Presented By: © TLC-PCP Person Centered Thinking Day 1

The Learning Community for Person Centered Practices envisions a world where all people have positive control over the lives they have chosen for themselves. Our efforts focus on people who have lost or may lose positive control because of society's response to the presence of a disability. We foster a global learning community that shares knowledge for that purpose. © TLC-PCP

Person Centered Thinking  underlies and guides respectful listening which leads to actions, resulting in people who:  Have positive control over the life they desire and find satisfying;  Are recognized and valued for their contributions (current and potential) to their communities; and  Are supported in a web of relationships, both natural and paid, within their communities © TLC-PCP

What are person centered thinking skills?  A set of skills that reflect and reinforce values that:  Propel the learning cycle  Help us support rather than fix  Work for humans  Work at every level in the organization  Build the culture of learning, partnership, and accountability  Affirm our belief that everyone can learn © TLC-PCP

Help people get better lives Not just better paper

Purpose of the day Learn how to 1.Use person centered thinking skills to gather a deeper understanding of the people we support 2. More easily organize that learning to inform our efforts to help people get the lives they value © TLC-PCP

How Today Works © TLC-PCP Work in groups Learn methods that anchor person centered practices Organizing Concept: Important TO and FOR and finding the balance between them Managing our support role using the Donut 3 Problem solving SKILLS that help us use what we are learning every day Questions Learning Log Working/Not Working

Working Agreements for the Day © TLC-PCP  Cell phones on vibrate  Misery is optional  Respectful listening  All questions are valid  Only share what you are comfortable sharing  The trainer is always right

Introducing the Core Concept: IMPORTANT TO AND IMPORTANT FOR AND THE BALANCE BETWEEN THEM © TLC-PCP

Important TO © TLC-PCP What is important to a person includes those things in life which help us to be satisfied, content, comforted, fulfilled, and happy. It includes: People to be with /relationships Status and control Things to do and places to go Rituals or routines Rhythm or pace of life Things to have

Important FOR ( Part One ): © TLC-PCP Issues of health: ― Prevention of illness ― Treatment of illness / medical conditions ― Promotion of wellness (e.g.: diet, exercise) Issues of safety: ― Environment ― Well being ---- physical and emotional ― Free from fear

© TLC-PCP  What others see as necessary to help the person: ― Be valued ― Be a contributing member of their community Important FOR ( Part Two ):

© 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

A Good Paid Life 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 Moving from Service Life to Community Life ‘To’ and ‘for’ present Closest people are paid or family Few real connections © TLC-PCP

Discontent is the first necessity of progress. -Thomas Edison © TLC-PCP

Discontent is the Engine of Change © TLC-PCP Anything you are happy with, you want to stay the same You are only interested in change when there is discontent There are there are 2 kinds of discontent  Cynical  Optimistic  We have too much cynical and  not enough optimistic

Cynical Discontent © TLC-PCP When you have discontent without hope you get cynical discontent. Cynical discontent results in:

Optimistic Discontent © TLC-PCP Requires hope based on trust that is created when there is: A history of acting on things that can be changed Honesty about those things that will take time to change Progress in acting on the things that take time Where cynical discontent is dominant… …trust must be created

© TLC-PCP Any changes an organization makes to it’s practices, structure or rules that result in positive differences in the lives of people. Level 1 Level 2 Level 3 Any change that results in a positive difference in the lives of people who use services or in your own work life. Any change in practice, structure and rules made at the system level. These changes have an effect on many organizations, and therefore many peoples’ lives. Levels of Change

Overview Day 1 and Day 2 Day 1 – working in groups Day 2 – working in pairs © TLC-PCP

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

Sorting Important to from Important for Important To Important For (and finding a better balance between them)

Relationship Map Rituals and Routines Good Day/Bad Day Two Minute Drill Communication Chart Reputations © TLC-PCP Discovery/Listening Skills 6 methods for collecting information

The “Relationship Map” 1 st Discovery Skill People Map for: Family People who support me at work or school Friends People whose job is to support me at home and other places © TLC-PCP

Rituals and Routines Rituals guide us through our days and bring consistency, comfort and control Morning Bedtime Mealtimes Transition Birthday Not Feeling Well Cultural/Holiday Spiritual Vacation Comfort Celebration Grief/Loss

© TLC-PCP Good Day/Bad Day What is a good day like for this person? What is a bad day like for this person (or a stressful or really difficult day)?

© TLC-PCP Listening to Behavior… What is happening_____ doesWe think it meansAnd we should A Communication Chart

© TLC-PCP Everyday Learning Skills questions Learning Log Working/Not Working (also called “What Makes Sense/Doesn’t Make Sense”)

© TLC-PCP Questions Using the “4 questions” to focus on learning and acting on that learning – – What have we tried? – What have we learned? – What are we pleased about? – What are we concerned about? And then the “+1” question - – What should we try/do based on what we have learned?

© TLC-PCP Date What did the person do? (What, where, when, how long, etc.) Who was there? (Names of staff, friends, others, etc.) What did you learn about what worked well? What did the person like about the activity? What needs to stay the same? What did you learn about what didn’t work well? What did the person not like about the activity? What needs to be different? Learning Log Using the learning log to replace typical progress notes

© TLC-PCP What works/ Makes sense What doesn’t work/ Doesn’t make sense Person’s perspective Parent’s perspective Staff’s perspective

Matching © TLC-PCP Management Skills Donut Sort

© TLC-PCP NOT OUR USUAL RESPONSIBILITY The Donut Sort Core Responsibilities Creativity & Judgment Defining Staff Roles and Responsibilities

© TLC-PCP A Matching Profile For each person – what are... Supports wanted and needed Skills neededPersonality Characteristics Needed Shared Common Interests (would be nice to have)

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

Day One © TLC-PCP Beginning Practicing Person Centered Thinking Skills Applying What We Learn

© TLC-PCP Have our own dreams and our own journeys Have opportunities to meet new people; try new things; change jobs; change who we live with & where we live Have what/who is important to us in everyday life; people to be with; things to do, places to be Stay healthy & safe (on our own terms) Each of us want lives where we are supported by & contribute to our communities

© TLC-PCP Terminal Irritation * Used with permission from Dave Coverly, Speedbump Comic

© TLC-PCP The Importance Of Environment HealingSupportiveToleratedToxic Power Over Power With Growth Occurs Here

© TLC-PCP Implementation of Person Centered Practices is: A Promise to listen To listen to what is being said and to what is meant by what is being said To keep listening A Promise to act on what we hear To always find something that we can do today or tomorrow To keep acting on what we hear

© TLC-PCP Implementation of Person Centered Practices is: A Promise to be honest To let people know when what they are telling us will take time When we do not know how to help them get what they are asking for When what the person is telling us is in conflict with staying healthy or safe and we can’t find a good balance between important to and important for

© TLC-PCP Understand Look/Listen What you see/hear depends on what you are looking/listening for

TLC-PCP This is an awareness test…

© TLC-PCP Important to and Important for and the Balance between them The Core Concept: And a core skill

TLC-PCP Sorting Important To from Important For (and finding a better balance between them) Important ToImportant For © TLC-PCP

What is important to a person includes those things in life which help us to be satisfied, content, comforted, fulfilled, and happy. It includes: People to be with /relationships Things to do & places to go Rituals or routines Rhythm or pace of life Status & control Things to have Important TO

© TLC-PCP Includes what matters the most to the person – their own definition of quality of life. What is important to a person includes only what people “say”: ― with their words ― with their behavior Important TO When words and behavior are in conflict, pay attention to the behavior and ask “why?”

© TLC-PCP – Issues of health: ―Prevention of illness ―Treatment of illness / medical conditions ―Promotion of wellness (e.g.: diet, exercise) – Issues of safety: ―Environment ―Well being ---- physical and emotional ―Free from Fear – What others see as necessary to help the person: ―Be valued ―Be a contributing member of their community Important FOR

© TLC-PCP Important To and For are Connected ‘Important to’ and ‘important for’ influence each other No one does anything that is ‘important for’ them (willingly) unless a piece of it is ‘important to’ them Balance is dynamic (changing) and always involves tradeoffs: – Among the things that are ‘important to’; – Between important ‘to’ and ‘for’

© TLC-PCP Finding the Balance We all make tradeoffs between the many different things that are important to us. – Some people may love living in a particular place. – And are willing to make the tradeoff when living there means a longer commute to the work they love. We also make tradeoffs between what is important to us and what is important for us. These tradeoffs can be temporary OR long term solutions. ―Fun time with my friends is important to me. Having a clean house is part of being valued by my friends. House cleaning occasionally comes before having fun with friends. ―Expressing personal opinions and speaking my mind is important to me, but not cussing in front of my neighbors is important for me

TLC-PCP Health and Safety Dictate Lifestyle Import ant FOR Important TO © TLC-PCP

All Choice No Responsibility Important FOR Important TO

© TLC-PCP Balance Important FOR Important TO

© TLC-PCP What works/makes sense What doesn’t work/Doesn’t make sense Julie’s perspective Staff’s perspective Shopping daily for favorite things Having lots of jewelry and no one getting into them without my OK Having my sister Joanne in my life Lots of blue, red and black clothes Polished nails, many colors & layers Living with Teddy, the Yorkshire Terrier Sleeping on my bed Snacks from my plate In my lap when I watch TV Staff don’t let me drink what I want Teddy leaving me during mealtimes Having no work to do at WAC, Inc. Staff not letting me buy things I want Favorite people doing activities with her, especially John Dandy Keeping Julie from falling – reminders to use her walker Level blood sugar – staff knowing signs of low and high blood sugar Joanne is active in Julie’s life Planning before Julie goes shopping Julie is less steady on her feet and falling more than she used to If you don’t make a plan with before shopping, Julie will want to buy more than she has money for – Julie may get very upset which can alter her blood sugar Julie gives Teddy food off her plate

© TLC-PCP What is important to Julie? What is important for Julie? What else do you need to learn/know? Julie Wrkbk pg 17

© TLC-PCP Julie – Answer Slide What is important to Julie? What is important for Julie? What else do you need to learn/know? Relationship with Teddy Having some control – Over what happens with Teddy What she buys/wears Her things Shopping a lot Her sister &John Dandy in her life Staying busy at the day service Drinking as much as she wants Keeping diabetes under control Monitoring blood sugar, giving insulin Weighing her food Controlling amount she drinks Helping her stay calm Supporting her relationship with Teddy Keeping her from falling Planning in advance/ budgeting in advance for shopping How interested/involved is Julie in her diabetes management? What about “no work to do at WAC, Inc bothers her? Is John Dandy really important to her?

© TLC-PCP What works/makes sense What doesn’t work/ Doesn’t make sense Julie’s perspective Staff’s perspective Her relationship with Teddy Feeding Teddy from her plate (food = love) Feeding Teddy the same food she is eating (people food) Staff removing Teddy during meal times Teddy barking and being upset at being locked in the back room Feeding Teddy dog food in his own bowl Julie’s relationship with Teddy Removing Teddy from the dining room during meals; monitoring Julie’s food/drink intake accurately Julie feeding Teddy from her plate Inaccurate monitoring of Julie’s food/drink intake when she feeds Teddy from her plate Teddy barking in the back room and upsetting Julie and other residents Teddy’s long-term health if he eats too much “people food.” Example of Working/Not Working Focused for Action

Matching © TLC-PCP Management Skills Donut Sort Sorting Important TO and FOR is a skill that works with all the other SKILLS

© TLC-PCP Ask Yourself “What do we know?” Before asking “What do we do?” If I had an hour to save the world, I’d spend 55 minutes defining the problem. ~ Albert Einstein 60

© TLC-PCP NOT OUR USUAL RESPONSIBILITY Inside a Person’s Life Defining Staff Roles and Responsibilities Core Responsibilities Judgment & Creativity 61

© TLC-PCP What is important to Harry? What is important for Harry? What else do you need to learn/know? Harry Wrkbk pg 20

© TLC-PCP What is important to Harry? What is important for Harry? What else do you need to learn/know? To attract women To spend his money as he wants To have George’s permission To learn what to wear that will cause minimal pain and embarrassment To learn to manage his money What does Harry understand about – Managing his money Attracting women, dating Where it is appropriate to wear what Harry – Possible Answers

© TLC-PCP Not usually our responsibility Use judgment and creativity Core responsibilities Harry – George’s Donut Wrkbk pg 21

© TLC-PCP Not usually our responsibility Whether or not he buys the shirt. Use judgment and creativity What you do/try to help Harry make an informed choice about – The odds against the shirt being a “chick magnet” Spending ½ his money for 2 weeks on 1 purchase Core responsibilities To help Harry make an informed choice – About the shirt About his money Starts with asking why he wants the shirt Harry – Possible Answers

© TLC-PCP …The Rest of the Story Harry…

© TLC-PCP What is important to Harry? What is important for Harry? What else do you need to learn/know? To be around this woman, have her “recognize” that she wants him. To have control and power over her. To know the legal consequences of stalking To stop stalking To understand that stalking doesn’t work to get an intimate relationship Harry #2 – Answer Slide More about the past history of this or similar behavior? How dangerous is he? Does he get what we think he gets out of stalking? Has he ever had a “regular adult” relationship?

© TLC-PCP Not usually our responsibility To help him get sex or keep him out of jail at all costs Use judgment and creativity Short term – How you keep the woman safe until you can get him treatment Longer term – how you learn, acting on what you learn, figuring out how he can get what is important enough to him that that he will participate in treatment Core responsibilities Short term -Keep the woman safe and in the process keep him safe (and out of jail) Longer term – teach relationship SKILLS, figure out why he is stalking, any pattern, and deal with it, seeking a way for Harry to live safely in the community Harry #2 – Possible Answers

© TLC-PCP Bob What is important to Bob? What is important for Bob? What else do you need to learn/know? Wrkbk pg 22

© TLC-PCP Bob – Answer Slide What is important to Bob? What is important for Bob? What else do you need to learn/know? To be one of the guys To keep his friends To be in charge of his own life To have a “typical” life To stay healthy To stay healthy – Take his medications as prescribed Stay out of the hospital/not cycle To be connected to his community How dangerous is it for him to go off medication and have a couple of beers? Would it be OK for him to drink 1 or 2 beers and be on his medication? Is there another medication where 1 or 2 beers would be OK? How well does he understand the risks that he is taking? Would he be willing to drink non-alcoholic beer? What role does his girlfriend play in this?

© TLC-PCP Bob Not usually our responsibility Use judgment and creativity Core responsibilities Wrkbk pg 23

© TLC-PCP Bob – Answer Slide Not usually our responsibility Whether or not Bob drinks What Bob’s psychiatrist does in response to the information Use judgment and creativity What you do to meet your core responsibilities around helping him make an informed choice – Informing Bob of the risks Educating yourself Exploring alternatives If part of the “problem” is the response of the psychiatrist – helping Bob find another Core responsibilities Helping Bob make an informed choice Informing Bob of the risks of his behavior Informing yourself of the actual risks and alternatives Making sure that Bob’s psychiatrist knows about Bob’s drinking Making an effort to explore with Bob alternative ways to get what is important to and important for him

© TLC-PCP Service Life Moving from Service Life to 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 Community Life Bob

© TLC-PCP Service Life Moving from Service Life to 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 Bob moves from community life to the Special Pool Hall at Day Hab Community Life A Good Paid Life Bob

Service Life Moving from Service Life to 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 Bob moves from community life to the Special Pool Hall at Day Hab A Good Paid Life Community Life Bob © TLC-PCP

Everyday Learning SKILLS questions Learning Log Working/Not Working (also called “What makes sense/Doesn’t make sense)

© TLC-PCP ? ? +1 – Given your learning what will you do next? ______________________________________________________ ______________________________________________________ ____________________________________________________ What you have done to improve your health and safety? What have you tried? 1 What have you learned? 2 What are you pleased about? 3 What are you concerned about? 4 Wrkbk pg 29

© TLC-PCP ? ? +1 – Given your learning what will you do next? _____________________________________________________ _____________________________________________________ _____________________________________________________ What have you tried? 1 What have you learned? 2 What are you pleased about? 3 What are you concerned about? 4 What did you do? When did you do it? Who else was there? What did you learn from your efforts? What did you like about what you tried? What went well? What worked for you? What challenges did you encounter? What didn’t you like about what you tried? What didn’t work for you? Pose the question you want people to answer

© TLC-PCP ? ? +1: Keep doing protein shakes; find someone local to cook occasionally; keep asking “what did you eat today, not just “did you eat today?” What we have done to address Liz’s malnourishment What have we Tried What have we learned What are we Pleased about What are we concerned about Healthy frozen meals Daughter cooking a week’s worth of food for her High protein shakes 2x a day She doesn’t like processed food Will almost always eat daughter’s home cooked food Protein shakes work really well If she is having a really bad day, might only drink one shake at best She is steadily gaining weight Found at least two options that work for her She is committed to eating when she can Stress on daughter to cook and drive 5 hours round trip every weekend Only eating once a day Will lose appetite again if depression comes back

© TLC-PCP Everyday Learning SKILLS questions Learning Log Working/Not Working (also called “What makes sense/Doesn’t make sense)

© TLC-PCP Learning Log Using the learning log to replace progress notes

TLC-PCP © TLC-PCP

Recording learning for Charlie: What we have learned about what is: What do we need to learn or figure out? wrkbk pg 27

© TLC-PCP PCT Trainer Candidate’s Learning Log Using the learning log to replace typical progress notes

© TLC-PCP Learning Log for Andrew (page 1) Using the learning log to show a family’s learning over time

© TLC-PCP Learning Log for Andrew (page 2) Using the learning log to show a family’s learning over time

© TLC-PCP Everyday Learning Skills questions Learning Log Working/Not Working (also called “What makes sense/Doesn’t make sense)

© TLC-PCP Focus in on a specific issue or area of life Helps you dig deeper Working/Not Working  Bridge to action planning What needs to be maintained/enhanced? What needs to change?  Negotiation Skill All must feel listened to – accurately reflect perspectives Start with common ground Remain unconditionally constructive Done in partnership

© TLC-PCP Person’s perspective Staff’s perspective USE THIS INFORMATION TO BUILD THE A G E N D A FOR THINGS THAT ARE TO STAY THE SAME USE THIS INFORMATION TO BUILD THE A G E N D A FOR THINGS THAT NEED TO CHANGE Disagreements

93 © TLC-PCP

Someone brings home a new puppy. Given your own experiences and those that you have heard from others, what does and does not make sense about having a new puppy in the house. What works/makes sense What doesn’t work/Doesn’t make sense Perspective of new puppy’s owner Wrkbk pg 32

Use to organize perspectives about a specific Issue or to get a snapshot description of NOW © TLC-PCP What’s WorkingWhat’s Not Working/What Could Improve What does the person say is working? What does the person say is not working or could be better? What does the family say is working? What does the family say is not working or could be better? What does the staff person/teacher/therapist (etc) say is working? What do they say is not working or could be better?

© TLC-PCP Julie – Answer Slide What is important to Julie? What is important for Julie? What else do you need to learn/know? Relationship with Teddy Having some control – Over what happens with Teddy What she buys/wears Her things Shopping a lot Her sister &John Dandy in her life Staying busy at the day service Drinking as much as she wants Keeping diabetes under control Monitoring blood sugar, giving insulin Weighing her food Controlling amount she drinks Helping her stay calm Supporting her relationship with Teddy Keeping her from falling Planning in advance/ budgeting in advance for shopping How interested/involved is Julie in her diabetes management? What about “no work to do at WAC, Inc bothers her? Is John Dandy really important to her?

© TLC-PCP What works/makes sense What doesn’t work/makes sense Julie’s perspective Staff’s perspective Her relationship with Teddy Feeding Teddy from her plate (food = love) Feeding Teddy the same food she is eating (people food) Staff removing Teddy during meal times Teddy barking and being upset at being locked in the back room Feeding Teddy dog food in his own bowl Julie’s relationship with Teddy Removing Teddy from the dining room during meals; monitoring Julie’s food/drink intake accurately Julie feeding Teddy from her plate Inaccurate monitoring of Julie’s food/drink intake when she feeds Teddy from her plate Teddy barking in the back room and upsetting Julie and other residents Teddy’s long-term health if he eats too much “people food.”

© TLC-PCP Kathleen’s perspective Mother’s perspective Staff’s perspective Wrkbk pg 35

© TLC-PCP Kathleen’s perspective Mother’s perspective Staff’s perspective

© TLC-PCP Beth’s Perspective Family’s Perspective After a Change in Seizure Medication… She doesn’t have seizures Generic medicine is less expensive than brand name med We think she’s dizzy and afraid of falling She can’t walk as well as she did before the new medicine She’s often angry She is getting aggressive She’s not herself – no longer a sweet person She’s afraid to walk, seems fearful of falling Behaviors started after changing seizure med from brand name to generic – We think the generic isn’t working like the brand name did Nothing

© TLC-PCP Perspective of Person Supported Your perspective Supervisor’s perspective Looking at how you are doing in your work... Wrkbk pg 36

© TLC-PCP What makes sense, is working, the up side, right now What doesn’t make sense, is not working, the downside, right now Logan Logan’s Mom -Nancy Logan’s Current Job Job Coach - Brenda Supported Living Coord. -Jackson Pay check-How much I earn Variety of stationary work & stocking tasks Co-worker’s support Riding the bus to/from work Getting off at 10 pm no energy to see live music Paperwork required for processing inventory Working Saturdays Mom driving me home on Friday and Saturday Logan developing new SKILLS Logan has more confidence making decisions, including making more friends Giving Logan rides home Fri & Sat. nights Concerned he rides the bus late at night Not spending as much time with family Complaining not able to see his friends as much Logan may get hurt using the stocking lift Good job SKILLS & good attitude toward work His hours 3-10 pm. Logan is a “night owl” Work provides natural supports on the job Has work friends Recently asking co-workers to do his paperwork Not as productive lately, takes more breaks Called in sick more this past month Getting write-ups for not helping customers Starting at 3pm allows Logan to sleep in Mondays off to assist with activities/tasks at home Logan complains no time to see live music Refusing support with medication prep and shopping for meal at work

Reflect © TLC-PCP

How did today go? © TLC-PCP As we close…

Thank you!!! © TLC-PCP