Community Living disABILITY Services Day Services Review Interim Report · 2019-05-31 · CLDS Day...

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Community Living disABILITY Services

Day Services Review Interim Report

December 2015

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CLDS Day Services Review – Interim Report December 2015

Authors and Contributors

Prepared By: Andrea Thibault-McNeill Sponsored By: Elaine Hawkins

Researcher: Lisa Sutton

Contributors: Lisa Lacroix Karen Mackintosh Marylea Mooney Manpreet Singh Lisa Sutton Craig Wynands

Manitoba Family Services Released: December 2015

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Executive and Managerial Sponsors and Team Members Executive Sponsor Charlene Paquin, Assistant Deputy Minister, Community Service

Delivery (CSD)

Project Sponsor Elaine Hawkins, Director, Community Living disABILITY Services (CLDS), CSD

Project Manager Manpreet Singh, Project Manager, Innovation, Information and Technology, Administration and Finance (AF)

Project Lead Andrea Thibault-McNeill, Senior Program and Policy Analyst, CLDS, CSD

Project Team Lisa Lacroix, Program Specialist, CLDS, CSD Karen Mackintosh, Senior Program and Policy Analyst, Strategic Initiatives and Program Support (SIPS), Community Engagement and Corporate Services (CECS)

Marylea Mooney, Program Specialist, CLDS, CSD Lisa Sutton, Program and Policy Analyst, CLDS, CSD

Craig Wynands, Program Specialist, CLDS, CSD Team Support Carol Antkowiak, Administrative Assistant, CLDS, CSD Betty-Lou Anderson, Administrative Assistant, Children’s disABILITY

Services, CECS Debbie Besant, Executive Director, Rural and Northern Services, CSD Cheryl Busch, Program Manager, CLDS, CSD Lissa Donner, Executive Director, Agency Accountability and Community Initiatives, AF Michelle Dubik, Executive Director, Winnipeg Services, CSD Andria Gudmundson, Research and Policy Analyst, CLDS, CSD Kelly Kolesar, Program Manager, Rural and Northern Services, CSD Ralf Margraf, A/Director, SIPS, CECS Marilyn McEachern, A/Director, Agency Accountability and Support Unit, AF Patricia O’Leary, Advisor, CLDS, CSD Sharon Weselake, inFACT User Support Analyst, SIPS, CECS

Agency Advisors Oly Backstrom, Executive Director, Sturgeon Creek Enterprises (SCE)

Lifeworks Krista Bissett, Executive Director, Connect Employment Services Charmayne Dubé, Senior Director, New Directions Darryl Marsch, Vocational Services Coordinator, enVision Community Living Kim McIntyre-Leighton, Executive Director, Work and Social Opportunities (WASO)

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Table of Contents

1.0 EXECUTIVE SUMMARY ..................................................................................................6

1.1 BACKGROUND ................................................................................................................................... 6 1.2 DAY SERVICES ................................................................................................................................... 6 1.3 PROGRAM PRESSURES ........................................................................................................................ 6 1.4 DAY SERVICES REVIEW PROCESS .......................................................................................................... 7 1.5 PRELIMINARY OBSERVATIONS/THEMES ................................................................................................. 8

1.5.1 Service Philosophy......................................................................................................................... 8 1.5.2. Agency/Community Engagement ......................................................................................... 8 1.5.3. Supporting Service Delivery ................................................................................................... 8 1.5.4. Funding Model ...................................................................................................................... 9 1.5.5. Quality Assurance ................................................................................................................. 9

1.6 DAY SERVICES REVIEW – FINAL REPORT ................................................................................................ 9

2.0 INTRODUCTION .......................................................................................................... 10

2.1 COMMUNITY LIVING DISABILITY SERVICES .......................................................................................... 10 2.2 DAY SERVICES ................................................................................................................................. 10 2.3 PROGRAM PRESSURES ...................................................................................................................... 10 2.4 DAY SERVICES REVIEW PROCESS ........................................................................................................ 12 2.5 DAY SERVICES REVIEW REPORTING ..................................................................................................... 12

3.0 DAY SERVICES MODELS IN MANITOBA ........................................................................ 13

4.0 ALTERNATIVE PROGRAMMING, VOCATIONAL TRAINING AND EMPLOYMENT OPPORTUNITIES 15

4.1 PROJECT SEARCH - WINNIPEG.......................................................................................................... 15 4.2 THE FRIENDLY CORNER BAKESHOP - GRANDVIEW ................................................................................. 16 4.3 THE SCRAP CAME BACK - WINNIPEG .................................................................................................. 16 4.4 CONTRACT WORK ............................................................................................................................ 17 4.5 OTHER SERVICES ............................................................................................................................. 17

4.5.1. Transforming Futures .......................................................................................................... 17 4.5.2. The Lunch Bell Café - Winnipeg ........................................................................................... 17 4.5.3. The Sawmill - Boissevain ..................................................................................................... 18

5.0 DAY SERVICES POLICY ................................................................................................. 19

5.1 SERVICES FOR YOUNG ADULTS AGED 18 TO 21 .................................................................................... 19 5.2 DAY SERVICES GOALS ....................................................................................................................... 20

6.0 COST DRIVERS OF DAY SERVICES ................................................................................. 21

6.1 REGULAR AND SPECIAL RATE PER DIEMS ............................................................................................. 21 6.2 INCREASING RELIANCE ON HIGHER LEVELS OF SPECIAL RATE FUNDING ..................................................... 21 6.3 IMPLEMENTATION OF THE SUPPORTS INTENSITY SCALE .......................................................................... 22 6.4 INDIVIDUAL INDEPENDENCE AND NATURAL SUPPORTS ........................................................................... 22 6.5 SUPPORTED EMPLOYMENT ................................................................................................................ 23 6.6 SUPPORTING INDIVIDUAL CHOICE BY OFFERING MORE CHOICES .............................................................. 25

7.0 FUNDING MODEL IN MANITOBA ................................................................................. 26

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7.1 DAY SERVICES COSTS FUNDED BY CLDS .............................................................................................. 26 7.2 PER DIEM FUNDING ......................................................................................................................... 26 7.3 GRANT FUNDING ............................................................................................................................. 28 7.4 CHALLENGES WITH THE CURRENT FUNDING MODEL .............................................................................. 29

8.0 PRELIMINARY OBSERVATIONS/THEMES ...................................................................... 30

8.1 SERVICE PHILOSOPHY ....................................................................................................................... 30 8.1.1. Philosophy, vision and intent of Day Services ..................................................................... 30 8.1.2. Individual choice and self-determination ............................................................................ 30 8.1.3. Natural support networks and the use of other community resources .............................. 30

8.2 AGENCY/COMMUNITY ENGAGEMENT ................................................................................................. 31 8.2.1. Communicating with the Department ................................................................................ 31 8.2.2. Agency Relations ................................................................................................................. 32

8.3 SUPPORTING SERVICE DELIVERY ......................................................................................................... 32 8.3.1. Life skills training in schools ................................................................................................ 32 8.3.2. Partnerships with collateral Departments and the spectrum of services available ............ 32 8.3.3. Sharing of resources across agencies .................................................................................. 33 8.3.4. Communicating the benefits of paid employment .............................................................. 33 8.3.5. Publically raising employment expectations ....................................................................... 33

8.4 FUNDING MODEL ............................................................................................................................ 34 8.4.1. Simplifying the funding model ............................................................................................ 34 8.4.2. Funding assessed needs and future goals ........................................................................... 34

8.5 QUALITY ASSURANCE ....................................................................................................................... 34 8.5.1. Service model standards ..................................................................................................... 34 8.5.2. Service standards and performance outcome measures .................................................... 35

9.0 DAY SERVICES REVIEW – FINAL REPORT ...................................................................... 35

10.0 WORKS REVIEWED ..................................................................................................... 36

APPENDIX A Phase 1 Agency Visits……………………………………………………………………………………………… 38

APPENDIX B Phase 2 Agency Visits……………………………………………………………………………………………… 39

APPENDIX C Map of Manitoba: Agency Locations………………………………………………………………………. 40

APPENDIX D Best Practices and Online Resources………………………………………………………………………..41

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1.0 Executive Summary

1.1 Background Manitoba’s Department of Family Services is responsible for Community Living disABILITY Services (CLDS), a program that provides a range of services to support adults with an intellectual disability to participate fully in community life, including: residential services, day services, transportation, respite and clinical supports. Services are grounded in the principles outlined in The Vulnerable Persons Living with Mental Disability Act, are person-centred and respect the individual’s autonomy and capacity to make decisions.

1.2 Day Services Although CLDS offers a range of services, this review is focused solely on day services. Depending on the individual’s goals and assessed need for supports, day services may include: supported employment; vocational and training opportunities; personal skills development; recreational or leisure activities; and senior’s activities. There are 63 agencies throughout Manitoba that receive funding from the Department to deliver day services to eligible CLDS participants. The findings presented in this Day Services Review Interim Report reflect the information gathered from 14 of these agencies.

1.3 Program Pressures An adult with an intellectual disability who is eligible for CLDS may require support for the duration of his or her lifetime, making CLDS a costly program for the province to administer. In Manitoba, the number of participants receiving day services has been steadily increasing. For the past five fiscal years spanning from 2010/11 to 2014/15, the total number of CLDS participants receiving day services increased from 3,150 participants in 2010/11 to 3,504 individuals in 2014/15, for an overall caseload growth of 11.2%. This translated into 108 additional participants receiving day services between 2010/11 and 2011/12, and then an additional 54, 58 and 134 participants over the following three years. Consequently, the cost to deliver the service has also increased. During this same five year time span, total expenditures increased from $45,020.3 million to $59,844.0 million, or 32.9%. The average annual cost per participant in 2010/11 was $14.3; five years later the average cost had increased to $17.1 or 19.6%.

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The table below provides the actual participant figures and expenditure data for the past five fiscal years: Table # A-1: Day Services Expenditures1 and Number of Participants: Five Year Trend

Notes: 1 Expenditures include per diem funding, administration and supported employment grants, and

exclude transportation costs.

1.4 Day Services Review Process Given the increasing financial pressures on day services and anticipated continued growth in the number of new participants, the Department commenced a review of day services in the fall of 2013 with the vision of using the information to transform the service into one that would become more efficient and sustainable over the long-term while continuing to deliver a high quality service to participants. Four objectives of the review were identified:

1. document the current service models and best practices in Manitoba; 2. develop a standardized, transparent and equitable approach to how agencies are

funded; 3. identify efficiencies in the delivery of services that promote individuals’ greater

independence and community participation; and 4. develop more robust service standards to ensure CLDS participants receive a

consistently high quality of service across Manitoba.

45,020.3

48,946.5 53,066.1

56,907.4 59,844.0

3,150 3,258 3,312 3,370 3,504

0.0

10,000.0

20,000.0

30,000.0

40,000.0

50,000.0

60,000.0

70,000.0

2010/11 2011/12 2012/13 2013/14 2014/15

Expenditures

# of Participants

Linear (Expenditures)

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1.5 Preliminary Observations/Themes Throughout the review process, various members of the Review Team met with staff from 14 agencies, board members, CLDS participants and regional departmental staff and documented their impressions of the issues, challenges and opportunities impacting day services. These impressions were then discussed at weekly team meetings and condensed into five preliminary themes. It should be noted that a formal quantitative and qualitative analysis of the data will be undertaken at the conclusion of phase 2 which will enable the Team to present themes identified through a more rigorous evaluative process.

1.5.1 Service Philosophy 1.5.1.1. The vision for what day services is intended to accomplish for the individual,

the underlying service philosophy that will support this vision, and the service models that the program can continue to support currently and over the long term, have not been reviewed and updated for some time.

1.5.1.2. To support individuals to make positive choices, it is incumbent upon the system to offer service options that are robust and reflect the real life choices available to all members of the community, including: a range of post-secondary programming; different vocational training opportunities; courses that promote personal skill development; and, a variety of employment options.

1.5.1.3. The partnering systems that jointly support adults with an intellectual disability (i.e. other government departments, external service providers and advocacy groups) should work together with a focus on supporting CLDS participants to develop natural support networks that will assist them to participate in all aspects of community life.

1.5.2. Agency/Community Engagement 1.5.2.1. Clarifying the roles of the various units within the department and simplifying

the communication process would support agencies to get their information needs met and improve the working relationship between agencies, the CLDS program and the Department as a whole.

1.5.2.2. Enhancing agency relation functions within the Department would improve opportunities for information sharing and allow the Department to offer support, advice and information on the global issues impacting CLDS, when needed.

1.5.3. Supporting Service Delivery 1.5.3.1. Enhanced, skill-based programming in high school would better prepare

students to transition from school into community living arrangements, as well as post-secondary programs, vocational training or employment upon graduation.

1.5.3.2. Strengthening the working relationship between Family Services and other ministries that support CLDS participants would better enable government to explore more opportunities to work in partnership and expand the types and responsiveness of services available to participants who have a range of needs in different stages of their lives.

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1.5.3.3. CLDS should work with agencies to document the resources available within agencies, within regions and across the province to develop strategies that would enable agencies to access the resources and supports they need in a more coordinated, timely and streamlined way.

1.5.3.4. CLDS should communicate the policies regarding the current earnings exemption within Employment and Income Assistance and the benefits of paid employment to agencies so that participants are encouraged to accept more hours should these be available at their place of employment.

1.5.3.5. CLDS, agencies and other service partners should raise the employment expectations of individuals by actively promoting the abilities, skills and aspirations of people with an intellectual disability to the public.

1.5.4. Funding Model 1.5.4.1. In order to fund agencies for the delivery of day services in a manner that is

fair, equitable and transparent, the funding model needs to be reflective of the various cost elements and ensure that both the assessed needs of the participant as well as the operational costs of the agency are addressed.

1.5.4.2. The individualized person-centred plan needs to establish goals for participants that promote independence and personal growth and reassess the participant’s level of funded supports regularly.

1.5.5. Quality Assurance 1.5.5.1. CLDS should strengthen and better articulate the standards a service model

must meet in order to be approved as a day service.

1.5.5.2. A strong quality assurance (QA) framework would introduce a more consistent service standard across the province.

1.6 Day Services Review – Final Report The day services review has moved into its final information gathering and analysis phase. A report summarizing findings, themes and providing recommendations is in the process of being drafted. The anticipated completion date is January 2016.

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2.0 Introduction

2.1 Community Living disABILITY Services Manitoba’s Department of Family Services is responsible for Community Living disABILITY Services (CLDS), a program that provides a range of services to support adults with an intellectual disability to participate fully in community life, including: residential services, day services, transportation, respite and clinical supports. Services are grounded in the principles outlined in The Vulnerable Persons Living with Mental Disability Act, are person-centred and respect the individual’s autonomy and capacity to make decisions.

2.2 Day Services Although CLDS offers a range of services, this review is focused solely on day services. Depending on the individual’s goals and assessed need for supports, day services may include: supported employment; vocational and training opportunities; personal skills development; recreational or leisure activities; and senior’s activities. There are 63 agencies throughout Manitoba that receive funding from the Department to deliver day services to eligible CLDS participants. The findings presented in this Day Services Review Interim Report reflect the information gathered from 14 of these agencies. To meet program eligibility for day services, an individual must be eligible for CLDS and:

• have significantly impaired intellectual functioning with impaired adaptive behaviour, existing prior to the age of 18

• be 21 years of age or older

• be a Canadian citizen or legally entitled to permanently live and work in Canada

• live in Manitoba Eligibility for day services is effective July 2nd of the calendar year in which the individual turns 21 years old. CLDS is a non-mandated program established within policy. As such, meeting the program’s eligibility criteria does not necessarily guarantee access to services, but is dependent upon the availability of resources.

2.3 Program Pressures An adult with an intellectual disability who is eligible for CLDS may require support for the duration of his or her lifetime, making CLDS a costly program for the province to administer. In Manitoba, the number of participants receiving day services has been steadily increasing. For the past five fiscal years spanning from 2010/11 to 2014/15, the total number of CLDS

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participants receiving day services increased from 3,150 participants in 2010/11 to 3,504 individuals in 2014/15, for an overall caseload growth of 11.2%. This translated into 108 additional participants receiving day services between 2010/11 and 2011/12, and then an additional 54, 58 and 134 participants over the following three years. Consequently, the cost to deliver the service has also increased. During this same five-year time span, total expenditures increased from $45,020.3 million to $59,844.0 million, or 32.9%. The average annual cost per participant in 2010/11 was $14.3; five years later the average cost had increased to $17.1 or 19.6%. It should be noted that expenditure data is generated by the Integrated Financial and Case Tracking (inFACT) system, an online payment and service plan tracking tool that generates expenditure and service reports for CLDS. inFACT currently does not separate the costs to deliver home-based day services from agency-based or community-based day services; therefore, the expenditure data includes some differently funded home based day services. The table below provides the actual participant figures and expenditure data for the past five fiscal years: Table # A-1: Day Services Expenditures1 and Number of Participants: Five Year Trend

Notes: 1 Expenditures include per diem funding, administration and supported employment grants, and exclude

transportation costs.

45,020.3

48,946.5 53,066.1

56,907.4 59,844.0

3,150 3,258 3,312 3,370 3,504

0.0

10,000.0

20,000.0

30,000.0

40,000.0

50,000.0

60,000.0

70,000.0

2010/11 2011/12 2012/13 2013/14 2014/15

Expenditures

# of Participants

Linear (Expenditures)

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2.4 Day Services Review Process Given the increasing financial pressures on day services and anticipated continued growth in the number of new participants, the Department commenced a review of day services in the fall of 2013 with the vision of using the information to transform the service into one that would become more efficient and sustainable over the long-term while continuing to deliver a high quality service to participants. Four objectives of the review were identified:

1. document the current service models and best practices in Manitoba; 2. develop a standardized, transparent and equitable approach to how agencies are

funded; 3. identify efficiencies in the delivery of services that promote individuals’ greater

independence and community participation; and 4. develop more robust service standards to ensure CLDS participants receive a

consistently high quality of service across Manitoba.

A CLDS Day Services Executive Management team and a Day Services Review team were established to undertake the work. Information regarding project governance and team membership is available on page two of this report. In keeping with the Department’s commitment to partnering with stakeholders throughout the review process, an advisory committee with agency representation was formed. The five member agencies were selected from both Abilities Manitoba and Manitoba Supported Employment Network (MSEN) and include: Connect Employment Services; enVision Community Living; New Directions; SCE Lifeworks; and Work and Social Opportunities (WASO). Thirty-four agencies from across the province were selected to participate in the day services review (see Appendix A). The selection criteria ensured that the agencies represented a range of unique factors, including: geographic location (urban, rural and northern); agency size; and service model variations (community based, site based and blended). Agencies were divided into two phases. Fourteen agencies were visited in phase 1, including the five member agencies on the Day Services Advisory Committee. In conjunction with the agency tours, a jurisdictional scan examined current best practices in the field of day services, as well as promising trends highlighting service models that promote greater participant independence and self-direction.

2.5 Day Services Review Reporting This interim report is a summary of the review team’s initial impressions of the issues, challenges and opportunities resulting from the information gathered in the first phase of this review. It should be noted that a formal quantitative and qualitative analysis of the data will be undertaken once all of the information has been gathered. A final report will be submitted

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January 2016, assimilating all information and presenting a comprehensive set of recommendations regarding the service model, funding model and quality assurance standards for day services in Manitoba.

3.0 Day Services Models in Manitoba In 2013/14*, the 14 agencies reviewed in phase 1 collectively supported 1,416 participants or 42.0% of the overall day services caseload, employed 500.6 full-time frontline workers, 68 full-time frontline supervisors, and 65.7 full-time managerial and administrative staff. Of the $56,907.4 expended on day services (excluding transportation), approximately $24,113.0 or 42.4% of that was expended by these 14 agencies. *Note: 2014/15 expenditure and participant figures for the 14 agencies are not yet finalized. The following chart is a description of the service models being delivered and the service types that fall within each model. All 14 agencies were delivering two or more different service types in order to support the range of needs and interests of participants.

Chart B-1: Service Models and Types of Services - Phase 1 Agencies Service Model and

Service Type Description of Service Model and Service Type

Site Based: Workshop

Individuals remain at a single location for the duration of the work day with other CLDS participants and paid staff, and are engaged in employment-based activities.

Site Based: Skills Development / Recreational

Individuals remain at a single location for the duration of the work day with other CLDS participants and paid staff, and engage in activities that promote skills development (e.g. personal care, domestic skills, literacy/numeracy training) and support the individual to achieve personal goals (e.g. balance a cheque book). Recreational activities may be intended to meet fitness, wellness or socialization goals and can be undertaken individually or in a group setting (e.g. stationary bike, yoga, playing cards).

Site Based: Seniors Program1

CLDS seniors and aging individuals who either choose not to participate, or are no longer able to participate, in activities with an employment or vocational focus attend a single location for all or part of the day with other CLDS participants and paid staff. Activities focus on leisure, recreation and socialization.

Community Based: Supported Employment

Individuals are engaged in paid employment within the community. Support is available from a direct service provider as needed for job coaching and mentorship. More support may in place initially, with a reduction over time to promote independence.

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Community Based: Vocational Training / Volunteering

Individuals participate in time limited vocational training with the goal of acquiring skills that will allow them to transition into the paid work force. Participants may also choose long-term volunteerism within the community to gain work experience. Participants whose vocational training has concluded, or who wish to transition from volunteerism to paid work, may require support while seeking competitive employment.

Community Based: Skills Development / Recreational

Individuals are engaged in personal skills development and recreational activities in the community either with a group of CLDS participants and one or more paid staff members, or with a single staff person only. Activities typically include: visiting restaurants, accessing recreational programming, shopping at the mall, or visiting other community sites.

Blended Model: Agency Owned Business

Individuals participate in employment-based activities at a business owned and operated by the agency in order to develop skills specific to that industry and provide a service to the community. Individuals are typically supported at the job-site by paid agency staff and work alongside other CLDS participants, and potentially other members of the community.

Blended Model: Vocational Training

Individuals are engaged in vocational training programming at the agency and in community-based settings with the goal of acquiring skills that will allow them to transition into the paid work force. Vocational training provided on-site by the agency is not necessarily time-limited and may be provided as long as it continues to meet the need of the individual.

Blended Model: Seniors Program

Participants begin their day services at home, transition into existing senior’s programming within the community for part of the day, then return home. There is no time spent at the agency.

Note: 1 One agency was delivering individualized day services out of participant residences. Although the

service model is identified as “site based”, the site is the residence and not an agency-managed day services location.

CLDS currently does not endorse a particular service model in policy, although within the disability community there has been a philosophical shift away from supporting any models that are perceived as supporting segregation from the community. The workshop model is either being phased out in many jurisdictions or has been eliminated altogether, particularly in the United States. Many advocacy organizations have likened the workshop model to the institutional model within residential services, where individuals with disabilities are housed together with minimal involvement or integration with the larger community. Despite the philosophical objections to the workshop model, members of the day services review team did meet several participants engaged in employment-based activities within the workshop setting who enjoyed the camaraderie of working alongside their peers, the stability offered by a daily work schedule, and who were extremely proud of the goods they were producing; however, for some participants, the option to choose a day service that best fulfilled their needs was limited to the services available in their community. In many rural communities where the number of potential employers and job opportunities were limited, the workshop model was developed as an alternative employment or vocational opportunity for individuals. Some agencies have also transformed the workshop model to support greater engagement between participants and the community (e.g. converting an area of the workshop into a storefront that sells products directly

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to consumers). There are unique dynamics and challenges to consider in such communities when considering the way forward to more community-based, inclusive supports.

4.0 Alternative Programming, Vocational Training and Employment Opportunities

Within the service models outlined above are a range of post-secondary and employment-focused opportunities that have been developed by external service partners who are committed to expanding the range of services available to support the independence and integration of Community Living disABILITY Services (CLDS) participants in the community.

4.1 Project SEARCH - Winnipeg Project SEARCH Winnipeg is an agency-based program operated by SCE Lifeworks that was launched in the fall of 2011 to support high school students with an intellectual disability or autism to obtain employment. The program originated in 1996 at the Cincinnati Children’s Hospital Medical Center and has been customized to suit Winnipeg’s service environment. The cornerstone of the program is the immersion of an individual into a large business or organization. Students learn employability and job skills while participating in a variety of worksite rotations with the goal of competitive employment. Work experience placements are determined based on the student’s experiences, strengths and skills, as well as the site host’s need. Project SEARCH serves as a workforce alternative for students in their last year of high school, developing valued roles in professional settings. Each day starts in a “classroom” (provided by the employer) where students learn essential employability skills. The majority of the day is spent in worksite rotations at the place of employment. Job coaches provide training to students for each work experience and site supervisors and managers provide natural supports. Some worksite experiences have included:

• Clerical work and filing • Data entry/scanning • Distribution and stocking of supplies • Warehouse work (e.g. picking, packing) • Mailroom/mail delivery • Training material preparation • Grounds keeping

Students end their day in the classroom, journaling their key learnings and supporting each other to succeed. The program operates for one full “school” year with the ultimate goal of obtaining competitive employment after graduation. Because Project SEARCH is a work experience program, students are not paid. Student transition into SCE LifeWorks’ supported employment supports upon completion of Project SEARCH.

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SCE Lifeworks has developed partnerships with two employers, Manitoba Hydro and the Government of Manitoba, both of whom offer valuable employment opportunities to eligible Project SEARCH participants within their organizations. Four school divisions have also partnered with the agency, including: Pembina Trails School Division; St James-Assiniboia School Division; Seine River School Division; and Seven Oaks School Division. Other stakeholders such as The Winnipeg Foundation and the Cincinnati Children’s Hospital Medical Centre have also supported the development of Project SEARCH Winnipeg. Project SEARCH Winnipeg is not funded by Community Living disABILITY Services.

4.2 The Friendly Corner Bakeshop - Grandview

Grandview Gateways Inc. is a non-profit agency located in the Parkland Region that operates the Friendly Corner Bakeshop, a popular restaurant frequented by community members. Because the town of Grandview is small with a population of approximately 860 people, the agency recognized that the number of potential employers in the community was limited. In 1993 the bakeshop was introduced to offer participants the opportunity to learn valuable restaurant and service skills, and to interact with community members who frequent the restaurant for breakfast and lunch. CLDS participants are supported by the agency’s day services staff while working at the restaurant. Duties include: bussing tables in the front of house, and working in the kitchen removing large baking sheets from ovens, transferring food items, mixing dough, washing pots and pans, wiping counters, unloading cutlery and dishes, and putting away ingredients. The agency reported that participants enjoy interacting with customers and that their responsibilities at the café have helped to instill a work ethic and a sense of pride in the valuable contribution they make to the community.

4.3 The Scrap Came Back - Winnipeg In March 2014, Direct Action in Support of Community Homes (DASCH), a Winnipeg-based non-profit agency, opened the Scrap Came Back in Winnipeg, an upcycled gift store and artist workspace that provides retail training and experience to eligible CLDS participants. Individuals have an opportunity to sell their artwork at the store and receive a pay cheque for their time. The majority of the store’s profits are redirected to support Project: Home, another DASCH initiative that aims to purchase wheelchair-accessible homes for people moving out of provincial institutions and into the community. The store provides an opportunity for CLDS participants to interact with members of the community as well as learn valuable retail and customer service skills.

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4.4 Contract Work Several agencies reviewed in Phase1 had negotiated contract work with various businesses, Rural Municipalities or private citizens in order to offer work-related opportunities to participants. Recycling was the most popular community–based contracted service. Agencies that operated the workshop model had also negotiated contracts with businesses and individuals for the production of a range of goods, including: wooden garden stakes, wooden furniture design and fabrication, braided rugs, and plastics assembly.

4.5 Other Services Through the exploration of the various service options available in Manitoba, the Review Team did become aware of other innovative services being offered by organizations that fell outside the scope of the first phase of agency visits but bear mentioning given their contribution towards expanding the spectrum of vocational training and employment opportunities available in the province.

4.5.1. Transforming Futures In June 2014, Red River College (RRC) introduced Transforming Futures, a new post-secondary program for students who do not meet regular RRC admission requirements due to significant barriers. The program is a demonstration project that allows students to participate in all aspects of campus life and is delivered in two stages. The first stage offers curriculum that focuses on three key learning outcomes: preparing the student for success at college (e.g. effective studying methods, strategies to improve learning retention and manage stress, and time management skills); essential employability skills (e.g. effective communication strategies, workplace safety practices and procedures, and essential math and writing skills); and, career exploration (e.g. identifying personal skills, strengths and interests and directing these towards appropriate educational programming and employment opportunities). Upon successful completion of stage 1, the student receives an RRC Certificate and alongside other RRC graduates, is invited to participate in convocation ceremonies. The stage 1 Certificate is a prerequisite for entry into stage 2 of the program, enrollment into either the Administrative Assistant program or the Culinary Arts program, two full-time, integrated programs offered by the college should the student wish to pursue employment in either of those vocations. A student is not required to continue into stage 2 after successfully completing stage 1, though direct entry into stage 2 can occur at a later date.

4.5.2. The Lunch Bell Café - Winnipeg In August 2014, the Winnipeg based non-profit agency Changes launched an innovative new restaurant training opportunity for CLDS participants receiving day services at their organization. In partnership with Red River College and with the support of city and federal funding, Changes opened the Lunch Bell Café, a training restaurant designed to assist participants to acquire valuable restaurant working experience with the goal of transferring these skills into meaningful work in the hospitality industry. An intensive, 56 week training program was designed for trainees and includes:

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∗ 20 weeks of classroom study where students learn essential skills such as kitchen safety, proper food handling techniques, personal hygiene, interacting with customers, and handling money (this curriculum was developed in partnership with RRC).

∗ Following the successful completion of the classroom component, participants then move into 10 weeks of training in the back of house where trainees work under the guidance of a professional chef and perform a range of tasks including sous chef duties; food purchasing; menu planning; and kitchen management. Participants can also receive their food safety/food handling certificate.

∗ Following this, individuals then spend 10 weeks working in the front of house, where responsibilities include: taking orders from customers, bussing tables and handling customer payments.

Upon completion of this training program, CLDS participants may pursue employment in the hospitality industry or further their culinary training at RRC which recognizes this program as a prerequisite for entry into the Culinary Arts program.

4.5.3. The Sawmill - Boissevain Prairie Partners Inc. located in the Westman region operates the Sawmill, a not-for-profit community café where CLDS participants prepare meals, interact with customers and offer a valued, meaningful service to the community. The Sawmill has been purposefully designed to attract a wide range of customers. Pool tables were introduced to encourage the town’s youth to spend time at the café with their friends. Musicians and bands are recruited by the agency to perform in order to attract a wider range of clientele. An area of the restaurant has been converted to selling used books, puzzles, and games as a means of encouraging community members to spend time in the café as well as to generate some revenue. Some items produced in the agency’s Handcrafter program are available for purchase at the café. The agency has partnered with Rural Roots Food Cooperative, a group of local farmers/producers that sell their produce from a store front at the Sawmill café. The Sawmill is a model that supports participants to lead independent, inclusive lives in the community while generating additional revenue through a number of community-focused activities.

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5.0 Day Services Policy

5.1 Services for Young Adults Aged 18 to 21 In Manitoba, The Public Schools Act provides the right for students to remain in school until the last school day of June in the year in which the student becomes 21 years of age or the day the person receives a graduation diploma, whichever comes first. As a discretionary program with limited resources, eligibility for day services funding does not commence until July 2nd of the calendar year in which a CLDS participant turns 21 as they already have the option of being served by the educational system. There is nothing prohibiting students with an intellectual disability from graduating at age 18 if they choose to; however, the post-secondary and vocational training options available to them after graduation are often limited, particularly in rural and northern communities where employment and training opportunities are limited for all graduates, not just those with an intellectual disability. The service system needs to ensure that students who wish to leave school at age 18 fully understand the service menu available for adults with an intellectual disability and the potential service gap that may occur after graduation. One program that is available for CLDS eligible participants under the age of 21 who demonstrate an interest in employment is the marketAbilities program (MAP). Funded by Manitoba Jobs and the Economy but delivered by Family Services, MAP offers a wide range of employment and vocational services to assist youth and adults with disabilities in preparing for, obtaining and maintaining employment. In 2012/13, there were a total of 162 eligible CLDS participants who received Supported Employment through MAP and of those, only one was between the ages of 18 and 21, suggesting that not a significant number of CLDS eligible students chose to graduate high school prior to age 21 in order to access the employment services available through MAP. An explanation for this low uptake is the potential for a gap in funded service. If a student elects to graduate at age 18 to pursue employment or attend vocational training and the placement ends prior to the age of 21, the individual cannot re-enroll into the school system or enter day services until the age of 21. New referrals to MAP are typically waitlisted and not immediately assigned to a case manager. There are also waitlists for funding. There is opportunity for CLDS to work with the Department of Education to strengthen the programming available for those students aged 18 to 21 who remain in school and would benefit from programming targeted towards enhancing their independent living skills and personal skill development. Although some school divisions are currently doing this, programming is not consistent, nor is there a formal mechanism in place that links the skill building needed in schools with the services and supports offered in day services. There is opportunity for CLDS and Education to work in partnership to develop a seamless continuum of programming that will support participants to develop valuable independent living skills and prepare them for the transition into adulthood.

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5.2 Day Services Goals Current day services policy states that the goal of day services is to support individuals in daily activities which increase independence, productivity and community integration, including access to competitive employment, training and support. Individual areas of interest and the type of day services training and support required are based on the goals and objectives established through an individualized planning process. The services delivered, based on the individual’s plan, are to provide participants with the opportunity to:

1. lead a satisfying and secure life in the community through the provision of:

a. training opportunities; and

b. a range of services that address the evolving needs of the individual

2. lead a productive life in the community through the provision of:

a. competitive employment with supports; and

b. opportunities to spend the working day engaged in meaningful activities

3. self-direct their own lives by:

a. supporting individuals to make decisions in the least intrusive/restrictive manner possible; and

b. affording individuals the opportunity to select their agency of choice

4. lead a life as part of the community by supporting individuals to access leisure, social and vocational activities of interest to the individual and that involve people who are not paid staff.*

*Taken from the current “Community Options – Day Services” policy, issued January 1, 2001.

It is challenging to objectively assess the effectiveness of the service models identified in chart B-1 above in achieving these high level objectives without measurable, performance-based service outcomes. Concepts such as “a satisfying and secure life”, “a productive life” and “a self directed life” are highly individualized, subjective and difficult to quantify. It could be argued that all of the current service models are striving to meet the intended goals as described in policy.

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6.0 Cost Drivers of Day Services

Regardless if a participant’s goal is supported employment, vocational training, personal skill development, seniors programming or any combination thereof, the funding for day services is structured around a core question: What level of support from a Direct Service Worker (DSW), program coordinators and administrative staff is needed to assist the individual to participate in the day service of his or her choice?

6.1 Regular and Special Rate Per Diems Agencies are funded primarily through per diems based on the assessed needs of each participant and the anticipated costs of supporting those needs per day. Per diems cover the hourly wages and benefits of DSWs, the salaries and benefits of an agency’s administration, the cost for rent and utilities, the costs of program development and supplies, and other expenses. Depending on the complexity of participant need, there are two per diem options: the regular rate and the special rate. Individuals who are assessed as being more independent and requiring less intensive support are funded at the regular per diem rate of either $27.40 (south) or $35.65 (north). Individuals who have more complex needs and assessed as requiring a higher level of staffing support are funded at a special rate per diem. The special rate is calculated based on the appropriate participant-to-staffing ratio and the corresponding administrative costs to support that ratio.

6.2 Increasing Reliance on Higher Levels of Special Rate Funding Day service expenditures are increasing at a significant rate. In 2010/11, the CLDS program expended $25,772.7 million on special rate funding for 1,564 participants; an average special rate cost of $16.5 per participant. Five years later in 2014/15, that amount had increased by an

estimated 46.3% to $37,701.6 for 2,221 participants, for an average special rate cost of $17.0 per participant. Agencies consistently report that the per diems CLDS provides for DSWs and other support costs are too low, making it challenging to recruit and retain skilled staff. As agencies experience high staff turnover, the availability and quality of service is impacted. The risk with relying primarily on paid staff supports to deliver a service that an individual will require for the duration of his or her lifetime is that the funding required to compensate staff will continuously be impacted by

three cost pressures:

1) the number of new DSWs who enter the service system every year to support the increasing number of new participants, many of whom present with more complex and challenging needs;

2) increases to the minimum wage; and,

3) the higher hourly rates paid by other sectors who require staff with similar skill sets.

● ● ●

In a five year span, special rate funding increased by 46.3%

● ● ●

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Despite the increased use of special rate funding, the overall Community Living disABILITY Services (CLDS) budget and the per diems provided to agencies have not adequately kept pace with these three cost pressures.

6.3 Implementation of the Supports Intensity Scale To begin addressing some of these challenges, CLDS has implemented the Supports Intensity Scale (SIS) as the standardized assessment tool to determine the support needs for individuals receiving funded services in the program. The SIS is a valid and reliable assessment tool specifically designed to measure the type, frequency and intensity of support an individual requires to fully participate in community life. The use of a standardized assessment tool is intended to ensure that:

• the CLDS program is more responsive to the identified support needs of individuals;

• the service system is more responsive to, and directed by, the support needs of individuals;

• individuals are supported to be as independent as possible and included in community life;

• the process for determining individual support needs, resource provision and funding allocation is more transparent, equitable, consistent and accountable; and

• the distribution of funding is fair and equitable, leading to greater sustainability of the CLDS program.

Using SIS assessment scores to guide planning for individuals and decision-making around the allocation of financial resources will support the program to ensure participants receive funding and staffing supports in an equitable way that is proportionate and matched to their level of need.

6.4 Individual Independence and Natural Supports Through the review process, the Review Team heard that families often expect the same level of intense staffing support when their adult children transition into day services as was provided in the school system. As a result, the schools, and then day services, have become a holistic, wrap-around service where the end objective is paid staff supports as opposed to assessing what the individual and community can offer and then building funded supports around that natural support network. Part of an individual’s day could include spending time on their own, spending time with family, participating in a social club or registering for a sport offered through the leisure guide. CLDS should promote greater use of natural supports to strengthen an individual’s ability for greater independence in the community and reduce reliance on high levels of paid staff supports to the greatest extent possible. Other jurisdictions are exploring various models to achieve this outcome. The 2011 Deputy Ministers’ Review of Community Living British Columbia (CLBC) noted the need to effect a significant change in focus from a service-dependent community to a community focused more

http://www.eia.gov.bc.ca/pwd/docs/Improving_Services_to_People_with_Developmental_Disabilities_Report_FINAL.pdf

http://www.eia.gov.bc.ca/pwd/docs/Improving_Services_to_People_with_Developmental_Disabilities_Report_FINAL.pdf

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on individuals’ abilities and their families, with an emphasis on individuals identifying and addressing their own needs with only targeted supports from government. Many participants in the Deputy Minister’s Review shared a sense of one of the key pressure points and flaws with the CLBC service delivery system: an over-emphasis on paid supports. Although community and generic supports were at the heart of CLBC’s conceptual basis when it came into being, much of its system was predicated on paid services being the end goal for individuals and families.

6.5 Supported Employment The growing trend across jurisdictions is the underlying principle that all individuals are employable and that the first option for participants entering day services should be employment. This Employment First philosophy has been adopted by 19 states in the United States, as well as in British Columbia and Alberta.

British Columbia According to the British Columbia Government (2011), Community Living (CL) BC estimated that roughly 50% of its participants were employable to some degree but had grown up in a system that assumed they would not work and; therefore, did not teach relevant skills and abilities to support their pursuit of independence. In March 2013, CLBC issued its Community Action Employment Plan (CAEP) to support more people with disabilities to become employed. CLBC defines employment as work which pays at least minimum wage and meets the conditions outlined in BC’s Employment Standards Act. Employment can be full-time, part-time or self-employment. CLBC funds service providers across the province to deliver a range of community inclusion programs, including: skills development, home-based community inclusion, community-based inclusion, and employment supports. According to the 2013 CAEP, approximately 10,000 people were funded in the full range of community inclusion supports, at a cost of approximately $210 million annually. Within this funding envelope, CLBC funded nearly 1,400 employment spaces that provided individuals with job coaching, job search, and on-the-job training and support at a cost of $10.7 annually. CLBC also invested in a number of projects and strategies to support the advancement of the CAEP, including:

• A BC Government Employees Union Scholarship fund in the amount of $100.0 to support individuals who were eligible for CLBC services to develop their skills and abilities through educational programming;

• STEPS Forward, a family based organization that partnered with six post-secondary institutions to offer educational programming to young adults with developmental disabilities who were not ready to proceed directly into employment;

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• includeMe!, an initiative that measured quality of life indicators for individuals in receipt of CLBC services and employed 20 participants to issue the performance measurement tool; and

• A Customized Employment Pilot Project which supported employers to customize employment opportunities for CLBC participants based on their abilities, needs, strengths and interests. The pilot ran from July 2008 to May 2012 at a cost of $4.31 million with the goal of providing employment opportunities for over 300 individuals. Approximately 50% of the individuals who were still involved in the pilot project at its conclusion were transferred to the Employment Program of BC; the remainder continued to be supported by CLBC.

Alberta Alberta issued its Employment First Strategy in May 2014 and committed to supporting persons with all types of disabilities, including those with complex and significant disabilities, to have access to post-secondary education, training and skills development to help them meet their career goals. The vision of the strategy is stated as follows:

Albertans with disabilities achieve meaningful employment that enables them to realize their full potential.

There are three main outcomes identified under the Strategy:

1. More persons with disabilities are employed

2. More workplaces are inclusive

3. Enhanced collaborative partnerships with community partners To achieve these outcomes, Alberta has committed to supporting individuals with disabilities through a number of initiatives and strategies, including: improving access to career exploration services; developing youth employment projects; realigning current policies to ensure congruence with the Employment First vision; working with employers to create more inclusive workplaces; and enhancing collaborative partnerships and networks among service providers to strengthen the spectrum of post-secondary programming, vocational services and employment opportunities available to persons with disabilities. Alberta is now in the process of developing the action plans to advance this agenda. Manitoba In Manitoba, service providers typically keep track of participant employment statistics, but no accurate figure is currently available to suggest how many CLDS participants may be employable in some capacity. There are a number of agencies in Manitoba that currently deliver Supported Employment to participants, a service that provides job coaching and mentorship to participants employed at least 15 hours per week with the goal of fading those supports over time. Other agencies have been working with potential employers to refine such techniques as “job customization”, where employers are encouraged to think outside of typical job descriptions and customize tasks to meet an individual’s abilities and interests. Additionally,

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the Department of Jobs and the Economy continues to implement Manitoba’s Strategy for Sustainable Employment and a Stronger Labour Market. This Strategy identifies several actions aimed at supporting those Manitobans who are not included in the workforce or not reaching their full potential in the labour market, including persons with disabilities, with finding and retaining good jobs. Under the action plan, the province has committed to continuing the development of partnerships with business, labour, non-profits and government to support people with disabilities to access meaningful employment. The Review Team noted that although current day services policy does not specify how funded agencies are to engage with potential employers to increase the opportunities for paid employment, the strategies identified above have contributed towards the expansion of employment opportunities for CLDS participants.

6.6 Supporting Individual Choice by Offering More Choices The province has the opportunity to change the expectations for people with intellectual disabilities by presuming that many participants are capable of employment (either full or part time) and should be supported to pursue employment as their first day service option. The review of Employment First models in other jurisdictions, particularly in the United States, did reveal one caution. The challenge, particularly in the United States, is that employment has often become the only acceptable outcome of day services, and funding for other day time programming has either been significantly reduced or eliminated altogether. As Manitoba determines how to position its day services in the future, there must be recognition that not every participant will be employed full time, or necessarily employment-ready, and that appropriate supports must be available for those participants where employment, vocational training or post-secondary programming is not a realistic option.

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7.0 Funding Model in Manitoba

7.1 Day Services Costs Funded by CLDS

For every service model identified in Chart B-1, all costs incurred by the agency can be funded by the CLDS program. Although there are some service models intended to generate revenue for the agency (i.e. site-based workshops and agency-owned businesses), CLDS can (and does) provide funding to address an agency’s overall expenses, even if the business or enterprise does not generate a profit. It should be noted that many agencies who participated in the review received revenue from other sources, including, but not limited to: fundraising events, unsolicited donations, federal grants, rental properties, and other government programs (e.g. marketAbilities). The review revealed that agencies redirected these funds to address various cost pressures, including increasing direct service staff wages, supplementing program costs, and investing for future use. At present, there is no CLDS policy that establishes parameters around how profits or revenues are to be used.

7.2 Per Diem Funding As described under section 6.1, agencies are funded primarily through per diems based on the assessed needs of each participant and the anticipated costs of supporting those needs per day. Per diems cover the hourly wages and benefits of DSWs, the salaries and benefits of an agency’s administration, the cost for rent and utilities, the costs of program development and supplies, and other expenses. Depending on the complexity of participant need, there are two per diem options: the regular rate and the special rate. Individuals who are assessed as being more independent and requiring less intensive support are funded at the regular per diem rate of either $27.40 (south) or $35.65 (north). These rates include an hourly wage for an eight-hour day, plus a percentage for administrative costs and the agency’s overhead and operating expenses. Individuals with more complex needs who are assessed as requiring higher staffing support are funded at a special rate per diem. The special rate is calculated based on the appropriate participant-to-staffing ratio and the corresponding administrative costs to support that ratio. Some supported employment agencies invoice at the regular per diem rate for either 50 days per year, or 130 days per year (rather than the typical 260 days per year) once an individual has completed one year of service and has acquired employment. This reduced funding would be determined by the individual’s employment status and level of independence. These are known as “follow up” or “bridge back” rates. Of the 14 agencies reviewed in phase 1, 11 were in receipt of regular rate funding for at least one participant, and all received special rate funding for the other participants; however, the range of staffing ratios that the regular rate supported, as well as the range of special rates and their corresponding staffing ratios, was highly variable. This was due to a number of factors: historical per diems and how recently the per diems were reviewed, changes in participant

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numbers, changes in participant needs, availability of funds from other revenue sources, and the differing administrative and operating costs incurred by the agencies. Table #F-1 below provides a synopsis of the range of special rates that CLDS was funding for ten participants who were randomly selected for inclusion in phase 1 of the review, and the subsequent staffing ratios that these rates were supporting.

Table #F-1: Special Rates and the Corresponding Staffing Ratios

Participant Special Rate Participant: Staff Ratio

Notes

A $21.80 1:1 2:1 staffing ratio sometimes provided

B $48.65 4:1 5:1 staffing ratio provided where possible

C $50.50 3:1 Participant receives 1:1 staffing but the difference is not funded by CLDS

D $72.83 3:1 1:1 staffing ratio sometimes provided

E $79.15 3:2 -

F $89.87 2:1 1:1 staffing ratio provided as needed

G $96.50 1:1 -

H $118.03 1:1 -

I $132.72 1:1 -

J $217.69 1:2 Due to significant needs, participant is supported by two staff at all times

The challenge with basing per diem funding primarily on participant-to-staffing ratios is that as participant needs change, the staffing ratios also change, and over time the per diem provided for a participant may no longer reflect the actual staffing ratio or the cost of the DSWs employed. Agencies then use their total per diem funding envelope to address the costs of their overall DSW staffing complement, as well as the overhead and administrative costs necessary to keep the agency operating. The result is what is demonstrated in table F-1. Agencies are using a wide range of special rates to support primarily the same high intensity 1:1 participant to staffing ratio. The current per diem funding structure does not accurately reflect the cost of the various service models in operation or the actual cost of direct service.

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7.3 Grant Funding Agencies also receive grant funding as a means of addressing the administrative and operating costs incurred to deliver service. Even though a portion of the per diems are intended to address these costs, agencies can use their per diems to offset shortfalls within their budgets; often this means directing a higher percentage of the per diems to DSW wages and benefits and reducing the funding available for non direct service costs. To bolster the envelope of funding agencies receive, CLDS provides two grants: the administrative support grant and supplemental rate grant. The administrative and supplemental rate grants, established in the 1990s, were created to augment the regular per diem rate that was perceived as inadequately addressing actual agency administrative costs. Over time, the Department converted lower regular per diem rates (i.e. $10.96) to a higher regular per diem rate of $27.40 as a means of addressing agency administration costs, though the grants continued to be delivered. The administrative rate grant is calculated using a rate of either $2.29 (south) or $2.53 (north) and multiplying by the capped number of participant spaces identified within each agency’s Service Purchase Agreement. The supplemental rate grant is calculated by multiplying the rate of $1.24 by up to 20 participants (if the agency has fewer than 20 participants, then the actual number of individuals is used). Both grants are paid twice annually. Chart #F-2 below illustrates how an agency’s total funding envelope, including per diem and grant funding, is structured: Chart #F-2: Current Per Diem and Grant Funding Structure

Regular Rate Per Diem

Direct Service Worker

Administration

Overhead Costs

Programming Costs

Special Rate Per Diem

Direct Service Worker

Administration

Administrative Support Grant

Administration

Supplemental Rate Grant

Start-Up Costs

Overhead Costs

TOTAL FUNDING

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7.4 Challenges with the Current Funding Model One of the challenges of the above funding formula rests in the inability to cleanly separate direct service costs from an agency’s overhead and operating expenses. The costs incurred by the 14 agencies over the last three fiscal years suggest that the current funding model does not adequately reflect the different cost pressures experienced by agencies delivering different service models, nor does it reflect the reality that some agencies have access to other revenue sources and; therefore, have additional funding to utilize. Under the operating/overhead cost category (e.g. mortgage, rent, utilities and insurance), agency expenditures ranged anywhere from 3% of an agency’s overall Community Living disABILITY Services (CLDS) day services funding (in this case the agency was delivering a strictly community-based service with lower overhead) to as high as 45% of an agency’s overall CLDS funding (this was a large organization delivering a range of services through a blended service model with a primary focus on customized, site-based service environments. This agency also received funding from other revenue sources that matched the amount received by CLDS). To receive CLDS funding, agencies submit funding proposals to the region for approval, reflecting the anticipated costs to support a participant within their service model. In the absence of clear funding guidelines, agencies consider a number of factors that affect the cost of delivering service: the staffing ratios already in place to support participants either in a community-based or a site-based setting; the administrative support employed by the agency; the overhead and programming costs for that participant; and any other expenses. As a result, a funding proposal from agency X may be very different than a funding proposal from agency Y to support the same individual. Per diems are approved based on the assessed needs of the participant and the staffing ratio to support those needs, but the per diems may be used differently by each agency depending on the cost pressures that agency is experiencing and whether other revenue is available, which is why per diems differ across agencies and why funding levels appear to be inequitable.

● ● ●

Overhead and operating costs ranged anywhere from 3% to 45% of agencies' day

services funding

● ● ●

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8.0 Preliminary Observations/Themes Throughout the review process, various members of the Review Team met with staff from 14 agencies, board members, CLDS participants and regional departmental staff and documented their impressions of the issues, challenges and opportunities impacting day services. These impressions were then discussed at weekly team meetings and condensed into five preliminary themes. It should be noted that a formal quantitative and qualitative analysis of the data will be undertaken at the conclusion of phase 2 which will enable the Team to present themes identified through a more rigorous evaluative process.

8.1 Service Philosophy

8.1.1. Philosophy, vision and intent of Day Services Although day services is grounded in the principles established within The Vulnerable Persons’ Living with a Mental Disability Act (VPA), and the current policy requires services to support individuals to lead self-directed, satisfying, productive and inclusive lives, there are no measures that define what the terms ‘satisfying’, ‘productive’ and ‘inclusive’ actually mean, or what the ultimate goal of day services is. The Review Team noted that the vision of day services (i.e. what day services is intended to accomplish for individuals), the underlying service philosophy that will support this vision, and the service models that the program can continue to support currently and over the long term, are not well defined. A better articulated vision for day services will lead to a more transparent and accountable system of services and inform the development of a quality assurance framework for CLDS.

8.1.2. Individual choice and self-determination The services delivered by all 14 agencies adhered to the principles established within the VPA and respected the individual’s choice and right to self determination. Although the review did uncover at least two situations in which respecting individual choice resulted in individuals choosing not to participate in activities that could have enabled them to become more independent in the community, this was not typical.

To support individuals to make positive choices for themselves, it is incumbent upon the system to offer service options that are robust and reflect the real life choices available to all members of the community. This includes a range of post-secondary programming, different vocational training opportunities, courses that promote personal skill development, and a variety of employment options. By expanding the service menu available, participants will be empowered to make service choices that better reflect their interests, goals and skills.

8.1.3. Natural support networks and the use of other community resources As part of the review process, each agency was requested to provide additional information on four randomly-selected participants in receipt of day services. In the participant survey, the agency was asked “Does the participant have a support network? If yes, please describe.” The survey did not provide a definition of “support network”, leaving the agency

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to interpret this as per their practice. The definitions varied, and the review found that support networks could include paid agency staff and/or the participant’s immediate family. If a friend was mentioned, that friend was often another participant at the same day program. There were also instances where family members, listed as part of the support network, actually played a very small role in the person’s life and were most likely mentioned due to being a relation rather than functioning in a regular support role. People’s supports are sometimes characterized as “rings” surrounding them in a decreasing order of support intensity. For many people, these rings are comprised of family, then friends, followed by community contacts and then finally by paid supports. In a review of the literature, Duggan and Linehan (2013) found that people with an intellectual disability tended to have small social networks that were usually comprised of paid support workers, immediate family members and other people with an intellectual disability.

The review uncovered that natural support networks are challenging to develop. The partnering systems that jointly support adults with an intellectual disability (i.e. other government departments, external service providers and advocacy groups) should work together with a focus on supporting CLDS participants to develop natural support networks that will assist them to participate in all aspects of community life.

A concern voiced by some board members who met with the Review Team focused on the difficulty participants experience when their support worker leaves the agency and a new worker is assigned. The primary relationships participants have throughout their lives should be with people who are naturally involved with the participant, such as through a familial connection, a friendship or a collegial relationship; people who will remain involved with the participant not because they are paid to, but because they have an interest in supporting that individual to succeed. These natural relationships are reliable, have longevity and are steeped in a genuine desire to be involved in that person’s life. They support community integration and can help to manage risk or perceived vulnerability in the community. These are the relationships that paid support providers, along with service funders, should be encouraged to develop and strengthen in partnership with the individual so that if the worker leaves, the support network continues.

8.2 Agency/Community Engagement

8.2.1. Communicating with the Department Through the review process, the Review Team discussed the current departmental structure and registered the challenges agencies sometimes experience when trying to determine where to direct questions or concerns. At present, agencies connect with the region for participant-specific issues including funding or securing specialized supports, the Agency Accountability and Support Unit (AASU) to submit reports as per their Service Purchase Agreements, and either the CLDS program office or the Regional Program Manager with queries about program policy or broader funding decisions. For agencies, this structure can be fragmented and confusing. Clarifying the roles of the various units within the Department and simplifying the communication process would support agencies

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to get their information needs met and improve the working relationship between agencies, the CLDS program and the Department as a whole.

8.2.2. Agency Relations Agency relations could be better supported through more formalized and strengthened mechanisms within the current environment. A strong working relationship between the Department and agencies delivering service would improve opportunities for information sharing and allow the Department to offer support, advice and information on the global issues impacting CLDS, when needed.

8.3 Supporting Service Delivery

8.3.1. Life skills training in schools At least three of the agencies reviewed in phase 1 reported to the Review Team that an increasing number of individuals graduating from high school are not equipped with the life skills necessary to transition into a more independence-focused day service. CLDS could work in partnership with the Department of Education to develop more skills-based programming while in high school (i.e. skills for managing a household, basic accounting, nutrition information, and kitchen safety). Enhanced, skill-based programming would better prepare students to transition from school into community living arrangements, as well as post-secondary programs, vocational training or employment upon graduation. Policies and financial resources would need to be realigned to support this approach to ensure that students retain funding between the ages of 18 and 21 years if necessary.

8.3.2. Partnerships with collateral Departments and the spectrum of services available

Aside from the CLDS program, many participants receive educational, financial, employment or clinical services and supports from programs managed by other government departments including: Jobs and the Economy; Labour and Immigration; Healthy Living and Seniors; and Health. Strengthening the working relationship between Family Services and other ministries that support CLDS participants would better enable government to explore more opportunities to work in partnership and expand the types and responsiveness of services available to participants who have a range of needs in different stages of their lives. Each of these departments contributes towards the spectrum of services available and by improving service coordination, challenges to service delivery could be more easily addressed, policies could be better aligned to ensure that services are seamless and resources are available, and new innovative service options could be funded, developed, implemented and evaluated in partnership with impacted stakeholders. Issues that were raised through the day services review that could be redirected to a multi-department working group included: the earnings exemption and availability of health benefits currently available through the Employment and Income Assistance (EIA) program; employment standards that must be met in order to qualify for minimum wage; the inclusion of adults with an intellectual disability in the development of community-based senior’s

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programming; and as mentioned earlier, the development of life skills programming for students aged 18 to 21.

8.3.3. Sharing of resources across agencies One of the objectives of the day services review is to find resource efficiencies that will

support the long-term sustainability of the program. CLDS intends to work with agencies to find cost-effective ways to do more with less and research has found that interagency collaboration can ease the financial burden on individual agencies, enable shared resources and expertise, reduce duplication and contain costs (Cohen, Hall, Freeze, Butterworth & Hoff, 2011).

The review identified four categories of resources that all agencies reviewed in phase 1 either used, accessed or could make available to other agencies if requested:

• governance resources (e.g. board training, Human Resource policies); • operational resources (e.g. insurance policies, office supplies); • direct service resources (e.g. staff training sessions, transportation, clinical

supports); • expertise and knowledge (e.g. some agencies had developed specialized expertise

and skills in certain areas, such as quality assurance best practices, job customization and supporting participants with complex, challenging behaviours).

CLDS can work with agencies to document the resources available within agencies, within the regions and across the province to develop strategies that would enable agencies to access the resources and supports they needed in a more coordinated, timely and streamlined way.

8.3.4. Communicating the benefits of paid employment The Review Team became aware of situations where CLDS participants who were competitively employed part-time had turned down additional hours out of concern that their EIA benefits would be reduced, resulting in less take-home pay. EIA’s policy regarding the current earnings exemption allows participants to keep the first $200 of their net monthly earnings, as well as 30 % of any amount earned over $200, before EIA benefits are reduced. It is in the participant’s best interests to earn more through competitive employment than to rely solely on EIA for financial support. CLDS needs to communicate the policies regarding the current earnings exemption and the benefits of paid employment to agencies, including information regarding additional supportive programs for people who exit EIA for work, so that participants are encouraged to accept more hours should these be available at their place of employment.

8.3.5. Publically raising employment expectations The Review Team speculates that not all CLDS participants aspire to become employed because it is not an outcome expected of them. For some families, the possibility of their

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son or daughter becoming employed was never considered a realistic option; therefore, they never discussed with their child what they wanted to do for employment as adults. Raising the expectations of families, the broader community, the business community, and ultimately the individual, would support all members of society to start thinking about day services as an educational and employment-focused program with a mandate to actively promote the abilities, skills and aspirations of people with an intellectual disability to the public.

8.4 Funding Model

8.4.1. Simplifying the funding model In order to fund agencies for the delivery of day services in a manner that is fair, equitable and transparent, the funding model needs to be reflective of the various cost elements and ensure that both the assessed needs of the participant as well as the operational costs of the agency are addressed. Overhead and operating expenses are typically much more stable year-over-year than the fluctuating staffing costs of direct service delivery. Participant needs can change; therefore, the mechanism to fund the cost of direct service support should be flexible and easily adjusted as required. The funding model must balance the changing needs of participants with the ongoing agency’s administrative and operating costs.

8.4.2. Funding assessed needs and future goals The Supports Intensity Scale (SIS) assessment will enable CLDS and agencies to determine the level, intensity and type of support an individual requires to fully participate in the community today. If the long-term goal of day services; however, is to support the individual to achieve the greatest level of personal independence as possible, or increase skills and require less intensive supports, then the individualized person-centred plan needs to establish goals for those participants who demonstrate greater capacity for independence and reassess the participant’s support needs using the SIS assessment tool. As the individual’s natural support network strengthens and becomes more involved and other employment and educational opportunities are made available, the likelihood of greater independence increases, enabling the program to redirect some of those funded supports to other participants who may require more intensive support.

8.5 Quality Assurance

8.5.1. Service model standards Although there are a number of service models currently operating in Manitoba, CLDS has not articulated the standards a service model must meet in order to be approved as a day service. Priority and planning documents, such as a strategic plan, would support agencies to confirm their organization’s direction and future goals, and assure the Department that they are moving in tandem with the overall vision and mandate of CLDS. For the agencies

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operating a social enterprise or engaged in employment-focused activities (e.g. contract work with a municipality), a business plan identifying viability within the community, anticipated revenue generation and long-term sustainability should be required. Other service model standards that could strengthen the overall day services system include, but are not limited to: requiring participant job descriptions for employment-based positions within the agency; establishing compensation rates reflective of skill level and capacity to meet industry standard; and articulating the program’s expectations regarding the use of profits.

8.5.2. Service standards and performance outcome measures A strong quality assurance (QA) framework would introduce a more consistent service standard across the province. The foundation of a strong QA framework is a well articulated vision and mission statement, a clear understanding of the service philosophy that will support the vision, and a well defined set of service objectives and goals. If the objective of day services is to promote greater participant independence, community participation and personal growth, Community Living disABILITY Services (CLDS) can then determine which service model(s) will best achieve these goals and develop standardized performance measures to assess the effectiveness and efficiency of the service models and outcomes for participants. From a departmental perspective, the Program would be better able to evaluate the success of day services at the macro level by using standardized performance measures to analyze trend data across the province and within regions (e.g. How many individuals participated in post-secondary programming this past year? How many participants attained competitive employment over the past three years?) Additionally, participants would be able to assess the impact of day services with respect to their own goals and outcomes identified in their individualized person-centred plans. Standardized performance measures will also empower agencies to evaluate their spectrum of services, the outcomes achieved for individual participants who participated in their services, the effectiveness of their own business practices and the efficiency of their service model.

9.0 Day Services Review – Final Report The day services review has moved into its final information gathering and analysis phase. A report summarizing findings, themes and providing recommendations is in the process of being drafted. The anticipated completion date is January 2016.

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10.0 Works Reviewed

Abbott, S., and McConkey, R. (2006). The barriers to social inclusion as perceived by people with intellectual disabilities. Journal of Intellectual Disabilities, 10(3), 275-287.

Alberta Employment First Strategy (2014). Available on website at: www.humanservices.alberta.ca/disability-services/employment-first.html

Alberta Government (2013) Report on Spring 2013 Persons with Developmental Disabilities Community Conversations. Available on website http://humanservices.alberta.ca/documents/PDD/pdd-what-we-heard-report-spring-2013.pdf

Alberta Human Services (2013). Transforming the PDD Program. Available at: http://humanservices.alberta.ca/newsroom/16668.html

British Columbia Government (2011). Improving Services to people with Developmental Disabilities: Deputy Ministers’ Review of Community Living British Columbia. Available at: http://www.sdsi.gov.bc.ca/pwd/docs/Improving_Services_to_People_with_Developmental_Disabilities_Report_FINAL.pdf

Cohen Hall, A., Freeze, S., Butterworth, J., and Hoff, D. (2011). Employment funding for intellectual/developmental disability systems. Journal of Vocational Rehabilitation, 34, pp. 1–15.

Community Living British Columbia and Community Partners (2013). Community Action Employment Plan (CAEP). Available on website at: http://www.communitylivingbc.ca/wp-content/uploads/Community-Action-Employment-Plan-FINAL.pdf

Disability Services Review Committee (2009). Disability Services Review II: Recommendations of the Disability Services Review Committee. Prince Edward Island Department of Social Services and Seniors.

Duggan, C. And Linehan, C. (2013). The role of “natural supports” in promoting independent living for people with disabilities; a review of the existing literature. British Journal of Learning Disabilities, 41, pp. 199-207.

Human Services Research Institute (2012). Working in the community: The status and outcomes of people with intellectual and developmental disabilities in integrated employment. NCI Data Brief, October 2012. Cambridge, MA: Human Services Research Institute. http://www.communityinclusion.org/pdf/Data_types_of_employment.pdf

Irvine, Angela; Lupart, Judy. (2008). Into the workforce: Employers' perspectives of inclusion. Developmental Disabilities Bulletin 36.1/2 (2008): 225-250.

Irvine, A., PhD. (2010). Conducting qualitative research with individuals with developmental disabilities: Methodological and ethical considerations. Developmental Disabilities Bulletin, 38(1), 21-34. Retrieved from http://search.proquest.com/docview/1425505353?accountid=147608

http://www.humanservices.alberta.ca/disability-services/employment-first.html

http://humanservices.alberta.ca/documents/PDD/pdd-what-we-heard-report-spring-2013.pdf

http://humanservices.alberta.ca/newsroom/16668.html

http://www.sdsi.gov.bc.ca/pwd/docs/Improving_Services_to_People_with_Developmental_Disabilities_Report_FINAL.pdf

http://www.sdsi.gov.bc.ca/pwd/docs/Improving_Services_to_People_with_Developmental_Disabilities_Report_FINAL.pdf

http://www.communitylivingbc.ca/wp-content/uploads/Community-Action-Employment-Plan-FINAL.pdf

http://www.communitylivingbc.ca/wp-content/uploads/Community-Action-Employment-Plan-FINAL.pdf

http://www.communityinclusion.org/pdf/Data_types_of_employment.pdf

http://search.proquest.com/indexinglinkhandler/sng/au/Irvine,+Angela/$N?accountid=147608

http://search.proquest.com/indexinglinkhandler/sng/au/Lupart,+Judy/$N?accountid=147608

http://search.proquest.com/pubidlinkhandler/sng/pubtitle/Developmental+Disabilities+Bulletin/$N/32979/PrintViewFile/232464852/$B/1421A96E28D173DC1A6/1?accountid=147608

http://search.proquest.com/pubidlinkhandler/sng/pubtitle/Developmental+Disabilities+Bulletin/$N/32979/PrintViewFile/232464852/$B/1421A96E28D173DC1A6/1?accountid=147608

http://search.proquest.com/docview/1425505353?accountid=147608

http://search.proquest.com/indexingvolumeissuelinkhandler/32979/Developmental+Disabilities+Bulletin/02008Y01Y01$232008$3b++Vol.+36+$281$2f2$29/36/1$2f2?accountid=147608

http://search.proquest.com/indexingvolumeissuelinkhandler/32979/Developmental+Disabilities+Bulletin/02008Y01Y01$232008$3b++Vol.+36+$281$2f2$29/36/1$2f2?accountid=147608

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Kendrick, M.J. (2011). “Getting a Good Life”: The Challenge for Agency Transformation so that they are more Person-centered. International Journal of Disability, Community and Rehabilitation, Keynote presentation. Available at http://www.ijdcr.ca/VOL11_01/articles/kendrick3.shtml

Lemon, C., & Lemon, J. (2003). Community-based cooperative ventures for adults with intellectual disabilities. Canadian Geographer, 47(4), 414-428. Retrieved from http://search.proquest.com/docview/228312448?accountid=147608

Nova Scotia Government (2008). Vocational and Day Program Services for Adults with Disabilities in Nova Scotia: A Summary Report. Available at: http://www.novascotia.ca/coms/disabilities/documents/Vocational_and_Day_Program_Review_Report-June2008.pdf

Queenswood Consulting. (2011). Review of Community Living BC Efficacy and Progress to 2011. Available on request from [email protected]

Viecili, M. A., Lunsky, Y., & Strike, C. (2009). BRIEF REPORT: Caregiver versus self-reported views on what is important to clients with intellectual disability. Journal on Developmental Disabilities, 15(2), 99-102. Retrieved from http://search.proquest.com/docview/210911393?accountid=147608

Zigler, E. (2001). Looking back 40 years and still seeing the person with mental retardation as a whole person. In H. Switzky (Ed.), Personality and motivational differences in persons with mental retardation. New Jersey: Lawrence Erlbaum Associates.

http://www.ijdcr.ca/VOL11_01/articles/kendrick3.shtml


http://www.novascotia.ca/coms/disabilities/documents/Vocational_and_Day_Program_Review_Report-June2008.pdf

http://www.novascotia.ca/coms/disabilities/documents/Vocational_and_Day_Program_Review_Report-June2008.pdf

mailto:[email protected]


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Appendix A Phase 1 Agency Visits

The chart below provides the names of the 14 agencies selected to participate in the first phase of agency visits for the day services review and their locations within the province. Phase 1

Agency Community Region Blue Sky Opportunities Inc. Altona Central Connect Employment Services* Winnipeg Winnipeg DASCH Inc. Winnipeg Winnipeg enVision* Steinbach Eastman EPIC de St. Malo Inc. St. Malo Eastman EPIC Opportunities Winnipeg Winnipeg Gateway Resources Inc. Winkler Central Grandview Gateways Inc. Grandview Parkland New Directions* Winnipeg Winnipeg Portage ARC Industries Inc. Portage la Prairie Central SCE Lifeworks* Winnipeg Winnipeg Trailblazers for Life Choices Inc. Winnipeg Winnipeg Transcona Springfield Employment Network Winnipeg Winnipeg Work And Social Opportunities Inc.* Winnipeg Winnipeg

* Note: These agencies were members of the Day Services Review Advisory Committee while the agency visits were underway.

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Appendix B Phase 2 Agency Visits

The chart below provides the names of the 20 agencies selected to participate in the second phase of agency visits for the day services review and their locations within the province. Phase 2

Agency Community Region Association For Community Living (ACL) - Flin Flon Flin Flon Northern Association for Community Living (ACL) - Interlake Stonewall Interlake Association For Community Living (ACL) - Virden Virden Westman Changes - Goals Day Service Winnipeg Winnipeg E.L.A. Essential Living Assistance Service Inc. Winnipeg Winnipeg Family Visions Inc. Brandon Westman Frontier Trading Company Inc. - Sports & Services Minnedosa Westman Hearthstone Community Group Inc. Selkirk Interlake Juniper Centre Inc. Thompson Northern Kelchris Inc. Virden Westman Mountain Industries N. D. de Lourdes Central Parkland Regional Community LINC Inc. Russell Westman Riverdale Place Workshop Inc. Arborg Interlake Rolling Dale Enterprises Inc. Rivers Westman Southwest Community Options Inc. Ninette Westman Sprucedale Industries Inc. Austin Central St. Amant Winnipeg Winnipeg The Pas Association For Human Development Inc. The Pas Northern Turning Leaf Community Support Services Inc. Winnipeg Winnipeg Winnipegosis & District Residential Services Inc. Winnipegosis Parkland

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Appendix C Map of Manitoba: Agency Locations

The map below identifies the locations of the thirty-four agencies within the province of Manitoba:

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Appendix D Best Practices and Online Resources

Identified through Research A review of the literature regarding best practice was conducted during phase 1. Unfortunately, there has been very little empirical research looking at best practices in programs for adults with intellectual disabilities; however, of the research available, three common themes were identified.

• Funders should have a consistent process for assessing need and allocating resources. • There should be resource sharing and collaboration amongst agencies. • Emphasis should be placed on building strong natural support networks and using

community generic services as much as possible. Identified by Agencies The following were identified as helpful best practices by agencies involved in phase 1 of the review: Staff Orientation and Training

• Have department managers orient their own new staff because the managers know their own areas best.

• Assign new employees to shadow more veteran staff before working independently. • Bring in content experts at staff meetings when discussing specific topics (e.g.

Alzheimer’s Society, Regional Health Authority, etc.). • Use the Family Services training manual for Direct Service Professionals. • Use IBEX Training Services – Professional Development for Managers. • Assign Human Resource staff to track all staff training. • Share the cost of training opportunities with other agencies. • Ensure that some staff are certified to deliver Non-Violent Crisis Intervention to co-

workers. • Understand staff learning styles and try to gear professional development to meet the

learning style of the individual. • Schedule training at the end of the day for an hour or two so it is not as difficult or

disruptive to staff and participants at the day program. • Let staff be involved in decision-making, where possible. • Do team building activities. • Involve all managers in day-to-day activities. • Streamline administration as much as possible to enable reinvestment of funding

towards direct service wages. • Schedule agency staff to meet at the beginning of each day for 15 to 30 minutes to

discuss the activities planned for that day and share information that might be relevant to support a participant.

• Schedule time at the end of each day for clean up, completion of paperwork, debriefing with the Program Coordinator, and following up with residential services if required.

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• Schedule a supervision meeting with each staff person once a month and a meeting bi-weekly with the Assistant Program Coordinator.

• Ensure that staff who attend additional workshops and training on Saturdays receive days off in and around the winter holiday season so that the program can shut down, and staff do not have to use vacation time over the holidays.

Assessment and Planning

• Use an assessment and planning tool. • Use the planning tools available through Non-Violent Crisis Intervention training. • Conduct regular staff meetings to ensure individual plans are regularly updated and

services reflect the needs and goals of the individual. • Request staff to keep daily journals that describe what’s working well for participants,

what needs improvement and suggestions for how to better support the individual. • Schedule daily staff debriefings. • Post daily schedules for everyone to see.

Staff Recruitment and Retention

• Implement recognition programs for staff. • Schedule gatherings or special events where staff are able to meet with Board

members. • Request exit interviews when staff leave. • Offer as much professional development training as possible. • Allow current staff to participate in interviews when hiring new staff. • Be flexible and allow staff time off with pay to attend important functions like a school

concert, medical appointments, etc. • Develop a sense of family within the organization. • Develop a supportive Board. • Ensure staff are able to participate in decision-making as much as possible.

Employment Services

• Engage with small, locally owned businesses as these are the employers who tend to have greater flexibility in their hiring practices.

Miscellaneous

• Invite a massage therapist to come in regularly for staff (individuals may choose to pay for this service).

• Encourage CLDS participants to save for an iPad (technology available on the iPad can have a positive impact on the individual’s development).

• Connect with community groups and access resources in the community as much as possible.

• Develop relationships and share resources with other agencies (e.g., policies, planning tools, database, training).

• Establish a parent or support network committee

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Online Resources • The Council on Quality and Leadership (CQL) Personal Outcome Measures provides

information on quality assurance and performance outcome measures: http://www.c-q-l.org/the-cql-difference/personal-outcome-measures

• David Pitonyak’s website provides information on how to support participants who exhibit challenging behaviours: http://www.dimagine.com/

• SPARK is a service of the Canadian Community Economic Development Network that works to match community organizations in Winnipeg with volunteers who have specialized skills: http://ccednet-rcdec.ca/en/spark

• The Government of Manitoba Non-Profit Organization (NPOs) web portal provides links to a range of supports and resources that support the start-up, operating, management and oversight of NPOs: http://www.gov.mb.ca/npo/

http://www.c-q-l.org/the-cql-difference/personal-outcome-measures

http://www.dimagine.com/

http://ccednet-rcdec.ca/en/spark

http://www.gov.mb.ca/npo/

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