Shifting the Paradigm: Increasing Opportunities for Choice and - PowerPoint PPT Presentation

Shifting the Paradigm: Increasing Opportunities for Choice and Control through Participant Direction National Resource Center for Participant-Directed Services March 9, 2010

Greetings and Introductions 2

Acknowledgements A collaborative workgroup are to thank for the development of this Maine curriculum. A special thanks to: Cheryl Ring Katlyn Blackstone   Julie Fralich Leslie Bray   Romaine Turyn Sharon Berz   Connie Jones Louise Olsen   Kathy Poulin Mark Richards   3

Acknowledgements A significant amount of the “ Consultant Training Program”  curriculum developed by K. McInnis-Dittrich, Ph.D., K. Simone, MM, and K. Mahoney, Ph.D. (April, 2006) was adopted for this project. The National Resource Center for Participant-Directed  Services also thanks Linda Velgouse of AoA, and Iris Chan and Amy Herr from the Lewin Group for their assistance in making this training possible. 4

Acknowledgements Also, slides from the “ Implementing the Principles of Self-  Determination into Everyday Lives and The Person Centered Approach to Planning” presentation developed by Jeff Keilson (2007), Advocates, Inc. were adapted to fit our curriculum. 5

A Note About the Curriculum Redefining the term “participant direction”  Scope of our discussions (program vs.  philosophy) “Care Advisor” vs. “Case Manager”  Intended for an inclusive audience  Recognition of diverse lenses and experiences-  please speak up throughout the training regarding your own experiences 6

Overall Goals of Training Increase understanding and appreciation for:  Benefits of participant-directed practice  Role of participants in choosing a participant-directed  model Supporting people to choose community-based services  that best meet their needs Incorporate principles of participant-directed  models into current practice 7

Why Participant Direction? Research findings… 8

Research Findings Health and welfare  Same or better health outcomes  Very few incidents of reported abuse, neglect or exploitation  Service use  Modest increase in obtaining equipment  Individuals more likely to obtain services they need  Need not cost more  Caregiver reaction  More satisfied with care arrangement  Expressed less emotional strain  Most felt well-trained to perform duties  9

Research Findings Positive influence on the quality of life  Increased satisfaction  Enhanced feeling of safety  Improves access to services  Participants receive necessary services  Reduces unmet needs  Promotes life in the community  Was shown to reduce nursing facility placements even  more than traditional services 10

Let’s look at it as not just one program, but rather a paradigm shift requiring us to change how we think about the ways we deliver services not just one program… 11

The Paradigm Shift from “Expert” to Coach and Trainer What is a Paradigm Shift? "one conceptual world  view is replaced by another“ (Thomas Kuhn, 1962) A change from one way of  thinking to another 12

Consumer Direction History Driven by the Independent Living (IL) movement  Movements that influence IL (initiated in 1960s)  Civil rights movement  Self-help movement  De-institutionalization and “normalization” movement  De-medicalization movement  Consumerism  McDonald and Oxford, www.acils.com/acil/ilhistory.html 13

Consumer Direction History (continued) Other movements with similar goals to address civil  inequities Women’s movement  Labor movement  Elder activism  McDonald and Oxford, www.acils.com/acil/ilhistory.html 14

Independent Living Philosophical Tenets All human life has value and every human being should have meaningful options and make choices pertaining to issues that affect their lives Consumer control  Cross-disability  Right to fail (take risks)  Choice  Exercise of power; no longer charitable  International Summit Conference on Independent Living, Washington, D.C., September 21-25, 1999 & C. Carr (2004). ADRC Cross-Training 15

The foundation of participant direction: Self-determination is a constitutional right 16

Defining Participation-Direction Participant controls What How When Who Those who provide care or services are accountable to  the consumer and/or representative The freedom for one to plan his/her own life  McInnis-Dittrich, Simone, and Mahoney (April, 2006) 17

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Participant-Directed Models 19

Commonly Used Terms Participant: the person who uses services.  McInnis-Dittrich, Simone, and Mahoney (April, 2006) 20

Commonly Used Terms Care Advisor: Individual who works with the participant in  designing their plan. The person the participant goes to with questions. McInnis-Dittrich, Simone, and Mahoney (April, 2006) 21

Commonly Used Terms Representative  Person appointed by the participant to assist in directing services.  Also known as surrogate or designee. Often unpaid Financial Management Services (FMS )  Appointed to assist an individual to manage fiscal employment  and/or budget responsibilities. Worker  Someone chosen by the individual to provide direct personal  assistance. May include friends and family. Individual Budget  An allocated amount of funds that a participant can use to hire  workers and/or purchase other goods and services to meet their support needs. The term “flexible budget” often indicates the ability of the budget to be used as a participant moves from one setting to the next. McInnis-Dittrich, Simone, and Mahoney (April, 2006) 22

Assumptions of Participant Direction McInnis-Dittrich, Simone, and Mahoney (April, 2006) 23

Requirements for Participant Direction MACROW Networks, adapted from Keilson, 2007 24

Does this process go against the grain of what you already know (or have done in the past)? 25

Modified from Keilson, 2007 26

How can we apply participant direction to existing programs? 27

Break 28

Video Clip: Examples of participant direction www.barnsley.nhs.uk/partnerships/ever y-adult-matters/individual-budgets- personal-stories.htm (Marion) 29

“Perhaps the greatest luxury of all: Choice” Brochure, Little America Hotels and Resorts Keilson, 2007 30

The role of the aging network staff needs to be flexible and mirror the needs of the individual 31

Beneficial Skills of Staff Listener Listen… listen, and listen some more Provides timely and accessible Communicator information; knows communication patterns of the individual Open-minded Leave judgments behind; patience Ensures knowledge of responsibilities, supports available, benefits and risks Teacher (upfront). Assists in building skills required (i.e. hiring workers, completing forms) Facilitates informed decision-making Facilitator and Coach through uncharted territory 32

Systems of Support: Care Advisor Services Supports participants to identify need and  potential solutions Trains participants on roles, responsibilities, and  required skills Supports participants to define and monitor  quality Keilson, 2007 33

Advising the Individual/Representative: Hiring Personal Care Workers Recruiting and interviewing workers  Use of criminal background checks  Managing and supervising workers  Identifying back-up support  Completing timesheets and working with fiscal  intermediary agency to complete required forms 34

Advising the Individual/Representative: Directing Individual Budgets Understanding opportunities to access adaptive  technology and services not otherwise easily accessed Understanding limitations of budget  Negotiating reasonable costs  Choosing and monitoring providers and services  Monitoring expenditures and tracking purchases,  payments, etc. 35

Systems of Support: Financial Management Services (FMS) Ensures compliance with laws/ regulations  (DOL, IRS, etc.) Administers payroll for directly hired workers  Pays providers on behalf of consumers  Provides monthly statements of hours or  expenditures Provides financial monitoring and reporting  36

Recognizing the Learning Curve … of both the participant and staff How to make informed choices  How to recruit and train workers  How to identify and address needs  How and when to ask for help  If using an individual budget: Knowing what you can and cannot use a budget for  What things cost and how to use funds  Keilson, 2007, Adapted from Self-Determination at a Glance, Access to Independence, Inc., 1999. 37

Providing the Option to All Participants How do we support people to make a choice in  how they receive support? What are the questions they should consider?  What information do they need to be fully  informed? How are we addressing agency liability?  38

Empowerment to Make Choices Some may choose agency services  Some may decide it is not right for them  Some may choose a combination of vendor  services and participant-directed services 39