Leading Practice Guidelines

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The Leading Practice Guidelines capture the current understanding of best practice for organizations striving for excellence in services and supports to adults labelled with intellectual disabilities. These guidelines represent the outcomes and practices that organizations would work towards in order to enhance and improve services. 

Click on the headings below to expand and learn more about the development of the guidelines and important definitions. Otherwise, scroll down to view and search the Guidelines.

Preamble

These guidelines have been developed to outline the current consensus on leading practice in service delivery. The expected outcomes should these guidelines be pursued by organizations:

  • Increased quality of services
  • Better consistency of services
  • Better outcomes for people
  • Shared vision and road map for service delivery
  • Competent, stable, confident workforce
  • Increased confidence in services

These guidelines rely upon the following principles and values:

  • People are respected and treated with dignity;
  • People belong, contribute and are included within their neighbourhood, communities and workplace;
  • People exercise rights and responsibilities as outlined in current human rights code, law or convention;
  • People receive responsive, timely personalized support;
  • People have the supports to achieve overall wellbeing and fulfill their potential;
  • People are seen, heard, known and valued;
  • Families and support networks are valued and respected;
  • People have choice & control and design lives of their choosing;
  • People have the material and social capital to pursue and achieve their dreams and goals;
  • People receive quality services defined and directed by the person that enables full inclusion and citizenship;
  • People enjoy continuity and stability of services and supports.

Throughout this document, ‘guideline’ is used as a collective term to describe both the outcomes and the statements which sets out the systems and practices that should be present within organizations.

Not every guideline will apply to every service depending upon if the organization provides temporary or ongoing supports, residential, clinical, respite, or employment supports, etc.

The “What Does This Look Like” section explains what achieving the guideline looks like in practice.

These guidelines do not replace or remove the need to comply with other legislation, regulations, codes and policy which sets out requirements for the provision of services. Organizations should continue to follow existing legislative requirements and best practice guidance which applies to their particular service or sector, in addition to striving to provide services in alignment with these guidelines. The guidelines should be used to complement the relevant legislation and best practice to support organizations to ensure high quality care and continuous improvement.

Each guideline covers common elements in each outcome area. In order to provide high quality services and to deepen practice in any particular area, an organization must consider: 

  • Expectations & Commitment - Do they have a statement of commitment and expectation that clearly outlines what they expect in their systems and practices?
  • Communication & Information - Have they given the required knowledge and tools to all stakeholders including people served, their families and support networks and staff?
  • Practice & Follow through - Is there a practice of follow through on stated expectations throughout the organization?
  • Measurement & Monitoring - Do they have a system of monitoring and measuring whether they are having the impact that was desired?

Please note: The guidelines are recommendations for practice. They do not stipulate or propose a single correct approach for delivering services or managing all situations. Decisions regarding specific services, support or clinical approaches require individualized considerations that are the ultimate shared responsibility of people served, their families and support network, service providers and professional health care providers. Leading practice guidelines can change over time as we learn and grow and thus will require ongoing attention and revision.

Acknowledgements

This work could not be possible without the energy, passion and work of many people. Acknowledging that the list below is by no means inclusive of the many contributors, collaborators and reviewers, we would like to thank:

Steering Committee:

  • Jay Rodgers, Deputy Minister, Department of Families
  • Dan Knight, Acting Assistant Deputy Minister, Department of Families
  • Elaine Hawkins, Director, Strategic Projects & Agency Relations
  • Andrea Thibault-McNeill, Acting Assistant Director, Agency Relations Manager
  • Sid Rogers, Community Living Manitoba
  • Margo Powell, Executive Director, Abilities Manitoba
  • Jennifer Hagedorn, Past President, Abilities Manitoba
  • Leanne Fenez, Quality Lead, Abilities Manitoba

Working Committee:

  • Andrea Thibault-McNeill, Acting Assistant Director, Agency Relations Manager
  • Marylea Mooney, Program Specialist, Community Living DisABILITY Services
  • Cheryl Busch, Centralized Resources
  • Laurel Litardi, Centralized Resources
  • Janet Forbes, Executive Director, Inclusion Winnipeg
  • Malinda Roberts, Executive Director, Winnserv
  • Richard Neufeld, Executive Director, Blue Sky Opportunities
  • Karen Leggat, Family Representative
  • Kevin Johnson, President, People First
  • Leanne Fenez, Quality Lead, Abilities Manitoba

Members of Key Stakeholder Groups:

  • Anna Strangherlin
  • Deb Roach
  • Valerie Wolbert
  • Monique Chaput
  • Judy Andrich
  • Jessica Croy
  • Linda Ormonde
  • Laura Schnellert
  • Bev Fyfe
  • Jane Schledewitz
  • Sid & Arvadell Egesz
  • …and many others

Accessibility:

These documents are available in alternative formats. For assistance, please contact Leanne Fenez at leanne@abilitiesmanitoba.org

Definitions

Should you find other terms that you feel might merit a definition, please contact leanne@abilitiesmanitoba.org with your suggestion.

Advance Care Planning - The process of dialog, knowledge sharing, and informed decision-making that needs to occur at any time when future or potential end-of-life treatment options and preferences are being considered or re-visited. The primary goal of Advance Care Planning is to seek consensus on care plans that reflect the best interests of the person.

Advance Care Plan - The form used to record medical intervention decisions reached through the Advance Care Planning discussions.

Behaviour support - A set of interventions developed to support people with challenging behaviour. These behavioural strategies are designed to improve an individual’s quality of life, are functionally based and are integrated with person-centred planning. (Definitions from Community Living B.C. (CLBC) Behaviour Support and Safety Planning Policy, May 2012)

Behaviour support plan - An individualized, written document developed to support individuals who have challenging behaviour. It outlines specific behaviour support interventions, strategies and implementation requirements. It is a tool for all support networks to be consistent in the strategies they are using when dealing with challenging behaviour. (Definitions from Community Living B.C. (CLBC) Behaviour Support and Safety Planning Policy, May 2012)

Challenging behaviours include:

  • Difficult or Unconstructive Behaviour: Impedes community acceptance or interferes with other behaviours and remains unchanged over time. It impedes community inclusion.
  • Serious Behaviours: Interfere with learning and daily activities and the behaviours are likely to become severe if they are not addressed. Serious behaviours greatly concerns family members, support network members or staff. This behaviour may prevent individuals from participating in community activities.
  • Critical Behaviour or Unsafe Behaviour: Is of such intensity, frequency, or duration that the physical safety of the individual or others is likely to be placed in serious jeopardy. (Definitions from Community Living B.C. (CLBC) Behaviour Support and Safety Planning Policy, May 2012)

Community Living disABILITY Services (CLDS) - services offered by the Province of Manitoba, Department of Families. More information can be found at https://www.gov.mb.ca/fs/CLDS/index.html

Crisis situation - A circumstance where:

  • Challenging behaviour places the person at immediate risk of harming himself or others or of causing property damage;
  • Attempts to de-escalate the situation have been ineffective; or
  • The behaviour is new or unprecedented in its intensity such that the Behavior Support Plan (BSP) does not effectively address it.

Culture - is a word for the way different groups of people do things. Different groups may have different cultures. A culture is passed on to the next generation by teaching and modeling. People express their culture in the way they write, talk, dress or interact with others. Specific cultures have different music, cooking or religion.

Delegation of Function - The extension of authority by a nurse or other regulated professional to an unregulated care provider who does not have the authority to perform the task as an assignment through their scope of employment.

Employment is defined as:

  • Activity that is compensated at not less than provincial minimum and not less than the customary rate paid by the employer for the same or similar work performed by other individuals without disabilities;
  • Occurs at an integrated location where the employee interacts with other persons who do not have disabilities to the same extent as others working the same or similar positions;
  • Where the person receives the same benefits provided to other employees without disabilities in the same or similar positions;
  • Presented, as appropriate, with opportunities for advancement that are similar to those offered to other employees who have similar positions

Family - Family is a word that can have many different meanings. People have many ways of defining a family and what being a part of a family means to them. For the purposes of these guidelines, family refers to people that the person supported acknowledges as being part of their family. When that is not known, it refers to people who are biologically or legally related to the person.

Functional Behavioural Assessment - An assessment that seeks to describe the behaviour, the environmental factors and setting events that predict the behaviour, and the function that the behaviour serves. Functions of behaviour may include communication, getting something, or avoiding something.

Health Care Directive - A self-initiated document that allows individuals to make health care preferences known in the event that they are unable to express them. In Manitoba, a Health Care Directive may indicate the type and degree of health care interventions the person prefers and/or may indicate the name(s) of a person(s) who has been delegated to make decisions (i.e. a “Proxy”).

Home - Refers to an emotional connection to a space. This space could be any dwelling where someone makes a home. The word home refers to more than a simple building and acknowledges that it is a place of warmth, comfort and sanctuary that goes beyond simple shelter.

Identity - Refers to the way one understands or thinks about themselves. People may think about themselves in relation to their culture, religion, family connections, ethnicity, gender, sexuality, economic status, etc.

Intimate Personal Care - Defined as activities of care of an intimate nature, associated with bodily functions and personal hygiene, which require direct or indirect contact with, or exposure of, the sexual parts of the body such as assistance with bathing, toileting, or dressing, etc.

Normalization - Means making available to people with disabilities the same patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life.

Organization - Service provider or agency which is funded through Community Living disABILITY Services (CLDS).

Over the Counter Medications - Refer to those medications that can be purchased and used without prescription. These include such items as cough syrup, ibuprofen, etc.

People - Typically when the term people or person is used, we are referring to people who receive services. Others are labeled as per their role such as staff, care providers, family, friends, support network member, etc.

Physical restraint - A holding technique, used by a person on another person, that restricts the latter’s ability to move freely.

Psychotropic Medications - A psychotropic medication is any medication that alters the chemicals in the brain and consequently impacts a person’s emotions and behaviours. Psychotropic medications treat a variety of psychiatric conditions including depression, bipolar disorder, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and psychosis.

Safety Plan - An individualized, written document designed to address situations where unsafe behaviour has the potential to harm the individual or those around them. The safety plan outlines the strategies and procedures to respond to the behaviours and reduce risk. Safety plans should only be developed as an adjunct to or in conjunction with an overarching Behaviour Support Plan. (Definitions from Community Living B.C. (CLBC) Behaviour Support and Safety Planning Policy, May 2012)

Spirituality - Refers to a variety of activities and experiences that have deeply personal meaning to someone and often involves a sense of connection to something bigger than oneself. Christina Puchalski, MD, Director of the George Washington Institute for Spirituality and Health defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”

Staff - Where the word staff is used in this document it includes all staff employed or contracted by a service provider (direct support, supervisory, management, administrative, executive). For the purposes of this document this would include foster providers and/or people contracted to provide a home share, employment or job coaches, clinical consultants, etc.

Substitute Decision Maker - A third party identified to participate in decision making on behalf of a person who lacks decision making capacity under the Vulnerable Persons Act. The task of a Substitute Decision Maker is to faithfully represent the known preferences and/or the interests of the person.

Support Network - Includes the individual’s family, friends, other natural supports, circle of support, or others chosen by the individual. An individual’s support network includes involved family members and others as directed by the person.

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Categories

Categories

Meals & Nutrition Guideline: Wellbeing

Guideline: Where meals are provided or supported by the organization, the organization works with the person to create healthy meals that…

Emergency Measures Guideline: Wellbeing

Guideline: The organization has comprehensive plans developed, maintained and communicated that guide staff and the people they support…

Mental Health Guideline: Wellbeing

Guideline: The organization helps people with disabilities to gain timely access to mental health services, where appropriate. People receive…

Sexual Health Guideline: Wellbeing

Guideline: The organization acknowledges that sexuality is an essential part of anyone’s health, well-being, and identity. Loving…

Intimate Personal Care & Support Guideline: Wellbeing

Guideline: The organization trains, assigns and supports staff so that intimate personal care is provided with sensitivity, privacy and…

Aging & Dementia Supports Guideline: Wellbeing

Guideline: Where appropriate, the organization has policies, procedures and practices that meet the needs of people as they age and are…

End of Life Planning & Grief Support Guideline: Wellbeing

Guideline: The organization ensures each person has had an opportunity to discuss their plans and wishes related to the end of their life.…

Rights & Responsibilities Resources Guideline: Rights & Responsibilities

The following resources and links may be helpful in your deepening your organization’s practice related to protecting and promoting…

Rights Protection & Promotion Guideline: Rights & Responsibilities

Guideline: The organization actively protects, promotes and enables people’s rights. What does this look like? The organization…

Rights Restrictions & Due Process Guideline: Rights & Responsibilities

Guideline: The organization does not limit or restrict rights without due process and only in response to a health or safety concern. What…