How CIS Scales Customized Care

Some industries have an easy time creating processes and systems. If you manufacture cookies, you design machines, you churn out cookies, and you strive for consistent quality. If you're an automaker, you do lots of quality checks to make sure everything meets standards. But when you move into people-centric services, those rules don't apply, at least not in the same ways.

That's because anyone who works with people knows that one size does not fit all. Humans accumulate a wide range of positive and negative life experiences. Their mental and physical abilities, combined with their experiences with support systems such as families, schools, and caregivers, influence how each person processes information. The result is millions of different people acting and reacting in millions of different ways.

When Janell and I started Community Integrated Services (almost two decades ago), we knew our success depended on developing custom plans for each new client. CIS was created to help people with developmental disabilities and a history of behavioral issues. When helping these people, we can't make assumptions or develop assembly line approaches: we have to meet each new client where they are.

But custom approaches can take a lot of time and money to execute, and we wanted to make every dollar count so that we could expand. There is a long line of people needing services like ours. We knew that if CIS could scale up, we could help more people. So how could we grow efficiently while still employing a totally customized approach?

Customized Doesn't Mean Unplanned

Community care at CIS is based on individual instruction and support plans (IISP) and positive behavior support plans (PBSP). Program managers create these plans for each client based on the client's history, abilities, goals, and progress.

While each plan is individualized, program managers start by working with an established framework to analyze needs. They then reference a set of established criteria and work with other specialists to create customized care plans that meet all state and federal guidelines and take advantage of the latest research and information.

Once a plan is created, it allows an entire team to work together. It serves as the shared point of reference for a group of people. Much like a medical chart in a hospital, a CIS care plan allows different people to interact with clients without changing direction. Direct Support Professionals, or DSPs, follow these plans closely to meet clients' emotional, practical, and medical needs.

We adjust and change plans based on our clients’ evolving needs or progress, but the process of planning is a core part of our business model.

Create a Deep Bench

We've found that the best way to provide consistent care is by helping our staff learn more than one skill. For example, many members of our senior team joined us to do one job but also showed skills in other areas. Once we spotted these abilities, we helped them grow into new positions that leverage their range of talents.

In sports, it's called creating a deep bench. We are intentionally creating a flexible workforce by helping current employees expand their knowledge and expertise (instead of hiring a new employee with siloed skills). Staff can cover for co-workers in other departments.

For example, if a DSP can also help out in compliance, we are growing two skill sets. That DSP might continue to work with clients, or they may shift into compliance full-time, based on skills, need, and aptitudes. Developing multiple skill sets also minimizes the impact when a key hire leaves.

Don't Assume

Assumptions allow people to navigate through the world efficiently. For example, we may assume people with a particular job title act or react in specific ways. Maybe we treat cashiers and teachers differently based on past experiences. Some assumptions help us navigate life without examining each encounter with fresh eyes.

However, assumptions are rarely helpful when interacting with social work clients. Each employee at CIS must meet each person without prejudices. We don't assume they will interact or react the same way as another client.

This approach requires our staff to work harder, observe more closely, and take more time to really learn how each client is unique. Observation and analysis are needed before we can begin to create effective care plans.?Our intentional refusal to make assumptions helps us serve our clients more effectively. It also prevents us from rushing into treatment plans based on the needs or behaviors of other clients.

Make Customization the Norm, Not the Exception

If you want to implement a fully tailored approach, it's crucial to make customization the core of your business model. That means that made-to-order is the norm, not the exception.

Instead of trying to create standard versions and adding customizations, develop processes that allow you to adapt every time. For every client, our approach starts with formal evaluations. We then submit paperwork to the state and assign a support team that includes DSPs, supervisors, and program managers. These steps are mandatory, and we do these things every time.?

But the evaluations are simply information gathering. They provide the data needed to create individualized plans for each client. And while these assessments have a framework and requirements, we can change them when needed. We have to meet baseline goals and objectives, but we can then include elements as we discover the need for them. For example, we may accept a client with paperwork that doesn't indicate any medical issues. During the course of our evaluations, we may discover they have significant hearing loss. That changes our approach, and we'll start creating plans incorporating hearing loss. We help the individual access a specialist or try out hearing aids to help us address all of the client's needs. We add and adjust as the complete client profile is developed.

Conversely, we don't discover hearing loss and then ignore it. Even though the hearing loss was not part of the initial profile, adapting and adjusting to new findings is part of what we do. It may add work to the process, but these shifts are never avoided or ignored. That's what true customization affords us: the ability to treat clients holistically.

Building on a Structure for Customization

In the end, we can be creative problem solvers if an organizing structure is holding it together. We have a basic framework that keeps us in compliance. It helps us maintain standards, develop efficiencies, routinize approaches, and establish pathways for success.

Like the framework for a house, our structure is spare, practical, and necessary. And it also allows us to build custom programs quickly and efficiently. The structure is there to support the customization.

With a solid structure providing core strength, we can continue to customize and grow. And in our line of work, growing also means helping more people. It's the rationale behind everything we do, and we wouldn't have it any other way.