Moving To Outcome Based Support Services

NOTE: The following is an excerpt from a personal communication with Andrea Erickson, Executive Director of Project Independence in Costa Mesa, California. In that letter, she outlined how her agency has successfully moved towards an outcome based support service.

BACKGROUND. Project Independence began in 1977 as a pilot independent living program providing time limited training in a supervised apartment setting. We quickly changed to a continuum model using different levels of training and support as well as separate funding rates. We also started a Supported Employment program in 1986. We had to perform a constant juggling act to provide services that actually helped people within the constraints of an outdated model. That challenge, rapid growth and a decade of experience helped us decide that we needed to view services in an entirely new way.

DEVELOPING OUTCOMES. In 1989, we implemented a quality assurance process that became the foundation for an outcome based evaluation system. Our primary focus was individual quality of life. We adopted the Outcome Policies from Options (in Madison, Wisconsin) and we developed indicators to measure each of the outcomes. We completed an annual Quality of Life review with all of the individuals we support that addressed income, housing, relationships and more.

STRATEGIC PLAN. Our strategic plan came next. We identified two major outcomes for the agency:

1. The best, most innovative services available. Our first step was to define the terms best and innovative. Next we established minimal, objective and optimal standards for all of our program services : ILS, Supported Employment and Community Based Day Services.

2. The best, most creative staff. We followed the same process.

Our next step was to tie our job descriptions directly to the results and standards. In addition, staff performance (and salary) was linked to standards and to individual outcomes.

Outcome standards for agency leadership and business practices were established that supported our service and personnel standards. We were all very enthusiastic during the development of standards because it was an opportunity to focus on what we wanted to accomplish. Implementation was much more difficult. We experienced internal and external challenges through this period.

WHERE WE ARE TODAY. Each individual has a futures plan prior to starting services. The working service plan (we call it the Key Action Checklist) details the necessary actions needed to achieve the Futures Plan. We analyze the Quality of Life of each individual using key indicators.

We follow the same process for all agency key results (e.g., community and business). We develop monthly and quarterly reports so that recommendations and problems are addressed immediately. In addition, all results are summarized annually. This report serves as a needs assessment for new services, a report card for the agency and provides us with important staff performance data. We feel that the benefits of outcome based services have been many:

Supporting Support Staff =
Quality Personal Assistance

By Suzanne LeBaron, Personal Assistant Coordinator
Becoming Independent, Santa Rosa, CA

For a Becoming Independent (B.I.) Personal Assistant (PA), the job duties vary as much as the individuals that our agency serves. Some PAs are live-in roommates providing basic support in health and safety, while others provide more extensive support through cooking, home maintenance, grocery shopping, exercise programs, and some times through modeling good parenting skills. The majority of our PAs provide some combination of intimate personal care and more traditional "attendant" services. At present, we employ about 45 PAs. Some are full-time employees with benefits, others work as few as six hours per week. This does not include those people assisting individuals who work only for In Home Supportive Services (I.H.S.S.).

As our supported living program has grown, we started to grapple with a multifaceted concern: How do we bring this diverse group of employees into the B.I. "family,'' make them feel welcome and supported, provide them with useful professional training, and respond to our agency's liability concerns? For employees who work in other B.I. support services, there are many things accepted as "givens.'' For example, a tremendous amount of peer support and advice, service review sessions, and regular staff meetings. However, our PAs typically work on their own with minimal supervision and support. This can lead to high levels of burnout and turnover, not to mention our agency's well founded concern about training and liability.

In order to confront this concern, I started working with a consultant (Carol Connelly) to develop a curriculum that would meet the agency's needs as well as the support needs of our PAs. Regular training classes for PAs began last fall (1995) and have included health and safety information, in-depth training on Adult Protective Services and special incident reporting. We've also tackled philosophical issues such as identifying caregiving styles, recognizing burnout, examining what creates barriers to good caregiving, and active listening. This is paid training time, in addition to the other training that all B.I. employees receive.

Some of the most popular classes have included interactive activities designed to help PAs feel what it's like to be on the receiving end of services. While the classes are training sessions they also serve as an informal support group for our PAs. During these sessions, our caregivers have the opportunity to talk to other people who really understand and work together on problem solving.

As our training and support program for PAs has developed, we also recognized the need for a PA management program for the individuals we support. So, in June we started a five week class titled "How to Manage Your Personal Assistant Services" which focuses on developing communication skills and reducing friction between recipients, and givers, of care. It's taught by myself and a team from a local advocacy organization (Citizens Advocacy) which includes Ross Long and Kathy Patterson (who received a grant to develop the curriculum). The curriculum for the class deals with the technical aspects of managing PA services (e.g., how to assess your needs for a personal assistant, being a successful manager/employer}. In addition, several of the classes parallel the PA class and deal with topics such as defining caregiving styles, understanding boundaries, barriers to good caregiving, recognizing burnout, and active listening. The last class in the series is open to both individuals and PAs for a practice session in active listening and an open discussion.

Robin Wright (the woman whose desire to live independently started us on the road to supported living) says that she has found the classes helpful and the curriculum right on target. Kathy Kirk, her daytime PA, says the training program has helped introduce her to "things that make you think about different kinds of disabilities, about getting too involved, and recognizing different kinds of care - this stuff has helped."

Person to Person

Note: This is an excerpt from the Director's Report, Colorado Division for Developmental Disabilities, Volume 3, Number 1, Fall, 1992.

Recently in France, a sheltered workshop asked its employees with developmental disabilities to volunteer to assist in the design and administration of a questionnaire to all other employees (Velche and Baysang, 1992). 51 individuals with mental retardation volunteered and 40 completed training on survey techniques and conducted surveys. These volunteers interviewed 355 individuals with mental retardation and successfully collected information regarding what adulthood meant to them, their feelings about roles, rights, duties, and rules in life and at work, meaningfulness of work, and other subjects. The results of this survey were used to develop revised rules for operation of the workshop. The benefits of the approach were: