Posted on January 28, 2021

By Michael Clausen

Education, Experience and Exposure. If you have worked with CQL | The Council on Quality and Leadership, you have likely heard this phrase. Education, experience, and exposure – or the Three E’s – play a fundamental role in all of our lives. People make choices from the moment they wake up until they go to sleep. The ability to make a choice is often taken for granted.

Whether this means choosing what you will have for lunch or choosing an elected official through casting a vote, we all have an expectation of being able to make decisions about day-to-day happenings, as well as those that affect our entire lives. Choice is a fundamental right.

We make choices based on information. We may choose a certain restaurant for their great food or service. We might choose a service based on the recommendation of someone we trust. When we don’t have the information we need, we might look for online reviews in order to better inform our decision. This informed choice is based upon something we might have experienced, had exposure to, or been educated about.

For people that receive services, choices are often limited or made by someone else because of assumptions about ability or concerns about ability. For service providers, there is real value in providing education, experience, and exposure as a tangible action that is fully integrated into the supports we provide, or even as a goal in and of itself.

The Three E’s & The Personal Outcome Measures®

The Personal Outcome Measures® (POM) reflect a person’s quality of life and the quality of services they are being provided. It is no coincidence that this internationally-recognized tool is rooted in informed choice and control.

In determining whether or not an outcome is present – such as ‘People choose where and with whom they live’ – people are not asked if they are satisfied with where and with whom we live. We ask whether they are choosing where and with whom they live. We assess whether people are choosing the type and frequency of this and other indicators including social roles, relationships, and participation in the life of the community. In fact, data suggests that people are 24.0 times more likely to choose where and with whom to live when organizations support people to explore all housing options so they can make informed choices.

The common denominator for all 21 outcomes is informed choice. People define what each outcome should look like for them. Because of this, supports can only be considered present when an organization understands and is responsive to the person’s definition.

The Three E’s Can Impact Outcomes

CQL data demonstrates that when organizations are providing education, experience, and exposure in relation to an outcome, it is more likely to be present. When the Three E’s are provided, the quality of our supports and the quality of life for people improve. POM data suggests that people who have the education, experience, and exposure necessary to make informed choices are more likely to have increased quality of life, such as to be free from abuse and neglect, have best possible health, participate in the life of the community, and have intimate relationships.

For example:

• When organizations provide people with information and education about exploitation, people are 2.5 times more likely to be free from abuse and neglect.
• When organizations support people to be aware of their medical issues and their impact, people are 11.6 times more likely to have the best possible health (outcome present).
• When organizations provide people with access to information about options for community participation, people are 6.5 times more likely to participate in the life of the community.
• When organizations assist people to explore and evaluate experiences in order to make informed choices about intimate relationships, people are 3.9 times more likely to have intimate relationships.

Sarah’s Decision-Making Journey

By Jennifer Dance, Quality Enhancement Manager, Community Living Oakville

Have you ever had to make a decision that caused knots in your stomach – the decisions that sometimes you avoid making so you don’t feel anxious? This is the story of Sarah and her journey of decisions to realize her dream.

Sarah is a woman who is supported at Community Living Oakville in Ontario, Canada. She moved into a home – a group setting with 3 other people – operated by the agency when she was 24 years old. Although she was glad she was able to take that natural step of adulthood and independence by moving out of her family home, she started thinking that maybe she did not actually need all of the support that she had been receiving through the organization. Maybe living with three other people was not what she wanted long-term.

Moving out on her own into an apartment is where she wanted to head next. Although there were many exciting thoughts about moving on her own, such as improving her privacy and doing what she wants when she wants, making this decision was also met with worries.

“I was worried I wasn’t ready. I was nervous about actually being on my own,” shared Sarah. She was thinking through questions like would she have enough money to pay her bills and would she be able to find an apartment where she knew people?

Important Choices & The Three E’s

Sarah’s support team was confident that she would succeed on her own, but making the decision had to come from Sarah. Community Living Oakville worked with Sarah to ensure that she had all the tools and the best information to make her decision. Over the course of a couple of years, Sarah and her team focused on ensuring that Sarah had the Three E’s – Education, Experience, and Exposure – to make the choices that worked best for her, when it worked best for her.

And so began the journey. Sarah searched online and in newspapers for available apartments. In addition, she talked with friends who lived on their own and came to realize that she wanted to live near those friends, while also being close to public transit and near amenities. Sarah visited different buildings and met with friends so she could have experiences to make her decision. She developed a budget and felt financially secure as she had a job. On paper it all looked good. She was ticking all the boxes to make her choices and live out her dreams.

Decision-Making Through Mindfulness

However, there was always anxiousness rearing its head and causing her to worry about the unknown. This is where Sarah and her support team delved into mindfulness to help Sarah in areas where she was worried. Sarah learned how to meditate to keep a clear mind and utilize music therapy to help herself when she feels emotional. “Sarah has embraced mindfulness. She has come to know her comfort zones and how to be grounded in the moment,” says Laura, Sarah’s direct support professional (DSP). “She has learned how to react based on experiences.”

In December, the call came and an apartment in the building she chose was available! It was ‘go time’ and she needed to make that decision. With her armor of Education, Experience, and Exposure, she had the confidence to feel she was making the best decision for her.

Today, Sarah is loving being on her own. She still gets support from Community Living Oakville and still practices her mindfulness and music therapy. “I love having my own place. I love my neighbourhood and there are so many cute shops that I can walk to and I love that I have friends in my building to reach out to when needed. When I get anxious, I can meditate or go for a walk. Some people doubted my ability and I love that I was able to prove them wrong.”

Integrating The Three E’s Into Our Work

In order to promote quality, organizations must become more intentional about providing education, experience, and exposure. People learn through their experiences, even when these experiences do not go as planned. In fact, it is often our mistakes that allow us to make better choices in the future. While we should take steps to prevent people from putting themselves into truly dangerous situations, the opportunity to fail and the related dignity of risk should be recognized by organizations as fundamental rights.

There is tremendous opportunity to integrate the Three E’s into our organizational values, staff development, and the supports that we provide. Education, experience, and exposure, or the Three E’s, is more than a slogan. It is a way to support people.