Creative and Innovative Approaches to Empower and Support People

to have Greater Control

Assets, Outcomes and Risk Enablement

• NHS Quality Strategy

• Person-centred

• Effective

• Safe

Long Term Conditions Alliance Scotland

• Background

• Membership

• Shared agenda

• Policy

What is Self Management?

• Process

• Information• Education• Support• Services

• Leading Partner

Assets

• Co-production• Shared decision

making• Mutuality• Lived experience

• People• Partnerships• Support

Raising Awareness

• How do you explain Self Management?

• How do you support people to self manage?

• People• Professionals

Conversations that Matter –Becoming Facilitators not Fixers

Ross Grieve

Conversations which Support Self Management at Thistle

• Relationship based care –person as lead partner • Focus on –

– working toward personal outcomes– Identifying and building on assets – ( person’s own resources, self management strategies,

social networks, community supports)– Small changes – Relapse management and enabling positive risk taking

• Peer support • ,

Choose the Person you want to work with

Choose to be the Practitioner the person wants to work with

The Non- Expert Stance

• Person as expert and authority in their life• Practitioner as expert in facilitating change

• What are the characteristics of a facilitative approach ?

Considerations

• Motivation• “ Everyone is motivated for something…..”• Find and work with that motivation• Non – compliance • “ Simply, two people working toward different goals - • but, the person in power gets to call the other non

compliant” • Resistance• “There is no resistance - just a person’s unique way of

co-operating”

Meeting the Person

• What do I know about this person that tells me they are likely to realise their hopes ?

How to help a person define what they want?

• Many people know what they don’t want

• John, what are you hoping to get from us working together ?

• “I don’t know….I’ve been so low. I’m anxious most of the time”

• So, if our work proves to be useful for you , what would you hope to be experiencing instead?

• “ I don’t know , a bit of hope maybe…. calmness ?”• Ok, so a bit of hope, calmness…. what else ?

How to help a person define what they want?

• What would people say if they are asked

• “ what was helpful about the practitioner asking you what you wanted to get from the work? “

Negotiate Change into Being….now !

• Many concerns (and therefore hopes) can start to change through the process of conversation

• Emotional states

• “I’ve no confidence, I feel so low , I don’t have control”

• Identity

• I used to be the main contributor

• I just want to be my old self again

• Strategy ( self management skills)

• I don’t know how to cope with the way my energy changes

Why does a focus on the future rekindle lost hope ?

• The importance of detailed description of the “outcome” people are aspiring toward.

• Grounds the description in day to day life • Helps people self correct if hopes appear “unrealistic”• People start to experience the physiological states

associated with the future description• People notice times they are already experiencing

aspects of the future they want ….

Identifying and building on existing personal resources, self management

strategies , renewed identities • Have there been any times recently when you have

noticed this ( “this” meaning the description of the future) happening already, even in a small way ?

• and strategic questions • How did you manage to do that ?• and perhaps identity questions• What does that say about you , the fact that you

managed that, give all that’s been going on for you ?

Micro - analysis

• Co-creating change through conversation• One utterance at a time • What influences what the practitioner says or does

next ?• Eg. Traditional role - the need to fix, to do to people • What are we trained to listen out for?• Eg. Information we require for assessment purposes

Micro - analysis

• What happens in conversation when we are trained to listen out for signs of:

• coping, resilience , survival• what people want and • descriptions of the future ( personal outcomes)• resources which will enable the future to be realised • ( assets)• Positive risk taking

Micro- analysis

• There’s been times recently when I’ve hardly had any sleep ?

• What’s different about the times when you have managed to get some sleep?

Micro- analysis

• Most of the time when I have a good day, I feel so relieved but then the next day I feel awful again - it’s the not being able to predict how I’m going to be, day by day, that I can’t cope with . I can’t plan anything ?

• ( practitioner picking upon “ most of the time”)

• What’s different about when you have a good day and don’t feel awful the next day… you know - you have another good day?

Micro- analysis

• I suppose I’ve had good days where I’ve taken it easy but there’s so much to do …

• Practitioner chooses to acknowledge difficulty ( but there’s so much to do) and focuses on the “ taking it easy” day)

• Sure ( nodding)… and on the good days you took it easy what happened on those days?

Summary

• PERSONAL OUTCOMES• Work with what matters most to people - the personal

outcomes which are important to them • ASSETS• Identify and build on a person’s own-

– Resources – Social networks– Community supports

• RISK ENABLEMENT• in a culture which actively promotes positive risk taking

NHS Lothian Self-directed Support Test Site

Risk Enablement

Allie Cherry

Self-directed Support is in line with;

• Equally Well• Better Health, Better Care• Shifting the Balance of Care / Control• Gaun Yersel!: Self Management Strategy• The Patient Rights (Scotland) Act 2011

• “Self-directed support can help people to stay healthy and independent for longer.

• Self-directed support means that people can choose how they get support and where they get it from.”

Scottish Government SDS

Strategy Consultation Paper, 2010

Self-directed Support Options

• Direct payment• Individual Service Fund• Directly Provided Services• A combination of options 1, 2 & 3

NHS Lothian Test Site - evaluation

Learning & Development requirements of NHS staff

Support staff to be confident in having SDS conversation, individuals are able to make an informed choice regarding the options available.

Risk averse nature of some staff

Risk Enablement

“Risk enablement is concerned with managing these risks effectively and finding a balance between the need to protect vulnerable people and promoting the rights of the individual. Individuals will be allowed to take informed risks if they understand their responsibilities and the implications of their choices.”

In Control 2011

Risk enablement takes a tailored approach to risk and goes beyond the physical components (e.g. risk of falling), to consider the psychosocial elements (e.g. impact on self-identity).

AHPs person-centred values base and skills in rehabilitation & reablement make them ideally placed to take a lead role in implementing risk enablement within acute hospital settings & throughout the journey of care.

Risk Enablement & Self-directed support

“Self-directed support promotes the choice and control of an individual in making decisions about their life and support. Providing choice and control for people who use social care means allowing people to take the risks they choose.”

Self-directed Support Test Site

“Risk Assessment

• What is Risk? Risk is in everything we do, from crossing the road to choosing what we eat. We are all responsible for keeping ourselves safe, and it is important we do so.

• What do I have to do? When you have a Self Directed Support Plan, NHS Lothian needs to be sure you have thought about how to keep safe.

• Health Risks Please write down how these services or pieces of equipment might be bad for your health, and what you will do to stop that happening, if there are no risks please say so.”

NHSL SDS Planning Document

“If you are buying a service When buying a service you will need to check that the person has the right qualifications. Please answer Yes / No to the questions below, and ask for photocopies of their certificates.

• Is the person a member of a professional body?• Do they have professional insurance?• Are they qualified to deliver the service?• Are you happy they will meet your outcomes?”

NHSL SDS Planning Document

SDS Test Site Process

• Health professional carries out standard assessment for patient.

• Health outcomes discussed and agreed• Health professional discusses alternative to NHS

standard provision inc risk assessment• Patient is supported to complete SDS plan inc Risk

Assessment section.• Health professional signs off SDS Plan

Mr A – Multiple Sclerosis

Weekly horse riding sessions with Riding for the Disabled 30 sessions @ £7.00 / session = £210

Anticipated Outcomes

• Improved physical & mental wellbeing• Increased walking distance & balance• Improved posture & muscle strength• Increased stamina• Increased energy levels & concentration

Mr A – Evaluation

• “I can still walk”

• Mr A has found riding to be very beneficial, particularly in maintaining muscle stability and mobility

• "SDS gave me the prod to do it and try it". The fact it was funded made Mr A more determined to get benefits from it

Kenny’s StoryDVD produced by City of Edinburgh Council

Allie Cherry

Project Manager – Self-directed Support Test Site

allie.cherry@luht.scot.nhs.uk

0131 465 5556

Discussion

• We are learning that bringing practitioners together in conversation to share good practice is one of the major innovations in accelerating culture change …..

• In what ways does your practice support an orientation toward : – Outcomes– Assets– Risk Enablement ?

• Hearing the specifics of how practitioners and teams have made these changes can help other practitioners make similar impacts within their own services …

• What does it take to practice in this way? • How have you overcome challenges to practicing in

this way ?• What advice would you give practitioners on how to

shift services toward an outcomes, assets based, risk enabling approach?

Reflective Practice

• What did I do differently today which: – enhanced a person’s experience of my support– focused my support on helping a person realise

their personal outcomes – identified and built on a person’s assets– Enabled postive risk taking

• What DIDN’T I do today which empowered the person I’m supporting

• What would you be most pleased to notice about your practice, following the sharing/ learning you’ve experienced in this session ?