orientation for odp service providers · watch or not watch on tv. you choose where you will go...

Orientation for ODP Service Providers Person-Centered Practices: Webcast #2

Music only.

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This webcast includes spoken narration.

To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation.

The written version of the narration appears to the right of the screen.

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Certificates of Achievement will be available to all staff of Direct Care Provider Agencies and Supports Coordination Organizations after completing all course requirements.

Please view and then save or print your certificate in order to receive credit for this course.

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Hello, my name is Robin Levine from The Columbus Organization. This is the second webcast in a course of six webcasts developed on the topic of Person‐Centered Practices for all newly hired service provider staff including managers, supervisors, Direct Support Professionals, Supports Coordinators, buildings and ground staff and administrative support staff.

This training content is offered by the Office of Developmental Programs to meet the General Orientation training requirements specific to the topic areas identified in the 55 PA Code 6100 Regulations.

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In this webcast we will focus on identifying the benefits and value of choice and how to support making choices. We will review the importance of Informed Choice and Supported Decision Making as well as the connection between choice and risk.

So let’s get started.

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Being able to make choices is a basic civil right. Choice is not only a right, it is an essential part of who we are as human beings and something we highly value in our society. Having the opportunity to make choices is important to everyone, including people with developmental disabilities.

This webcast will focus on how you can support choice in a way that keeps the focus on the person.

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First – how many choices do you think you make each day? 5,000 choices? 10,000 choices? 25,000 or 35,000 choices?

Take a moment to make your selection. When you are ready, click the submit button to continue.

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Some estimates are that you can make as many as 35,000 choices each day! That’s an average of almost a choice every 2.5 seconds!

You choose what clothes to wear. You choose your friends and when you will spend time with them. You choose where you will live and who you live with. You choose what to watch or not watch on TV. You choose where you will go each day, how you will get there and what you will do. You choose what to eat, when you eat and who you will eat with. In fact, researchers at Cornell University found that you probably make over 200 choices each day just on food.*

*(Wansink and Sobal, 2007).

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Sometimes the choices you make are based on your preferences, choosing things that you enjoy, value or that have meaning to you.

Sometimes the choices you make are based on your needs; to make money, to stay healthy, to be safe, to belong.

Sometimes the choices you make are based on your desire to learn or do something different in the future; to go to school or vote in an election.

Sometimes the choices you make are not the best choices.

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Having the freedom and opportunity to make choices, even choices other’s may not agree with or may not be in your best interests, is a right everyone has. Having control over the choices you make and determining the things you want to learn and try is part of living. Making choices and learning from those choices helps you to become more independent in your home and your community and to have that everyday life we all look for. Having the freedom to make choices helps to keep you happy, safe, and content.

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In Pennsylvania, having the opportunity to make choices and increasing the opportunity for control and self‐determination are embedded in ODP’s Mission Statement. Choice is a key element within Everyday Lives and in the services that are provided through the Office of Developmental Programs (ODP). Our job is to support all of the people we serve to have choices about where they live, choices about who they live with and choices about what they do during the day.

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The opportunity to exercise choice and control is one of the elements that is measured in Pennsylvania through the annual Independent Monitoring for Quality process (or IM4Q). The IM4Q survey asks specific questions to measure the level of choice that people with developmental disabilities report they experience.

The chart on this slide shows that based on the 2016 IM4Q data, only 28% of people choose to vote, 71% choose what they do during the day, 49% of people choose where they live, 33% have their own key to get into their home, and 52% carry some form of identification card. While these numbers are an improvement from the past, we still have a long way to go to help ensure that everyone has the level of choice and control they deserve.

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How we make choices can vary.

*Sometimes the choices we make are more impulsive. If the first option seems acceptable, we go with it.

* Sometimes our choices relate more to just going along with the most popular or pleasing option or to please someone who is important to us.

* Sometimes we hand the decision over to someone we trust.

* Sometimes we choose to not choose, ignoring or avoiding making a choice.

* Sometimes the choices we make are made after weighing the alternatives, prioritizing the available choices or reflecting on past similar choices and results.

**https://go.roberts.edu/leadingedge/the‐great‐choices‐of‐strategic‐leaders

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https://go.roberts.edu/leadingedge/the-great-choices-of-strategic-leaders


Think about that for a minute. What are some of the choices you have made in just the last hour?

Did you chose when you would watch this webcast? Or where you would watch it or who you would watch it with? Did you choose to watch the webcast or read the print version? Did you choose to get a cup of coffee or a snack first? Did you choose the cup to use or whether you would add cream or sugar to that coffee? Did you choose to snack on a few carrots sticks or on some potato chips?

What other choices did you make?

Use the text box below to write down a couple of those choices and then think about whether those choices were impulsive, were based on a suggestion from someone else or to go along with what others were doing. Were there different options available for you to choose from? Did you leave any of these choices up to someone else? Were any of the choices based on balancing these choices with getting something else that is important to you? When you are ready, click the submit button to continue.

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One of things we have learned from researchers about choice is that regardless of the type of choice (impulsive, delegated, or choice based on priorities):

* People tend to choose situations where choices are available.

* People tend to participate more where choices are available.

* Having choices can sometimes improve a person’s performance.

* Opportunities for choice appears to decrease some problem behaviors.

* People tend to tolerate unpleasant situations more, when they have some choice or control.

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Think about choice in your own life.

* Would you choose a restaurant that only offered one option for dinner or a restaurant with a variety of meals to choose from?

* Would you be more willing to participate in an activity if you had a choice of who you did the activity with or if someone else made that decision?

*How might you act differently at an activity you chose to participate in rather than one where the choice was made for you?

* What if there was a task that needed to be done, but it was not something you particularly enjoyed? Maybe it’s washing dishes or going to the doctor. If you had a choice in the time of day or who would be with you, would that make the activity at least a bit more bearable?

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Having choices and making choices is more than just choosing between Option A or Option B. Making choices is a skill that is learned through life experiences and developed with practice. We might start with few choices such as what cereal to eat for breakfast or what television show to watch. As we gain experience some of the choices we make can get more complicated. For example, what car to buy or where to live.

We know that many people with a developmental disability have not had the opportunities to develop that skill in choice‐making. Maybe others have made those choices for them in the past or didn't share information about the choices available resulting in the person not knowing what to choose for themselves.

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Without the experience of making choices or the understanding of what the choices are, it can be like picking a door without knowing what’s behind it.

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If your lucky, the door you pick could lead to something you wanted or will really enjoy.

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But your choice could also lead to something you didn’t want or won’t enjoy.

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Successfully making choices not only requires having the opportunity to make choices, but also understanding the choices available and having the experience to make choices. This is sometimes referred to as “Informed Choice”.

Informed choice is what most people use to make a decision. Outside sources (the internet), experience (I’ll never do that again), and trusted advisors (talking to friends) are called upon to understand the options available, the possible consequences or impacts, and the reasons for a course of action. With the help from people and information, the person making the choice can understand the options available.

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Simply saying that ‐ this is the person’s choice ‐ is not sufficient if the person does not have all the information on the alternatives and potential consequences to make the best choice. To ensure that the individual can make an informed choice, the people in the person’s life need to describe as many of the potential results of the choice in a way that helps the person to best understand the opportunities and consequences of the choice that he or she is making.

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Regardless of your role or job responsibilities, you are likely to have an opportunity to help the person your organization supports to learn to make choices. Supporting choice in a person‐centered way requires a level of trust that builds over time in large and small ways. The person you support grows to trust you because you know and respect their likes and dislikes, their preferences, and you encourage and demonstrate for them how to stay healthy and safe.

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For example: You walk into the breakroom and you see Vicki at the vending machine, and she seems to be overwhelmed by the number of choices. You offer to help asking,

“What kind of candy do you like?”

She answers, “Chocolate.”

Ok – there are several things that have chocolate.

“Is there anything you don’t like?”

“Well I can’t have anything with peanuts.”

You point out the four possible choices remaining at which point Vicki says, “I like cookies.” and she chooses the Oreos. She says “Thanks” as she walks away smiling and opening her purchase.

You have just helped Vicki to make an informed choice.

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Helping people to make choices also includes understanding their experience and ability to make choices.

As I mentioned earlier, people with developmental disabilities may not have had a lot of opportunities or life experience in making choices. Open ended questions like “what do you want to do tonight” could be overwhelming if they have little experience choosing activities. For someone with little experience making choices, narrowing it down to two or three specific choices might work better. (Would you like to go to the park, go to a movie, or stay home and play Uno?)

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Supporting choice also includes understanding what the person may know or not know about the available choices and providing opportunities to experience these choices so that the decision is easier to make in the future. Encouraging people to try new things, new activities, new foods, new hobbies, music, trips, or sports, all help to build the life experience of the person so that they can make better, more informed decisions in the future.

Sometimes when supporting choice, the people who are providing support may not have the knowledge or experience to help the person to make that informed choice. When this happens we need to look for other people, opportunities and resources to get more information to help ensure that an informed choice can be made.

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Let me give you another example. I was recently at a restaurant with Derek. Derek doesn’t use words to communicate but pointed to the picture of a hamburger that included sliced avocado as a topping. I had never seen Derek eat avocado and wasn’t sure if he would like it or not.

“Have you ever tried an avocado Derek?” He shook his head no.

“How about trying a small piece first before deciding if you would like it on your hamburger?” He nodded in agreement.

I asked the waitress if she could bring a small slice of avocado for Derek to try. When she brought him the avocado, Derek took a bite and immediately made a funny face. This was definitely a new taste for him.

“Did you like it Derek?” Derek shrugged his shoulders.

“Do you want it on your hamburger?” Derek made that same funny face and shook his head no.

“OK, we’ll order the hamburger, but without the avocado.” Derek smiled and when his dinner arrived, he definitely enjoyed all of it.

With this new experience, Derek was able to make an informed choice and we learned something new about what he likes and dislikes.

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Supporting choice also includes understanding how the person may communicate their choice with their words AND with their actions. Their words may say door 1 because they think that’s what you or others want to hear, but their actions show you that they actually want door 2. We’ll talk more about understanding people’s communication in the next webcast.

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Everyone needs information and supports at times to make decisions. But people with disabilities may need more or different kinds of supports. Giving people with developmental disabilities the help they need to make their own choices is called Supported Decision Making.

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Imagine that you want to find a place to live, but don’t know how to make decisions about what you can afford, or what kind of apartment would be a good place for you to live. So you ask your sister for help.

* Your sister asks you questions about what kind of apartment you want.

* She listens to you about how much money you earn and how much you spend on other things like food and clothes.

* She helps you figure out how much money you can afford to pay in rent.

* Maybe she helps you understand that an apartment, with all of the things you want, could be too expensive for you to afford and helps you figure out which of the things you want are the most important to you.

* Then she helps you look for apartments and maybe even helps you make a few calls.

* She may even visit the apartments with you.

In the end, you understand the choices you have. You decide which apartment you want and you sign the lease. You have received a lot of support, but you still made all of your decisions.

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**The Right to Make Choices: Supported Decision‐Making – Julia Bascom – PATC 2016

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If you don’t provide direct support to people with a developmental disability in your job, but you help maintain the building or work in the office, you can still help someone to make an informed choice. Maybe they are trying to decide what kind of job they want to get and would like to have a chance to watch what you do or even try it out with you to see if that is something they would enjoy. Maybe you enjoy exercising and the person is looking for a gym or exercise group to join and you can provide some information about the opportunities available in their community.

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Sometimes the choices we make may not be the best choice for us because the best choice is unpleasant. You may not like cleaning your house or taking out the trash, but to be healthy and safe, this is something you have to do. Also by cleaning your house, you will provide a welcoming and comfortable place for your family and friends to visit.

Supporting good choice‐making can mean finding ways to make those unpleasant choices just a little bit more tolerable.

Think about it this way. Has there been a time in your life where you had to choose to do something that was unpleasant or was not particularly enjoyable for you? Did you make a point of doing something afterwards that you really enjoyed to compensate for it? Maybe you treated yourself with some ice cream, or met a friend for coffee, or went to your favorite store and bought something for yourself that made you feel a little better.

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Here’s an example of how you might use this same strategy for someone you support.

Ashley has some medical issues that need to be closely monitored for her to stay healthy. She really dislikes going to doctor appointments, especially when those appointments might require a shot, bloodwork or an exam. These appointments can make for a really bad day for Ashley and she could choose not to go and put her health at risk. But Ashley loves being around animals. She loves to watch, feed, and pet them.

When Ashley has a doctor’s appointment, the people supporting her make sure to plan an activity with animals after the appointment. A trip to the zoo, an animal shelter, or just visiting a friend who has dogs. Ashley wants to keep healthy but still dislikes having to go to the doctor. Knowing that after the appointment she’ll be able to spend time with animals, makes choosing to go to the appointment a little bit easier.

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Just because choice is a right, does not mean that the choices we make take precedence over the rights of others.

For example. I can choose to drive my car down a residential street at 55 miles per hour when the speed limit is 30 miles per hour. That speed limit may be established because of the number of children and pedestrians in the area and to protect their right to be able to cross the streets safely in their neighborhood.

Your right to choose to speed down that street does not give you the right to endanger others and will not get you out of the speeding ticket.

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But when choice is involved, there is always a risk. Risk of failure, risk of being harmed or harming others, risk of endangering our health and safety are factors to be considered in making choices. Like the speeding example, sometimes there can be consequences for the choices we make. Sometimes the choices we make may not be the choices others who care for us would choose because of those risks and consequences.

The risks that may come with some choices shouldn’t be ignored, but they shouldn’t keep us from making those choices either.

Think of a choice that you made that maybe wasn’t the best choice. Things did not turn out the way you thought they would. If you had to make that choice again, would you make the same choice or would you choose differently?

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Even when we don’t make the best choice, we can learn from the experience. The next time we have that choice, we will have more information and will hopefully make a better decision.

Without having the opportunity to make choices, and sometimes take chances, there is no opportunity to learn, to grow, and to change.

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One strategy to help figure this out is to ask three basic questions:

* What would the impact be on the person if we do nothing about the potential risk of the choice?

* What opportunities for the person would be lost if we don’t support the person to make a choice that includes risk?

* What alternatives could be offered that would allow the person to make an informed choice but minimize the potential negative impact of the risk and lead to new opportunities for choice?

Let’s look at an example of how this strategy could work.

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This is Josh. Josh is 23 years old and has been going to the same barber shop for years with his support staff or his Dad. Josh is a man of few words but when he chooses to use them it can be a challenge for people to understand what he's saying. Josh loves going to his neighborhood barber shop and when he’s in that barber shop; they get him. Everyone knows Josh’s name. He does the “fist bump” with all the barbers and has a special greeting for Tim, the barber who regularly cuts his hair. Josh also likes to be independent. Recently his Dad and support staff have noticed that Josh doesn’t seem to want them around when he is at the barber shop. He may motion to them to leave after a few minutes and even gently block them from entering the shop.

Josh appears to be choosing to stay at the barber shop without the support of his Dad or staff. Josh’s family is concerned about allowing him to make this choice.

*What if Josh did something dangerous while at the barber shop without support?

*What if the other guys in the barber shop don’t understand something that Josh says?

*What if Josh decided to leave and there was nobody there to help him get home?

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But his family and supporters also realized that being more independent is something Josh values. He wants to make this choice to be in the barbershop without his Dad or support staff. Josh being able to go to places in his community without support could relieve some of the stress for his family. And the guys at the barbershop seem to truly like Josh and enjoy having him there.

You have an idea of some of the concerns and that this could be an opportunity for Josh to make the choice to be more independent. What alternatives could they try that might support Josh’s choice‐making while keeping him safe and remaining welcome at the barbershop?

Take a moment to write down some of your ideas. When you are ready, click the submit button to continue.

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One option his team came up with was using Josh’s cell phone. Josh had already learned to send a basic text message. After some planning and practice everyone agreed that when Josh was dropped off to get his haircut and hang out in the barbershop with the guys, he would take his cell phone. If he chose to stay there alone, when he was ready to leave he could send a text message and the person supporting him would be nearby and come pick him up within a couple minutes.

Maybe you had a similar idea. Maybe you had a different idea. That’s okay too. The important thing is that the people supporting Josh were able to identify an alternative that allowed Josh the opportunity to choose to be more independent and still be safe.

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Being person‐centered means understanding how and why people make choices. Being person‐centered is about supporting people to make informed choices where the risks and benefits are understood and the person has the freedom and opportunity to experience and live their personally defined good life.

Regardless of your role or job responsibilities, look for opportunities to help the person to gain the experience and knowledge they need to make informed choices. When you do, your efforts to support choice‐making can improve the amount of control and independence in the person’s every day life. You will make a difference.

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This concludes the second webcast on the Orientation for ODP Service Providers: Person‐Centered Practices. Please be sure to watch all six webcasts and complete all the course requirements in order to obtain your Certificate of Achievement and training credit.

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This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

Thank you for participating in this lesson.

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