HCBS Training

Different Ways to Make Person-Centered Changes

One way to think about how to make person-centered changes in HCBS is to emphasize three different levels that describe how this work can be achieved.

Level 1 Changes are the decisions we make daily when supporting a person. We can help support someone in a different way by making simple changes in how we work based on a person's preferences or desires. Level 1 changes are made without needing approval from a supervisor or director. These choices are made on our own to improve someone's quality of life.

Havi is a supervisor working in a program supporting people with traumatic brain injury and other disabilities. Havi works with Sam, a person who is very cheerful and positive about life. Sam enjoys working and likes spending time with friends. One day, Havi noticed that Sam looked unhappy. When Havi asked Sam what was wrong, they replied by looking down and saying in a sad tone of voice, “It is ham salad day and I hate ham salad”. Sam is 56 years old and has tried ham salad many times. Sam has never enjoyed eating ham salad.

Sam lives with three other people in a house that is supported by staff during the day. Havi called both Sam and the staff at home to ask about how lunch decisions are made. Sam’s staff replied that "it was Thursday and that means ham salad is on the menu for everyone". The staff said they could not change the menu because most people like ham salad and that it is difficult to make changes in menu options for each person.

Havi offered to help by working with Sam to create a new lunch option.  After confirming Sam did not have any food allergies, Havi and Sam went to the store to pick out the bread and sandwich toppings. Sam bought bread, peanut butter, and strawberry jelly for lunch. Now on days that ham salad is on the menu, Sam has a peanut butter and jelly sandwich instead.

Level 2 Changes require a director, CEO, or other leader to approve a decision to make person-centered changes because these changes impact an organization's policies and procedures, or require allocation of resources. Level 2 changes are used to improve  person-centered practices by altering how an organization works.

A director of a small organization supporting adults with Intellectual and Developmental Disabilities in employment settings wanted to improve person-centered practices. The director invited staff from different areas of the organization and people receiving services to form a team that would help assess the organization’s strengths and needs. The team did a good job reaching out to people receiving services as well as to all staff members, supervisors and managers, and people in the human resource department. The consensus of everyone involved was that in order to become more person-centered, training and supports were needed for new staff members. The team looked at different person-centered approaches and recommended staff receive training in a type of training called Person-Centered Thinking. Everyone in the organization participated in a 2-day training. The team also recruited a small group of staff members who were taught how to coach their peers in using the Person-Centered Thinking tools. The coaches now meet on a regular basis to discuss how well everyone is learning to use Person-Centered Thinking.

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Level 3 Changes are often made by larger state or federal systems to make it easier for organizations to be person-centered.

Level 3 changes are made at a state or federal level and can result in policy and funding changes. These changes take time to achieve because they may require collaboration across multiple agencies or procedural changes. For example, the Centers for Medicare and Medicaid Services (CMS) is a part of the Federal Department of Health and Human Services. CMS is working with many partners to change the way services are delivered to improve the quality of life for those using these services. CMS has made changes in policies and procedures to help ensure that services are more person-and family-centered. As part of this legislation some of the language and requirements have changed. These changes require states to change their service-delivery practices, legislation rules, and statutes. As a result of CMS changes, Minnesota has added person-centered language and person-centered training requirements to rules and statutes governing service delivery.

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Please Note: This information comes from The Learning Community on Person-Centered Practices. Please visit the Module 1 Resources Page for more information about The Learning Community.