• Megan MacDonald

Suggestions for Implementing Independent & Quasi- Independent Facilitation/Planning in Ontario

Updated: Sep 7, 2020

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Introduction Facilitation and planning with people with developmental disabilities is important and valuable work. As the landscape of funded and fee-for-service continues to change, individuals and agencies are exploring ways to modify and/or expand their current facilitation and training practices. The information in this paper is based on interviews conducted in August and September 2019 with people and agencies in Ontario who offer some model of independent and/or quasi-independent facilitation/planning and also with people who had been involved in these types of planning models. The information collected during these interviews resulted in a list of factors to consider when implementing either quasi-independent or independent facilitation/planning have been identified.

For the purposes of this paper, independent facilitation/planning refers to services offered by someone who is not an employee of the Transfer Payment Agency (TPA) involved in providing direct support to the person. Conversely, quasi-independent facilitation/planning refers to planning done by TPA employees who are not directly involved in providing supports to the person.

A companion paper, “Facilitation & Planning in Ontario: Current trends in Independent & Quasi- Independent Facilitation/Planning” contains information about the process, time commitment, time frame, scope, cost, what the plan document looks like, and methods/tools used by respondents.

At the end, there is a list of the terms and acronyms used in this paper. Also, three documents were used as a reference point to anchor the implementation suggestions in this paper:

Respondent Information For this project, 21 people participated in a semi-structured open-ended phone or face-to-face interview. Respondents included people doing planning and/or facilitation independently (4), people doing planning and/or facilitation as part of a facilitation organization (3), representatives from developmental service TPAs who offer planning on a fee-for-service basis and/or have a quasi- independent model of planning (9), employees who support people who have had a plan developed by an independent or quasi-independent FP (4), and one person for whom a plan was developed.

Respondents do not represent a random sample. Potential respondents were identified based on known contacts and then by asking respondents for additional contact suggestions. Respondents were primarily based in southwestern Ontario. Not all potential respondents that were contacted were able to be interviewed within the required timeframe.

Planning versus Facilitation It can be helpful when discussing the ideas that form the basis of this paper to be explicit about how people use the terms planning and facilitation. Many respondents articulated that planning and facilitation are different. In the broad terms and for the purposes of this paper, facilitation refers to the process during which someone comes alongside a person and works with them and their support network to identify new opportunities and explore what the person wants in their life. The facilitation process may or may not be guided by a written document and may or may not result in a written document.

Conversely, planning refers to the process of working with a person and their support network to develop and create a written document that is the person’s and provides a holistic picture of the person, including current goals. The development of the plan generally includes connecting with the person and people who know them well through one or more meetings.

Some respondents provide facilitation supports, some planning supports, and some a combination of both. All respondents were clear that neither planners nor facilitators are direct support professionals and do not provide direct support on an on-going basis. In some cases, respondents provide support to a person to explore opportunities, but this is always on a short-term basis.

Implementation Frameworks Respondents were asked about process, time commitment, time frame, scope, cost, the plan document format, and methods/tools used. The implementation suggestions and considerations below are based on the interview responses. Overall, there was a large amount of variation in responses. Some variation can be attributed to a person directed philosophy. While other variation may be an indication that there is not one way to provide FP. That said, the suggestions below will help guide those interested in offering quasi-independent FP or FP on a fee-for-service basis.

Implementing Quasi-Independent Facilitation/Planning Respondents from TPAs that provide quasi-independent FP spoke about the importance of having a clear vision for the process and the role. This should include being specific about how success will be measured. Will the measure of success be how many plan documents are completed each year that meet QAM ISP requirements or will success be measured in terms of the changes in people’s lives? In addition, respondents emphasized the importance of management support of the person-directed philosophy. As one respondent articulated: “the FP needs to be focused on the best interests of the person, not the best interests of the agency (or staff team), and it’s important that management support that approach”. Respondents noted that when management is not clear about the vision and how success is measured, quasi-independent planning can fall short of the ideals noted in the three reference documents of being person-directed, fostering community contribution and belonging, and strengthening relationships and natural supports.

Agency contacts indicated the FPs were most successful when the agency philosophy and management supported planning and QAM ISPs as unique elements. Respondents expressed that there is a difference between life planning and support plans (this difference is also noted in the MCSS reference document Person-Directed Planning and Facilitation Guide, November 2013). Several TPA contacts shared that the QAM ISP and planning can at times feel like duplication, but it is important to see them as distinct but interconnected processes. Factors that contribute to seeing the processes as distinct but interconnected were:

  • having separate documents, one that meets QAM ISP requirements and different planning document(s);

  • distinct expectation regarding the frequency and timelines for review;

  • clarifying which roles are responsible for each element (e.g., DSP team is responsible to complete and document QAM ISP specific elements such as with whom the plan can be shared);

  • use of technology to reduce duplication (e.g., agencies using the database found it particularly easy to link, yet distinguish between planning and the QAM ISP requirements, while at the same time have FPs assist teams in writing goals that reflect compliance advisors’ expectations).

Based on the information from respondents, there is no one best approach to providing quasi- independent planning. The benefits or challenges of any aspect of an agency approach are often linked to specific agency decisions or philosophies. Agencies considering changing their approach to planning may need to make some key decisions (see below) and then use information from this paper to inform and guide subsequent decisions regarding the framework to implement and maintain a quasi- independent planning model.

Philosophy and Vision

  • What is the vision? And how does the vision support a person-directed process?

  • How will success be measured? What job performance outcomes will the FP be accountable for (e.g., number of plans that meet compliance dates and requirements versus change in person-specific outcomes)?

  • Will the person and/or the people important to them have a choice in who is the FP?

  • How will planning and QAM ISPs be distinct but interconnected processes?

  • How will management at all levels support the philosophy (once determined) and the FP, if the FP role is required to hold peers or superiors accountable?

Facilitator/Planner Role and Responsibilities

  • What are the skills and attributes associated with the FP role (i.e., what is on the job description)? How could the Developmental Services Human Resource Strategies Core Competencies be used to help identify the specific skills/behaviours of the role and placement in the organizational structure/compensation grid?

  • Will employees who do planning have dedicated roles or will they have other positions/responsibilities? If the FP role is only part of an employee’s responsibilities, what safeguards will the agency put in place to ensure neither role is over emphasized or neglected?

  • How many people will each FP plan with?

  • Will there be a team approach to planning in all communities? (The bullets below list some benefits of team approach articulated by respondents):

o In a team model, if one FP leaves the role or organization, there is not a sudden gap in skill and service.

o In a team model, FPs can provide support, coaching and mentoring to each other.

o In a team model, FPs can implement double checking of documentation and support improvement in writing skills.

o In a team model, the person can choose a FP they prefer.

  • Will participation in one or more communities of practice be part of the role responsibilities?

Screening & Training

  • What will be the recruitment and screening process for the role?

  • Based on the job description, recruitment and screening, what, if any, initial training will be provided?

  • What will on-going training, development, mentoring/coaching, and peer support look like?

Process and Documentation

  • Will there be a standardized process FPs must follow, or will the process be flexible?

  • Will there be a specific time per person, or will there be a flexible case load approach when working with people with base-funding?

  • Will FPs be required to track and account for the time spent planning with each person?

  • Will there be a standardized plan document, or will the documentation be flexible?

  • What role will the FP have in completing QAM ISP required documentation? What role will the FP have in monitoring and documenting goal implementation?

Implementing Independent Fee-for-Service Facilitation/Planning Increasing the options and opportunities for people to purchase independent FP is important to people and the overall service system. Many respondents noted that both independent and quasi-independent FPs can reduce the potential or perceived potential for conflict of interest, as the FP is not directly involved in providing support. Having an external independent FP is particularly beneficial when there are differences in perspective between the person and support team, the person and their family, and/or the family and the support team. Independent FP can be helpful is when change is needed, particularly a change in the model of support or changing which agency provides direct support.

At the time of this paper, based on feedback from respondents, there was little demand for planning on a fee-for-service basis. Several of the respondents from TPAs indicated, that while a few years ago they offered planning on a fee-for-service basis, they currently do not. Representatives from TPAs indicated that in addition to limited demand, internal capacity to offer this service is also a factor. Internal capacity includes both having employees with capacity within their current responsibilities and also retaining employees with the required skills and/or training (either at the agency and/or in positions with capacity within their role responsibilities).

Similarly, respondents who provide FP independently or through a facilitation organization, said that in the fall of 2019, demand for their services was low. This project did not include a comprehensive review of services available across the province. However, it does appear that some Ontario communities have agencies (TPAs or other) and/or individuals that offer planning on a fee-for-service basis and other communities do not.

Suggestions to consider when offering independent FP on a fee-for-service basis include:

  • Articulating your philosophy and vision when providing independent FP services. This can include stating that the person and/or those that know them best are in control of the process and outcome.

  • Be flexible in what you provide with respect to hours provided, outcomes (a document or not a document), process, etc.. This includes being flexible with the total cost. While the MCCSS Passport program states that no more than $2500 can be spent on person-directed planning, many respondents spoke about thinking beyond the $2500 dollar amount, remembering that some people may want or need a service that is less than $2500 and others may have other sources of funding and will want or need a service that is more than $2500.

  • Be clear about what you offer and what you will do and not do. Having a clear package (or a flat rate cost) and/or list of offerings with associated costs, have been noted as helpful fee-for- service approaches. This includes identifying any applicable fees for travel time and mileage.

  • Factoring the time associated with participating in a community of practice, professional development, and coaching/mentoring into fee-for-service costs. Cost breakdowns and/or various packages appears to be a more common approach in communities that were not part of the OIFN demonstration project. During the OIFN demonstration project agencies were funded a specific amount per person. In many cases agencies in the demonstration project used a case load model, in that facilitators were responsible to work with a specific number of people, and some people received more hours of service and some people received few hours of service. It was noted that the flexible case load model used by some doing fee-for-service can be challenging when few people are requesting this service. Worth mentioning, is that respondents involved in the OIFN demonstration project noted that the time estimates from the project were not financially sustainable.

Conclusion Facilitation and planning for people with developmental disabilities continues to evolve and change. Part of that on-going evolution is the increased awareness of the value of having an independent or quasi- independent FP. The suggestions noted in this paper provide a starting point and framework for those wishing to move towards a more independent approach to FP either within a TPA or on a fee-for-service basis.

Terms Used in this Paper To ensure all readers have the same understanding, this section outlines some terms and acronyms used in this paper. The terminology below is specific to this document only and may not necessarily reflect other definitions used within the developmental services sector or across sectors.

Independent Facilitators: People who do planning and/or facilitation either as a sole proprietor or for an independent facilitation organization that is not directly funded by the MCCSS to provide these services.

OIFN: Ontario Independent Facilitators Network provides support to independent facilitation and planning by strengthening self advocacy and autonomous family voices, offering mentoring, and education for independent facilitators in their local practice. https://www.oifn.ca/

Person-directed: In this paper, the term person-directed is used to capture both person-centred and person-directed philosophises, unless the interviewee was specifically referring to the use of HSA Person-Centred Thinking practices and tools.

Facilitators/planners (FPs): People who do planning either independently, as part of a planning/facilitation organization, or as an employee of a developmental service transfer payment agency.

QAM ISP: The Quality Assurance Measures (QAM) regulation outlines that each person must have an Individual Support Plan (ISP) which meets a specific list of requirements.

Quasi-independent planning: In this paper, the term quasi-independent planning is used to refer to planning done by employees of a transfer payment agency who are not directly involved in providing supports to the person.

Reference documents: The three guide-type documents that were reviewed and used as a reference point and are listed at the beginning of this paper.

Respondents: People who provided information via phone or face-to-face interviews that contributed to this paper.

Prepared April 2020 by Megan MacDonald (Freelance/Consultant) www.meganmacconsulting.com

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Tavistock, Ontario