Exploring the Meaning of a Purposeful Adult Life
Providing insights into building a meaningful adult life through activities like Community Life Engagement and Person-Centered Planning for a Meaningful Day. Emphasizing the importance of feeling engaged, connected to one's purpose, and aligning gifts and passions with values to create a fulfilling life.
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Building a Meaningful Adult Life November 21, 2022
Goals of Presentation To provide an overview of the term Meaningful Day To provide clarity on the purpose of Community Life Engagement To provide guidance on the Community Life Engagement as a wavier service
Its a NEW Day for Day Services Building a Meaningful Life
Meaningful /m niNGf l/ adjective having meaning. having a serious, important, or useful quality or purpose. "making our lives rich and meaningful"
Meaningful A meaningful life is one in which you feel engaged, connected to purpose, and able to connect your gifts and passions with your highest values.
Person-Centered Planning for a Meaningful Day For all people of working age (age 18-60), the person-centered planning (PCP) should include a focus on exploring Employment that identifies barriers to employment as well as supports that may be needed to address unmet needs or concerns. The PCP should include the person s interests in exploring employment and community engagement as well as other goals, needs and wants to have a meaningful life.
Meaningful Day The term Meaningful Day is used to describe the individual s entire day including unpaid supports and paid day and employment services in the NOW, ROW and Supports Waiver. The Purpose of Meaningful Day services is to support participants of working age on their path to employment (no matter where they are on that path), including wrap around supports and for individuals of retirement age to take part in retirement activities. Each person should be supported to build a day, a week and a life that is full of meaning, based on their individual person-centered outcomes, goals, interest and needs. Supports should include natural, community, local and state resources in addition to waiver services.
Meaningful Day Meaningful Day services are based on the belief that all individuals with developmental disabilities can work when given the opportunity, training, and supports that build on a person s strengths and individual social networks. Employment should be viewed as the first service choice considered for ALL people of working age, but not the only choice, as other services may wrap around to support the person as needed. Activities should be focused on keeping, learning or improving skills and functioning for daily living. However, what activities a person chooses is going to be based on their outcomes, goals, experiences and barriers. All Meaningful Day services should be designed to support the facilitation of community membership and the highest level of independence appropriate.
Building a Meaningful Day When building a meaningful day for each person: For each person, think about the community and employment resources you currently have, need, or want to explore and develop in each of the five areas below. Be creative! Everyone s needs, wants and interests will be different! Personal Strengths and Assets 1. Community Resources 2. Technology 3. Relationships 4. Eligibility Supports 5.
Personal Strengths and Assets Examples: Work Experience Volunteer Experiences Knows about different jobs Responsibilities at home Responsibilities at school Vision or dream for a job Communicates ideas, needs, thoughts Good Social and everyday skills
Community Resources Examples: Schools Public Transportation Local Businesses Churches Public Safety Libraries Parks and Recreation Civic Engagement
Technology Examples: Cell Phones Tablets Smartphone Apps Alarm Clocks Electronic Reminders Calculator Computer/laptop Online classes or training Internet job search or community mapping Remote Supports Adaptive Equipment Social Media
Relationships Examples: Family Friends Roommates Neighbors Coworkers Community members Church Members Acquaintances
Eligibility Supports Examples: Local disability services and programs Special Education program Section 8 Housing Food Stamps Medicaid State plan services Louisiana Rehabilitation Services (LRS) Waiver Services
Employment and Community When you work with each person to establish their goals, wants and needs and then you gather all of the resources from each of these five areas to fill in the missing pieces, you have helped this person create a meaningful day! The goals, wants and needs may fluctuate, but when you establish the connections for a meaningful day you have opened up endless possibilities for helping this person live their best life!
Community Life Engagement Definition: Community Life Engagement refers to supporting people with IDD to access and participate in their communities outside of employment as part of a meaningful day. Also referred to as community-based non-work , wraparound supports, holistic supports, or community integration services.
Community Life Engagement CLE activities may include: volunteer work postsecondary, adult, or continuing education accessing community facilities such as a local library, gym, or recreation center participation in retirement or senior activities at the senior centers and anything else people with and without disabilities do in their off-work time outside their home
Community Life Engagement CLE may also include activities that could lead to employment: career exploration for those not yet working or between jobs, supplement employment hours for those who are working part- time, or serve as a retirement option for older adults with IDD
Why Is Community Life Engagement Important Recent federal guidance has further illustrated the need to define and provide high-quality Community Life Engagement supports. Center for Medicare and Medicaid Services (CMS) In January 2014, CMS also released new rules that defined, described, and aligned home and community-based setting requirements. The new rules specify that states must maximize the opportunities for individuals to access community living in the most integrated setting. To meet this standard, states are turning to both supported employment and Community Life Engagement supports. Department of Justice (DOJ) DOJ has clearly stated that in order to be in compliance with the ADA and the Supreme Court decision in Olmstead v. LC, states must provide day and employment supports in integrated settings (U.S. Department of Justice, 2014; United States v. State of Rhode Island, 2014), placing pressure on all states to move individuals from segregated settings to more community-based models of support.
Why Is Community Life Engagement Important ICI Information States and providers report growing numbers of individuals with IDD in non-work services (CLE). The National Survey on Day and Employment Services, conducted annually by ICI under the Access to Integrated Employment project, categorizes day and employment supports into four quadrants based on whether they are work or non- work and community- or facility-based. Community-based non-work (CBNW) services, those services in the non-work and community-based quadrant, have seen considerable growth. CBNW services have the potential to support Community Life Engagement when used effectively, yet there has been limited regulation or study of CBNW to date and so it s ever evolving. CBNW generally involved a wide range of activities supported, populations served, and goals. There is inconsistent use of specific guidelines such as staffing ratios, group sizes, or proportion of time spent in community settings. The desire to provide individualized supports was counterbalanced by structural and budgetary constraints, resulting in varied levels of individualization, choice of activities, and hours of support offered. The relationship between CBNW and work was also inconsistent, with some individuals receiving both work and CBNW supports, but more often CBNW serving as a substitute for employment
Community Life Engagement and Employment We don t want the focus strictly on Community Life Engagement where it will detract from the employment focus. Community Life Engagement supports should be used to promote and/or wrap around employment, which should be the primary expectation for individuals who are working or wanting to work, or who are unsure of how they feel about work. CLE activities should promote community inclusion and integration. For example, volunteer work should be an activity that is meaningful to each individual and occurs alongside community members without disabilities in whatever capacity the individual chooses.
ICI Guideposts for CLE Guidepost 1: Individualized supports for each person Guidepost 2: Promote community membership and contribution Guidepost 3: Use human and social capital to decrease dependence on paid supports Guidepost 4: Ensure that supports are outcome-oriented and regularly monitored
Guidepost 1: Individualized supports for each person Community Life Engagement supports should be tailored to the interests and needs of each unique person. In order to be individualized, supports must: Show understanding of personal preferences, goals and skills. Regardless of the process used to uncover interests and passions, the goal should always be the same: to identify and pursue activities that appeal to the individual and/or support their longer-term goals. As interests are pursued, consider each person s unique support needs to ensure success. In contrast to this individualized approach we have always practiced group models which typically has emphasized general ideas about what others feel/believe everyone with disabilities should be doing. Emphasize person-centered planning and discovery. Staff must take the time to get to know the individual through some form of person-centered planning or discovery, whether formal or informal. This will allow for time to uncover the most accurate and detailed information about each person. Community Life Engagement supports can provide an excellent opportunity to determine interests and skills for employment and for networking toward finding jobs. Consider creative grouping, staffing, and scheduling. Providers should use strategies including creative and purposeful grouping of individuals such as those with similar interests or friends in the same community Pay careful attention to scheduling, logistics, and staff communication; redefining staff roles to include community facilitation and to encourage natural supports; and accessing, braiding, or blending funding resources.
Guidepost 2: Promote community membership and contribution In order to promote community membership and contribution, supports must: Start with inclusive settings and activities. The starting point for promoting community membership is that individuals are being supported out in the community in activities that provide opportunities for interaction with community members. High-quality implementation means supporting people in an inclusive environment in our community where adults would be learning meaningful skills in the community, in inclusive and integrated settings with people without disabilities. Accessing inclusive opportunities often involves providers partnering with other local, non-disability-specific organizations to identify community resources and to generate new community-based options. The value of fully inclusive settings, is not only for the individual with a disability, but also for the larger community. Ensure staff presence does not limit connections with other community members. Another factor in increasing community connections is ensuring staff presence does not interfere with developing relationships with community members. Train staff to get out of the way of the individual and allow them to make the connections. Train staff on the new expectations and new settings. Place value on not just presence, but membership in the community. This includes being known by people in one s community, forming relationships, and making a contribution to the community through work or volunteer activities. Providers want to identify places and activities where people can go beyond presence to participation to contribution. Providers/staff can help people make community connections by tapping into the social networks of individuals, their families, and support staff. Consider an individual's preferences. Community connections should not be pursued unilaterally for all people. Some individuals may prefer a less connected life, and that should be an option as long as it is an informed choice. An expert noted that people may already have community connections through other aspects of their life, such as their job.
Guidepost 3: Use human and social capital to decrease dependence on paid supports Individuals should be actively engaged in the community with the minimal supports that are commensurate with their needs. In order to achieve this, Community Life Engagement supports must: Use social capital to create natural supports. As individuals make more connections in their communities, the social capital they are building can be used as natural supports. Tapping into this social capital then leads to a level of interdependence with others in the community and not just on paid supports. For example, by participating in the same yoga class every week, an individual will get to know other class participants as well as some of the gym staff. This level of familiarity can reach the point where staff support is less necessary and the individual can simply be dropped off for the class, knowing that the environment is safe, secure, and everybody within those activities knows the individual. The goal is not necessarily about the person becoming more independent but just as much about creating an intentional community around somebody. Relying on natural supports can enable participation in activities without a paid support person and when supports are not available. It also frees up staff resources to support those who need support and do not have natural support. It also allows the stretching of service dollars and allowing more individuals to receive supports. Teach skills to build human capital. Human capital refers to the specific skills an individual brings to his or her job and/or community. Community Life Engagement activities can be used to build individuals human capital by teaching specific skills for community access and employment. This initial investment in skill-building enables more fading of supports over time. This can also include peer-to-peer strategies, for example, having a person with more mastery of a particular skill, such as riding the bus, teach someone who is still working on that skill. Using Community Life Engagement supports to build employment skills, both hard and soft, is working on communication, initiative, and problem solving. The skills gained can range from soft skills such as appropriate hygiene and behavior, to hard skills such as office or culinary work, to related skills such as accessing public transportation to get to work.
Guidepost 4: Ensure that supports are outcome- oriented and regularly monitored In order to achieve outcomes such as life satisfaction, community membership and contribution, and increase in natural supports, Community Life Engagement supports must be oriented toward, and monitored in relation to, those outcomes. Here are some examples of how to do so: Emphasize goals rather than processes. The focus should be on outcomes such as satisfaction, individualization, and connectedness to community, rather than on process measures such as times and locations of activities. Measures should include the extent to which such activities are focused on what the person wants to focus on, not just what happens because they go to this particular program or that particular program. Lead to or complement employment Individual goals, which each person s Community Life Engagement supports are based on, should include age-appropriate roles in the community, with an emphasis on employment. In general, these supports should move individuals in the direction of integrated employment for those that are of working age. For those who are younger, goals may involve postsecondary education or specific job training. For older people, the goal may be a healthy and sociable retirement. Regardless of age, the basic expectation is that people with IDD have the same kinds of roles as their same-age peers without disabilities. Community Life Engagement can also supplement employment supports to create more of a full life, filling in any gaps in time, engagement, or interests, particularly for the many people with IDD who work limited hours. For example, someone may be working two days a week in a quiet office setting and using Community Life Engagement supports on the other three days to make more social connections or to be more physically active.
Waiver Services Utilizing waiver services to help build a meaningful day
Community Life Engagement Service Day Habilitation Classification NOW, ROW and Supports Waiver: T2021 UQ Community Life Engagement (1:2-4 ratio) T2021 UQ: Used when the provider is serving the individual in the community in a 1:2-4 ratio
Community Life Engagement Service Rates T2021-UQ NOW: $3.41/15 minute increment ROW: $3.88/15 minute increment Supports Waiver: $3.56/15 minute increment
Community Career Planning Prevocational Classification NOW, ROW, and Supports Waiver T2025 UQ Completed in a 1:2-4 ratio Used when the provider is providing job readiness, discovery and job preparation services for individual employment in the community
Community Career Planning Service Rates T2025 UQ NOW: $3.88/15 minute increment ROW: $3.88/15 minute increment Supports Waiver: $3.06/15 minute increment
Individual Supported Employment Future services: A new service array has been developed and will be added to the all 3 adult waivers in the coming year: Job Assessments- (3) Job Development/Placement Job Support/Stabilization Extended On the Job Supports Ongoing Job Follow Along (4x month)
Onsite Day Habilitation Day Habilitation Classification NOW, ROW and Supports Waiver T2021- Day Habilitation (1:5-8 ratio) Used when the provider is providing services onsite in day habilitation.
Onsite Prevocational Services Prevocational Classification NOW: T2019- 1:8 ratio/ 15 minute increment ROW: T2025-1:8 ratio/ 15 minute increment Supports Waiver T2025-1:8 ratio/15 minute increment Used when the provider is providing services onsite in career planning (updated prevoc service).
Group Employment Must make minimum wage Must work in a job that is integrated into the community and working alongside people without disabilities Must be doing job tasks that are similar to those employees who do not have disabilities Must have quarterly documented quarterly discussions around individual employment options Anyone who becomes employed in group employment setting after 3/17/2023 must have the expectation of going to work in an individual job
Questions Email any questions to ocdd-hcbs@la.gov
Resources Volunteering https://employmentfirstma.org/files/DDSVolunteer-Unpaid_Work-Feb17.pdf https://www.disabilityscoop.com/2021/06/25/zoo-program-teens-disabilities/29393/ Introduction to Community Life Engagement file://dhh-isb-fs01/User%20Folders/rmorales/Downloads/ici_community-life-engagement_feb2015.pdf file://dhh-isb-fs01/User%20Folders/rmorales/Downloads/community-life-engagment-guideposts.pdf https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost4_brief7_F.pdf https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost3_brief%206_F.pdf https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost2_brief4_F.pdf https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost1_brief4_F.pdf https://www.thinkwork.org/sites/default/files/files/CLE_issue9_F2.pdf https://scholarworks.umb.edu/cgi/viewcontent.cgi?article=1035&context=thinkwork
Progress is IMPOSSIBLE without CHANGE! Rosemary Morales Rosemary.morales@la.gov
