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PERSON CENTRED TEAMS Helen Sanderson Person centred planning can be a life changing, enriching experience. It can also be a distressing disappointment if nothing changes. Lisa's plan described how she wanted to live by herself, ride a motorbike, have friends and go to Cyprus. She invited her sister and staff to plan with her to achieve her dreams. Then her key worker was moved to another staff team. Other `priorities' engulfed the team and nothing changed for Lisa. She could not understand why she did not move immediately, and became angrier at having to continue to share a house. Lisa became violent. The psychologist was called in to help with her `challenging behaviour'. The person centred planning guidance is creating a planning epidemic. We need to invest in these plans being implemented, or risk leaving people disillusioned and cynical. Or in Lisa's case, understandably bitter, violent and depressed. Implementing plans means moving from planning to action, reflection and back to action. In our early efforts with person centred planning we assumed that the hard work was developing a creative plan
that truly represented the person. We assumed the once you had the plan, implementation would be straightforward. Our assumptions were wrong. As Beth Mount says, "In many ways, finding capacities is fascinating and creating a positive future is exciting. The long-term benefits of implementation are rewarding but the process of Solving problems
over time is just plain hard work. There is no way round it." We have learned that there are many conditions that make change more likely in people's lives. Where people are supported in services, these conditions include effective leader
ship, a team that is committed to the person and a service that is flexible. For many individuals, staff are the only people involved in putting the plan into practice. Our track record of services implementing plans is variable. There are many reasons why teams of staff have failed to implement plans. After the meeting had finished, Doreen's team simply lost momentum. They saw person centred planning as additional to their work rather than central to it. Implementing person centred planning is not the icing on the cake it is the cake. Successful implementation will require different strategies for different teams. For some teams, like Derek's, it required strategies to embed the planning within team meetings and staff supervision. Nadeen's team developed an `implementation plan' that described how the team kept the plan alive. Our challenge is to discover ways that the spirit of the dream and vision can inspire other actions, rather than just achieving goals. Teams need to change how they work to make the plan a living document that defines and guides their actions. For many teams and organisations, putting person centred plans into practice requires a change in thinking about support staff. This means managers being person centred with staff. This chapter addresses how we can support team managers and teams to
become powerful levers for change, which complement the other conditions for change. This work is based on research in developing `person centred teams'1. A `person centred team' is one which sees its purpose as supporting an individual to achieve the lifestyle they want as part of their local community
; who are characterised by a willingness to listen and learn continually; and who highly value personal commitment and relationships with the people they support. This chapter presents and illustrates a way of building person centred teams, beginning with a change in thinking that results in a change in practice. A CHANGE IN THINKING Being person centred with staff Some of the fundamental principles
of person centred planning are that we involve people in all decisions about their life, build on their existing skills and interests, identify what support they need and provide it. Developing person centred teams extends those principles to staff. This means that managers and team leaders need to: · involve support staff in decision-making that affects them · discover the existing skills and interests of staff and see how these can be used to support people using the service · find out what support staff need and discover the best way of providing it This is a change in thinking about power. John O`Brien and Connie Lyle O`Brien suggest that when organisations operate by having `power over' their staff, support staff typically mirror that relationship with the people they support, acting as if they are in charge of them. All relationships within organisations need to be based on `power-with` rather than `power-over`. `Power over others is the most common and familiar form of power. People expect its use, feel uncomfortable in its absence, fear the uncertain consequences of denying it, and easily fall back upon it in times of stress...But power over others poisons THE RELATIONSHIP
s necessary to support people with disabilities in taking their rightful place
s in community life. ` John O`Brien and Connie Lyle O`Brien, 1994 Most organisations operate by having power over their employees, who are instructed what to do and then are checked on to ensure that they have done it. On John's first day as a support worker he was given the policies file, told to read it, and then sign a sheet to say that he had read them. Then he was given a list of tasks that needed to be completed by the end of his first week, and told his first day off would be the following Tuesday. It is easy for professionals and support staff to assume the same relationship with the people who use the service. `Power over' people can poison relationships and extend 1 For a description of the research see ` CRITICAL ISSUES
in the implementation of essential lifestyle planning within a complex organisation: an Action Research
investigation within a learning disability service' Helen Sanderson, 2000 Manchester Metropolitan University
, UK unpublished PhD
to demeaning, dishonest practices. Suki loved to thread beads. She has a job working from home making necklaces that were given to the `bead man' every Friday night. There was no `bead man'. Whilst Suki slept the staff unthreaded the necklaces and gave the beads to Suki to start again the following week. This was cruel `power over.' There was no respect or honesty for Suki. `Power with` arises from mutual respect and a willingness to listen and learn from each other. It is about co-operation and sharing, questioning and negotiating. In management terms, this is described as using a participative approach and building semi-autonomous teams. Moving towards `power with` challenges the organisation at all levels. As with person centred planning, the process of developing person centred teams begins with getting to know people, their skills, interests and support needs, matching these as closely as possible to what the person using services requires. The person using services always takes priority in this process. We all know of situations where a service user supports Manchester City and attends all their games, until there are staff changes and suddenly the service user is an avid Manchester United
fan and follows all their games. In person centred teams staff's interests to not dominate what the person using the service does. The person centred plan identifies what is important to the person, and then staff's interests are used to support actions and activities, not the other way around. In traditional planning with `strengths and needs' lists, the service user's strengths were supposed to be used to meet their needs. In person centred teams, the support staff strengths and interests are used to meet the service users needs and desires. The team and team leader have three important interfaces: with the individuals they support, with THE COMMUNITY
and with the rest of the organisation. Their characteristics reflect the values, skills and understanding required to support people effectively, build bridges into the community, support each other and influence organisational change
. Characteristics of a person centred team · Sees the team's purpose as supporting people to achieve the lifestyle they want and contributing to their community · Highly values personal commitment and relationships with the people they support · Sees itself as being `with' people not `over' them · Reviews itself not the people it supports · Invests in community connections · Continually tries new ideas and evaluates whether it improves the support it is providing to achieve the team's purpose Characteristics of an effective person centred team leader · See themselves as coaches who bring out the best in people · Create an environment where team member
s can identify and solve problems on their own, delegating real power and responsibility · Demonstrate and articulate the values of the organisation
· Look for ways to use staff's interests and strengths in directly supporting people · Share decision making
· Have a clear vision and direction · Encourage personal involvement with the people being supported To become effective person centred team leaders, people need to identify their coaching and training needs
. Team leaders must find their own strategies for building a person centred team. The following describes an approach based on research on person centred planning (Sanderson, 2000). Examples of how teams worked to implement plans are shown to illustrate this process and clarify why a change in practice as well as thinking is required. A CHANGE IN PRACTICE The process for developing person centred teams is described as a sequence. In reality, different teams will be at different stages. Each stage may need to be revisited several times over a team's `life`. When existing team members leave and new people join, the first stages will need to be revisited. Stage 3 is where the issues of person centred planning begin to be addressed. Each stage begins with a question, followed by goals for the team to address the question. There are practical ways and examples of how teams have achieved the different stages.
The Person Centred team development
Model (Sanderson,2000) Stage 1 - Why are we here? This stage is about clarifying values and direction. All teams need to be clear about the values and direction of the organisation. This is more than just reading a mission statement
. It involves providing an opportunity to think and talk about what being `person centred` means, and what the principles and philosophy of the organisation mean in practice. If the organisation is going though a change process
the team needs to discuss where the organisation is now, why change is required and what it is changing to. Finally, support workers need to be clear about what their personal values
are, where these may differ from those of the people they support and what the practical implications of this are. The team who support Liz and Jen spent a half-day thinking about their purpose. They did this by asking themselves, `What is the purpose of our team, what are we here to do?' Once they had agreed on a statement that communicated this simply, they chose pictures to illustrate it. This poster is displayed on their office wall. When they have difficult decisions to make, they consider whether the decision would take them closer to or further away from their purpose.
A team, which was developing volunteering opportunities, spent part of a development day `envisioning success'. They imagined what their successful team would look like and recorded this graphically. This helped people to think about their team in a positive way from the beginning and enabled them to share their expectations of the team in a collaborative way. The poster is on their office wall to provide ongoing inspiration. This success poster was developed by the VOX Team, Oxfordshire Learning Disability NHS Trust and facilitated by Jo Harvey & Charlotte Sweeney The goals at this stage are for the team to: · Share the organisation's direction and values · See its purpose as supporting people to achieve the lifestyle they want, within their community · See themselves as being with people, not over them and valuing personal commitment · Reflect on their values and how these may differ from the people they support
Teams have done this by: · Attending values-based training · Devising their own team mission statement developed from the organisation's mission statement · Setting aside one team meeting every other month to do values exercises to reflect on their values and the impact this has on their day to day work · Using individual supervision sessions to explore what one issue (e.g. power-with, choice, relationships`) means to the person and consider the practical applications
of this in their work · Describing graphically the purpose of their work by doing a `Purpose Poster' or an `Envisioning Success Poster' Stage 2 - Who are you? How can we support each other and work together? This stage focuses on building trust within the team to answer the questions `Who am I? ` `Who are you? ` And `How can we support each other and work together?' During this stage individuals identify their strengths and look at how they can work together in the team. This stage involves clarifying the support that each member of the team and the team leader requires. There is no prescription for this. As well as addressing support issues, the team needs to be clear about what autonomy they have, how they make decisions and how far they can use their own initiative. The following example is adapted from the team plan developed by the Supported Lifestyles Directorate Management Team, Oxfordshire Learning Disabilities
NHS Trust. This team meet on a monthly basis to manage the operational and development work of the directorate. The plan was facilitated by Charlotte Sweeney and Kathy Brown. They began developing individual introductions using a `Reputations Exercise'. The team then worked on a communication chart, as this was an area of development the team had identified. The plan ends with identifying what matters to the team as a whole and as individuals. We have only included issues that relate to a couple of team members. The complete plan refers to each of the 6 team members.
Thoughtful / in supporting Can explain things logically so I can understand them Helps pull things together Systematically thinking Knowledgeable and explains things well Keeps the momentum going A good person to approach for information Organized My other buddy and thinking partner Helps me to clarify my thinking Methodical and deep Logical
Confidence and clarity Forces us into action Very positive Often calm but not afraid to challenge forcefully when faced with situations that she sees as unjust Makes sure we gets things done Gets things moving Calming influence Bubbly enthusiasm Supportive and enthusiastic always Lively and innovative Tenacious `rotweiller' tendencies don't give up
Is. ... Bored Embarrassed Inspired Worried Angry Pleased
S/he does this Day-dreams' switches off, don't talk. Go quiet, look down at feet dwell on it for hours get preoccupied. Jiggle about, talk fast, nod lots, arms go like windmills. Frown, go quiet and thoughtful Go very quiet, sulk even, opt out, look annoyed Smile lots, feel benevolent, talk more.
S/he wants this Kick me, change subject, and let me say something. Leave me, let me talk through when I am ready help me put it to bed. Agree with me possibly calmly; help me turn ideas into action. Give me a chance to come back later when I've thought things through, don't pressure me but let me talk when I am ready. Leave me alone till I calm down. Talk to me, two way reinforce and join in.
Look switched off,
Bring me into the
maybe yawn and don't
Embarrassed Go red and quiet
Leave me until my acute embarrassment has gone
then let me speak.
Talk a lot or try to butt Listen calmly to my idea in with my idea, jiggle and talk it through with
about in my seat and me.
wave my arms.
I hold my arms across be Listen carefully; don't defensive and go quiet dismiss it as nothing.
Either go very quiet or look very unhappy or
Listen to what I have to say but in a calming way.
burst out with it, in a
Don't aggravate me by
very aggressive manner. arguing aggressively with
Grin a lot, look animated. To ask me what I am so pleased about, because I
always like to talk about
THINGS THAT MATTER
To Us all!
Things that matter to us all That team meetings are useful and productive.
How we support each other Everyone attends eight out of twelve meetings
That we are action focused and follow things through. That we keep the team plan alive. That we all feel safe to ask for help when we need it. We can admit that at times we do
We set clear objectives with timescales and monitor these. Review and update every three months Recognise each others strengths and accept our weaknesses without judgement
not know the answers. That we have fun together That we apply the principles of `Thinking Environment' e.g. Respect, honesty, equality That we celebrate our successes and learn from things that did not go so well
Make time for celebration both in and out of meetings and getting to know each other Don't indulge in destructive gossip or have hidden agendas Build regular time into our meetings for this
That we are all committed to the same vision That there is a mix of personalities, strengths and preferences within the team
Revisit this every year Find out what these are and make sure that we build in opportunities to use them
Things that matter to individuals in the team
How we support them
That some team members
These individuals spend time
share my values
working and chatting with me
That I find my own way of doing That others are clear with me
about what they want me to
achieve and then let me find my
way to get there
That I have good professional That I deal with my working and
working relationships withpersonal relationship
Sometimes I like to think aloud That others give me enough
and may not express myself time to finish what I am saying
even if I am not making total
sense. Be patient
Relying on other team
That we do what we promise Jo
members to deliver what they
Having people around to
Let me Stay Connected
inspire, support, listen and think
That we do not spend all our Ensure we stay action focused.
time talking, but actually get Know who are best people to
help with this.
Smaller Working Groups
have clear objectives
The goals for this stage are for team members and team leaders to: · Identify their strengths and interests and found ways of using these to support each other · Look at ways that their strengths could be used within the organisation, e.g. people with interest or skills in training being utilised or people contributing to relevant working parties. · Know what support they need and how they can be best supported · Know what they have autonomy over in decision making · Agree how decisions are made in the team · Decide what the boundaries of innovation are Teams have done this by: · Using a formal assessment e.g. Belbin's team profiles, Team Strength Audit, Myers-Briggs type indicator etc. · Doing a planning style on their own life and sharing that with the team, e.g. ELP, relationship map or any other map from Personal Futures Planning, Sharing their dreams and nightmares from Maps or PATH · Developing an `Essential Team Plan` which describes the what support they want from each other, what support they want from their team leader and what support their team leader wants from them · Setting team ground rules about how they communicate with each other, how decisions are made and what the boundaries are · Developing a team `doughnut', which identifies the teams core responsibilities to the people they support and to each other and where they can use their judgment and creativity in their work · Identifying different team roles in team meetings according to each person's strengths Stage 3 - What are our goals? This stage looks at three questions: Who are the individuals we are supporting?
What is our role in your life?, How can we support you?. These questions are answered with the people the team is employed to support: This, of course, is described in person centred plans. An effective person centred team can get good results out of almost any planning - it is the attitudes and values that are important - not the technology of planning. All styles of person centred plans generate actions. Essential Lifestyle Planning and Personal Futures Planning also specify what people need to have in their lives everyday. The goals for teams in this stage are the specific actions from the meeting take place and ensuring that people get what they need and want on a daily basis. This is more complicated to achieve. The goals for this stage are for the team to: · Get to know the individuals they support and discover together what lifestyle they want; and what contribution to their community they may like to make · Have clear goals to help the individuals to achieve this · Be clear about their role in supporting the person and what support is required · Know who is important in the person's life and how they can be supported and encourage to maintain and develop their relationship Teams have done this by: · Supporting the person to make a personal portfolio if they want to · Using any of the planning styles described earlier Stage 4 - Who does what, when and where? This stage takes the plan and the goals and asks `Who need to do what, when and where to make this plan happen? It also returns to what was learned in Stage 2 to ask `How can we use our interests/talents to support the individuals?' Some teams have achieved this by developing an implementation plan.2 Mark lives with five other people, supported by a staff team of twelve led by Gail. Gail used some aspects of `active support', a PLANNING PROCESS
which structures how staff use their time, in implementing the plan. The team members use simple planning sheets for each week. The sheet incorporates what is important to the person from their essential lifestyle plan, including the times of the day when this matters. Activities that can happen at different times of the day are written at the side of the sheet. At the beginning of each week a team member plans that staff will provide individual support to each person at specific times throughout the week. Gail tries to take into account the skills and interests of staff and Mark's own preferences for particular members of staff. The sheets are displayed on a pin board, and activities are ticked off as they happen. If Mark chooses not to do the activity a particular day, staff put a cross, along with a brief explanatory note. 2 For further details on Implementation Plans see `Essential Lifestyle Planning a facilitators guide by Michael Smull and Helen Sanderson. Details available from the www.nwtdt.com
Each day one member of staff acts as shift co-ordinator. The person reminds other staff members
of their responsibilities and checks that the routine tasks get done. The goals for this stage are for; · Each member of the team to know what their role is in ensuring that the plan happens and that the person gets the lifestyle or moves closer towards the dream as expressed in that plan · Each member to have explored how any of their strengths or interests could be used in this · The team to agree what structure and support they require to implement the plan · The team to decide what it will take for them to ensure that the plan stays a living plan and how it can be monitored with the person themselves/their advocate Teams have done this by: · Doing a Gantt chart to project plan their actions · Developing an implementation plan · Deciding when to evaluate each goal and planning these into forthcoming team meeting agendas · Having it as a standing agenda item for each team meeting and supervision session · Completing a Team Path to ensure that the goals that they are responsible for from the persons plan happen at the right time Stage 5 How are we doing? These stages involve looking at how the plan is being implemented and how the team is working generally by asking, What is working? What is not working? How well are we listening to the person? How are we using our power? This reflection is powerful when it happens on a daily basis by individual team members and in a less frequent but more formal and structured way. Some services require a planning review meeting to reflect on actions. Circles of support review how they are doing at their regular gatherings. Regular reflection is vital. The person themselves and their family must be central. Tom meets with the team leader each month to give his views on how things are going in relation to the plan. The team leader feeds back on Tom's views at team meetings. It can be helpful for external people (for example independent facilitators, care managers) to keep teams on track. Karen's mum and the care manager meet every six weeks with someone from the day service and short-term support service to review the plan and problem solve any issues. Traditionally it has been the team leaders role to monitor the team's performance. Using a person centred approach means again that we find out what works best for each team and team leader rather than using a standardised approach. Reviewing progress requires that we look both at what is being done, how things are done and whether this reflects what is in the plan.
It is much easier to count activities than to see whether the person's preferences for the pace of their life are being honoured. · In Kath and Derek's team, the key workers took responsibility for checking that the plan was being implemented and then reporting back to the team at a team meeting each month. · In Simina's team, the team leader collated information from the teams paperwork, and worked alongside the team for a few shifts each month and reported back to the team in team meetings. · In Tom's team, each member was responsible for feeding back on a particular `theme` or part of the plan at their individual supervision each month. This was then discussed with the team at a team meeting. It is vital that teams share their successes and barriers with implementation groups and senior managers. The ongoing goals for this stage are for the team to; · Continually examine the fit between the team's activity and what is important to the person · Recognise that people's jobs are complex, and that there are tensions between choice, safety and risk · Have a forum for reviewing how the team is responding to those tensions · Have regular opportunities to review larger, ongoing problems together and bringing in outside help where necessary · Celebrate achievements. · Give feedback to senior managers about Policies and Procedures
that limit people receiving the service they want · Give feedback to senior managers about the effects of organisational changes on the team and in the lives of the people they support This stage needs to be a continual process and cycle of learning.
Teams have done this by: · At each team meeting each person says one thing that has worked well and one thing that could be improved about the support that the person has received over the last two weeks Bringing in an outside facilitator or member of the community team to help with large or complex problems · Having one team meeting a month for administration and one for review and planning · To use the doughnut exercise to review how the team is supporting an individual with a particular issue in their life · Reviewing what is working and not working in the person's life and sharing this information with managers and implementation groups Stage 6 What else can we try? A plan is never completed. The process of implementing a person centred plan begins with learning through a structured process of asking and listening. People continue to grow and change. As what is important to them changes, and as our understanding continues to deepen, the plan should change. On-going learning needs to take place on two levels: what we are learning about the person, and what we are learning about ourselves and the support we provide. Each style of planning provides a particular `lens' to look with someone at his or her life. If you started with Essential Lifestyle Planning then using other styles of person centred planning are vital to add to our understanding of the person and creating a picture of the future.
As well as learning about the person we also need to continue to learn about ourselves, how we work together, and find ways of improving the support we provide. In the North West training and development
Team every team meeting starts with sharing something that is working well in your work life and something that is working well in your personal life. We have half an hour to do a `development exercise' that deepens our understanding of ourselves, each other, or the heart of our work. In this way we continually learn about each other, and develop the relationships between team members. The ongoing goals for this stage are for the team to; · Identify what they are learning about the person · Find new ways of listening to the person and their dreams for the future · Review new ideas and evaluate whether they improve the support people receive. · Generate new ideas and plan how they can be tried and evaluated · Develop the team's understanding of each other and the way the team works together Teams have done this by: · Every couple of months using a `map` from Personal Futures Planning to help look at the person's life from a different perspective if the original planning tool was ELP or Path · Putting the ELP into landscape. Reformatting the plan so that the text of the plan covers half of the page and encouraging people to write on this as they learn about the person · Using the Learning Log
to record day-to-day information that focuses on what is being learned rather than simply what has happened · Supporting the person to use the accessible learning log if they want to record their thoughts about their day or week · Using a style of planning that has a different focus on the person's life · Incorporating development sessions as part of team meetings · Having retreats to re-energise the team · Team Building
Conclusion Person centred planning is a process to enable people to get the life they want and to make their contribution to the community. Investing in staff and team leaders is essential for lives to change. The plan needs to be seen as a living plan, which grows and changes and does not wait, inert until a short time before the next prescribed review. It needs to be constantly re-visited, so that teams can consider the progress they are making together as a group, as individual team members and most importantly, with the person themselves. If person centred plans are to be living plans, they need to be part of every way that team works together. We need to ask how implementing person centred plans has changed team meetings, supervisions sessions, the ways that rotas
are drawn up, and most importantly, the way the team sees and works with the individual. Keeping plans alive is rooted in continual learning. This continual learning happens in three directions: what the team learns about the people they support in the context of their community, learning about how the team implements the plans and learning about how the team can effectively work together. The six stages to develop person centred teams provide a framework for this learning, action and reflection. `The effectiveness of a plan depends on a support group
of concerned people who implement the dream by learning to solve problems, build community, and change organisations together over time. ` Beth Mount Acknowledgements Thank you to Jo Harvey and Charlotte Sweeney for their contributions to developing person centred teams