Category Archives: Person-centred working

The Art of Co-ordinating Care

Person-centred (2009)
Person-centred (2009)

Care co-ordination, the role of the care co-ordinator, has become a challenging function of our care and support services, attracting more than its fair share of negative connotations. A genuine tension exists between the passion and artfulness of human relationships on the one hand, and the pursuit of a scientific basis for interventions on the other. The science of research seeks to impose a sense of reassurance by means of consistent results when defined sets of circumstances are observed or applied.

By contrast, the quality of an artful endeavour may be measured more by its emotional characteristics and the feelings it engenders in those involved or observing. In reality, the experience and practice of mental health and learning disability services is primarily a study of people’s emotional experiences, feelings and behaviour patterns. So we should be wary of any attempts to understate the elements of artfulness and passion; and we should recognise the potential impact this may have on our enjoyment of the work, as well as our motivation for doing it.

Arguably, one of the most crucial effects of the evidence-based practice focus of research is that it undermines the art of relationship-building. The pursuit of a rigorous scientific rationale places a clear priority on the cult of numbers. ‘How many?’ and ‘How frequently?’ and ‘How quickly?’ become the valued quantitative outcomes of an efficient service. But what is the cost of this, in terms of an effective, good quality experience for the individual service user within this wider research picture? Or, indeed, what is the cost of its impact on the qualitative experience of the work that, for many practitioners, is their motivation? Ideally, we need to strike a careful balance between art and science in the delivery of good quality care and support.

Check out my 2009 publication The Art of Co-ordinating Care, written with Andrew & Roberta Wetherell, for the best practice to achieve person-centred working and delivery of care and support.

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Podcast Episode 047: Anne Clilverd Interview ~ Narrative Therapy

TheStrengthsRevolution_albumart_2-2This episode is the first part of an interview with Anne Clilverd, formerly Team Manager of the Kings Cross Community Mental Health Team in London. In this discussion Anne reflects on where she first became aware of Narrative Therapy, how she followed through the specific training faciltated by Michael White, and some of the challenges of embedding it into her primary work role in a community service.

The concept of the ‘outsider witness’ as a distinct function within Narrative Therapy is explored in relation to the therapeutic role offered with clients. Specific reference is made to use of the therapeutic approach in locally designed ‘Mental Health Matters’ workshops, where a client, carer and practitioner are able to work together in supporting people to tell and analyse their own story. The role of family and cultural values are able to be honoured as an element that can emerge through a workshop style of approach to embedding the ideas of Narrative Therapy.

The approach can also be shared and adapted through staff supervision with practitioners open and interested in developing the ideas into their practice, and for exploring how they are functioning in the practitioner role.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/047-anne-clilverd-interview/id867043694?i=335937142&mt=2

Podcast Episode 046: Valuing Narrative

TheStrengthsRevolution_albumart_2-2The term narrative is important for many reasons; it is the means by which we recount our lives, the events, emotions and experiences that make up the patchwork of our existence. It is the core of each interpersonal relationship, and it has become a continual theme throughout my working career. The fundamental basis of mental health care is the trust and confidence built through the power of working relationships, enabling people to tell their stories.

Documenting our work also presents a conflict between the dominance of bureaucratic tick-box approaches and the need to represent someone through a narrative of their lives. Then there is narrative therapy as a psychotherapeutic approach to talking treatments. This episode concludes by outlining two of the core components of narrative therapy, before the next episode which will take the form of an interview with a friend and colleague who has trained in narrative therapy.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/046-valuing-narrative/id867043694?i=335428751&mt=2

“We construct a narrative for ourselves, and that’s the thread we follow from one day to the next. People who disintegrate as personalities are the ones who lose that thread.” [Paul Benjamin].

Values-Based Practice

TheStrengthsRevolution_albumart_1In 2013 Oxleas NHS Foundation Trust, in south-east London, commissioned a piece of work from Practice Based Evidence and the Mental Health Foundation to explore ways in which ‘values-based practice’ can be practiced and evidenced more in the day-to-day work with service users and carers within the Adult Mental Health Directorate. So far, the programme has engaged with six pilot teams and produced a set of draft guidelines. In 2014 the programme explore innovative ways of implementing the ideas, and spreading ideas to staff in other directorates.

Now in 2015 the programme draws to a close with a focus on a specific group of people, explored elsewhere in a few podcast episodes, the team and ward managers. These are seen by the programme developers as the key people for embodying and promoting the culture change needed within teams in order to implement refined approaches to the day-to-day challenges of working with peoples strengths and focusing on person-centred values in practice rather than just words in policies and mission statements.

WHY FOCUS ON VALUES-BASED PRACTICE?

They influence everything we think, decide and do in day-to-day practice, though often in a more sub-conscious way rather than overt statements and discussions. Good practice is not about adhering to one set of right values, we should respect and embrace values diversity. Values can be very personal, professional or organisational statements, but the focus here is on the values that underpin the day-to-day language of focusing on the needs and priorities of the individual service user. Practitioners need to be supported to be able to work where values of the service user, organisation, or professional may differ or conflict.  A recent high profile report in the UK highlights the need to put this approach to values-based practice into context:

Francis Report into Stafford Hospital “People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.” Excerpt from press release statement by Robert Francis QC in Stafford (5/2/13).

One product of the overall programme has been the development of brief practical guidelines linking together values and principles, working with strengths, positive risk-taking, and the role of person-centred care planning. A modified version of these can be accessed on request through The Strengths Revolution blog.

Podcast Episode 035: Care & Support Planning

TheStrengthsRevolution_albumart_2-2Why develop care or support plans in health and social care services? Isn’t it just another one of those bureaucratic requirements from the world of box-ticking, form-filling, audit-pleasing managerial culture? Well no it shouldn’t be; we need a thoughtful person-centred approach to the complex physical and psychological needs experienced by many people across all age groups and disabilities.

The strengths approach focuses specifically on the priorities expressed by the person through the vehicle of a strengths assessment, and these priority wishes will only become achievable goals if we put some kind of plan in place. The planning element is essentially about actions and responsibilities for actions. Within a strengths approach care or support planning is not limited to strengths-based wishes, we also need to plan for the difficulties and concerns that need to be managed. But the paperwork, paper-based or electronic, will have a role to play if we can keep it to the essential minimum amount.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/035-care-support-planning/id867043694?i=326563007&mt=2

https://soundcloud.com/stevemorgan57/035-care-support-planning

“Spontaneity is one of the joys of existence, especially if you prepare for it in advance.” [Alan Dean Foster].

Podcast Episode 032: Why plan?

TheStrengthsRevolution_albumart_2-2This episode raises the philosophical question of ‘why plan?’, and what role does planning play in our day-to-day lives? We all have needs and wants, and it is the conscious or subconscious plans that help us to exert some control in our aim of achieving them.

We engage in relationship plans, financial goals, career planning, and chosen uses of leisure time. It is a natural human activity that can become quickly mired in the bureaucratic jargon of goal-setting, care planning, support planning, where we talk of being person-centred when our systems are imposing service-centred solutions on people.

It can be a conflict between a requirement for order and a way of managing chaos, even though some people claim to prefer chaos. Plans can’t guarantee success but they can help to build confidence, apply order and structure, focus our energy, provide a road map. In the event of a crisis we have means of responding with our own personal crisis plans; and in anticipation of something desired going wrong we should have some kind of contingency plans.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/032-why-plan/id867043694?i=322813027&mt=2

“Failing to plan is planning to fail.” [Alan Lakein].

Podcast Episode 031: Say hi to Dave

TheStrengthsRevolution_albumart_2-2Dave is a reported case example (not interview) of someone advancing in age and who is not only coming to terms with complex health problems, but is also adamant about exerting his own views of what a plan for his life should look like when in contact with health care professionals.

Dave has recently lost his wife in a road traffic accident, and his children are concerned about his care needs as he is now diagnosed with Alzheimers disease. Dave puts his strengths to work, using skills he has developed over many years as a financial advisor, as well as his passion for reading up about his condition and the way services should work for him, not making him fit into a standard bureaucratic process. He challenges his local services to be genuinely person-centred and flexible in the way they meet with him, listen to him, and document his wishes. He also makes it very clear that he will not become a token gesture to service user involvement by refusing an invitation to join a local strategic committee.

To access the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/031-say-hi-to-dave/id867043694?i=321218937&mt=2

“It is not true that people stop pursuing dreams because they grow old, they grow old because they stop pursuing dreams.” [Gabriel Garcia Marquez].