Innovative Planning A Collaborative Approach To Helping People With Complex Support Needs
Inside The main topics A description of Innovative Planning...3 When to consider Innovative Planning...5 Reasons to try Innovative Planning...7 How it works...9 Referral...15 This handbook describes the Innovative Planning Process developed and used in the PDD Central Region to improve supports provided to adults with developmental disabilities who have complex service needs. For more information, call Community Supports Supervisor Tim Lowe at 403 340 7199 (email tim.lowe@gov.ab.ca), or check the PDD Central website at www.pdd.org/central. Published November 2010 by: 2
What A Brief Description of Innovative Planning When the history of a person with complex support needs is examined, one may discover that, for a very long time, many concerned individuals and organizations have been involved in providing the person with an array of concentrated (and often costly) supports and services. Despite the concern and effort of capable, wellintentioned individuals and organizations, and despite the expenditure of significant resources, it is not uncommon to find that the person continues to experience repeated collapse of supports and a steady drift toward long term isolation or institutionalization. For a relatively small group of people who experience the recurring frustration and failure of their supports, the typical planning that works so well for most, simply fails to meet their needs. Something more is needed. 3
Innovative Planning provides the additional support, expertise, decision making ability and coordination that is necessary to identify a person s needs and ensure that person receives appropriate, effective and sustainable support. Innovative Planning has been successful in ending the cycle of failure and frustration for people who experience repeated or catastrophic collapse of their supports. Innovative Planning begins with the assumption that behaviour of concern is a symptom of insufficient or inappropriate support. The individual is deemed nonculpable; his or her behaviour is a reasonable and logical reaction to inadequate or inappropriate support. A key feature of Innovative Planning is the extensive exploration of a person s fundamental needs. A team works to identify what needs are crucial and what supports are missing in the person s life. The team then garners the resources the person needs and develops a plan that identifies what action is needed and who is responsible. A case coordinator is assigned to ensure the plan is carried out. He or she coordinates supports and services, and works to minimize barriers, mitigate risk and make sure people get what they need in a timely manner. 4
When When to consider Innovative Planning Innovative Planning extends, but does not replace, typical planning processes. Innovative Planning is invoked in situations where people experience catastrophic or recurring collapse of their support systems: Loss of all or most of their supports, leaving them at significant risk. Recurring loss of significant elements of their support systems, leaving them at risk. Innovative Planning is invoked when a person lives with an untenable level of risk: Person can not control high risk behaviour, resulting in a high degree of restrictions or restrictive interventions. High risk behaviour results in recurring crisis. Attempts to modify the risk behavior have been unsuccessful. Attempts to mitigate risk have been unsuccessful. 5
As a result of recurring high risk behaviour: The person causes significant hurt or harm to self, others or property. The person is at risk of significant social disadvantage such as: Loss of home Rejection by community Loss of service provider(s) Loss of day program/supports Alienation from, or rejection by, family and friends Innovative Planning is also appropriate in cases where the person: Needs a high degree of flexibility and coordination to meet his or her needs. Requires support from a large number of stakeholders or requires specialized support. Has been admitted to, or resides in, an institution. Is new to PDD services and is described as being at risk. 6
Why Reasons to try Innovative Planning Innovative Planning leads to more effective and appropriate support for the person by: Extending planning and service delivery when need and circumstances go beyond the capacity of what is deemed as typical. Accessing the additional support, expertise, decision making ability and coordination that the specialized team members can offer. Innovative Planning will help to: Identify the person s unique needs. Identify and minimize barriers to quality of life and community inclusion. Identify strategies based on best practice to meet the person s complex, challenging or ongoing needs. Speedily and efficiently access resources available within Central Region. 7
Partner with other service providers and stakeholders to provide needed support. Identify potential methods to mitigate risk. Make decisions in a timely manner. Ensure that people receive assistance from partnering organizations and stakeholders in a timely, effective and coordinated manner. The goal of Innovative Planning is to provide the quantity, frequency and type of support the person needs to minimize risk while maximizing quality of life. 8
How The basic steps The responsibility for developing a stable and sustainable support system for a person with complex planning needs rests with a number of stakeholders. There is no standard of who should participate in Innovative Planning. Who qualifies as a stakeholder is broad and includes any person, provider or organization that can directly or indirectly support the person with complex needs and can make timely decisions. Examples include: PDD representatives Family members Guardians Service providers from a range of ministries Equally important to the planning process is support from: Friends Other professionals such as counselors, psychiatrists, physicians, probation officers, social workers 9
Identifying Fundamental Needs The most complex task that team members must accomplish is assessing a person s needs. By shifting the focus away from goal directed, systemic or policy based activities to the identification of basic needs, the team gathers important information, gaining insight into the person s life to explain the complexity of his or her situation. Once the team identifies a person s needs, they evaluate the risks associated with having or not having these needs met, and develop strategies to meet the person s needs and to mitigate those risks. To gauge needs, the team looks at twenty two domain areas. Domains run the gamut from nutrition to cultural identity. Team members identify which domains in a person s life need the most attention and do in depth reviews of each one. 10
Four fundamental needs are given first priority. 1. Maintain the individual s home or find a new home. 2. Maintain relationships with key individuals and principal supports in the person s life. Maintain or develop relationships with key stakeholders. 3. Maintain job and/or regular activities (or develop if required). 4. Maintain the individual s community. For each domain, the team answers four questions: 1. What are the causes of this complex situation? 2. What is needed? 3. What are the risks? 4. How do we manage these risks? The next three pages offer an example of the charts an Innovative Planning team may provide. These charts are intended to illustrate how the process works; they have been modified to fit the page format and the details they contain are fictitious. 11
Jane s Story Form 1 Identifying Information Current Information Age 21 Autism Moderate developmental disability Since the age of 14 Jane has been aggressive toward her mother and younger brother Behaviour increasingly erratic over the past year; most recent escalation began 4 months ago Jane has numerous professional supports and a friend from school Intervention failed to stabilize her behaviour so Jane was admitted to hospital two months ago Her behaviour is stable; hospital is requesting she be discharged What Needs to Change Current residence Will require a service provider Follow up psychiatric support Day time activities Behaviour management intervention Change to management strategies (how to get Jane from hospital to her new home without increasing her anxiety) Mobility considerations Needs service to enhance feeling of being safe and secure Build relationship with family Needs to build relationships outside of family Communication system Fundamental Needs Domain Home Health/mental health Valued social role Work/vocation Safeguards Relationships Priority (as set by the team) Home Service provider Mobility Family involvement Safeguards Recreation/vocation Review of behaviour Management plan Change management strategies 12
Jane s Story Form 2 Fundamental Needs Assessment Domain: Home Pertinent Information What is Needed Risk Associated with Action/Inaction Risk Assessment Likelihood Level of Harm 1 to 5 (high) 1 to 5 (high) Jane has always lived with her family Jane does not like loud, unorganized events She had a room and basement to herself until the family moved to a new home and Jane had to share a room with a sister who has medical issues Stairs in the previous home were modified to meet Jane s needs Jane enjoyed the back yard at the previous home; new home does not have a fenced yard Must move to an alternative home living situation New home must meet the following specific needs: 1. A room of her own 2. Well structured routines 3. Manageable stimulation 4. Fenced back yard 5. Structure must fit Jane s mobility needs Jane would remain in an institution If the home does not meet her needs, Jane is at risk of increased anxiety and agitation, which will stimulate aggression If the home is not modified to meet Jane s mobility needs, she is at risk of harming herself 3 5 4 4 5 4 Ideal Situation Risk Mitigation Home with a basement suite modified to meet Jane s mobility needs, with an area she can call her own Fenced back yard Identification of service provider with experience in working with individuals who have challenging behaviours Work with service provider to develop a new home or modify an existing home to meet Jane s specific needs. 13
Jane s Story Form 3 Follow up Tracking Domain: Home Need Service Provider Follow up Required Investigate capacity with three service providers experienced in providing supports to individuals with complex behaviours Home, A Find and secure home Home, B Safeguards Apply for complex needs funding to make minor modifications, if required Develop a plan to move Jane from hospital to her new home with the least amount of anxiety Individual Responsible Jane, coordinator and parents will find service provider Jane, service provider, coordinator and parents will secure home Complex needs team will apply for funding Team, hospital, service provider, Jane and her parents will develop move plan Target Date for Completion Nov. 1, 2009 Nov. 15, 2009 Nov. 20, 2009 Nov. 25, 2009 Follow up Completed Yes No 14
Referral How to access Innovative Planning If you know a person who meets the criteria for Innovative Planning, contact your Community Supports Coordinator. A word of caution, however. Innovative Planning is appropriate for people who are at the highest level of risk. Innovative Planning impacts a significant number of people and begins a time and resource intensive process. These resources especially time are scarce and need to be expended judiciously. The degree of risk a person s situation presents is the basis for making an appropriate referral for Innovative Planning so it follows that assessing risk correctly is crucial to the process. Although risk can be effectively evaluated in most circumstances, Innovative Planning does not deal with usual circumstances. A formal, structured risk assessment is preferred. The full Risk Assessment document (online at www.pdd.org/central) goes into considerable detail about risk and is recommended reading on this subject and all others summarized in this booklet. 15
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