Building Blocks to Best Practice: People Centred Services

1. Building Blocks to Best Practice:People Centred Services Maria Walls Director of Research & Membership Services

2. St. Michael’s House Co-Presenter Mary O’Connor Early Services Development Manager St. Michael’s House, Dublin OHM & ISQSH - 4.12.02

3. Linking Experience Theory Practice Early Intervention Services Overview Levels • Child & Family • Teenager & Family • Adult • Family At • Individual • Service • Organisation OHM & ISQSH - 4.12.02

4. 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 OHM & ISQSH - 4.12.02

5. 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 OHM & ISQSH - 4.12.02

6. Quality and Fairness Accountability 4 Principles Quality of Care Equity People Centred OHM & ISQSH - 4.12.02

7. People Centred The key principles to guide Person Centred Services are: • The right to equal citizenship/rights based approach • Social Inclusion and Integration • Promoting informed choice/equity • Respect for individual choice and respecting diversity OHM & ISQSH - 4.12.02

8. 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. OHM & ISQSH - 4.12.02

9. 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 OHM & ISQSH - 4.12.02

10. Conceptual Framework Voluntary Agency Learning Organisation Organisation System Leadership Family system Collaboration Child and Family Centred Family Team Partnership Organisation Teams Participation in Decision Making Team Social Model Inclusion in Decision Making Organisation Wider Society OHM & ISQSH - 4.12.02

11. Building Blocks of the Child & Family Centred Services Child & Family Centered Rights Based Perspective Inclusive Community Social Model Services closer to families Outcomes Focused Approach Implementing Reviewing Evaluation Inter-disciplinary/ Trans-disciplinary Teams Individual Family Service Plans Partner-ship Collabo-ration OHM & ISQSH - 4.12.02

12. 3 Core Values Rights Based Perspective Inclusive Community Social Model OHM & ISQSH - 4.12.02

13. Building Blocks of the Child & Family Centred Services Child & Family Centered 8 Key Elements Services closer to Families Outcomes Focused Approach Implementing Reviewing Evaluation Partnership Collabor-ation Inter-disciplinary/ Trans-disciplinary Teams Individual Family Service Plans OHM & ISQSH - 4.12.02

14. 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 Child and Family Centred Services OHM & ISQSH - 4.12.02

15. Key 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 Working in Collaborative Partnership OHM & ISQSH - 4.12.02

16. Family Multi-disciplinary Teamwork Team OHM & ISQSH - 4.12.02

17. Inter/Trans-Disciplinary Teamwork Team Family OHM & ISQSH - 4.12.02

18. Key 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 Inter-Transdisciplinary Teams OHM & ISQSH - 4.12.02

19. 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 OHM & ISQSH - 4.12.02

20. 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 OHM & ISQSH - 4.12.02

21. 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.” OHM & ISQSH - 4.12.02

22. St. Michael’s House Case Study Mary O’Connor Early Services Development Manager St. Michael’s House, Dublin OHM & ISQSH - 4.12.02

23. Moving from child centred to child & family centred services in early intervention

24. Older models Child Individual Encapsulated Handicapped Newer models Family Family system Ecological Universal Wasik, 1990 The Client OHM & ISQSH - 4.12.02

25. Older models Expert Problem solver Decision maker Newer models Collaborator Facilitator Negotiator Wasik, 1990 The Role of the Helper OHM & ISQSH - 4.12.02

26. Individual Programme PlansOlder ways • Developmental domains • Motor development • Communication • Cognitive development • Social and emotional development • Self-help skills OHM & ISQSH - 4.12.02

27. 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. OHM & ISQSH - 4.12.02

28. 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 OHM & ISQSH - 4.12.02

29. Making the Transition Using Outcomes for Families • Families are informed • Families choose child development goals • Families choose their goals • Families choose services and supports OHM & ISQSH - 4.12.02

30. 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 OHM & ISQSH - 4.12.02

31. 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 OHM & ISQSH - 4.12.02