There are many techniques that can be used to help providers better learn about people’s preferences and needs. Some suggestions for making those opportunities more productive include:
- Asking a person open-ended questions about choice, independence, individual rights, and community access and integration. Specific questions could range from, “What types of opportunities do you have to spend time in the community with other community members?” to “What types of interactions are common for you to have with members of your community?” Other things to ask include:
- “What do you like about your work?”
- “What do you like about your housing?”
- “What do you like about your services?”
- “What would you change about each of them, if anything?”
- Other important questions are: “Have you felt like there are situations in which you haven’t been treated fairly? If that’s the case, can you describe them?”
- Listening carefully to the person’s answers and following up on their responses. This can be done by seeking details and examples of how people’s services have supported or hindered the opportunities they would like to have to be integrated members of the community.
- Observing the person while they answer questions to evaluate if body language or other signs suggest people’s true feelings are different from their words. It is helpful to reassure people that their answers will not be used against them, but instead to help improve services they or others receive.
- Using visual aids or technology solutions such as photos or communication devices to learn the preferences of a person who is unable to verbalize his or her responses. For example, a staff member may show a person pictures of community activities and ask the person to select a preference and identify a friend who might want to come along.
Staff can have these structured conversations to learn more about people’s needs and preferences during their intake meeting, following up at future annual, semi-annual or support team meetings, during day-to-day interactions, and at regular one-on-one meetings.
Providers may also use a tool such as Planning Alternative Tomorrows with Hope (PATH), which is an eight-step process to identify a person’s dreams and then work backward to lay out steps to reach that goal. Through annual or semi-annual meetings, people and the staff supporting them can discuss what they would like to accomplish in the next year and beyond. After each meeting, a staff member can share the person’s dreams and passions with the people who work closely with him or her.
Promising practices from HCBS providers
Assessing interests and preferences
As they are moving in, people and their interdisciplinary care team members complete a formal interest and activities assessment. This assessment asks questions about their history and preferences in community activities, traveling, special events, active games and group activities. It also asks more open-ended questions about hobbies or other interests the person finds particularly valuable or motivating. Then we review the assessment at regular intervals and talk about any areas where people’s interests and preferences have changed over time. We can use this information about new preferences to plan upcoming activities.
We record a snapshot of individual preferences, interests and needs on a person’s One Page Profile. This one-page summary is shared with key team members who work with the person. We use it as a reference point in one-to-one biweekly conversations and individualized planning between support staff and the person. The questionnaire focuses on identifying people’s preferences for their employment schedule, frequency of community engagement and what specific actions of support occurred over the past six months to help them explore any interests identified in the previous evaluation. We then review the information with the person and the support staff and adjust strategies as needed to increase success.
We complete a “Satisfaction Inventory” (or other similar survey tool) annually with all people we support. In this survey, people list their favorite and least-favorite activities, suggest activities we are not already providing, let us know their preference for in-house or community-based activities and indicate if they want to work or not. We use these preferences to design activities and events throughout the year. Staff are also encouraged to explore people’s preferences informally during day-to-day interactions and adjust planned activities accordingly.
Listening for informal requests and stated interests
Moira was sitting outside enjoying a nice afternoon, and asked one of our support staff members walking past if she could camp in the yard. Moira did not have a tent, but the staff member asked around our team and found one to borrow. Moira and the staff member planned the campout together to accommodate for some medical issues, and they were able to make the impromptu camping trip happen for her. Moira later found a used tent online that she liked and purchased, and our team is now working with her to find other opportunities for her to camp that support this interest and promote community inclusion. One potential option is an upcoming event at a nearby state park.
Asking friends and family
After asking for consent from the person, we explore the activities and community engagements a person likes and dislikes taking part in with their guardian, family members or friends. In one such case, we discovered that a person loved to go fishing. So, for the past few years, we have hired a local angler to take the person and others fishing in a pontoon boat a couple of times each year.
Hosting group discussions about interests and preferences
At least monthly, people gather in groups to express any community and activity interests for the following month. Staff bring community calendars to this meeting so people can get ideas about the activities that are going on in the community.
Getting feedback on past activities
People and staff hold “Monday Morning Meetings” on a weekly basis to discuss activities. They talk about last week’s activities, what they enjoyed, what they didn’t, what the schedule is for the week ahead and opportunities in the community that might be available in the evenings or on weekends. During this meeting, the presider always asks, “Can you think of anything you would like to do this week or in the weeks ahead?”
Learning about people as individuals
People we support have created a “Get to Know Me” Hall of Fame. This is a hallway where people post pictures, share their interests, provide updates on activities they have engaged in and share ideas (Note: This was created by people themselves, but we ensure full confidentiality as directed and desired by each person and get appropriate releases if a person wishes to share information).
Using nonverbal communication tools
When a person has limited or no verbal communication, staff use numerous methods to ensure people have a choice. Our computers have touch screens and software for assisting with communication. We also use iPads, picture schedules, Picture Exchange Communication System (PECS) and a large interactive touch-screen board to help people to communicate their choices. Staff encourage people to use their communication devices to share their ideas about what they would like to do in the greater community.
