Willowbrook Expectations …for day services in the community and at program

1. Willowbrook Expectations…for day services in the community and at program Willowbrook Training Module June 2009

2. The world has changed from… • BIG campus settings • with TOO many people • service-centered • that isolate people from community life

3. People with developmental disabilities do not want… Same shoes, Same services for all

4. They want homes, not beds. They want to decide where to live and with whom.They want to do meaningful things during the day and contribute in the workplace.

5. OMRDD Mission: To help people with developmental disabilities lead richer lives. • Enjoy meaningful relationships with friends, family and others in their lives • Experience personal health and growth • Live in a home of their choice • Fully participate in their communities

6. Ensure Choice OMRDD assumes that all people with developmental disabilities have some capacity for self-advocacy, decision making and can express choice

7. Willowbrook Expectations for Day Services • Per the Willowbrook Permanent Injunction, class members are to receive meaningful, full day habilitative programming and services appropriate to their individual needs each day during week days.

8. Goals… • There should be valued outcomes and scheduled activities that are: • consistent with the person’s capacity; • meaningful and challenging; and • relate to his/her assessed needs. • The methods to achieve valued outcomes should be known to staff and implemented as designed. • The class member should be actively involved in accordance with the schedule. • Staff should interact with the class member in an active or passive (but appropriate) manner.

9. Meaningful activities are NOT …busy work activities designed to keep a person occupied

10. Long-term relevance… • Valued outcomes and scheduled activities should be relevant to the long-term view of the class member: • Look for appropriately high (but realistic) expectations for outcomes. • “Appropriate” means all sources of information are used to establish and articulate what long-term is for the person. • Low expectations may result in fewer opportunities offered to the person and less growth than possible.

11. Functional • The total program should be designed to develop functional skills that move the class member toward independence • Independence = skill development AND activities related to communication, socialization, autonomy, decision-making, etc. • Even if the class member is not likely to achieve total independence in a certain activity, i.e., taking their own medication, they need to learn to be as independent as possible by doing parts of the task, i.e., perhaps pouring their own water.

12. Program considerations • The valued outcomes and activities for the class member are age-appropriate and sufficient in number/scope to ensure that he/she receives a full program. • The amount of time scheduled for an activity is adequate for learning AND is implemented. • The setting and materials used are appropriate to the learning situation and person. • Group size should be as small as possible as appropriate to the activity. • Special programs/services are provided as necessary.

13. Think about… • Are individuals practicing skills (such as cooking, making purchases, table-setting, etc), or do they “learn” a skill never to use it again? • Are the habilitative activities designed to reach the chosen outcomes? • Are services and activities based upon preferences as well as needs? • Are habilitation activities individualized? • Are all individuals “learning” the same skills regardless of their interests, preferences and capabilities?

14. Think about… • Do staff members make decisions about activities based upon their own values rather than the choices of the individuals served? • Does the program have mechanisms to ascertain the individual’s preferences for activities? • How do individuals indicate their preferences? • Do staff understand and act upon those choices?

15. Think about… • Do individuals participate to the extent they are able in the routine tasks of the program, or are things done for them (e.g., lunch prepared and served by staff even when people have the ability to participate)? • Once individuals learn a skill, are people moving forward and learning additional skills in other areas of identified need?

16. Willowbrook Expectations for Community Inclusion • Individual strategies based on capabilities and needs are incorporated into the person’s plan of services • Frequency: as often as possible based on need • Group size: as small as possible as appropriate to the activity • Opportunities to individualize and personalize activities with community members • Documentation to confirm implementation

17. It is Community Inclusion When… • The individual uses facilities that are available to community members • The individual interacts with people who are not paid and who are not developmentally disabled

18. Community Inclusion is not • Taking people around to community places in large groups • Bringing community members into segregated programs in large groups

19. When people don’t use words… • “Listen” to their body language and their eyes • You can tell happiness or sadness with direct eye contact and facial expression • Watch people’s faces • Follow their gaze • See their smiles • Look for other nonverbal cues such as open arms and widened eyes

20. When people do not use words… • Watch their behavior • See what they enjoy most • Think about whether there is any common theme related to happy and sad behavior • See what they look forward to doing, or whether they do not respond positively to a particular activity

21. Important questions when thinking about inclusion • What are the person’s favorite places? • Who are the most important people in their lives? • What is unique about the person? • What are the things that make the person most happy? • What sensory opportunities does the person enjoy? • Are there special considerations when dining out, i.e. fast food vs. dining, table vs. booth, special diet, highlights from the menu?

22. Based on the things a person enjoys… • Identify stores and vendors where they can become valued customers or regulars • Locate places to go that build upon religious and ethnic heritage • Consider opportunities to meet new people and nurture relationships with family and friends

23. Keys to making inclusion more than an outing • Consider it important • Be innovative • Be functional • Go small • Be regular • Stay close to your neighborhood • Focus on membership

24. Look for opportunities for membership or volunteering • Clubs • Service organizations • Civic events • Sports, health and fitness groups • Community and personal support groups

25. Build purchasing power • Frequent local merchants. • Buy food and flowers from street vendors. • The decoration of people’s program rooms can be a focus for community experiences. • Ensure that people have pocket money for spending during the program/work day.

26. Enrich family relationships • Support expenses for letter writing and card exchange and activities with local families. • Bring a birthday cake or flowers over to the family for the person’s day. • Support a special lunch out for the person and invite family or a special friend to join.

27. Support people’s heritage • If a person responds when family speaks in Spanish, support purchases at stores with Spanish speaking vendors. • Shop at neighborhood bodegas. • If a person observes Kosher requirements, support lunch out at Kosher restaurants and become acquainted with the restaurant employees. • Support people in seeking stores and hair salons related to fashion and hair styles consistent with their heritage.

28. Take a person to purchase his or her own craft or hobby supplies. Be a regular in the store. Look for clubs that match people’s interests and preferences, and support related expenses. Look for classes at a local high school, college or continuing education program. Join a special interest group. Use “walk in” craft locations, i.e., community darkroom for photograhy, Color Me Mine for pottery. Contribute to local causes and associations where people meet others who share their interest or hobby, such as a drama club or volunteer fire department. Develop hobbies

29. Keep fit • Support individual memberships at local gyms or “Y” programs. • Consider the use of personal trainers or swim lessons/classes. • Support membership in health related support groups, i.e., Weight Watchers. • Ensure that people have pocket money to purchase a beverage after classes or training sessions.

30. Access reading materials • Frequent local book stores. • Whenever possible, support expenses related to library use, book club activities, literacy program participation. • Purchase magazines or book CDs that address special interests or hobbies. • To the extent that people can read or enjoy the pictures, they can subscribe to a local newspaper or magazine. • CDs in other languages offer important opportunities to support cultural/ethnic heritage.

31. Target the senses • Consider purchases that involve sensory experiences available in the community, the sights, sounds, smells and tastes of the neighborhood. • For those who like bright lights, consider going to the local disco and travel to see fireworks. • Purchase movie tickets that offer sights and sound, but select the show carefully to match the person’s interests and preferences, and their ability to sit for an extended period. • For people who enjoy music, attend concerts in the park and at local theaters, listen to new releases at record stores (remember the earphones), and to purchase CDs for enjoyment once home.

32. Target the senses (continued) • Arrange music lessons from a music student. • Bakeries smell great and allow people to be customers. • People who benefit from tactile stimulation can become regulars in spas and hair salons where they can enjoy a manicure, facial, and massage. • Even those who like their “own space” may enjoy the relaxation and soft touch of these experiences. Enjoy the smells of a perfume counter, and the feel of lotions and creams from bath and body stores when considering a purchase.

33. Participate or watch sports • Sports fans can become regulars at local sports groups – public schools, sports leagues, professional sports. Purchase seasons tickets for local teams. • Participate in special ski programs if available. Support individual memberships at local gyms or “y” facilities and consider use of personal trainer or swim lessons/classes. • Join a bowling league. • Consider therapeutic riding experiences. • Ensure that people have pocket money for spending during the sports event.

34. Make and relate to friends • Support the expenses for the person with developmental disabilities at public locations, such as a restaurant or entertainment venue, or arrange for a shared experience that builds on a mutual interest or preference. • Support lunches out with co-workers.

35. Dine out • Support dining out for one or two people to a restaurant with preferred fare or ethnic foods/specialties. • Support people to go to dinner with friends and family. • Support expenses for a local lounge, club, café, coffeehouse.

36. Think about… • Is there a community inclusion strategy present as part of the individual’s overall plan of services? • Is it established consistent with the interests, preferences and capabilities of the individual? • Is there person centered variety? Person-centered frequency? • Are community inclusion experiences being implemented and documented properly?

37. Think about… • How do individuals make use of the community as part of day program activities in accordance with individual plans of service? • Do they participate in shopping/errands, or are these activities done by staff only? • Do people make use of recreational opportunities in the community, such as parks, movies, YMCA, restaurants, etc.? How often?

38. Think about… • Do individuals go out in large groups only, or are opportunities provided for people to go out one-on-one or in small groups of two or three with people of their choosing? • If they do arrive together to an activity in a large group, are they encouraged/permitted to split up into smaller groups or individually upon arrival, if appropriate? • How are community activities chosen? Do people participate in any community volunteer-type activities -- local park clean-ups, for example?

39. Think about… • How often do individuals use community resources and do people use the community in normalized ways or only in large groups participating in some sport or special event? • Are individuals able to “opt out” of community activities? If the Class Member refuses community activities, are reasons for the refusal documented? • Has the team considered alternatives to accommodate choice of experiences?

40. Think about… • For day habilitation, do individuals receive services in accordance with needs identified in the ISP that assists with the acquisition, retention or improvement in skills that train and assist in developing appropriate social behaviors that are normative in the surrounding community, i.e., conducting oneself appropriately in restaurants, on public transportation vehicles, in recreational facilities, in stores and other public places? • For day treatment, is each particular community integration opportunity; i.e., the activity and its associated outcome, shall be time-limited as specified by the ITT, but no longer than one year and shall focus on the initiation/enhancement of a specific developmental skill/behavior appropriate for increasing the person’s independent functioning in the community?

41. What are your next steps?