Heike Boeltzig-Brown
Avenues Supported Living Services of Valencia, California was founded in 1997 by a husband and wife team, Scott and Lori Shepard. The agency provides supported living and community life engagement (CLE) services to individuals with intellectual and developmental disabilities (IDD). Key to Avenues’ success is a staffing approach that is grounded in client relationships. The agency limits staff hours to two shifts per week with the same individual.
This is done to facilitate client-staff matching and relationship building, but also to prevent potential burnout and frustration by ensuring both the clients they support and their staff have variety in their schedules. Avenues staff have expanded what they do by mentoring other agencies from within, thereby increasing service choices for individuals with IDD and their families. As of October 2016, Avenues provided CLE support to 26 individuals with IDD. Of those, 23 also received supported employment. Avenues does not have any supported employment funding per se, but provides job coaching in combination with individualized day services / CLE.
A focus on meaningful and productive activities guides Avenues’ CLE supports, which wrap around individuals’ work schedules. Examples of CLE activities include support with seeking and maintaining a job (paid or volunteer), enrolling in college classes or via adult education programs, and enrolling in recreational or hobby classes through local parks and recreation, the YMCA, etc. The approach lets clients gain exposure to new and preferred community activities, and provides structured support during times when the clients are not working. Clients can get up to 16 hours of CLE per day at a time that is convenient for them.
The amount 4 of support is based on a client’s individual needs. If a client needs less support during a particular activity, Avenues staff will start fading support for that activity. Scott Shepard provided the example of a client, Peter, who had been working in food services for over 20 years. Peter had a three-hour, five-day-a-week job. In the morning, Peter would go to Gold’s Gym, where he was a member. A staff member would help him choose and enroll in different classes. After having lunch, Peter would then work from 12:30PM until 3:30PM.
Avenues makes sure that in any given class, gym, volunteer job, or paid job, no more than 10 percent of the people there have disabilities. “When people are actively engaged with people that care about them and that they care about and have some places they call their own where they can see they're doing something meaningful and productive, their lives tend to be better, just like ours,” Scott explained. “So our mission is to help use that person-centered planning or thinking process to help people find connections and niches in our community that make sense for them.”
Staff have no more than two shifts per week with the same client. Avenues has found that, if a staff member spends too much time with the same individual, both the staff and the client tend to exhaust the relationship. The two-shift approach ensures that both clients and staff still look forward to seeing each other. This helps the relationship flourish. Avenues’ staffing approach also addresses the fact that staff take time off or go on leave. If one staff works five days a week with the same individual, and then takes a week off or goes on leave, the client’s routines change drastically.
In contrast, if a staff works with five different individuals (one each day), and he or she takes a vacation or goes on leaves, then each of those clients has only one day of their week disrupted. As an article from TASH puts it, “It is easier to create good matches between support people and people receiving support when the priority is not based on a person’s need to work a specific number of hours, but a person’s ability to fulfill the needed duties of the shift.” Avenues offers staff flexible work schedules, the total number of hours being subject to clients’ support needs and schedules. Avenues typically introduces newly hired staff to clients who have support hours available.
It takes time before a staff member can get into full-time employment, because they have to develop relationships with the individuals they support before increasing their hours. As of October 2016, Avenues has about 80 employees. Of those, 15 are roommates (i.e. they get paid to live with and support an Avenues client), and some of those also work with other people Avenues supports. Nine are middle management, and two are both roommates and middle management. About 15 other staffers are full time and the rest are part time, ranging from five to 30 hours a week. Some of the part time staffers are interested in more hours, but most are working the hours that fit their schedules.
During job interviews, Avenues leadership asks candidates about their interests and experience 5 to get a feel for which clients they may get along with. They then decide on the first individual to introduce a new staff to. Based on the training with that individual, leaders determine other people the new staff member may work well with. All staff are hired as employees (rather than contractors) and get benefits according to their status.
Despite pressure from funding sources to increase the number of clients, Avenues leadership chooses to remain a small program, serving no more than 20 clients. Adding more clients, in the Shepards’ opinion, would compromise the quality of services and supports that they provide. Avenues staff have expanded what they do by mentoring other agencies from within. The goal is that staff develop a relationship with clients and then branch off into their own agencies.
Supported living and CLE service providers in California actively share resources, ideas, and supports with one another, so mentorship was a natural way for Avenues to support the expansion of the provider community as well as increasing service choices for individuals with IDD and their families. “We hope that by nurturing new agencies to provide quality services, families will have real options and not be stuck with whoever has an opening,” said Lori. As of October 2016, Avenues has supported four staff members in creating their own programs.
Avenues was, itself, mentored into existence, and subsequently has mentored two other agencies. It has also assisted others in going through the process of becoming vendors. Each agency’s situation is unique and treated individually. In one case, the new agency directors had a lot of experience in providing services, but needed help on the business end. In another, the directors needed help in doing assessments and navigating the systems involved in service delivery. Some agency staff come to Avenues for help in writing up their service design or creating staff training modules, and others just want advice on a variety of topics.
Avenues has a good relationship with most of the other agencies in their area that provide similar services, since this is generally a non-competitive field. Avenues staff are currently working with a few agencies at various stages of development. It often starts with Avenues staff sitting down and going over a person-centered plan for the agency director. From there, the mentorship is customized. Some potential agencies do not go beyond this planning stage, while others continue to work with Avenues over time.
Using this staffing approach has enabled Avenues to keep staff turnover low. Retaining staff allows Avenues clients to maintain long-term relationships and trust. With that trust comes a willingness to try new things and take chances on other relationships. Lori noted that many former employees keep in touch with the clients they supported, even 10 years after they have left Avenues. Holiday and birthday cards are exchanged, and many staff even visit when they are in town. 6 Clients see staff once a week (instead of every day).
Different personalities work together in different ways, so a client can look forward to doing a variety of activities with staff who also enjoy those things. For example, one client may enjoy live concerts and work with a staff on Friday nights who also enjoys concerts. That staff may not be a good cook, so the client would not want to spend every evening with that staff. Variety in the staff schedule is good for staff as well. A staff can work with someone who needs a lot of physical support on Monday, a person who is non-verbal on Tuesday, a person who talks constantly on Wednesday, a person who needs a lot of emotional support on Thursday, and a person who is really active on Friday.
This variety helps staff to enjoy and look forward to each day. It also allows for administration to schedule staff to work with their strengths. A staff member who is a good cook can work five evenings with a different client each day, thereby positively affecting five clients. A staff who likes to work out or enjoys crafts or is a great organizer can likewise be valuable to five different teams. In contrast, if that staff works with the same client each day, it would get monotonous for both the staff and the client. “We all spend time with a variety of people and friends, engage in a variety of activities and get chores done in our own life. We try to ensure the people we support have the same opportunities,” said Lori.
Avenues limits staff time to two shifts per week with the same individual. The two-shift approach prevents potential burnout and frustration by ensuring that both clients and staff still look forward to seeing each other, which helps the relationship flourish.
Avenues recruits and hires staff with clients in mind. Effectively matching clients with staff is important for providing fully individualized CLE in combination with employment supports (job coaching). Giving both clients and staff a choice about who they would like to work with is key to successful client-staff relationships.
Scott Shepard, Executive Director: shepard6@pacbell.net
Lori Shepard, Director of Operations: avesls@pacbell.net
Website: http://www.avenuessls.org
Shepard, L. (2006, September/October). Opening New Doors Through Mentorship. TASH Connections, 32(9/10), 18-20.
Avenues Supported Living Services of California and Katahdin Friends, Inc. (KFI) of Maine implemented Guidepost 1 in an effort to individualize supports for each person. Use the sidebar on the left to read their stories.
Heike Boeltzig-Brown
Headquartered in a small rural town in northern Maine, Katahdin Friends, Inc. (KFI) provides community employment and life engagement supports, as well as home supports, to individuals with intellectual and developmental disabilities (IDD). KFI’s services extend throughout northern and southern Maine, including the cities of Portland and Bangor.
A flexible approach to staffing and support scheduling helps KFI ensure customized daily support schedules that meet individual goals. This approach also allows individuals to interact with a variety of direct support professionals, which is important for having a more engaged and meaningful life in the community.
As of July 2016, KFI supported 66 people with IDD through combinations of home, community, and work supports, and 28 people with a variety of disabilities in short-term job development funded by the public vocational rehabilitation program.
While most providers assign a group of individuals with IDD to each staff, KFI takes the opposite approach, assigning a team of three to five staff members to each individual. Because of this unusual staffing system, they are able to offer one-to-one support to many individuals at once via a rotating weekly schedule.
This means that one staff spends one to five hours with one individual, and then goes on to support another individual, sometimes in the same day. Other individuals have staff live with them at their home in revolving, 56-hour shifts. Support schedules are customized by day and continuously updated by KFI’s regionally based support teams to accommodate last-minute changes in individuals’ schedules, as well as any staff changes.
Using this flexible staffing approach was a natural outcome when KFI closed its center-based facilities and began supporting individuals in their homes and communities, says Gail Fanjoy, KFI’s CEO. Several KFI staff had different community connections that they could use on behalf of the individuals who they were serving. Staff used these connections across individuals to more deeply integrate them into their communities.
To ensure a flexible staffing arrangement, KFI staff need to be well versed in both employment services and community life engagement. “Our staff who work in these support schedules do everything,” explains Fanjoy. “They may be job coaching. They may be helping individuals connect in their community. They may be at a music jam in the evening, helping individuals to explore their love of music and entertainment.”
Forty-seven of KFI’s 84 direct support professionals are certified employment staff. While not mandated by the state of Maine, KFI expects all of their direct support professionals to take the College of Employment Services online training that incorporates the Association of People Supporting Employment First (APSE) nationally recognized supported employment competencies.
The direct support professionals that KFI hires need to be “joiners” who participate in their communities. Especially in the smaller, more rural communities, KFI staff know almost everyone, making it easier to connect community members to the individuals they support. KFI also looks for staffers who have proficiency with family engagement, and who understand the process of “person-centered thinking” and the concept of self-determination for people with IDD.
KFI prioritizes staff training and encourages staff feedback to make sure the goals of individuals with IDD are being met, and that those individuals are continually afforded full choice (including the occasional bad choice) in what activities they want to do. KFI has frequent staff meetings, pre-established quarterly goals, and required benchmark reports. Goals are intentional, but with a certain amount of flexibility when it comes to carrying them out. Direct support professionals together with their clients modify activities to meet individual goals and interests.
Staff flexibility allows for variation in each individual’s schedule, discourages prescriptive “programming,” and maintains KFI’s “person-centered thinking” ideals. Support providers become experts about each individual they support. This means that KFI clients have access to a range of supports based on their particular needs, up to and including 24/7 support in the home.
Individuals respond well to the rotating staff perhaps because this staffing pattern more authentically represents how most people spend their days: with a variety of people rather than just one. Each staff member brings their own interests to the individual for them to explore. This makes the training and fading of staff easier, as each newcomer is surrounded by several familiar staffers who know the individual’s routine inside and out.
Transportation barriers are addressed as support providers use their own cars and are reimbursed for the miles. This allows for flexibility to mold to people’s busy schedules.
KFI staff appreciate the flexibility that comes with their job, allowing them to better balance family and work life. The amount of flexibility granted to a staff member increases with seniority on the job. Staff flexibility not only positively impacts staff retention but also works as an incentive to recruit new staff members, says Fanjoy.
Root all practices in a clear philosophy. KFI has a strong, philosophical approach in everything they do, including how their supports are designed and delivered. These values are manifested in every aspect of the organizational culture, from hiring, to training, to individualized and highly flexible supports.
Focus on individual experiences. For KFI, community life engagement is all about building experiences for people and creating opportunities for individuals to be engaged in natural settings. Their services do not involve person-centered planning so much as person-centered thinking throughout all aspects of the organization.
Cross-train staff for multiple roles. Staff need sufficient training to fill various roles, including providing home, community, and work supports.
Gail Fanjoy, CEO: gfanjoy@kfimaine.org KFI website: http://www.kfimaine.org Another KFI promising practice: “Making Mission-Driven Choices About Funding and Service Innovation”