Tag Archives: social care

Podcast Episode 067: Strengths-Based Questions

TheStrengthsRevolution_albumart_2-2When delivering ideas about a strengths approach I am frequently confronted by the need for practitioners to discuss their most extreme example of a severly depressed completely entrenched person who has no strengths.

My immediate response is that everyone has strengths, just on some occasions it is a greater challenge identifying and developing them. The real failure of perception is to take the superficial picture as the whole picture. We need to dig beyond the surface in creative ways that respond to each individual and their personal circumstances.

In this episode I outline 10 questions to keep in mind when the search for strengths proves most challenging. These questions have some similarlity with the approach adopted in Brief Solution Focused Therapy, with an emphasis on exception-finding, scaling, coping and what’s better types of questions.

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/067-strengths-based-questions/id867043694?i=346798305&mt=2

“Setting a goal is not the main thing. It is deciding how you will go about achieving it and staying with that plan.” [Tom Landry].

Podcast Episode 066: Strengths-Based Planning

TheStrengthsRevolution_albumart_2-2You may be a supremely spontaneous individual, but we all still need degrees of planning if we are to be confident of setting in motion the powerful action to help us in achieving our dreams and aspirations.

In planning for achievement it is common sense to think that our strengths will be focal in the process, but they apply equally to plans for managing our concerns and crises. ‘Working with Strengths’ is a process that follows the path of strengths assessment to stated priorities to strengths-based support plans.

In this episode I offer brief checklists of prompts to guide the construction of strengths-based plans for achieving our priorities and for managing our concerns. It is the application, not just the identification of our strengths, that enables action and positive change. These checklists should apply equally to personal reflection or to our work in supporting others.

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/066-strengths-based-planning/id867043694?i=346798304&mt=2

“To accomplish great things, we must not only act, but also dream; not only plan, but also believe.” [Anatole France].

Podcast Episode 063: Truly meeting the need

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

Within the context of service-centred working can a meeting ever be person-centred?

In this episode I outline experiences of ward rounds and community reviews that are frequently presented by the services as being person-centred, but are clearly service-centred.

Our use and misuse of language is more often than not a reflection of our values and ultimately a reflection of what we deliver as a service, so it needs careful attention.

Attendance at meetings does not equate to involvement in meetings. So what will it take to make service meetings, particularly client reviews more genuinely person-centred? I present four messages to guide us towards this aim.

For the full content of this episode click 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/063-truly-meeting-the-need/id867043694?i=344569092&mt=2

“If you had to identify, in one word, the reason why the human race has not achieved, and never will achieve, its full potential, that word would be ‘meetings’.” [Dave Barry].

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.

Podcast Episode 061: Constructing Strengths Assessments [3]

TheStrengthsRevolution_albumart_2-2Building up a strengths assessment based on personal reflection, or helping others to construct a picture requires a positive outlook and a determination to enquire into what has worked in the past, what is working at present, and what is wanted in the future.

Alongside the picture of who we are, we should concentrate on building the picture of what we have and what we want. In the practical but essential components of shelter, finances and relationships, it is important to reflect on what works for each of us, and why it works? In terms of housing, where we live can be equally as important as what type of accommodation we prefer to live in.

In this episode I explore the questions that help us to dig for the detail around home, work, relationships, leisure, daily living, and spiritual reflections.

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/061-constructing-strengths/id867043694?i=343344278&mt=2

“Being deeply loved by somebody gives you strength, while loving someone deeply gives you courage.” [Lao Tzu].

Podcast Episode 060: Constructing Strengths Assessments [2]

TheStrengthsRevolution_albumart_2-2Building up a strengths assessment based on personal reflection, or helping others to construct a picture, requires a positive outlook and a determination to enquire into what has worked in the past, what is working at present, and what is wanted in the future. It is about developing an inventory of resources that can then be productively applied to achieving desired future priorities and/or managing life’s difficulties and challenges with greater skill and confidence.

It should start from some of the big open-ended questions about who we are, and what we like about ourselves, and what we want for the future. With this standpoint in mind, a reflection on personality traits and personal qualities helps to focus attention more on the question of who we are.

In this episode I briefly explore some of the personality traits and qualities that help to define us, and how we might identify them in ourselves or others. Issues of health are also explored alongside these traits.

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/060-constructing-strengths/id867043694?i=343344279&mt=2

“Always be yourself, express yourself, have faith in yourself, do not go out and look for a successful personality and duplicate it.” [Bruce Lee].

Targets, what targets?

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

How can we make more effective use of targets as a means of developing best practice? Perhaps a more pertinent question is: ‘Can we make effective use of targets at all?’

Nothing drains passion more effectively than constant demands for information to meet apparent targets, asked without consultation or explanation, and with no meaningful returns in the form of useful feedback. Auditing everything has become an industry – but to satisfy what? The function of co-ordinating care, specifically the Care Programme Approach (CPA), has become a focus for quantitative returns that seemingly have little to do with the quality of the working relationships and everything to do with numbers and signatures. As many service users, carers and practitioners will testify, presence at a meeting and signing a form does not necessarily reflect influence, involvement or even truthful agreement with the documented outcomes. Yet, the bureaucratic process keeps requiring the numbers with no apparent reciprocal benefits for practitioners and teams.

I wouldn’t argue against the need for auditing practice; but it does appear from conversations with many practitioners that there are widely differing perceptions about priorities between the management of services and the deliverers of services. Anecdotal sources suggest that most practitioners feel they only receive feedback from audit sources when things go wrong, and that good practice is not confirmed or highlighted when it happens. If practitioners, service users and carers were asked to define the parameters of what needs to be audited, there would be some disagreements between them but the priorities would probably look a lot different from what currently occurs. Most people in the real world are concerned about relationship-building in order to support people to be more self-reliant through identifying and working with their own strengths. Audit needs to be of practice and for practice, with a focus on sustaining current good practice. But that would only put an awful lot of middle management and auditors out of a job, for their focus is ‘change’ for its own sake; as long as the merry-go-round keeps moving they will have a purpose.

See ‘The Art of Coordinating Care’ publication for a detailed framework on delivering a service user-focused, strengths-based, bureaucracy-busting approach to real practice. It has been developed as a reflection of what good practice looks like, but will challenge all practitioners to step up to the mark to deliver values-based personalised services based on working with people’s strengths. Failure to do this leads to the alternative… the more usual current situation of an over-regulated system driven by the need to satisfy the politicians and public that if anything goes wrong ‘it will never happen again’. What the current system can ensure will never happen again is the enjoyment and creativity fuelled by the passion of people who want to make a positive contribution to service users lives.

Feel free to add your own comment about any issues raised above.

“Bureaucracy destroys initiative. There is little that bureaucrats hate more than innovation, especially innovation that produces better results than the old routines. Improvements always make those at the top of the heap look inept. Who enjoys appearing inept?” [Frank Herbert].

Playing with numbers

I am often mindful of the need to criticize the quality of leadership and management in health and social care services; particularly the obsession with numbers, the tick-box mentality, and the blind faith placed in targets for driving change and daily practice across services. I am surely not a lone voice in this critique, but is it valid or just a reaction against the sound of the pips squeaking?

I do believe that an absence of targets or defined outcomes, and a failure to establish high standards for provision of services only leads to inconsistencies between practitioners and teams… what is often referred to as a postcode lottery. Service users don’t deserve to be on the receiving end of either stressed out practitioners fearful of constant criticism, or laid-back practitioners doing their own thing. Audit and regulation have a place, but surely they need to be clearly joined up to practice, not existing in a vacuum somewhat disconnected from the realities within which good practice has to operate.

The ever-growing chasm between person-centred practice and business-focused managerialism does little to promote a culture of organizational collaboration that may encourage a more engaging form of audit and regulation across services. My solution would be to eliminate most of the current audit requirements imposed on practitioners and teams, particularly that which they experience as wholly time-consuming and unhelpful. So far so good, say the practitioners amongst you; please do share your thoughts, but read on before you do…

Over the last 12 years, through the Practice Based Evidence initiative, I have been developing tools designed specifically for use by practitioners and teams. These tools have flexible uses: personal reflection, individual supervision, team development and team evaluation. Used diligently they should be able to provide a host of qualitative and quantitative data, which in turn should offer useful feedback to practitioners and teams for practice development purposes.

Updated Risk Resource (2013)
Updated Risk Resource (2013)

The Risk Decision-Making publication includes examples of these tools, and a specific example of data emerging from their use in a specific organization to help identify good practice and priorities for further development.

So, the sting in this tail is that practitioners and teams need to own the processes of audit and regulation if they are to reflect and develop good practice. For those auditors and managers fearful of losing their jobs if Practice Based Evidence emerged as the norm, you could always make use of the data to tick your boxes; better still, you could prioritise your time more effectively by getting in and alongside practitioners and teams to support a quality revolution. You might then be in a stronger position to challenge and inform the thinking of the inter-galactic warlords from distant planets a.k.a. commissioners, Department of Health, Care Quality Commission.

Podcast Episode 049: Anne Clilverd Interview ~ Team-Working

TheStrengthsRevolution_albumart_2-2An interview with Anne Clilverd as she reflects back on three specific teams to identify what elements contribute to good team-working.

An acute admissions ward where, despite being based on a hierarchy, a strong sense of belonging was fostered. The environment was supportive through all staff being encouraged to contribute their observations in a way that was respected by multidisciplinary colleagues.

Compass as a walk-in advice and mental health centre also offering a degree of outreach work as a new initiative at a time when long-stay hospitals were beginning to be closed down. This initiative was joint funded and managed by health and social care, operating as a small multidisciplinary team of four people committed to a strong set of values and principles. As a group the workers need to feel confident to have their ideas openly and constructively critiqued; and they were supported by an advisory group that included several service users and representatives of local voluntary sector services.

As team manager Anne worked in the Kings cross Community Mental Health Team. This type of team functions as a group of individuals who come together for a common purpose, but belonging may be more to the team name than a sense of full collective working. The team manager carries the specific responsibility to stamp a personality on the team through a vision for common goals and purpose, and the quality of supervision as a means for encouraging reflection and professional/personal development.

Anne also briefly reflects on the optimal size of good functioning teams. 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/049-anne-clilverd-interview/id867043694?i=337032545&mt=2

Podcast Episode 045: A Place for Carers

TheStrengthsRevolution_albumart_2-2In this episode the focus is on informal unpaid carers in the health and social care system. Who carers are, and the roles they perform, are honoured as amazing strengths that can be relied upon. However, the role comes with burdens and pressures, and services have not been so quick to see carers as a priority for the vital support they need.

The focus for this episode was triggered through reading an article by Nicci Gerrard in the Observer newspaper (UK Sunday broadsheet). She was reflecting on her father’s experiences of dementia, and more specifically on the damaging effect of a hospital admission on his ability to function independently. It is not a way of blaming staff or the service, but more a reality check on how the demands of an ageing population are overloading the existing service.

John’s Campaign has been established to promote greater access for carers on to hospital wards, particularly to continue supporting their loved ones who have succumbed to dementia. The costs are very minimal and the benefits for patients, carers and staff are very significant. Good practice in this issue exists in small pockets, but the challenge of the campaign is for best practice to become standard practice everywhere.

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/045-a-place-for-carers/id867043694?i=334927346&mt=2

“To care for those who once cared for us is one of the highest honors.” [Tia Walker].

“I am sickened that the government thinks my value is so low when actually carers save the government billions.” [Anonymous carer survey response].