and end. You will work on the outcomes for which the Habilitation Provider is listed as the Person Responsible.

14. How Many Outcomes Do I Have To Document?
You need to document each outcome listed in the ISP which specifies the Habilitation Provider as the “Responsible Person”. This will differ from client to client. Some ISP’s may not be that specific. In that case, we will contact the SC to clarify which outcomes you should be documenting.

15. How Long Should It Take To Achieve Each Outcome?
The length of time that you spend on a single outcome varies. Some outcomes may take a month, some six months, some a year. Some factors affecting this time span include:
Complexity of the outcome
Skill level of the client in relation to the outcome
Effectiveness of teaching strategies
You will determine when you hope to achieve the outcome. This information should also be in the ISP. If you do not achieve the outcome by that estimation, that’s fine. You may need to continue working on it beyond your estimated completion date. You will include this information on your HAH report.

16. When Do I Work On These Outcomes and How Long Should We Work?
You will work on your HAH outcomes during your HAH sessions. Try to keep your HAH session to about 2 hours or less. Any longer than that is really pushing the client too hard for too long. We all have a limited attention span and you don’t want to frustrate your client. Some outcomes may be unique and require a longer timeframe. You will need to evaluate this on an individual basis. But a good standard is about 2 hours. The State starts to question anything longer than that. Remember that you can provide HAH, RSP, and ANC for the same client and you may divide your time with them into a HAH session and a RSP or ANC session as needed. For example, if you are with your client from 8:00am-4:00pm, you may want to do HAH for the first 2 hours, then RSP for 4 hours, and HAH again for the last 2 hours (or whichever combination the situation may require). Just be sure to distinguish between these services on your timesheet.

17. How Do I Determine The Best Way To Help My Client Achieve Their Outcome?
Everyone is unique and responds differently to various strategies. Everyone has different learning styles and interests that may motivate them. As you spend more time with your client, you will have a much better personal understanding of their needs. Until you reach that point, use your resources to get to know the client and their needs better. Parents and therapists are great resources to learn more about your client.

18. Study the ISP
You can learn a great deal about the needs of your client, their personality, strengths, and goals within the ISP. Use this as a tool to better understand your client. You will not only be working on outcomes with your client, but you will need to determine the BEST way to work on these outcomes. This will depend on the client. You need to know the individual you are working with in order to provide the very best support and teaching for their individual needs.

19. Work with the Parents
Who knows your client better than their parents? Communicate with parents to gain a better understanding of their child and their child’s needs.

20. You Will Become Your Own Resource
As a Habilitation Provider, you usually see your client more often than their other therapists. You have a unique opportunity to build a close rapport with your client as well as spend more time working toward outcomes. You will ALWAYS continue to use the input of the parents and therapists, but you will eventually have a much better understanding of your client yourself, and be able to build on outcomes from month to month.

21. Be Creative!!!
Really try to come up with exciting and creative ways to help your client achieve their outcomes. They may have been working on the outcomes already. They may just need a new and fresh idea to get them excited about learning. Maybe you can do something so fun, that they don’t even realize they are working! Parents need you to provide unique and new methods to help their children achieve their outcomes. If you are struggling with creative ideas, please let me know and I will help you brainstorm.

22. Teaching Strategies
You will not be writing the outcomes because these are already written in the ISP.
You will be developing the teaching strategy based on the outcomes documented in the ISP. In other words, how will you teach the outcomes?
If the client has already had HAH with another provider, the teaching strategies may already be established. If so, we will continue with the existing teaching strategies unless revisions are needed.

23. Teaching Strategies The teaching strategy should include:
The original outcome
Present performance level
Step-by-step instructions for how you will teach the outcome (this should include the steps the client and you will take)
Who will implement the teaching strategy
When and where the teaching strategy will be implemented
Any supplies, materials, or supports needed to teach the outcome
Data collection procedure
Refusal strategy
Phase change criteria

24. Habilitation Reports
As a habilitation provider, you are responsible to turn in a monthly habilitation report, as well as a quarterly habilitation report. These reports will be based on outcomes listed in your client’s ISP.

25. Habilitation Reports
When you first begin working with a habilitation client, you will need to determine the outcomes that you will be working on. You can find these in the ISP. You will document this on page 1 and 2 of the habilitation report (Outcome and Teaching Strategy pages).
Ideally, you will fill this out with the parents at the orientation session, or shortly thereafter.
The monthly data page will be completed each day you work with your client throughout each month.
The following slides show you an example of the Habilitation Report- Outcome and Teaching Strategy Pages:

28. The following slide shows you a sample of a completed Outcome and Teaching Strategy- page 1

30. Outcome and Teaching Strategy (Page 1)
Please be sure to complete all client information at the top of the page. PLEASE make sure to write in the support coordinator’s name and office location.
You can find the name of the SC in the client’s ISP. Parents usually know who their SC is also. If you are still not sure, ask me and I can look it up for you.
The ISP date is the date the ISP was conducted (written in the ISP).
The outcome start date is the date that you complete the form- this is when you will start working on the outcome.

31. Outcome and Teaching Strategy (Page 1)
Outcome (as written in ISP):
This is the outcome you will work on. You should be able to copy this directly from the ISP.
Ideally , the outcome should be written clearly and should include a specific end time. If the outcome is not written clearly and does not include the necessary information, we will work together to revise the outcome as needed.
Present Performance Level-
What can your client currently do in relation to the outcome? What is their starting point?

32. Outcome and Teaching Strategy (Page 1)
Teaching Strategy- This is a step by step explanation of how your client will achieve the outcome. This could include steps that the client will take or even steps that you will take, depending on the outcome. The example lists each step that Austin will take to initiate a social interaction with a peer. Note how specific this is. SC’s really want to see detailed steps as to how you plan to achieve the outcome. For example, there could be more than 20 steps to brush your teeth. If you need more space to write your steps, you can use a second page.

33. The following slide shows you an example of page 2 of the Outcome and Teaching Strategies Pages.

35. Outcome and Teaching Strategy (Page 2)
Who Will Implement the Teaching Strategy?
This is probably you and the client. Who is involved in the steps of the teaching strategy?
When and Where the Teaching Strategy will be Implemented-
“When” for this example would be “3 times a week”
“Where” for this example is optional, because a specific location is not specified. As long as Austin is interacting with a peer from his neighborhood, this could occur in various locations. If the location is specific, such as “brushing teeth in the bathroom”, then the location would be “the bathroom”.
Supplies or Supports Needed-
If you require any supplies to complete the outcome, such as scissors, eating utensils, etc., list these here. This is depend on your outcome. If your client needs any supports, such as a mobility or communication devises, list these here as well.

36. Outcome and Teaching Strategy (Page 2)
Data Collection Procedure (Data Key)- This defines what symbol will represent a success, refusal, barriers, etc. This data key will depend on your outcome and how you think it is best explained and organized. In the example, the provider also used “A” to represent “with assistance”. Barrier refers to anything that may have prevented you from working on the outcome that day. For example, if the client is sick. Refusal Strategy- This explains the process you will follow if the client refuses to complete the steps of the outcome. In this example, if the client refuses after all listed prompts, he will wait and try again another day. For some outcomes, however, you will not be able to just wait and try another day. For example, if the client is working on preparing his own breakfast and he refuses, he cannot just wait another day to eat. You will need to include steps that you as the provider will take in the event of a refusal if necessary. For the breakfast example, you could say that after all prompts, the provider will make the breakfast for the client and place it on the table in front of him.

37. Outcome and Teaching Strategy (Page 2)
Phase Change Criteria-
What will you work on with your client if they accomplish their outcome sooner than expected?
If the client masters the outcome right away, you can always let me know and we can contact the SC and the parents to discuss changing the outcome.
Also, if the client is having a hard time with the outcome, we may need to discuss changing the outcome to a more obtainable level.
Please make sure to sign and date this form and have the parent sign and date as well. I will sign and date the form after you turn it in to me.

38. When Do You Turn In the Outcome and Teaching Strategy-pages 1 and 2?
I need the Outcome and Teaching Strategy pages 1 and 2 for EACH outcome that you will work on with your client by 10 days after the start of service with that client. Ideally, you will fill these pages in (or the majority of these pages in) during the orientation meeting with the parents. You have up to ten days to finalize these pages and scan and them as a .pdf to Please title your with the client’s last name- Outcomes and the date (month and year). Ex. Jones-Outcomes 4/12 At this point, I will send them to the SC.

39. What If I Have Several Outcomes I Am Working On With My Client?
You may have a client with multiple outcomes for which you are responsible. If you have several outcomes you need to work on, you will need to complete the outcome and teaching strategy pages for each of your outcomes. You will only need to complete the outcome and teaching strategy pages for each outcome, one time. You will not have to submit new outcome and teaching strategy pages until you have met these outcomes and are ready to move on to new outcomes that need to be documented.

40. Monthly Data Page
Once you have turned in your outcome and teaching strategy pages, you will begin compiling data on the monthly data page. This page is completed monthly and the data will be used to complete your quarterly data page every three months. The following slide shows you the data page of the Habilitation Report:

42. The following slide shows you a sample data page of the habilitation report:

44. Monthly Data Page
Be sure to fill out all information at the top of the page. Make sure to write in the outcome that you are collecting data for. This way, the SC knows which outcome goes with what data.

45. Monthly Data Page
In the data collection table, to the left you see “Steps”. This is where you will list each step of your teaching strategy. These steps are taken straight from page 1 of the habilitation report under “Teaching Strategy”. The sample teaching strategy only has 4 steps, but your teaching strategy may have many more steps. If you do not have room on this chart, you can use as many data pages as needed to write in each step. Each number across the top of the table represents the dates of the month. You will only fill in data under the dates that you worked with your client. To keep track of the data for each step, you will need to create a data key under the “Data Collection Symbols” section. This is taken straight from page 2 of the habilitation report under “Data Collection Procedure”. These symbols should address what defines success, refusals, and barriers. It can also include any other information you feel is necessary to document your outcome. For example, on April 2nd, Austin successfully completed the first 2 steps independently and required assistance to complete the last 2 steps. You will go through each step each day you work on the outcome and document the client’s progress. Don’t forget to initial each day.

46. Monthly Data Page
Go through the entire month, collecting data for each day that you work on habilitation with your client. Each day, you will mark down the symbols that represent your client’s performance level. If you work on each step multiple times during one day, consider the overall performance level of that step for that day and record that information. At the end of the month, on the right side of the table, you will need to total the success/attempts. First, add up all the days that you ran the outcome. DO NOT include BARRIER days in this total. These are days that you were not able to work on the outcome, so they do not count in the total. On the sample, if you add the days across the table, and minus the barrier day, you have a total of 12 attempts. Then, add up all of the successes, or “+” days and that will equal the success total. For example, for the step “identify a peer to approach”, there are 9 “+” days. So under success/attempts you would write 9/12. Remember, on your own data sheet, you will need to determine what = a success or “+” for your steps. Then, to the right, under the % success, you will need to find the % of 9/12. Just divide 9 into 12 and you end up with .75, which equals 75%. Do this for each step. You will need to then find the average % success and write that in on the bottom right corner of the table. You will add all of the percentages from the steps and then divide by the total number of steps to find the average %.

47. Monthly Data Page
At the bottom of the data page, you will need to fill in the following information:
When was it run?- For the example, you would write “3 days a week”. If you have any more information , you would write that as well. For example, afternoon, morning, etc.
Who was involved?- This is probably the client and you
Supplies or Supports Needed- Just as you wrote in on the outcome and teaching strategy page 2
Add Summary Comments- This section should explain any refusals and provide an overall summary of the month. Also discuss the type of positive reinforcements you used and how successful they were
Barriers- In this section, explain any barrier days
Make sure you and the parent sign the data sheet at the end of the month. I will fill in the “Date Report Sent to DDD” space.

48. Always take the time to review the data report with parents at the end of the month. This gives them a chance to really see the progress that their child is making. It also gives you both a chance to brainstorm any new ideas regarding outcomes.

49. You Will Need To Complete A Separate Monthly Data Sheet For Each Outcome You Are Working On
Make sure to keep track of each outcome you are working on throughout the month on separate data sheets. You will need to turn in a separate monthly data sheet for each outcome.

50. When Is the Monthly Data Page Due?
Your monthly data pages for all of your outcomes are due to me, by the 5th of the following month. You will collect data for the entire month, and then you have 5 days to gather all the information and send me the completed report. You do not need to resend me the outcome and teaching strategy pages each month. You will need to scan and your data page as a .pdf to each month by the 5th. Please title your with the client’s last name and the month and year the data was collected. For example: Jones 4/12

51. What If I Haven’t Been Working With My Client For a Full Month When the Report is Due?
When you establish a new client, you may not have been working with your client for the full month leading up to the monthly report. You will just document the time during that month that you have worked with your client. For example, if you started working with your client on May 10th, you will document the 10th through the 31st for May on the monthly report. Even if you only work one or two days of the month with your client, you will still need to complete a monthly report. That way, the information will be able to be included in your quarterly report.

52. Do I Need New Outcomes For The Next Month?
You will not work on new outcomes each month. You will just keep working on the same outcomes until the completion date. If the outcome you are working on has an estimated completion date of 6 months, then you will continue to work on that outcome for 6 months and you will not need to turn in new outcome and teaching strategy pages. Once an outcome is completed or it is time to start working on a new outcome, you will need to complete new outcome and teaching strategy pages for each new outcome.

53. Quarterly Data Page
At the end of each quarter (July, October, January, and April), a quarterly data page is due. This compiles and summarizes your data for the 3 previous months. This allows you, the parents, Bees Knees, and the SC to see the overall data and progress for each quarter. The following slide shows you the Quarterly Data Page:

55. The following slide shows a sample Quarterly Data Page:

57. Quarterly Data Page
At the top of the quarterly data page, you will complete the same information that you filled out on your monthly data pages.

58. Quarterly Data Page
On the left side of the table, you will write in each step of your teaching strategy for the outcome. In the center of the table, you will transfer your monthly data for the past 3 months. Fill in the months on the table. Cross-reference your monthly reports to transfer the number of refusals, number of barriers and the month % success. The number of refusals and barriers is just the exact amount of refusals and barriers for the month. It is not a %. The month % success should be taken directly from your monthly data page on the far right of that table. Put in this % for each step. Complete all sections for the monthly data for all three months.

59. Quarterly Data Page
For the quarterly data, on the right of the table, you will first add the total number of refusals for all three months. Do this for each step. Then, add the total number of barriers for all three months. Do this for each step. Next, look at the month % success. You will need to average the 3 month % success for each step. Just add the 3 percents (one for each month) and divide that number by 3. This will give you the average % success for all three months. Do this for each step. To find the overall average % success for all of the steps of the outcome, you will need to add up each average % success for each step and then divide it by the total number of steps. This will give you the overall average % success. In this example, you would add and that = 310. Then, since there are 4 steps, you would divide 310 by 4, which = 77.5, which you can round to 78%.

60. Quarterly Data Page
Underneath the table, you will fill in information similar to the information on each monthly data report. Fill in when the outcome was run, who was involved, and what supplies or supports were needed. You will then complete a quarterly summary. This might include information from your monthly summaries and it will also provide an overall look at the progress of the last three months. This should also include the type of positive reinforcement you are using and how the client is responding to that. If this is the final quarterly report for your client’s outcome, you will need to provide a more detailed summary that concludes this goal. If the client has not yet reached this outcome and the proposed time period is completed, you will need to document this as well and recommend that the client continue working on this outcome. If this occurs, you will need to complete revised outcome and teaching strategy pages with new goal dates and possibly revised steps to help the client better achieve the outcome.

61. Quarterly Data Page
Under “Current and Potential Barriers to Achieving Outcome” you will summarize the barriers that the client experienced over the last three months.
In the example, this would be the days that the client was sick. You may have other barriers that you will need to document.
You will also document anything that might currently be a barrier for your client or something that may potentially become a barrier.
In the example, Austin’s family will be moving in Sept. This is a life changing event and could potentially cause a barrier to achieving the outcome. The provider notes that she will monitor this. If this event does pose a problem, the provide should notify me and let me know that this has become an issue. This is something that I will need to let the SC know about so they can make any adjustments needed for the client.
Please remember to have you and the parent sign and date the quarterly data page. I will fill in the “Date Report Sent to DDD”.

62. When is the Quarterly Data Page Due?
Quarterly data pages are due by the following dates:
July 5th-
This will compile data from April, May, and June. So on July 5th, you will be turning in your June monthly data as well as your quarterly data.
October 5th
This will compile data from July, August, and September. So on October 5th, you will be turning in your September monthly data as well as your quarterly data.
January 5th
This will compile data from October, November, and December. So on January 5th, you will be turning in your December monthly data as well as your quarterly data.
April 5th
This will compile data from January, February, and March. So on April 5th, you will be turning in your March monthly data as well as your quarterly data.

63. What If I Haven’t Been Working With My Client For a Full Quarter When the Report is Due?
When you establish a new client, you may not have been working with your client for the full three months leading up to the quarterly report. You will just document the time during that quarter that you have worked with your client. For example, if you started working with your client on May 10th, you will document the 10th through the 31st for May and then the full month of June. You will only be able to include about a month and a half in your quarterly report. You will still need to turn in a quarterly report. If you have been working with your client for less than one month, you will not have to turn in a report for that quarter. For example, if you started working with your client on June 15th, you will not need to turn in a quarterly report on July 5th. This would only be able to include ½ month and would not accurately represent data for the quarter. You would, however, still need to turn in a monthly data report for the ½ month of June.

64. Due Dates
Outcome and Teaching Strategy Pages: Due- on or before 10 days after the start of services (for EACH outcome) Monthly Data Pages Due- 5th of each month (for EACH outcome) Quarterly Data Pages Due- July 5th October 5th January 5th April 5th I will send out reminders before all due dates.

65. Please Turn Your Data Reports In On Time!!!
I am required to send all data reports to the State. I ask for your reports by the 5th, so that I have time to gather everyone’s reports and send them in by the State’s due date. Why is this important? Your clients depend on this. If the SC does not receive HAH data reports, they have no proof that the client is benefiting from the HAH hours, or even using them correctly. This could cause your client to lose their hours. Please make sure to faithfully complete and submit these reports so that your client can continue to benefit from this amazing service.

66. You can always access this presentation on the website for reference.
Conclusion
You can always access this presentation on the website for reference.
This concludes your Bees Knees habilitation training! The next slide will link you to the training test. Please make sure to answer all the questions on the
training test. Please to or fax the test to
when completed.
As soon as your test has been received and reviewed, you will be issued a certificate of training completion.
Congratulations on your position! We look forward to working with you and we are always available if you have any questions.

67. Habilitation Test
Below is the link to the test document for the habilitation portion of the training. This will open in your Internet browser window as a .PDF. If it does not open on top of the slide show, it may be open underneath the slide show in a separate window or tab. If you do not see the Internet window on top of the slide show, you can toggle between the slide show and your other window by pressing Alt and Tab. This will allow you to view and print the .PDF document.
Habilitation
Test