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Oregon Department of Human Services Senior and People with Disabilities State Unit on Aging-ADRC

Oregon Department of Human Services Senior and People with Disabilities State Unit on Aging-ADRC In partnership with Portland State University School of Social Work Center for Improvement of Child and Family Services. Challenge. An Overview of Options Counseling for AAA Directors

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Oregon Department of Human Services Senior and People with Disabilities State Unit on Aging-ADRC

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  1. Oregon Department of Human Services Senior and People with Disabilities State Unit on Aging-ADRC In partnership with Portland State University School of Social Work Center for Improvement of Child and Family Services

  2. Challenge

  3. An Overview of Options Counseling for AAA Directors and Program Staff

  4. Introduction to Options Counseling • Definition of Options Counseling • History and context (ADRC development) • Options Counseling in Oregon • Values and Principles • Core Competencies

  5. Learning Objective: Have a working understanding of the definition of Options Counseling (OC) and how it is different from information, referral and assistance and case management.

  6. OC 101, 102 & 103 Introduction to Options Counseling The Art of Options Counseling – skills Communication, Assessment, Decision-Making Support, Documentation Advanced Options Counseling Understanding Change and Motivation Decision-Making Support Problem Solving, Conflict Resolution Facilitating Family Meetings

  7. Evaluation: Making sure we are getting there. • For Staff • How is it working? • What do you need (e.g., information, training, support)? • For Consumers • Preferences, values and needs supported. • Empowered. • Aware of all options. • Making decisions that preserve resources & independence. • Satisfaction with Options Counseling services.

  8. Evaluation The evaluation of the ADRC program is being conducted by Portland State University's Institute on Aging in partnership with the ADRC and SPD Staff. • Evaluation forms at each training session • Brief electronic survey 3 times a year • Focus groups Other evaluation activities include: • Consumer satisfaction telephone survey. • Interviews or focus groups with ADRC managers & supervisors, and AAA Directors.

  9. What is Options Counseling? • History and context • Defining Options Counseling • Understanding the value of Options Counseling for our consumers.

  10. History and Context of Options Counseling • Older American’s Act of 1965 • Information & Referral • Amendments in 2000, 2006 • Home and community-based long term care development activities • Evidence-based disease prevention and health promotion services • Family Caregiver support • Aging and Disability Resource Centers

  11. History and Context of Options Counseling • 2008-Development of Real Choices • Funds from Center for Medicare/Medicaid Services • Person-centered hospital discharge planning • Demonstration site for ADRC at LCOG • 2009-Development of statewide ADRC Plan • Funds for Administration on Aging • Added Oregon Cascades West COG and NW Senior and Disability Services to ADRC project • Community Living Plan: keep private pay clients in the community; divert people from nursing homes

  12. Aging and Disability Resource Centers ADRCs What are they? • Awareness, Access, Assistance • Benefits to consumers • Single entry access • Person-centered values • Wide range of resources • Broad consumer population

  13. ADRCs The Four Core Services • Information and Referral • Options Counseling • Care Transitions • Healthy Aging

  14. What is Options Counseling? Options Counseling one of the Four Pillars of ADRCs

  15. Oregon Definition Options Counseling supports informed long-term care decision making through assistance provided to individuals and families to help them understand their strengths, needs, preferences and unique situations and translates this knowledge into possible support strategies, plans and tactics based on the choices available in the community.

  16. What is Options Counseling?Sound Familiar? "I was thrust into a situation I wasn't fully prepared for," Susan said. "Care-giving on my own consumed the time otherwise needed to arrange the appropriate short and-long term care and support for both my parents. I thought to myself, what do I do now? Where do I start? I cannot do this by myself.“ Susan Turpin of Hillsboro

  17. Benefits of Options Counseling • Consideration of available community-based options before institutional placements happen. • Help sorting through lots of information that is available online, but can be complex, contradictory, and confusing. • Individualized support for families making decisions about long-term care. • Helping make people aware that they can and need to plan ahead for long-term care support needs.

  18. Benefits of Options Counseling • Options Counseling is proactive and interactive. • Options counselors are able to connect consumers to a full range of community supports, both public and private. • Options Counseling may help consumers to preserve their resources and maintain their independence.

  19. How is it different from what we do? • Options Counseling is more than information and referral. • Emphasis is on relationship building, counseling and decision support. • May involve more time spent with consumer and their family. • Includes documentation of decision support provided and action steps for consumers, families and the ADRC. • Follow-up activities to support the consumer in their planning process.

  20. Understanding the Role of Options Counselor • Facilitator of Options Counseling process • Moving from I&R/A to Options Counseling • Providing decision-making support • Working with broader definition of “consumer” 20

  21. Continuum

  22. Activity For each scenario, identify whether this is I&R I&A Options Counseling Discuss the reasons for your decision Write a list of 4-6 questions to help staff identify the difference. Share with larger group 22

  23. Options CounselingValues and Practices • Relationship-Based • Empowering Personal Choice • Facilitating Connection to Resources

  24. Who Receives Options Counseling? Adults with disabilities over 18 years old and all older adults and their families, regardless of income. 24

  25. Where does it occur? Wherever the consumer needs it to happen • On the Phone • E Mail • Face-to-Face • In-Home Visit

  26. Timing for Options Counseling • When an individual has immediate or short range long-term care needs. • Prior to Hospital or Long-term Care discharge • When a family caregiver needs help to continue providing care. • When a long distance caregiver has concerns about the increased frailty or care needs of a loved one.

  27. Decision Support in Options Counseling

  28. What Does Options Counseling Offer? • A supportive relationship that helps consumers and their families make informed choices about meeting current and long-term needs. • A firm foundation in quality information about state and local resources • As assessment approach that is person-centered and incorporates consumer preferences, strengths, culture and individual situations. • The skills to assist individuals and families in decision making.

  29. Core Competencies of Options Counseling Six Core Competencies • Determine the need for Options Counseling • Assess needs, values and preferences • Understand public and private sector resources • Demonstrate respect for self-determination • Encourage future orientation • Follow-up 29

  30. Skills for Options Counseling • Communication • Active Listening • Assessment • Values, needs, goals and strengths/resources • Motivation and change. • Decision Making Support • Creating person-centered plans. • Working with family and natural supports. • Clear Documentation • Goals and needs, options considered, action plan. 30

  31. # 1: Determine the Need for Options Counseling During initial contact with the ADRC, staff determine if OC is appropriate. Assess the purpose of the contact. • What kind of help is the consumer looking for? • How do they see their situation and needs? • Do they want assistance in making decisions about their care needs? • Clarify uncertainty.

  32. Determine the Need for OC • Introduce and explain your role • Set a welcoming tone and convey openness • Ask open-ended questions • Allow the consumer to tell their personal story. • Listen for underlying issues or concerns • Assess/ask if the person would like to continue the discussion face-to-face, or with family present.

  33. Determine the need for OC Skills Needed Active Listening Skills • Take time to listen. • Paraphrase, reflect and ask open and closed-ended questions to clarify and summarize. Understand that people may not know what they want or need. Articulate, clarify and discuss assumptions.

  34. # 2: Assess Needs, Values and Preferences Getting to know the person and their situation Questions to consider: • What are the feelings of the individual and the family regarding the present circumstances? • What are the physical, mental and social needs? • What are the person’s strengths, resources, community, family and friends that can aid in planning? • What are the person’s values, goals, and cultural perspectives?

  35. Understanding Culture • Self Awareness. • Implicit Bias. • Personal Values • Awareness of Others • Understanding difference. • Suspending judgment.

  36. Assess Needs, Values and Preferences Identify core issues • Housing • Care needs • Family and social support • Assistive technology • Finances: private and public. What can they afford? • Eligibility and benefits • Future planning

  37. Skills for Options CounselingAssessment • Goals • What the person wants to continue, change or accomplish. • Strengths and Resources • Who this person is: values, culture, family, history • The building blocks for accomplishing the goal. • Needs • Why a change, action or service is needed • Options and Strategies • How that need will be met. • Measurable Outcomes • Results that will tell us we met the needs and accomplished the goal. These can be defined by consumer and by program 37

  38. #3: Understand the Public and Private Sector Resources • Understand and facilitate access to resources Public Community Private Personal supports • Be able to discuss potential availability, criteria and costs. • Give information in doses. www.ADRCofOregon.org

  39. #4: Demonstrate Respect for Self-Determination • Assist in planning that meets consumer’s needs, values and goals • Work with consumers from a strength-based perspective • Honor Culture • Empower consumer to make the decisions that meet their goals • Be aware of personal bias and assumptions • Let go of the outcome. Stay dedicated to the process.

  40. #4: Demonstrate Respect for Self-Determination Working with consumer’s natural supports, family and friends to empower consumer-driven planning. • Helping family to help their loved one. • Family Meetings • Working with concerns. • Helping family members discuss concerns • Reinforce that decisions are a process

  41. Respect for Self-Determination • Empowering • Building competency • Increasing confidence • Enabling • Working harder than the client • Deprives people of the opportunity to learn and grow. • Abandoning: not offering enough.

  42. Respect for Self-Determination Client Locus of Control • People are invested in plans they help make. • When people are seen as capable they achieve. • Client self-determination involves respect. • Instead of telling clients what to do, we ask them how we can help.

  43. Respect for Self-Determination Be committed to the process. Let go of the outcome. • Options Counselors are responsible for ensuring the best process for decision-making. • The consumer is responsible for the decisions they make.

  44. #5: Encourage Future Orientation • Look beyond immediate needs and help consumer consider future needs. • Consider the impact of decision-making on future possibilities, and outcomes of decisions. • Look beyond “fixing” • Think outside the “service box” • Reach out to family caregivers in helping them anticipate and plan for future needs.

  45. #6: Follow-Up Follow-up serves a critical role in assessing the usefulness of services as well as strengthening the consumer’s relationship with the ADRC.

  46. #6: Follow-Up Follow-up activities • Follow-up with the consumer to assess effectiveness and usefulness of plans and services. • Revise action plans as needed. • Document information from the follow-up call.

  47. #6: Follow-Up Considerations and challenges • What are the challenges and/or barriers to consumer following through with plan? • Leaving the door open for future contact.

  48. How does knowing all this help? Helps I & R/A and other staff know when to act and when to step back and refer to OC Takes I & R/A and case manager staff out of the perpetual “fix them” mode Work smarter, not harder Helps remove some of the resentment that can develop with consumers who “never take our advice”. 48

  49. I & R/A - - - Options Counseling Offering the right amount and depth of assistance at the right time in order to support the person, and family, to make an informed decision.

  50. Wrap up and Review Six Core Competencies • Determine the need for Options Counseling • Assess needs, values and preferences • Understand public and private sector resources • Demonstrate respect for self-determination • Encourage future orientation • Follow-up 50

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