Expanding our Horizons

Month: May, 2015

Horizons Annual Plan Update: Executive Summary, April 2015

When I look back on 2014, I will think of it as a year of growth. We opened a new, seven person apartment building in the spring. By the end of the calendar year, 17 additional people were offered Supported Living (SLS) resources. By March 2015, eleven new people were enrolled in our SLS program with three more in process. In the Children’s Extensive Support Waiver, we have enrolled two new children for a total of four. While these numbers are relatively small, they represent significant growth in our program.

We have achieved many important things:

  1. Seventy-two employees have been trained in Person Centered Thinking.
  2. We are maintaining financial sustainability by limiting growth in agency expenses and increasing revenue.
  3. We developed systems to maximize our use of the funding hierarchy for Early Intervention services.
  4. Individuals are being served in an SLS model using Routt County mill levy funds.
  5. Three individuals were enrolled in our Medicaid comprehensive services program.
  6. Four individuals are enrolled in CES. Three more are approved and one in process. This represents 300% growth for us.
  7. We have 20 one to one mentors for the adults in our programs. These partnerships do a variety of things: attend fundraisers for other non-profits, go skiing, go out for coffee, go for walks, go out for meals, attend social media classes, play billiards, attend local sporting events, go to community concerts, and go to local restaurants for Happy Hour.
  8. We held our third annual Pick a Dish event in Moffat County in April. Interested individuals in Horizons’ adult programs were paired with chefs from local restaurants. Together they prepared a dish to share at the event. About 200 people attended and voted on their favorites. The primary goal of the event was to develop relationships between our chefs and the restaurant chefs that would result in employment. No job offers yet…
  9. Tommy Larson and Sylvia McFeaters were two of the five finalists for the Direct Support Professional of the Year award by Alliance at Awareness Day at the Capitol.
  10. All Adult Service Coordinators have been trained by the Labor Relations Board to conduct investigations.
Jamie Ogden and Ashleigh Santistevan partner with Castle Ranch at this year's Pick a Dish fundraiser in Craig.

Jamie Ogden and Ashleigh Santistevan partner with chefs from Castle Ranch at this year’s Pick a Dish fundraiser in Craig.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

We have maintained many important things:

  1. The president of the board of directors is a liaison between the Grand County Advisory Board and Horizons’ board.
  2. We are maintaining our collaborations with Aging Well, the Northwest Colorado Center for Independence, the Yampa Valley Autism Program, Steamboat Adaptive Recreation Services (STARS), and the Council on Aging.
  3. We work closely with Behavior Services of the Rockies and with Mindsprings Health.
  4. We have maintained a high level of supported employment in Routt County.

Our priorities for 2015 include:

  1. Identifying needed growth in infrastructure in response to an additional 15 SLS resources, and growth in CES and comprehensive programs.
  2. Identifying staff to become Person Centered thinking trainers.
  3. Upgrading our vehicles with $81,400 in funding from the Colorado Department of Transportation.
  4. Updating and/or creating policies and procedures.
  5. Improving our system for monitoring agency performance.
  6. Defining our relationship with the local autism program.
  7. Continuing to monitor our budget to ensure that we are limiting growth in expenses and maximizing revenue.
  8. Advocating for choice in Case Management to include Horizons CMs.
  9. Advocating for a solution to CFCM that preserves our mill levy.
  10. Celebrating our 40th anniversary! We are planning 1970’s dance parties in Steamboat and in Craig.

Susan Mizen, Executive Director

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I Can Do Better

The R word. The H word. And now the C words: consumers, clients. When can we stop using words to differentiate “us” from “them”? People with disabilities, people in our programs, individuals—do these work? How do we maintain compliance within the current system but still move forward to change it? It was Maya Angelou who said, “I knew then what I knew how to do. Now that I know better, I can do better.”

If language is how we activate our values, what do these words and phrases reveal about us, our perspectives, our intentions and our services? And how do we take buzz words like person first (a good first step) or person centered and transform them into valid change agents for our practices?

At our Person Center Thinking (PCT) Training by Bob Sattler from The Learning Community, we learned that PCT is an ongoing search for effective ways to deal with challenging barriers and conflicting demands. It’s a way to assist people in defining and pursuing desirable futures. PCT takes clarity, commitment and courage. It’s based on respect for the dignity and completeness of every person. To be person centered, we need to ask why (a lot) and consider others’ perspectives. It’s not us versus them; it’s simply us.

Bob Sattler leads the grip of Horizons support professionals through discussion on person centeredness.

Bob Sattler leads a group of Horizons employees through a discussion on person centeredness.

The goal of PCT is to move from a service life to a community life. Bob reminded us that we are not trying to make people independent, but autonomous. After all, how many of us are actually, truly independent? Maybe independence too is a buzz word—one that was well intentioned but not quite accurate?

One focus of the training was the importance of environment. Environment is not a disability issue; everyone is affected by it. Environments can be toxic, tolerated, supportive or healing. A toxic environment can cause depression, aggression or withdrawal. A tolerated environment can lead to feelings of helplessness or powerlessness. Many people live in toxic or tolerated environments and they result in one person (the paid counselor) having power over the other.

Environment is powerful and complex.

Environment is powerful and complex; it can be positive and/or negative.

A supportive environment allows people to grow and blossom. This should be the accepted minimum standard for everyone. A healing environment is needed by those who’ve been hurt in toxic or tolerated environments, and the focus is on restoration and wellness. Both supportive and healing environments foster a sense of empowerment.

While there are distinctions between the kinds of environments we live, work and play in, we can be in multiple environments at the same time. Environments are powerful and multidimensional. They can often be the cause of a symptom we treat; what we see and hear depends on what we’re looking and listening for. This is a reminder to be self-reflective, to continuously look at what’s working and what’s not working, and to address issues effectively.

When we talk about creating person centered lives, we can’t prioritize what’s important to people over what’s important for them. PCT doesn’t mean giving up on health and safety issues for the sake of pure joy and constant happiness. A person centered life is one where a desirable lifestyle has been purposely crafted—it’s full of engaging experiences and rewarding possibilities. It emphasizes dreams and hopes. It fulfills who the person is rather than meeting the needs of the person’s diagnosis.

PCT tells us not to fix people but to support them. Bob’s playful phrase “Don’t should on people!” helps instill this value. And because PCT is part of a process of improving how we support people, it’s important to remember that we’re doing the best with what we know. While Maya Angelou’s words are eloquent and poetic, we can also refer to Bob’s wise words: “My name is [counselor’s name] and it’s been [X] days since I’ve tried to fix someone.”

Adult Program Director Tatum Heath follows up with a work session on implementing PCT tools and strategies.

Horizons Adult Program Director Tatum Heath follows up on Bob’s training with a work session to implement PCT tools and strategies.

Stop Stress!

Children and adults with intellectual or developmental disabilities often experience stressful events and interactions and then use maladaptive strategies to manage these situations. In addition, the presence of behavior challenges in children is linked to elevated stress in parents. Stress is an epidemic in our western world. It’s implicated in 7-10 of the leading causes of death (heart disease, cancer, stroke, suicide, homicide) and indirectly linked to cancer, liver disease and emphysema. 75-90% of visits to primary health care doctors are for stress related concerns. Stress negatively impacts our physical, emotional and psychological wellbeing.

jim-porter_smallHaving recently attended Dr. James Porter’s presentation, “Stop Stress This Minute,” at the Yampa Valley Medical Center, we learned about the causes and effects of stress as well as effective management strategies to reduce its powerful impact.

What causes stress? Is it your job, finances, relationships, responsibilities? No, Dr. Porter says; it’s you! Stress is the result of you, or more specifically, your thinking. Stress is a word that stands for problems. But stress is your problem to solve. Taking responsibility for solving your problems doesn’t mean that you are to blame. It means that you are the one to solve the problem.

Stress is related to feelings of control (a concept so important for people within the I/DD world). People who feel in control of their lives are invigorated and challenged by busy schedules. They believe there’s a solution to every problem. People who don’t feel in control of their lives are overwhelmed. They tend to see problems as unsolvable. In order to feel in control, we need to believe we’re in control. Control begins in our minds.

Stress is the body’s response to demands placed on it. It’s different for everyone; what stresses you out is different than what stresses your coworker or roommate out. Your signs and symptoms are specific to you. Stress is not what happens to you, but how you respond to it.

While today’s stressors have evolved from those of the caveman 25,000 years ago, the physiological reaction is the same. We inherited the Fight or Flight response from our ancestors. When we feel threatened and can’t escape (a predator attacking its prey), our bodies activate a supercharged, high octane response. The hypothalamus sends a message to the adrenal glands. The heart pumps 2-3 times faster, sending nutrient rich blood to major muscles. Capillaries close down and blood pressure rises. Eyes dilate and bodily functions associated with long term survival shut down (digestion and sexual function stop, the immune system shuts down, and excess waste is eliminated). Fight or Flight is short term for survival.

Physical signs of stress can include a pounding heart, upset stomach, dry mouth, rapid pulse, skin rash, perspiration, sleeplessness, diarrhea, recurrent colds, headache, fatigue, weight loss or gain, frequent urination, unexplained or frequent “allergy” attacks, gritting or grinding teeth, neck ache, back pain and muscle spasms. Emotional signs can include anger, frustration, worry, fear, panic, anxiety, feelings of loneliness or worthlessness, and overreaction to petty annoyances. Psychological signs can include crying spells or suicidal thoughts, depression, frequent or wild mood swings, obsessive or compulsive behavior, lies or excuses to cover up poor work, and difficulty in making decisions.

Today, most people manage stress by smoking, eating, drinking, spending money or using drugs. Stress is a ubiquitous and dominating lifestyle factor. So why don’t we manage it? Dr. Porter suggests that our culture promotes stress like a badge of honor—it’s synonymous with the American work ethic. We’ve cultivated a mindset against managing stress. Doctors receive little or no training about its impact on health. As a result, we don’t know how stressed out we are.

Stress is cumulative and our levels vary throughout the day. If something small bothers you, your stress levels have accumulated and you need to hit the reset button. It takes 1-2 hours for stress chemicals (adrenaline and cortisol) to come down to baseline. Dr. Porter encourages us to know our stress number: 0 = no stress and 10 = a panic attack. If we’re at 5 or above, we need to use a strategy to bring it down.

One strategy is Cognitive Restructuring. It’s based on the equation: A (activating event) + B (belief) = C (consequence). Cognitive Restructuring means changing your thinking and it requires a commitment to transformation. It challenges us to get rid of negative self-talk. For example, when we get a flat tire on the way to work (A), we tend to get stressed (C). Most people believe that A = C, when it’s actually our beliefs about the flat tire (B) that determine the consequence. Cognitive Restructuring implies that if we change our thinking (B), we can change the outcome of a stressful event. Instead of responding to A by thinking, “Why does this kind of stuff always happen to me?!”, choose to accept what can’t be changed and stop passing judgment. We can’t change events, but we can change the way we view them. The only thing standing between us and our new behavior is a single thought (B).

Another strategy is to Self-Regulate. This includes deep breathing, progressive muscle relaxation, mindfulness and meditation. Deep breathing opens the capillaries that close during fight or flight. Progressive muscle relaxation relaxes the muscles and lowers blood pressure, heart rate, and respiration. It’s simply the tensing and then relaxing of each muscle group of the body, one group at a time. Mindfulness is all about being in the present moment. In today’s society, we tend to do things mindlessly, or we let our minds wander into the future and feel anxiety or reflect into the past and feel anger. In meditation, we notice the in breath, the out breath and the gap in between. Meditation trains the mind to identify thoughts without judging them or becoming them. Meditation allows us to notice what goes on in the present (where life happens) and breathing is how we bring ourselves into the present.

We’re all somewhat addicted to stress. It’s a buzz; it makes us efficient! It can be the spice of life, but it can also be the kiss of death. So when you decide what it is you want to change—which events or situations cause toxic stress—start small. Make one change at a time and practice it for weeks, if not months, before adding in additional layers of change. First, become aware of the need to change, learn why you should change and consider how you want to change. Once you take action, focus on maintaining your healthy behaviors.

A Time Management Matrix can help you decide which behaviors you want to change.

A Time Management Matrix can help you decide which behaviors you want to change.

And for those of us who know, work or live with people with I/DD or children with behavioral challenges, Dr. Porter’s work reminds us to be curious about how stress presents itself and knowledgeable about strategies to manage it. While stress is a natural human state calling us to pay attention, it can also be identified and nurtured to work for us rather than against us.

There's a relationship between increasing levels of stress and optimal performance--but only to a certain point.

There’s a relationship between increasing levels of stress and optimal performance–but only to a certain point.

Dr. James Porter has presented seminars on stress management at West Point and for The FBI, The Navy, The Department of Homeland Security, The American Heart Association, The International Stress Management Association and at Time Life Headquarters in NYC. His work has been reported on in a wide variety of national media including Good Morning America, PM Magazine, Ladies Home Journal, The Daily News, The Dallas Morning News and in such medical Journals as The Journal of Bio-communication and the Journal of Cardiopulmonary Rehabilitation and The Journal of Family Practice. He is currently a fellow of The American Institute of Stress.

See more at: http://www.youtube.com/watch?v=qAqoKGy9zHM