1. Progressive Community Services
Lifecourse
CQL
MO Quality Outcomes

2. Where did we start? - What could/should we do with LC
* Thinking of the ALL in Buchanan County
* Organizationally
Looked at roles/ functions
* Support Coordinators
* Residential Supports
Low Hanging Fruit
* landed on Support Coordination and early adopters
Thinking of the “ALL” is ever evolving…..

3. 65% Missourians with DD (62,087) 18% 17%
96,122 estimated Missourians with Developmental Disabilities*
65%
(62,087)
18%
17%
Paid DD
Services
Targeted
Case
Management
Not Known to
DD State System
As Reported by MoDDD (May 2016)
Total State DD: 33,315
TCM Only: 16,210
TCM Plus Paid DD: 17,107
Of Paid DD, Residential: 7,012
Of Paid DD, State ICF/DD:
As a SB40 Board which needed to become conflict free it was a great time to focus on the ALL. So in the CFCM decision “the all” was how PCS decided to proceed. NOW…….what does a really good SB 40 Board look like, how do we reach the all, support the all?
*Based on 1.58% prevalence of 6.1 million citizens, US Census (2015)

5. Supports for ALL???? Universal Playground Family Navigator
Family Training
Housing
Before/after school
PARTNERSHIPS
City, County, University, Support Groups, YMCA etc
That’s right – for ALL. Typically when we talk about supporting ALL we think of Waiver Services but not everybody needs or wants those. Some people just need information, accessible play, jobs, housing, educational opportunities or peer support OR EVEN a place to play.

7. Universal Strategies for Supporting Good Lives for ALL
DD Services
Parent to Parent/Peer Support
Family, Self-Advocacy & Sibling Networks
Inclusive education with supports
Adaptive equipment & Accommodations
Universally designed and affordable homes
Grocery carts for older kids
EMT and Police knowledgeable and supportive
Strong families and friends to share lives with
Inclusive, accepting spiritual and recreational opportunities
P2P interacts both directions!!

8. Three Types of Supports
Goods &
Services
(Day to Day, Medical, Financial Supports)
Discovery & Navigation
(Info and Training)
Connecting & Networking
(Talking to someone that has been there)
--The 100% can have access to the 3 buckets - even if they never receive formal services
--YOU don’t have to know everything or provide it – but you can refer them to someone that does. MO like every other state has a family to family organization, and a parent to parent network.
Judy Chezik and MPACT story

9. Getting closer to the “all” in Buchanan County….. messaging
Strategic Plan
VISION: An inclusive community where all people have value
Website
Designed for families
Meetings
Vision for the meeting
Integrated Star
PFH requests

10. VISION……without one you have nothing to aim for

15. Getting closer to the “all” in Buchanan County….. new positions
Family Navigator
Immediate support for immediate needs – start planning
Closer to 100%
No waiver eligibility requirement
No Medicaid eligibility requirement
If/when they qualify for Support Coordination there is a good start on a plan so they hit the ground running with their Support Coordinator
Intake Specialist
Individualized support to complete the intake packet
Increase number that are completed
Decrease the amount of time it takes to determine eligibility
Refer to Family Navigator at the same time as intake for any crisis situations
Support Coordinator II
LC Mentor

16. Infusion…… Human Resources and beyond……
Interviewees
Vision of Position
includes what to avoid / what we don’t want
Job Description
identifies skills and knowledge in all 5 areas of integrated support
Interviews
One Page Profile
Performance Evaluations

21. This tool will help define the search for the person Progressive Community Services needs to help coordinate and guide the Intake Specialist for PCS. Ensuring that the Intake Specialist develops a culture that supports individuals and families think about how to work in partnership to support their vision for a good life.

26. Changing the trajectory
Taylor
John
And more…………….

30. John Kretzer receives Case Management Only
John Kretzer receives Case Management Only. I was having a hard time with figuring out how to support John. I was only having quarterly contact with him and each time we met he was always “doing good”, “didn’t need anything”. Figuring out a way to identify what his true needs were was challenging for me. So, I used the Life Course Tools. John is 26 years old. He recently got a job through connections that his mom has. He works at Uncle D’s doing janitorial work. He is super excited about this. He hops from home to home, living with girlfriends or friends, never having a true home of his own. His mom and his step dad are big supports for him. He also has a brother that he is really close to. John is a bachelor living a bachelor life. His friends are extremely important to him. The tools helped identify what is important to him and where I can support him to help him achieve his vision of a good life.

31. Shay, Support Coordinator Integrated Supports Star Worksheet
Brief description of the person being supported and the unique circumstances
Explain how you used the tools and the effects it’s made on the individual’s life.
Review star and trajectory for Candace from 6 months ago to present
Share that the tools were done in crisis and how it has since stabilized

32. Shay, Support Coordinator Vision Tool

33. Becky, Support Coordinator Vision Tool: Family
Becky (will just have the first slide for the vision)
Brief overview of the person being supported
Explain how you used the tools and the effects it’s made on the individual’s life.
Discuss the balance between the family and the individual
What ah ha moments were there between the family and the person?

34. Lisa, Support Coordinator Life Trajectory Worksheet
Highlight how the trajectory can be used with the support staff

35. HCBS and LifeCourse ISP template through the lens of LifeCourse
Ensuring the ISP is not just another piece of paper
Ensuring that Personal Assets and Strengths are part of the discussion and seen as a resource
Ensuring Technology is a part of life like it is for everyone else
Ensuring that relationships are noted, developed and valued
Ensuring that community based supports are explored and utilized
Ensuring ALL eligibility based supports are explored and utilized

36. Life Domains Daily Life and Employment Community Living
Safety and Security
Healthy Living
Social and Spirituality
Citizenship and Advocacy

37. You don’t ENTER the future………..you CREATE IT!
Life Stages
Prenatal /Infancy
Early Childhood
School Age
Transition
Adulthood
Aging
You don’t ENTER the future………..you CREATE IT!

42. Keeping the “all” in mind PCS….. budget
Keep the vision in front
Note investments that will get us closer to our vision
Keep our values in mind
Don’t lose our mission
- Integrated Supports

45. Focus on “The Good Life”……PFH
PFH requests are presented through LifeCourse tools
- ensure there is a vision and the requested supports lead to that Vision
- ensure integrated supports have been considered:
- technology
- community
- eligibility
- relationships
- personal assets

46. Integrated Supports STAR
resources, skills, abilities characteristics
i-pad/smart phone apps, remote monitoring, cognitive accessibility,
Adaptive
equipment
family, friends, neighbors, co-workers, church members, community members
MAPPING
PROBLEM SOLVING
PLANNING LTSS
PLANNING ACTIVITIES
We ALL do this without even thinking about it
school, businesses, church faith based, parks & rec, public transportation
SHS services, Special Ed, Medicaid, Voc Rehab, Food Stamps, Section 8 R
100%

51. LifeCourse, CQL and Mo Quality Outcomes
Tying it all together…….
PCS has been living in several parallel universes for years……….PCT and Leadership Institute, then coupled Community of Practice, CQL (pre-accreditation) and LifeCourse. And impending Federal changes…….through all of these the message was the same Good lives for all people we support. Where the “system” provided supports around individuals and families.

52. Shift in Thinking
- The 100% - In color and integrated support - Vision: Where are we going? - Vision: Where does the individual see themselves that defines a good life for them?

53. CQL vs. Traditional Systems
The focus is on program standards
Service action is based on professional criteria
The person is assigned to program
Expectations for performance are defined by program
PERSONAL OUTCOME MEASURES®:
The focus on the person
Service action is based on the person’s criteria
Services and supports are designed for the person
Expectations for performance are defined by the person

54. PCS CQL ACCREDITED 2015 Basic Assurances Personal Outcome Measures
21 indicators are used to understand the presence, importance and achievement of outcomes, involving choice, health, safety, social capital, relationships, rights, goals, dreams, employment and more. The insight gained during a Personal Outcome Measures® interview can then be used to inform a person-centered plan, and at an aggregate level, influence an organization’s strategic plan.
Basic Assurances
contain 10 factors and 46 indicators. These Basic Assurances® are a balance between concerns for individual Health, Safety and Security and the necessity of social constructs such as Respect, Natural Supports and Social Networks to ensure sustainable outcomes for people.

57. Type of Change that is Needed
Transitional Change
Transformation Change
“Retooling” the system and its practices to fit the new model
Mergers, consolidations, reorganizations, revising systematic payment structures,
Creating new services, processes, systems and products to replace the traditional one
Fundamental reordering of thinking, beliefs, culture, relationships, and behavior
Turns assumptions inside out and disrupts familiar rituals and structures
Rejects command and control relationships in favor of co-creative partnerships
Transitional change – can’t just keep changing names and adding things on – have to think very differently.
The LifeCourse Framework is the way we can achieve Transformational Change
Have/change conversations; problem solve; navigate; educate; plan
Tools to give confidence, to start conversations, actually USE the tools
Creating Blue Space, Hanns Meissner, 2013

59. CQL Basic Assurances 10 BASIC ASSURANCES® FACTORS
Rights Protection and Promotion
Dignity and Respect
Natural Support Networks
Protection from Abuse, Neglect, Mistreatment and Exploitation
Best Possible Health
Safe Environments
Staff Resources and Supports
Positive Services and Supports
Continuity and Personal Security
Basic Assurances® System
Indicators are on two dimensions, System and Practice, and both must be present for the overall indicator to be considered present.
SYSTEMS describe organizational policy and procedure and supported through staff training and other approaches. PRACTICE
What is happening in people’s lives as a result of these systems. Organizational practice demonstrates how an organization’s supports are put into action for each person.

60. Vision…….. Trajectory…………….. Important to have a vision
To keep that vision alive
Parents-to-be never have a vision of needing paid supports
Typically visions of healthy, happy children who discover what they love, their natural gifts and talents, do OK in school, etc., who grow up to find friends and maybe love, have a family, career or whatever fulfills them……
1992
- Our job is to keep that vision alive, not squash it
- Encourage and inspire
- If the vision has already been damaged – identify what isn’t wanted until a new vision is identified

61. Where did PCS start?
Leadership meetings with UMKC – Where can we take this? What do we want to do with it?
First we looked at:
Functions
Low Hanging Fruit
- Organizationally
- With Individuals

62. Look at us GO! Two Years Later – on our own………..
Original 6 Support Coordinators are now mentors
Meet monthly as a team
Much more buy-in – proof was in the stories and lives
Larger group of SCs meet every 6-8 weeks
There has been a Shift in Thinking – now Support Coordinators think in terms of the trajectory and the integrated star
Families are starting to OWN their own portfolios
“To get everyone working together is no small feat.”
- Charlie Rose

63. SCALING IT UP……. EMPLOYEES!
Job Descriptions
Star illustrates skills and knowledge helpful in the position
Trajectory shows the desired outcome for the position and what we do not want from the position
Interviews
One page profile
Interview Star
Performance Evaluations
- Trajectory
- Star

64. Scaling it UP! New Positions
Support Coordinator Mentor
Train and support SC’s on LifeCourse tools and their different uses
Intake Specialist
Encourage and support to complete DMH application process
Increase number of completed applications
Shorten the application / approval timeframe

65. Scaling it Up! Messaging
From hiring new employees to Board of Directors
Tools at meetings to address issues
Website
Strategic Plan

66. POM’s cont’d
PERSONAL Starts with the person’s own view of his or her life

67. Services and Supports are Evolving
Everyone exists within the context of family and community
Traditional
Disability Services
Integrated Services and Supports within context of person, family and community
The diagram on the right shows how supports should be delivered instead of how they have been traditionally in the two left circles because everyone lives in the context of a family (as they define it).