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Innovative Business Strategies for Adult Day, Employment, and Transportation Services Columbus Center for Human Services, Inc.

Where We Started

Initial Stakeholder Meeting

During this meeting, we discussed our hopes, fears, and expectations for this process

What fears do you have about this process?

  • What is the best way to serve folks with additional needs?
  • Continuity and lack of family/guardian involvement in individuals' lives (we have struggled to get families engaged through existing councils)
  • Staffing and workforce development
  • Transportation (vehicle access and efficiency)
  • Not going deep enough (sticking with the status quo)
  • Funding (sustainability)

Participation in Starfire's Community Conversations

People supported by Starfire, along with their staff and members of the community, gather on a semi-regular basis to discuss what projects they are currently working on and brainstorm next-steps in small groups to spur further development.

The CCHS team actively participated in all of the Community Conversations that were taking place that day.

Our main takeaway:

  • All projects individuals were working on were entirely led by the individual.

Initial Plan Development

Following our visit to Starfire, our team met to discuss possible service delivery models and ideas that we would like to pursue given what we had learned and discovered to date:

  • Creation and implementation of "Cultivate" Circles (our own version of Starfire's Community Conversations model)
  • Creation of "On-the-Go" Group(s)
  • Continuation of Mobile Unit Express
  • Continuation of Job Search and Job Skill Development
  • Continuation of Employment Supports
  • 1:1 service model development
  • Continuation of current service model as we develop and transition to new model(s)

We also identified the following needs which we addressed in the next phase of this process:

  • Revision of our mission statement, core values, and philosophy
  • Board and family engagement strategies
  • Budget redistribution, allocation, and focus areas
  • County Board engagement and buy-in
  • Development of community partners
  • Alternate usage plans for existing land, space, and building
  • Staff development (different way to hire, train, and develop quality staff members)

A Business Plan Built to Break Barriers and Build Community

Project Statement:

We will progressively and intentionally develop and implement prototypes that lead to full community engagement and role-building. Trials of multiple prototypes will allow for testing and continual transformation; ultimately resulting in sustainable community-based service models focused on valued roles for all.

We developed a comprehensive business plan designed to allow for a sustainable transition to full community-based services which addresses the financial, socioeconomic, societal, and staffing barriers that were identified in the assessment and planning process.

Our Road Map: Steps to Full Community-Based Services

Road Map Step #2:

Revision of Our Mission, Vision, and Core Values

This process made it abundantly clear that our mission, vision, and operating philosophy was out of date and no longer accurately represented our organization.

So, one of the first things we did was change them!

Road Map Step #3:

Identification of Team and Engagement

We realigned our current staff along with developing and hiring for new positions specifically for the implementation of this transition.

Existing Staff

Our existing staff have transitioned to new roles as Innovators. They are responsible for creating engaging experiences for individuals when they are not in the community.

New Positions

Community Connectors - Our Community Connectors are leading our On-the-Go prototypes; helping to inspire the life journeys of the individuals they work with on a day-to-day basis in the community.

Step #4: Development and Implementation of Initial Prototypes

Career - Two options available that are designed to meet the unique needs of each individual:

Exploring Community Employment

  • Designed to help individuals develop skills, explore opportunities for employment, create resumes and participate mock surveys with employers.
  • This fully community-based model serves a maximum 4 individuals at a time with one staff who is highly trained in providing employment related outcomes and support.
  • The individuals participating in this prototype will experience individualized opportunities for employment exploration within community business networks through skill development and job seeking.
  • Skills to Pay the Bills educational curriculum will also be offered to individuals in various community settings.

Connecting to Employment

  • Designed to help individuals apply for, interview, obtain, train, and maintain community employment.
  • Individuals will receive one-on-one support from an experienced, and highly trained Employment Connector.
  • As individuals progress and develop, we will begin to fade our support; instead, encouraging natural support networks and independence through the use of existing community resources.

Activity - Opportunities for individuals who need support in their transition to full community-based services:

  • Designed for individuals who enjoy community experiences, but who are hesitant to be in the community full-time.
  • Individuals can participate in the weekly Community Connections planning group which will generate ideas for things they'd like to experience in the community.
  • Individuals in the Activity model will receive support from our Innovator staff who will help them explore their passions and develop the confidence needed to transition into the community.
  • The CAC team will meet with each individual at least quarterly to review the other options available for career and community-based experiences.

Community - On-the-Go's (OTG's) offer individuals the opportunity to build valued roles, explore interests, and make connections entirely within their communities, eliminating the need to come to our building each day.

On-the-Go #1 - Leisure

  • This small-group OTG provides opportunities for those who have leisure-related community goals to have fun while exploring their interests and develop friendships.
  • Individuals are supported by a dedicated and experienced Community Connector.
  • Individuals are picked up at home, spend their entire day in the community, and are returned home in the afternoon without ever having to come to the CAC.

On-the-Go # 2 - Volunteering & Community Service

  • This small-group OTG offers individuals interested in community participation opportunities to serve their communities through volunteering and membership in Individuals are supported by a dedicated and experienced Community Connector.-related organizations.
  • Individuals are supported by a dedicated and experienced Community Connector.
  • Individuals in this OTG are also picked up at home, spend their entire day in the community, and are returned home in the afternoon without ever having to come to the CAC.

On-the-Go #3 - Leisure Hybrid

  • The leisure hybrid small-group OTG shares the same goals as the leisure OTG, but provides additional support for individuals who due to medical and personal care needs, require use of lifts and equipment.
  • Individuals are supported by a dedicated and experienced Community Connector.
  • The leisure hybrid group will be in the community for the entire day, returning to the building only for medical and personal care needs.

On-the-Go #4 - Health & Wellness

  • This OTG is focused on the health and wellness goals of the individuals who participate.
  • Individuals who have health and wellness goals will participate in a variety of activities available through existing community networks such as the YMCA, Metro Parks, and Weight Watchers, among others.
  • Folks in this OTG are also picked up at home, spend their entire day in the community, and are returned home in the afternoon.

On-the-Go #5 - Community Exploration

  • This OTG focuses on exploration for those who haven’t yet had many experiences in the community on which to base their interests, desires, or goals. This exploration is designed to assist individuals with identifying their passions so they can begin to work towards achieving them in the community.
  • Individuals are supported by a dedicated and experienced Community Connector.
  • Individuals in this OTG are also picked up at home, spend their entire day in the community, and are returned home in the afternoon.

On-the-Go's #6-8 - One-on-One Individualized Support

  • The remaining OTG's all provide one-on-one, individualized support.
  • The individuals participating in this model will be paired with a Community Connector who will help them achieve their goals by linking them to existing networks and resources in their communities.
  • Individuals in this OTG will also be picked up at home, spend their time in the community, and be returned home without needing to come to the CAC.

Step #7: Board Engagement

To help increase Board engagement, our strategic planning session was World Cafe style, and was predominately centered around building community.

This unique process allowed for our Board of Directors, our leadership team, and key members of our staff to develop new and innovative ideas and strategies for success related to the transition away from facility-based services.

Performance Measurement and Analysis

We are committed to evaluating our performance and measuring data for the purpose of optimizing efficiency, effectiveness, and impact.

Our transformation plan will measure the following performance indicators:

  • Number of individuals receiving services in facility vs. number in community models
  • Measurement of time individuals spend in community vs. facility
  • Use of Cultivate Circles data to capture individualized progress through MILESTONE mapping
  • Number of new individuals selecting each focus area CAREER - ACTIVITY - COMMUNITY
  • Career Data: Number of individuals obtaining community jobs; their average hourly wage for individual; tenure of employment; length of time from beginning search to being hired; natural supports and relationships developed through employment
  • Volunteering: number of volunteer connections obtained; number of hours volunteered; relationships created through volunteering
  • Activity: number of community experiences per individual, per week; individual MILESTONE mapping
  • Community: number of community experiences offered and implemented; individual MILESTONE mapping; natural supports or relationships developed in community
  • Alternate Transportation: tracking of referrals to alternate transportation resources; number of individuals linked to and using public transportation and/or natural supports
  • Budget and Financial Impact: monitoring monthly departmental budget reports identified in the plan
  • Business and Community Partners: number of monthly connections made categorized by type of relationship (i.e.: funder, tenant/renter, volunteer group, etc.)
  • Satisfaction Surveys

Each month, this data will be digitally compiled and analyzed through internal and external methods to:

  • Monitor results to ensure that initiatives are implemented as designed
  • Inform stakeholders of progress made towards objectives; celebrating success
  • Solicit support from other partners that can help us achieve our mission
  • Identify areas for improvement
  • Develop new prototypes
  • Discern prototypes to continue, expand, or phase out
  • Make budgetary decisions based on community models

Long Term Targets

Career Track:

2019

  • 75% successful job placement
  • 90% retention

2020

  • 80% successful job placement
  • 92% retention

Activity Track:

2019

  • < 50% of individuals receiving primarily facility-based services (meaning 10% or less of time in spent community)
  • > 25% of individuals receiving primarily community-based services ( meaning more than 50% of time spent in community)

2020

  • < 40% of individuals receiving primarily facility-based services (meaning 10% or less of time in spent community)
  • > 30% of individuals receiving primarily community-based services ( meaning more than 50% of time spent in community)

Community Track:

2019

  • 25% of all individuals supported by Career, Activity, & Community will be participating in the Community track, spending 100% of their time in the community.

2020

  • 30% of all individuals supported by Career, Activity, & Community will be participating in the Community track, spending 100% of their time in the community.

Where We Were

Pre-COVID:

Progress towards goals/targets:

  • 100% of individuals program-wide are out of building at least 10% of time
  • 45% of individuals program-wide are out of building at least 50% of time
  • 10% of individuals program-wide are in the community 100% of the time

Financial Sustainability:

  • OTG Model (for Waiver) - running at a $78K loss/yr. which we supplemented with funding from increased ICF contracts, these grant dollars, and additional grants from MORPC and The Columbus Foundation

Factors Contributing to Deficit

  • Reimbursement did not cover small group size
  • Requires designated vehicle for each group (need arose for additional vehicles)
  • Multiple trips throughout the day in community-based models
  • Smaller staff/individual ratios

COVID Impacts

On Road Map & Goals:

  • We closed our building well in advance of the Governor's Stay-at-Home order - giving us the opportunity to move forward with our plan to be facility-free more quickly.
  • All OTG's became fully community-based. Eliminated hybrid option to remain facility-free and meet all COVID guidelines.
  • Utilized our existing AccessABLE Community Garden as a new OTG/STEP model. The individuals in this garden-based program also operate a weekly Farmer's Market where they share their harvests with the community - at a safe distance, of course.
  • Increased acuity payments, STEP funding, and additional grant revenue have allowed for further financial sustainability, however, when that funding ends, we will need a new plan. We encourage all providers to seek alternative funding whenever possible.
  • We had a need for more vehicles to accommodate small groups. Previously, most of our vehicles were large buses.
  • More equipment, supplies, and staffing needed for sanitation, screening, and ensuring COVID protocols in place are followed.
  • We've suspended any further work on rental of our building and Innovation Co-Op until pandemic ends.
  • We have reassigned our Innovators (previously scheduled in the building doing activities) to 1:1 STEP services, HPC, and to our residential locations.
  • Created Individual Experience Form - this online JotForm allows staff to document the daily experiences of the individuals we support (organization-wide) in a simple form using both words, and perhaps more importantly, pictures.

On Financial Sustainability:

March - June:

  • Program closure resulted in a loss of revenue for this time period

July - Current:

New funding options, increased acuity payments, supplemental payments, and flexibility have allowed for the reimbursement of the smaller, community-based models.

  • STEP funding and HPC options allow for 1:1 and small, community-based models to receive more adequate reimbursement for services and transportation
  • Operation of these programs during the COVID period has required additional vehicles, cleaning supplies, PPE, and sanitation supplies, all coming with an increased cost
  • Temporary increased acuity payments have allowed for the smaller model to be more financially sustainable (if/when reversed, we would encounter the same financial issues previously discussed where, without supplemental income, we would not be able to financially support the smaller group, community-based services)

Feedback/Outcomes:

The small group, and 1:1 community-based models have produces amazing outcomes!

  • Decreased behavior supports required
  • Allowed for many successful community volunteer and job placements
  • Every person participating has provided wonderful feedback including: individuals, families, other providers, APSI, teams, etc.