The Challenge of Developing a Person Centered System Michael Smull & Mary Lou Bourne Support...

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


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


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


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 ---


We also respond to “internal pressures”

• Values, assumptions, and attitudes• Structures & practices• Skills • Organizational culture


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?


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


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


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.


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.


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.


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

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


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


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

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