parallel session 4.2 ‘it’s what matters to me that counts’ – keeping the person at the heart...
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“It’s what matters to me that counts” – keeping the person at the heart of the services we deliver
Real Change
“When people not used to speaking out are heard by people
not used to listening, then real change is made”
(John O’Brien, undated)
Improved confidence and skills
Improved mobility
Improved symptoms
Smale et al (1993)
Thistle’s journey towards a person centred approach
15 years ago Thistle Foundation became serious about commitment to person centred services. Social care world changing rapidly:• large institutions closing• people previously considered too disabled or too
challenging returning to the community• existing services not able to respond to needs and
many new provider organisations emerged
So…
Thistle acted decisively and radically to survive in new world:• Implemented complete service restructure and redesign:
residential homes closed, people supported in own homes, including people with much more complex medical and social needs
• Expected staff to work in new ways, grappling with concepts such as empowerment and inclusion
• Invested heavily in the development of new accredited training programme for support staff
HEC in Person Centred Approaches
• From 2002, over 600 support workers (in Thistle and other agencies) undertook this course, accredited by Queen Margaret University
• Course synthesised ideas from person centred therapeutic approaches (Carl Rogers) with person centred planning tools and concepts originating in North America and Canada (Michael Smull; John O’Brien and others)
Fast forward: What worked well?
• Course very successful, winning several awards• Led to many positive changes in work practice resulting
in better outcomes for people using services• Workers very focussed on building best possible
relationship with person being supported • Experiential nature of learning worked: workers learned
much from sharing in consistent cohorts • Length of course (two years part time) helped to process
learning and embed practice change
What else?
• Workers embraced modules relating to self awareness
• Workers became more reflective - aware of values, prejudices, strengths and development needs – and able to work on these
• Workers understood what is meant by active listening
What didn’t work so well?
In a number of cases, while huge beneficial impact on
course participants, this not translated into equally
positive changes in quality of life of someone using service
Which meant that...
• Workers did not always recognise development and maintenance of ‘right relationship’ was for clear purpose - to be able to recognise and work towards personal outcomes
• Sometimes when workers attempted this, focus was on outputs rather than outcomes
• Some workers stuck in ‘helper mode’, thinking they knew what was in person’s best interests based on own values and judgements
Putting our learning into practice
All staff development activities delivered by Thistle
emphasise the concept of:
A person centred relationship with intent
Person centred approach – a trinity
Identifying and realising personal
outcomes(aka personalisation)
A focus on assets and
positive reputations
A relationship based on the
core conditions
What does a person centred approach mean in practice at Thistle?
Workers must be able to...
• Keep person at centre – and in control - of process
• Build strong, real and respectful relationships with person using the service
• Focus on person’s assets and strengths
• Involve family and friends as partners
Cont’d
Workers must be able to...
• Focus on what’s important TO person...........while also paying attention to what’s important FOR person [ health and safety and safeguard positive reputations]
• Intentionally sustain and build connections in community
• Go beyond conventional service responses
• Continue to listen and learn with person
Simultaneously…
Organisational systems and processes:• Strategic direction must reflect outcomes • Language must be used consistently • Person centred relationships must be modelled • Policies and procedures need to be responsive to
individual needs, as well as fulfilling statutory requirements
• Participative leadership needs to move from rhetoric to reality
• Cross organisational working groups can help e.g. Personal Outcomes Group
One of the things that is making a significant difference…
Using Talking Points framework helps to embed link
between person centred relationships and working towards
personal outcomes
Talking Points – A Personal Outcomes Approach
• Outcomes are the end results of support and/or service(s) in the person’s life
• 15 years of research identified a framework of inter-related outcomes relating to:
• Quality of Life (getting or maintaining it)• Process (interaction between staff and person)• Change (for a better life)
Outcomes for people we support
Quality of life Process Change
•Feeling safe•Having things to do•Seeing people•Staying as well as you can•Living where and as you want •Dealing with stigma/discrimination
•Listened to•Having a say •Treated with respect •Responded to •Reliability
•Improved confidence / morale•Improved skills•Improved mobility•Reduced symptoms
Supporting person to identify and realise outcomes
•Holding good conversations (include people who don’t communicate verbally), actively listening to find out what really matters to the person in life – the outcomes
•Working with person's outcomes to identify what activities, supports and/or services are required to realise them over agreed timescale
•Maximising person’s own assets, strengths, skills, and involvement in realising their outcomes along with family, community etc.
What kind of outcomes?
Input Process Outputs Outcomes
Joe, Joe’s SW, Employment Advisor, Supported Employment service
Meet Joe, listen to him, find out what he can do, what he’s interested in doing ; book training courses.
Training certificates; supported paid or unpaid job
Joe wants to do something with his time to feel good and to increase his skills.
Ann, Ann’s family, Ann’s SW, Heart Failure Nurse
Meet Ann, listen to her hopes, discuss how everyone can support Ann to live her life
Plan for Ann’s supported self management
Ann wants to stop worrying about diagnosis and get back to doings things she enjoys
What are we learning?
• The personal outcomes journey takes time• Don’t start with paperwork• Improve practice before proving practice• To measure the difference made, get a baseline• Common language in recording is essential for
consistency• Workers need ongoing support and feedback• Record all contributions (not attributions) to outcomes –
not just Thistle service
A cautionary reminder…
“The overwhelming evidence is that what people do for themselves and with others – not services – delivers the bulk of social outcomes”
Routledge and Witton, 2010
Contact us
Thistle Foundation:
Nikki Bruce [email protected]
Learning and Development Manager
Gail Cunningham [email protected]
Research and Development Coordinator
Joint Improvement Team:
Chris Bruce [email protected]
Lead on Outcomes