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Program Design

Support Services for the Deaf

PROGRAM DESIGN
SUPPORT SERVICES FOR THE DEAF

(We gratefully acknowledge the assistance of Vickie Vining who prepared the initial version of this document.)

Overview

Support Services for the Deaf provides services to developmentally disabled client who are deaf. Clients live in their own homes and require some level of support in order to live successfully. Clients may require extensive, ongoing support for the entire day or may be able to assume responsibility for more of their life. It is hoped that clients will progress in their ability to be more independent in their lives.

The hallmarks of this program are the focus on deaf clients, the integration of deaf language and culture, and the employment of deaf persons both as support staff and management.

Purpose and Philosophy

The purpose of these services is to assist clients to each have their own life which is based on what makes sense to them and for them. The services are designed to help clients live in their own homes, learn new things, earn a living, be a part of both the deaf community and the general mainstream community, have satisfying relationships with other people, and in general just have a regular life like other adults their own age. The goal is for client to be happy and content in their lives, working toward the life that they envision for themselves.

All persons involved in a Circle of Support will watch for practices or procedures which keep clients from feeling like it is their own life or their own home. Staff will be particularly aware of practices that might make clients' homes feel “institutional,” such as things on the wall related to staff duties or other organizational issues.

Staff will also work on an ongoing basis to ensure that clients have a voice in all things that pertain to their lives and services. The Circle of Support will make sure that services include increasing clients' abilities to communicate more effectively and to advocate for themselves in productive ways. All decisions should be made by them to the greatest extent possible. Where others must substitute their judgment for the client's, people should consult them or take into consideration their wishes and needs.

The purpose of the service is also to implement the goals and objectives of each client's Individual Program Plans (IPP). Through these plans, clients will make progress on achieving the things that are important to them. The provider's and staff's role is to help them to have choices about what they want to do, both big choices about their lives (jobs, where to live, with whom to live, etc.) and everyday choices, (such as what to eat, what to wear, where to go, etc.) Deaf clients are capable of telling people what it is that they want. Support staff will need to listen to them and make sure they (the staff) are not trying to control of them. An important part of the supported living philosophy is that the people receiving the services are the ones in charge of their lives. Staff and the Circle of Support should be focused on supporting them to live successfully without taking over their lives.

Another important value of supported living is that clients should be as independent as possible in their lives, while receiving the support that they need to be successful. The support needs to change as their needs change. Staff should view their work as finding ways to provide assistance that will help clients to have the skills, judgment and resources to live their own lives.

Relationships and Circles of Support

Services will be provided based on an understanding of what works best for clients. This will be achieved primarily by continually involving clients in choices and decisions that affect their lives. An understanding of what works best will also come through the lifelong relationships of family, and through caring, sensitive new relationships formed with support people and others in their Circles of Support. All people involved in their lives will be expected to treat them with respect and to treat them as deaf persons trying to have a normal life. Staff should see their roles as “support and guidance,” not “care and supervision.”

Services will also be based on assisting them to utilize the larger circle of the deaf community. Since all of the clients have hearing impairments and utilize American Sign Language, the deaf community will be an important part of the support circle. The deaf community will provide a source for finding staff who have the skills and sensitivity to provide support to clients. They will also provide social activities where clients can communicate freely and feel a part of things.

The supports provided to clients will be focused on helping them to become a part of the mainstream community as well. They will be assisted to plan and carry out many activities in the community: movies, bowling leagues, shopping, the zoo, spending time with friends, church and other activities that interest them. Clients usually enjoy being active and getting out in the community. They also have fewer problems when they are able to keep busy doing things they enjoy doing. Staff will assist clients to find ways to make connections in the community through volunteering, joining groups, etc.

Part of the support staff's responsibilities will include helping them to make friends in the community. This will include helping them to communicate with people who do not use American Sign Language and helping them to work out problems that they might encounter in the community or in their own homes.

Clients may have difficulty in handling some situations that frustrate them. They may sometimes express their frustrations by getting upset and aggressive. Staff will assist clients to work through difficulties with other people by helping them to understand what is happening and helping them to calm down and find a peaceful solution to the problem. Staff will not use force, coercion, humiliation or power over clients to control behavior. They will help by getting them involved in another activity or by helping them to leave the situation where the problem is occurring. They will help to prevent outbursts by making sure that clients follow the proper schedule for prescribed medications and by trying to avoid situations that are overly stressful.

A client's Circle of Support is composed of the client's support staff, the case manager, a sign language interpreter and other persons involved in the client's life. The Circles of Support will be used to help clients work toward goals, solve problems, plan activities, make decisions, and they will keep an eye on how people treat them and make sure that people honor their commitments to them.

The Circle of Support will meet at least monthly in order to accomplish all this. In order to provide coordinated and consistent services, staff will have written directions which will need to be followed as well as regular staff meetings to discuss appropriate ways to provide services.

It will be important to keep the Circle of Support as a group of people who are trying to help clients live their own lives. The circle should respect clients' rights to control their own decisions and to pursue their own goals.

Staffing

Positions:

Case Manager: Responsible for all matters relating to the services provided. Must be familiar with the strengths, needs and preferences of clients. Must conduct assessments of the clients; participate in IPP development, Circle of Support meetings, etc. Must monitor client health issues and supervise and safeguard medications. Must develop and monitor daily program plans and reports. Must be prepared for emergencies and monitor the safety of clients including special incident reporting and follow-up.

Auxiliary Support Personnel: (Number of positions and work assignments to be determined by clients' program plans.) Includes American Sign Language interpreters, facilitators who can provide a bridge between deaf staff and the hearing community. Assist, for example, with telephone calls, completing forms, reports and applications, etc.

Support Staff/Senior Support Staff: (Number of positions and work assignments to be determined by the support schedules)

Recruiting:

Support Services for the Deaf will recruit staff mainly through the deaf community. The deaf community will be a good source of staff who use American Sign Language and are either deaf themselves or who have lived with people who are deaf. It is important that all staff working with clients are not only fluent in American Sign Language, but also that they have experience signing in the everyday context of being deaf themselves or growing up with someone who is deaf. Each person will be certified in American Sign Language or demonstrate a fluency in American Sign Language that is equivalent to certification. Other sources of staff will include contacts through friends that are deaf or who are associated with schools for the deaf. California State University at Northridge (program in deaf services) will be another source of recruiting staff.

Staff Characteristics:

In addition to the qualifications listed on the job descriptions, staff are expected to exhibit the following characteristics:

  • Certified in American Sign Language

  • Mature and responsible

  • Have the experience, education and background that will fit the job

  • Non-controlling person, willing to help them work through problems rather than forcing them

  • Able to meet the minimum employment requirements

  • Capable of following a daily program plan

  • Capable of writing daily reports

  • Able to provide transportation, as necessary, including current registration, insurance and driver's license

  • Able to use a two-way communication device

  • Able to use a TDD

  • Able to address safety issues and emergencies

  • Able to administer medications and monitor side effects

  • Friendly

  • Helpful

  • Understanding

  • Patient

  • Smart

  • Nice

  • Cooperative

  • Active, enjoys going out and participating in activities

  • Compatible with clients

    Screening:

    Candidates will participate in as many interviews as it takes to determine if they are the right person for the job. The main criterion for employment is that clients (whoever the staff person is to be assigned to) feel comfortable with the person. During the interview, the case manager will ask questions that are designed to determine how they feel about the job; what kind of methods they would use to control behavior; etc. The case manager will develop a set of questions that will be used for each interview.

    Clients will also interview the applicants and ask the questions that are important to them. Candidates who pass the initial screening will spend time with clients for them to determine whether they feel comfortable with this applicant. The screening process will include enough time with the applicants prior to hiring to insure, as best as possible, that the applicant will be successful.

    All staff will be employed by     Support Services for the Deaf; therefore they must meet the minimum qualifications for employment as specified by Support Services for the Deaf. These qualifications include valid social security number, eligibility for employment in this country, acceptable finger print and background screening, acceptable Department of Motor Vehicles record, and other criteria as specified by Support Services for the Deaf.

    Hiring:

    Upon selection as a staff person, each person will be given an employment application to complete which is established by Support Services for the Deaf. Each new staff will be given a copy of their job description and an employment agreement which defines their job responsibilities, rate of pay, and conditions of their employment.

    Scheduling Staff and Assigning Responsibilities:

    Staff will be scheduled for work at times that fill the requirements for clients. A staff schedule will be established as much in advance as possible. The staffing schedule will be available in each person's home so that all staff knows who is working when. Staff will complete the timesheets given to them by Support Services for the Deaf (following instructions and time frames for completing them) in order to be paid for the hours they work. Staff are not to work overtime hours (more than eight hours in a given day or more than 40 hours in a given week). If staff are approaching overtime hours, they should contact the case manager to let him know.

    When staff are not able to complete their assigned work schedule, they are to notify the case manager at least two days in advance if possible. The case manager will assign a relief staff for that person's schedule. If staff are not able to give advance notice, then the case manager will cover the person's shift if he is not able to get another staff person to cover. The case manager will be available on pager at all times.

    Assignments will be given out by the case manager as appropriate. Staff will meet weekly to discuss what will be happening for the following week. At the staff/circle meetings, people will share ideas that have worked, problems that they are encountering and information that needs to be known by all. Clients should be present if they wish to participate. They should play an active role in determining how people help them. Assignments will be given out in order to fulfill the objectives of the IPP and the Individual Service Plan for clients. Staff will be held accountable for the tasks for which they are responsible.

    Monitoring and Evaluating Staff:

    The case manager will be responsible for monitoring the performance of staff. He will do this by frequently observing how a staff person interacts with clients and how well they carry through on assignments and tasks.

    Staff will receive written evaluations of their work at least annually. Clients will have a major role in determining the satisfaction with their staff's work. Staff will be given feedback and assistance as needed when their work does not measure up to standards. When a staff person fails to respond to the feedback and assistance, the case manager will notify     Support Services for the Deaf that he may have to terminate an employee. Support Services for the Deaf will advise the case manager on the proper method of terminating the person's employment in order to avoid problems.

    • Training

    New Employee Orientation:

    New employees will receive an orientation by the case manager within the first two weeks of hiring, in most cases before they start working. The orientation will include the requirements of the supported living regulations as follows:

  • Overview of Support Services for the Deaf's policies, practices and philosophy of supported living services as contained in this program design

  • Client's IPP objectives

  • Focus on the practical use of supported living services to promote self reliance in clients

  • Clients' protections and rights including:

  • The grievance procedure

  • Fair hearing rights

  • Special incident reporting requirements

  • Protecting client from abuse and exploitation

  • The specific rights protected in Title 17

  • Appropriate conduct in establishing and maintaining personal relationships with clients

  • Participation of client in all aspects of the services including teaching staff how to provide services

    The new employee orientation will also contain extensive descriptions of client's support needs and ways to support them. The case manager or senior support staff will spend time with new employees, showing them their responsibilities and appropriate methods for carrying out their responsibilities. New staff will not be left alone with clients until the case manager feels they are capable of doing the job.

    Ongoing Staff Training:

    Staff will receive training on the job as needed. Training will focus on the specific needs of clients as well as supported living services in general. This training will occur on a regular basis, no less than annually (per the supported living services regulations). Staff will be informed of upcoming conferences and outside trainings on supported living services and encouraged and, in some cases, required to attend.

    Training for Clients and Circle Members:

    As per the supported living services regulations, the case manager will make sure that clients understand the following:

  • Philosophy of supported living services

  • Their rights

  • What abuse and exploitation are and how to report them

  • The grievance procedure if they're not happy with their services

  • Strategies for building and maintaining an effective Circle of Support

    The case manager will make sure that any people involved in a client's circle has access to training on these topics as well if they need it or request it.

    • Individual Support Plans

    The case manager will develop comprehensive individual support plans for client. These plans will be updated on a weekly basis or more frequently if circumstances warrant a change.

    The support plans will detail the types and patterns of support that will be needed by each client. The plans will also detail the goals and objectives that support services will be expected to address for each of clients. Clients will be actively involved in all aspects of determining what services look like. Goals and objectives will focus on “real life” aspirations and expectations, showing what clients want to do with their lives. Wherever possible, support will approximate the pattern of life of people without developmental disabilities    . The support plans will also contain a description of what type of adaptive devices will be needed by each client and how staff will be trained in their use.

    Since these services cover all areas of need for support (including day time hours,) the support plans will also contain how clients will be supported to find and maintain employment. The Circle of Support will work with clients to determine what type of employment interests them and what type of support they would need in order to be successful.

    The support plans will change as clients' needs change. Circle meetings will be used to determine any changes that need to occur in the services. All staff will be trained to focus on changing service needs for all clients.

    The case manager will be responsible for making sure that services are provided according to the support plans. He will also be responsible for determining how the support budgets will be used to implement the support plans. The case manager will make assignments to staff regarding the support plans goals and objectives and will assist staff in understanding how to go about addressing the goals and objectives.

    Grievance Procedure

    If clients are not satisfied with the services they are receiving, they can let family members or the case manager know. They can also discuss any concerns they have with their regional center representative (when a sign language proficient service coordinator is available) during his/her quarterly meeting. It is understood that the continuation of supported living services is contingent on the continued wishes of the person receiving services to have that vendor provide services to them. The regional center service coordinator will assure that clients continue to wish to have Support Services for the Deaf be their provider of service.

    Health and Safety

    The case manager will be the primary person responsible for planning and implementing practices and procedures which will ensure the health and safety of client (this includes personal hygiene). These plans will include detailed descriptions of each of their health needs (in the Individual Support Plan). The support plan will also include how those issues will be addressed on an ongoing basis.

    The case manager will also develop plans for emergency situations, including earthquake and fire safety. These plans will be a part of the new employee training and will be available in clients' homes. Included in the safety plans will be a description of the special adaptive devices that will be needed in each of their homes to accommodate their deafness, such as flashing light smoke detectors.

    The emergency health and safety procedures will also include a description of what staff should do in the event that a client cannot bring himself under control. The procedures will detail whom to call and what alternatives might be available to him.

    Record Keeping, Reporting and Communication

    Goals and objectives from the support plan will be assigned to different support staff as appropriate. Assignments will be communicated by the case manager. This schedule is an electronic, computer based system that generates daily schedules, information and records of what should and does happen each day.

    Since many of the staff may be deaf themselves, the electronic communication devices (including alpha pagers as well as the palm held devices) will be an important part of keeping in communication with staff.

    The case manager will provide reports to the regional center about clients' progress on their support plan goals and objectives. These reports will be narrative (unless a goal lends itself to numerical data). The reports will focus on the achievements that clients have made; the problems they encountered during the quarter and a description of efforts planned for the coming quarter. In addition, the case manager will maintain communication with the regional center on all matters related to clients' services.

    The case manager will assure that all staff follows the requirements for timely reporting of special incidents to the regional center. The case manager will submit to the regional center (within 24 hours of occurrence) a written report of any event that is unusual, involves injury or potential injury, might adversely affect clients, or anything else that is required by regulation in Title 17.

    Client will each have a medical file. The case manager will enter information concerning medical appointments, medication assistance, and other health and safety needs.

    As per Title 17, the following records will be kept for a period of three years:

    Time sheets

    Payroll records

    Accounting records

    Training records

    Service evaluations

    Internal grievance procedure records

    Historical data documenting the actual delivery of service to consumers for which the supported living services vendor has claimed payment

    Other records required by the terms of the contract and the regional center

    Resources

    The case manager will work with deaf community agencies to identify and learn how to utilize a variety of resources. These resources include places where client can get needed assistance with housing, food, medical needs, recreation and other types of needs and interests. He will also be using a variety of resources related to the deaf community, including CSUN, Greater LA Council on Deafness, Orange County Deaf Center, churches for people who are deaf and other resources.

    Clients will be registered for housing assistance through HUD programs as available in the area. The case manager will work with clients and their circles to find appropriate housing that is affordable.

    Any decisions about housing and use of resources will involve clients to the greatest extent possible. Resources will also be seen as a means of helping them to meet people and become more active members of their community. An example of this is having them volunteer at a food bank or food program where they also receive assistance. Staff will receive training in how to utilize these community resources, with additional training in how to help them to be a part of their community as valued members.

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