Everybody who comes onto the program hates testing.
They’ve gone through a phenomenal amount of testing
before they’ve seen us, and they come here and here’s
yet another set of tests. So we thought that we would
make it easier by basically doing testing a little bit here
and there over a period of a full month. And they hated
that. They wanted to get it over with. We had to throw
out the first plan . . . now, the bulk of the testing is done
in a two week period. That was participant feedback
that drove that change.
Participants are also directly involved in directing
day to day activities: Participants “set their goals, their
tasks for the week, and then they bring us those tasks,
and Monday afternoon the staff meet and actually set
up the week’s schedule based on the participants’
tasks.”
At the staff level, staff are involved in decision making
concerning programming, ranging from mission
and values to deadlines and content: “Staff . . . are always
in on the ground floor of whatever’s evolving.”
For example, “one of the areas we needed to do some
real work on was what happens around behavioral incidents.
And so I developed a policy and procedure based
on the feedback from staff.”
As a direct result of participant feedback, “Over time
we’re gradually involving family members more and
more as well.”
At the board level, members include a combination
of professionals and people in the community with
stakes in the situation, ranging from frontline vocational
counselors to a graduate of the program.
In addition to community representation on the
board, “We’re now working on a survey to go to people
who have left the program, and the next on the list will
be developing a survey for payers and community
agencies.”
Its processes and strategies reflect health promotion
theories and beliefs. For example, a holistic approach
to health is taken. “We work with not just the physical
being but . . . the emotional being, to some degree the
spiritual being. It’s the whole person we’re working
with, not just one category, one area.”
Its processes and strategies reflect health promotion
relevant evidence. Evidence on which to base decisions
and plan programming has been drawn from a wide
range of sources: published literature, unpublished
material, staff and board members’ experiences and
understanding, feedback from participants, information
from other agencies and individuals inside and outside
the field, the internet, funders, participants’ community
workers, and results from regular evaluations of all program
components. Both objective and subjective evidence
are considered; for example, assessments of participants’
progress through standardized tools and
through direct input from participants themselves. Both
quantitative and qualitative evidence are considered:
The concrete results that we’re seeing already are that
the outcome measures that we use to look at power, the
degree to which a person feels that they have control
over their lives, are showing very, very favorable
changes. That’s a very numerical result. The feedback
that we get from participants [a qualitative result] is
that it is very difficult, taking responsibility for your
own life is very difficult, and there are moments in
which they would prefer that we take responsibility for
their lives, but in the end, as they progress through the program, they really appreciate it and realize how important
that is for them.
Its processes and strategies reflect a health promotion
understanding of the environment. Brownstone talks
about the critical importance of “climate,” or, in health
promotion terms, the necessity for a supportive
environment:
I think the climate is really critical. The setting up of an
atmosphere that says to the participants, “This is your
place, and this is your program, and this is your life,
and you need to take control and make use of the opportunities
you have in being here, and through that
opportunity build more opportunities for yourself and
your whole life.” And I think that’s a critical piece of
the puzzle, here, in terms of best practices. And whenever
I have a chance, I say, and I think that the staff say,
“The door is open, you have concerns about your program,
concerns about anything that’s going on here,
you let us know.”
For the staff, the climate is a very supportive board,
knowing that that’s there, that there isn’t a fight. In a lot
of agencies, there’s this kind of pressure between
board and staff, and that isn’t there. So that’s part of the
climate as well, climate of support.
The actual physical plant is also important. So often
people with disabilities, because of funding of programs,
end up in industrial areas. It’s very important to
me that we have a very nice central location that is as
bright as possible in terms of lighting and those kinds
of things, so that the feel of the agency when you walk
through the doors is welcoming and light and open.