Introduction to Individually-Based Limitations (IBLs) in the Oregon ISP
Module 2: Basic Introduction to the Oregon ISP
This module introduces you to the process of gathering person centered information, the purpose of the Risk Identification Tool, and how to build a one page profile.
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Putting the Plan into Action: Implementing the ISP
We’re Better Together
Facilitating better plans through partnerships
Facilitating planning is a skill and an art form – it involves gathering and incorporating information from different perspectives into a living set of documents that reflect the person’s choices. It is no small feat, nor is it one that a Services Coordinator or Personal Agent (SC/PA) can accomplish in isolation
Facilitating planning requires “experts.”
Recognizing expertise is a valuable skill in any facilitator’s kit. It is the first step to facilitating planning in partnership, as it helps us figure out what type of information is needed and with whom we might collaborate. It is also useful in building relationships by noting each person’s contribution and validating his/her perspective. There are two types of “experts” involved in good plan facilitation.
“Process experts” know the rules. They are familiar with required documents and how they are to be completed, which is key to ensuring a person’s supports are in place as needed. This is the facilitator’s (SC/PA’s) role in planning.
“Content experts,” on the other hand, have the crucial information that needs to go into the plan and planning documents. These are the meaningful details about the person’s life, perspective, goals, preferences, and choices. The primary content expert in any person’s life is him/herself. In addition, others who know and care about the person may be able to provide valuable information, with the person’s permission of course.
Identifying the content experts in a person’s life lets us know who might have insight or relevant details needed for planning, and it can help us gather meaningful information about the person. However, we must not stop at naming content experts. We need to learn more about the relationships in the person’s life in order to know with which content experts to plan.
Just because someone knows the person, does not necessarily mean that he/she should automatically be involved.
We all have people in our lives who we trust, and who might support us to make plans or decisions. In the same regard, we may have some people in our lives with whom we choose NOT to discuss personal matters—who, for a variety of reasons, we do not enlist for help when we make decisions or plans. When facilitating a person’s plan or gathering person centered information to contribute to planning, the same notion applies. It is important not only to find out which supporters are in the person’s life, but what type of relationship they have and how the person feels about their involvement in planning together.
How do we know which supporter in a person’s life is a good candidate for planning together? The key is to recognize with whom the person has meaningful connections as well as his/her choice regarding their involvement. Asking supporters the following three questions can give us valuable insight into a person’s relationships:
- How long have you known the person, and how much time do you spend together?
- What do you admire most about the person?
- When was the last time you had fun together, and what did you do?
Answers to these questions can help us understand the person’s relationships better. Specifically, they can tell us if who we are asking has spent enough time to know the person well, and whether or not they have developed a personal connection – if he/she has direct knowledge of what is ‘important to’ the person. This may be different for everyone.
Effective plan facilitation is not a solitary task. It involves partnerships and collaboration. As SCs and PAs are the designated ISP facilitators in Oregon, understanding and using partnerships is vital to gathering meaningful person centered information in a way that works for the person. These tips and points to consider help to make sure that each person on a planning team (whatever this may look like in the person’s life) understands his/her role and is able to contribute meaningful information efficiently. By working together, we can develop better plans—plans that truly reflect the person’s perspective, meet his/her needs and honor his/her choices
A Brief Introduction to Protocols
As we move toward the goal of making sure providers have the information they need to support a person well, it is important to have quick and simple tools for communicating information about necessary supports in a way that is easy for providers to understand and follow.
When a serious risk has been identified, there are several ways it can be addressed. Protocols are one available tool that can provide a helpful structure to address a medical risk.
A protocol is a document that contains personalized instructions that tell support providers how to care for a specific risk or other medical issues.
Protocols are typically written by someone who works directly with the person and who knows the person well. This is done by taking into account what is ‘important to’ and ‘important for’ a person.
Teams may want to seek the advice of a physician or other qualified professional when developing risk management strategies. In this way, the professional’s guidance can inform how the protocol is written.
Most doctors will not want to fill out the entire protocol but will be willing to answer specific questions. Physicians and other qualified professionals can help teams determine if a risk is or is not present and may suggest specific ways to address a risk. This information can then be incorporated into the protocol in a way that providers can understand and follow.
There are a couple things to keep in mind before asking a physician or other licensed medical professional to write a protocol:
- When a licensed medical professional writes a protocol, it should be treated as an order from that professional. Any changes to the protocol should be made or approved by the person writing the order. This can be time consuming for a provider and a burden on the person and medical professionals.
- Physicians use medical jargon that others might not understand. Providers must be able to understand and follow the protocol. The protocol should be written in language that is commonly used
Nurses need the opportunity to review and approve any support document (protocol, procedure, etc.) that addresses an issue identified in a person’s Nursing Care Plan. Nurses may be but are not required to be the original author of support documents; they may review a document created by someone else, modify it as needed, and then sign the document to indicate that it is consistent with the person’s Nursing Care Plan.
When a person lives in a 24-Hour Residential setting, protocols must be used as directed by the ISP process. In other settings, like Foster Care and In-Home, the person writing the protocol can choose to use and develop protocols in a way that is most helpful.
When a person lives in a 24-Hour Residential service setting, providers supporting that person (i.e. Residential, Employment, and Day Support providers) are required to use standardized protocol formats to address the risks of Aspiration, Choking, Constipation, Dehydration, and Seizures. The Financial Plan must also follow a standardized format. A general protocol, as well one for pica, is also available. All of these standardized protocol formats are available for download in Microsoft Word Document format at http://oregonisp.org/forms/.
When a person lives in a setting other than 24-Hour Residential, providers may use any format that works well for them. They can choose to use the available standardized protocols or create their own format.
If creating your own protocol, keep in mind that there are some basic components that a good protocol includes:
- What is the issue? Describe how you know the person is at risk for the issue.
- What does it look like? List the signs and symptoms to look for. What are the warning signs for the risk?
- How do we prevent it? Describe the preventative measures to be taken. What will be done to minimize the chance of the problem occurring?
- What do we do if we see it? Describe the specific steps to take if any warning signs are observed. This typically includes instructions on who to call and where to document that the problem occurred.
- When do we need to call 911? List the circumstances for when 911 should be called immediately. Remember, you don’t need permission to call 911.
Generally speaking and in all settings, if a provider is being paid to support a person, the expected supports must be written down. A few places these supports can be recorded are: in the ISP, in a Service Agreement, or in a Support Document (e.g. Protocol).
There are times when it is helpful to use a protocol. The Services Coordinator or Personal Agent may direct the use of protocols based on their professional judgement. Because of this, it is important for all Services Coordinators and Personal Agents to understand the fundamental purpose of a protocol and have a basic knowledge for when using one is helpful, regardless of the setting in which they provide case management.
- When there are multiple providers supporting a person, protocols help to ensure the person is being supported consistently. They make sure that all people who provide support have the same information to do a job well.
- When there are very specific or complex steps that must be taken, protocols can provide clear instruction that might otherwise be forgotten or missed, especially during a stressful moment.
- When it is important for the provider to know how to prevent a risk, what the warning signs are, what to do if they see a problem, and when to call 911, protocols offer all this information in one, easy-to-access document.
To learn more about support documents, including protocols, refer to the ISP Instruction manual chapter on Risk Management Strategies at http://oregonisp.org/instructions/.
Module 1: What’s in Your Plan?
Want to learn more about the Oregon ISP process? Watch this video designed for people who have an Individual Support Plan (ISP) and their families & friends.
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Please note: We do not provide certificates of completion for our online training modules. Please keep your own documentation of time spent in training, if required.