Support Person-Centred Thinking and Planning
Person centred theory came from Carl Rogers who believed in being warm, genuine and understanding make a difference in clients’ condition and its improvement. Believes and values are very important in person centred thinking and planning. Carl Rogers identified three main core conditions that have a significant influence when supporting vulnerable people, which are an unconditional positive regard, empathy and congruence. However, later on he expands his list to a six core conditions in total. “1. Two persons are in Psychological contact.
2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, whom we shall term the therapist is congruence or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic understanding of the clients’ internal frame of reference and endeavours to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.”
Person-centred approach talks about growth-promoting climate, which is all about enabling people to discover the capacity of relationships as a right place for growth and change. Instead of looking at relationships as perspective of how can things get treated or cured, but how can one provide the right support in an improved relationships for clients to grow individuals. It is believed that individuals have recourses for basic attitudes, self-understanding and self-directed behaviour therefore they only need an inspiring and supporting relationships for their growth-promoting climate.
Person-centred thinking is based on the individual; it looks at what is important to that particular person, what are ones values, hopes and possible achievements. Individuals are in control of the person-centred approach and they make the decisions. The support is only there to advice and direct individuals, not plan for them, also provide needed information while focusing on what individuals are looking for and aiming to achieve in their lives. It is important to review plans with individuals in order to ensure the success.
Person-centred planning has five key features – the person must always be at the centre of the planning process; family and friends get involved as partners in planning; consideration of what is important to a client now and in the future and reassuring the support needed; encouraging a person to be a part of a community; and by considering hopes and wishes making sure that the current plan stays alive in the future and carries on in a positive progress. Each individual should be recognised as a part of the family and included in family decisions. It is important to communicate within family, also including friends and professionals that would help addressing the issues as they appear and are not left for a long period of time.
This may come across as a very different approach in some families. Therefore, members of a family have to be supportive and learn to prioritise individuals’ plans in order to achieve good results and improve ones well being. Decision-making can be also a tricky adjustment for family members when using person-centred approach as they may have been used to making decisions for vulnerable people, instead this control goes over to individuals in order to improve their confidence and support their independent living.
The social model of disability looks at removing barriers that society has organised over the years and caused restrictions over life choices for disabled people. Disabled people can become more independent and equal to society, have more control over their lives once the barriers are removed or
minimised to the maximum.
There are also social inclusion principles that work like a guidance in order to achieve the best results when including into social life by giving opportunities to those who may be limited. These principles talk about aspirations and approaches. The main aspirations that people want to achieve are reducing disadvantage, increasing social, civic and economic participation and developing a greater voice, combined with a greater responsibility. Approaches that should help people to get their focus on building strengths of each individual and a community as a whole; developing tailored services as well as building partnerships with key stakeholders; giving a priority to early interventions and preventions; using evidence and integrated data to inform policy and so on.
Michael Smull is one of very influential and supportive people who has done an amazing job working with disabled people for the past 40 years and covered nearly all aspects of developing community services. He has worked in 47 states and six countries by helping changing structures in order to support self-determination and he managed to help lots of people leave institutions in the US and the UK. He has worked with universities, and currently focusing on helping organisations and systems make the needed changes in skills, practices and polities that would help individuals become more independent and self-directing in their lives. He also developed an Essential Lifestyle Planning along with Susan Burke-Harrison, which is very detailed and was mainly developed for people with complex support need. It usually has a health action plan as well as a section on communication.
There is a list of tools that come with person-centred thinking which are used in order to help individuals achieve their goals. Important to/for tool is about balancing between what is important to a person and for that same person. The things that are important to people vary and are seen through their behaviour and things that they like. The things that are important for people, are the things that help them become or stay healthy and safe regardless whether that is important to them or not. The doughnut sort is another tool which is divided into three rings – the first one being the inner ring which consists of core responsibilities of people providing support; the second being all the areas that staff have to take their own judgement into account, use their creativity and problem solving skills to think about possibilities and potential. And the third ring is about all the other areas that are beyond staff’s roles and responsibilities which can be in place as formal boundaries or informal such as family preferences and so on.
The matching staff tool is also very important as it helps the person providing support bond with the vulnerable client as well as it helps the client relate to that particular member of staff by having matching characteristics, and sharing common interests. Relationship circles tool help people learn who is actually important in their lives, who they can talk to when developing a plan and it also helps identify the relationships that can be strengthened or supported. Communication charts tool helps to focus on peoples’ communication whether they use words to speak or not; it also helps to identify and clarify communication whenever actions communicate different from the words. Learning logs tool is a great opportunity to reflect on important records of what exactly works on each person individually. These logs are most useful when clients try out new things and by having records of how it went, how the person found the experience, it is more likely that the action will be repeated if they have a positive feedback. Also this can improve on how to support the person best and maintain those methods. Four plus one questions tool is another brilliant tool when learning about persons’ preferences and wishes. It asks four questions – what have you tried; what have you learnt; what are you pleased about; what are you concerned about.
Once they’re answered, it leads to one final question – based on what we know, what should we do next? It is a quick way to learn what works best for each client and help staff avoid things that are mentioned on the ‘what are we concerned about’ list. The decision making agreement tool is a way of reflecting on how decisions are being made. It helps to think about power and control that people have in their lives, it also helps clarify how decisions are made as well as it increases peoples’ choice and control in their lives. Presence to contribution tool helps to think about activities and interests individuals have, what they do on a day to day basis and the opportunities that may arise for getting more involved, meeting new people, making connections and contributions. It helps to look at where people are now and think of possibilities and planning actions. Working/not working tool is there to create an action plan in order to make sure that changes actually happen and it is powerful in three ways. Firstly, it is a great way to analyse things that are happening in ones life, whether they are important to an individual and he/she is provided with agreed support. Secondly, it is very important to look at areas of disagreement in the context of what people see to be the same.
This tool enables people see and hear from a different perspective. And lastly, it prevents staff from changing aspects of ones life that are working for them. Good day/bad day is a tool that simply addresses persons’ day to day life and how they feel from when they wake up to the end of the day. By asking an individual how he could describe an especially good day and particularly bad day, it enables staff to understand what needs to be present and absent in order to improve their day to day lives. Making action plans (also known as MAPS) is a planning process which has a lot of questions that helps put a story together about an individuals, their dreams, ambitions, journey through life and having this information allows staff build a plan to move towards ones aspirations and goals. And yet another very creative planning tool called PATH (stands for planning alternative futures) and it starts in the future and works backwards to an outcome of first beginning steps that are possible and positive. PATH is comprised by eight steps (O’Brien, Pearpoint & Kahn 2010, 63): 1. Locate the North Star;
2. Generate a Vision of a positive possible future;
3. Describe the Now;
4. Invite Enrolment;
5. Decide to Get Stronger;
6. Identify Bold Steps;
7. Organise the month’s work;
8. Agree to Next Steps.
A one-page profile is a great way to learn about someone. It is often used as one of the first tools to collect the information about an individual, what is his/her best support and what do staff need to know to support them. Typically it has three sections – an appreciation about the person; what is important to that person from their perspective; and how to support them well. Once this primary information is collected and recorded on a one-page profile, other tools can be used to develop person-centred plans in order to achieve the best results when supporting an individual.
Person centred approach has a review process that should be annual in order to check how the year has been for a client, address any changes, discuss the possible outcomes, and look for improvement. There are few steps that have to be done before the review and planning and preparation is most important for it. Before the review, carers main responsibility is to make sure all paper work is filled in, there are no missing documents in clients care plan, monthly summary sheets are up to date (key workers responsibility).
It is important to prepare the client for the meeting as well, it is recommended to discuss possible questions, living arrangements and get a consent for appropriate people to be able to attend the meeting. Supervisors are responsible for arranging the meeting, getting in touch with social workers, doctors if needed and family members if client requests. In the meeting, client has a support from supervisor and even key worker if requested by client. All aspects of life have to be discussed in a review – living arrangements, social life and activities, health, diet and so on. It is important to go through the current arrangements, discuss possible changes and/or look for new ways of improving clients’ quality of life.
There are current legislations, policies and guidance out that look after and protect person centred thinking and planning. There are relevant sections from Community Care Act (1990), also Disability Discrimination Act (1995 – amended 2005), and Human Rights Act 1998. Also government published a White Paper Valuing People (2001): a new strategy for learning disability for the 21st century and also White Paper Valuing People Now (2007) from progress to transformation.
Relationship between person centred planning and personalised services are very important and significantly influential therefore they have to be positive, supportive and very active. It is important to interact at all times in order to keep up to date with new ideas that can improve clients’ lives, also be aware of what is needed and wanted by clients. Using the information from the reviews provides better intelligence about what services may need to be developed in response to current and future needs, also what works for an individual. Keeping up good relationships also allows significantly identify actions that need to be taken to achieve certain things; also it helps resolve issues that may occur in the process. Assessing costs and use of recourses is another highly important issue that needs to be addressed and having active and supportive relationships makes it easier to deal with.
Person-centred team has a structured sense of purpose and knowledge of what is important to and for its members. Team produces a team plan and allocates roles and tasks to meet staff’s strengths and interests. To make this type of team work in a social care setting, the whole organisation has to get involved so person centred thinking approach should be implemented across organisation for it to materialize. Learning experience should be shared, reflecting on work could help identify issues that need to be improved, involving staff in a decision-making would provide them with a motivating feeling valued and respected.
Managers should be familiarised with a plan of person centred team and aware of the benefits of it in order to pass on the message and encourage the staff to take the approach on board. Facilitator is an important key in planning tasks for the team and supporting them to get involved in discussing ideas, focusing on what is best for individuals. Managers may need to explain the role of facilitator to the staff so that everyone is aware of their part in a team planning.
Person centred thinking can be used working with both individuals and teams. Working with individuals, person centred thinking comes in handy when defining roles and responsibilities, matching staff to be key workers with individuals in the service. This type of thinking allows management identify actions and manage possible risks. It also works very well when involving significant others in the process of planning and working with self-directed support. Person centred thinking is very useful within the team context, for instance when clarifying the purpose of the team, recording and updating information about the purpose, also identifying what is important for a team
and what support they need.
It is crucial for members of staff working in social care setting to understand their own role in person centred thinking, planning and reviews when supporting clients. Expectations have a significant impact to it, both personal and of others. It is important to find the link between them, understand what one as a carer want to achieve, and also relate to other peoples’ (clients, management, team members, relatives and so on) expectations when it comes to caring for someone. Keeping an organised and sufficient track of records such as plans, actions and other activities help one stay on top of things. It is part of carer’s role to keep updating clients’ health changes, any routine checks, diet and social activities.
There is no work setting without challenges and it is essential to be aware of different difficulties one may come across in order to know how to overcome it without causing any damage. Carers may come across issues of control when it comes to assisting clients with their daily routines or supporting them with activities. One may want to intervene more than it is appropriate or offer his/her opinion, which would distract individual from their own valuable choices. There are other risks involved such as health risks (to both carers and clients), possible breaking of boundaries and others. It can be very challenging when dealing with personal issues and also when accepting a constructive criticism from colleagues, management team, and especially service users.
Another challenge is a conflict of values as every individual has their own understanding of values and prioritise different things, and therefore it is important to keep boundaries, think in person centred manner and approach opinions in a very open minded way. One of the most challenging things for service users could be a fear of change (sometimes resistance to change) even if it is only for the best of clients’ interests. Unfortunately there are things in life that no one can control and they cause changes that can be very stressful and sometimes even unbearable. As a result of possible challenges, people have been thinking and publicizing ways to overcome those challenges. For instance, one of very good ways to deal with misunderstanding or learn about individuals’ values and believes and finding the best way to work with is by using person centred thinking tools mentioned earlier on. One of significant homework that carers should do is assessing their own values in order to open minds, readjust to other people’s opinions and help deal with individuals in a professional manner. Peer reviews are another excellent tool when dealing with mentioned challenges.
Being able to apply person centred planning in relation to own life is a very useful skill that could help identify what works and what doesn’t work. It is easy to know the tools and use them on others, but it is important to be honest when addressing the questions to oneself. Asking yourself for instance who am I, what are my hopes and fears, my gifts and capacities can lead to a wonderful discovery of ones identity and uniqueness. Other tools that are mentioned above can be useful when learning about yourself for instance Making Action Plans (MAPS) and Planning Alternative Futures (PATH) or Dreams and Nightmares. All of mentioned tools are a great way to be used when thinking about own community connections, also future aspirations. They all help identify strengths and weaknesses, highlight abilities and help focus on the plan in order to achieve what one is going for.