Self-Directed Supports System Map

1. DRAFT DRAFT Self-Directed SupportsSystem Map Starts with the person…

2. Advantages of Website Format • Non-linear • Hyperlinked and easily navigable • Friendly, Flexible • Adaptable to all audiences • Responsive, can adapt to group needs mid-flight • Combines Text and Graphics and color • Easy to visualize and understand • Appeals to all learning styles • User can recollect graphics and link to earlier experiences and material • Serve as foundation for hard copy resources • Detailed info on specific roles, resources, processes

3. Starts with the person… • Authority • Control • Responsibility • etc… RLC RLC RLC RLC

4. Pathways to Community Life Olmstead Provider Managed Real Life Choices Self-determination Self-directed Day Community Life

5. OLMSTEAD SPACER

6. Olmstead Components Budget Planning Natural Support Community Life Team Training

7. Support Team for Olmstead Friends & Family Transition Case Manager Support Coordinator Family/Peer Mentors Monitors Developmental Center Staff Team Guardian Friends & Family HOME

8. Support Team for Olmstead Transition Case Manager Transition Case Managers are the link between the Developmental Center, Support Coordinator Agencies and community agencies. They provide valuable information to the team, and assist in the development of an individual’s plan of care. Team

9. Support Team for Olmstead Developmental Center Staff Developmental center staff are part of the person’s core team, actively participating in the individual’s planning for their move into the community. They provide important insight and understanding of things that are important to and important for an individual, from their first hand knowledge through working and developing a relationship with the person. Team

10. Support Team for Olmstead Bureau of Guardianship Services The Bureau of Guardianship Services (BGS), provides guardianship for those determined to be in need. If a person is served through BGS, his or her guardian participates as part of the team. Families of individuals who are under BGS may also choose to be part of the team. Team

11. Support Team for Olmstead Peer Mentor Peer Mentors are individuals with a developmental disability who have experience living in an institutional setting and can listen with a sensitive ear. Peer Mentors are available to: • Offer information from a personal perspective that will help in making choices • Provide support to people so as to strengthen skills in exercising choice and controlling their resources and their lives • Be a general support from the person’s perspective Team

12. Support Team for Olmstead Family Mentor Family Mentors are people who have a family member with a disability living with them or have some other significant relationship with a person with a disability. Family Mentors are available to: • Share their personal experience, knowledge or resources, person-centered thinking, and problem solving techniques to assist an individual/family and their team to work through any concerns that may arise • Be encouraging of choices • Provide support from the family perspective. Team

13. Support Team for Olmstead Monitor Monitors are DDD employees, and coordinate the self-directed team. Responsibilities of the Monitor include: • Providing technical assistance to Support Coordinators, people, families, and the fiscal agent • Review of the person-centered-plan, ensuring that identified services are waiver eligible and that all health/safety needs are addressed • Approve the plan of care • Ensure services are being provided • Ensure that expenditures are within the person’s individual budget Team

14. Support Team for Olmstead Support Coordinator A Support Coordinator works collaboratively with individuals/families, and their network of supporters, as they navigate the person-centered-planning process, ensuring that supports and services are working for the person. Responsibilities of a Coordinator include: • Facilitate planning • Budgeting • Helping families to find and connect to services • Providing technical assistance in self-direction • Making changes to the Essential Lifestyle Plan as needed Team

15. Olmstead Budget Olmstead budgets are based upon the level of support an individual needs. The “Developmental Disabilities Resource Tool” (DDRT is a Self Care Assessment tool designed to gauge in general “how much” service a person needs. These needs then correlate into an individual budget. The assessment assumes that the less an individual’s ability for self care the more she will need assistance from others. Individual’s moving from one of the Division’s Developmental Centers are assessed by the DDRT in the following areas: • Self-care • Behavioral needs • Medical needs When the DDRT is completed, it places the person into one of four distinct levels of need for support. Each level of support has an “up to” budget amount to be utilized to purchase services and supports identified in the person’s ELP. A major advantage of an individual budget is that if the person or their family becomes dissatisfied with their supports and services, they can purchase those supports elsewhere. In essence, the money follows the person giving them the flexibility and control to create the life they want. HOME Budget Levels

16. Olmstead Budget The Olmstead budget grids on the next several pages indicate the maximum “up to” budget for each level based on the results the DDRT Self Care Assessment. Additional funding is allocated based on an individuals’ behavioral and/or medical needs assessment. For individuals residing on their own, additional funds are provided for housing start up costs.

17. RLC SPACER

18. Planning Real Life Choices Components Budget Natural Support Community Life Team Training

19. Support Team for Real Life Choices Need graphics Fancy arrows and people Friends & Family Family Mentors Support Coordinator Monitors Peer Mentors Team Staff???

20. Support Team for Real Life Choices Support Coordinator A Support Coordinator assists individuals, families and supporters through the person-centered-planning process. They help ensure that supports and services work for the person. Responsibilities of a Coordinator include: • Facilitating the planning process • Facilitating plan updates as needed • Budgeting • Guiding individuals and families in finding and connecting to services • Helping individuals and families navigate Real Life Choices Team

21. Support Team for Real Life Choices Staff Individuals and families may be eligible to hire paid supporters who will help to implement the plan. The plan outcomes must reflect the need for staff assistance. Individuals and families may hire staff directly and pay them using the fiscal intermediary. Staff can also be hired by contracting with a qualifier provider agency. Team

22. Support Team for Real Life Choices Monitor Monitors are an individual or family’s first link to self-directed services. The Monitor provides information regarding the Divisions’ Real Life Choices and Self Directed Day service system. This enables individuals and families to make an informed decision as to whether self-direction is for them. Responsibilities of the Monitor include: • Providing technical assistance to Support Coordinators, individuals and families and the fiscal agent • Reviewing the person-centered-plan, ensuring that identified services are waiver eligible and that all health/safety needs are addressed • Approving the plan of care • Ensuring services are being provided • Ensuring expenditures are within the person’s budget limits Team

23. Support Team for Real Life Choices Family Mentor Family Mentors: • have a family member with a disability living with them or have some other significant relationship with a person with a disability • share their personal experience, knowledge or resources • use problem solving techniques to assist an individual, their family and team to work through any concerns • inform and encourage choices • schedule, organize and coordinate family networking meetings • provide support from the family perspective Team

24. Support Team for Real Life Choices Peer Mentor Peer Mentors: • are individuals with a developmental disability who are self-directing independently or with the help of their family. • offer information from a personal perspective that will help in making choices • provide support to strengthen a person’s skills in exercising choice and control of their resources and their lives • schedule, organize and facilitate peer networking meetings • provide support from a first hand perspective Team

25. Support Team for Real Life Choices Family & Friends As with all people, family and friends are the people who love us and who we love. They are there to support and celebrate with us as we travel through life. In Real Life Choices, they are a key part of the planning team. One of the wonderful aspects of self-directed supports is that the person and his or her family make the final decisions about their life. They hold the control and authority. Team

26. RLC Budget Real Life Choices budgets are based upon the level of support an individual needs. The Developmental Disabilities Resource Tool (DDRT): • assesses a person’s capacity for self care • assumes that the greater the person’s capacity for self care the less assistance they will need • places the person into one of four distinct budget levels of support need based on capacity for self care A major advantage of an individual budget is portability. If services are not satisfactory, they can be purchased elsewhere. This gives the person the flexibility and control to create the life they want. HOME Budget Levels

27. RLC Budget Levels Level I inset links Lowest Support Time Needed, Highest Self Care Score Level II Low Support Time Needed, Medium Self Care Score Level III Medium Support Time Needed, Low Self Care Score Level IV High Support Time Needed, Lowest Self Care Score HOME

28. Support Team for Real Life Choices Level I Lowest Support Time Needed, Highest Self Care Score • Description: A majority of people can do all activities of daily living, but may need help with public transportation. • Budget: Up to $23,742

29. Support Team for Real Life Choices Level II Low Support Time Needed, Medium Self Care Score • Description: A majority of people can eat, drink, toilet, care for clothing, make bed, clean room, use microwave, prepare foods, and wash dishes. Need assistance to shop, count change, or do laundry. • Budget: Up to $35,162

30. Support Team for Real Life Choices Level III Medium Support Time Needed, Low Self Care Score • Description: A majority of people can eat, drink, toilet, and dress. Need help to care for own clothing, use money, or count change. A good deal of time is required from caregivers to provide needed supports. • Budget: Up to $48,822

31. Support Team for Real Life Choices Level IV High Support Time Needed, Lowest Self Care Score • Description: Many people may require assistance to do all activities of daily living, but a majority can eat and drink. Assistance is required to toilet or dress themselves. Most of caregivers time is spent providing needed supports. • Budget: Up to $67,053

32. SELF-DETERMINATION SPACER

33. Planning Self-determination Components Budget Natural Support Community Life Team Training

34. Support Team for Self-Determination Support Broker • Support Brokers work collaboratively with individuals and families, • as they navigate the person-centered-planning process, • ensuring that the plan, supports, and services are working for the • person. • Responsibilities of Brokers include: • Facilitating circles of support • Facilitating development of the annual support plan • Creating annual budgets, and providing assistance in budget management • Connecting to resources, including the hiring of staff • Troubleshooting and brainstorming • Providing technical assistance in self-direction Team

35. SELF-DIRECTED DAY SPACER

37. PLANNING SPACER

38. Planning Essential Lifestyle Planning HOME

39. Essential Lifestyle Planning • is a facilitated person centered planning process that creates a user friendly snapshot of how someone wants to live and be supported • helps discover what is important to a person in everyday life • identifies what support the person requires and any issues of health or safety • describes what you have learned in a way that is positive, respectful and easily understood by those who will support the person to get what is important to them • a way of making sure that the person is heard, regardless of the severity of his or her disability. • identifies and separates what is important to someone, from what others see as important for them and finds a balance between them

40. PATH and MAPS • PATH and MAPS are creative person centered planning tools, designed to identify doable action steps in the direction of desirable futures. Both utilize graphic facilitation. • The heart of the MAPS process is the story of the person at the center of the MAP. • PATH is a sharper planning tool, used to cut through complex situations and and move into action. • Both tools are excellent for team building, and • are loved by people who actually want to • change the way we currently work.

41. Planning Personal Futures Planning • involves values, ideals, and methods for person centered plan facilitation • challenges us to learn to listen and take direction from people with disabilities • effective facilitators learn to listen with an open mind while shaping the ideals of a person’s dream toward reaching the five accomplishments: • Community Presence • Community Participation • Encouraging Valued Social Roles • Promoting Choice • Supporting Contribution

42. TRAINING & SUPPORT SPACER

43. Training & Support Real Life Choices Lifeline for the Journey Essential Lifestyle Planning Pathways Family Networking Meetings Life after 21 HOME Training

44. Conference Conference Family Network HOME

45. Conference Self-directed Supports Conference • Purpose • Other information HOME NJ Map

46. Family Networking Meetings • Purpose • Support and Information Sharing • Customized training and technical assistance • Informs conference planning • Helps disseminate shared learning from conference HOME NJ Map

47. Person Centered Thinking • Person Centered Thinking refers to the foundational skills and tools that underlie all person centered assessment, planning and delivery of supports. This workshop teaches structured ways of listening and finding balance between what makes a person happy and what helps them stay healthy and safe.  It provides effective facilitation methods for gathering, organizing, powerfully presenting, and continually acting on on-going learning.

48. Essential Lifestyle Planning • Essential Lifestyle Planning is a person-centered process intended to change the way we plan, design, and deliver supports. This workshop is intended for those interested in facilitating the Essential Lifestyle Planning process. Participants will learn to gather information to produce powerful and effective support plans.

49. Families Planning Together • As parents of children and adults with disabilities you may often find yourself wondering how to make people aware of the great things about your son or daughter and the support s/he needs to be happy and safe. Whether you are a the parent of a toddler, school-aged child, young adult transitioning out of school, or an adult with a disability, person centered thinking and planning is a good start to helping your child reach his/her goals and dreams. • Person Centered Thinking refers to the foundational skills and tools that underlie person-centered planning and supports. This workshop for families teaches structured ways of listening and finding balance between what makes your child happy and what helps him/her stay healthy and safe.  It provides effective methods for gathering and organizing information, as well as sharing that information so that other people in your child's life are better able to understand what s/he wants and needs.

50. Lifeline for the Journey • Life Line for the Journey is an interactive training session assisting families of children from infancy through age 14. At this stage, families are typically wondering and worrying about what the future holds for their child with a developmental disability. The information presented includes vision building, as well as, the different systems that they may encounter, and the scope of service provision for each including eligibility criteria. Networking time is built into the sessions so that families have an opportunity to connect with other families facing similar concerns.