2016 NYSACRA Annual Conference Lake George New York Co-Creating Supports and Services Hanns Meissner, Ph.D.

Defining Co-Creation “You never change things by fighting the exiting reality… Build a new model that makes the existing model obsolete” Buckminster Fuller Co-production (aka co-creation) means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbors" (New Economics Foundation)

Origins of Co-Production Originally coined by Elinor Ostrom and colleagues at Indiana University. They recognized that services- in their case policing – rely as much upon unacknowledged knowledge, assets and efforts of service “users” as the expertise of professional providers.

Concept of Core Economy Core economy is made of the resources embedded in people’s everyday lives – time, energy, wisdom, experience, knowledge and skills – and the relationships between them – love, empathy, watchfulness, care, reciprocity, teaching, and learning. Like an operating system in a computer, core economy is the basic, yet essential, platform upon which specialized services (education, health care, mental health, IDD) function. Basically are underpinned by the family, the neighborhood, community and civil society.

Co-Creation –What it is? Radically reframes the potential role of “users’ and ‘professionals” in the process of producing services. Far from being passive consumers or needy drains on public finances, people, their family, friends and communities are understood as important agents with the capacity to design and deliver services with improved outcomes. Professionals need to find ways of engaging meaningfully with the core economy – help it to grow, flourish and realize its full potential – not atrophy as a result of neglect or exploitation. Co-creation is not about consultation or participation – except in the broadest sense. The point is not to consult more, or involve people more in decisions; it is to encourage them to use the human skills they have to help deliver supports – a sharing of responsibility. The assumption is that the individual and family have something to contribute to the support arrangement. Co-creation is highly individualized and based on the development of a long-term relationship between the provider and the individual and family

Challenges of Co-Creation Current mind-set (mental model) of traditional models of service provision. Assumption that professionals have “the answer” Current top down driven mechanics of funding and regulation misalign with co-creation of supports – they work against this process, not with it. Outcomes of co-creation are difficult to measure. Tendency towards replication and blueprinting (“bringing it to scale”) contradicts co-creation’s roots in local application. Co-Creation suits smaller organizations – movement towards bigger is better works in the opposite direction. Environment is one of mistrust and concern of fraud and abuse. Used as a method to withdraw services, make additional demands on people who rely on services or get ideas from people but not experience design or delivery roles.

Benefits of Co-Creation Highly individualized support solutions. Moves individuals and families out of dependency and low power arrangements Has increased potential to realize valued personal outcomes through deep commitment. Enables and promotes a citizenship role (although goes beyond this to partnership) Empowers DSPs. Meets the elusive promise of choice. It generates innovation. Maybe the key to build sustainable public services.

Five Modes of Creating a Support Plan Tell (Demand Compliance) Sell (Seek Buy-In)Test (Invite Response) Consult (Request Input) Co-Create (Collaborate) Does the plan or program already exist? Yes, final form Draft formNo Who decides on the final plan, program, or supports? Provider, state agencyManaged Care organization Managed Care organization and individual and family Individual, family and provider Individual and family with provider Communication MethodTop down transmission of information Top down and bottom up transmission of information Negotiation and Dialogue Deep dives and dialogue Level of Engagement & Commitment Low MediumHigh Care or Support ModelInstitutional CareManaged Care Integrated SupportsCommunity Supports

Bureaucratic ListeningAdministrative Listening Person-Centered ListeningCommunal Listening Transformation Starts With Listening Deeply to Families And Shifting Your Attention

Doug and Brian.stayed at home vs. ICF Placement.1 st of its kind support arrangement -modification of parent’s house.supported day activities out of the home – redirecting group habilitation funds to individualized supports.volunteer at a day care.connected to their neighbors

Providers as sole service planners Providers and individuals/family/ community as co- creators of the support plan Provider accessed for input when needed as a resource or for specific expertise Provider as service deliverers Traditional Providers Institution/Managed Care service provision Person-centered planning with service providers delivering services (typically habilitation services) Providers as holding specific resources/expertise Community Supports Providers and individuals, families, community as co-deliverers of supports Individuals and families involved in traditionally designed services Fully integrated supports with full co-created partnerships with individuals, families and providers Families and individuals implementing supports with little provider involvement Individuals/families/ communities as sole support deliverers Individuals/families/ communities as deliverers of professionally planned services Individual/family/ community implementation of co-planned or co- designed services Self-organized community provision of supports Responsibility for the delivery of services Responsibility for the design of the services Co-Creating Supports and Services Grid

Recognizing People as Assets Shifting mental models from passive recipients of services and burdens on the system to equal partnership with providers Building on People’s Existing Capabilities Shifting mental models (embedded perceptions) of individuals with disabilities from being deficit to being capable Mutuality and Reciprocity Engage individuals and providers in reciprocal and right relationships Personal and Peer Networks Connect and nurture networks among individuals and providers (e.g., communities of practice) Blurring Distinctions Blurring the distinction between all role holders by co-creating (designing and implementing) services and supports Facilitating rather than Delivering Providers assuming change catalyst and facilitator functions rather than central providers of service. Key Elements of Co-Created Services and Supports

What needs to develop in these areas to nurture and grow co-created supports?

Next Steps for Co-Creation Identifying appropriate measures – the culture of targets, standards and best practice tends to count against innovation Tackling the accounting problem – tying the benefits of innovation to co-creation is elusive – savings often accrue to other areas Facing the fear of reasonable risk Developing and testing practical models

Professional Mental Model Professional Role People with disabilities are deficient People with disabilities are clients People with disabilities are consumers People with disabilities have assets People with disabilities are partners People with disabilities are citizens People with disabilities are … How does our mental model of people with disabilities lead to actionable roles we assume?