Adult Day Program

Adult Day Program
Kyle Holcomb, Dave Carr, Jerry Stark | A&R Case Management

Adult Day Program
We are excited to announce that we will be restructuring the Adult Day
Program.We will now have a team that includes the hourly supported
living participants, the participants attending our day program, and
team members!Welcome to ourTeam!The hourly supported living
participants and team members are coming over from the umbrella of
Supported Living.

Itinerary
 Introductions (15 min.)
 History (5 min.)
 Mission (5 min.)
 Vision (5 min.)
 Leaders (15 min.)
 Top Down (15 min.)
 Program Hierarchy (5 min.)
 CSRTraining (15 min.)
 Attendance Policy (20 min.)
 Break (10 min.)
 Project Scope (5 min.)
 Milestones (10 min.)
 Cost Analysis (5 min.)
 Profit Margins (5 min.)
 Conclusion (10 min.)

History
 A&R Case Management was established on May 30, 1995 as a Sub
Chapter S Corporation and is owned and operated by Joanne Anderson
and Lori Rainboth-Owen for profit.
 We started in the JoanneAnderson’s residence, progressed to Lori
Rainboth-Owen’s residence, and just a few years later A&R moved into
the Hasbrouck House.After the Hasbrouck House was not suitable we
moved on over to the previous location off of Holly street.The company
then decided to upgrade to a newer building in the year of 2012.We
remain in this location off of 12th Ave. in Nampa, ID
 During the past 20 years of business A&R has expanded from just a
handful of participants to serving a couple of hundred of participants
and employing nearly two hundred team members.

History Continued…
 Also, during that time we have been apart of positive and negative
experiences.We have learned that the most important part of running a
successful business is utilizing The Golden Rule.
 Some of the most positive include serving individuals during Special
Olympics and getting to know each participant for who they are and not
by their disability.
 Some of the negative include state-laws that gave us the opportunity to
adapt and continue in a different direction. Even negative happening
have allowed us to become stronger and better suited for future
endeavors.

Mission Statement
 A&R Case Management believes that every individual can achieve
greater independence with the right support, encouragement, and
positive environment.
 The mission of A&R Case Management is to provide Service
Coordination, Habilitative Intervention, Habilitative Support, Age and
Disabled Waiver Services, Residential Habilitation, Supported Living,
and Personal Care Services.
 The Adult Program has printed out personal mission statements for
each one of our team members.We have also provided a web address
that will grant access to a free online copy as well for future use.
 http://www.daveramsey.com/entreleadership/mission/

A&R Adult Day ProgramVision
 Our vision is to expand at a rate that we can continue to serve our
participants very well in regards to therapy, dignity, and respect.
 Slow and steady expansion wins the race
 Our vision is to expand into multiple therapy rooms and accommodate
ample resources for all participants and team members
 This also includes developing future leaders in the Adult Program to
help facilitate activities, events, training, and other business endeavors.

A&R Adult Day ProgramVision continued…
 Have a program that has less than 15% of downtime
 Has a waiting list for admission
 Action Items
 Objectives that enhance learning to the full potential
 Daily activities that encourage learning to the full potential

A&R Leaders
 A Leader Defined:
 A person that can be;
 Passionately serving
 Mavericks (independent minded person) who have integrity
 Disciplined risk takers
 Courageous while humble
 MotivatedVisionaries
 Driven while loyal
 Influential learners

A&R Leaders continued…
 An A&R Leader needs to have a servant mentality by leading our team
members.
 Teaching and mentoring
 Protecting team members from inappropriateness (sexual harassment, etc.)
 Digging the trenches
 Reprimanding a team member or even allowing him to work somewhere
else.
 Passion
 You cannot lead without passion and passion is a force multiplier.
 Passion is simply caring deeply!
 The byproducts of this are quality, excellence, impressed customers,
employees who become team members, and ultimately a higher
likelihood of profit.

A&R Leaders continued…
 There is more energy in an organization with a passionate leader and team.
 People are naturally more productive when they care deeply about the outcomes and
company
 If I am a customer and I believe you deeply care about delivering to me, I am more
forgiving when there is a mistake.
 Unity only comes when a group of people truly believe each member cares.
 If people are merely looking for a J-O-B we will allow them to work somewhere else
 Passion is so key in leading and creating excellence that our team will hire passion
over education or talent every time.

From theTop Down
 Developmental Specialists Responsibilities
 Developmental Application
 H/C
 Developmental Evaluation
 Medical Notes
 Mental Healthy Diagnosis
 PSR
 ISP/PIP
 6MR and AR
 Med. Social, IEP, Sib-r, etc.
 Program Coordinator Responsibilities
 Program Implementation
 DevelopmentalAssessment
 Implementation Program Plans
 6MR & 12MR
 ISP Meetings
 Safety Plans & Behavioral Plans
 Assist team members
 Incident Reports
 QualityAssurance

From theTop Down continued…
 Developmental Specialists and Program CoordinatorAdditional Responsibilities
 Activities and Events Coordination
 Marketing & Selling
 Program
 Therapy
 A&R Brand
 Observations
 Customer Service
 Personnel Issues
 Answering to Management whom answer to the Department of Health &Welfare
 Also, in my case roughly 10-15 hours a week of Habilitative Intervention

From theTop Down continued…
 DevelopmentalTechnician
Responsibilities
 CSR’s
 Data
 Scheduling
 Changing, tube feeding, behaviors, health, and
many other
 Answering to Supervisor who answers to Management
whom answers to the Department of Health &Welfare
 Also, in many of your cases roughly 10-15 hours a week
of Habilitative Supports or other services
 Direct CareTeam Member
Responsibilities
 CSR’s
 Data
 Scheduling
 Transportation as needed

Program Hierarchy
Supervisor
Program Management
Administrative
Lori Rainboth-
Owen & Joanne
Anderson
Adult Day
Program: Chris
Haskell
Kyle Holcomb David Carr Jerry Stark
Supported
Living: Shane
Quesnell
Deidre
McConnel
Ryan Hansel

Program Hierarchy
 First Contact
A. Team Lead
 Lori Sells (M-F 8AM-4PM)
 P: 463.9313 EX. 231
B. Developmental Specialist
 David Carr (M-F 9AM-5PM)
 P: 463.9313 EX. 227
 Kyle Holcomb (T-F 8AM-6PM)
 P: 463.9313 EX. 228
 Jerry Stark (M-F 9AM-5PM)
 P: 463.9313 EX. 214
C. Program Manager
 Chris Haskell (T-F 8AM-6PM)
 P: 463.9313 EX. 210
On-Call
 P: 703.2688

CSRTraining
 Reference Document

Attendance Policy
 Attendance PolicyGuidelines and;
 Implementation
 We need all team members printed name, signature, and date
 Staffing Coordinator
 P: 208.703.4133

Project Scope
 Work to be accomplished
 Program Expectations
 What’s the purpose or business need for this project?
 The purpose of this project is the expansion of the Adult Day Program, increase participant
interaction, increased profit margins, and customer satisfaction.

Objectives
 Identify overall project objectives:
 Team Member Responsibilities and
Expectations
 ProfessionalismTraining
 Prompt HierarchyTraining
 HierarchyVerbal Intervention
 Screen Usage Guidelines
 6STraining
 DTTM
 Monthly
 Positives
 Goals
 Action Items
 Conclusion (Questions or
concerns)
 Time Management and
Organization
 SMART Goals
 Weekly Activity Planner
 Prioritized Action Items

Project Schedule and Milestones
Milestone 1
• 11.18.15
Milestone 2
• 12.2.15
Milestone 3
• 12.16.15
Milestone 4
• 1.13.16

Milestone Schedule
 HSLTeam Members:
 Will receive all four of the milestone trainings
 Adult RoomTeam Members:
 Will attend the monthly DTTM meetings only unless they need a refresher on any of the
trainings.

Milestone 1
 Team Member ResponsibilitiesTraining
 Team Member ExpectationsTraining
 ProfessionalismTraining

Milestone 2
 DevelopmentalTechnicianTraining Meeting (DTTM)
 *Direct CareTeam Members are expected to attend
 Monthly
 Positives
 Goals
 Action Items
 Conclusion (Questions or concerns)
 Time Management & Organization
 SMART Goals
 PrioritizedAction Items

Milestone 3
 Outlook CalendarTraining
 Identify places that participants would like to attend quarterly
 Scheduling Protocol

Milestone 4
 HierarchicalVerbal InterventionTraining
 Prompt HierarchyTraining
 6STraining onWorkplace Organization

Cost Analysis
$-
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
Attendance Wages ADP Budget ADP Renovation Building Expenses Benefits Insurance
Annual Cost

Profit Margins
 Number of Participants:
 30 Participants
 11 Percent Profit Margin
 60 Participants
 90 Participants
 Benefits of Increased Profit Margins
 Opportunities for advancement
 Increased benefits
 How do we get there?
 Quality of Service
 Process Improvement
 Passion
 Team members versus employees

Success Factors
 Satisfied clients
 Meet project objectives

Conclusion
 Question andAnswer
 Please provide an email address and phone number for business purposes
 If a team member does not have an email to provide please stay seated.We will conduct a
quick email creation training and expect an email address from each team member by our
next meeting. Our next meeting will be sent out on checks when applicable.
 Please submit personal Mission Statement by our next meeting if you have not
already. If less than 80% are submitted by our next meeting we will take time to
complete our Mission Statements during our next meeting.The Mission Statements
can be submitted early via email: kyleh@arcasemanagement.com
 Thank you for your time!!

Itinerary
 Mission Statements
 Professionalism
 DTTM
 Time Management Expectations and;
 Organization
 Outlook CalendarTraining and;
 Scheduling protocol

Mission Statements
 15-30 minutes to complete Mission Statements if less than 80% of HSL team members
have completed the document.

ProfessionalismTraining
 Professionalism LearningObjectives:
 Define professionalism
 Describe key professional attributes
 Describing methods for teaching and assessment of professionalism
 Describe the most common examples of unprofessional behavior

 Professionalism:
 Without questions…the most important career competencies
 Most common reason for “failure” in a career is a lack thereof professionalism

ProfessionalTraining
 Distractions that interfere with professional behavior:
 Financial worries
 Time constraints
 Fatigue
 Physical illness and;
 Family stress

 Definition of a profession: Being in a profession means much more than simply getting
paid for what you do!!

 Definition of a Profession:
 Distinct body of knowledge
 Responsibility for advancing knowledge
 Responsibility for transmitting knowledge to the next generation
 Special code of behavior- A true higher standard, a calling!!
 Moral Imperative
 Put the people you serve above your own self interest

 Definition of a Profession:
 “The great use of a life is to spend it on something that will outlast it.”
-William James

 Desirable ProfessionalAttributes:
 Humility
 Participants needs are put first
 Honesty
 Truthfulness
 Integrity
 Responsible
 Reliable
 Accountable

 Consistency
 Persistence
 “When you learn to quit it, it becomes a habit.”
 Vince Lombardi
 Balance
 Home Life and working life
 Attention to personal health
 Physical and;
 Psychological

 Respectful
 Loyal
 Commitment to Excellence
 Developing daily
 Commitment to self-directed learning
 Reading, education, developing goals and achieving
 Compassion and sensitivity
 Appropriate hygiene and personal appearance

 Intellectual curiosity
 Look at what we need to improve
 Insight into personal strengths and weaknesses
 Maturity
 “You don’t make your character in a crisis, you exhibit it.”
-MarkTwain

 Characteristics of Effective Feedback:
 Timely
 Specific
 Suggestions for improvement and;
 Timeline for improvement
 Privacy
 Focused on the specific behavior not personality
 “Sandwiched” with praise for work well done

 Teaching Professionalism
 Lectures
 Seminars
 Role-playing exercises
 Directed reading
 Modeling of proper behavior
 One-on-one counseling

Professionalism (Milestone 1)
 View Activity 20-30 minutes

 Top 10 Examples of Unprofessional Behavior:
 Dishonesty
 Arrogance- too great a sense of entitlement
 In the work place and;
 Social situations
 Prejudice
 Disrespectfulness
 Lack of Accountability
 Fiscal Irresponsibility
 Lack of sustained commitment to self learning
 Lack of due diligence
 Carelessness or;
 Laziness
 Personal Excesses- substance abuse or gambling
 Sexual Misconduct

 Assessment of Professionalism:
 Focus on modifying undesirable behaviors, not changing an individuals personality

 Take a look at ourselves:
 Punctuality
 Consistency in attendance
 Dress
 Respectfulness in interacting with others
 Respect for diversity
 Ethnicity
 Lifestyle
 Willingness to accept personal responsibility for outcomes

 Willingness to seek help when needed
 Communication
 Family Members
 Team Members
 Participants
 Dependability
 Work Ethic
 Attitude
 Be part of the solution not part of the problem

 “Just do it!”

 Conclusions:
 Be nice!
 Be virtuous!
 Strive for excellence but accept imperfection!
 Do the right thing!

DTTM (Milestone 2)
 DevelopmentalTechnicianTraining Meeting (DTTM)
 *Direct CareTeam Members are expected to attend
 Monthly
 Positives
 Goals
 Action Items
 Conclusion (Questions or concerns)
 Time Management & Organization
 SMART Goals
 PrioritizedAction Items

Positives
 Lets take a minute and state some positives from the last month!

S.M.A.R.T. Goals
 S.M.A.R.T.Goals
 Specific
 What, where, how?
 Measurable
 From and to (when the goal is complete)
 Assignable
 Group or individual
 Realistic
 Challenging, yet achievable within the time frame
 Time-based
 When?

Goals
 PersonalGoals:
 Develop the A&R Case Management Professionalism training document by 1.13.16.
 Work-out
 I want to start my Master’s in BusinessAdministration program through NNU by January 15,
2016 and graduate by June 1, 2018.
 Team Goals:
 Please take 10 minutes and develop two goals for the upcoming month.The goals can be
work related or for personal advancement. Our next meeting will be January 13.16 which
would be a good due date for the goals.

Stephen Curry
 https://www.youtube.com/watch?v=rxsdiusm1NQ

Time Management and Organization
 Making a schedule
 Creating aTo-Do-List
 Utilize the first twenty minutes of each day to write out Action Items
 Number the list in order of most important to least important
 Re-write the list in the correct order and complete sequentially

 Four Quadrants
 Quadrant 1: Important and urgent
 Examples: production deadlines, payroll, completing data, running programs, and being two steps ahead of
our group
 Quadrant 2: Important but not urgent
 Examples: Exercise, strategic planning, goal setting, reading non-fiction literature, taking a class or three,
relationship building, prayer, date nights with significant others, a day off devoting to brainstorming, and
having the oil changed in your car.
 Quadrant 3: Not important but urgent
 Example: Checking email while writing a report.The email creates an inbox alert and you are distracted like
a moth with a light.You check the email and loose your train of thought on the important document. Other
examples include, but are not limited to…
 Quadrant 4: Not important and not urgent
 Example:Television, Facebook, andTwitter. These are activities that people fall into and almost never
intentionally set out to waste that time.

 When problems arise (unless it is a safety issue)
 1) If something arises: I would like to analyze and give some ideas for resolution and then
challengeTeam Members to come back with 3 good ways to solve the problem.
 2)Team Members will find three or more possible solutions to a problem and a suggested
course of action before bringing to the Supervisor’s attention.
 3)Team Members are sending Supervisor’s emails, texts, etc. telling what the problem or
opportunity was, what the possible solutions were, and how they already solved it.

Outlook CalendarTraining
 Teach how to log-in and view calendar.
 Adult Room team members create the calendar and HSL team members are welcome
to attend community events and activities with participants. Please encourage
participants that you are working with to attend these activities.
 For instance, If I wanted Kai to attend the bowling activity I would present the information to
Kai with two choices. Providing the two choices gives Kai a since of involvement and control.
When I present the two choices I will be very careful of what I say. If I say, “Do you want to go
bowling or not go bowling today?”There is a chance that Kai will choose not to go bowling.
However, if I state, “Kai would you like to go bowling in a half an hour or bowling in fifteen
minutes?” Kai will most likely choose one of the two options. If she does not I would redirect
her by stating, “That was not one of our choices and present the choices again.”
 Please do not make any changes to the calendar at this time.This will change in the
future but will be clearly defined by management.

Closing
 Any questions or concerns?
 CSR’s
 Please ensure to fill out a daily response and;
 If you have a client from 2:30PM-5:30PM please stop filling out data at the box that states
5:15-5:30 instead of 5:30-5:45
 In conclusion, I would like to thank you for your time, and wish you a Merry Christmas
and a Happy NewYear!

Itinerary
 Positives
 Goals
 HierarchalVerbal Intervention
 Prompt Hierarchy
 6STraining
 Conclusion

Goals
 PersonalGoals:
 Finished the professionalism training
 Make five contacts a week for bundledblessingsfertility.com for the next four weeks.
 Work out three times a week for one hour each session for the entire year of 2016.
 Team Goals:
 Please take 10 minutes and develop two goals for the upcoming month.The goals can be
work related or for personal advancement. Please ensure that the time frame is obtainable.
 Our team goal will be to have 100% accuracy on our CSR’s for two consecutive weeks by our
next meeting. If we have 100% accuracy for two consecutive weeks two pairs of movie
tickets will be raffled off to the HSL team members.

Intervention Hierarchy (Student Centered)
 Non-Verbal Intervention
 Planned Ignoring
 Signal Interference
 Proximity Interference
 Touch Interference

HierarchyVerbal Intervention
 Hints
 Name dropping
 Humor
 Question awareness of effect
 Do we understand that by hitting Charlie it would hurt him?

HierarchyVerbal Intervention
 I message…
 I like it when Chelsey completes her money program
 Direct Appeal:
 Whisper to participant and ask for him/her to complete task for you
 Positive Phrasing:
 As soon as you do X, we will doY
 Are not for:
 Centers are not for throwing items

HierarchyVerbal Intervention Continued…
 Reminder of rules
 GlassersTriplets
 What are you doing?
 What rule are we breaking?
 What should we do?
 Explicit Redirection:
 Stop ________ , instead do ________
 Close with broken record
 Example: Stop.That’s not the point (Repeat like a broken record)

Consequences (Teacher Centered)
 You have a choice:
 Stop_____ and begin______ or; _____ And then you and I will discuss privately later, you
decide
 I see you have chosen to _____ . Please do it now. Follow the broken record if
necessary. Do it now. Do it now or you will be removed by our Developmental
Specialist, (walk away and then come back with time limit). I can see you have chosen
to be removed by the DS-Must follow through

Rules forVerbal Intervention
 Whenever possible use non-verbal first
 Keep as private as possible
 Keep as brief as possible
 Speak to the situation, not the person (Ginnot, 1972) ***
 Set limits on behavior, not on feelings
 Avoid sarcasm or anything that belittles
 Fit the student, situation, and is closer to a student-control then a teacher-influence
 If the first verbal control does not work, then use a different control which is closer to the teacher-influence end of hierarchy
 When considering where to start on the hierarchy, teacher-centered works better with younger, developmentally immature children while
student-centered works better with older, more mature students
 If more than one or two, verbal interventions have been unsuccessful, move to Logical Consequences

IneffectiveVerbal Intervention
Encourage inappropriate behavior
 “I dare you to do that again”
 “aren’t you sorry for what you did?”
 “Why don’t you just admit you have a problem?”
 “grow up!”
 “You’ll never amount to anything”

Positive Comments
 Positive:
 Please walk with me
 Nice hands please
 Sand is for the ground
 Please come inside with me
 Negative:
 Don’t run
 Stop pulling on that
 Don’t throw sand
 Get back in here

Prompt Hierarchy
 Please refer to Prompt Hierarchy document
 C:UsersKyle & Shauni HolcomDesktopPrompt Hierarchy.docx

6STraining
 6S is workplace organization
 Sort Out
 Set in Order
 Shine
 Standardize
 Sustain
 Safety

6STraining
 Training IntroductionVideo -YouTube

6STraining
 Form a team
 6S team should include:
 Leader/facilitator
 Members from designated area
 Using the 6S approach
 Implementing the 6S process
 Mentoring others and encouraging 100% participation
 Create a map
 Select an area
 Take before and after pictures

6STraining
 Notify affected personnel
 An important part of initiating a 6S event is to notify the affected personnel before starting
the event.
 What is happening?
 When will it happen?
 How will it affect them?

6STraining Key Points
 Sort out
 We have sorted out the majority of items that we need and do not need. We can continue
this process by looking at the items that we use daily and the items that we rarely or never
use. If we feel like there are items that need removed we can red tag them. If the red tag
remains on the item for an additional week and does not get used we can remove that item
either temporarily or permanently
 Set in order
 We have also completed this process but could continue to look at room organization. Are
the items in an area that is ergonomic for the participant and staff. Can we improve this?
 Are items labeled?
 Easily identifiable
 Easy to find needed tools and organized

 Shine
 This has been completed.We can continue to upgrade items in the Adult Room such as new tables when
necessary, etc.
 Standardize
 We are working on labeling items appropriately.
 A couple of the following action items we could incorporate to standardization of room organization:
 Cleaning microwave should be conducted daily. One group can be responsible for this task throughout the week. It is best to
clean the microwave immediately versus waiting until food residue has dried onto the surface
 New items that enter the adult room must be approved by myself and this will require an appropriate bin and label before
being granted
 When crafts are created a picture can be saved on the tablet within a created folder and then all products of the craft must be
sent home
 When a group or individual uses an item it must be returned to the appropriately labelled area once item is no longer needed

 Sustaining
 Every 6M we will go through the entire room in order to sustain organization duringADH. Having the participants take
ownership of this room will improve our likely hood of successful 6S integration
 Regularly scheduled audits
 Teamwork
 React immediately to issues
 Safety
 The part that I have decided to add to the 5S model is safety. If there are ever any concerns in regards to safety we will
address them immediately. Such as, if a client needs a chair to reduce the likely hood of pinching fingers, etc.
 Knowing where the following items are vital to a safe environment within the adult room:
 Fires Escape route
 FirstAid
 Employee Documentation
 Community and;
 Center based documents
 Keeping up on training
 Etc.

Screen Usage Guidelines
 Please refer to document
 C:UsersKyle & Shauni HolcomDesktopAdult Program Screen Usage Guidelines.dotx

Closing
 Any questions or concerns?
 CSR’s
 Please remember that 100% accuracy will result in a movie ticket raffle!!!
 In conclusion, I would like to thank you for your time, and have a great week!

Adult Day Program

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