Thistle’s journey towards a person centred approach15 years ago Thistle Foundation became serious aboutcommitment to person centred services. Social care worldchanging 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 newworld:• 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 oncourse 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 practiceAll staff development activities delivered by Thistleemphasise the concept of: A person centred relationship with intent
Person centred approach – a trinity Identifying and realising personal outcomes (aka personalisation) A relationship based A focus on assets and on the core conditions positive reputations
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‟dWorkers 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 linkbetween person centred relationships and working towardspersonal 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 supportQuality of life Process Change•Feeling safe •Listened to •Improved•Having things to •Having a say confidence /do •Treated with morale•Seeing people respect •Improved skills•Staying as well •Responded to •Improvedas you can •Reliability mobility•Living where •Reducedand as you want symptoms•Dealing withstigma/discrimination
Supporting person to identify and realise outcomes•Holding good conversations (include people who don‟tcommunicate verbally), actively listening to find out whatreally matters to the person in life – the outcomes•Working with persons outcomes to identify what activities,supports and/or services are required to realise them overagreed timescale•Maximising person‟s own assets, strengths, skills, andinvolvement in realising their outcomes along with family,community etc.
What kind of outcomes?Input Process Outputs OutcomesJoe, Joe‟s Meet Joe, listen Training Joe wants toSW, to him, find out certificates; do somethingEmployment what he can do, supported with his time toAdvisor, what he‟s paid or unpaid feel good andSupported interested in job to increase hisEmployment doing ; book skills.service training courses.Ann, Ann‟s Meet Ann, listen Plan for Ann‟s Ann wants tofamily, Ann‟s to her hopes, supported self stop worryingSW, Heart discuss how management aboutFailure Nurse everyone can diagnosis and support Ann to get back to live her life 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 forthemselves and with others – not services – delivers thebulk of social outcomes”Routledge and Witton, 2010
Contact usThistle Foundation:Nikki Bruce Nikki.Bruce@thistle.org.ukLearning and Development ManagerGail Cunningham Gail.Cunningham@thistle.org.ukResearch and Development CoordinatorJoint Improvement Team:Chris Bruce Chris.email@example.comLead on Outcomes
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