0 | | February 2011 The Art of Options Counseling for Front-Line Staff

1 | | February 2011 Technical Assistance Exchange Technical Assistance Resources  Weekly Electronic Newsletters  Websites  Resource Materials  Examples from the Field  Grantee Surveys Building a Grantee Community  Teleconferences/Webinars  Trainings  National Meetings  Online Forum Introductions

2 | | February 2011 The Art of Options Counseling Please select the answer that best reflects your role. ► Provide Information and Referral/Assistance (I & R/A) ► Provide Options Counseling ► Provide I & R/A and Options Counseling ► Manage/supervise people who provide options counseling ► Other Poll

3 | | February 2011  Understand what options counseling looks like and how is it similar and different from traditional I & R/A.  Understand the components and core competencies of options counseling.  Learn how to identify consumers in need of decision support and what level of support is needed.  Learn some strategies to examine the balance between respecting self determination and supporting informed decision-making. Learning Objectives

4 | | February 2011 The Art of Options Counseling What do you hope to learn? Learning Objectives

5 | | February 2011 The Art of Options Counseling Why is Options Counseling an “Art”?

6 | | February 2011 The Art of Options Counseling  What is Options Counseling?  “A Day in the Life” of an Options Counselor  Conclusion and Additional Resources Outline

7 | | February 2011 Foundations of Options Counseling  Families need individualized support making decisions about long-term services and supports  Lots of information is available on-line and from different I&R providers, but it can be complex, contradictory, and confusing  Institutional placements often occur without consideration of available community-based options  Few people plan ahead for long term support needs Value of Options Counseling

8 | | February 2011 Results from Wisconsin Evaluation “What happened? What didn’t?” 42% resulted in other than “service”

9 | | February 2011 Public Policy Context  Toward Single-Entry-Point/No Wrong Door Systems  Aging and Disability Resource Centers  Toward Participant-Direction  Cash and Counseling  Veteran Directed HCBS  CLASS Act  Toward More Attention to Transitions  Money Follows the Person Demonstration  Evidence-Based Care Transitions National Trends Are Moving:

10 | | February 2011 Public Policy Context AoA’s National Options Counseling Standards Development  Group of states, experts, and stakeholders contributing through regular meetings  Identify how options counseling intersects with all types of core functions  Establishing core competencies for options counselors  Developing a comprehensive set of minimum national standards for options counseling.

11 | | February 2011 Foundations of Options Counseling Defining Options Counseling – Draft Options Counseling is an interactive decision-support process whereby individuals, family members, caregivers, and /or significant others are supported in their deliberations to make informed long-term support choices in the context of the individual’s preferences, strengths, needed services, values, and individual circumstances.

12 | | February 2011 Foundations of Options Counseling Defining Options Counseling – Draft  The Options Counseling process facilitates person-centered, streamlined access to supports and includes the following components at the direction of the individual:  gathering information about his or her current situation;  providing information on and educating about long term support options;  weighing pros/cons and potential implications of various options;  facilitating enrollment in participant directed services;  assisting with enrollment in publicly funded services;  assisting in connecting to privately purchased and/or informal supports;  collaborating to develop a long term support plan; and  following-up with the individual.  Individuals/families preferably receive Options Counseling from one counselor over time but it may be collaboratively provided by more than one person or agency.

13 | | February 2011 What is Options Counseling? Information + Education + Personal Experience = Knowledge Decision Support Information Provision Education Decision Support

14 | | February 2011 What is Options Counseling?  How do you know when decision support is happening? Discussion

15 | | February 2011 What is Options Counseling?  OC takes more time than traditional information and assistance services, e.g., average call times increase.  OC usually involves in-person meetings and includes family members  OC includes documenting decision support provided and action steps for consumers, families, and the ADRC  OC should be guided by standard operating procedures  OC involves tracking consumer outcomes over time How do you know when options counseling is occurring?

16 | | February 2011 Core Competencies of Options Counseling 1. Determining the need for OC 2. Assessing needs, values and preferences 3. Understanding and educating about public and private sector resources 4. Facilitating self-direction / self-determination 5. Encouraging future orientation 6. Following-up ACTIVE LISTENING SKILLS Six core competencies of options counseling

17 | | February 2011 Core Competencies of Options Counseling Dennis calls the ADRC concerned that his father’s memory is getting worse, he is losing weight and his mother refuses to take his father to the Memory Assessment Clinic in town What would you say? Core Competency #1: Determining the need for OC

18 | | February 2011 Core Competencies of Options Counseling Example Strategies  Set a welcoming tone and convey openness; establish rapport  Ask open-ended questions such as “what type of assistance would help you” or ask them to describe a typical day  Listen for cues that signal the person is at the point of decision-making, such as “maybe I…” “I don’t know…” “Someone told me I need…” “ I can’t…”  Ask directly if the consumer would like additional support thinking through options and making choices  Allow the caller to tell their personal story  Listen for underlying problems  Ask what the consumer would like to see happen as a result of their contact to the ADRC  Assess/ask if individual would like to continue the discussion face to face Core Competency #1: Determining the need for OC

19 | | February 2011 Core Competencies of Options Counseling Core Competency #2: Assessing needs, values, and preferences

20 | | February 2011 Core Competencies of Options Counseling Core Competency #2: Assessing needs, values, and preferences

21 | | February 2011 Core Competencies of Options Counseling Core Competency #2: Assessing needs, values, and preferences

22 | | February 2011 Core Competencies of Options Counseling Core Competency #2: Assessing needs, values, and preferences Example Strategies  Allow sufficient time to understand the issues Physical, mental and emotional needs Social supports: community, family and friends and their roles Financial resources and benefits Values of individual: What is important? Cultural considerations, personal goals  Suggest/be open to meeting with the family  Consider using person-centered planning tools

23 | | February 2011 Core Competencies of Options Counseling Core Competency #3: Understanding and educating about public and private sector resources

24 | | February 2011 Core Competencies of Options Counseling Stages of Change: An ADRC Perspective on Motivational Interviewing (handout) ► Pre-contemplation ► Contemplation ► Preparation ► Action ► Maintenance ► Relapse Core Competency #3: Understanding and educating about public and private sector resources

25 | | February 2011 Core Competencies of Options Counseling Example Strategies  Explore public, private and informal support options  Be able to discuss potential availability and cost  “Dose” information  View options counseling as a service  Seek out continuing education opportunities to enhance knowledge Core Competency #3: Understanding and educating about public and private sector resources

26 | | February 2011 Core Competencies of Options Counseling Core Competency #4: Facilitating self-direction / self-determination

27 | | February 2011 Core Competencies of Options Counseling Example Strategies  Encourage involvement of and control by the consumer  Ask “What do you need to help you make this decision?”  Educate family about importance of self direction while also providing caregiver support  Let go of the need for consumers to do the “right thing” as you see it  Remember that few decisions are irreversible and they are always a learning experience Core Competency #4: Facilitating self-direction /self-determination

28 | | February 2011 Core Competencies of Options Counseling Core Competency #5: Encouraging future orientation

29 | | February 2011 Core Competencies of Options Counseling Core Competency #5: Encouraging future orientation

30 | | February 2011 Core Competencies of Options Counseling Example Strategies  Help consumers weigh the pros and cons of different choices  “What might happen if you take no action?”  “What might happen if you tried a homemaker twice a week?”  Assist families to anticipate and plan for future needs  “What would you like to do when your daughter (caregiver) goes back to work full-time?”  “Where would you like to be living in five years? Ten years?” Core Competency #5: Encouraging future orientation

31 | | February 2011 Core Competencies of Options Counseling  Documenting decision support (consumer and staff) Assessment of need Options discussed Action plan  Strengthening the consumer’s relationship with the ADRC Consumer decisions made Outcome of referrals (public and private) Services started Additional follow-up needed  Documenting outcomes to assess  Value of options counseling interaction  Continuous quality improvement Core Competency #6: Following-up

32 | | February 2011 Additional Information  Options Counseling Trainings  Tools on  Motivational Interviewing: Stages of Change  Tip Sheet Active Listening Skills  Which LTC Program is Best for Me?  Holding a Family Meeting  Comparison Chart for LTC Options Counseling (Excel Tool)  PATH of Person Centered Planning  Wisconsin Options Counseling Toolkit  Indiana Strategies for Making Tough Choices  I & A Caller Brief Assessment TAE Resources

33 | | February 2011 Additional Information  Options Counseling Training Resources and Tools page  Options and Benefits Counseling page tae.org/tikiindex.php?page=OptionsBenefits&catx=317&filter=n ewhttp:// tae.org/tikiindex.php?page=OptionsBenefits&catx=317&filter=n ew adrc-tae.org

34 | | February 2011 Additional Information  Motivational Interviewing   Person-Centered Planning  Cornell University IRL School Employment and Disability Institute – Person-Centered Planning Education Site  Amado, A. N. and Mc Bride, M. (2001), Increasing Person-Centered Thinking: Improving the Quality of Person-Centered Planning: A Manual for Person-Centered Planning Facilitators. Minneapolis, Minnesota: University of Minnesota, Institute on Community Integration. Further Reading….

35 | | February 2011 Conclusion  What would it take to for you to be able to implement the competencies we discussed today in your daily work with individuals and families?  What standards/supports would be needed in your organization?  Additional training needs? What do you want more of?  Best practices to share with others? How was your “day in the life”?

36 | | February 2011 Our job is to give people the tools they need to choose the right path for themselves…