Inspiring more ‘light-bulb’ moments
A group coaching technique called Action Learning is encouraging staff to think differently about the problems they face at work. Mike Bloodworth is trained in the process and enthusiastic about the results.
“In essence, Action Learning follows the principle that it is only the person with the problem that is able to find the solution that works best for them. Although other people may have had faced similar challenges, the problem won’t be the same as it will be viewed with different life experiences, different emotions, different perspectives and within different contexts. In Action Learning, the ‘problem-holder’ brings their issue to an Action Learning group, known as a ‘set’. The other members asks the problem-holder carefully constructed questions aimed to stimulate them to think differently about their issue – to create a ‘light-bulb’ moment. Action Learning peers are careful to not offer advice or guidance, but instead will act as ‘critical friends’ to enable the problem holder to realise their own solutions and actions.
The real learning takes place in between meetings when members are encouraged to test out their light-bulb moments in real-time. In this way, it is quite different from simply following instructions from a line manager or repeating the steps that someone else took when addressing a similar issue. It is between set meetings when true learning takes place, as we are given the space and time to try out our own self-identified solutions. In action learning, the problem-holder is committed to updating the group on the actions they have taken at the next meeting. If not resolved, then their problem will undoubtedly have changed as a result of taking action, and the set member can once again choose to re-explore their problem with their peers at the subsequent or future set meetings.
The system performs most effectively when the set is made up of people performing different roles within the organisation. This has been the case with the group I have been facilitating at Certitude. This set that I have been facilitating for the Individual Service Fund Pilot, has been meeting regularly for the last six 11 months and is made up of people from HR, Finance, Mental Health Services, Learning Disability Services.
Clearly ISF has thrown up some new and challenging issues which require creative solutions, so this has been a particularly useful time to introduce Action Learning. Each session begins with a catch up on previous issues and some shared learning resulting from any actions that have been taken and will follow by two or three problems being explored. I think there is something magical about the process and it has been inspiring to watch the set grow closer and more trusting of one another as the months have passed. The feedback from participants has been very overwhelmingly positive with everyone noticing an improvement in confidence and many also appreciating the opportunity for time out to reflect on their working practices. It’s been rewarding to see how people are putting what they have learned into practice and facing up to their challenges with more self-belief, being bolder in their decision-making and seem more willing to try new things as well.”
A Planning Live session benefits from an optimistic atmosphere which may be why a Saturday session proved such a success for the three people who live at Uneeda Drive. Manager Mercy Cole and her team arranged their session at the weekend to ensure everyone could make it and the large open-plan mezzanine area at Westgate proved a relaxing space to accommodate the people who live at Uneeda as well their families and the staff who support them.
May Lee, Certitude’s Person-Centred Development Manager, facilitated the session which was designed to enable everyone to share their views and to think creatively and positively about how the people being supported could have more choice and control over their lives. Everyone was encouraged to talk about their dreams and aspirations and to feel unrestricted in planning what their lives could be like in the future.
The session started with an introduction from May and the chance for everyone attending to share something about themselves with the group. Next they moved onto break-out tables with the person being supported and everyone involved in their circles of support on each table. Each group was given a series of headings to assist the discussions. These included: What is working; What isn’t working; What is important to me now? and What is important to me in the future.
As well as considering ways in which overall support could be more personalised, the session also looked at how people would like to spend their “In My Control Hours”. These “In My Control Hours” had been identified as part the Individual Service Fund pilot using a Care Fund Calculator.
On average each person at Uneeda has 4-5 hours per week within their individual control so this Planning Live Session provided a great opportunity for some blue-sky thinking about how people would like to spend their free time.
The hopes and aspirations of the participants ranged from specific objectives such as “finding a girl to have a relationship with” and “learning to drive”, to more on going requests such as “getting out and about more”, “making new friends” and “keeping in good contact with my family”.
For Mercy and her team of Support Workers the next step is to implement more personalised rotas and to find new and creative ways to fulfil these aims. We’ll keep you up to date with how everyone at Uneeda is getting on in a few months.
Assistive Technology – a way forward
“I’m a bit of a geek when it comes to gadgets so when I heard the management team were looking for someone to take on responsibility for assistive technology I was quick to put up my hand.
Assistive technology is defined as any item of equipment or system that is used to maintain or improve the functional capabilities of individuals with disabilities and it covers everything from a simple alarm to the latest in biometrics. I like solving puzzles and problems so researching the latest technology and finding the best ways to apply it to the people we support is right up my street.
I am in the process of assessing how assistive technology can help all the people we support and I am starting with everyone involved with the Individual Service Fund pilot. Establishing ISFs and identifying “in control hours” is about giving more choice and control to the people we support and helping them achieve as much as possible within their own budget. The application of new technologies can often help us achieve both objectives.
It requires a different mindset to resolve traditional problems with assistive technology so I am meeting with everyone involved in the ISF Pilot to talk to people about what it is and how it works. We are already beginning to find some new solutions to old problems.
Accessible technology such as tablets and iPads are proving a great help for many people – especially in the area of communication. One lady we support who uses Makaton now has an iPad with a Makaton App. She takes it with her when she goes out and uses it to communicate in shops and cafes. It means can choose to do things for herself and can go out on her own. Not surprisingly, it’s transformed her life.
We are also realising how technology can help in shared services where people have different support needs. For example, we currently have a house where two people live with one support worker; one person likes to stay in a lot and the other one likes to get out and about. It has been hard to leave the individual in on her own as she likes to answer the phone and front door – which can be unsafe. If we apply up to date call barring technology, install a new front door security system and equip her with a mobile phone it may be that we can minimise the risk and give both people more of the kind of lives they want to lead.
I’m working closely with our creative communication specialist, Lucy Harrison, to see how additional equipment can support her Intensive Interaction programme. We are looking into speech generating devices like those produced by DynaVox and an incredible gadget called the V-Pen which actually ‘reads’ sound codes off printed paper.
It may all sound a bit MI6 but applications like biometric finger-print recognition, GPS location bracelets and eye-movement operated computers are all on the market and readily available. Technology is evolving all the time and we need to keep abreast of the changes. Assistive technology is opening up new opportunities for the people we support and I am excited to be part of an innovative team which is making the most of everything that’s available.”
Philomena Strollo, Service Manager
Ben and Manjoula’s journey of discovery
Having recently undergone intensive person-centred training, Support Worker Ben is making good use of his new skills to find out what makes Manjoula tick.
“Manjoula has been living at Van Gogh house for several years and more recently it seems as though her life has contracted. She no longer wants to go out on her own – something she was happy to do when we first knew her – and she isn’t really interested in any of the activities we offer her,” explains Ben.
Manjoula’s reluctance to communicate or join in with activities was starting to leave her isolated. Ben applied his person-centred training and spent time with her to try and discover new ways to support her.
“Person-centred tools such as Perfect Week and Circle of Support helped us confirm that Manjoula’s Mum is very important to her, that she enjoys shopping and that she doesn’t like classroom based activities,” says Ben. “But I soon realised that person-centred thinking required a complete change in the way I think and work – aside from these processes. It made it essential for me to take a step back and to stop making assumptions. I think I learned most about Manjoula by taking the time to get to know her better, by observing her and by giving her time to make her own choices.
“For example, it became obvious from our shopping trips that Manjoula loves make up and nails– so now we are in the process of setting up a nail painting group. Similarly, Manjoula has stuck to a rigid and restrictive diet, but by taking the time to let her show us what she likes by letting her sort through the food cupboards we have been able to expand her menus. Breakfast was always tricky but now we have found out she loves Weetabix – quite a discovery!”
It also became clear that Manjoula’s circle of support – both paid and unpaid – could be expanded. Her apparent reluctance to “join in” had left her with a limited number of acquaintances and Ben was keen to find some more activities which Manjoula would enjoy and where she could make new friends.
“We were all surprised to find out that Manjoula enjoyed drama. She was given the opportunity to visit a local drama group with someone else from the house and she hasn’t looked back since. She goes once a week from 10 – 4pm and seems to particularly enjoy the improvisation.”
Manjoula has also found a local weekly church group which she likes to visit and is planning to try her hand at bird watching in the Spring. Manjoulas’s enjoyment of a night out at the pub has inspired the Van Gogh support team to set up a Monthly Pub Group with people from other Certitude houses locally. The group plan to try out a number of local pubs and will be reviewing the service, accessibility and welcome of each hostelry after every visit!
With Ben’s support Manjoula’s life is expanding, her weekly routine is taking on a new shape and her circle of support is growingAnd according to Ben the change in Manjoula has inspired the entire Van Gogh team to work more closely together.
“I’ve really enjoyed this last six months, learning more about person-centred practices and getting to know Manjoula,” says Ben. “I’m looking forward to sharing more of what I’ve learned with everyone else at Van Gogh. If I had a top tip it would be to stay determined, encouraging the person you are supporting to take centre stage in their own lives can be challenging, but the results are definitely worth the effort.”
Achieving true control
“This Individual Service Fund pilot has pushed us all to be more focused, risk-taking and person-centred. We have supported David for several years during which time, his life was hampered by his diabetes. We were amazed that with just two sessions with the community nurse David could manage his own insulin injections. Now he is in control of his own medication and doors have opened up all over his life.
Looking at David’s Perfect Week and the results of his Planning Live session it was clear that David was frustrated by the unchanging routine of his life which involved weekdays spent at a day centre and every weekend with his parents. He wanted to get out and about more, meet people, and get a job. David is fun and sociable and wanted to live more like any other young man in his thirties.
Once David was in control of his own diabetes – and he now takes his own blood sugar readings as well as managing his injections – we could explore so many more options together. In a matter of six months his life has completely changed. He cut down his day centre visits and they will probably go completely in September when he hopes to start a college course. He has a job at a cafe at Ealing Hospital which is supported at the moment but we expect him to go alone in the next few months. He travels there on the bus but only needs “shadowing support” so he’ll soon be doing that on his own too.
During the day David works out at a general keep fit class at a local church, enjoys urban tours with the Ealing Mencap Bike Hub and goes on lots of trips with Out and About. He hits the dance floor in search of a girlfriend on the last Friday of every month at The Bass. He’s met a few nice girls, there’s no one serious so far – he has made a lot of new friends though.
We’re planning a holiday to Tenerife in September where David might slow down a bit. He loves the sun and enjoys lazing the days away on the sun loungers. I might need the rest too! David’s new life is pretty hectic and demanding but the positive nature of the change has brought all the Support Workers at Uneeda together as a team. It’s invigorating to watch his transformation and his progress is so fast-moving we’ve started writing a blog to exchange news about how he’s getting on. It’s more fun and informative than writing notes and it means we’re all up to date with what’s changing.
Before it was like David was living the life others wanted for him – now he is living his own life. He’s getting to know himself and is happy to tell us what he wants. He is making friends and contacts wherever he goes and it feels like there are so many opportunities for him to explore; I’m looking forward to what comes next.”
Steve Penfold, Support Worker, Uneeda Drive
Lambeth Team turns things around!
A new manager, some fresh ideas and a real sense of equality has transformed the lives of the people we support who share a house within Lambeth.
Several years’ ago we recognised that the support we were offering was not up to scratch; the people who live at this property have learning disabilities and complex needs and they were not getting enough choice and control over their lives. To shake things up we introduced a new house manager and she has created a team so dynamic, imaginative and cohesive that we wanted to share their learning with everyone in the organisation.
The first thing the new manager Catherine did was to encourage staff to take more time getting to know the people they were supporting. They used person-centred thinking to actively communicate with people living at the house and to find out as much as possible about them as well.
As some of the people find it hard to communicate verbally, the manager called in our intensive interaction specialist, Lucy Harrison, who showed the team different techniques to encourage people to open up. This has altered relationships in the house dramatically with people who had previously resisted most attempts to communicate, now initiating interaction themselves.
Staff have been encouraged to be more risk enabling and new ideas are welcomed. Catherine supports staff when they want to do something ambitious or different which is illustrated perfectly by the activities of Joseph who, it turns out, really enjoys clubbing and football. Lewis and Richard, who support Joseph, organised a night out clubbing and they all got in at 5am. The same day they got themselves up and out to watch Crystal Palace play a match in the afternoon. Just a regular weekend for many guys his age, and now the first of many for Joseph. In fact last we heard Joseph is on the VIP guest list of his favourite nightclub!
With a blast of new ideas and energy sweeping through the house, the team has also learned to support one another more effectively. They have welcomed apprentice support workers – and their bold ideas – and have a greater respect for one another as well as the people they support. They recognise their strengths and weaknesses and support each other when things don’t go to plan.
Catherine says: “The team are always looking support people to try new things based on person centred principles and staff matching. The team also work much better together, accepting and working with strengths and needs. They understand that they must work together to offer the right support and understand the importance of supporting people with profound and multiple learning disabilities. They know even though things can sometimes be tough that it is also so rewarding.”
The team has also become genuine advocates for the people they support. This is illustrated once again by the team who argued against Nicos being moved to a nursing home. The whole team set about showing how things could be adapted and now Nicos has been able to stay in his home where he is happy.
As well as a considerable shift in attitudes, some practical changes have made a difference. Accessibility has been improved with new kitchen adaptations for wheelchair users and a coat of paint and better decor throughout the house have created a more homely environment.
Learning Disability Director, Janette Gaffney, has met the team to talk about their approach and achievements, and is keen to see the same transformation in other properties.
“I am thrilled by the energy and enthusiasm which comes from this house. It’s a real joy to see this cohesive group of people out and about, supporting each another and having fun. It is clear that spending time building good relationships and embracing new ideas is at the heart of this team transformation.”
A positive impact
There’s no question that the positive impact of the ISF pilot is rippling out across our organisation. I am excited about the changes I am seeing – and feeling – around our services. I am beginning to notice a power shift as the people we support are empowered to take more control over their own lives and those of us supporting are encouraged to think bigger, bolder and more creatively about how we play our part.
Of course, all this change can be challenging and I know we still have a long way to go to move some entrenched views. Person-centred thinking tools are a good way to instigate change and I think they have helped many of us understand how much more we can be doing to help the people we support live the lives they want.
In many ways person-centred thinking is simply a common sense approach. It hands control back to the people we support and it encourages a risk enabling approach which is invigorating for everyone. For example I recently spoke to a support worker who was concerned she would need to undertake a risk assessment before someone could go horse riding, “in case they got kicked by the horse”. I pointed out that anyone could be kicked by a horse and that with some simple instructions (“don’t walk behind the horse”) there was no need for undue concern.
Another way we are beginning to think differently is in the way we connect with local community groups. These groups can be anything from voluntary organisations and charities to support groups and dance classes. Matching people up with a suitable group or activity can be a simple and effective way of expanding social networks and building independence. We recently ran some Community Development Training at Westgate which asked participants to go out into west London to find out what was on offer locally. One Support Worker told me afterwards, “This has completely transformed the way I think and work. It’s opened my eyes to the opportunities which are out there for people.”
The ISF pilot has also encouraged those involved to get together and exchange ideas. We recently held some workshops to talk about what we felt was working and not working and this process of getting together and exchanging ideas was stimulating. Perhaps there are lessons for us as an organisation to try to get teams together more often; it certainly seems to boost morale.
There’s no question that the change required to make Individual Service Funds successful is significant but we are well on our way. We have to challenge ourselves so that people we support can have more choice and control over their lives. And as we embrace this bolder approach our jobs will become more rewarding, more interesting and yes, I think more fun.
Janette Gaffney, Director of Learning Disability Services
Mental health services join the ISF pilot
Hirila Anaughe is a Supported Living Manager and is overseeing the Individual Service Fund pilot in two residential registered mental health services in Lambeth.
We started this process about six months after the learning disability directorate started theirs, so we are in a position to learn from their approach. We have started by using the Care Fund Calculator (CFC) to help us assess how support is currently being provided to people. It’s important to be accurate in measuring how we spend our time to ensure we can properly identify a person’s “in my control” hours. We defined these hours as one to one hours in which the person being supported could change the purpose of and had maximum choice and control over .
The CFC is a desk top exercise. We made good initial estimates about people’s hours in the first instance but we are still making adjustments. As a final check we are currently accounting for every half hour of our time over a four week period. To be honest it’s been a cumbersome process but worthwhile; I’m confident that this will give us the best possible measurement.
Once we have the CFCs sorted our next step is planning with people and we’re looking at how we can do this in a way which best suits the people we support. We have had informal discussions with people and it’s become clear that they aren’t interested in a group planning approach such as *Planning Live, so we’re going to take a more individualised approach. We’ve identified a couple of excellent facilitators who are having extra training so we hope to be ready to move on this in the New Year.
One of the most obvious benefits of the detailed person-centred approach required for the ISF pilot is how we talk to individuals – both in the questions we ask, and how we ask them. We are shifting the emphasis away from it all being about managing risk and giving people more opportunities to do what they really want to do.
Many staff have really embraced this approach – particularly managers. For some, however, it has been more difficult. Staff inevitably build up close relationships with the people they support and I understand that they want to protect them, but I think we have to let people explore more options. Everyone should have the opportunity to learn from their experiences, both good and bad.
It can be challenging when we are working with people who find it difficult to identify what they want to do. Many of the people we support have spent their lives being told what to do by doctors and social workers. They aren’t used to being asked for their opinion and so they aren’t sure how to express it. Fortunately as a team we have had a lot of person-centred training so we are well equipped with the tools we need to help people find their voice.
Day to day we are already seeing the benefits of being more person-centred. We are working with eight people within the ISF pilot but I have changed my approach in all the services I manage and I am encouraging my staff to do the same. We are changing shift patterns to give people more choice about who supports them and we are doing our best to put them at the centre of decisions which affect their lives.
I have been really pleased to have been involved; I’ve learned a lot and I can see the change we are making. If I were doing it again I would have liked more time for team meetings to get everyone together at the same time. There is a lot of support to be gained from hearing about other people’s experiences – both positive and negative. Implementing something new like this can sometimes feel hard and isolating but when you feel you are all in it together it can make a big difference.
*Planning Live is the process of getting the individuals, families and staff together to gather information and plan. Planning Live balances sharing information and examples with the whole group with working in small teams around each individual.
Natalie explains the Care Fund Calculator – the challenges and the breakthroughs
Natalie Bishop is Certitude’s Personalisation Accountant. She plays a pivotal role in the Individual Service Fund project as the person who best understands the workings of the Care Fund Calculator.
“Before we started on this pilot I had been trained in using the Care Funding Calculator (CFC) and had used it for a couple of other projects. However, it wasn’t until we embarked on our own Individual Service Fund pilot that I fully understood how this tool can be applied not just to cost support – but to help us reach a better understanding of how support is being provided. I realised that the CFC can be adapted to different situations; the key is that everyone involved in using the CFC uses it in exactly the same way and adheres to the same definitions of categories of support.
The CFC basically enables us to split a person’s support time into three categories; “one to one”, “shared” and “background”. Once these categories are defined and people are clear about the activities they entail, the process becomes relatively simple. Although I had run some training sessions for groups of staff I thought it would be better to train managers on the CFC individually and face to face. Sitting down with each manager and going through the first one carefully and in detail usually takes about an hour, but once the process is underway and the important questions have been answered each case might typically take 30 minutes.
The CFC has now been completed for every individual in the pilot and most have been validated (by double checking our timings are correct, checking for input errors in the Needs tab, ensuring that the total hours make sense given the staffing establishment at the service, etc.). It has been hard for me to let go but it’s important to move the responsibility for these plans as close as possible to the individuals being supported.
I’ve really enjoyed visiting people and their teams and finding out more about what goes on – I know we are doing a really positive work and it makes me feel good about my job. To begin with I found it quite isolating to be the only one in the organisation who really understood the details of the CFC so it’s been great to share this knowledge and to see how well it is working. While I have had some great support, especially from May Lee, it has felt like quite a responsibility.
It’s been a challenge for me to live with some of the uncertainty which goes with a pilot like this. Decisions take time and plans get delayed and I have learned to cope with that. One example of this was the need to create a proper definition of “In my personal control” hours as the one we were working with was too vague. This took several meetings with senior team members and a lot of discussions but in the end we defined these hours as any one to one hours in which the person being supported could change the purpose of and had maximum choice and control over. So for example, they had given their input on how the time was being spent, who the time was spent with, when and where the activity was undertaken and what was being done. It was quite a breakthrough and I’ve discovered that these breakthroughs take time and hard work.
If I was advising someone in my position embarking on this project I would recommend that they make time to take the big decisions early on – once the difficult questions are answered the rest falls into place. So for example, what version of the CFC you are going to use, who is responsible for each stage of the process and how will the allocated time be valued in monetary terms once it has been identified. At the same time I would caution against over-complicating, sometimes keeping it simple works. I would certainly suggest one-to-one training for managers – that was really successful – and finally, I would say don’t reinvent the wheel. There is a lot of information available on this subject in books and on the internet – so you might as well use it.”
Natalie Bishop, Personalisation Accountant
Daunting? Not any more. Carolyn Berry discusses her involvement with the ISF project
When I was first asked to be involved with the Individual Service Plan pilot I was pleased but also daunted. My role is to implement the plan at house level, working with two managers across three houses in Hounslow. I can see that these changes will improve the lives of the people we support and I believe in them, but when I first saw the project plan I was overwhelmed by the scale of the task and the potential impact on my workload.
The first thing I did was work with May Lee, Certitude’s Person Centred Development Manager, to break down my part of the plan into more manageable chunks. Suddenly everything looked more possible. We also tweaked some of the time frames to create more achievable deadlines. May has been an incredible support throughout this project and my regular meetings with her are really important to me.
I soon realised that a face to face approach was also going to get more positive results with my own managers. Originally I had asked them to write specific plans for their houses – these were not forthcoming! So instead, we decided to sit down together and work out a plan as a team. We soon discovered that three heads are better than one and together we created a workable step by step approach. Just like me, my managers had been daunted by the project and the prospect of writing their own plans seemed too big a task. By working together the undertaking became much less intimidating. Now we have regular team meetings so we can share our ideas and learn from one another’s experiences.
I’m pleased to say that we’ve made a lot of progress in the last couple of months but some of the results have been unexpected. We began by applying the Care Funding Calculator (CFC) which involves identifying support needs and the setting of costs at an individual level. By using the CFC, we’ve found that many people do not have as many ‘In my personal control‘ hours as we expected. It’s good that the new system will make sure we act to improve the situation.
There’s also been a lot of information gathering – for example, charting a ‘typical week’, making notes on important relationships and places and testing out ‘I statements’. I’ve learned that some people are better at encouraging people to talk than others. I discovered that one member of staff, who has a degree in drama and is a brilliant communicator, is particularly talented in this area so we have used her skills to help other key workers.
This project has taught me a great deal and I am really pleased to be part of it and the more I get involved the more I appreciate what the benefits will be to the people we support. Social Care is well-known for being slow to react, but by using person-centred tools and following a step by step approach I can see change happening fast – and it’s pretty exciting.