1. Person-Centered Practices and Planning
Welcome to this day of training covering the nuts and bolts of transition coordination under the Money Follows the Person initiative and the principles and suggested practices for successful person-centered supports and services.
This is certainly an exciting time in Virginia. Money Follows the Person funding has literally opened the doors of Virginia’s institutions and provided opportunities for individuals to live in communities of their choice. You are part of the group of people in Virginia who are going to help to make that happen. As the parent of a young adult with intellectual disabilities, I thank you for your dedication, hard work and commitment to people with disabilities in our state.
Along with Money Follows the Person, Virginia has been awarded other funding in the form of grants to help us transform our system of long term care for the benefit of the individuals who use publicly funded supports and services. One such grant is the Systems Transformation Grant (STG) which has Virginia refocused on person-centered practices, self directed supports and services and eventually self directed individual budgets. These changes to how services are delivered are designed to change the way individuals with disabilities experience life in their communities.

2. The Department of Medical Assistance Services (DMAS)
Presented by
The Department of Medical Assistance Services (DMAS)
the Office of Intellectual Disabilities
(formerly OMR) and
the Partnership for People with Disabilities
With funding through the Systems Transformation Grant (STG) from the federal Centers for Medicare and Medicaid Services (CMS)
Today there will be three presentations brought to you by
the Department of Medical Assistance Services, perhaps better known to you as DMAS, the state Medicaid agency.
the Department of Intellectual Disabilities, perhaps better known to you formerly as OMR, the Office of Mental Retardation Services, a part of DMHMRSAS
The Partnership for People with Disabilities at Virginia Commonwealth University, Virginia’s university center for excellence in developmental disabilities under the federal Developmental Disabilities Act.
This is the first of a series of trainings that will be offered on person-centered practices under funding provided by the Centers for Medicare and Medicaid Services, the federal Medicaid agency.

3. Today’s Agenda A.M. An overview of person-centered principles
and a description of person-centered thinking skills
Break
Virginia’s Individual Support Plan and Process
P.M.
Lunch (12:00 – 1:15)
The nuts and bolts of transition coordination under MFP
This is a quick summary of today’s agenda.
We have an overview of person-centered principles and skills this morning for about 90 minutes.
We’ll take a short break and then DMAS will present on the nuts and bolts of transition coordination for MFP.
At around 12:15 we will stop for lunch. Lunch is on you own and we ask that you be back from lunch at 1:30. At that time DMAS will finish up its presentation on the nuts and bolts of transition coordination for MFP.
Following DMAS will be the Office of Intellectual Disabilities presentation on the Individual Support Plan that has been developed to reflect a more person-centered approach to planning for and supporting individuals with disabilities.
It is a full day so you should also know that the rest rooms are …..
While we will only have one formal break please feel free to use the facilities at any time.
As for questions….

4. Welcome and Introductions
Do we have time for an introductory round?

5. Virginia’s Principles of Person-Centered Practices
Is there anyone here today who is not familiar with the term “person-centered practices”? Perhaps you are more familiar with the terminology “person-centered planning”, something that has been around for at least 20 years.
Many of you may be thinking…here we go again. What are we doing here? I am already person-centered. In fact person-centered planning is one of those terms that has been so used and maybe a little misused over the years that it is water downed and has a different meaning depending upon to whom you are speaking.
For different populations of people with disabilities, person-centeredness plays out differently. For some people with physical disabilities or for individuals who are aging and who are used to directing their own lives as well as their own supports and services, the idea of being person-centered may seem redundant. They have achieved that type of relationship already with the people who support them, be they family, friends or employees. For other populations of people with disabilities their experience may be more system directed.
When the systems transformation grant was written, approaching service planning and delivery through the use of more person-centered practices was considered important enough that it became the core of the grant’s goals and objectives. But even prior to the funding of the STG, OID (the OMR) had organized stakeholders from all around Virginia to begin to address this issue, based on the findings of the Office of the Inspector General, the interest of the Advisory Committee on Intellectual Disabilities (TACID) and the strategic direction of the DMRMRSAS.
Virginia Person-Centered Planning Leadership Team
Virginia Systems Transformation Grant Resource Team

6. Principles of Person-Centered Practices
We see a Virginia where individuals of all ages and abilities have the supports we need to enjoy the rights of life, liberty, and the pursuit of happiness and the opportunity to have a good life.
Is there anyone that you would want to exclude from enjoying any of these attributes of a good life?

7. Principles of Person-Centered Practices (continued)
Having a good life means different things to different people. It includes joy and happiness, health and safety, hopes and dreams, meaningful activities, intimate relationships with family and friends, having a home, transportation, work, money (bank accounts), and the ability to contribute to family and community.
Is there anyone that you would want to exclude from enjoying any of these attributes of a good life?

8. Principles of Person-Centered Practices (continued)
We believe that a good life is best led by the voice of the individual and by following these person-centered principles.
And here is the crux of person-centeredness … if we are talking about me, it is my voice that provides the direction in defining what a good life means for me and what is important to me.
That is not to say that there are not those who know me well and love me who can contribute their ideas, even their assistance to me in my pursuit of a good life but in the end it is my voice that has the final say.

9. “I am listened to.” “I have a voice.” “I listen to others.”
Listening
Individual choices and descriptions of a good life are
respected and followed. 1
Principle
I would like to begin with the first principle of Virginia’s PCP Principles, which is Through this presentation, we hope that you gain an understanding of the importance of shifting our focus from the needs of our system to the lives of the people we support. This shift in focus is at the very heart of our principles.
Picture of solitary vision.
Individual preferences and dreams are honored. Everyone has wishes for the present and visions of a desirable future. Person-centered practices help us to find our dreams, share our dreams and support our dreams.
My personal choices and vision can be discovered by getting to know me, listening carefully, asking the right questions and hearing what I really say.
People who know and care about me are involved in discovering my preferences and visions.
Cultural preferences and customs are respected and supported in helping me realize a good life with others.
My vision is respected, shared by others and supported by people with responsibilities in my plan.
My plan supports what’s important to me and reflects my personal preferences, idiosyncrasies and values.
My plan focuses on a whole life, complete with meaningful, valuable, interesting experiences that lead me increasingly closer to my dreams.

10. “I have friends and family that I see often
“I have friends and family that I see often.” “I am part of my community.” “I have found groups, organizations and social activities that interest me.”
Community
Relationships with families, friends, and people in
the community are very important and at
the center of planning. 2
Principle
Partnerships with families, friends and communities are forged. Person-centered practices value and embrace the natural supports from families, friends and communities.
My plan focuses on relationships and building connections in my community.
I am supported in staying connected to family and friends, have personal advocates and opportunities for new friends and participating in new circles.
I receive supports to meet others with confidence and dignity.
I choose how, when and with whom to spend time and share my interests, gifts and talents.

11. “I have choices.” “I am responsible for my choices.” “I am respected.”
Self-direction
Personal choice and control are supported. 3
Principle
Personal choice and control are supported. Person-centered practices give individuals (even those who cannot speak for themselves) the support they need to have control of their lives and resources.
My rights and responsibilities are affirmed and protected.
I have authority over my future, my services, my resources and the assistance I need with personal responsibilities.
I am informed, empowered and a voice of a Virginia citizen.

12. 4 Principle Talents and Gifts
“I am able to contribute to family and community. “I learn new things.” “People are nice to me.” “I respect others.” “I am nice to others.”
Talents and Gifts
The experience, talents, and contributions of
individuals, families, and communities are
strengthened and supported. 4
Principle
Competence, capacity and contributions of individuals, families and communities are enhanced. Person-centered practices assure that information, education and learning opportunities are available and accessible to individuals, families and communities. Individuals have valued roles and supported in contributing to home and community. Innovation and creativity
in supporting individuals in real lives are rewarded, and new choices and ways of supporting individuals become increasingly available.
There are materials and information that I can understand and professionals providing effective and meaningful learning experiences.
The people who support my growth and empowerment, grow and become empowered along with me.

13. “I am responsible for my choices.” “I receive quality support.”
Responsibility
There is shared responsibility for supports and choices. 5
Principle
Accountability and balance are expected. Person-centered practices emphasize personal responsibility and accountability across all stakeholders. Plans are implemented as promised. Support is available when, how and as needed by individuals and families. Concerns and measures for health and safety are balanced by the value and opportunities for growth and change that are afforded by risk.
There is commitment to action from all stakeholders.
I and the people who support me consider ways to balance what’s important to me with what others think is important for my health and safety.
I have choices beyond traditional, system-centered services and my plan is not compromised “for convenience of staff.”

14. Systems Transformation: looking through a different lens
Transforming a system is I think a lot like herding cats. For those of you who have been in the field for any length of time you have seen efforts at systems transformation come and go. The truth is systems are rarely dramatically changed except maybe when governments are overthrown (remember the American Revolution…that was a significant systems change and not just to the English). More likely change occurs in the form of evolution as we gradually change the way we do business so that our actions will line up with the new ways we see things. We begin to look at the same people and the same activities but we seem them through a new lens. How does the new lens of person centeredness change the way we look at the systems that supports people with disabilities?

15. System Centered vs. Person Centered
Focuses on deficits and labels
Focuses on capacities, gifts, strengths, & dreams
Plans usually include ‘placement’ in a program
Plans support a rich and active community life based on the individual’s gifts & interests.
Inflexible, offering a limited number of program options
Flexible, finding new possibilities unique to each person
Eileen

16. System Centered vs. Person Centered
Puts the professional in control
Supports individuals in making decisions
Distances people by emphasizing differences
Brings people together by discovering common experience
Budgets are structured to maintain invest-ments in programs, building and property
Budgets structured to provide individualized packages to support people
Eileen

17. Person-Centered Practices
Description of Person-Centered Thinking Skills
Seven Questions
A tool for helping people find
a new place to live
Through their work over the last 30 plus years, Michael Smull and his associates in the Learning Community, have learned that having good paper is not enough to help people get the life they want. People in the field, including Michael, spent a lot of time teaching people to write good plans. What he and his colleagues found was that better plans did not mean better lives. So Michael and others have put together a collection of skills that help people help others have better lives.
In Virginia, we have done training on these skills and their use in a 2 day workshop. Presently, we have 4 in-state trainers who can deliver PCT training but there are12 more who are in the process.
Today, I will briefly describe the skills.
As well, I will share 7 questions that anyone supporting an individual should be able to answer about that individual.
And then I will give you a tool for helping people find a new place to live. You are probably already using many of these skills with the people you support. These just give structure and a way to self-evaluate the process you are using.

18. Important to/ Important for and finding the balance between them
Sorting what is important to a person from what is important for a person is a fundamental skill. This is done by listening first to what the person is telling us with words or behavior and then also listening to those who know and love him/her.

19. Important to What makes a person happy, content, fulfilled
People, pets
daily routines and rituals,
products and things,
Interests and hobbies,
places one likes to go
Important to is what makes a person happy, content, fulfilled. This may include people, pets, daily routines and rituals, products and things, interests, hobbies, places one likes to go. Think about your own lives. (Give your own example and then elicit responses)
What is important to you?

20. Important for What we need to stay healthy, safe and well
health and safety
things that others feel will contribute to being accepted or valued in the
community
Important for is what we need to do to stay healthy and safe. Services are usually very good at describing and delivering what is important for a person, for example what medication is needed, how a person must be positioned, how to make sure they are clean. (Give your own example and then elicit responses)
What is important for you in your lives?
If someone has diabetes and needs insulin injections but hates the thought of needles, is getting the insulin imp to them or imp for them?
Another aspect of important for are things that others feel will contribute to being accepted or valued in the community. We all learn what is socially acceptable and what isn’t. Some of us learn through modeling, through social cues, trial and error. When we haven’t learned these things, we depend on others to teach or tell us what is acceptable. Maybe some of you can relate to having a teen come down stairs to go out and you ask—where are you going dressed like that? Another example might be physical boundaries. I had to intentionally teach my daughter about boundaries.

21. Finding the balance between important to and important for AND
Asking: What else
do we need to
know or learn?
Once you know what is imp to and imp for a person, finding a good balance between the two is the challenge. A balance is what we all strive for. This is a human issue, not just a disability issue. None of us pay perfect attention to everything that is important for us. We all seek to address what is important for us in the context of what is important to us. (EX me and tennis)
Let’s say someone’s favorite food in the whole wide world is cheese and they find out they have high cholesterol. If cheese is eliminated from the diet, a person will not feel very happy. But if the cholesterol is ignored, they may not be around to care how they feel. How do we support balance? Suggestions?
The third simple question we need to ask is, What else do we need to know or learn?
Helping a person learn, or acquire new skills needs to be taken in context. Rather than simply helping a person acquire the next skill in a hierarchy, we should be looking to see what they might learn that will help them get more of what is important to them.
We are never finished learning about a person and how to best support them.

22. Determining Staff Responsibilities
Core: responsibilities that have to be done in a certain way or there will be grave consequences
Creativity and judgment: how to help someone satisfy what is important to him or her
Not our paid responsibility
If people are to get what is important to and what is important for them, staff need to know what the expectations are for their roles and responsibilities. They need to know where they are expected to use creativity and where they are not. They need to know where their job stops or what is not their paid responsibility. The donut is a way to tell staff what these expectations are.
It helps invite creativity without fear—but within boundaries.
This skill takes training and a lot of practice.
Examples if needed-each individual and circumstance is different but,
Core—taking care of a g-tube site-has to be done in a certain way or there will be grave consequences—no creativity here
Creativity & Judgment-how to help someone fulfill a dream of being a vet when they have an intellectual disability, how to help someone study for a driver’s test
Not our paid responsibility—whether someone has a beer if they are of age, who a person choose for a friend

23. Matching Staff For each person, what are the:
Supports wanted & needed
Skills needed
Personality character-istics (present/ absent)
Shared interests
(nice to have)
How many here have supported people who were fun to work with-where the time went quickly? How many of you have supported someone who rubbed your fur the wrong way?
This difference has to do with not good or bad staff members or people, it has to do with bad match.
This skill stresses the importance of matching staff with the preferences of those who use services and gives an organized way to describe the staffing needs of each person.

24. Communication Chart Learning, using, & recording communication
What is happening
_______ does
We think it means
We should
This skill provides a structured way of learning and recording how people communicate. Where people do not use words to talk, or where they communicate more clearly with their behavior, it is critical to record their communication and what it means.
How many of you live with another adult? When what they are saying does not match their behavior, which do you pay attention to—the words or the behavior?
Most direct service providers have a wealth of knowledge about those they support and how they communicate. Often, this knowledge gets lost when the provider leaves the agency. This skill saves time and energy and keeps a person from having to “train” new staff members over and over.

25. What’s working/ What’s not working
Analyzes situations from various perspectives
The individual, family
member, staff member
The next 3 tools provide ways to look for and record learning soon after it has happened.
Plans that are done as annual events rarely get used. The learning that is obtained throughout the year needs to be recorded and used.
Sorting out what’s working and what’s not working is a powerful way to help people step back and look at a situation. It is done from various perspectives. It is a good way to begin the process of determining goals and helps with negotiation where there are disagreements. People feel listened to and common ground can be established.
This helps determine what needs to stay the same and be enhanced and what needs to change.

26. 4 + 1 Questions What have we learned? What are we pleased about?
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?
How many of you spend part of your working day in meetings? Do you spend time in long meetings with lots of talk but not enough action or the same things get discussed over and over with no clear action plan? What percent of meeting time is productive? Because time is the scarcest resource, this tool provides a productive way to manage time that is more efficient in working through issues and finding solutions.
This is a great way to get everyone’s input and ensures that there isn’t a ‘dominant’ voice in the meeting. It is a helpful process to use whenever a group of people gather to talk about the supports and services that a person is receiving.
Before a meeting starts, the first 4 questions can be posted on big post-its around the room. Everyone is given a marker and writes their answers before the meeting starts. Before the meeting even starts, you have the information you need to work on the 5th question.

27. Learning Log Helpful in situations where people are trying new things
Looking at working/not working in specific situations
Provides a way to grow plans and add to a living description
May replace progress notes
The Learning Log is a detailed way for staff to document what is working/not working in new or specific situations. If the same people are doing the same activity over and over again, the learning log will lose its effectiveness. The learning must be used for the tool to be effective.
In the UK, they have developed a learning log for the person using services in which they are taught to record their own learning.

28. If the person is to get the balance described
Seven Questions that you should be able to answer for each person you support
What is important to the person?
What is important for the person?
Is important for being addressed in the context of what is important to?
Is there a good balance between important to and important for?
What does the person want to learn; what else do we need to learn?
If the person is to get the balance described
and we are to learn:
What needs to stay the same (be maintained or enhanced?)
What needs to change?
c The Learning Community for Person Centered Practices
If we are successful in spreading the person centered thinking skills, then everyone who is part of a person’s life should be able to answer these questions about the person.
If anyone is interested in the 2-day training on these Person-Centered Thinking Skills, please contact me and I will notify you when we offer it.

29. Helping People Find a New Place to Live
Developed by
Peter Kinsella and adapted by
Michael Smull and Amanda George
The previous 7 questions will give you a good start when helping someone find a new place to live because they help provide a living description of a person.
There are many ways of helping people move. We have given you an example of one tool to use when someone is moving. You have a copy in your folder and I will just briefly describe it.
It was developed by Peter Kinsella and adapted by Michael Smull and Amanda George.

30. Helping People Find a New Place to Live cont’d
Moving is done in partnership with an individual and his/her family
It is important to know how, where and with whom a person wants to live
It is helpful if a living description is already available. This may be in someone’s person centered plan.
I know I am preaching to the choir, but,
When people move it needs to happen in partnership with the person and those closest to the person. We need to help people move rather than “place” them. Someone who is “placed” is the object of a process not a partner in it.
Secondly, if we are to help people move, we need to know about that person. Not only what type of personal assistance they may need or what they need to stay healthy and safe, but what their preferences are and where they want to live and with whom.

31. Helping People Find a New Place to Live cont’d
Structured brainstorming process
Takes into consideration what’s important to/important for
Moving should only happen if the person is moving to somewhere that more closely matches what s/he wants
Like most brainstorming processes, this one is done with a group of people including the person who is moving. It is important to include people who are supportive of the process and who have information or skills that will be helpful to reach your outcome. It might be helpful to invite someone who is really good at brainstorming. It can be done in a 2 hour meeting especially if information has been gathered before the meeting.
The tool takes you through a series of steps that will help find a home that supports a good balance between what’s imp to a person and what’s imp for a person.

32. On the Learning Community Website
For More Information
On the Partnership’s Website
On the Learning Community Website
Is there anyone here today who is not familiar with the term “person-centered practices”? Perhaps you are more familiar with the terminology “person-centered planning”, something that has been around for at least 20 years.
Many of you may be thinking…here we go again. What are we doing here? I am already person-centered. In fact person-centered planning is one of those terms that has been so used and maybe a little misused over the years that it is water downed and has a different meaning depending upon to whom you are speaking.
For different populations of people with disabilities, person-centeredness plays out differently. For some people with physical disabilities or for individuals who are aging and who are used to directing their own lives as well as their own supports and services, the idea of being person-centered may seem redundant. They have achieved that type of relationship already with the people who support them, be they family, friends or employees. For other populations of people with disabilities their experience may be more system directed.
When the systems transformation grant was written, approaching service planning and delivery through the use of more person-centered practices was considered important enough that it became the core of the grant’s goals and objectives. But even prior to the funding of the STG, OID (the OMR) had organized stakeholders from all around Virginia to begin to address this issue, based on the findings of the Office of the Inspector General, the interest of the Advisory Committee on Intellectual Disabilities (TACID) and the strategic direction of the DMRMRSAS.