To start, usually I think of something I want to do and just start designing. But sometimes I think of things when I'm not at my computer, so they end up on random scraps of paper, like this:
And then I work on it in Illustrator til it looks like this:
Then I print them out on high-quality paper.
I mix the paint colors to match:
And then handpaint the edges of the wooden plaques.
Finally, I adhere the printouts to the plaques, trim them, add the hangers and any extra bling, and voila!