Common Ground is committed to the belief that those we serve have the right to fully experience life. It is our role to assist the community in supporting each of its members along their journey

- Mission Statement

This site visit report is based on a three day visit, in April of 1997, to Common Ground. The purpose of our visit was to document innovative, integrated daytime supports for people with developmental disabilities, focusing on those directed at assisting people in community involvements other than or in addition to supported or competitive employment. During this visit, we spent time with a number of people who receive support from the program, as well as program staff. We gained insight into some typical days for people and the nature of support provided for them, both during the day and in other aspects of their lives. Our discussions with staff members taught us about the organization and birth of Common Ground, strengths of the program, and some of the challenges that they face.

Common Ground employs five full-time team leaders; team leaders coordinate the work of a group of Community Integration Specialists (CISs). Together, team members are responsible for the provision of daytime support for 7 to 12 individuals. All of the CIS positions are part-time. The only benefit is earned leave with pay. CISs use their own cars-for which mileage reimbursement is received. They support people on an individualized basis as well as in small-group activities. The availability of some one-to-one support for everybody allows each person the opportunity to pursue individualized connections and involvements. One team leader described the advantage of having the staffing available to provide one-on-one support, as follows:

We used to have to think, if you found one person who wanted to go skiing, OK, do we have three other persons to go skiing; now, we can just go do it with one person.

Impetus for Creation

Before Common Ground was created in 1994, the agency operated two sheltered workshops. Tempo, which opened in the mid-1970s, in Littleton, and Tempo South, located 20 miles south in Woodsville, which was opened in the mid-1980s in an effort to offer local services to residents of the southern part of the 22-town catchment area.

According to the Area Director, these workshops were good programs, with dedicated staff, who recognized the need to move people out of the facilities and into community placements. However, as the Area Director put it:

It was clear that we had a facility based system that we were trying to stretch to provide community-based supports and services. We had a building that got in the way. Due to our staffing pattern, we couldn't figure out how to do community integration except in groups of people. In Woodsville, where many of the people had severe disabilities, community integration was very limited. Eventually, we said, "What we are doing is not enough."

In addition to this recognition of the need to change from within the agency, there was pressure from a variety of sources to offer more individualized supports, as well. Students with disabilities who had attended regular schools, their families, and their school personnel did not want these students to end up in a sheltered workshop after having attended regular schools. In general, the State Department of Developmental Disabilities was urging service providers in all regions to move toward more individualization. Attention was in part directed at this region because there were two workshops serving the large geographic area encompassed by this region. Thus, this was the most expensive program, per person served, in the state, primarily due to the costs of running two facilities and the high transportation costs.

How the Change Took Place

Four years ago, a new Area Director came to what is now Common Ground. She knew that changes had to be made and spent much time trying to figure out what she could do so that they could support people in more individualized ways in the community. Her plan was to close the workshops and serve everyone in the community. She put a lot of thinking into how this could be done: "I spent a lot of time looking at the budget and the staffing pattern. It was clear there were too many chiefs; too much of the budget was tied up in chiefs." This led her to the belief that they needed to start from "ground zero." A question raised at the time by one of the staff members in many ways epitomizes her belief: "Can we fix this, or is it broken?"

It was clear to her that the workshop system, which had once been viewed as "cutting edge," was not capable of providing appropriate community opportunities. It was broken. So, she began a reorganization within the agency to create the Common Ground program. Originally, there were 25 full-time staff for the workshops. All of the staff positions were readvertised--with only five full-time positions (team leaders); the rest were part-time, with only the earned time benefit. From those she hired, she created five teams, each functioning somewhat like a "mini-agency." They share resources across teams, but the teams have responsibility for the people on their team. In hiring the part-time staff, she hoped that paying them a few dollars an hour above minimum wage would attract some good-quality part-time people in a region where jobs are scarce. She wanted people who could work flexible hours and who were "connected with the community."

They discontinued the use of vans to drive groups of people around the community. Most people now travel in staff cars, with reimbursement for mileage paid to staff. For those who need them, there are wheelchair-accessible vans. However, they are no longer filled up with groups of people. According to the staff, the Department of Transportation used to offset the cost of buying vehicles, but no longer does so in the Littleton area because they are not filled to capacity.

One of the keys to success in this changeover to integrated day activities was the provision of additional staff training and support, since staff now didn't have the backup of a facility. During the first year, the staff inservice budget was tripled. The agency did a lot of its own training, as well as sending people out to conferences and workshops. They opened up their own training sessions to other local service providers, as well. The Area Director also recognized that the agency needed some additional vocational expertise in order to find more community job opportunities, but that team leaders didn't have time to do a lot of job development. So she created a new staff position to address this need.

This new reconfiguration within the agency, now called Common Ground, began April 1, 1994. The staffing changes were felt by the Area Director to be the most difficult part of the change and the most controversial. Many community members and human service system employees were very upset about the significant reduction in full-time staff positions; in addition, others within the larger service system did not appreciate this region's relatively high pay scale for part-time employees. Overall, however, while she still feels badly about having to let a number of people go, she says it was "crystal clear" that such changes had to be made in order to shift the focus to true community support. Although the changes have been difficult, over time, there is a very positive sense among staff, family members, and people with disabilities about the directions they are moving in. In addition, community members and others working in human services throughout the state have come to appreciate the innovation and creativity of Common Ground. The following section describes some of the supports provided to individuals and families by this agency.

However, as an agency, they have also assisted people to begin the development of paid work options other than supported or competitive employment. In addition, they do not aim exclusively toward paid work as the single most meaningful involvement; rather, they look more broadly to supporting people in a wide variety of integrated day activities, based on personal interest, that promote meaningful and valued roles in the community. This may involve any combination of activities including supported or competitive employment, self-employment, volunteer work, leisure activities, community connections, advocacy, and so on. The following sections describe some of the examples of support for self-employment, volunteer work, other community activities, and relationships.

Self-Employment

The program has supported a few individuals to start their own businesses, some under the auspices of the program and some fully independent of it. For instance, Stephanie expressed a career goal to do mailing and collating. When the workshops were in existence here, she was the lead employee for this type of work. Program staff tried to help her find this type of job in another business, but she faced a barrier in that her limited mobility made it difficult for her to run all of the equipment. She decided to look into obtaining specialized equipment, such as folding machines and collating machines so she could start her own business. Staff then helped her think about options for location of the business. Running the business out of her mother's home did not seem like a good idea. They found temporary free space for her in the town of Lancaster, but to operate a business in her own space she would need a support person to help her deal with signing contracts, phone calls, and various other details. Stephanie does not have Medicaid waiver funds, so she would have had to pay for a support person herself. Since she doesn't have the resources to do this, she decided to use office space at Common Ground for the time being. Eventually, she would like to have her own space, once the business is going and she has accumulated enough funds to pay for rent and a support person. The vocational support staff at Common Ground explained that Stephanie's work style is to work alone--so her office is small, but private. During our visit, Stephanie was in the midst of doing an 10,000 piece mailing for the Littleton Chamber of Commerce; she is also a member of the Chamber and they help to advertise her business. She has enough work at this point that she may be looking to hire an assistant in the near future. Two other people supported by Common Ground own a recycling business that was initially generated within the program, and one person is considering starting a hooked rug business.

As compared with the stories above, Steve's business is fully independent of Common Ground. Steve receives waiver funding, which covers support staff for him. Steve's mom, Jessica, has chosen to directly receive all of the support money for Steve. She did this for a few reasons. After Steve graduated from school, she had helped arrange a job for him doing deliveries in a hospital, but she felt he was isolated in his work there. In addition, she had seen many other young people who had gone from high school into various employment programs, and she wanted something different for Steve. She decided to receive the money herself and arrange the needed support to assist him in experiencing a meaningful, integrated day.

I wanted the experience of seeing what it's all about. And, I was tired of knocking on doors. I wanted somebody knocking on my door.

Steve's delivery business involves taking lunch orders from people around the community, picking them up, and delivering them. In addition, in the mornings, he stops by a number of local businesses with food for sale (e.g., bagels, donuts, fruit, salads, etc.). At the time of our visit Steve was in between support persons, so his mother was assisting him with his delivery business and was looking to hire someone new. Since Steve's business started, in 1995, they have had two different support people. According to Jessica, the first person they had was very good at working with Steve, both encouraging him to participate in the deliveries and engaging him in social interactions. The second person, the one who just left, "didn't have a clue how to support him"; Steve would typically sit in the truck, while this person did the deliveries. Currently, Steve's mother is encouraging him to get involved once again.

Jessica bills the area agency for a set amount. Within this, there is some flexibility in how she spends the money. For instance, now that she doesn't have a support person, she is paying herself to provide support for Steve. When she does hire someone, she can determine the rate of pay. She feels that "in general, in this field, support people are not valued." She has made an effort to counter this by paying Steve's supporters about $10 per hour.

Volunteer Work

Several of the individuals supported by Common Ground are involved in volunteer jobs. For example, Peter volunteers to go to the post office each morning to fetch the mail for the agency. In the afternoon he stamps the agency's mail and walks to the post office to mail it. Scott has a volunteer job delivering meals for Meals on Wheels. Scott is 27 years old and became disabled about 9 years ago. He has been doing this job for 4 years now, with the help of his current CIS, Ellie, for the last 2 years. Two times a week, Ellie and Scott drive to the local senior center where Scott picks up the list of people to receive meals for that day. They then drive to the local hospital where the meals have to be packed. Here, Scott joins several people--mostly seniors citizens--from the community at-large in sorting out which meal gets what in it. Scott has a cup of coffee while he packs the meals for which he is responsible. Ellie helps Scott count out various different food items and they use this job to work on memory skills which are a bit hard for Scott. Once the meals are packed they go to do Scott's 2 1/2-hour long meal route. Scott reads the names off the list and together Ellie and he work on remembering where each house is so that Scott will be able to help his new CIS find the houses in the future (Ellie was about to take a maternity leave). Several times during his route Scott stated that he "loved" his job.

Most of the people who the agency supports in paid employment do not work full time. These people sometimes choose to do volunteer work in addition to paid employment. Others who do volunteer work do not have paid employment. However, the agency does not view volunteer work as a substitute for paid work. They are committed to increasing the opportunities for paid employment for people they support, and have directed resources to this effort (e.g., the creation of the job development position).

Community Connections and Leisure

Work--whether paid or volunteer--does not fill up the whole day of Ann, Scott, Peter, Stephanie, and others at Common Ground. Helping people to spend their remaining daytime meaningfully can be a challenge, but not a challenge of which Common Ground is afraid. Integration into the community, if it is to occur in the true sense of the word, has to go beyond simply physical presence in the community. It is also important to have social connections and leisure opportunities in the community. In a small rural town, where winter snows make road travel enormously difficult, establishing community connections is not always easy. Staff at Common Ground recognize this difficulty and have put significant effort into helping find meaningful connections and experiences.

When hiring CISs, the program asks them about their community connections, interests, and hobbies. Common Ground feels it is very important that people are supported by a CIS who enjoys similar activities. For example, in the afternoons, Scott chooses how he wishes to spend his time. Often, he chooses to go for a swim or a walk--he loves to walk and chat with Ellie at the same time. Peter has a free day once a week, during which he hangs out with Ed (his CIS) and Ed's roommates--they may all go out for lunch, bake or cook something, shoot baskets, or listen to music--activities that Peter also enjoys. He also likes to go swimming or bowling, on occasion.

Scott always wanted to be an actor. In fact, his mother says that while in high school--before he became disabled--he often talked about dropping out of school and becoming an actor. Since Scott still talked about wanting to act, Ellie helped him get a part in a local community play. She supported Scott to act in the evening practices and performances. Scott used to have a paper route in his home community. Although this job did not last, Scott's mom felt that he enjoyed doing the route as it was in his home community and he knew the people, as he was known by them. Ann also has a number of friends in the community who she enjoys visiting on a regular basis. She is also involved in a self-advocacy group.

Scott and Peter have been supported by Common Ground for a couple of years, so they and the staff have had some time to discover meaningful leisure time activities. Maggie, on the other hand, is new to Common Ground. Consequently, the focus of Maggie's support workers is "trying to find things she enjoys." For example, they have learned that she likes extensive, fast motions (the alpine slide, skiing). Staff at Common Ground would like to write a recreation grant so that they can purchase a bike trailer so Maggie can go biking. Maggie's current CIS, a student intern at the agency, spends about 10 hours a week with her, during which time they go out to lunch, go shopping, and explore other activities to learn what Maggie enjoys most.

Both Peter and Maggie have made friends through their CISs. Peter and his CIS, Ed, spend time with Ed's roommates and his friends. They go out bowling together, hang around and listen to music, and shoot hoops. Peter also has met many people in the community through all of the members of the family that he lives with. Maggie's support person has introduced Maggie to her friends and has invited Maggie to some of her family gatherings. Because Maggie went to her local school, many people in the community already know her. However, before her involvement with Common Ground, other than school, she rarely spent time in the community.

At Home

Although the focus of this report is on daytime supports provided by Common Ground, it was also interesting to see how people are supported in their living circumstances.

Some people, such as Steve and Maggie, live at home with their families. Peter and Scott live with home providers. Home providers are typically families in the community who get paid for opening their homes to a person with a disability. Providers offer their homes for a variety of different reasons. Peter's provider, Marcia, had been a home provider for years, so Marcia and her kids were used to living with people with disabilities. Marcia wanted to continue to open her home. Scott's providers were experiencing "empty nest syndrome." Both home provider couples felt that these young men were part of their family; likewise, both Scott and Peter seemed very comfortable in their homes. Scott's mom, Terri, felt that it was important for Scott to live in a home outside of his family home now that he is an adult. Marcia felt that it was very important for providers and the people with disabilities who live in their homes to enjoy some common activities. For example, she felt Peter would be a good match for her family, since he and the family share an enjoyment of camping and other outdoor activities.

Ann owns her own home. She was the first person in New Hampshire to buy a house through the state's Home of Your Own (HOYO) project. Four years ago, Kris, her case manager, worked with the director of the National HOYO project and the housing coordinator for WMMH+DS to facilitate Ann's move to her home. Ann explained that not everyone felt that the actual house she now owns was the best choice for her. However, when Ann first saw the house, she explained, "I knew it was for me. I could see how I wanted to fix it up to make it my home."

Although Ann clearly loves owning and living in her own home, some challenges have existed, the biggest of which is finding in-home staff support that feels like support and not shift work to both Ann and the support people. Together, Ann and staff who provide housing services within WMMH+DS have tried to set up a situation involving two live-in housemates, one for part of the week, the other for the other part, rather than have constantly changing shifts of support workers. However, it has taken some time to figure out a workable division of the week for the two housemates. Originally, Ann had a housemate who lived with her 5 days a week and another who provided support the other 2 days, but this didn't work so well. Now, one housemate is there for 4 days and the other for 3 days. Throughout all of this, it is positive that the support staff see this challenge as their problem, rather than Ann's.

From our visit to Common Ground we found three key areas of innovative practices and challenging dilemmas. These areas include agency change, self-determination, and valued community roles and membership.

"Can We Fix This, or Is It Broken?"--Agency Change

Change is rarely an easy process. Although filled with the excitement of a new start, change also tends to be fraught with apprehension. In many ways the question, "Can we fix this, or is it broken?", raised among the staff before the creation of Common Ground epitomizes the tone of change for this agency. To the Area Director, it was clear that the workshop system at Littleton was too broken to simply fix into a community system; that they couldn't do a quality job of supporting people in the community within the old framework. She knew that what was needed was a radical change, which would not necessarily be a popular course of action.

A number of important lessons can be learned from the changes that took place at Common Ground. Some of these lessons are:

• Change is not a formula. The decisions that were made were based on the particular circumstances within this agency. They would not necessarily be the optimal ones for every agency undergoing change.

• Need for a new agency role: Relinquishing control. Closure of the two facilities and provision of all supports in the community calls for the agency to relinquish significant control of staff, in order to let them work creatively within the community. However, this does not mean there is no staff accountability. Team leaders spend a lot of time in the community supporting and monitoring the work of the CISs. As one staff member put it,

It is not OK to just be doing custodial care in the community. For instance, it is not acceptable for someone to go to the mall all day every day.

• Need for new staff roles: Reliance on the community, not a facility. By closing their sheltered workshops and creating a totally new program focused on community integration, Common Ground has allowed for the individual daytime support of each and every person that they support. Their practices are impressive. Now, it could be argued that this is not a very large program; therefore, this accomplishment is easier than in a larger program. However, it is important to remember that Common Ground also serves a rural population where the reality is that participation in certain activities may require a few hours of travel for staff and the people they support, and, in the winter, there is sometimes cold and dangerous weather to be contended with.

Staff agree that not having the facility pushes them all to be more creative and come up with new solutions and strategies for support. While there are no regrets about closure of the facilities, not having them brings other issues to the surface. For instance, they wonder if they have created additional hardships for some people in having to deal with lengthy transportation and being "out in the community" in the sometimes harsh winter weather. At the same time, they realize these are problems faced by all people who live in this region, not just those who have disabilities, and that solutions that match individual circumstances, desires, and needs will evolve.

Another issue is having a place, during the day, to use for people who need special help with personal care. As one staff member put it, "We didn't feel comfortable just using the bathroom in McDonalds for that." So, as one solution, the program has rented a small apartment in the village. They are not sure if this will be a short-term or long-term solution. What they do know is that they are committed to searching for ways to assist people to "be in the community with dignity."

• Support for staff has been key to successful change at Common Ground. As previously noted, it was significant that during the first year the staff training budget was tripled, in order to help staff develop increased competence in supporting people in the community. In addition, on an ongoing basis, an atmosphere has been created in which staff feel supported by one another; staff members feel encouraged to think creatively; and, as a staff, they are not afraid to have open disagreement and discussion of issues.

• Change involves trade-offs which may bring both advantages and disadvantages. In order to free up the budget to support people in individualized ways in the community, the Area Director reduced the number of staff and the pay and benefits to many staff. While there are many advantages from the new, more individualized staffing for the people they support, at the same time, the disadvantage is that they cannot offer full benefits to part-time staff and they have not always been able to retain good staff people who have desired or needed full-time work and comprehensive benefits. This is a direction that many other agencies would not choose to go. However, this example points to a dilemma faced by many agencies--how to increase individualized staff support and at the same time support staff well. Agencies should not have to be in a position where they feel that the only way to provide individualized support is to reduce staff benefits. As such, a challenge for states is to provide resources and incentives that enable agencies to both provide individualized support and at the same time offer staff comprehensive benefits. For its part, Common Ground is committed to seeking the means to offer full-time work and/or comprehensive benefits to more of their staff.

Common Ground has made efforts to promote increased self-determination for people with disabilities. They view "self-determination" broadly; as expanding people's control and choices in a variety of ways. As such, they have made efforts to increase self-determination in a number of ways, such as through support for: individualized funding, self-employment opportunities, and advocacy/self-advocacy. Issues related to each of these are discussed below.

• Individualized funding. One option is for people with disabilities and/or family members to receive individualized funding, as Steve's mother has chosen to do. While this has, overall, been a positive experience for Steve and Jessica, Jessica also notes some frustrations. For example, in general, she feels that within the service system as a whole, "families are more highly scrutinized than agencies in terms of how they spend money." In addition, because Jessica receives money for Steve directly, the program is not funded to provide any support to her. Therefore, if she were to hire a behavioral consultant, as she has contemplated doing, the expense would have to come out of the money she currently receives. At the same time, though not funded to provide support for her, program staff have given her both emotional and informational supports, such as ideas and strategies related to interviewing and hiring people, writing job descriptions, and holding people accountable. Despite this, Jessica says that she sometimes feels isolated and out of touch with the resources of the service system. Overall, however, she is enthusiastic about continuing to receive the funding directly, and has many ideas for possible expansion of Steve's business in the future, should he be interested in pursuing these.

While the program staff envision moving in the direction of increased self-determination for people, they do not envision everyone receiving their own funding. From the point of view of people with disabilities and their families, they feel that some may always want a service agency to play a role in assisting them with services. And, from the point of view of the program itself, they recognize that it wouldn't exist if everybody received their own funding. They feel that they, as a program, are an important resource, providing (1) support to some individuals and families who choose to receive support through a program or agency; (2) support in some situations where a parent or guardian might not make choices that were most reflective of the person him- or herself; and (3) a pool of resources that might not otherwise be available to an individual or family receiving funding on their own. At the same time, they are committed to exploring individualized funding as one among many options for people they support, and in the coming 3 years will do so as part of the Robert Wood Johnson Foundation's self-determination grant within New Hampshire.

• Self-employment opportunities. Common Ground has put significant effort into listening to people's ideas about what kind of work they might want to do, and then helping people figure out how to pursue these ideas. Second, as an program, they have lent significant support to helping some of these business ventures get started. Their vision and future challenge is to help these business, over time, be further rooted in, associated with, and supported by the community, rather than the program.

• Advocacy/Self-advocacy. Common Ground staff are strong advocates for the people they support, and encourage and support these people, as well, to be advocates for themselves. In situations of conflict between the desires of family members and adults with disabilities, it is notable that the agency staff view themselves, first and foremost, as supporting the choices and desires of the person with disabilities. In daily community situations, staff support people to advocate for themselves. For instance, Ann complained that the public library was not wheelchair accessible. A staff person assisted her to write a letter about this, and the library now is constructing an accessible entryway. A few of the program staff act as advisors for a local self-advocacy group. This has created important opportunities for some people with disabilities to work together and support each other on advocacy issues. At the same time, it may create dilemmas for these staff in situations in which people with disabilities might raise issues related to the services they receive from Common Ground.

It is notable that Common Ground has recognized that there are many more daytime options, besides paid employment, for promoting valued community roles and membership. Promoting valued roles in the community entails assisting people to participate in valued activities, settings, and relationships with a diversity of community members. Staff make ongoing efforts to assist people with this. At the same time, they acknowledge the difficulties in doing so, which are briefly discussed below.

• Roles and relationships take time. Staff are working on assisting people to build roles and relationships and to spend time in places where they are likely to have diverse experiences and interactions. However, this takes time. Despite participation in integrated settings, many people they support were very isolated for many years, and still have limited contacts outside of the human service system. For instance, Ann has expressed the desire to have more friends and be engaged in activities in her free time. When assisting her to brainstorm about possibilities, staff have tried to help her to think of activities she might be interested in that would also involve contact and interaction with other people.

• Roles and relationships require shared community places and experiences. In order for roles and relationships to occur, people must spend time with other community members. However, for the younger people supported by Common Ground, many of their peers without disabilities are working. Thus, for those they support who are doing paid or unpaid work, Common Ground strives to help them attain work in settings that offer opportunities for interaction with peers. Second, for those they support in other activities, the challenge for Common Ground is to find activities and settings in which they do have some contact and interaction with a diversity of community members.

It is especially challenging to figure out how to assist those who live in isolated, rural communities to expand their experiences and social networks. For some people, it may involve significant travel time to connect with others for desired activities; for others, it may involve seeking out what connections are possible within their immediate, rural locality. As one illustration, staff related the story of a man named Joe, who lived a very isolated life in a very rural area and never came to the program at the workshop. According to staff, Joe only said a few words, one of which was "wood." They knew that he loved chopping down trees and doing other work related to wood. At first, staff assisted Joe, with a loan from the program, to buy wood to split and sell. However, over time, what they have found works better for Joe is to take on small jobs of cutting wood for other community members as needed. Thus, since the creation of Common Ground, staff have been able to support Joe to both do some work he enjoys and to have contact with other community members, within this very rural area. On the other hand, Steve's mother, Jessica, has been concerned about his lack of relationships beyond his family, since he finished school. She is still not sure what is the best approach to helping him expand his social network, and is debating whether the family should move to a larger community.
 

• Common Ground only supports people for a limited part of their day. Common Ground is only funded to support people for 6 hours per day. They recognize that this limits their ability to have an impact on people's lives. As one staff member put it, "We deal with days, but people's lives are more than 6 hours." For instance, Scott would like to get out more in the community in the evenings. He likes music very much, and would love to go dancing, but he has no one with whom to go. Both his CIS and his mother feel that this is an important issue to deal with. Staff at Common Ground make a significant effort to coordinate their work with family members and other service providers in order to help expand the impact on people's lives outside of the 6 hours that Common Ground is funded to provide support. In addition, the program actually provides a significant amount of support to people above and beyond what they are funded to provide.

This report is based on a site visit to Common Ground in April 1997 and reflects the program as it was at that time. All names used throughout the report are pseudonyms.

For further information about the program, contact:

The preparation of this report was supported in part by the National Resource Center on Community Integration, Center on Human Policy, School of Education, Syracuse University, through the U.S. Department of Education, Office of Special Education and Rehabilitative Services, National Institute on Disability and Rehabilitation Research (NIDRR), through Contract No. H133D50037. No endorsement by the U.S. Department of Education should be inferred.