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“It’s what matters to me that counts” – keeping the person at the heart of the services we deliver

“It’s what matters to me that counts” – keeping the person at the heart of the services we deliver. Real Change . “When people not used to speaking out are heard by people not used to listening, then real change is made” (John O’Brien, undated). Improved confidence and skills.

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“It’s what matters to me that counts” – keeping the person at the heart of the services we deliver

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  1. “It’s what matters to me that counts” – keeping the person at the heart of the services we deliver

  2. Real Change “When people not used to speaking out are heard by people not used to listening, then real change is made” (John O’Brien, undated)

  3. Improved confidence and skills Improved symptoms Improved mobility

  4. Smale et al (1993)

  5. Thistle’s journey towards a person centred approach 15 years ago Thistle Foundation became serious about commitment to person centred services. Social care world changing 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

  6. So… Thistle acted decisively and radically to survive in new world: • 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

  7. 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 toolsand concepts originating in North America and Canada (Michael Smull; John O’Brien and others)

  8. 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

  9. 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

  10. What didn’t work so well? In a number of cases, while huge beneficial impact on course participants, this not translated into equally positive changes in quality of life of someone using service

  11. 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

  12. Putting our learning into practice All staff development activities delivered by Thistle emphasise the concept of: A person centred relationship with intent

  13. Person centred approach – a trinity

  14. 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

  15. Cont’d Workers 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

  16. 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

  17. One of the things that is making a significant difference… Using Talking Points framework helps to embed link between person centred relationships and working towards personal outcomes

  18. 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)

  19. Outcomes for people we support

  20. Supporting person to identify and realise outcomes • Holding good conversations (include people who don’t communicate verbally), actively listening to find out what really matters to the person in life – the outcomes • Working with person's outcomes to identify what activities, supports and/or services are required to realise them over agreed timescale • Maximising person’s own assets, strengths, skills, and involvement in realising their outcomes along with family, community etc.

  21. What kind of outcomes?

  22. 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

  23. A cautionary reminder… “The overwhelming evidence is that what people do for themselves and with others – not services – delivers the bulk of social outcomes” Routledge and Witton, 2010

  24. Contact us Thistle Foundation: Nikki Bruce Nikki.Bruce@thistle.org.uk Learning and Development Manager Gail Cunningham Gail.Cunningham@thistle.org.uk Research and Development Coordinator Joint Improvement Team: Chris Bruce Chris.bruce@scotland.gsi.gov.uk Lead on Outcomes

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