KACL Client Definition Policy Analysis Paper
November 23 2007
If a man owns a hundred sheep, and one of them wanders away, will he not leave the ninety-nine on the hills and go look for the one of them that wandered off? And if he finds it, I tell you the truth, he is happier about that one sheep than about the ninety-nine that did not wander off. In the same way your Father in heaven is not willing that any of these little ones should be lost.
Unfortunately while the sheppard is off looking for the lost one, the other ninety-nine are left at risk. Given the limited resources at the disposal of teh Kenora Association for Community Living, the Association must select not only who, among those who are eligible for services that it will serve, and what supports it will provide. Unfortuantely it can no longer support all.
A mission statement is a broadly defined but enduring statement of purpose that distinguishes an organization from others of its type and identifies the scope of its operations in terms of clients and services. It should embody its members' philosophy, reveal the image it wishes the association to seek reflects the association's self-concept and indicates its primary client's needs that the association will attempt to satisfy.
The mission statement of KACL reads as follows:
The goal of KACL is to ensure that all persons with special needs have the opportunity to live a meaningful and satisfying lifestyle and interact as an equal in their community by providing continuing opportunities for personal growth through education, training, support, advocacy and an informed public.
An organization must be careful to guard its integrity. It does so by clearly defining its mission. Its mission determines among other things who it intends to serve and what supports and services it intends to provide. Where it secures government funding, it must stay within the government definition of funded supports.
Beyond basic income support, government have generally provided social benefits to groups rather than individuals. Government funding, in part, determines how much service it can provide to each subcategory of clients it chooses to serve. To get services from KACL, ann adult must belong to a group bearing a label: "Developmental Handicap" (DH) (Developmental Services Act) or "Serious Mentally Ill" (ultimately back to Mental Health Act). The term "persons with special needs" is not legal terminology but rather Association terminology. At the same meeting that recognized an extension of its client base to include ABI and FASD within the category "Developmental Handicap", the Board recognized that certain consumers with one general accepted community definition may not all fit one government funding category or alternatively may be eligible for two or more funding sources. Thus persons with ABI may be recognized as DH if the mental impairment occurred in the formative years but not if it appeared post 22 birthdays. Similarly some persons with "dual diagnosis" may be eligible for both MCFCS and MOH funding.
An association, which has a mandate to serve both groups, must optimize available resources over its entire population of consumers. Resources may not be available to serve all the needs that such individual might possess.
As well, at the same time as it extended its client base, the association revised its notions towards waiting lists. While the Association is still committed to equality in the distribution of resources as far as possible, it also recognized that within its existing allocation of resources, not everyone would be able to be served. Equity in the distribution of resources does not mean equal amounts of service to all consumers. The amount of supports required varies from individual to individual. Further, government methods of distributing resources to the Association come with conditions.
Government funded programs come with very vague guidelines as to who is a client of the program and dictates which consumers may be served with government dollars. As well, broad policy guidelines such as, Making Services Work for People, also provides broad guidance as to priority for services when there isn't enough dollars to serve all. This does not prohibit the Association from taking on additional client groups but the availability of funding will be depended on other government programs or funding that the Association may be able to generate.
In the past, government have dictated that,
Thus Government itself discourages government supports in the first instance. It does not expect to pay 100% of the services an individual requires.
Further because of the ever increasing complications imposed on the Ministry by the Governments required complicated "social system" the Association has had to begin to clarify the level to which a client has been accepted as client, and the level of supports that it is prepared to provide.
The definition of the client group is "Child at Risk etc" and is not restricted to only children with the medical designation "mental retardation". It was defined for Infant Development by MCSS in its 1987 guidelines. In this document three categories of risk are described: 1) established risk - related to diagnosed medical disorders; 2) biological risk- related to biological insult(s) to the central nervous system and; 3) psychosocial risk - related to individual characteristics or life experiences. An infant's development may be in jeopardy due to a single or multiple risk and is not restricted to only children with the medical designation "mental retardation". In 2002 the age of the client was increased to the end of 5th year.
The definition of the client group for the Community Integration Program is more restrictive than the Infant Development Program. To be a legitimate client of the Community Integration program the child must notionally bear the designation "Developmental Handicap". Children who lack this designation notionally should be referred to the organization who receives funding for providing supports to such individuals, (Generally a Child Developmental Centre). Other the past 10 years, this program has become more careful to clarify this requirement.
Kid's Zone is licensed for 20 children in the "Junior Room" (18 months to 3 years, maximum of 20% can be under two years of age). With one Resource Teacher position in this room, KACL is permitted up to 4 special need children in attendance at any given time. The Senior Room during the school year has up to 25, 4 to 6 year olds and one Resource Teacher permits 4 special needs children at a time. In the summer the Senior Room has 30, 4 to 9 year olds.
The Toddler program is licensed for 10 children, 18 months to 2.5 yers with 20% being permitted undert 18 months.
Both Kidszone Lakeside and TA Annex have an after school program for school age children up to 12 years.
The term "developmental handicap" is used in the Ontario Developmental Services Act. It is defined as "a condition of mental impairment present or occurring during a person's formative years that is associated with limitations in adaptive behaviour". According to Ivan Brown (in Brown and Percy, 1999),
"The purpose of such definitions in has typically been to provide general descriptions of a population that is viewed as requiring special services, rather than to define the term by which that population is called. As a consequence, it is rare for the contents of definitions to form specific criteria for the services that are being offered. This has allowed a somewhat flexible state of affairs within which both the social meaning of developmental disabilities and the services that are offered to people considered to have developmental disabilities can evolve" Page 19
Not surprisingly as the pace of integration quickens, people with disabilities seldom refer to themselves by terminology at all. Presumably this is because they see themselves as human beings living in the community with other human beings.
Developmental handicap is a legal term but generally it has been assumed to be roughly synonymous with the medical term "mental retardation" (MR). The definition generally accepted is reasonably clear with three criterion (1) sub-average general intelligence (Criterion A) that is (2) accompanied by significant limitation in adaptive functioning (Criterion B) with the onset occurring before age 18 (Criterion C).
Criterion A
The essential feature of Mental retardation is significant sub average general intellectual functioning (Approximately 2 standard deviations below mean in intelligence quotient IQ, e.g. below 70 + 5 on Wechsler Intelligence Scale (Also see memorandum in Appendix B). The problem is one of determining who is sub-average intelligence with Kenora Professional Resources. In the past KACL took those who succeeded in getting into Kinvalley. Doctors have the power to deem someone "mentally retarded" although there is a great deal of scepticism of the value of a designation given because of a view expressed by certain doctors that they will give what ever designation is necessary to get services for an individual who requires services. This, in the eyes of some doctors, includes individuals who have learning disabilities, Fetal Alcohol Syndrome Disorder (with general diminished impulse control), Acquired Brain Injuries, ADHD and trauma etc.
Psychologists use Intelligence Quotient tests in part to make determinations along with other tests but they too appear at times to be highly questionable due to cultural or language biased tests.
Criterion B
"That is accompanied by significant limitations in adaptive functioning in at least two of the following skills area: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety
Criteria C
The onset of the condition must occur during the formative years. Obviously this is not a problem when the diagnosis is made during such years. However, we are often asked to take individuals who have not been diagnosed.
Staff can apply a strict or a flexible standard. Where services are provided on a supply available basis rather than demand, the more persons that are included in government funded programs, the less average funding level available for everyone else. Government by implication indicate that everyone who may be qualified to receive services may not be able to receive services. There must be a prioritization of services. At the moment the government is not coming up with sufficient funding to cover all groups for all the support services required. Therefore, the Association is pushed to a choice to fund raise or a stricter interpretation of client definition or the nature of the services that it provides.
In the 1980s, when the Association reviewed whom it wished to serve it defined its client base as "people with special needs". At the time 1987-88 it served children (in a Nursery and Infant Development Program), persons with mental illness funded under the Homes for Special Care, Ministry of Health and Long-term Care and persons who loosely fit the then current medical definition of "mental retardation". At the margins, there were additional individuals that would not fit within any of these categories but were accepted because of difficulties caused by deafness, alcohol (maybe Fetal Alcohol Syndrom/Fetal Alcohol Effect), cerebral palsy and impoverished cultural backgrounds. The exact grounds upon which they were included are somewhat obscure but all such individuals were included in Ontario Special Olympics. At the time it was recognized that many such persons were improperly included as clients of the Association. The principle issue concerned the issue of stigmatizing that such consumers got when they were improperly included in programs designed for persons with mental retardation (a medical designation). There were also concerns that funding designated for certain groups might be diluted by serving individuals not properly located within the designated class.
In the 1984 to 1990 time frame individuals, who did not have mental impairments were discharged and post 1987-1988, no new individuals without mental impairments were admitted to adult programs. Individuals with mental impairments, who were not generally recognized as falling within the medical designation of Mental Retardation or Serious Mental Illness, did participate in an ODSP Employment program for which the Ministry of Community and Social Services paid a contracted rate above and beyond the funded programs for persons with mental retardation.
Post 1987-88 until 2003, the Association did not accept as consumers, individuals with Acquired Brain Injuries (ABI) unless accompanied with a generalized cognitive (mental) impairment. However, in addition the Association appears to have made a distinction between individuals who acquired the generalized cognitive impairment as a result of physical trauma (e.g. motorized vehicle accident) and others who acquired the cognitive impairment through other means (e.g. prolonged oxygen deprivation at birth or subsequent sustained seizure)? This interpretation was dropped October 1 2003.
Post 1987-1988 until 2003 the Association did not accept as adult consumers with Fetal Alcohol Syndrome Disorder (FASD) unless accompanied with a generalized cognitive (mental) impairment. Certain individuals have been taken into service with doubts as to the existence of a cognitive impairment due to the absence of assessments and cultural background. Such individuals have been assisted to find accommodations and taught basic survival skills in the Kenora Area. They have also been offered ODSP employment supports if funded by the Ministry. Most such individuals tend to move on to either Thunder Bay or Winnipeg. Such supports are transitional and not expected to exist beyond an initial transitional period.
Commencing in early 2002 a policy review of client definition was begun which led to a revised policy late September/October2002. The Association's policy was revised to accept both Persons with ABI and FASD as consumers for appropriate support services - where resources permitted - where mental impairment was present or occurring prior to the consumer's 22nd birthday. However in the next 5 years funding continued to lag services demanded and further restrictions became neccessary.
Appendix B sets out the current crieria for access centers in determining eligibility for services.
The Association must always assess the work that it does and determine whether it is providing a necessary and beneficial service or whether it is merely replacing a natural social network or being an obstacle to natural growth and development in the community.
The following issues must be considered:
Issues of equity must be balanced with past dependencies created. Individuals must be weened gently from such dependencies where possible and in the interest of both consumer and society.
This may not always be able to be predetermined. However, if no differences are being made in the individual's lives and a determination is made that further deterioration of the situation is not being prevented, then respect for those who alternatively could be receiving supports demands that resources be moved on.
There will never be "Enough" Resources and hence there must be allocation of service dollars. Again, this does not decide the issue of who is entitled to receive services - merely how much they receive. However, when the level is reduced beyond a certain point, it is fair to say the distinction between the two is insignificant. Individuals who can function quite independently on their own and merely wish to receive a designated label for purposes of receiving the higher ODSP amount will receive very minimal services when funds are most scarce.
Where generic services are available and can be accessed unobstructed and economically from KACL's point of view they should be preferred over the use of specialized funding and supports. This is merely an acceptance of the existing Governments policy directions. This includes using generic medical services, Community Care Access etc. It does not mean necessarily that the individuals should be forced into generic nursing homes or other more intrusive service options.
KACL is not formally qualified to challenge formally qualified assessments. This does not mean that all assessments are of equal value or quality. Verbal assessments or one or two sentence assessments from Doctors may be totally valueless. In the face of such assessments KACL staff must determine how much if any services they can provide in the face of competing demands.
The Provincial government desires to steer individuals away from a very expensive Criminal Justice System without compensating other systems that are being asked to step into the gap. Individuals who have low impulse control, who are loud and appear aggressive require supports to gain greater social acceptability, skills and self-management planning functions. However vulnerable consumers must be served in such a fashion that they do not become more vulnerable because of other consumers receiving services. Further, social support organizations should not be asked to place a general social control function over the interest or desires of competent and autonomous individuals. We are not and should not allow ourselves to become jailers. Some individuals will consent to service merely to avoid jail or jail like services. The conditions upon which an individual are accepted should be clearly set out up front and the consumer agree to such conditions.
Equally important the safety and concern of other consumers must be respected and such concerns to a certain extent influence options of services that can be provided. Aggressive individuals by nature cannot co-locate or reside with physical frail individuals. Where resources are limited the most vulnerable must be protected and the public at large fend for them selves where their governments are not willing to meet the necessary demands for services.
The Association receives funding for supports for Persons with serious mentally ill.
Serious mental Illness; The three categories to identify these individuals are: disability, anticipated duration and/or current duration, and diagnosis.
Disability: Refers to the fact that some individuals lack the ability to perform basic living skills such as eating, bathing, or dressing; maintaining a household, managing money, getting around the community and appropriate use of medication; and functioning in social, family and vocational-educational contexts.
Anticipated Duration/Current Duration: Evidence may indicate that the client's problem may be ongoing in nature. This does not mean that the problems are continuous. There may be intermittent periods of full recovery.
Diagnoses: For example, schizophrenia, mood disorder, organic brain syndrome, and paranoid and other psychoses. Other diagnosable disorders such as severe personality disorder, concurrent disorder and dual diagnosis are also included.
All individuals who have a mental illness may not qualify for "intensive case management".
In 2003 as a result of continuing request for services for persons with Acquired Brain Injury the Association reconsidered its position with respect to serving such individuals. A survey of families and individuals provided additional information. In general families wanted KACL'S involvement in the provision of support services. Reasons given were as follows:
The stigmatization issue has been a concern to both families and consumers alike. Individuals do not wish to be labelled "mentally retarded". Families do not wish the "double stigma".
KACL wishes to support individuals with the resources it can secure from any Ministry but it must do so in a way that minimizes labels and stigmatization. Its ability to secure funding from the Ministry of Health to service individuals who are not able to benefit from funding under the DH label under the Developmental Services Act is very uncertain.
At the moment KACL adult programs do not accept consumers who are Attention Deficit Hyperactivity Disorder, Learning Disabilities, and Physical Handicapped unless concurrent with a DH assessment. KACL senior staff is constantly requested to do so.
There are severe difficulties at times determining whether an individual at the margins should be included or excluded
Funding for services varies with disability. Until recent years the Ministry of Community and Social Services recognized our primary catchment areas as those portions of Kenora District, roughly East to but not including Vermillion Bay: South roughly to but not including Nester Falls (Dividing line informally determined by school board districts; North Treaty Three Territory, West: Manitoba Border. KACL traditionally took on consumers from the North where such services were not available but since around 1991 Red Lake commenced to provide services and Sioux Lookout Claims territory North of Sioux Lookout.
Sometimme in 2007 or shortly before the position of the Minsitry of Community and Social Services appears to have changed and clients are regarded as coming not from a local catchment area. Clients cease to belong to the Agency serving that catchment area to being clients of the entite system.
Prior to December 1 2007 the Associations position seemed to be as follows:Individuals residing outside the Geographical area served by KACL or their families on their behalf may request that services be provided to such individuals in Kenora.
The following factors can and should be considered in determining the Association’s capacity to support outsiders:
The Association has a strong bias in favour of supporting the individual in his home community where the individual is connected with friends and family. Where an individual relocates to Kenora an effort should be made to secure funding from government or the agency which previously provide services.
Prior to December 1, 2007, the issue seemed to be whether KACL would serve individuals from outside our catchment area if they moved to Kenora. The KACL Board did not want KACL to be serving clients living outside our catchment area where the client intended to remain outside our catchment area. In 2007 ISN's staff indicated that if KACL was not prepared to accept certain clients in Kenora then they would get other Association who were willing to supervise clients in the Kenora area.
Kacl has identifed approximately 5 situations where this might be the case:
Case 1 KACL differs with other Associations as to the desirability of a consumer living in Kenora because the client does not wish to live in Kenora but an agency does (Tikinogan, ISN, etc).
Case 2 KACL differ with another Association as to the desirability of a consumer living in Kenora because he/she preys upon KACL's other clients and KACL and the Justice System has not been successful in deterring such conduct
Case 3 KACL differs with other Associations as to which Ministry should be providing the bulk of the funding for supporting a consumer or the level of funding necessary to support a consumer. This is particularly true of individuals in difficulty with the law and community and where the main issue of supports is mental Health rather than developmental supports. Here by permitting the individual to draw dollars from the limited DH pool, rather than the Minsity of Health or other Ministries dollars, dollars are being drawn away from other consumers who are more legitimately entitled to DH dollars
Case 4 KACL differs with other Associations as to the amount of dollars necessary to support an individual. This is particularly true of individuals in the mild "mental retardation" range and FASD, where other Associations often misjudge the heavy expense involved in dealing with crisis which seem to be ever ongoing.
Case 5 KACL will not support the higher lifesharing rate for consumers who are living with other foster children. By requesting other Association's to be involved foster families hope to get a larger rate.
While KACL may agree with an implicit ISN position that competition is not necessarily a bad thing, KACL does invision the following problems:
1. Assuming that outside agencies are prepared to support clients for lesser fund than KACL believes to be adequate, attempts may be made to employ KACL resources to make up the shortfall. How does KACL get reimbursed for such support services if indeed it is required to make such supports available.
2. Where consumers participate across more than one program there exists certain economies of scale. Information gained in one program is utilized in another KACL program. Co-ordination problems are reduced. Will KACL make some of its programs available to clients of another Association and at what costs?
3. The Kenora public will be confused when KACL refer problems to an external agency
4. Other Associations have different pay scales and benefit packages and Associations will be come competitors for new and existing employees.
As a result of such problems, it is anticipated that there will be increased conflict between Associations.
.The goal of KACL is to ensure that all persons with special needs have the opportunity to live a meaningful and satisfying lifestyle and interact as an equal in their community by providing continuing opportunities for personal growth through education, training, support, advocacy and an informed public.
This document has been reviewed, revised and approved by the Ministry of Community and Social Services as common expectations and standards for all four access agencies in the northern Region to guide their work. Northern Region access agencies and Ministry funded develomental service (DS) agencies will follow these Standards for all new consumers. In implementing these standards, it is understood that they are subject to further revisions that may occur as a result of the development of a long-term plan to transform the developmental services system.
1. Eligibility Criteria
To be eligible for adult developmental services, a person must be at least 18 years of age and must satisfy either Number 1 or Number 2 of the following diagnostic criteria:
1. A formal written diagnosis of Mental Reatrdation (mild, moderate or severe) and may include Pervasive Developmental Disorder, by either a Medical Doctor, or a Registered Psychologist or an Associate under their review and/or registered with the College of Psychologists, must be received.
The reference in the Diagnostic Statistical Manual IV, American Psychiatric Association, for the former is 317, or 318 or 319 and for the latter is 299. If the diagnosis of Pervasive Developmental Disorder is Non-Specific (NOS) documentation in regards to the impact of the condition in relation to adaptive functioning should be included.
2. ALL OF THE FOLLOWING A, B AND C, MUST BE SATISFIED:
a) IQ score equal to or greater than 70 (second percentile), A well documented broad, non-psychiatric, qualitiative distortion of thought or thinking process.
AND
b) Relevant assessments obtained:
Examples:
Vineland Composite score equal to or greater than 70
AAMR Adaptive Behaviour Scale (ABS) score equal to or greater than 70
Professionally documented that the individual's functioning is severely affected in two or more areas of adaptive functioning as per AAMR list
(second percentile or lower)
AND
c) Age of onset: 18 years of age or less
Note: The central access agency will determine the need for additional assessments and/or documentation to establish eligibility where it is unclear or ambivalent. It is the responsibility of the referral agent, in collaboration with the access agency or community service partner, to provide such assessments to the adult DS access agency to determine eligibility for services.
2. Referral and Access to Services
Access to services will follow the established referral and intake processes including determination of eligibility, completion of common intake requirements, needs and community need-meeting supports/services and priortization. The access agencies accept referrals from any source with client consent. The method of obtaining consent will be determined by each access agency. Fair and consistent tools will be developed for case resolution service decisions, expected outcomes, and priorities for additional service system resourcing.
3. Assessment of Needs
At intake, families and individuals requiring services shall participate in a minimum number of applications and assessments and shall provide necessary information only once according to a common process which includes but may not be limited to:
-a face to face interview with the client
-conducting home visits
-reviewing the current situation
-interviewing other support services and the people involved in that person's life
-gathering and reviewing supporting documentaion and assessments
-discussing the request for service with stake holders and potential providers with family and consumer involvement -determining the individual planning process
4. One Waiting List per District
There is one community waiting list for the adult developmental service system in each of the four districts in the Northern Region. These districts are5. Transitional Aged Youth (Crown Wards)
The Northern Adult DS Access agencies will maintain a common Transitional Aged Youth(TAY) planning protocol with each local Child Welfare Agency for youth that are deemend to require adult Developmental Services (and other community supports) at age 18 years.
The adult DS access agencies will collaborate with each CAS to gather, update and share a Crown Ward (TAY) summary (chart) for all TAY (crown wards) in their districts who are 15 years of age or older who are deemed to require DS services as adults. This update will be completed by March 31st of each year.
All eligible referrals will include, as part of the planning process, the involvement of natural/family, all mainstream community suports and services that are appropriate and available to all citizens prior to accessing adult developmental services in the service system.
Adult DS Access Agencies will provide information and/or refer those who do not meet the eligibility criteria to more appropriate services in the community including community crisis supports, as necessary.
Social Supports enable individuals to participate in community in non-work related activities, to promote community involvement, to provide opportunities for social interaction and enjoy positive relationships.
Independent Living Supports enable individuals to live independently and to participate actively as full members of the community. They focus on skill and capacity development, including capacity-building related to self-management of personal care, using transportation independently, developing key social skills and pursuing work-related activities.
Accommodation Supports provide effective care and supervision to vulnerable adults in a safe and healthy environment, with an emphasis on community inclusion.
The type of support will vary based on the individual’s level of need and wants as identified in the Individual Support Plan.
Family/caregiver Supports enable families and caregivers to continue to care for their individuals at home.
These supports will enhance family/caregiver skill and capacity, improve quality of life for the individual and the family, and help to prevent crises from developing.
Asset and Income Supports could be generated through a family trust fund, individual earnings, or public funds, such as the Ontario Disability Support Program.
Planning for an individual’s needs will include a consideration of asset and income supports to ensure the individual has an adequate personal income for care and security.
Planners need to ensure that the individual and family are aware of available asset and income supports, and how to access them.
Specialized Supports are available across a spectrum. They include:
clinical services (assessment and counseling, speech and language services, behavioural management interventions and clinical consultations)
Communication to all new potential clients must specify that intial services of assessing the needs for services, and the
dreams, desires and aspiraions of the potential clients and planning for supports is limited in scope and time and
should not be taken as acceptance of KACL for any responsibility to deliver further supports and services. Responsibility of the consumer and other family members must be clearly specified. A memorandum of Understanding of the responsibilites assume by KACL and the family must be documented in writing.
medical services
special necessities (e.g. payment for special diets so individuals can live independently).
Appendix D Interim Requirements for all new Clients of KACL
Sample Memorandum of Understanding
1. The purpose of this memorandum is to clarify the supports and services which will be provided by the Kenora Association for Community Living.
2. The Kenora Association for Community Living (KACL) is an incorporated association of members who have as
their mission statement,
the goal of KACL is to ensure that all people with special needs have the opportunity to live a meaningful and satisfying
lifestyle and interact as equals in their community by providing continuing opportunities for personal growth through
education, training, support, advocacy and an informed public,
and a set of Service Delivery Principles found in schedule A of this memorandum.
3. KACL agrees to provide the supports and services as specified in Schedule B upon the terms and conditions set out in schedule C. Such supports may change upon minimal notice based on Ind. needs and KACL’s ability to provide resources.
4. Ind., a resident of Kenora wants to live in the community in a state of respect and dignity and has requested certain support services from KACL to do so. [Ind. agrees to the commitments contained in schedule D.]
5. [The Family wants to have Ind. live in the community in a state of respect and dignity. Fam. Ind. accepts the principles of service delivery adhered to by KACL, the terms and conditions contained in schedule C and further agreed to the commitments contained in schedule D.]
6.This agreement may be terminated by Notice,
(1.) immediately by IND. or his Guardian,
(2.) upon 15 days notice by KACL.
7. This agreement shall be reviewed by the parties upon 15 days notice, and failing agreement by the parties within another 15 days, may be unilaterally altered by KACL.
Signed by the respective parties or their duly authorized agents this day, ____________, 2xxx.
Kenora Association for Community Living
______________________________________
Ind.
_______________________________________ Family
KACL will make an intial asessment of the personal supports needs of IND and a determination of the supports and services it can provide. The Acceptance of KACL to make this initial assessment and determination does not imply any continuing obligation on the part of KACL to provide further supports and services.
(Memorandum of Understanding)
KACL, Ind. and Fam. agree to the following provision of services:
1. KACL will provide:
a. Staffing: up to ^ hours per week to support Ind. in working towards and gaining greater independence in the following areas:
i. Maintaining and developing skills in personal hygiene, physical fitness and healthy lifestyle habits,
ii. Maintaining and developing knowledge and skills in homemaking such as home maintenance and cleaning, laundry, meal preparation and shopping, banking and budgeting, fire safety,
iii. Develop the skills to access employment and/or volunteer activities.
iv. Accessing social and recreational activities at home and in the community,
v. Support in maintaining and developing family roles and friendships, i.e. as a ^son, ^brother, friend, neighbour, etc. including communicating significant life events to family and friends,
vi. Provide opportunities to entertain guests,
vii. Provide opportunities for Ind. to maintain reading and writing skills,
viii. Provide opportunities for Ind. to exercise independent action,
ix. Provide opportunities for Ind. to experience multiple environments,
x. Provide opportunities for using communication skills and provide training in communication.
b. Personal Planning:
i. Assist Ind. to explore and select alternative living arrangements,
ii. Assist Ind. to express goals, interests, likes and dislikes to adapt ^ lifestyle to ^ changing abilities and interests.
iii. Act as a personal planning resource to research, obtain and share information on issues agreed to by the parties.
Schedule C
Terms and Conditions
Schedule D
Individual or Family Commitments
Fam. agree to:
a. Participate in planning with KACL for Ind.'s future, including alternatives which provide natural supports and involvement in Ind.'s social circle and family relationships,
b. Notify KACL of any significant changes which may affect provision of services, i.e. planning or staffing, such as family vacations, health issues, etc.
c. Notify KACL of any concerns regarding Ind. and the services ^ receives, utilizing established channels of communication: communication at regular meetings with personal planner at a minimum of once every two weeks, verbal or written communication with Supervisor, written communication with Director of Services and written communication with Executive Director in the event
of unsatisfactory results.
Kenora Association for Community Living
___________________________________________
________________________________________________
Ind.
_______________________________________________
_________________________________________________
Fam.
_________________________________________________
>Reference
American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition commonly referred to as DSM-IV.