Slide 2 (of 64)

Welcome to the Training Partnership

Housekeeping notes for the day: • Cell Phones• Elevators are located…• Ramps & automatic doors are located…• Schedule including breaks…• Act 48 Credits…• Certificates of Completion…• Follow-up Surveys and Evaluations…• Reimbursement…• Questions

Developing a Good ISP

Transition ConferenceJuly 23, 2009

Slide 4 (of 64)

The Pennsylvania Training Partnership for People with Disabilities and Families

• Achieva

• Institute on Disabilities at Temple University

• Mentors for Self Determination

• Self-Advocates United as 1

• Vision for Equality

Five organizations across the state are working in unison

to bring trainings on the Mental Retardation system to

people who receive supports through this system. They

are:

The Partnership in Pennsylvania

Slide 6 (of 64)

The Partnership is funded by theOffice of Developmental Programs (formerly

the Office of Mental Retardation), Department of Public Welfare.

This presentation has been reviewed and approved by the

Office of Developmental Programs (ODP).

Slide 7 (of 64)

What Will You Learn Today?• What is an Individual Support Plan (ISP)?

• How is the ISP used?

• What kind of information is included in a plan?

• What is an outcome?

• How do I write outcomes that will lead to the life I want?

™ Supports Intensity Scale 2004 AAIDD

Slide 8 (of 64)

Knowledge is power.

When We Think About What is Important to Us in Life, We May Think of:

Everyday Lives

CommunicationCommunity Inclusion

Source: Everyday Lives, Making It Happen Booklet, November 2001, Pennsylvania Department of Public Welfare, Office of Developmental Programs

Slide 10 (of 64)

What Is An Individual Support Plan (ISP)?

• The ISP is a planning document.

• In collecting rich and vital information about a person, the ISP can be a supportive document.

• The ISP is a tool to outline supports and services to drive a good quality of life.

The ISP outlines, through outcome statements, the actions people need to take to ensure a safe, healthy and happy life for a person.

Slide 11 (of 64)

Why is an Individual Support Plan Important?

Because:• It is a plan to support the goals and dreams of a person.• It is a plan to make sure all of your needs are met.

• It is the contract between the person and the Administrative Entity/county for the supports and services.

Slide 12 (of 64)

What Should Happen at Individual Support Plan Meetings?

• People come together with the person to talk about what is important to the person and what he or she wants his/her life to look like.

• All important aspects of life should be discussed; all the person’s needs, health, safety, medical, etc.

• Identifying services and supports that will help support a person’s choices.

• Most importantly, the team will make commitments to action, so that the plan will actually happen.

Slide 13 (of 64)

Who Do You Think Should Be Part of the Team?

Slide 14 (of 64)

who have information that

will help reach the person’s goal who are willing to teach

the person a new skill

who support the person

who are willing to take action on the person’s

behalf

who can help the person make his or her vision for the

future happen

whose opinions the person valuesPeople:

Who Should Be at the ISP Meeting?

who may share a common

interest

Slide 15 (of 64)

Can People Who Don’t Use Words To Talk Participate in their

Individual Support Plan?

?

Slide 16 (of 64)

“Nothing About Me Without Me!”

Team members must honor and expect that:

• ALL people for whom ISPs are completed can contribute to their meeting and ISP development.

• ALL people for whom ISPs are completed can drive their ISP meetings.

Slide 17 (of 64)

Promoting Full Participation and Leadership at the Meeting

• Self-advocacy – start young with membership on teams.

• Communication tools – systems, devices, therapies to assist with communication.

• Communication chart – tool to help us understand what is being said.

Slide 18 (of 64)

Promoting Full Participation and Leadership at the Meeting (cont.)• Essential Lifestyle Planning (ELP)

tools – many tools to help us learn about a person and what is important and meaningful to a person.

• Decision-making tools and systems – to help people make choices about their lives.

Slide 19 (of 64)

An Individual Support Plan (ISP) is a plan developed by the person and his or her team to assist in gaining the support the person needs to live the life he or she envisions.

Vision of the Future

Slide 20 (of 64)

Exercise: Vision for the Future

Think about what is important to you or your

family member. Think about the values you or

your family member holds. With those in the

back of your mind, imagine what life looks like

5 years from now.

Slide 21 (of 64)

Creating a Good Plan• People who are involved in the

planning process need to really know the person.

• The person’s plan addresses all his or her identified needs.

• The person’s plan for the future must be clear and respected by all.

• Think creatively about all of the ways someone could be supported to live the life of his/her choosing.

The Planning ProcessGATHERING

INFORMATION

PUNS IM4Q

SIS and PA Plus

Person-Centered Plan

Other assessments

PUTTING ISP INFORMATION TOGETHER—

Team input

Outcomes/goals

Identify supports

FUNDING FOR ISP

Slide 23 (of 64)

Some Things to Think About For the Plan• Home living • Community living • Employment• Health and Safety• Teaching and Education• Behavior• Social• Protection and Advocacy

Slide 24 (of 64)

Let’s Look at the Individual Support Plan

• Individual preferences• Medical• Health and Safety• Functional Info• Financial• Services and Supports• Monitoring

Slide 25 (of 64)

Individual Preferences

What makes sense

Desired activities

Know and Do

Like and Admire

Important TO

Slide 26 (of 64)

Like and Admire

• Include what other people think!– What qualities do we

admire about the person?– What personality traits do

we like?– What makes this person

unique and valuable?

Slide 27 (of 64)

Know and Do• Details about what we KNOW about the person.• Details about how what we know influences

what we DO.• Make sure the DO section of the plan is strong.• If done right…

• Helps prevent people from teaching the same things over and over.

• Can really help ensure that people get support the way that works best for them.

• Important that it is written in plain language.

Slide 28 (of 64)

Desired Activities• The person’s interests and vision should lead the

discussion.• Should reflect the person’s likes.• Never include what other people think!

– What does the person enjoy? – How does he/she like to spend his time? – Where would they like to live or work?

NEXT STEP: Ask how can we increase opportunity for desired activities that will enrich his/her life?

Slide 29 (of 64)

Important TO• Consider all areas of life:

– Friendships and relationships – Living arrangement– Employment opportunities or current job situation– Spiritual or faith community

• Could include information about what kinds of people I need to support me.

• Never include what other people think should be important!

Slide 30 (of 64)

• All people balance what is important TO them and what is important FOR them.

• Important TO are things that really matter to someone.

• Important FOR are things to keep someone healthy and safe.

Balance of Important TO and Important FOR

Slide 31 (of 64)

Balance

Created by The Learning Community for Person-Centered Practices

Slide 32 (of 64)

What Makes Sense• Gathers information from different perspectives

about what is currently working in a person’s life.– Use individual’s perspective– Use the family’s viewpoint– Use the support staff’s or friend’s viewpoint

• Also gives insight into things that are not working or don’t make sense.

• This will help inform outcomes later on in the planning process.

Slide 33 (of 64)

Medical• Names of various doctors and their

contact information

• Prescription/medication information

• Do you take your medicine independently?

• Allergies

• Track appointments and frequency of doctor visits.

• Brief Medical History

Slide 34 (of 64)

General risks and safety precautions

• Fire safety• Traffic safety• Kitchen safety

Water safety (including

temperature regulation)

Outdoor appliances

(for example, lawn mower)

Self-identifying information

Health and Safety

Sensory Concerns

Slide 35 (of 64)

Supervision: intensity and

staffing

Behavior support plan

Stranger awareness

Meals/eating

Who is designated to support the person in making health care

decisions?

Health promotion

Health and Safety

• Learning conflict resolution skills

• Learning about social expectations and social boundaries

• Knowing how to act in different places

• Accessing and obtaining mental health support like counseling and therapy

• Knowing when to get support if things are not going well

• Controlling anger and aggression

How Will the ISP Help the Individual If There Are Behavioral Concerns?

Slide 37 (of 64)

Functional Information• Physical development

• Adaptive/self help

• Learning/Cognition

• Communication

• Social Emotional information

• Educational/vocational information

• Employment

• Understanding Communication

Slide 38 (of 64)

Understanding Communication

It is essential that everyone understands what someone says and how they say it. This section should be clear, concise, and detailed!

Communication ChartWhen this is happening (or just happened)…

I do this…. It usually means…. And I want you to…

#3• In the environment

• What’s just gone on

•The “trigger”

#1 (or 2)• The behavior

• What others notice

• Can be seen, heard, and felt by others

#2 (or 1)• Meaning of the behavior

• What the emotions and feelings are

• What’s going on inside

#4• What other people should do in response

• Or not do…..

Slide 40 (of 64)

Exercise: Understanding Communication

• Use the chart from the ISP section called “Understanding Communication” to write out a couple of ways that either you, a family member or someone you know communicates without words.

Slide 41 (of 64)

Financial Information

• This section describes a person’s income and any financial management issues.

• It also looks at available resources, such as bank accounts.

• People with disabilities need to be aware of the limits on income and resources that may affect their eligibility.

Slide 42 (of 64)

What is an Outcome?

Outcomes shouldreflect the priorities,dreams and hopes of the person.

Slide 43 (of 64)

Use phrases that link the needed service to the goals or desires of the individual:

“…in order to…”

“…so that…”

“…to ensure that…”

“…to enable her to…”

Developing Outcome Statements

What are examples of outcomes important to you or your family member?

Slide 44 (of 64)

Supports and Services: Outcome Actions

OUTCOMES… SERVICES and

SUPPORTS……are used by your

Supports Coordinator,

based on your input, to

determine which

services and supports

are needed and funded!

…are directly tied to

one or more of the

outcomes and should

promote the outcomes!

Slide 45 (of 64)

The Outcome Actions section is where you talk about what needs to be done.– What are the needs?– What steps need to be taken to achieve the outcome?– Who is responsible?– How often and for how long will the action be needed?– How will we measure progress?

Supports and Services: Outcome Actions

Slide 46 (of 64)

How Do Outcomes Relate to Services and Supports?

• Using outcomes as the guide, the team determines what services and supports are needed.

• Remember services and supports are directly connected to one or more of the outcomes.

• Services and supports must outline the actions needed to promote the outcomes.

• “Outcomes supported by MR funding must be within the context of the health and safety of the person and assuring their continued life in the community.”

Slide 47 (of 64)

After the ISP is written, with

outcomes and the supports and

services needed to achieve

them, the budget is drafted and

attached.

Slide 48 (of 64)

Your Budget Should Be:• Developed with the Supports

Coordinator; • Submitted to the Administrative Entity

(AE)/county;• Once approved by the AE/county,

returned for your records.

Once your plan is AUTHORIZED and APPROVED, you can

start making contact with qualified Medicaid waiver

providers to secure the supports and services outlined in

your ISP.

Slide 49 (of 64)

If You Have A Waiver…

• The ISP is your plan for services and supports and must be approved by the AE/county.

• Authorized services in the ISP must be provided.

• If they are not provided, you can request dispute resolution, and/or Fair Hearing.

Slide 54 (of 64)

Remember Tips for Creating a Good Plan

• People who are involved in the planning process need to really know the person.

• The person’s plan addresses all his or her identified needs.

• The person’s plan for the future must be clear and respected by all.

• Think creatively about all of the ways someone could be supported to live the life of his/her choosing.

Slide 55 (of 64)

A Good Plan Should Help Us Answer These Questions:

• Can we describe the person to a stranger so the stranger might say I would like to meet that person?

• Can we name 5 of the most important things TO that person?

• Does everyone close to that person know what the person’s vision is for his/her life in 6 months, 1 year…5 years?

• Does everyone know his/her role in helping that person to live the life that s/he wants to live?

Slide 58 (of 64)

Your Plan Should Be A Life Story…

YOUR life story!

Everyone should have a

plan whether or not

there is funding

available.

Slide 57 (of 64)

What If I have Questions About the Individual’s ISP?

• Contact the Supports Coordinator.

• If something needs to change, gather the team and have a new meeting to address the issue.

• ISPs should change with the changes in a person’s life.

Slide 59 (of 64)

Knowledge is power…

USE IT!

Slide 60 (of 64)

The Learning Community for Person-Centered

Practices for all the tools they continue to give us

and the use of some of their concepts and graphics

for this presentation.

The Picture Communication Symbols™ ©Mayer-

Johnson LLC. All rights reserved worldwide. Used

with permission.

Special Thanks To:

Slide 61 (of 64)

Thank you!

Slide 62 (of 64)

Resources

• ODP Customer Service 1-888-565-9435.

• Community Advocates working out of the regional Disability Rights Network offices – #1.800.692.7443 or www.ppainc.org

Slide 63 (of 64)

ResourcesPerson-Centered Planning Resources• www.elpnet.net• www.inclusion.com • www.allenshea.com/friendsCircles of Support

www.circlesnetwork.org

www.TheTrainingPartnership.org