1 OHM & ISQSH - 4.12.02

Building Blocks to Best Practice:People Centred Services

Maria Walls

Director of Research & Membership Services

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Co-Presenter

Mary O’Connor

Early Services Development Manager

St. Michael’s House, Dublin

St. Michael’s House

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Early Intervention Services

Linking Experience Theory Practice

Levels Child & Family Teenager &

Family Adult Family

At Individual Service Organisation

Overview

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National Federation of Voluntary Bodies Providing Services to People with

Intellectual Disability

Formed as Network in 1972 Secretariat established in 1998 60 Members 22,000 Service Users In excess of 14,000 staff 80% of services to people with Intellectual Disability Equivalent in size to two Health Boards

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Definitions 1946 World Health Organisation (WHO) Constitution

– Health is a complete state of physical, mental & social well being and not merely the absence of disease and infirmity

– 1986 WHO Ottawa Charter embraces this broader practice positive definition and adds “Assisting the individual to increase control over and improve health, focusing on completeness and full functioning”

Social Model of Disability Implications for Disability Services

– Whole life Focus

– O’Brien principles

– Increase in the number of Departments funding services

– Mainstreaming Agenda

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Quality and Fairness

People Centred

Equity

Accountability

Quality of Care

4

Principles

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People Centred

The right to equal citizenship/rights based approach

Social Inclusion and Integration

Promoting informed choice/equity

Respect for individual choice and respecting diversity

The key principles to guide Person Centred Services are:

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This requires that: All the resources and activities of the agency are directed

at supporting what really matters to the service user.

The organisation has a reliable system of asking services users what supports they require and identifying their priority needs.

The organisation measures the extent to which it is responding to each individuals needs and priorities

The principles which direct service activities span the entire spectrum of services which an agency provides directly or in conjunction with other agencies.

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Delivery of People Centred Services Requires:

Management Commitment

Promotion of Leadership at all Levels

Partnership with Service Users and Staff

Innovation and Creativity

Effective Service Co-ordination/Teamwork

Accountability to Service Users and Funders

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Child and Family Centred

Family

Team

Organisation

Wider Society

LeadershipOrganisation

System

Learning Organisation

Voluntary Agency

Collaboration Family system

Team Partnership

Organisation Teams

Participation in Decision Making

Social Model Inclusion in Decision Making

Conceptual Framework

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Building Blocks of the Child & Family Centred Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Partner-ship

 Collabo-ration

ImplementingReviewing Evaluation  

Inter-disciplinary/Trans-disciplinaryTeams

Individual Family Service Plans

 Services closer to families

 

Inclusive Community

 Child &FamilyCentered

 

Outcomes Focused Approach 

 

Social Model

 

Rights BasedPerspective

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3 Core Values 

 

Social Model

 

Inclusive Community

 

Rights Based

Perspective

 

 

 

 

 

 

 

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Building Blocks of the Child & Family Centred Services

 

 

 

 

 

 

 Child &Family

Centered

8 Key Elements

 

 

 

 

 

 

 

 

  Partnership

 

Collabor-ation

 Inter-

disciplinary/Trans-

disciplinaryTeams

 Individual

Family Service

Plans

 Outcomes Focused

Approach

Implementing Reviewing Evaluation

 

 Services closer to Families

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Child and Family Centred Services

Key issues: Parents as partners and decision

makers in the early intervention process

Family in centre - Services as collaborator

Not just receiving information from parents asking to do therapy at home but acting in all parts of the process

Adaptation Process Capacity Building

Evidence: Provision for siblings Home visits Involvement in all parts of

assessment process in defining the issues, and devising solutions

Meeting parents together Timing of visits Video of intervention for father Key worker

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Working in Collaborative PartnershipKey Issues: Dunst, Trivette and Johanson 1994

“requires abdication of paternalistic approaches to helping relationships and adoption of empowerment, participatory involvement and competency enhancement approaches to help giving”

Success intervention on quality of provider - family relationship

Dale 1996 propose Negotiated Model “that parent and professionals have separate but highly valuable contributions to make”

Evidence: Parents being asked about the level

and nature of their involvement Asking where involvement should

take place Using a problem solving format Committing resources to enable parent

involvement in advisory programmes Facilitating parent to parent contact Using evaluation and parent

satisfaction surveys Consulting on the planning and

development of services Family directed service

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Multi-disciplinary Teamwork

Family

Team

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Inter/Trans-Disciplinary Teamwork

Team Family

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Inter-Transdisciplinary TeamsKey Issues: Team is the mechanism that makes the

intervention work - Tuchman 1996 Model of Teaming

Inter-disciplinary = share common goals, are committed to communicating and work through planned interaction, parental involvement, better co-ordination of tasks between members.

Trans-disciplinary = share common goals, plan together using systematic process or sharing roles and crossing disciplinary boundaries. Family participation and concerns on decision making are crucial.

Tuchman TD best service to families as they integrate the principles of co-ordination and family centred service

Evidence: Dedicated Teams Plan on needs of the

child & family Joint assessments Joint planning -

families seeing fewer therapists

Natural Environment Work - greater involvement of wider team in child’s life

Child based filing system

Parent always member of the team

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Charity

Disabling

Medical

Expert

Prescriptive

Professional Driven

Segregated

Group

Therapy

Multidisciplinary

Discipline Focused

Standards

Centre based assessment

Deficit

Rights Empowering Social model Child and family centred Collaborative consultation Consumer driven Mainstream/Inclusive Individual Whole life Inter/trans disciplinary Age group programme based Outcomes Integrated real environment assessment Strengths based

Policy Change SummaryParadigm Shifts

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Implementation Issues Raised

Structure dedicated

Leadership and Co-ordination

Understanding Change

Teamwork and Time

Getting Parents involved

Move from uni-dimensional to multi-dimensional approach

It’s Complex

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Change

Charles Handy 1988 in Understanding Voluntary Organisations says that:

“to change the culture of an organisation from role to task based culture is one of the

most difficult changes to make.”

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Case Study

St. Michael’s House

Mary O’Connor

Early Services Development Manager

St. Michael’s House,

Dublin

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Moving from child centred to child

& family centred services in early

intervention

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The Client

Older models Child

Individual

Encapsulated

Handicapped

Newer models Family

Family system

Ecological

Universal» Wasik, 1990

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The Role of the Helper

Older models

Expert

Problem solver

Decision maker

Newer models

Collaborator

Facilitator

Negotiator» Wasik, 1990

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Individual Programme PlansOlder ways

Developmental domains

Motor development

Communication

Cognitive development

Social and emotional development

Self-help skills

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Individual Plans - Newer Ways

Goal: James will use his hands to play

How will this goal be supported

(who, when, where?) Physio and OT will do two joint home visits to show Lucy how to position James in his standing frame and in his chair. They will lend Lucy appropriate toys to try. Lucy will decide on when and how often she will be able to position James. Link worker and Laura (James’s granny) will also be shown how to position James to use his hands. Physio and OT will visit on dates arranged with Laura (6 visits each in three months). Review.

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Individual plans - newer ways

Goal: Lucy will be able to go out for one evening per week with her husband

How will this goal be supported

(who, when,where?) Key worker will work with Lucy to support a family member to learn key skills for managing James’ care in the evening

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Making the Transition Using Outcomes for Families

Families are informed

Families choose child development goals

Families choose their goals

Families choose services and supports

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Providing Services in a New Way

Information giving

Key workers/co-ordination

Teams that comprise staff relevant to child and family needs as described by the family

Collaborative work/working in trans-disciplinary ways

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The Challenge

“The progressive and inevitable ambiguity of

disciplinary boundaries represents one of the

central challenges facing the field of early

childhood intervention”

Shonkoff and Meisels