When health and safety is at risk, such as during the pandemic, it’s natural for our thoughts and priorities to shift towards health and safety. During this time, we are all reconsidering what “a good balance” means in our lives. How do we balance what is important to us and what’s important for us?
All Minnesotan’s are encouraged to carefully consider what health experts are learning about COVID-19, the impact and severity of community spread and public health guidance.
It’s also critical that all Minnesotan’s balance these risks with what’s most important to us: the things that bring us happiness, comfort and meaning in life. If we deeply understand what’s important to us, we can explore ways to have a lot of those things present, even during a pandemic. It’s hard to hear that we should not spend time with people outside of our own house. How might we still have what is most important to us present?
Providers balance many variables as they support people during the pandemic, including the complicated ways that each person’s rights and choices may impact their housemates, staff, families and the agency as a whole. All of this complexity is the very reason it’s important for us to slow down our conversations. It takes time to really understand what’s important, brainstorm possible choices, find ways to limit risks and understand each person’s different risk tolerance. Creative and innovative solutions can be discovered when we work together.
To help stay true to these values and practices, we are sharing a tool to help guide our collective efforts. The tool is designed to help you structure and capture conversations as they evolve. When used in combination with Person Centered Thinking and Discovery skills, it can help us all to stay focused on what’s important to and for the person being supported (rather than focus only on the systems’ needs or our own values, risk tolerance).
It is important that the person and their whole team engage in the process. Hear from everyone impacted. For example, Michael may say “I want to go home to visit with my family for the holiday,” while the provider may be thinking, “If Michael goes home, how do we reduce the risk to others and to staff if he returns with COVID?” It is critical for all team members to share their perspectives and concerns openly. Our choices impact others, now more than ever.
We hope that the following steps – combined with Minnesota providers’ existing strengths in person-centered discovery – will help guide our collaborative efforts and will help us honor the input of everyone involved.
A printable version of this tool (PDF) is available. DHS and Mainsl collaborated on this document and is being shared with the broader community to be used as a tool to support service planning activities.
Have a conversation and learn what is important to and for the person about the situation or choice. What is on the surface, and what is deeper about what matters to them? Example 1: Christmas day with family, opening gifts is more deeply connected to being a fun Aunt. What else do we need to know or learn?
Remember to stay engaged in a discovery process during all these steps. The questions in the tool can help you start the process but each conversation will be different. Take time to dig deeper and really understand what matters to the person and the specific things they (and others) are concerned about.
Laura had a decision to make about what she was going to do during the upcoming holiday time. The choice Laura was contemplating was about having a traditional overnight at her mom and dad on Christmas Eve, with family Christmas Day brunch and gift exchange with siblings, nieces and nephews. Laura and her team discussed what about this choice was important to Laura. They also discussed what about this particular activity or choice is important for Laura, and what risks were others concerned about? They came up with the following important to and for sort:
|
Important TO the person |
Important FOR the person / What risks do WE worry about? |
|
Christmas Eve services – children’s choir (remembering what Christmas is really about … services can be attended in person or online) |
Not spending too much on gifts, budgeting |
|
Dinner, making cookies Christmas eve and having cocoa before bed in front of the tree |
Not drinking too much caffeine with Dad, too many cookies (concerns about being pre-diabetic, overweight) |
|
Coffee with Dad on Christmas morning, the smell of Mom’s cinnamon rolls baking |
Not getting into fights with family |
|
Brunch with siblings and their kids Christmas morning (being a fun aunt) |
Following public health guidelines for people at higher risk from COVID |
|
Helping Mom stuff stockings for the kids and watching kids open gifts from me (making family happy ) |
Not exposing housemates and staff to extra COVID risk |
After initial discovery conversations, the team discovered a few more questions they had, which included: Is the church having Christmas Eve service? If so, is it in person or online? Why does it matter to participate? What’s special about Christmas morning with extended family?
Additional learning from digging deeper are included in parentheses above.
Have a brainstorming session to generate a list of different possible options for the situation. Discuss how the person might have what is important to them. No option is right or wrong: take time to slow down and consider them all. Explore the pros and cons (e.g. risks) of each option with the person.
In the next step you will explore how to limit risk. You may come up with a few more options later, too.
Next Laura and the team brainstormed ideas. They talked about what would be the pros and cons of each idea. They took some notes on all of their ideas. Here is what they came up during this step of the process:
|
Option |
What works (Pros) |
What doesn’t work (Cons / Risks) |
|
Stick to usual traditions, especially staying overnight at Mom and Dad’s |
It feels good (tradition, spending time with mom and dad, being in the family home, family tree/ornaments) |
It’s risky to not following public health guidelines. Could get really sick and die of COVID or have long-term issues Exposing staff and roommates, have already had staff out a lot with COVID |
|
Christmas service (online and in person are both options) |
Same church/routine as always Less risk to participate online |
Not seeing church members if going online, being without family |
|
Family members agree to quarantine beforehand |
Less COVID risk |
Inconvenient, one sibling works retail another in a hospital and can’t quarantine |
|
Doing overnight but not doing the full family brunch |
Time with parents |
Missing usual routine with siblings, playing with toys, and being an awesome aunt |
|
Make stockings and gifts at home, deliver to family’s houses ahead of Christmas … zoom opening |
Giving gifts, awesome aunt delivering early gifts! |
No hugs, can’t play with toys together |
|
Before Christmas cookie/food exchange to replace brunch |
Fun to do before holiday |
Would miss eating together (could zoom when we eat) |
|
Having Family visit at her house for bonfire or ice skating or cookie exchange as a new tradition |
Seeing family in person Getting to host vs. help the host Starting a new tradition |
Family might not want to do new things, more risky to see people in person (could be outside) |
During this step of the process, Laura and her team have more questions to dig deeper into. They were curious to know what Laura’s family was planning to do and whether there was another time when Laura did not go home as planned. These questions generated more conversation with the team.
It is important to note that all choices have some risk and everyone has a different tolerance for taking risks. During this step, list the choices the person would like to explore further. Then discuss each option, the downside, the risk involved and come up with ways to limit or mitigate risk. What might be the safest way to get what is important to the person? What options might create a good balance for the person?
For example, it may be important to the woman in Example 1 to have brunch and open presents with extended family, but a lot of the ritual is about being a fun Aunt. How else might she experience this? How might she balance the desire to be with them, with her concern for her housemates’ and staff’s safety? Open and honest conversations about what is important to and for everyone involved are important.
Laura and her team decided on three options they wanted to explore further. They discussed the option and the ways to limit risk for each option. Here is what they discovered during these conversations.
Option 1: Staying overnight … downsides are that it’s more risky if not quarantine beforehand, other family can’t quarantine so brunch feels risky to Laura and she feels okay to leave out this year
Three ways to limit risk (ex: mask, cues, learning, technology, etc.)
Option 2: Deliver gifts…downsides are that it’s not in person, no hugs, feels like a less awesome aunt
Three ways to limit risk (ex: mask, cues, learning, technology, etc.)
Option 3: Having family over for bonfire in round robin style (one family at a time) outside
Two ways to limit risk (ex: mask, cues, learning, technology, etc.):
After reflecting on these three options, Laura wanted to explore how to stay overnight with Mom and Dad; deliver gifts in a Santa hat before Christmas to family; and having family visit her house for a bonfire.
This is a time to have a conversation about what else we may want to learn to make the decision. How can we learn more? Are there other people to talk with? Other resources or supports to explore? New options?
Based on the conversation about Laura’s choice, there was more Laura needed to learn. Since Laura wanted to explore an overnight stay at her mom and dad’s home, the team needed to learn more about how Laura’s family feels about having her come for an overnight. Second, Laura decided she wanted to talk with her family and find out if her family would be willing and feel safe visiting her house for an outdoor bonfire. Third, Laura and her team would need to talk with Laura’s housemates and staff to see how they felt and what they were planning to do for the holiday. Lastly, Laura and her team discussed what resources and supports could be needed for Laura, such as help with hosting (if the bonfire was chosen) and help setting up zoom calls and online shopping.
After learning more, review all you have learned together and look for anything new to add. Discuss the choices, risks, ideas to limit risks and talk about what choice feels right to the person.
Arrange for any additional support the person wants or needs. Work as a team to feel confident that the choice made is one that balances rights and responsibilities as well as what’s important to and for the team.
Laura and the team took time to review and discovered more information to add to steps 2 and 3. They learned the following:
After reviewing the choices and risks, Laura decided to go home to spend the night on Christmas Eve (parents are quarantining to reduce risk). She will be delivering stockings and gifts ahead of Christmas but decided hosting a bonfire sounds like too much work and maybe too cold for her. She wants to drop off gifts to families’ doors and host zoom calls to open gifts with family. Lastly, she thought spending Christmas Day with housemates was a good idea. Supporters will help Laura shop for gifts online, deliver the gifts to families’ door, set up zoom calls and find a way to visit with Grandma, even if it is through the window.
We value and appreciate the work you do to keep Minnesotans safe and preserve the rights of those we support during these challenging times. We all know that balancing rights and responsibilities is not a simple, black and white process. It can’t be boiled down to a form. However, as you work with those you support, we hope this tool will be a helpful guide. Please email positivesupports@state.mn.us for support and consultation if you are facing particularly complex choices, or your teams are struggling to find a comfortable balance.
