This month's story from NorthStar Services is written by Jonathan Peakall, direct support staff from the coastal town of Fort Bragg, CA.

The Friday night gang started simply because Kyle and I were looking for fun things to do on Fridays. On a whim, we decided to call Ian, who had recently started to be supported by North Star. It turned out to be a great fit, not only with Kyle and Ian, but with myself and Ian's support person Michaela. Over time, this "once in a while" thing became a regular thing. Kyle would always ask me what we were doing with Ian as soon as I arrived! He began coming up with ideas of things to do.

In the beginning, we had simple plans, meeting to go swimming or going out for coffee after dinner. It began to slowly expand until we were eating dinner together every Friday and then hanging out for the evening. At this point, the friendship between Kyle and Ian really started to form and Michaela suggested that we invite a third to our little group, Rosemary (Kyle and Rosemary had known each other for 30 years).

Along the way, Michaela and I started to do more thoughtful coordination and have conversations about how to account for the different personalities and needs within this group. It went slowly at first and then more quickly as the group really started to come together.

As everyone grew more comfortable with each other, we started engaging in more ambitious plans: BBQ on the beach, parties, camp out's at my place and so on. We also started to see changes in the group, both individually and collectively. By now, all the members of the gang were planning ahead, coming up with things to do, really taking over the direction and clearly caring for and about each other. And it had become a tradition and an important thing in their lives.

But life changes, and it came to be that both Michaela and I stopped working on Fridays. We were very worried that the Friday gang would dissolve. However, just a couple of weeks ago I got a photo sent to me of the gang at the local Coast Guard station after having taken a tour of the boats, with big smiles on their faces. While I have to admit there was part of me that felt sad that we were no longer needed, I was so glad to see that the friendships we had helped to forge were strong and capable of taking care of themselves.

Carole White says - It captures the kind of thinking that we at NorthStar constantly try to instill in our work. It requires openness and the asking of many questions.  A bit of history to this story, is that Kyle and Rosemary have known each other for over 30 years. But as adults, their ability to spend time together was still tied to their mothers' time and organizational abilities! Now that they are receiving supported living services they are able to create time to spend together.

Here is another success story from NorthStar Services in California of putting what is important to a person first and supporting them with health and safety to achieve their dream.

Teresa is someone that we support that has Prader Willi Syndrome. For years she lived in a group home with several other women that also have Prader Willi Syndrome. Teresa and her mom Ann worked very hard advocating for individualized supports in the form of Supported Living Services through NorthStar Services. Teresa has now been living in her own home, with support, for 5 years very successfully and independently.

Teresa has had a goal of getting her black belt in karate for over 6 years. She wanted to learn self-defense, and wanted to exercise in a way that was fun for her.  She started this quest while she was living in the group home, but was not able to attend very often due to the limitations of congregate living. Once she moved into her own apartment she began attending regularly 2-3 times per week. Throughout this process she met many wonderful people that were willing to give their time and expertise in order to help her achieve her goal.

The instructors at the gym went out of their way to help Teresa learn the moves with the proper form and technique. They also encouraged the class (of regular non-disabled students) to pair with Teresa, go a little bit slower while she learned, but to keep true to the principles of karate. During the last six months of her training, she participated in a black belt preparation class. This class was not at her normal gym, and had all new instructors for her to work with. It was soon apparent that Teresa had the dedication and the heart, but needed just a bit of extra support, so a buddy was assigned to her, Mrs. Gomez, to work alongside Teresa and help with slowing the moves and routines down for her.

Teresa had to pass all of the same requirements as the rest of the class, and became their model of "Never Give Up." Teresa was recognized for her persistence during the black belt ceremony on December 10^th, 2011. She is so proud of herself that we decided to use the achievement tool to help us focus what we learned during this journey. It was a great way to help with the celebration and record the learning so that we can have many more of these fabulous experiences with Teresa.

Valerie, Community Support Facilitator, from NorthStar Services in California writes this blog as part of a series from NorthStar on community connecting with the people they support.

Heidi is someone we support that does not have many close relationships. She has many friends, but does not get together with them outside of her sheltered workshop very often. Many of her friends reside in group homes, which really limits their ability to have after hour fun. Heidi loves to talk with people; she will talk with them at the store or bank. She doesn't take it further, such as exchanging phone numbers or setting up time to meet and hang out.

Heidi has a passion for animals! She had pets in the past, but has a difficult time taking care of their needs, and not getting frustrated with the noise, mess and daily care required with pets. This does not stop her from wanting one, and from loving them.

We have tried numerous times to get Heidi to try volunteering, or to join a group, but she is happy with the friends that she has, and does not like to make commitments that take away from her relaxing, fun time in the evening and weekends. She lives with another individual that receives services, and they both have staff. She gets plenty of socializing without stepping foot outside of her apartment…but we found a way to make it happen!!!

Knowing what is important to Heidi was crucial in making this match. We also had to look at where in the community we could find a resource that matched her interests and was able and willing to look for ways to maximize her abilities. For a long time we did not have much success, until Heidi just happened to go to a store across town, while they were having an animal adoption day. We got a flyer, found a good contact person that was eager for help and interested in working with Heidi, and a match was made.

We combined Heidi's love of animals with her desire for talking to community members and found the perfect position with her. She now volunteers one weekend per month with a group that helps find dogs loving homes. She walks the dogs, pets the dogs, provides a good introduction to interested families and most importantly she gets to love the dogs. The fact that the adoption days only happen once a month made it easier for her to try it. It does not take up too much of her time, but gives her an opportunity to be part of a group, to give back and to make new friends. There is also the possibility for increased volunteer time if she gets comfortable enough, but the short time commitment is perfect for her right now. We are in the beginning stages of this success, but are hopeful that we have found a home for Heidi.

For the past 15 years developing a person centered service/support coordination role in the developmental disability system has been a priority for me. I have seen the changes from the mid 1990's of service coordination role to the present role. Luckily, we as a state system are moving back to the roles of advocacy, support, facilitation and resourcing that we were really getting good at in the mid 1990's.

When I started in 1995 with the Department of Mental Health as a service coordinator, my vision/passion and job were in alignment - helping people and their families live the lives they wanted. I spent time with people and their families in rural Missouri. There were few paid services, thus we relied on networking and coalition building to get people and their families supports they needed. We had time to get to know people and develop plans with them that focused on real outcomes. Service coordinators were identifying what changes needed to happen in the system to facilitate "real lives" for people. When paid services were authorized, congregate days services and vocational programs were switching to individualized supports in peoples' communities and supported employment was key. Service coordinators linked families together to provide support to one another, share resources and talk about school experiences - a general support network.

What happened?

Scarcity of resources and increased attention to quality of supports and services. The role of the service coordinator became inspector, monitor, justifyer of paid services and then if time, advocate, facilitator and resourcer. What I have seen is a gradual move away from the activites that save the system money (resourcing, advocacy, networking) to regulatory activities to keep people safe and preserve the limited dollars available within our state system. It seems strange that an increase in focus on quality would change the role of service coordinators so dramatically. Quality is good afterall.

When I ask this question around the country to service coordinators, "How many of us became service coordinators to monitor, complete paperwork,bill for our time, justify the need for services, and/or act as "police" in finding mistakes and concerns with agencies providing residential services?" No one has yet to raise their hand. These activities are not inherently "bad". Ensuring quality services/supports that do help people achieve their person outcomes is a really great thing! Service coordinators want to help people achieve success all around. Scarcity of resources brought about high numbers of people each service coordinator/support coordinator was supporting and fear on the "system's" part that we might run out of money. We built our system to respond to crises rather than prevent crises. This costs more in resources: money and time.

Recently in our state, we have started to hear the words supporting, connecting, planning with families and people and advocacy.  We are seeing traditional service models change - the advocacy service coordinators have been doing for years of saying people need more choices - to live how they want to live, work where they want to work and have CONTROL in their lives, is slowly changing.

Service coordinators have continued to be one of the voices from within the system for change. Using person centered thinking tools to identify what is working/not working from their perspective, as well as learning this for all the people they support, provides a foundation for action and change. We need this information in order to do the true sense of service/support coordination.

When Ben was three, I developed a one pager for him to take to his new preschool teachers. It turned out Ben was more interested in his page than his teachers. It had pictures of dinosaurs and whales on it. As I look back at his three year old page, I see many similarities - hugs for teachers is still one of the highlights of Ben's day, dinosaurs, whales and now prehistoric sharks are passions of his…and we are just beginning to get into dragons.

What has changed, is him seeing himself as an "expert" in all things dinosaurs and really prehistoric life. Every year at his school, there is a dinosuar week - for two weeks! These two weeks are the highlight of Ben's year other than his birthday and Christmas. He has been reading about all things prehistoric since he was 2 ½ (well Mom has been reading to him). He is quite the expert among other five year olds and some teachers. He brings some of his dinosaur books, fossilized shark teeth, and fossilized whale/dolphin bones home with him.

Stuttering has also become a part of Ben's life. We noticed it a bit last year and now realized it is "real". His teachers noticed it is more revelant when he is speaking to the class or trying to ask a question of his teachers. We are waiting on speech therapy to start in early 2012. So there is some frustration for Ben. He has all this knowledge he wants to share but struggles to share as much as he would like. We hope the therapy will resolve his stuttering or at least give us coping techniques, in addition to what we do now.  We ask him to take a deep breath if he gets stuck on a word. His teachers let him know they are listening - he has their attention.

Ben will go to public kindergarten next year. This is a bit scary for me - the transition away from the comfort of friends he has known for 3.5 years and teachers that really know him. Thus, I am starting drafts of his one page profile to provide an introduction to Ben to a new school and new people. The one page profile is so much more for me than Ben!

Laurie is our guest blogger this month. She works as a manager with North Star Services in California.  She supports Pam and her staff. Laurie shares the story below of how they listened to Pam and helped her achieve a dream and be more connected to her community....

Ever since she was a little girl she wanted to be an entertainer! Whether it was signing to "You Light Up My Life" on any stage that would have her, or doing it for family, friends or support staff, yes entertaining is her passion!

Pam receives 24 hour a day supportive living services. When out in the community, Pam has no fear of strangers and if she thinks she knows you she will go with you without fearing for her safety. 24 hour a day staffing a must we once thought!

When I met Pam 9 months ago, I noticed that she carried 2 red pom-poms with her everywhere she went. When Pam would meet someone for the first time she would get those pom-poms out and show off her stuff. I thought to myself … a Cheerleader!  Yeah, A Cheerleader! Why not! Why can't Pam be a cheerleader!

Being involved as a volunteer cheer coach I thought, can we support Pam in making a connection in her community doing what she loves?  Entertaining! Cheerleading! Wow! I asked Pam if she would like to cheer on a cheer team.  Pam answered, "That's right." I got excited!

When cheerleading was presented to the team some said, "Pam has "sun downers" and will not go out at night" (practice is every Wednesday night from 6:30 pm to 8:00 pm). Others said, "If it's at night she won't go out." And a few said, "Let's try it!" So that is what we did.

Pam attended a trial class three months ago and has not missed a class since she decided to join All Star Elite "Heart Droppers!" She has made many new friends and has attended other events with her new friends from her team. To watch Pam interact with her teammates will bring tears to your eyes. The care Pam shows to her team, the love in her eyes and the smile on her face says it all. She has found a connection where she is able to entertain, be the star that she wants to be! Each Wednesday night Pam puts on her cheer shirt, packs up her Debbie Boone CD and her 2 red pom-poms and excitedly heads to her cheer practice.

Today, Pam's cheer coach has asked support staff to drop her off and leave. Staff came to her last Focus Meeting and asked, "Can we do that? Leave Pam at cheer practice without support and come back?" That question was answered with another question - "Why not?"

Her support staff now take her to cheer practice, drops her off for that hour and a half, and then come back. Something nobody on her team thought they would be doing just three short months ago.

Later this week we have an appointment for our son to have a speech evaluation. It isn't anything really serious, mild stuttering, but it is bringing up all kinds of emotions and anxieties. We had noticed it, but were wondering if his teachers also noticed.  When I brought it up to them, they immediately responded with examples of what they had observed. They had planned to have a conference with us, and were relieved when I brought it up first. So, it is real; others are noticing it. 

I want to be prepared and provide information that will be really helpful for the evaluator to use and help us know how to support Ben. 

I am working on the 4 plus 1 to capture what we know right now to help identify all that we have tried/done (whether or not it was intentional) to address his stuttering which is usually getting stuck on the first letter of the first word in a question he is asking. We are not sure of our approach in supporting Ben and need some guideance and ideas from a professional. 

I found completing the tool to be helpful in getting my thoughts organized and coherent to be ready to share with the evaluator. I may or may not put the whole tool in front of the speech therapist, but at least I will be able to describe what we have learned and our concerns. If nothing else it gives me peace of mind that I have something to do that is productive while we are waiting for his appointment. I have a sense of being proactive and more confident about getting Ben the support he needs.    

This month's blog is provided by Claudia Bolton of NorthStar Services...........

Historical Perspective:

NorthStar Services, a supported living agency in California, have always strived to support each individual who receives services to have a great life and to be a valued community member. Our concern has been that while the individuals we support are living good lives in the community, for many people, their circles of support are made up primarily of people who are paid to be in their lives. Also, while the people we support are active, participating members of the community many of them do not have valued community roles.

 What we have Tried:

If you have been following this blog you know that we are attempting to imbed value based community connecting "tools" and subsequent skills for community building into our organization's culture.  Since Amanda George,  of HSA, came to our agency and did a "kick off" for the HSA community connecting tools we have tried introducing a "tool of the month" to each individual and their support teams.

In August 2011, we reviewed how our community connecting work is moving along.  We used a Person Centered Thinking tool, 4 +1, to evaluate; what we have tried, what we have learned, what we are pleased about, what we are concerned about and what our next steps would be.  Here are our findings and plans for the future.

What we've Learned:

1. Tool use is not the outcome - valued community roles and relationships are the outcome - Duh!!  The leadership team knew this however, by focusing on tool use we have to keep this in the forefront so that we never assume we are doing all we can just because we are using tools.  The tools help us build our work, just like a carpenter's tool only helps to build a home.  Having and using the tools is only the beginning.
2. We have layers of work and discovery to do.
3. The tools have helped us with the discovery about the person's gifts and the community opportunities.
4. The CSF's (managers/case managers) must have competence and confidence in using the tool prior to taking them to the individuals and their team.  The tools look easy to use but we have discovered that it takes some practice to really use them well.
5. On some teams - we are using the tools but we aren't sure that the staff and individuals are thinking more about community connecting.
6. The Community Support Facilitators cannot be the only implementers for using the tools and for supporting community building.  The direct support staff must participate.
7. We want our staff to have an entire toolbox of community connecting tools so they can decide which tool to use and when. Our goal is that the tools will teach skills and help the staff think more thoughtfully.
8. The team and individual are more interested if the tool and vision for an outcome are visible. For example if the "tool" is posted where it can be seen.
9. The behaviour of some people makes community connecting more challenging.
10. We knew this - but it is clearer for our staff now - that some people don't have connections outside of paid staff, other individuals who receive services, and superficial connections in the community. Recognizing this is a first step.  We are no longer in denial or distortion.
11. When things don't work out as planned we must view it is as a learning opportunity and ask: what worked, what didn't work, and what will we try differently? 
12. The staff and individuals on some teams are just "going for it" and this has resulted in some exciting outcomes for people (i.e., Michelle is volunteering at the library). 
13. Staff matching will be important to the success of our community connecting work. 
14. We need to get more "buy in" from the direct support staff. 

What We Will Try In The Future:

1. Provide support and training to the Community Support Facilitators, so that they are confident and competent in using the tool prior to taking the tool to the individual and their team.
2. Slow down in introducing the tools. We started by introducing one new tool each month and this did not allow everyone to learn about the value of the tool and how it could be used. 
3. Provide more staff training in the use or applicability of each tool before we support the individual's to develop the tool for themselves. For example have the staff try using the tools on themselves or with a team member.
4. Keep the tools visual - Post the tool in the individual's home (with permission of course) prior to their team meeting so that they and their staff will be thinking about the tool before the meeting.  Send the tool out with paychecks.
5. Review and work with the tools at Focus Meetings (like a Circle Meeting).
6. Develop an Action Plan that moves toward tool use implementation and a desired community or relationship outcome for the individual.
7. Recognize staff who take initiative, and who use creativity and judgment in community connecting work
8. Be intentional in staff matching: Discovering each staff person's gifts, capacities, interests and connections can help us make a good job match.  This is something we have been doing but we need to be more intentional about matching when there is an opportunity for community building.
9. We need to slow down, remember the purpose of community connecting work and find ways to share our learning:
10. We could use a Learning Log to record what was tried and what worked/didn't work.
11. We will share our stories - even when it seems like there isn't the time.  
12. We could put our stories and learning logs on the NorthStar server so we have a shared place to retain and share our learning.

In summary, the main things we have learned are:

1. The tool is not the outcome; valued community lives are the outcome. 
2. We must take action.  It's not enough to gather information (about the person and the community). We must go from gathering information and discovery to using creativity and judgment to take action. 
3. The tools appear simple to understand and use, but to use them well it takes practice, thought and sharing of experiences.
4. We must create opportunities within the organization and with others doing community connecting work, to share our learning, celebrate success and learn from what worked and did not work.  

This month's blog comes from NorthStar.......

We had an extremely inspiring month with our community and relationship building efforts. We were fortunate to be able to attend the Learning Community for Person Centered Practices Annual Gathering, where we were able to brainstorm, learn and share with many members that are trying to attain great community lives with important people in their lives. We also were able to participate in a web-ex conference call with Michelle and Amanda, with HSA,  to hear great efforts being made in other parts of the world, then take the information gathered at these two inspiring events to renew our passion for taking the community connecting efforts forward with in our own agency.

Michelle shared how she uses The Who Am I...My Style tool to learn more about the people she is serving. We were inspired to go out and try it and had a great time getting to know each other with two individuals that we support and their teams. This was a great tool to use to get to know each other better. Practicing it with staff first made it a fun way to get the individuals and their teams to open up and share what they know about each other and gave us ideas we may not have had when it was the individuals turn.  This was a great team building exercise as we got to know each other better and looked at what makes us have great days, what gifts we have to share and how we can find opportunities to share those gifts and passions. After completing the tool we came up with an action to take in order to ensure that this was an exercise that has some on-going meaning.

Throughout our learning process of the last few months we have found some things that we would like to share about our tool use.

1.  If you put the tool of the month sample in with paychecks, staff receive them.

2.  If we don't come up with an action plan after using each tool it loses meaning and application. The action plan keeps it in peoples minds more as they go out and try things.

3.  If we practice on ourselves and staff, the people we support enjoy the process more as they don't feel like we are doing something meaningless to them. They enjoy giving input to those that support them.

4.  Practicing the tool on a staff member also helps that staff person think of ways to improve their community lives, therefore making them a more valuable asset to the people they support.

5.  It is ok if we are not "experts" in building community and relationships. What is important is that it is important to us so we keep trying, and that we continue our learning and growth so that we can become experts.

We appreciate all the shared learning that we are receiving in our journey to support great community lives and want to thank HSA and the Learning Community for Person Centered Practices for all the inspiration, guidance and help along the way!

This month's blog is provided by NorthStar.....

Using the "Community Connecting Tools" really enhance our ability to work with individuals and staff on day to day basis.  After our meeting with a Amanda in February, we at NorthStar have put into practice the tool of the month using community connecting tools.

Every individual that we support and their staff meet on a monthly basis.  At these Focus meetings we review community connecting tool(s) and how it is working.  When people we support focus on tool each month (with support from their staff), they feel in control of their success!

We started off with "Who am I…My Places".  It was very beneficial for all staff to see where each person feels comfortable, where each person is already a member and where we can continue to build connections.  This tool reminded staff that many of our individuals already have connections that can be strengthened. 

The second tool that we introduced was "The Relationship Circle".  This was very fun for our individuals; they liked to put down the people in their lives that are important.  Looking at each person and selecting where they would fit on the Relationship Circle was an exercise that took some thought and was a good expression of where the individual sees their Family & Friends.                                

We had a specific success story using the Relationship circle.  Lauren, is very active in the Special Olympics.  She participates in many sporting events throughout the year.  After using the Relationship Circle we found that she was very comfortable with several friends and her coaches.  Lauren and staff decided that this was the perfect opportunity for her to be out in the community and participate without staff at her side.   This was a very big step for Lauren and created a sense of independence that she did not already have.

Another success story happened just this past weekend.  Lupe, another individual, attends church on Sundays.  She goes to church and does not usually participate much.  Her staff is very diligent in trying to get Lupe to be part of the community rather than just being in the community.  The church had a parade in town and Lupe asked to be in the parade.  It was her choice to become PART of her community and to participate.  This was very exciting for Lupe as well as her staff.