Meaning full life presentation

1. Building a Meaningful Adult Life
November 21, 2022

2. Goals of Presentation
To provide an overview of the term “Meaningful Day”
To provide clarity on the purpose of Community Life Engagement
To provide guidance on the Community Life Engagement as a wavier
service

3. It’s a NEW Day for Day Services
Building a Meaningful Life

4. Meaningful
/mēniNGfəl/
having meaning.
having a serious, important, or useful quality or purpose.
"making our lives rich and meaningful"
adjective

5. Meaningful
A “meaningful life” is one in which you feel engaged, connected to
purpose, and able to connect your gifts and passions with your highest
values.

6. What Makes Your Life “Meaningful”?

7. Person-Centered Planning for a Meaningful Day
For all people of working age (age 18-60), the person-centered planning (PCP) should include a focus on
exploring Employment that identifies barriers to employment as well as supports that may be needed to address
unmet needs or concerns.
The PCP should include the person’s interests in exploring employment and community engagement as well as
other goals, needs and wants to have a meaningful life.

8. Meaningful Day
The term “Meaningful Day” is used to describe the individual’s entire day including unpaid
supports and paid day and employment services in the NOW, ROW and Supports Waiver.
The Purpose of “Meaningful Day” services is to support participants of working age on
their path to employment (no matter where they are on that path), including wrap
around supports and for individuals of retirement age to take part in retirement
activities.
Each person should be supported to build a day, a week and a life that is full of meaning,
based on their individual person-centered outcomes, goals, interest and needs.
Supports should include natural, community, local and state resources in addition to waiver
services.

9. Meaningful Day
Meaningful Day services are based on the belief that all individuals with developmental disabilities
can work when given the opportunity, training, and supports that build on a person’s strengths and
individual social networks.
Employment should be viewed as the first service choice considered for ALL people of working age,
but not the only choice, as other services may wrap around to support the person as needed.
Activities should be focused on keeping, learning or improving skills and functioning for daily living.
However, what activities a person chooses is going to be based on their outcomes, goals,
experiences and barriers.
All Meaningful Day services should be designed to support the facilitation of community
membership and the highest level of independence appropriate.

10. Building a Meaningful Day
For each person, think about the community and employment resources you currently have, need, or want to
explore and develop in each of the five areas below.
Be creative!
Everyone’s needs, wants and interests will be different!
1. Personal Strengths and Assets
2. Community Resources
3. Technology
4. Relationships
5. Eligibility Supports
When building a meaningful day for each person:

11. Personal Strengths and Assets
 Work Experience
 Volunteer Experiences
 Knows about different jobs
 Responsibilities at home
 Responsibilities at school
 Vision or dream for a job
 Communicates ideas, needs, thoughts
 Good Social and everyday skills
Examples:

12. Community Resources
 Schools
 Public Transportation
 Local Businesses
 Churches
 Public Safety
 Libraries
 Parks and Recreation
 Civic Engagement
Examples:

13. Technology
 Cell Phones
 Tablets
 Smartphone Apps
 Alarm Clocks
 Electronic Reminders
 Calculator
 Computer/laptop
 Online classes or training
 Internet job search or community mapping
 Remote Supports
 Adaptive Equipment
 Social Media
Examples:

14. Relationships
 Family
 Friends
 Roommates
 Neighbors
 Coworkers
 Community members
 Church Members
 Acquaintances
Examples:

15. Eligibility Supports
 Local disability services and programs
 Special Education program
 Section 8 Housing
 Food Stamps
 Medicaid State plan services
 Louisiana Rehabilitation Services (LRS)
 Waiver Services
Examples:

16. Employment and Community
When you work with each person to establish their goals, wants and
needs and then you gather all of the resources from each of these five
areas to fill in the missing pieces, you have helped this person create a
meaningful day!
The goals, wants and needs may fluctuate, but when you establish the
connections for a meaningful day you have opened up endless
possibilities for helping this person live their best life!

17. Community Life Engagement

18. Community Life Engagement
Community Life Engagement refers to supporting people with IDD to access and
participate in their communities outside of employment as part of a meaningful
day.
Also referred to as “community-based non-work”, wraparound supports, holistic
supports, or community integration services.
Definition:

19. Community Life Engagement
CLE activities may include:
 volunteer work
 postsecondary, adult, or continuing education
 accessing community facilities such as a local library, gym, or recreation center
 participation in retirement or senior activities at the senior centers and
 anything else people with and without disabilities do in their off-work time outside their home

20. Community Life Engagement
CLE may also include activities that could lead to employment:
career exploration for those not yet working or between jobs,
supplement employment hours for those who are working part- time, or serve as a
retirement option for older adults with IDD

21. Why Is Community Life Engagement Important
Center for Medicare and Medicaid Services (CMS) In January 2014, CMS also released new rules
that defined, described, and aligned home and community-based setting requirements. The new
rules specify that states must maximize the opportunities for individuals to access community living
in the most integrated setting. To meet this standard, states are turning to both supported
employment and Community Life Engagement supports.
Department of Justice (DOJ) DOJ has clearly stated that in order to be in compliance with the ADA
and the Supreme Court decision in Olmstead v. LC, states must provide day and employment
supports in integrated settings (U.S. Department of Justice, 2014; United States v. State of Rhode
Island, 2014), placing pressure on all states to move individuals from segregated settings to more
community-based models of support.
Recent federal guidance has further illustrated the need to define and provide high-quality Community Life
Engagement supports.

22. Why Is Community Life Engagement Important
States and providers report growing numbers of individuals with IDD in non-work services (CLE). The National
Survey on Day and Employment Services, conducted annually by ICI under the Access to Integrated Employment
project, categorizes day and employment supports into four quadrants based on whether they are work or non-
work and community- or facility-based.
Community-based non-work (CBNW) services, those services in the non-work and
community-based quadrant, have seen considerable growth. CBNW services have the potential to support
Community Life Engagement when used effectively, yet there has been limited regulation or study of CBNW to
date and so it’s ever evolving.
CBNW generally involved a wide range of activities supported, populations served, and goals. There is
inconsistent use of specific guidelines such as staffing ratios, group sizes, or proportion of time spent in
community settings. The desire to provide individualized supports was counterbalanced by structural and
budgetary constraints, resulting in varied levels of individualization, choice of activities, and hours of support
offered.
The relationship between CBNW and work was also inconsistent, with some individuals receiving both work and
CBNW supports, but more often CBNW serving as a substitute for employment
ICI Information

23. Community Life Engagement and Employment
We don’t want the focus strictly on Community Life Engagement where it will detract from the employment
focus.
Community Life Engagement supports should be used to promote and/or wrap around
employment, which should be the primary expectation for individuals who are working or wanting
to work, or who are unsure of how they feel about work.
CLE activities should promote community inclusion and integration.
For example, volunteer work should be an activity that is meaningful to each individual and occurs alongside
community members without disabilities in whatever capacity the individual chooses.

24. ICI Guideposts for CLE
 Guidepost 1: Individualized supports for each person
 Guidepost 2: Promote community membership and contribution
 Guidepost 3: Use human and social capital to decrease dependence on paid supports
 Guidepost 4: Ensure that supports are outcome-oriented and regularly monitored

25. Guidepost 1: Individualized supports for each person
 Show understanding of personal preferences, goals and skills. Regardless of the process used to uncover
interests and passions, the goal should always be the same: to identify and pursue activities that appeal to the
individual and/or support their longer-term goals. As interests are pursued, consider each person’s unique
support needs to ensure success. In contrast to this individualized approach we have always practiced group
models which typically has emphasized general ideas about what others feel/believe everyone with disabilities
should be doing.
 Emphasize person-centered planning and discovery. Staff must take the time to get to know the individual
through some form of person-centered planning or discovery, whether formal or informal. This will allow for
time to uncover the most accurate and detailed information about each person. Community Life Engagement
supports can provide an excellent opportunity to determine interests and skills for employment and for
networking toward finding jobs.
 Consider creative grouping, staffing, and scheduling. Providers should use strategies including creative and
purposeful grouping of individuals such as those with similar interests or friends in the same community
 Pay careful attention to scheduling, logistics, and staff communication; redefining staff roles to include community
facilitation and to encourage natural supports; and accessing, braiding, or blending funding resources.
Community Life Engagement supports should be tailored to the interests and needs of each unique person. In
order to be individualized, supports must:

26. Guidepost 2: Promote community membership and contribution
 Start with inclusive settings and activities. The starting point for promoting community membership is that individuals are
being supported “out in the community in activities that provide opportunities for interaction with community members.”
High-quality implementation means supporting people in an inclusive environment…in our community where adults would
be…learning meaningful skills in the community, in inclusive and integrated settings with people without disabilities.”
Accessing inclusive opportunities often involves providers partnering with other local, non-disability-specific organizations to
identify community resources and to generate new community-based options. The value of fully inclusive settings, is not
only for the individual with a disability, but also for the larger community.
 Ensure staff presence does not limit connections with other community members. Another factor in increasing community
connections is ensuring staff presence does not interfere with developing relationships with community members. Train staff
to get out of the way of the individual and allow them to make the connections. Train staff on the new expectations and new
settings.
 Place value on not just presence, but membership in the community. This includes being known by people in one’s
community, forming relationships, and making a contribution to the community through work or volunteer activities.
Providers want to identify places and activities where people can go beyond presence to participation to contribution.
Providers/staff can help people make community connections by tapping into the social networks of individuals, their
families, and support staff.
 Consider an individual's preferences. Community connections should not be pursued unilaterally for all people. Some
individuals may prefer a less connected life, and that should be an option as long as it is an informed choice. An expert noted
that people may already have community connections through other aspects of their life, such as their job.
In order to promote community membership and contribution, supports must:

27. Guidepost 3: Use human and social capital to decrease
dependence on paid supports
 Use social capital to create natural supports.
 As individuals make more connections in their communities, the social capital they are building can be used as natural supports. Tapping into this social capital then
leads to a level of interdependence with others in the community and not just on paid supports.
 For example, by participating in the same yoga class every week, an individual will get to know other class participants as well as some of the gym staff. This
level of familiarity can reach the point where staff support is less necessary and the individual can simply be dropped off for the class, knowing that the
environment is safe, secure, and everybody within those activities knows the individual.
 The goal is not necessarily about the person becoming more independent but just as much about creating an intentional community around somebody.
 Relying on natural supports can enable participation in activities without a paid support person and when supports are not available. It also frees up staff
resources to support those who need support and do not have natural support. It also allows the stretching of service dollars and allowing more individuals to
receive supports.
 Teach skills to build human capital.
 Human capital refers to the specific skills an individual brings to his or her job and/or community. Community Life Engagement activities can be used to build
individuals’ human capital by teaching specific skills for community access and employment. This initial investment in skill-building enables more fading of supports
over time. This can also include peer-to-peer strategies, for example, having a person with more mastery of a particular skill, such as riding the bus, teach someone
who is still working on that skill.
 Using Community Life Engagement supports to build employment skills, both hard and soft, is working on communication, initiative, and problem solving. The skills
gained can range from soft skills such as appropriate hygiene and behavior, to hard skills such as office or culinary work, to related skills such as accessing public
transportation to get to work.
Individuals should be actively engaged in the community with the minimal supports that are commensurate with their needs. In order to
achieve this, Community Life Engagement supports must:

28. Guidepost 4: Ensure that supports are outcome-
oriented and regularly monitored
 Emphasize goals rather than processes.
 The focus should be on outcomes such as satisfaction, individualization, and connectedness to community, rather than on process
measures such as times and locations of activities.
 Measures should include the extent to which such activities are focused on what the person wants to focus on, not just what happens
because they go to this particular program or that particular program.
 Lead to or complement employment
 Individual goals, which each person’s Community Life Engagement supports are based on, should include age-appropriate roles in the
community, with an emphasis on employment. In general, these supports should move individuals in the direction of integrated
employment for those that are of working age.
 For those who are younger, goals may involve postsecondary education or specific job training.
 For older people, the goal may be a healthy and sociable retirement.
 Regardless of age, the basic expectation is that people with IDD have the same kinds of roles as their same-age peers without disabilities.
 Community Life Engagement can also supplement employment supports to create more of a full life, filling in any gaps in time,
engagement, or interests, particularly for the many people with IDD who work limited hours.
 For example, someone may be working two days a week in a quiet office setting and using Community Life Engagement supports on the
other three days to make more social connections or to be more physically active.
In order to achieve outcomes such as life satisfaction, community membership and contribution, and increase in natural supports, Community
Life Engagement supports must be oriented toward, and monitored in relation to, those outcomes. Here are some examples of how to do so:

29. Waiver Services
Utilizing waiver services to help build a meaningful day

30. Community Life Engagement Service
NOW, ROW and Supports Waiver:
T2021 UQ – Community Life Engagement (1:2-4 ratio)
• T2021 UQ: Used when the provider is serving the individual in the ‘community’ in
a 1:2-4 ratio
Day Habilitation Classification

31. Community Life Engagement Service Rates
NOW: $3.41/15 minute increment
ROW: $3.88/15 minute increment
Supports Waiver: $3.56/15 minute increment
T2021-UQ

32. Community Career Planning
NOW, ROW, and Supports Waiver
 T2025 UQ
Completed in a 1:2-4 ratio
Used when the provider is providing job readiness, discovery and job
preparation services for individual employment in the community
Prevocational Classification

33. Community Career Planning Service Rates
NOW: $3.88/15 minute increment
ROW: $3.88/15 minute increment
Supports Waiver: $3.06/15 minute increment
T2025 UQ

34. Individual Supported Employment
 A new service array has been developed and will be added to the all 3 adult waivers in the coming year:
 Job Assessments- (3)
 Job Development/Placement
 Job Support/Stabilization
 Extended On the Job Supports
 Ongoing Job Follow Along (4x month)
Future services:

35. Onsite Day Habilitation
NOW, ROW and Supports Waiver
T2021- Day Habilitation (1:5-8 ratio)
Used when the provider is providing services ‘onsite’ in day habilitation.
Day Habilitation Classification

36. Onsite Prevocational Services
NOW:
 T2019- 1:8 ratio/ 15 minute increment
ROW:
 T2025-1:8 ratio/ 15 minute increment
Supports Waiver
 T2025-1:8 ratio/15 minute increment
 Used when the provider is providing services ‘onsite’ in career planning
(updated prevoc service).
Prevocational Classification

37. Group Employment
 Must make minimum wage
 Must work in a job that is integrated into the community and working alongside people without disabilities
 Must be doing job tasks that are similar to those employees who do not have disabilities
 Must have quarterly documented quarterly discussions around individual employment options
 Anyone who becomes employed in group employment setting after 3/17/2023 must have the expectation of
going to work in an individual job

38. Wrap Up and Questions

39. Questions
Email any questions to ocdd-hcbs@la.gov

40. Resources
 Volunteering
https://employmentfirstma.org/files/DDSVolunteer-Unpaid_Work-Feb17.pdf
https://www.disabilityscoop.com/2021/06/25/zoo-program-teens-disabilities/29393/
 Introduction to Community Life Engagement
file://dhh-isb-fs01/User%20Folders/rmorales/Downloads/ici_community-life-engagement_feb2015.pdf
file://dhh-isb-fs01/User%20Folders/rmorales/Downloads/community-life-engagment-guideposts.pdf
https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost4_brief7_F.pdf
https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost3_brief%206_F.pdf
https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost2_brief4_F.pdf
https://www.thinkwork.org/sites/thinkwork.org/files/files/CLE_guidepost1_brief4_F.pdf
https://www.thinkwork.org/sites/default/files/files/CLE_issue9_F2.pdf
https://scholarworks.umb.edu/cgi/viewcontent.cgi?article=1035&context=thinkwork

41. “
”
Progress is IMPOSSIBLE without
CHANGE!
Rosemary Morales
Rosemary.morales@la.gov