The Challenge of Developing a Person Centered System Michael Smull & Mary Lou Bourne Support Development Associates 1 © Support Development Associates

© TLC-PCP Service Life Community Life ‘Important for’ addressed No organized effort to address ‘important to’ ‘To’ and ‘for’ present Active circle of support Included in community life ‘To’ and ‘for’ present Closest people are paid or family Few real connections A Good Paid Life Focus on connecting, building relationships and natural supports ‘Important to’ present ‘Important to’ recognized Moving from Service Life to Community Life Wkbk pg 5

It is more than planning Person centered planning – by itself Results in Better paper More often than it results in Better Lives © Support Development Associates3

It is also more than a few examples of best practice. We have to move from isolated examples to a person centered system © Support Development Associates4

The national context – business as usual is not sustainable Demand is going up and increases in public funding will not keep pace with increased demand The federal perspective is to talk about Long Term Supports and Services – not disability specific services © Support Development Associates5

6

7

8

9

You have to create a new “path of least resistance” You can’t just change the destination Most of us do what we already know – Moving off the old path requires pressure that is greater than the resistance – You have to make it easier to do the new and harder to do the old © Support Development Associates10

External Pressure The external pressure that we typically respond to the most are the “3 whats” 1.What is required and inspected 2.What is measured 3.What is funded These three “whats” are established by the system managers --- © Support Development Associates11

We also respond to “internal pressures” Values, assumptions, and attitudes Structures & practices Skills Organizational culture © Support Development Associates12

Start Typical Practice External pressures 1.What is measured 2.What is inspected 3.What is funded Internal pressures 1.Values and assumptions 2.Structures & practices 3.Skills 4.Organizational culture

Typical Practice New Vision/Destination External pressures 1.What is measured 2.What is inspected 3.What is funded Internal pressures 1.Values and assumptions 2.Structures & practices 3.Skills 4.Organizational culture

How do you change the pressures and create a person centered system? © Support Development Associates15

A system requires 7 parts – working together 1.Vision, mission, and values that are routinely used 2.Effective ways to learn the outcomes that each person wants 3.Effective use of the skills needed for implementation 4.Alignment of external and internal pressures to support the 1 st 3 © Support Development Associates16

Requirements for a person centered system - continued 5. Advocacy – external and internal - for the vision and alignment. Including what does and does not get public funding 6. A quality management system that measures effectiveness and identifies areas for improvement 7. Leaders that understand all of the above and engage in sustained and consistent actions for their implementation © Support Development Associates17

A Version of Our Vision People with Disabilities…  Have positive control over the lives they have chosen for themselves.  Are recognized and valued for their contributions (past, current, and potential) to their communities.  Are supported in a web of relationships, both natural and paid, within their communities. © Support Development Associates18

A Mission That Goes With the Vision Our organization provides effective and efficient services that move the people we support toward our vision while making the best use of public and private resources. © Support Development Associates19

Values How You Judge Everyday Behavior Everyone can have the life our vision describes. The people who use services and their families are the experts. We continuously seek to have the best outcomes for the people we support using the fewest public resources. We work collaboratively with all stakeholders in a culture of learning and accountability. © Support Development Associates20

The Basic Approach: 21 Person Centered Thinking leads to Person Centered Practices which lead to Person Centered Organizations which create Person Centered Systems that support Person Directed Lives © Support Development Associates

Important To Important For & The Balance Between Donut Matching ?s Learning Logs Working Not Working Relationship Map Routines & Rituals Good Day Bad Day 2-Minute Drill Reputation Communication Discovery/ Listening Skills Management Skills Everyday Learning Skills © TLC-PCP

© Support Development Associates23

© Support Development Associates24

© Support Development Associates25

TLC-PCP

Some Impacts of Using the Skills © Support Development Associates27

Important To/Important For For the Person Helps people get more of what is important to them without ignoring important for Identifying what still needs to be learned Helps people make critical decisions only when the relevant information is present For the Organization Teaches critical thinking Reinforces “think before you act” Helps people feel listened to Supports an active learning culture 28 © SDA LLC 2011

USE JUDGEMENT & CREATIVITY CORE RESPONSIBILITIES NOT OUR PAID RESPONSIBILITY The Donut Sort Defining Staff Roles and Responsibilities © SDA LLC 2011

30 Defining roles and responsibilities – using the “donut” For the person - Makes it more likely that those things that are most important (to or for) will happen People will be creative in support Those paid will “keep their noses out of” those things that are not their paid responsibility For the organization - Builds a culture of accountability Clearly delineates who is responsible for what Supports being creative without fear © SDA LLC 2011

Supports NeededSkills Required PERSONALITY CHARACTERISTICS NICE TO HAVE (SHARED INTERESTS) Matching for____________ © TLC-PCP Pcd pg 7

Matching staff with those who use services For the Person - Because staff find more pleasure in their work they stay longer (more stability) Where there is a good match – – People who use services are more likely to have what is important to them – New learning about what is important to people is more likely to happen For the Organization - Reduces turnover Makes those who use and provide services feel valued/respected Helps support “real” relationships Decreases likelihood of incidents 32 © SDA LLC 2011

What works/makes senseWhat doesn’t work/make sense Working/Not Working Person’s Perspective Others’ Perspective © SDA LLC 2011

34 Mindful learning: Working/not working For the person - Results in greater clarity about what needs to stay the same and what needs to change in each person’s life Helps in determining goals/outcomes that help the person move toward a desired life For the organization - Teaches critical thinking Promotes better problem solving Leads to clarity about what needs to change and what needs to stay the same Supports a learning culture © SDA LLC 2011

4 + 1 Questions (focus on learning and act on it) What have we tried? What have we learned? What are we pleased about? What are we concerned about? And then, what should we try/do based on what we have learned? © SDA LLC 2011

36 Mindful learning: 4 plus 1 questions For the person - Provides a record of those things that have been tried and their efficacy Those who support are less likely to continue to do those things that are not working in support Figuring out better ways to support people are likely to happen faster For the organization - Everyone has a voice and feels listened to Collective learning/knowledge is gathered efficiently More effective use of meeting time Facilitates effective problem solving © SDA LLC 2011

It requires more than training © Support Development Associates37 Exposure Competence Habit TrainingCoaching

Key Roles Trainers – – Do formal teaching – Support coaches – Provide feedback Coaches – – Train by demonstrating – Take the skill from competence to habit Leaders – – listen and act on the learning © Support Development Associates38

© Support Development Associates39

Helen Sanderson Associates/Support Development Associates

Requirements for Change Person Centered Thinking & Coaches Exposure Competence Habit Level 1 changes Interest from Org & System Leadership Structured Ways of Listening to Coaches “Easy” Level 2 & 3 Changes Commitment from Leadership Plus Quality Management Skills Creating a Learning Cycle “Difficult” Level 2 & 3 changes Changes inside Current Efforts Changes in Practice Changes in structure

But you also have to bring assumptions to the foreground Question/challenge assumptions And Leaders don’t just question assumptions Leaders change assumptions © Support Development Associates42

SDA October Person Centered Thinking Person Centered Planning Person Centered Practices Person Centered Organizations Person Centered Systems It Goes Beyond Person Centered Planning… © Support Development Associates

What changes do we see in each level? Changes in language Changes in one person’s life Changes in our tools and documents Changes in our processes and our structure Changes in system structure and external relationships 44 © Support Development Associates

Shifting to a Person Centered System Moving Away from This….Towards this Underlying Assumption System is the expert; dependent on the system Person is the expert in their life; enhance capacity of natural support Intake and Eligibility List of deficits; complex; no time frame Capabilities and strengths to build on; transparent and timely AssessmentComprehensive list of needs; system fully responsible Customized list, based only on support identified by the person, their family or loved ones PlanningHealth and safety is priority; goals identified by professionals; ameliorate problems Interests, comfort and satisfaction equally important to health and safety; outcome for the person MonitoringVerify; emphasis is compliance; establishes a blame culture Accountability for learning and improvement Financial Structure Slots, vacancies, programs fundedResources allocated to the person – move with them Quality Management Assess what’s wrong; comply with minimum Results oriented; shared learning Copyright SDA LLC45

For more information… Michael Smull – Mary Lou Bourne – © Support Development Associates46