Five-Star Quality Principles & Standards

Five Questions We Can Ask Ourselves

1. How can we assist people have more choice and control in their lives?
2. How can we assist people make valuable, contributions to their communities?
3. How can we increase a person's presence in their neighborhood and community?
4. How can we assist people make and maintain friendships?
5. How can we assist people to develop their abilities?

Some Things To Do…

1. Facilitate positive engagement with others who are not paid, especially the development and maintenance of friendships
2. Promote good citizenship through work, reciprocity, and positive private and public contributions
3. Promote decision-making and problem-solving that end clienthood and encourage citizenship
4. Based supports on being able to demonstrate and develop known interests and talents - outside of the disability bubble
5. Do not require compliance with rules based on a prejudicial group mindset and encourages positive options to manage for dynamic tension and resistance
6. Include a plan to prevent and manage behavioral and other crises minimizing any restrictions of citizenship
7. Support the individual to learn from their mistakes
8. Challenge the status quo and stereotyped expectations of the institutional mindset and disability bubble
9. Staff are expected to model positive social engagement and learning is focused on the natural environment and not disability focused and controlled settings.
10. Maintain a consistent application of core values and has obvious integrity to the vision and mission of the organization (the core promise to the individual receiving services).
11. All staff are aware of the goals and desires of the individual's Person Centered Plan/MyPlan/PATH.
12. Staff are encouraged and rewarded to take reasoned risks, take initiative, and demonstrate the desired skills which support the core values, etc.
13. Celebrations of accomplishments, efforts, success, etc. are a common occurrence.

Selection of learning focus is guided by three primary considerations:

1. Learner's informed choices
   • Learner chooses to learn.
   • Learner is presently attempting this task.
2. Learner's needs based upon demands of environment.
   • Learner would use this skill in present and future environments of home, community, leisure and/or work.
   • Learner would frequently use this skill.
3. Choice of content which grants release from custody (more freedom)
   • Someone else must now perform this task
   • The person would require less supervision if they master this task

Procedures for developing learner's preference & encouraging choice

1. Provide choices about how to achieve a goal
2. Provide choices from observed likes and dislikes
3. Provide choices from real alternatives
4. Provide open-ended choices
5. Provide for examination of why choices are made - including likely consequences of making and not making a certain choice
6. Provide information and choices to consumer about their rights and responsibilities
7. Respect choices made

Helping the person to identify their individual needs and desires

1. Discuss his/her short and long-term goals and desires with the learner
2. Observe the learner in the environment
3. Interview natural supports and others who care about the person and an advocate, family, or caregiver considers this a critical skill
4. Consider the skill sets of peers without obvious disabilities

   Age relevant skill because it is performed by peers without obvious significant disabilities.

Selecting content to reduce custody

1. Apply goals of independence in daily living skills
   • It will increase the self-concept and or social acceptance of the learner
   • Reduce hopeless feelings and increase self-worth
   • Reduce stigma and increase normalization
   • Reduce isolation and increase community membership and social integration
   • Reduce social burden and increase social contribution
   • Reduce custody and increase skills for self-sufficiency
2. Minimize intrusiveness in their life
   • Psychologically safe skill to teach because the intrusiveness and/or embarrassment associated with instruction will be acceptable to the individual
3. Physically safe
   • It will increase the learner's personal safety
   • It is safe to perform even when done inappropriately or without supervision
4. Prioritize what is to be taught

Some questions to ask

• How much assistance does the person really need? (physical assistance, medication, supervision, personal care, understanding communication, being interested in someone else, not overeating, etc.)
• Under what circumstances does the person need help?
• Who provides this assistance now?
• Could someone from the community provide the necessary assistance?
• How could someone be trained or supported to provide the necessary assistance?
• What are the implications for the person's participation in various community activities?

Some things to watch out for…

• Thinking that person-centered, community focused services that emphasizes natural supports will cost more money or require more staff (it will require professionals to work differently, and smarter, but not necessarily harder)
• Requiring community people to be volunteers rather than "just friends" or "just neighbors" or "just family", etc. Friends don't document their relationships on a service note (they use a scrapbook, a blog, or diary)
• Using behavior, skills, deficits, mental health, etc. of the person as an excuse for not going what the should be done
• Using "liability" as a justification for not supporting individuals in having as integrated and independent a life as possible
• Using "risk-taking" or "trusting" as a justification for carelessness, thoughtlessness, or inadequate planning
• Trying to "over-program" and "formalize" all activities
• Compromising on ethics and agreed upon standards of professional behavior

Some suggestions to promote positive outcomes for people with disabilities:

• Examine the major priorities of life and redirect energy and resources to those priorities
• Start conversations about the importance of developing community based and natural support focused solutions
• Prioritize supporting people in the life of their choice, helping people learn how to make choices, supporting community membership, etc. This includes helping people establish friendships
• Examine creative uses of time
• Promote natural supports over formal and volunteer roles
• Encourage creativity regarding the solutions and collaboration
• Trust the natural capacity of the community, and provide sufficient support for that capacity to be realized
• Recognize that small changes can make a big difference
• Recognize that overall change takes a long time

Some things to minimize:

• Random stressors
• Aversive stimuli
• Unnecessary exposure to overt opportunities for problems
• Destabilizing factors
• Extensive negative role model exposure

Some things to maximize:

• Work skills
• Physical activity
• Physical wellness

Necessary Ingredients:

• Comprehensive staff training
• Consistent staff interactions (behavior plans for staff)
• Quality "clinical supervision" for staff
• Interdependence of development and relational advantages and clinical imperatives is maximized