Becoming a Person Centered Organization

1. Becoming a Person CenteredOrganization Michael Smull October 2005

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4. August 2005 ELP Learning Community 4 When you compare the mission with reality Change is happening � But it is too slow We have known how to meet the mission for more than a decade Yet there is still more typical practice than best practice

5. August 2005 ELP Learning Community 5 We have learned what doesn�t work for system change - Best practice models don�t infect all of typical practice and cause change Pilot efforts work but become another program Only requiring person centered plans improves the quality of the paper more than the quality of lives Change by memo has no effect

6. August 2005 ELP Learning Community 6 What we are learning about things that work - You have to change how people think It has to be everyone - top to bottom and side to side New ways of thinking have to become habits Organizational culture has to reflect the values and support the skills All of the efforts have to be integrated Changing structures and policies has to arise from and reflect the learning

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9. August 2005 ELP Learning Community 9 Introduce and apply person centered thinking skills Formal training for � All managers � senior, middle, front line Selected direct support staff Key players, the �opinion molders� among the self-advocates, family members, board members, funders, inspectors, service coordinators, etc.

10. August 2005 ELP Learning Community 10 Help the skills become habits  Support the pervasive and routine use of the skills In day to day work In problem solving Use the skills to develop �living descriptions� of how people want to live through partnerships with � Those who use the services Family members Those closest to the person Make and celebrate level 1 changes Create optimistic discontent

11. August 2005 ELP Learning Community 11 Build Person Centered Teams

12. August 2005 ELP Learning Community 12 Increase organizational efficiency: Positive and Productive Meetings

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14. August 2005 ELP Learning Community 14 Active, integrated use of �quality improvement� techniques Measure progress Aggressive efforts to reinforce person centered practices and improve organizational efficiency � Review of processes and structures Ruthless review of all paper requirements Integrate learning � Change policies, structures, practices

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16. August 2005 ELP Learning Community 16 Go over the next slides quickly if people have already seen them just remind them of the concepts. If the slides are new to the audience spend the time needed for people to get the concepts. But keep in mind that they will be practicing using the concepts for most of this training. Emphasize that this is about humans not about disability - As it is easier to see in others ask people to think about their own relationships � do they have a good friend, a partner who in some area of their life says one things but does another. E.G. Words about wanting to lose weigh and behavior that results in weight gain. For people who use disability services - We often need to look at behavior because we have done a really good job of training people to tell us what we want to hear Note that when people have given up hope, where there is no real trust, people will tell us what is really important to them as trust is created and hope is restored. Ask � If you were working with someone who needed insulin injections but hated them and the finger sticks that go with them � would diabetes management be important to or important for? Go over the next slides quickly if people have already seen them just remind them of the concepts. If the slides are new to the audience spend the time needed for people to get the concepts. But keep in mind that they will be practicing using the concepts for most of this training. Emphasize that this is about humans not about disability - As it is easier to see in others ask people to think about their own relationships � do they have a good friend, a partner who in some area of their life says one things but does another. E.G. Words about wanting to lose weigh and behavior that results in weight gain. For people who use disability services - We often need to look at behavior because we have done a really good job of training people to tell us what we want to hear Note that when people have given up hope, where there is no real trust, people will tell us what is really important to them as trust is created and hope is restored. Ask � If you were working with someone who needed insulin injections but hated them and the finger sticks that go with them � would diabetes management be important to or important for?

17. August 2005 ELP Learning Community 17 Read the slide � then ask You are working with someone who dresses appropriately for the weather, but you show-up to take them to church and they are wearing a tank top, shorts and flip-flops. Do you say something or just take them to church? Given an example from your life � e.g.Michael doesn�t decide when he gets haircuts-his wife doesRead the slide � then ask You are working with someone who dresses appropriately for the weather, but you show-up to take them to church and they are wearing a tank top, shorts and flip-flops. Do you say something or just take them to church? Given an example from your life � e.g.Michael doesn�t decide when he gets haircuts-his wife does

18. August 2005 ELP Learning Community 18 Tell the participants that when they came up with the Teddy plate answer they gave an answer which provides a balance between important to and important for. To better see how this works they are going to do the important to and important for sort for Julie. Point out that the page where you are asking them to do the sort has an extra question � �what else do we need to know�. This question should always be there because we never know everything and recognizing what we don�t know is often critical in our efforts. Have copies of this slide for everyone. Break them up into groups and have them fill it out based on what they saw. Either put Julies �wms� slide back up or give out copies. After people are done show them the Julie answer slide. Give everyone a copy. (Be sure that you have your handouts organized so that people don�t get the �answers� before they do the work.) If someone comes up with a great answer that isn�t on the sheet acknowledge it and move on. On a number of the answer slides there could be more written but there isn�t room on the slide.Tell the participants that when they came up with the Teddy plate answer they gave an answer which provides a balance between important to and important for. To better see how this works they are going to do the important to and important for sort for Julie. Point out that the page where you are asking them to do the sort has an extra question � �what else do we need to know�. This question should always be there because we never know everything and recognizing what we don�t know is often critical in our efforts. Have copies of this slide for everyone. Break them up into groups and have them fill it out based on what they saw. Either put Julies �wms� slide back up or give out copies. After people are done show them the Julie answer slide. Give everyone a copy. (Be sure that you have your handouts organized so that people don�t get the �answers� before they do the work.) If someone comes up with a great answer that isn�t on the sheet acknowledge it and move on. On a number of the answer slides there could be more written but there isn�t room on the slide.

19. August 2005 ELP Learning Community 19 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

20. August 2005 ELP Learning Community 20 Libby is an articulate self-advocate who lives in California her own apartment. She is fiercely independent and helps to plan a 1,200 person conference every year. She also is someone who has a form of cerebral palsy known as �rag doll syndrome� and most of what happens has to be done for her. Tell people that she has a very clear idea about how all of these things should be done and expects them to be done that way. Illustrate with a story for each area. The following give some ideas - Core - She uses a g-tube because anything going into her mouth is likely to end-up in her lungs. If there is skin break down where the g-tube goes through the skin the person responsible would be fired. Judgement & creativity � her support person thought she might be able to dust. Put a cloth on her hand and her hand on the counter. She drove the wheelchair and dusted. Tried vacuuming-she can really maneuver the wheelchair. Hooked-up the vacuum cleaner to the wheelchair, but the power cord on the vacuum got caught-up in the wheelchair-didn�t work. But we tried. Not our paid responsibility -Doesn�t want advice/meddling in her love life; if you are paid you shouldn�t be involve yourself in it. But if she were to take up with the local crack dealer it would move back in to judgement & creativity Note that there is much more detail than fits on the graphic version of the donut (for example Libby needs to have 1500 cc�s of fluid a day and it is your core responsibility as she does not feel thirsty). When you write this up it works better to do it in columns. Libby is an articulate self-advocate who lives in California her own apartment. She is fiercely independent and helps to plan a 1,200 person conference every year. She also is someone who has a form of cerebral palsy known as �rag doll syndrome� and most of what happens has to be done for her. Tell people that she has a very clear idea about how all of these things should be done and expects them to be done that way. Illustrate with a story for each area. The following give some ideas - Core - She uses a g-tube because anything going into her mouth is likely to end-up in her lungs. If there is skin break down where the g-tube goes through the skin the person responsible would be fired. Judgement & creativity � her support person thought she might be able to dust. Put a cloth on her hand and her hand on the counter. She drove the wheelchair and dusted. Tried vacuuming-she can really maneuver the wheelchair. Hooked-up the vacuum cleaner to the wheelchair, but the power cord on the vacuum got caught-up in the wheelchair-didn�t work. But we tried. Not our paid responsibility -Doesn�t want advice/meddling in her love life; if you are paid you shouldn�t be involve yourself in it. But if she were to take up with the local crack dealer it would move back in to judgement & creativity Note that there is much more detail than fits on the graphic version of the donut (for example Libby needs to have 1500 cc�s of fluid a day and it is your core responsibility as she does not feel thirsty). When you write this up it works better to do it in columns.

21. August 2005 ELP Learning Community 21 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

22. August 2005 ELP Learning Community 22 Person centered thinking skills - 3

23. August 2005 ELP Learning Community 23 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

24. August 2005 ELP Learning Community 24 Give people a brief training in building a communication chart. Go over what is meant by each of the headings. Tell people that is easier to fill out if they complete one of the 2 middle columns 1st Walk through an example from the audience -- it need not be a person wit h a disability, it can be about a partner, or a teenager, or whatever works for you.Give people a brief training in building a communication chart. Go over what is meant by each of the headings. Tell people that is easier to fill out if they complete one of the 2 middle columns 1st Walk through an example from the audience -- it need not be a person wit h a disability, it can be about a partner, or a teenager, or whatever works for you.

25. August 2005 ELP Learning Community 25 Communication chart For the person - Use of the communication chart in day to day support insures that - There is an increase in the presence of what is important to the person People using services feel listened to There is a decrease in frustration and the behaviors that go with it For the organization - Recognizes learning done by those who support Reinforces learning culture Provides new/relief staff with a quick way to get off to a good start Decrease in challenging behaviors and therefore a decrease in incidents Increases/reinforces observational skills

26. August 2005 ELP Learning Community 26 See Julie�s story See Julie�s story

27. August 2005 ELP Learning Community 27 At this point in the training you have a choice. If time permits you can tell Kathleen�s story (available separately) and then have people fill out the analysis. Point out to them that it says our �guesses� about Kathleen�s, her mother�s and staff�s perspective � that you expect them to guess based on what they heard/read. Where they don�t know, where important information is not in the story have them write those items on the �things to figure out/what else we need to learn� sheet. If you have the time you can then have them complete an action plan for Kathleen.At this point in the training you have a choice. If time permits you can tell Kathleen�s story (available separately) and then have people fill out the analysis. Point out to them that it says our �guesses� about Kathleen�s, her mother�s and staff�s perspective � that you expect them to guess based on what they heard/read. Where they don�t know, where important information is not in the story have them write those items on the �things to figure out/what else we need to learn� sheet. If you have the time you can then have them complete an action plan for Kathleen.

28. August 2005 ELP Learning Community 28 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

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31. August 2005 ELP Learning Community 31 Mindful learning:learning log For the person - Because people are recording what is working and not working in support � More of what is working and Less of what is not working will occur For the organization - Those doing the work feel listened to Learning done by those doing the work is recorded Provides a vehicle for learning to be synthesized and recorded Helps with problem solving/hypothesis testing Creates good paper Reinforces a learning culture and teaches critical thinking

32. August 2005 ELP Learning Community 32 # 5 Mindful learning � 4 + 1 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 What should we try/do based on what we have learned?

33. August 2005 ELP Learning Community 33 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

34. August 2005 ELP Learning Community 34 Use the tools to create �living descriptions� of how people want to live and what we need to do to support them

35. August 2005 ELP Learning Community 35 Learning logs replace progress notes (or whatever your audience calls them). Progress notes tend to be one of 2 kinds � The minimalist type that could be done with a rubber stamp � e.g. �went for coffee, he enjoyed himself�; �slept through the night� The novelist � As I took Charlie out the door, the wind stirred the leaves� Neither does a good job of recording learning � one is too short with too little content, the other is too long with any learning being buried in the narrative. Point out a couple of the ways that Charlie�s works, 2 or 3 examples are enough The learning log records the learning as it happens and meets the requirements for documentation. We have learned that those who fill it out have to be trained and that someone has to take the learning from the learning log and get it into the plan . Where this is happening those who are doing the day to day work feel listened to and see their learning making a difference Make sure to tell people what it is a powerful tool but doesn�t work for everyone in every situation. E.G. The 87th time you have taken Charlie for that walk you will not be learning new things very often � that would take �new� eyes Learning logs replace progress notes (or whatever your audience calls them). Progress notes tend to be one of 2 kinds � The minimalist type that could be done with a rubber stamp � e.g. �went for coffee, he enjoyed himself�; �slept through the night� The novelist � As I took Charlie out the door, the wind stirred the leaves� Neither does a good job of recording learning � one is too short with too little content, the other is too long with any learning being buried in the narrative. Point out a couple of the ways that Charlie�s works, 2 or 3 examples are enough The learning log records the learning as it happens and meets the requirements for documentation. We have learned that those who fill it out have to be trained and that someone has to take the learning from the learning log and get it into the plan . Where this is happening those who are doing the day to day work feel listened to and see their learning making a difference Make sure to tell people what it is a powerful tool but doesn�t work for everyone in every situation. E.G. The 87th time you have taken Charlie for that walk you will not be learning new things very often � that would take �new� eyes

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37. August 2005 ELP Learning Community 37 Person centered thinking coaches are: Champions � advocate for the use and utility of person centered thinking skills Actively reinforce the use of the skills Informal teachers � Demonstrate the skills Give those who are using the skills feedback in how they are doing

38. August 2005 ELP Learning Community 38 Difference between a coach and a trainer Trainers teach skills in formal settings using a fixed curriculum Coaches � Teach informally, using teaching �moments� Demonstrate skills thru modeling Give people �immediate� feedback as they are using the skills and help them improve

39. August 2005 ELP Learning Community 39 Effective Coaches� Recognize teaching moments Understand how people learn Know the goal is to help others learn to do for themselves, not make the coach look smart Talk the talk and walk the walk

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42. August 2005 ELP Learning Community 42 Blame culture You have blame culture when - Real responsibility is avoided �Thinking outside the box� results in psychic decapitation Advice from others focuses on risks more than rewards and the importance of �CYA� activities A strong blame culture kills creativity, distorts learning, and eventually drives out many of those you want to retain.

43. August 2005 ELP Learning Community 43 In an accountability culture you know what the boundaries are before you meet them In a blame culture you discover the boundaries by crossing them Accountability versus BlameCulture

44. August 2005 ELP Learning Community 44 Passive (only professionals learn) Culture

45. August 2005 ELP Learning Community 45 Partnership Partnership is built on a foundation of � Respect and Trust Partnership requires that everyone is clear about their roles, responsibilities � while being flexible Partnership is about sharing power and about following the rules of trust

46. August 2005 ELP Learning Community 46 Creating the ground rules for partnership How do you know if � Respect is present in the workplace Trust is present in the workplace Partnership is present in the workplace Vote for the top 5 and then, with discussion, pick no more than 10

47. August 2005 ELP Learning Community 47 Learning culture A learning culture requires � That everyone is heard & feels their voice matters Learning is continuous � not just during review or planning meetings What is learned is recorded as it is learned People are supported in acquiring the skills they need � and opportunities to enhance skills are routine

48. August 2005 ELP Learning Community 48 In a learning culture there is�Good paper� Our memory, a place to record what we have learned What helps new people to meet the person It serves to focus our efforts, our learning Helps with problem solving Is useful in day to day support

49. August 2005 ELP Learning Community 49 Accountability Everyone knows what the expectations are for their job � what the boundaries are They can be creative without fear Those who do not meet the expectations, who cross established boundaries, are held accountable

50. August 2005 ELP Learning Community 50 Discontent is the engine of change Good plans create a kind of mirror � they reflect how people want to live Discontent comes from comparing what is with what could be There are 2 kinds of discontent � Optimistic, and Cynical Change only occurs where there is discontent � happy people don�t change. But discontent comes in 2 �flavors� and only optimistic discontent creates positive pressure for change.Change only occurs where there is discontent � happy people don�t change. But discontent comes in 2 �flavors� and only optimistic discontent creates positive pressure for change.

51. August 2005 ELP Learning Community 51 Optimistic discontent requires trust based on � A history of acting on those things that can be changed immediately Honesty about those things that take time Signs of progress in acting on the things that take time Where change is new trust must be created

52. August 2005 ELP Learning Community 52 Cynical discontent One of the things that good plans do is hold a mirror up to the system and create discontent with what is. Without hope for change this level of discomfort becomes intolerable. Without hope for change you get denial, distortion, or departure People say this is no different from what we have always been doing Plans are distorted to suggest that what people want is what is already offered The people who have the most passion for change leave (depart) when they see no hope for change

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54. August 2005 ELP Learning Community 54 2 levels of change Level 1 change � those changes that can be made without becoming a change target � without changing core structures, responsibilities, etc. E.G. � helping people with their morning rituals, honoring what is important that doesn�t require that people move or major changes in staff responsibilities

55. August 2005 ELP Learning Community 55 2 levels of change Level 2 changes � Changes that make you a change target New responsibilities, practices, structures