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Rutgers, The State University of New Jersey Liberty Plaza, 335 George Street, New Brunswick, NJ 08901
rwjms.rutgers.edu/boggscenter p. 732-235-9300 f. 732-235-9330
Jeff Ballenger Senior Director
Charles Lea Center Spartanburg, SC
Supporting the Transition to Independent Living: A Technology-Based Approach
September 30, 2016 APA Hotel Woodbridge, Iselin, NJ
The attached handouts are provided as part of The Boggs Center’s continuing education and dissemination activities. Please note that these items are reprinted by permission from the author. If you desire to reproduce them, please obtain permission from the originator.
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Supporting the Transition to Independent LivingA Technology‐Based Approach
Jeff BallengerSenior DirectorCharles Lea CenterSpartanburg, [email protected]
Charles Lea Center• Opened as a pre‐school and hearing clinic in 1971
• Accepted the first individuals from state institution to community ICF in 1981.
• Supported living apartment opened in 1984.
• Opened its first group home, day & work program in 1986.
• CLC offers, residential, day, vocational, case management, early intervention, nursing, HASCI (head and spinal cord injury) and behavioral services.
• Operate a lawn and cleaning service to employ people receiving services.
• Employs 855 people (280 receive services).
• Operate and own 57 (4 bed) homes, four (8‐16 bed) homes, and 2 apartment complexes.
• Supports 310 people receive residential services of which 102 are supported with less than in their own apartment or home.
• Community Transitional Program begun in 2014 with 3 ladies.
• Funded through single bands (fee for service)
• Is second largest provider of services in South Carolina.
• Has a operating budget of $30 million
• Utilizes eight (8) corporations to manage properties and vehicles.
• Purchased a franchise “Linked Staffing” for the sole purpose of generating additional funds for programs.
• Is CARF accredited.
• Begun utilizing technology to support people in 2008with one person.
• Established and utilize a Foundation to fund programs the state does not.
• Developed a app for individuals, families and staff to aid in communication.
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The Transitional Journey Begins
Why Develop Transitional Services?
• We were not meeting the outcomes for people we served.
• We were over serving people.
• We desired to reduce the waiting list in our community for services.
• It’s the right thing to do
• We could reallocate save dollars.
Three ‘s to considerQuality of Life
Individuals have more control over one’s life and live how they want to.
Quality AssuranceDashboard provides instant visual documentation of events and activities.
Quality CareResponse time, accurate information, more quality time spent with the individual. Supporting people only when they really need you.
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Questions to Consider Before Embarking on this Journey
• How will technology support mission of organization?
• Do you have a strong culture embracing “Person Centered practices”?
• Do you have a process for getting buy‐in from key stakeholders?
• Board• Person served, guardians and families• Funding sources• Employees
• Who can you partner with?
• Are you thinking outcomes First and not savings?
Components For Success
• Services driven by the person.
• Person Centered Thinking modeled throughout organization.
• Cultivate a culture of Innovation
• Success is a must
Services Driven by the Person• We used a tool called “My Life My Story”.
• We added person receiving services to board of directors.
• Developed new services only after input from person receiving services.
• Conduct satisfaction surveys bi‐annually (services in general & transitional services specific).
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Person Centered Practice Modeled Throughout Organization
• Trained staff from every department and program.
• Trained all supervisor
• Added person centered training to orientation
• Currently 4 staff will be certified Person Centered trainers by SDA
Cultivate a Culture of Innovation
• Developed a staff pledge.
• Developed a “Celebration” staff nomination & recognition.
• Support individuals and staff to attend state, regional and national conferences.
• Encourage networking with other organizations.
Success is a Must
• Everyone is looking at you.
• One mistake could kill the program.
• Take it slow with 1‐3 individuals first
• Developed a staff pledge.
• Select persons who are easier to transition first
• Right staff
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One “STEP”at a Time
Supporting
Transitions
Equipping
People
Begin with a “STEP”Why?
• Three ladies desired to develop skills needed to live in their own apartment and be a part of their community.
• The challenge was they lived in a different group homes and staffing supports where limited.
• It’s the right thing to do.
Begin with a “STEP”What?
• We believed offering individuals an opportunity to Transition/STEP to more independent living would be successful.
• The traditional way was to move them to a apartment and work on their skills once they moved.
• We discovered this options could be less costly than traditional support options.
• We knew they were being over served.
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“STEP” Cont’dHow?Develop a program that utilizes assessments, individuals support teams, person centered planning, technology, remote monitoring (safety, health and security), and specific skills training for individuals and staff.
Our CommitmentWe give them an opportunity to live a healthy, safe and productive life. We train them to be independent and develop skills needed to function in their communities. We dedicate time and resources to ensure they are ready.We motivate them by offering continual encouragement and support. We help them lead more fulfilling lives and realize their dreams as they see them.
kathy Jo, Ansonia & Tammy’s Video
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TRANSITIONAL SERVICES IS BORNMission“Breaking Barriers To Experience Life”
Vision
To implement sustainable support models with various living options for persons supported to become true contributors in their community.
Motto“The greatest shock in this age of transition…What you have thought all the time as impossible is actually the way of life”. Author unknown
About “STEP” Transitional Services • First have a “Transitional Cheerleader” to carry the message.• We believe all people deserve an opportunity for high‐quality, innovative and customized services.
• The “STEP” program is committed to the development and enrichment of people and organizations which support them.
• The STEP program creates a customized transition plan to go from 24 hour support to support based on needs of person. The model systematically decrease the need for staff while ensuring health, safety, and protection are met.
About “STEP” Transitional Services
• Usually can take up to six months to transition participants.• Partners with case management and other support providers.• Utilizes Support Intensity Scale, supplemental assessments, and participant & family interviews to develop transition plan.
• The Transition plan serves as the “road map”. The Transition plan gives way to the Individual Achievement plan.
• The Individual Achievement plan outlines the specific supports a person requires to be successful.
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PROGRAM MAKEUP• Interest meeting with person and family/guardian• Transition plan meeting• STEP assessment• Technology assessment• Participant Independent training• Apartment hunting• Functional assessment and observation• Staff Training (NADD Certification)• Participant hires staff to support them• Transitions Survey prior to moving• Move in and begin community training
PROGRAM MAKEUP
• 30 day fidelity check• 60 day fidelity check• 90 day fidelity check• Family/Guardian input• Transitional Survey after three months• Collect Outcome Data
Certificate Training for Individuals Supported
Community Inclusive Residential Supports provides an 8 week/ 1 hour training curriculum for individuals who are transitioning.
35 individuals obtained certificates.
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8 focus areas of training
My STEP/CIRS: Transition Plan, Life Vision, Pathway, responsibilities
Home Living: meal planning, healthy cooking, kitchen safety, grocery shopping.
Community Living: good citizenship, community safety
Health and safety: Signs and symptoms and basic first aid, medication admin., healthy living, toxins and flammable substance, fire safety, safety and emergency procedures.
Social Networks: Community supports
Advocacy and Finances: Financial Responsibilities, check writing
NADD Competency‐Based Direct Support Professional Certification Program.
DSP must demonstrate competency in five area:
• Assessment and Observation
• Behavior Support
• Crisis prevention and intervention
• Health and Wellness
• Community Collaboration and Teamwork.
• 25 certified/ 4 trainers
Programs Developed“STEP” Program – “Supporting Transition Equipping People”
“NIGHT” Monitoring – “New Innovative Gateway of Home Technology”
“SMART” Homes – “Supporting Mobility Around Redesigned Technology”
“HOMES” – “Helping Other Manage Environments Safely”
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Programs Developed“STAGES” – “Supporting Transitions around Generationally Enhanced Services”
“TRRUE” – “Totally Redesigning Residential to Understand Everyone”
“CIRIS” – “Community Inclusive Residences Individually Supported (state program)
Supported Living I/II – “Supervised Living Program” (state programs)
Number of People Supported
4
21
2
118
42
20
1
12
63
6
42
3
23
14
7
0
5
10
15
20
25
30
35
40
45
SMART STEP/CIRIS HOMES NIGHT SECURE TRRUE
Current People Supported Future People Supported
Total Supported next 12 months
Cost Per Day
$218
$159
230
177
55
ICF CRCF High Mgmt Low Mgmt SupportedLiving
Traditional
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Cost Per Day
301
185
136
112
38 8
SECURE TRRUE NIGHT STEP/CIRIS CTS HOMES
Transitional
Assistive Support Technology
Why Technology?
• Empowers independence
• Monitor daily routines and activities
• Less Intrusive • Allows staff/caregiver to be proactive• Individualized based on persons needs• Cost effective compared to traditional supports
• Be proactive about safety and health• Customizable response options
• Gives a peace of mind
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• Night time activity and sleep patterns
• Access to medications, health monitoring (Telehealth)
• Toileting frequency, incontinence, bathing frequency
• Cook and eating habits, use of appliances
Common Applications• Adjusting temperature
• Inactivity, wandering, falling, egress
• Ability to page staff support
• Speak directly to staff using phones
• Trends in behavior
• Environmental controls
• Medication dispensers
• Ring Video Doorbell
• Telehealth & wellness products
• Automatic door openers
Types of Support Technology• Tablets & environmental
controls
• Personal emergency
response systems (PERS)
• Wireless sensor systems
Typical Floorplan
1 Bed padsand lamps
2 Motion andFront Door
3 Refrigerator, stoveand cabinets
4 Medicine cabinetand water sensor
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Benefits
• Independent living• Self Directed Services• Varied support options• Increased community integration• Care coordination and communication• Increased safety, health and accountability• Self determination• Cost‐Effective
Outcomes
What We’ve Learned From The Supported Living Satisfaction Survey
Survey Results From People in Spartanburg, SC in 2016
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Do you like where you are living?
97%
3%
94%
6%
0%
20%
40%
60%
80%
100%
Yes No
2016
2015
Do You Feel Safe in Your Home?
100%
0%
97%
3%0%
20%
40%
60%
80%
100%
Yes No
2016
2015
Can You Talk on the Phone in Private?
82%
8% 10%
100%
0% 0%0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
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Do you trust your staff?
98%
1% 1%
98%
2% 0%0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
Do You Get to Help Choose the Staff Who Work With You?
78%
19%
3%
65%
34%
1%0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
Do Staff Help You Learn How to do Things for Yourself?
96%
3% 1%
95%
5%0%
0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
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Do You Have Friends Who Are Not Paid Staff?
85%
12%3%
90%
10%
0%0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
Do You Get to go to Fun Things in Your Community?
94%
5% 1%
90%
10%0%
0%
20%
40%
60%
80%
100%
Yes No N/A
2016
2015
Meet Jonathan• Was in a terrible accident at age 18 and
now has a Head and Spinal Cord Injury• Family was proving supports and
paying out of pocket weekly• Asked if the Center could support him
and he private pay for services• Introduced to supportive technology in
2013.• Has become a strong advocate for
person with disabilities and special needs
• Contracts with Charles Lea to train staff• Currently a member of Charles Lea
Board of directors.
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Meet Vicki & LauraVicki:• Lived at home with family until 2005• Moved into a traditional group home and
developed friendships with housemates.• Desired more independence and moved to
STEP home in February 2014 with her best friend.
• December 2014 moved into her own apartment/signed her own lease and asked her best friend to be her roommate.
Laura:• Lived in a group home for 21 years• Desired more independence and moved
into the STEP home with her best friend in February 2014.
• Signed her own lease for an apartment with her best friend in December 2014.
Meet AnthonyAnthony:
• Lived in a group home for 15 years
• Mother refused to allow him to try to live in own apartment
• For two years he continued to press his mother to visit a apartment with him.
• Mother agreed in April 2016 to visit apartment complex after speaking with another parent.
• Moved into his own apartment July 2016
Meet Jeffery and KalenJeffery• He exhibited some behavioral challenges when he lived at home with his mother and as a result he was awarded placement in a high management group home.
• He received the highest funding band an individual could receive in S.C.
• In 2014 he moved into a NIGHT monitoring home where he learned skills to self‐manage.
• August of 2016 he moved into his own condo with Kalen.
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Meet Jeffery and KalenKalen• In 2015 he and his parents approached Charles Lea for advice to support Kalen.
• The one option they had was a university independent living program.
• Kalen was #4328 on waiver service waiting list which meant he would not receive Residential supports until he was age 35, eight years later.
• Kalen asked his parents to help him and Jeffery purchase a condo.
• August 2016 he moved into his own condo with Jeffery.
Meet Ben• Ben came to Charles Lea at the age of 17 due to significant behavioral challenges living with his mother.
• Moved into a group home 10 years ago and received his high school diploma.
• In 2012 desired more independence and asked to move to a staff live‐In home.
• Ben and his mother agreed it was time for him to experience greater independence.
• In 2013 Ben moved into the STEP. • In June 2014 Ben moved into his own apartment. • He’s been able to decrease his Psychotropic medications from 7 to 3.
• He has also lost 63 pounds since moving into his own apartment.
FUNDING SOURCES
• Medicaid Waivers
• Transition to Community $ saved
• One‐time grant
• Private Pay
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The Charles Lea CenterEnhancing Lives Encouraging Dreams
Jeff Ballenger
Sr. Director of Family & Residential Services
www.Charleslea.org
Reference and Reading List Prepared by Jeff Ballenger
Robert Schalock and Miguel Angel Verdugo Alonso (2002) Handbook on Quality of Life for Human Service Practitioners.
Michael Smull and Mary Lou Bourne, Support Development Associates, Developing Person Centered Organizations. www.sdaus.com
The Learning Community for Person Centered Practices, Inc. 2008. www.learningcommunity.us/
The NADD Competency‐Based Direct‐Support Professional Certification Program
Able Link, ATLAS custom survey ‐ www.ablelinktech.com
Centers for Independent Futures, “Independent Living Skills Tool Kit” (2012). www.independentfutures.com
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