IN OUR COMMUNITIES:
A STUDY OF VARIABLES
CRITICAL TO SUCCESS
• Literature Review
• Three Agency Review
– Behavioral Institute in Los Angeles
– Community Agency in Eugene Oregon
– The HOME Society in Abbotsford BC
SUPPORTING INDIVIDUALS WITH
INTELLECTUAL DISABILITIES AND
IN OUR COMMUNITIES:
A STUDY OF VARIABLES CRITICAL TO
A PARTNERSHIP BETWEEN
ELMWOOD RESIDENCES` INCORPORATED
AND COMMUNITY LIVING DIVISION,
SASKATCHEWAN SOCIAL SERVICES
1. Philosophy of the Organization
The philosophy of the organization is
clear and guides all actions. It
embraces a total commitment to the
provision of supports individuals
require to live meaningful, satisfying
2. Quality of Life
Quality of life is the focus of supports.
Measurement of quality of life includes the
amount of choice and control individuals
have over directing the course of their lives,
the development of meaningful social
relationships, and community integration.
3. Committed Leadership
Committed leadership is provided by
informed and involved individuals within
the organization. The leadership knows the
individuals in their program, what their
needs are, and whether or not they are being
successful in supporting these individuals.
Leadership ensures the program upholds its
4. Recognition of the Contribution
of Front Line Staff Members
The organization recognizes the contribution
of front line staff members in the provision
of supports to individuals they serve and are
committed to supporting front line staff
members in the fulfillment of their jobs.
5. Person Centered
Person Centered Planning places the
individual at the center of planning and
focuses on the individual's abilities,
preferences and desired lifestyle outcome.
Planning occurs within a team comprised of
the individual, friends, family and staff
members. Inclusion on the planning team is
dependent upon a close relationship with the
individual requiring supports.
6. Individualized Responsive
and Flexible Supports
Supports are individualized, responsive and
flexible. Individuals receiving supports are
not expected to change to fit into the
program, rather the program adapts and
changes to better meet the needs of the
individuals it is supporting. Size of delivery
unit is important in maintaining the intimacy
required for the provision of individualized,
responsive and flexible supports.
7. Context of
Community Living Options
Programs are delivered in the context of
community living options. Individuals
receive the supports necessary to live in a
regular range of residential options and
participate in community life.
8. Flexible Funding
Funding is flexible and based upon
individual planning and assessment
9. Supports to
Front Line Staff Members
Supports to front line staff
members include training, the
availability of expert resources,
assistance in the development,
implementation and ongoing
evaluation of support plans.
10. Ongoing Assessment,
Review and Adjustment of
There is a commitment to ongoing
assessment, review and adjustment
of support plans. Review on an
ongoing basis ensures the
environment is best meeting the
needs of each individual requiring
Summary Statements: Philosophy
and Guiding Principles
• Programs supported individuals to live the lives
they wanted to live.
• There was a commitment to each individual so that
if things went badly they were not excluded from
the agency's supports.
• It was critical that one philosophy permeated the
organization and was part of the organization's
Summary Statements: Administration
• Most programs served a limited number of individuals and
wanted to remain small to maintain a personal touch
• In a larger organization, teams served a limited number of
individuals to personalize each individual’s program
• Staff members had a valued role in all aspects of programming
• Decision making was based on a participatory model using
planning and advisory groups and circles of support
• Staffing structure was hierarchical with an executive director,
supervisory and front line members
• The management staff were knowledgeable about the
individuals in the program and had direct input into the
individualized program development process
• The board varied in size and included family; professionals
from related fields; neighbors and community at large
Summary Statements: Funding Models
• Regardless of funding model the agencies were accountable to
meet the individual's needs.
• In most cases funding was initially linked to the individual's
needs determined by pre-admission assessment.
• In general, funding fell into two categories:
– Grant funding to an agency or program responsible to operate a program
for a specific population.
– Individualized funding where funds were directly linked to an individual
and followed that individual.
• Several funding models and options were identified. These
included program grants, individualized funding, service
brokerage, micro boards, for-profit business and Co-
• Programs based on individualized funding stressed the
importance of separating shelter, food and clothing from
program support costs.
Summary Statements: Evaluation of
Program and Outcomes
• Staff members understood the desired program
outcomes and how well the program was achieving
• Assessment was related to outcomes that were of
value to the individual.
• Not all organizations formally assessed their
programs; those that did regarded this as an
Summary Statements: Family Involvement
• Programs tried to maintain or increase family
involvement similar to relationships with other adult
• Family involvement included planning
supplemental funding, reciprocal visiting, staff
hiring, educating and participating on the board.
Summary Statements: Population
Movement and Linkages
In the very few instances where service had been
discontinued, it was because of illness or death,
moves to be closer to family, or philosophical
differences between program and family.
• Generally admissions had been primarily from
family residences and institutions.
Summary Statements: Assessment of and
Response to Community Needs
• The organizations did not have a mandate to
formally assess and plan for the community's future
• Organizations readily responded to needs presented
to them but were not proactive regarding long-term
Summary Statements: Relationships
with Other Professional Services
Programs had different levels of internal expertise
for specifics such as behavior technology and
• The programs accessed services within the
community but arrangements varied from site to
• At some sites community based professional
services to the individual were delivered at the site
Summary Statements: Admission and
• Program populations were stable with limited
admissions and few discharges.
• Most admissions were based on government agency
• Organizations did not have waiting lists; these were
maintained by local or regional government
• The pre-admission protocols were extensive and
varied from formal to less formal.
• Discharges for behavioral reasons were very rare.
A Focus on Change
We were committed to changing
– Our Agency
– Our Processes and
– Our Selves
• Need to provide 24/7
response by Coordinators
and Ex. Dir.
• Fluid response and
transitions – no failures, no
more revolving doors, use of
in home emergency respite
• Commitment to work closely
with external agencies;
Police, 911, Emergency
Services, Mental Health,
Forensics, and Courts
• Gentle Teaching Philosophy
• Warmth – 1,000 hugs a day
• Support Families - No more blame
• Change language- Companions, care givers, those
we support, the person you hangout with.
• Use of Mentors
• Welcoming Neighbors
• Constant Evolution of HOMES
• The HOMES family – Life time commitment
Change our own lives
• Keep each other safe and valued
• Open our homes to those were support
• Involve our families – GT is a Way of Life
• 24/7 response from managers
• Reach out to families and neighbors
• Mentor and honor our care givers
• 1,000 hugs a day for our own families and
those we support.
Our dual Focus
1. Those individuals coming from
years of institutionalization
2. Young folks who repeatedly
failed to live in the Community.
Often FAS, may live with
Personality Disorders, Dual
Diagnosis, often known to the
Those individuals coming from years of
Gentle Teaching is many things. Gentleness toward others, in spite
of what anyone does or does not do, is the critical factor. It is a
Fists are met with hugs. Cursing is met with words of affection and
nurturing. Spiteful eyes are met with warmth.
Gentleness recognizes that all change is mutual and interwoven. It
starts with caregivers and, hopefully, touches those who are
most marginalized. Its central focus is to express unconditional
The main idea of gentleness is not to get rid of someone else’s
behaviors, but to deepen our own inner feelings of gentleness in
the face of violence or disregard.
Transition from Institution
Visits to Institution
Reports tell the worst
Use an informal friendly approach
Which care givers are the favorites?
What’s the off the record description?
New home preparation
Martha Stewart approach- colors, texture, smells, sounds, lighting, and furniture
Food- snacks, drinks, treats, varied locations Use food to explore home and
Food becomes a way of connecting
Group gathers to honor and Welcome new arrivals. May
include drumming and smudging ceremony.
The Young and the
• Have a history of problem solving by running
away or getting tossed from programs.
• Don’t hesitate to test out what the boundaries are.
• May be addicted to alcohol and drugs
• Thrive on excitement
• May not hesitate to steal or sell personal property.
• May exchange sex for drugs or alcohol
• Cells, text messaging, chat lines and MSN are a way of life for these
• Don’t learn from past mistakes.
• The young women can be surprisingly violent. The women usually have
limited police or court response. “They have tried to charge me 156
times and it was always thrown out. You can’t do anything to me”
spoken to a Police Psychiatrist.
Fast Paced Response
• Challenging situations quickly go from line care giver to team
leader to coordinator to ED and or directly to 911- This can be
self initiated. It is not uncommon for the excessive use of
stimulants like tobacco alcohol to proceed a crisis.
•Response must be warm and caring - assuring that
all are safe and loved
•Rush to the crisis but walk through the door.
•Line care givers need 24/7 response if the
revolving door is to be stopped.
•Don’t provoke violence
•Less talk, slow the pace, sit down, model cooling
things down, share some tea, make few demands
• In the same evening 911, Police,
hospital emergency, and mental health
services may all be involved – the
need for a plan and protocols is
• To complicate life, the above agencies
have rotating staff often working 12
hours shifts and one rarely sees the
same people or professionals twice.
• Use appropriate generic services as
required or requested but keep a line
of communication open with liaison
staff and remind all of protocols. Don’t
abandon some one in an ambulance or
• Remind them that you are there to
keep them feeling safe and loved.
Nurture with food, words and touch 32
• Downplay the crisis. Walk in as if you
are just visiting – greet with hugs
• Use a tag team approach to give relief
• Broaden the space for movement.
• Work to reconnect the care giver.
• Ignore the incident if possible – clean up and get on
with life. Use the cleanup as a way of connecting.
• In extremes be prepared for suicide attempts after
• Use emergency respite to avoid crisis rather than a
response to crisis.
• A crisis can come on fast but be over in 10-15 minutes.
Provide face saving options – go for a coffee, make a
phone call etc.
• Don’t attach blame – tough times are part of all out
• Use humor. Bring the energy down.
• Value care givers through verbal praise, emails, team
meetings and lots of hugs
• In the middle of a crisis at the emergency ward it is not
uncommon for the person to decide to go home.
• Thank the hospital staff before heading home.
• Even in a crisis it is important that everyone feel
SAFE, LOVED, ENGAGED and LOVING
Prayer of Saint Francis of Assisi
Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
and where there is sadness, joy.
O Divine Master, grant that I may not so much seek
to be consoled as to console;
to be understood as to understand;
to be loved as to love.
For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life. Amen
Thanks for your time
1) When the person presents a danger (e.g., sexual attacks, house burning, severe aggression) what do you
do? How do you respond? Your house, Dave's, sometimes jail, sometimes a hospital)
2) How do you make sure no one gets hurt--the person, staff, the neighborhood, the community at large?
3) How do you teach everyone Gentle Teaching and keep it up over time?
4) How do you make a culture of Gentleness?
5) How do you, or do you, write this up?
6) How do you get accredited?
7) What is your cost?
8) What does a culture of gentleness look like at HOMES?
9) What kinds of environmental modifications do you do to protect or slow down someone?
10) How do you make sure staff are gentle?
11) How can you create a system that cuts through all the bureaucracy and still meets basic regulations?
1) When the person presents a danger (e.g., sexual
attacks, house burning, severe aggression) what
do you do? How do you respond? Your house,
Dave's, sometimes jail, sometimes a hospital)
2) How do you make sure no one gets hurt--the
person, staff, the neighborhood, the community at
• Focus on the person – build a life
• Best Care Givers work with the newest and
potentially the most challenging
• Flexible scheduling
• Dual coverage using managers
• Side by side homes
• Good fences
• Hire Neighbors – teens
• Play out scenarios - chess 39
3) How do you teach everyone Gentle Teaching and
keep it up over time?
• Go for the heart – lots of hugs
• Begins with hiring
• Receptionist’s role is to greet warmly with hugs
• Office is a center of warmth and caring
• Surround ourselves with partners who are also warm & caring
• Ladybug Organics, Valley Water, Habitat for Humanity, Rose’s
Flower Shop, Cob’s Bread etc.
• Lots of Family events
• Create ambassador’s of Gentleness - Tasha
4) How do you make a culture of Gentleness?
• What is culture – Tradition, Food, Music,
Gatherings, words, photos, video, etc.
• Celebrations – Entire community
• We don’t do fund raisers – we ask for help and
ask what we can do in return
• Lots of warmth
• First Nations circles and ceremonies have taught
• Encourage our care givers to share their cultures
• Encourage family visits to care giver homes.
5) How do you, or do you, write this up?
• 250 page RFPs
• Stop focusing on programs
• Don’t do RFPs anymore
• 5 Video’s, many thousands of photos, let those we serve
and their families act as the spokes people for HOMES
• Lots of web sites GTI for last 12 years
• CARF – Behavioral Standards – Former Restraint and
Seclusion – Now “Non Violent Practices”
• Emails to CLBC
6) How do you get accredited?
• Wow – Accreditation Canada
• You are welcome to any thing we have
• Heading toward CARF but want to combine
standards. Behavioral Health and Community
• ShareVision – Technology and warmth.
• Our restraint and Seclusion Policy is
E.140 Restraint and Seclusion Policy
The H.O.M.E. Society follows the practices and philosophy of Gentle Teaching
and therefore does not support restraints, seclusion or restrictive practices.
We believe in teaching by example, providing direction, and giving praise.
The H.O.M.E. Society will not approve of any of the following interventions for
managing the behavior of the men and women we support. Examples of
restrictive methods include, but not limited to:
Exclusionary time out
Seclusion time out
Deprivation of basic Rights
Punitive withdrawal or restriction of food.
7) What is your cost?
• 4 Person Home
• 2 Person home
• 1 Person home
• Supported Family Care
8) What does a culture of gentleness look like at
• In the moment
• Warm greetings and partings
• Teaching our companions to be warm and loving with others
• Looking for opportunities for relationship and community
• First time interviews
• “Wow! – He or seems to be a good fit for HOMES”
• Welcome ceremonies.
• Gifts, photos, testimonials
• Newsletter totally created by caregivers and their companions
• Warm greetings for visitors
• Mini Videos
10) How do you make sure staff are
• Begin at recruitment
• Model and Mentor
• Repeat values
• Photos and Videos
11) How can you create a system that cuts through all
the bureaucracy and still meets basic regulations?
• Keep then safe and loved
• Invite bureaucrats to meet people. Connect them.
• Ask them how you might improve given limited budgets
• Change the words.
• Facilities become homes
• Consumers become men and women supported
• Agency’s facility becomes Tom and Ted’s home
• Residential and Day programs become Tom’s day
• Don’t go for basic go for the best. Better to fail while striving for
the best that to succeed at achieving the basic requirements.
• Our budgets are higher than most but everyone knows that we
strive to give the best possible value and service.
• Favorite quote with bureaucracy “We can be more costly that
others. Why don’t you try others first and if it does not work out
give us a call”