the challenge of developing a person centered system michael smull & mary lou bourne support...
TRANSCRIPT
The Challenge of Developinga
Person Centered System
Michael Smull & Mary Lou BourneSupport Development Associates
1 © Support Development Associates
TLC-PCP 2012 www.learningcommunity.us 2
~ Ruth’s One Page Description (at home)~
What is I mportant to Ruth
Living with granddaughter and grandson-in-law
Being warm and feeling safe with caregivers
Having “a little pour” before bed (rum and tea)
Being a part of whatever is going on at home ~ being in the middle of it!
Sweets during the day!
What People Like and Admire about Ruth
Such a “grandmother” A true lady Has the gif t of gab ~ can hold a
conversation with anyone! Always dressed so nice ~ everything
always matches, right down to socks and earrings
Very liberal thinker for her age
Supports Ruth Needs to be Happy, Healthy and Safe
Needs people to ask f requently if she is warm enough and help her put on sweater/ sweatshirt if she is not (she’ll be cold when you’re not)
Must have assistance with her medications ~ knows them by color but you need to dole them out and keep track of times
Needs assistance with bathing and dressing ~ will tell you what clothes she wants to wear for the day/ event
When bathing, no water on face ~ she will wash with cloth Must talk with daughter 2-3 times a week on the phone ~ will need you to
dial f or her Must see her doctor right away if she has cough, fever or is “off
balance” ~ indications of systemic infection that will grow quickly!
People Who Support her Best Like to chit chat Are timely and stay busy Polite and mannerly Have a witty and dry sense of humor Can be reassuring and help Ruth feel
safe
But it is more than planning
Person centered planning – by itselfResults in
Better paperMore often than it results in
Better Lives
© Support Development Associates 3
And we have examples of best practice but we have to move from
isolated examples to a person centered system
© Support Development Associates 4
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 Associates 5
6
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 Associates 7
External Pressure
The external pressure that we typically respond to the most are the “3 whats” 1. What is required and inspected2. What is measured3. What is fundedThese three “whats” are established by the system managers ---
© Support Development Associates 8
We also respond to “internal pressures”
• Values, assumptions, and attitudes• Structures & practices• Skills • Organizational culture
© Support Development Associates 9
Start
TypicalPractice
External pressures1. What is measured2. What is inspected3. What is funded
Internal pressures1. Values and assumptions2. Structures & practices3. Skills 4. Organizational culture
Typical Practice
New Vision/Destination
External pressures1. What is
measured2. What is
inspected3. What is funded
Internal pressures1. Values and assumptions2. Structures & practices3. Skills 4. Organizational culture
How do you change the pressures and create a person centered
system?
© Support Development Associates 12
A system requires 6 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
© Support Development Associates 13
Requirements of a person centered system - continued
4. Structures, processes, and policies that work together in supporting the 1st 35. A quality management system that measures effectiveness and identifies areas for improvement6. Leaders that understand all of the above and engage in sustained and consistent actions for their implementation
© Support Development Associates 14
A Version of Our VisionPeople 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 Associates 15
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 Associates 16
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 Associates 17
The Basic Approach:
18
Person Centered Thinking leads to
Person Centered Practices which lead to
Person Centered Organizations which create
Person Centered Systems that supportPerson Directed Lives © Support Development Associates
Important To Important For &
The Balance Between
Donut
Matching
4 + 1 ?s
Learning
Logs
Working
Not Worki
ng
Relationship
Map
Routines &
Rituals
Good Day
Bad Day
2-Minute Drill
Reputation
Communication
Discovery/Listening Skills
Management Skills
Everyday Learning Skills © TLC-PCP 2012 www.learningcommunity.us
© Support Development Associates 20
© Support Development Associates 21
© Support Development Associates 22
TLC-PCP 2012 www.learningcommunity.us 23
~ Ruth’s One Page Description (at home)~
What is I mportant to Ruth
Living with granddaughter and grandson-in-law
Being warm and feeling safe with caregivers
Having “a little pour” before bed (rum and tea)
Being a part of whatever is going on at home ~ being in the middle of it!
Sweets during the day!
What People Like and Admire about Ruth
Such a “grandmother” A true lady Has the gif t of gab ~ can hold a
conversation with anyone! Always dressed so nice ~ everything
always matches, right down to socks and earrings
Very liberal thinker for her age
Supports Ruth Needs to be Happy, Healthy and Safe
Needs people to ask f requently if she is warm enough and help her put on sweater/ sweatshirt if she is not (she’ll be cold when you’re not)
Must have assistance with her medications ~ knows them by color but you need to dole them out and keep track of times
Needs assistance with bathing and dressing ~ will tell you what clothes she wants to wear for the day/ event
When bathing, no water on face ~ she will wash with cloth Must talk with daughter 2-3 times a week on the phone ~ will need you to
dial f or her Must see her doctor right away if she has cough, fever or is “off
balance” ~ indications of systemic infection that will grow quickly!
People Who Support her Best Like to chit chat Are timely and stay busy Polite and mannerly Have a witty and dry sense of humor Can be reassuring and help Ruth feel
safe
It requires more than training
© Support Development Associates 24
Exposure Competence Habit
Training Coaching
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 Associates 25
Helen Sanderson Associates/Support Development Associates
SDA October 2010 27
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
28 © Support Development Associates
Shifting to a Person Centered SystemMoving 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
Assessment Comprehensive list of needs; system fully responsible
Customized list, based only on support identified by the person, their family or loved ones
Planning Health and safety is priority; goals identified by professionals; ameliorate problems
Interests, comfort and satisfaction equally important to health and safety; outcome for the person
Monitoring Verify; emphasis is compliance; establishes a blame culture
Accountability for learning and improvement
Financial Structure
Slots, vacancies, programs funded Resources allocated to the person – move with them
Quality Management
Assess what’s wrong; comply with minimum
Results oriented; shared learning
Copyright SDA LLC 29