Supported Living Final Program Design

Supported Living in Uttarakhand Independence and Support for a

Full Life

SECTION 1: ExECuTIvE Summary-SuppOrTEd LIvINg IN uTTarakhaNd

This paper outlines a new community-based model of service designed to support people with disabilities to leave custodial care institutions and live lives of freedom and contribution in communities across uttarakhand. Building on the success of Community Lives, established in 2019, this model offers semi-independent living for people who require some support to live independently and safely, but do not require 24-hour staff assistance. Supported Living will launch as a model project in 2024, in a collaboration with the uttarakhand department of Women’s Welfare and keystone human Services International’s keystone Institute India through the support of the rural India Supporting Trust.

SECTION 2: BaCkgrOuNd

India is one of the first signatories to the United Nations Convention of Rights of Persons with Disabilities and demonstrated commitment to the well-being of people with disabilities and their families by enacting the Rights of Persons with Disabilities (RPWD) Act in 2016. These rights cannot be realized until persons with disabilities are able to access autonomy, independence, belonging, access to community, and all the benefits of community life.

Across India, people with disabilities languish in custodial institutions for little reason except that they have a disability label, with scarce possibility for growth, accomplishment, valued work, or community life. In Uttarakhand, 5 women’s shelter homes house nearly 200 women and girls. The existing exit pathways are three in number: 1) Community Lives - a project which provides 24-hour support in small, normative community homes is intended for those with intellectual disability and higher support needs. 2) Family Reunification 3) Trans- institutionalizing people in state mental hospitals, or facilities in their home states. If none of these options are available, people are likely to spend their entire life in the shelter home, heavily restricted and controlled. Intensive mapping processes undertaken by Keystone Institute India in 2023 reveal that many of them have relatively low support needs, so that people who have been living there can lead relatively independent lives with the minimal support and protections that they need.

At the same time, the 8 women who left the facility at Kedarpuram and are served in small homes in Herbertpur under the Community Lives model over the past 4 years have grown and developed in ways that could not have been predicted. All are deeply satisfied with their living situation and life conditions. Several have expressed a desire to continue to increase their independence by moving into a selfmanaged flat or small home with staff assistance only as needed. This is an excellent starting point for launching Supported Living with two women currently served within Community Lives, who are well known, and clearly ready for this new phase of life. Once they have settled into their new living space, space will be made for two more women to leave custodial care institutions into Community Lives.

Supported Living gives that opportunity to people with disabilities to live lives within the community, with as much independence as possible while still receiving the support they need. It helps the community include members who have long been segregated be a part of it, because there is room for everyone in the community and the welfare of all is vested in the welfare of each one. The community is richer in every way when all its members are included in its fabric.

We propose to establish one home, initially, with two women from the Community Lives project to live in them with minimal support, though they will need more support in the beginning. The safety and security of the women will be a priority. All the medical and clinical supports will be provided to the women while ensuring their full participation in the community.

SECTION 3: hISTOry

Women with developmental disabilities as well as those with psychosocial disorders have been locked up in institutions for years with little chance of returning to community life. Loosely defined, institutions for people with disabilities can be seen as facilities where such people are congregated in groups, segregated from typical people and places in the community, subjected to routines and schedules which are highly regimented, and granted limited access to acquire or store one’s own personal possessions. There are rather few, if any, exit pathways out of institutions. Across India, there is a movement towards reintegration of institutionalized disabled persons in accordance with RPWD Act of 2016 and the UN Convention of the Rights of Persons with Disabilities (UNCRPD). The state of Uttarakhand has already pioneered this area by partnering in the implementation of the Community Lives project, assisting eight women to return to the community with excellent outcomes.

This project now takes this pilot a step further and is an answer to the question-Can people with developmental disabilities lead progressively more independent lives with the minimal supports they need?

SECTION 4: purpOSE Of ThIS dOCumENT

This document has been created as a roadmap which outlines the overall procedures for the projectas well as to give guidance for basic framework for operations and services. It is the property of Keystone Human Services International (KHSI) and Rural India Supporting Trust (RIST) and is available to the three partners, associated staff, and consultants of the Supported Living Project. It is not to be further copied or distributed without the express permission of KHSI.

SECTION 5: COLLaBOraTIONS

The Supported Living Project represents a collaboration between the government of uttarakhand (department of Women Welfare) (GoUK), keystone human Services International- Liaison Office (KHSI-LO) and keystone human Services India association (KHSIA). The GoUK and KHSIA will fund the project, with KHSIA also being the implementing partner which will operate and manage the services.

KHSI-LO will be the technical assistance partner providing support training, program design, guidance, and assessment. Each of the partners have agreed to work collaboratively and seamlessly to provide high quality, responsive services to the women so that they too may experience the good things of life along with the independence and choices experienced by each person in the state of Uttarakhand. Major financial support for the project is provided by the Rural India Supporting Trust as well as the Government of Uttarakhand.

SECTION 6: Our SharEd vaLuES aNd

Our vision

Our vision is to create a society in which people with disability have full, rich, and meaningful lives which include home, belonging, autonomy and freedom, choices, friends, work, and a valued presence in the community.

Our values

We believe in the sanctity (preciousness, sacredness) of all human life.

This belief guides us to approach our work with a deep recognition that each and every human life has value, that true equality among all people must be what our efforts are working towards. Everything we do within our partnership must work towards recognizing and honoring each human being, including those with disabilities. Within this belief lies our shared understanding that vulnerable people must be seen as unique individuals, that disability must be understood from a social perspective rather than a medical one, and that safeguarding the welfare of vulnerable people will include fostering both people and organizations becoming strong and more independent, freed from dependence and marginalization. To accomplish this, we will always promote, and model individualized, person-centered processes that keep the welfare of people and society at the heart of our work.

We believe that all people should have access to the universal “Good Things of Life”.

The good things of life include such universal human needs as home, friends, family, community membership, financial stability, being respected by others, and experiencing normative freedom and autonomy within the society. We recognize that it is having valued social roles which bring this wellbeing to all people within all societies, and all that we do will contribute to people with disabilities having valued and authentic roles within Indian society and their local communities. Implicit in this belief is the recognition that segregation and congregation of marginalized people inevitably leads to poor treatment, and we will assure that our shared efforts are always moving towards inclusion in normative, everyday life, and away from segregation and separation by disability. In particular, we believe in the natural authority of families, as they know their family member and deeply identify with them in ways that professionals and caregivers rarely can.

We believe that all our efforts should contribute towards an improved quality of life for all people, and that the welfare of human society as a whole depends upon the well-being of each member.

A society learns to embrace and celebrate its own natural diversity only when it engages in everyday life side-by-side with people who may be considered different. Tolerance, respect, and dignity afforded to people with disability will be facilitated by assisting such people to live in typical ways, and experience many of the natural pathways of Indian life. All that we do and say should portray a positive interpretation of people with disability, through our language, behaviour, media, and action.

We believe we have an obligation to keep our promises.

To work towards the freedom and equality of others, we must, first and foremost, keep our promises to vulnerable people and those who care about them. Trust must be earned. Partnerships with all facets of government, people with disability, family groups will be marked by honesty, responsiveness and will work towards developing services that are both relevant to people’s needs and effective at meeting those needs. Only in this way will wariness turn to trust and shared commitment.

We believe that all people have enormous lifelong potential to grow, learn and achieve and bring these positive expectations to all our shared work.

Those high and optimistic expectations apply to us as a partnership, to people with disabilities, to families, and to organizations. They will be reflected in the education we provide, in the way we advocate, and in the services we promote. We have an obligation to apply these high developmental expectations to the most vulnerable populations, including people from rural areas, people living in deep poverty, and people experiencing the most deeply devalued impairments and disabilities. We recognize that many people with disability will require some support across the lifespan, and such support must be flexible, responsive, and adaptable over time.

Statement of project philosophy

It is the intent of Supported Living to assure that all people receiving services are treated with dignity and respect and in a manner that is consistent with our vision and the principles of Social Role Valorization (SRV). We believe that we have an obligation to develop and mentor strong and powerful leaders to carry the work of creating a just and inclusive society. Finding, developing, equipping, and connecting emerging leadership will bring our foundational work into the future. We will seek those who authentically desire change, those who identify deeply with vulnerable people, and those passionate about working for change. Humility, deep commitment, and the will to translate ideas into action are characteristics we will seek, nurture, and build in everything we do.

definitions

The following definitions are offered for clarification:

principles of Social role valorization (Srv): Social Role Valorization is a theory based in the social sciences which describes how groups of people in a society who are seen as different and valued negatively are treated by that society. It predicts the likely social outcome for such devalued groups and suggests ways in which such groups and individuals may be protected and/or defended from further harm, the benefits of assisting such people to move into valued social roles, and the concrete steps to help people be successful.

dignity: Worthy of respect and honor.

respect: Esteem or positive regard for a person.

autonomy: The independence and freedom of a person to self-govern.

rights: That which is due to anyone by just claim, legal guarantees, moral and ethical principles.

Choice: An act of selection. Choice implies the opportunity to select a preference from two or more alternatives. Implicit in choice is the idea that there is sufficient information to make an informed choice in order to decide between one thing and another.

Informed Choice: Having sufficient information to make a judgment about a selection or decision. Implicit here is the idea that people when given adequate information and education can make effective decisions.

Translating values into action

Operations will reflect the mission of the project and SRV including but not limited to the following:

• Human resource processes

• Public relations information

• Services and supports.

• Quality outcome measurement

• Educational programs for staff and other stakeholders

Operations will support the following core activities within each home:

• The establishment promotion, and support of valued social roles for people served.

• The development and teaching of competencies and skills

• Social and physical inclusion

• Conscious use of image enhancement on behalf of all people associated with Supported Living and the physical location of all services, and service activities.

• Individualization, self-determination, and person-centered supports

• The principle of home, friends, family, work, community presence, and full inclusion

• Respect for personal human service.

• Servant leadership

• Choice and control

• Use of the culturally valued analogue Partnership with families

• Efficiency, relevance, and potency in service delivery

The importance of opportunity for reflection

• Enhancing the physical and mental health, safety, well-being, and security of the women served, and safeguarding for vulnerability.

Terminology and its use

A language of acceptance will be used in reference to all people associated with this project and in all communications regarding the work of the project, including language to and about the people we serve. Language has historically been used as a powerful force allowing segregation, separation, and devaluation of others. Confronting language forces a struggle with basic values and attitudes. Language is a public window on our deepest feeling about those attitudes.

We request that, for example, referring to the people served as children, patients, or inmates be avoided, while normative, respectful terms be used that convey adult standing and citizenship. For example, the

women living in Supported Living Project could be referred to using their names, using titles of honor dependent on their age, or referring to them collectively as the “women we serve”.

All stakeholders are expected to use language which is understandable, familiar, culturally valued and which conveys a positive message about the person. Organizational leaders will model this expectation for all stakeholders.

SECTION 7: dEfINITION Of SuppOrTEd LIvINg

Supported Living is a concept and yet another model to create an exit pathway out of institutions. In this model, two to six women with developmental or mental health disabilities choose to live together in an independent setting with support from part time Direct Support Practitioners.

The Supported Living model is different from other models as it encourages the women to live as independently as possible while receiving the individualized staff support they need. The emphasis in this model is on independence within their own home, rather than supports which they may need. This ensures that the women truly are independent and are living lives that are full, rich, and meaningful within community and making choices and filling the myriads of roles that are filled by any other member of society like friend, neighbour, tenant, hostess, home maker and so many others.

• Special care will be taken regarding the safety of the women in their home. CCTVs on the outskirts of the premises of their home is required. All the features will be installed within the house to ensure safety and security of the women.

• Services will be similar to those provided to the women in the Community Lives Project with increasing independence and choices to the women as they manage elements of their home and take care of it. Twenty-four-hour staff support will be on-site until the Program Specialist specifies that they are safe without direct staff supervision as they adjust to the new space and neighborhood.

• All services required by the women regarding vocation, speech, occupational, counselling and physiotherapy will be provided to them as needed.

SECTION 8: BrOad OBjECTIvES

• Objective #1: To demonstrate that people with disabilities can live independent lives within the community while receiving the support they need.

• Objective #2: To demonstrate that governments and civil society organizations can join hands in partnership to assist the process of deinstitutionalization and create exit pathways out of institutions.

• Objective #3: To give an opportunity to two to six women to choose to support each other in living full, rich and meaningful lives within the community.

SECTION 9: parTNEr rOLES aNd rESpONSIBILITIES

govt of uttarakhand (department of Women Welfare)

The Government of Uttarakhand will provide support to this project through engagement with the program goals and participation in the analysis of the outcomes. It will do a full contribution to the cost of rent, food and clothing.

KHSIA

KHSIA will provide full funding for the initial project start-up costs, and additionally, the ongoing running costs of the Supported Living Program. Any major assets purchased for these homes, including real estate, remain the property of KHSIA. KHSIA along with technical partner, KHSI-LO will monitor and evaluate the progress of the project on periodical basis. KHSIA and KHSI-LO will train staff and conduct monitoring and evaluation studies.

KHSI-LO

KHSI-LO will design and lead the assessment process, develop, and approve the policies, procedures and operations for the Supported Living Project, design and conduct values-based training programs for all staff, and conduct monitoring and outcomes measurements. KHSIA and KHSI-LO will develop a “Supported Living Program Description” detailing all macro/micro level guidelines, roles and responsibilities, policies, procedures, operational aspects & monitoring plans and will further supervise the planning processes for each individual using a team approach. This document will be the guiding document for all collaborating parties in running the project. KHSIA along with technical partner KHSI-LO will monitor and evaluate the progress of the project on a periodical basis.

ALL

All parties will have designated staff who will have access to the homes for monitoring, observation, visiting and support while respecting the privacy of the women.

SECTION 10: phySICaL SETTINg

• The service setting will include 1- or 2-bedroom apartments located in the vicinity of Dehradun and having the following facilities:

• Close access to market and public recreational facilities such as parks, sports facilities, theatres, public transportation, and other public venues for shopping, skill development, and community participation.

• Typical/valued community standard in quality and type, blending in well with surrounding neighbourhood.

• Owned or leased via rental as available and preferred, with lease being held by the one or both women staying in the premises.

• The home will be located in a safe neighbourhood, with adequate security and reasonably appointed.

• Both women will share a bedroom, with maximum choices provided and flexibility in arrangements.

• Initially One bedroom/bath will be reserved for support/care staff who will live-in with the resident(s) full time, which will be later used for part time support staff.

• An adequate outside area will be provided (if possible), in the form of a terrace or yard, where the women can engage in gardening or other outside activity.

• The homes will be located close to the current community homes to provide easy reach for the staff of the Community Lives Project to reach soon in case of an emergency as well as for mutual support and staff sharing.

SECTION 11: SELECTION aNd maTChINg

The women will express their desire to move into an independent setting and then the collaborating parties will determine the women who will move to Supported Living based on specific criteria focused on the following themes:

1. Developmental or psychosocial disability is present - does she have a primary diagnosis of developmental or psychosocial disability?

2. Age - Is she over the age of 18?

3. Preference and willingness of the individual - does she want to move? does she desire to live independently?

4. Ability to identify appropriate and desired housemates - does she have friends or likely people she may like to live with?

5. Availability of financial resources from partners - are there enough funds available for the woman to stay independently?

6. Appropriateness of supports available for Supported Living - Can her needs be met with the support we have in Supported Living?

7. Low likelihood of family reunification - If family reunification is possible, recommended, and desired, this is a preferable living situation.

8. Length of time institutionalized - Longer stay residents are a priority.

The interested candidate will have the opportunity to visit the home before the final decision is made. Consent will be taken to move into Supported Living, but it must be recognized that the women have little actual experience to make such a choice and may need to experience living in the new situation before they really understand the change. As the initial program pilot involved two women who are already served in Community Lives, their spaces will be held for them for the first six months, in case they reconsider their decision to move.

SECTION 12: prOjECT TraNSITION

A support team comprising of the focus person, staff from the residential team from where the transfer is being made, Program Specialist, Direct Support Staff, Shelter Home Staff (if applicable), Medical Specialist, and Community Representative will form the initial transition team which will lead the transition planning process.

Once selected and an agreement has been reached, transition activities will begin immediately. Required renovations will be done to provide safety and accessibility to the women. Free information sharing and joint planning is built into the transition design.

An individualized transition plan will be developed by the support team for each woman, and will include the following seven areas of tailored support:

• Health and well-being

• Home skills

• Community participation

• Relationships

• Personal adjustment

• Work and livelihood

• Spirituality

Based on assessment and individualized plans, the women will be assisted with transition to their home, and ongoing support will be provided in the form of 24-hour support initially, teaching and care assistance, personal care, healthy home-style meals, security and safety, developmental activity, vocational assessment, and job support. Specialized support needs for each woman will be identified and arranged for during this period.

Transition will include visiting the new home, as well as the women helping to plan and set-up the home itself as appropriate and possible, making decisions about décor and set-up.

SECTION 13: LEgaL TraNSITION

Once identified, the women who will move into each home will be assisted to gain all the clearances and legal assistance to make it possible. The government will retain guardianship of each person. For nearly all, this will mean that the government will -

1. Ensure each person has appropriate and adequate identification and documents, including Voter ID, Aadhaar enrolment and card, and other necessary documents.

2. Ensure each person is enrolled and accepted into all government schemes and programs for which they are eligible.

3. The designated representative will accompany each person to the magistrate to take permission for the move.

4. Provide a letter to grant each person permission to move.

SECTION 14: STaffINg aNd SuppOrT

The basic staffing structure and positions will be as follows, with the actual number of positions to be determined by the needs of the women living in each home.

a. Selection of Staff

The home will be staffed by 1 full time coordinator and 1 part time staff initially. As the women take on more leadership and independent roles, the staff will be spending less time with the home, and may, with time, require only 1 part time staff. These workers will be selected and trained carefully, based on their:

• Ability to relate to the women served.

• Willingness and demonstrated ability to provide coaching, support, training, guidance, and respectful and dignified supervision to the women living in the home in all aspects of daily life.

• Excellent references and background clearances

B. Training

• Staffing levels will be tailored to the individual needs of the women, but basic staffing levels will include one Direct Support Worker (DSW) during overnight hours, and one DSW staff on duty during all other hours, till necessary.

A minimum two-week training period will be provided to each Support Staff, which will cover the following areas:

• Organizational Philosophy and Values

• Relational skills – with people with disabilities as well as the neighbouring community

• Program Implementation

• Abuse and Neglect

• Household management

• Community inclusion and integration

• Safeguarding and support

• Promoting valued social roles

• Developing positive community relationships

• Teaching skills

• Documentation Procedures

• Medication monitoring and supervision

• Effective and respectful behavioural support

• Immediate action and first aid.

C. management and Supervision

The home will be supervised by the Project Coordinator (PC) who will be well qualified with both a management and disability background, responsible for managing the day-to day activities of the home and making a schedule for the day/week in consultation with the women. She will spend a significant amount of time with the women served in a support role. The person in this position will also design and implement vocational and meaningful day activity for each woman in the home.

d. programmatic Support

The home will share a Program Specialist (PS) with Community Lives project, who will facilitate the developmental planning process for the women in Supported Living home. This professional will have a background in psychology, education, or social work, and will be responsible for the completion of annual assessments, SRV use and advisement, inclusive practice advisement, the annual person-centered planning process, quarterly progress reviews, individualized goal plans, and individual program design. The Program Specialist will facilitate the use of all associated specialists in the “Specialized Services Pool” to be used for individual people as needed and identified in the Assessment and Annual Development Planning process.

E. Clinical supports

A range of supports and services will be provided as per the individual needs of each woman identified through her assessment. Such services will be provided on a contractual basis as required, and will include medical care, counselling, behavioural support, speech, occupational, and physiotherapy, educational tutoring, and nursing care.

SECTION 15: aCCOuNTaBILITy aNd SafEguardINg

Each home will be subject to monitoring and standards of all appropriate regulatory bodies. Levels of safeguards include the following:

1. Policies and operating procedures of the Supported Living homes, developed by the implementing organization and self-monitored by organizational management.

2. A collaborative assessment will be conducted by a selected team of trained project leaders, with the first assessment within 6 months of project start, and annually thereafter.

3. 24 hour on-call support will be available to the women staying in their independent homes, with emergency phones available to one person off site, to provide backup support, assistance, guidance, or crisis management.

4. Appropriate security will be provided in the home, first in the form of normative security located in access areas to colonies or apartment complexes. Being sensitive to the privacy of each woman served, CCTV will be considered for entrances and exits from flats or homes as is normative.

5. Excellent relationships will be developed with the local police and medical staff, to assure proper response and supportive assistance, if necessary, in the case of emergency.

6. Each woman served will be supported in the development of self-advocacy skills – learning to express opinions safely, understanding appropriate and inappropriate treatment by others, selfprotection, empowerment to speak out whenever they are not treated respectfully, and how and who grievances may be reported to. This will be the responsibility of the Program Specialist.

7. Adverse events: All adverse events and incidents will be reported immediately to management via the 24-hour management support system once immediate action is taken to assure the well-being of each person.

Adverse events are defined as:

1. Illness or injury of a person served.

2. Hospitalization,

3. Allegation of verbal, physical or psychological abuse

4. If a person served is missing or without supervision (if such supervision is required by assessment)

5. Involvement of police, fire, or ambulance services, facility malfunction in major system (flood, fire),

6. Other adverse events as identified, notifications will be made to all appropriate parties including guardian, Department of Women Welfare, KHSI-LO and KHSIA. A detailed policy will be in place to assure this process is in place.

SECTION 16: rIghTS Of pEOpLE SErvEd

Each person served will be fully entitled to the following rights, except where those rights are limited by guardians or official substitute decision-makers. The Bill of Rights will be reviewed prior to moving into the home and annually thereafter.

Each person served is guaranteed the following rights:

• the right to treatment in the least restrictive setting available

• the right to full participation in the development of treatment/habilitation plans

• the right to handle personal affairs including marrying, obtaining a divorce, writing a will, the control of personal money and possessions, holding public office and appearing as a witness or defendant before a court of law (unless declared incompetent by a court of law)

• the right to be assisted in the assertion of civil rights, see a lawyer or advocate at any time, and be represented.

• the right to receive and send unopened letters.

• the right to have ready access to telephones.

• the right to the freedom of thought, conscience, and religion

• the right to establish political affiliations of choice, and to vote in public elections.

• the right to unrestricted private communication the right to make complaints and to have unresolved concerns heard and resolved promptly.

• the right to not be subjected to any harsh or unusual treatment.

• the right to not engage in labour that is forced or productive labour for which there is not legal compensation.

• the right to be free of the forced wearing of distinguishing marks, clothing, uniforms, or labelling that subjects a person to prejudicial treatment.

• the right to not be discriminated against in the areas of treatment, employment, finance or housing because of race, creed, skin colour, caste national origin, sex, age, mental or physical disability or sexual preference.

A grievance procedure (ANNEX 1) is outlined for use when a person using services or their family member/ guardian believes that she is being denied the rights outlined and available to her, is not receiving adequate services, or is being treated unfairly. This grievance procedure is to be reviewed prior to moving into the program and yearly thereafter.

Upon request, an individual shall have a staff-advocate appointed whose sole responsibility is to assist the individual in the use of the grievance procedure. The individual shall receive a written response verifying the results of the inquiry for all grievances.

SECTION 17: famILy rELaTIONShIpS

When appropriate and possible, staff will make every effort to establish or re-establish positive relationships, with an eye to family reunification. If the person served is receptive, families will be invited and welcomed to visit the women in their home, attend annual planning meetings, household celebration, parties, and gatherings. Transportation will be provided for these visits where feasible. For the women served, relationships with extended family are another possibility, and efforts will be extended in this area as well. Individualized goals towards the strengthening of each person’s family ties will be included in the annual plan for each person and will be guided by the wishes of each person served, the history of the relationship with family, and the safety and well-being of the individual woman.

SECTION 18: hOuSEhOLd rOuTINES aNd hOuSEkEEpINg

The women living in the home will share all responsibilities and aspects of the household, including cooking, cleaning, shopping, and marketing, laundry, care of the home, budgeting for common expenses, and maintenance of the home, assuring dignified, safe, and healthy practices in each area. Staff will assist as necessary. Each of these areas will be considered potential goal areas for increasing independence and autonomy, with the staff taking an increasingly less prominent role as the women gain independence. Support staff will take special care to assure that positive and supportive relationships are forged with all neighbours and will instruct and support the women living in the home to engage in positive and helping roles as neighbours. Each woman will be supported to individualize the home, add personal touches, and collaborate with her housemate on care and décor of common areas. Regular engagement in community activities and individual engagement by the women in valued roles in the community is encouraged, and staff will be expected to accompany, teach, support, and engage in such activities with the people served as required.

The home will be kept in good repair, with high quality fixtures and fittings replaced and repaired as required due to wear and tear. The décor of the home will reflect the high value of the women living there, and any signs that this is a ‘program’ rather than a home will be minimized in every way.

Adequate supplies will be kept within the home to prepare and serve excellent, wholesome, high-quality food tailored to the needs, requirements, and preferences of the women living in the home. Staff are expected to share meals family style with the women as invited, modelling mealtime behaviour, encouraging conversation and a relaxed environment.

SECTION 19: hOuSEhOLd BudgET

As a part of the developmental curriculum, each woman will be supported to manage her personal funds as appropriate, and she will be given the opportunity to do so per her individualized plan. Each person served will be supported to gain access to any pension or monthly allotment of finances or aid she is due and access all government support programs. A normative portion of these funds will be contributed to the household budget. All personal funds will be carefully safeguarded and accounted for by program staff and will be used as per the choice of the individual person. Guidance and support may be provided by program staff as noted in the individual support plan to increase money management skills.

Household budgeting with pooled funds will be available to the women as appropriate to serve as an opportunity for developmental learning in budgeting and household finance. Staff will assure these are funds are fully protected, accounted for, and documented properly.

SECTION 20: dECISION-makINg aNd auTONOmy

Each person served will be allowed the maximum amount of decision-making as appropriate to her age, legal status, and developmental understanding. Efforts to increase each person’s role in decision-making in everyday choices and larger life choices will be on-going. When there is a substitute decision-maker appointed under the law, that guardian will be invited to participate fully in planning and program design and will be encouraged to maximize developmental opportunities to permit the individual person served to make choices, as is appropriate and reasonable, and always to keep the well-being of the individual at the center of the decision-making process.

SECTION 21: CONTINuum Of SuppOrT

In order to safeguard precious resources, as well as provide for a potential trajectory of forward life outcomes, person-centered planning will include a continuous effort to increase independence, decrease reliance on formal, paid support, and increase natural supports. Opportunities to encourage movement to more independent settings will be considered, as well as decreasing the number of paid staff support within the homes. Conversion to a family living model will always be considered, resulting in less costs, or in room made for more women to leave the shelter home. For some women, this may be ‘home for life’; for others, this may lead to other preferred living options. In either situation, this project will strive to support growth change, and transformation for each person, whatever their situation and desires for the future.

SECTION 22: mEdICaL SuppOrT

One of the most important, and perhaps demanding responsibilities faced is the coordination of medical treatment to ensure the best medical care is available to the women served.

Because many people with developmental disability are not able to communicate by conventional means, it is important that staff know the individual’s personality and how they usually express themselves. Unusual behaviour may be the only way that person can communicate to the community support staff that they are not feeling well.

Consistent observation and communication between staff will help ensure the health and well- being of each person served.

In an effort to provide on going and routine medical care to individuals, the project is required to provide pre-admission physical examinations, annual physical examinations, as well as annual dental, vision, and audiological evaluations. The latter three evaluations may occur more or less frequently as recommended by the attending physician. If psychotropic medications are prescribed, medication reviews with an experienced physician or psychiatrist are required every three months or as recommended. Under no circumstances can the medication reviews exceed six months for psychotropic medications.

SECTION 23: SafETy

By design, staff presence is provided as needed and required for safety and developmental support to the people living there. Initially, staff will be provided in the home 24 hours per day. An intensive training project will be provided to assure each person has safety skills in the following areas:

• Stove and gas safety

• Fire Safety

• 24-hour immediate staff support contact

• Police and fire numbers and ability to use them.

• Stranger safety

• Visitor safety

• Medications self-administration

• Food safety

• What to do in a medical emergency

• Other safety areas

• Community safety, including orientation, traffic safety, and money skills

The Program Specialist is responsible to conduct an assessment in each of the above areas and determine if the person can be left unsupervised by staff for any period of time and under what circumstances. Technology is encouraged to add safety features (such as automatic gas shutoff stove) that allow the women to be without supervision of staff. All team members must be notified when there is a change in supervision requirements, in writing.

In the event of any emergency or potentially dangerous situations:

1. Staff will take immediate action to preserve the safety and well-being of the individual.

2. Staff will notify the appropriate authorities (fire, police, ambulance, emergency) if necessary.

3. Staff will notify and inform management of the home using the management support system.

4. All adverse events and incidents will be reported immediately to management via the 24-hour management support system once immediate action is taken to assure the well-being of each person. Within 24 hours, notifications via an Adverse Event Report will be made to all appropriate parties including the Department of Women Welfare, KHSI-LO and KHSIA. A detailed policy will be in place to assure this process is in place. Adverse events are defined as: (1) illness or injury of a person served (2) hospitalization (3) allegation of verbal, physical or psychological abuse (4) if a person served is missing or without supervision (if such supervision is required by assessment) (5) involvement of police, fire, or ambulance services, facility malfunction in major system (flood, fire), and (6) other adverse events as identified, notifications will be made to all appropriate parties including Department of Women Welfare, KHSI-LO and KHSIA. A detailed policy will be in place to assure this process is in place.

5. Public or private statements to the media may only be made by designated senior leaders with prior written permission from The Department of Women Welfare, Government of Uttarakhand.

6. All staff will receive pre-service training in first aid procedures and managing medical emergencies.

7. Fire Safety Guidelines:

• Evacuation Plan: A written fire evacuation plan will be developed and maintained for all service settings, indicating the frequency of fire drills, the planned evacuation routes, designated meeting place, and emergency shelter locations.

• Equipment: Smoke detectors and fire extinguishers are required for each home, using recommended standards for the number of each. Fire extinguishers will be inspected annually by a certified professional, and the batteries will be changes on the smoke detectors twice yearly.

• Training: Employees are required to participate in and role model fire safety practices for fire prevention and evacuation. Both employees and people living in the home will participate in fire safety training upon hire/moving in, and annually thereafter. Education will consist of general fire safety, fire drill responsibilities, smoking safety, smoke detectors and fire alarms, emergency services notification, fire safety pan, and documentation requirements.

• Fire Drills: Fire drills will occur unannounced on a monthly basis, and at least one fire drill will occur during sleeping hours. All fire drills will be documented and reviewed by the Project Supervisor. Any difficulty with evacuating the home by the people living there will be addressed promptly through teaching plans and adaptations.

• Fire Department: Project staff will establish and maintain a collaborative relationship with the local fire department.

project Specialist

SECTION 24: pOSITION dESCrIpTIONS

The Program Specialist facilitates, manages, and supervises the developmental programming for people with disability to move towards full, rich meaningful lives embedded in their community. This is achieved by managing the assessment, planning, documentation, progress, and teaching plans for people with intellectual disability to live well within their community, growing and learning.

It also involves providing overall supervision and facilitation of the learning, developmental programming to assist the women in the Supported Living Project to learn, grow, and fill valued roles within their communities. This position is a part-time position which will involve supporting 8-10 people with intellectual and developmental disabilities.

direct Support Staff

The direct support staff will be responsible for the day-to-day smooth functioning of the project. This includes but is not limited to assisting each person to follow a flexible and normative schedule, provide dignified and private personal care, encourage good and firm relationships within the community and neighbourhood, work in shift duties, always be available during an emergency and willing to work extra hours. Their purpose is to ensure the safety and wellbeing of the women while supporting them to take valued social roles within the community. They will report directly to the Home Coordinator.

aNNExurE 1

grievance policy

Introduction- KHSIA recognizes the importance of good relationships between everyone we are associated with. We endeavor to establish an atmosphere in which problems can be discussed and resolved, and our aim is to encourage open communication. We are committed to providing an environment that ensures that every person is treated with dignity and respect and afforded equitable treatment. KHSIA will not tolerate any form of harassment and is committed to take all necessary steps to ensure that its employees are not subjected to harassment in any form.

All complaints of harassment will be resolved by the Complaints committee within 15 days of the complaint being made.

KHSIA understands that it can be difficult for the victim to come forward with a complaint of harassment and recognizes the victim’s interest in keeping the matter confidential in some cases. To protect the interests of the victim, the accused person and others who may report incidents of harassment, confidentiality will be maintained throughout the investigatory process to the extent practicable and appropriate under the circumstances.

All records of complaints, including contents of meetings, results of investigations and other relevant material will be kept confidential except where disclosure is required under disciplinary or other remedial processes.

We are committed to ensuring that no employee who brings forward a harassment concern is subject to any form of reprisal. Any reprisal will be subject to disciplinary action. The Company will ensure that the victim or witnesses are not victimized or discriminated against while dealing with complaints of harassment.

In conclusion, the KHSIA reiterates its commitment to providing every person with a space that is free from harassment/ discrimination and where every person is treated with dignity and respect.