Workshop Title From Apart to A Part Facilitating Community Engagement as a Self-Directed Outcome Joseph S. Grabowski, QDDP, BS

Who are you? What is your role? What makes YOUR life good? Introductions Who are you? What is your role? What makes YOUR life good?

Why this Presentation Matters We can embody the philosophy and values  We can empower the people we serve We can educate our support staff But how do we engage the community? This Photo by Unknown Author is licensed under CC BY-SA-NC

Learning Outcomes By the end of the session, participants will be able to:   identify societal barriers to inclusion, and how to recognize "institutional thinking"  connect core person-centered values and philosophies to existing societal norms  become liaisons between people and their communities through universal relationship building strategies

From Apart … Rick & Rene’s stories, part 1 – Institutional Living

Overview

Inclusion

This Photo by Unknown Author is licensed under CC BY-NC-ND Exclusion Illustration: First day at new job / school / community This Photo by Unknown Author is licensed under CC BY-NC-ND

From Exclusion to Inclusion

Full Inclusion

Inclusion and Diversity

Barriers to Inclusion

Traditional Barriers Money Transportation Support Communication Accessibility Fear of the unknown Ignorance

Societal/System Barriers Ignorance Unclear boundaries Confidentiality concerns Funding Staffing Liability “Institutional Thinking” This Photo by Unknown Author is licensed under CC BY-NC This Photo by Unknown Author is licensed under CC BY-SA-NC

Institutional Thinking What are some types of modern-day institutions?

“Institutional Qualities” SETTINGS THAT HAVE THE EFFECT OF ISOLATING INDIVIDUALS RECEIVING HCBS FROM THE BROADER COMMUNITY The final rule identifies settings that are presumed to have institutional qualities and do not meet the rule’s requirements for home and community-based settings. These settings include those in a publicly or privately-owned facility that provide inpatient treatment; on the grounds of, or immediately adjacent to, a public institution; or that have the effect of isolating individuals receiving Medicaid-funded HCBS from the broader community of individuals not receiving Medicaid-funded HCBS.

“Institutional Qualities” Settings that have the following two characteristics alone might, but will not necessarily, meet the criteria for having the effect of isolating individuals: The setting is designed specifically for people with disabilities, and often even for people with a certain type of disability. The individuals in the setting are primarily or exclusively people with disabilities and on-site staff provides many services to them. https://www.medicaid.gov/medicaid/hcbs/downloads/settings-that-isolate.pdf

“Institutional Qualities” Settings that isolate people receiving HCBS from the broader community may have any of the following characteristics: The setting is designed to provide people with disabilities multiple types of services and activities on-site, including housing, day services, medical, behavioral and therapeutic services, and/or social and recreational activities. People in the setting have limited, if any, interaction with the broader community. https://www.medicaid.gov/medicaid/hcbs/downloads/settings-that-isolate.pdf

Connecting Values

Core Values Person-centered Self-advocacy Self-determination​ Least restrictive environment​ Clients rights​ Balancing choice and safety​ Dignity of risk Supported Decision Making

Social Norms Unwritten rules of behavior Unspoken expectations Manners Law Conformity The culture

… to a Part … Rick & Rene, part 2

The Language of Behavior

Maslow’s Hierarchy of Needs Truman Show, part 2 – Escape from the Island This Photo by Unknown Author is licensed under CC BY

Belonging to a small-scale social group​ The Good Things of Life Family​ A place to call home​ Belonging to a small-scale social group​ Friends​ A belief system​ Meaningful work​ Safety and security ​

The Good Things of Life Opportunities to discover and develop one's abilities, skills, and talents. To be viewed as human and treated with respect.​ To be dealt with honestly.​ To be treated fairly.​ Being treated as an individual.​ Having a say in important decisions affecting one's own life.​ ​

The Good Things of Life Access to the community.​ Access to everyday activities.​ Being able to contribute and have one’s contributions recognized as valuable.​ Good health. Wolfensberger, Thomas & Caruso (1996) ​

This Photo by Unknown Author is licensed under CC BY-SA Locus of Control Truman Show, part 2 – Escape from the Island This Photo by Unknown Author is licensed under CC BY-SA

Self-Directed Outcomes Come from internal motives, hopes, dreams; the pursuit of “The Good Things of Life” Individual sees the value and benefits of moving in the direction of his/her dreams Choice - exercising self-determination based on personal preference

Let’s Talk!

Rights Responsibilities Respect Reciprocity Relationships The “R” Words Rights Responsibilities Respect Reciprocity Relationships Person-centered team discussion and consensus – proactive rather than reactive

The “R” Words RISK! * To individual / * To agency

Community Liaisons

Liaison (n) a "go-between"; "a person who helps organizations or groups to work together and provide information to each other" Depends on community's reception Depends on individual's interest and internal values Be prepared to fade back paid supports as natural supports are established and natural resources are utilized This Photo by Unknown Author is licensed under CC BY-SA-NC

Building Relationships What makes up a community? Physical proximity Shared interest Shared experiences Shared beliefs/values Common goals

Traditional Community Supports INDIVIDUAL PAID SUPPORTS

Invisible Community Supports INDIVIDUAL PAID SUPPORTS

Fading Paid Community Supports INDIVIDUAL PAID SUPPORTS Community Supports Paradigm Shift – see support role not as a program, but as a vehicle

Facilitating Community Engagement

"Key Components to Support System Transformation" 3. Connect with the Community in Resourceful Ways (https://www.medicaid.gov/medicaid/hcbs/downloads/training/community-inclusion.pdf) Providers are in a unique position to make community connections. States should encourage providers to: Build relationships with local businesses to create and reinforce inclusion on all fronts: social, recreational, employment Link a participant’s unique interests with potential community connections; use these connections to inform choice … assist providers to figure out methods for productive community outreach and to create avenues of communication with the community and its resources Break down discrimination and other barriers to inclusion through community education

"Key Components to Support System Transformation" 6. Train, Train, and Then Train Some More Build a common understanding of the values, principles and requirements underlying system change Assess competencies of stakeholders, providers, participants and design focused training strategies to include: The federal regulations Person-centered thinking, planning and practice Barriers and how to overcome them Community resource mapping to support community inclusion Accessing public transportation

Set the Example We want the people we support to be invited into the life of the community… We should lead the charge by inviting the community in as stakeholders and peers in the lives of ALL its citizens. This Photo by Unknown Author is licensed under CC BY-NC

Contact Information Joseph Grabowski (802) 224-6568 joeg@uvs-vt.org uvs-vt.org / Upper Valley Services