This month Emmett McConomy and Arthur share how Person-centred thinking has enabled Arthur to achieve a lifetime ambition.

Arthur has been supported by Derry Supported Housing since January 2011. It has been a lifetime ambition to learn to drive. So with support from the team, Arthur has started to learn to drive.

The commitment from the team to support Arthur to reach this landmark in his life was supported by the use of person-centred approaches and we were able to support Arthur the way he wanted (person-centred review, what's working/not working, communication profile), this clearly demonstrates that we can make a real positive difference to the people we support.

He has been making steady progress and Arthur knows that he has a lot of learning to do. Bryan Morgan,his driving instructor, has worked for Action on Hearing Loss for a number of years in Harkness Gardens as a Support Worker before starting his own Driving School.

Arthur said "I'm really happy to be learning to drive, its hard work".

"Well done, keep up the hard work Arthur!!!" - Emmett McConomy Service Manager

In the Policy and Practice team, we provide support to services. A lot of the support has recently been around how to deliver personalised services and our next challenge is to support services to be person centred within staff teams. We feel that the only way to be able to support other teams to be person centred….is to do it ourselves! This blog and some future blogs will talk about some of the challenges we faced and how we overcame them.

We started off by doing our one page profiles so we know what matters to people and we can get the best out of each other. We all thought this was really hard until we realised it was a chance for other people to say some lovely things about us. It was very useful and we all learned useful information about each other, especially how best to support each other being a widely dispersed team and all mostly home-based.

We had a discussion about how the one page profiles would be used. Some people didn't feel comfortable about certain information being shared throughout the organisation, but we decided that we would be doing work one page profiles and people could share personal information only if they felt comfortable. As a team we decided if we expect other people to do one page profiles, we should demonstrate our commitment by sharing our own.

In our team meetings, we have a big blank sketch book and in this we have drawn a rough version of the team plan.

Next, we had a bit of a thought shower about our team purpose and vision. We found it difficult as our purpose became very wide. We tend to help out wherever we are needed which can sometimes extend beyond our job descriptions. We decided to use the doughnut tool to work out exactly what our core responsibilities are, where we could use our creativity and judgement, and what was definitely not our responsibility.

This generated more discussion as some of the things we do have elements of "core responsibility", and elements of "not our responsibility". In our role we often work in partnership with other people and teams, so sometimes get involved with extra pieces of work. We have decided to discuss our job descriptions at the next team meeting to see whether they need to be updated as a result of this exercise.

We find it best to keep dipping in and out of the creation of our plan to keep it alive and keep learning. Watch this space for a future instalment where we will discuss the use of communication charts and the stress and support tool.

This month, Jill Roberts from the Policy and Practice team shares how Action on Hearing Loss is responding to the challenges of delivering personalised services.

In December 2011, the Personalisation Board, which guides our work on person centred practice, requested all care and support services to complete a self-assessment on Progress for Providers. Teams completed this in February 2012 and responses were collated by teams and areas to identify where services were delivering person centred support well and where more support was needed.

We found there were clusters of similar responses. We asked Helen Sanderson Associates for support to analyse the findings.

As a result of this we organised 3 days bespoke training with Helen Sanderson Associates where the learning objectives were tailored to the area. Some of the objectives were:

• How to use tools and approaches to support development of choice and control.
• Tips on how to make person centred thinking a habit.
• How to use person centred thinking tools and approaches in different situations including recruitment and selection and supervision.
• To consider next steps to embed person centred culture and move towards team plans.

People from other departments were invited to the days. For example, Becki Elphick, HR Business Partner, was invited and discussed how she was using the person centred recruitment process to inform the revision of HR policies and procedures.

Although it was clear from the 3 days that most people are using person centred practices, this is often done in an informal way and not consistently recorded. Participants described many coaching opportunities where the tools could be used not only to assist in a naturally occurring situation, but also to show staff how the tools could be used.

(Lisa Orme, Bernadette Sweetman & Jill Roberts creating a team graphic)

There were some similar themes that emerged over the three sessions;

• How do we do all this with shrinking budgets?
• How do we move forward staff who are unwilling to change?
• What do we do next to develop person centred working?

Taking the learning from these 3 days and reflecting on progress to date, the Personalisation Board worked with Helen Sanderson in January to scope out next year's priorities.  These include a one page strategy for person centred working, stream-lining paperwork and developing person centred reviews.

In this month's blog, Tracey, Deputy Manager at one of our care homes shares how the person centred thinking tools have been used to support Jonathan on his first home visit.

"Christmas was approaching and some of the people we support go home to their families for a few days. This was a difficult and tense time for Jonathan as this was to be his first home visit. We sat and chatted to Jonathan to find out what he wanted for his home visit, and used the Doughnut tool to plan a strategy.

The result was a communication and lifestyle manual to enable him to communicate with his family more effectively. The manual included information about what Jonathan could do independently.

Jonathan worked alongside staff choosing his own images, which were mostly photographs of him completing different tasks. The manual included prompt cards to remind him that he should bathe each day and clean his teeth. It also included a program of activities to help his family build a structured day to try and prevent him from becoming bored or being ignored. We used the Emotions communications chart to explain what to do should Jonathan become upset or angry. We developed this information with Jonathan by using Good day/ bad day and How best to support me.

Previously, Jonathan had needed encouragement to take his medication; now he does this independently. He has a chart he signs himself to remind him if he has taken it or not, therefore not relying on family members to remember.

Before Jonathan went home the Important to and Important for tool was used…this gave us the information that it was important for Jonathan to maintain his family relationship and contact.

On his return we used the what's working/ not working tool to help arrange another visit. Jonathan's parents and family were delighted with the progress he had made, and so are his staff team."

The New Year is a good time to reflect on what has been achieved and can help with planning what to do next. At Action on Hearing Loss one of the highlights of 2012 was developing the mini book of Person-Centred Thinking tools for people who use BSL.

It was developed using Helen Sanderson Associates set of Person-Centred Thinking tools as a starting point. The language and grammar was then adapted to make the tools more accessible for staff and people we support who use BSL as a first language.

BSL is a rich and creative language so this mini book acts as a starting point for interpreting and communicating how the tools can be used. A copy of the mini book can be found here.

The idea for adapting the tools started in our Midlands services. The Head of Service, Lisa Orme, is an experienced and keen devotee of person-centred working. She listened to staff and people using services, and found that they struggled at times with the English explanations of how to use the tools. Working with staff and people we support who use BSL as their first language, Lisa coproduced a draft version of 10 adapted tools.

The adapted tools were piloted with people who are d/Deaf BSL users and also experience learning disabilities, mental health issues, physical disabilities or other additional needs.

Our feedback led us to talk to HSA about what we had done and what had worked. Helen was very supportive and offered to produce the mini book.

Now all services and staff have copies of the mini book. It is used as part of our induction of new staff and by our person-centred champions across the organisation.

To aid accessibility we worked with Remark to produce BSL clips to explain the tools.

We now have another way to engage with and support people in a format that works for them. A number of our blogs in 2012 demonstrated how people had made positive changes using the tools.

We hope to continue learning and developing our approaches in 2013. We look forward to sharing our ideas and experiences in future blogs.

Lindsay Hodgson, Outcomes Implementations Manager shares how she used person centred thinking tools to design and implement the new outcomes tool.

Today is my three year anniversary working for Action on Hearing Loss. When I accepted the job I accepted the task of developing an online Outcomes Tool for Care and Support services. This meant that I also took on the task of convincing 500 people that it was a good idea to use it in their everyday jobs. Here's the story of how I achieved both of those things…

Having worked in Care and Support myself I know these things:

-          Staff are often under pressure and pushed for time

-          Staff have to record a lot of information, some of it duplicated in lots of different places

-          Staff can struggle to access computers due to location, equipment and skills.

My goal was therefore to create an online application that was:

√        Quick to use and only collecting meaningful information

√        In line with what Support Workers did already - not an addition or duplication

√        An intuitive, easy to use 'click-of-a-button' IT system.

On August 29^th we launched the tool in all 51 services and have since trained 64 Outcomes Tool Champions through interactive workshops.

Their feedback is the best way to show that we have achieved our goals:

How did we achieve this result? We ran person centred workshops. We centred the training around each staff member and their own life. We each shared our own goals, plans, achievements and outcomes. I'd tried this once before at a managers' conference and after using the Working / Not working tool I realised that this was the key to success. I captured this journey using the Achievement Using Person Centred Thinking tool.

Now we have an Outcomes Tool to help us ensure that the people that we support are getting the personalised care and support that is important TO and important FOR them. It helps Support Workers plan their activities and have evidence based reviews and it demonstrates to friends, families and commissioners that we are delivering a service valued by the people we support.

Ian, who uses services, shares with us how the "presence to contribution" tool has made changes to his life.

Before having support from Action on Hearing Loss I spent many years trapped in my house and was very isolated, my confidence was low which meant that I wasn't able to communicate with anybody. I felt that I didn't fit in the deaf world or hearing world, i had become very depressed and self harmed every day.

Although I was under the care of Social Workers, local Mental Health Team and CPN's I had never built up any relationships with them and it was always just focused on my health.  The first step I needed to take was getting well and rejoining society.

Action on Hearing Loss Staff used a tool 'Presence to Contribution' with me to help me get started, basically, these were steps and things I needed to do so that I could achieve my goal of rejoining society.  When we started the thought of rejoining society was too overwhelming, but it was something I wanted and needed to do, so visually breaking it down has made this easier to manage but also reinforce the positive of each small step.

It started where staff would encourage me to leave the house for 10 minutes, then we go to town, then to a coffee shop. Everything was broken down into manageable steps. Using the tool enabled me visually to see how I was going to achieve this and has contributed positively towards my mental wellbeing as I can already see the steps I have already taken.

This tool became a two year plan, from a time in my life where I wouldn't make eye contact with anybody and hide behind my Support Worker.  Over time my Support Worker, me and Hettie get known, people stop and talk, at first it was like 'oh no get out of here' but now I'm relaxed to communicate with people who ask about my Hearing Dog, Hettie and with one person this has developed into building friendship and meeting this person by myself.

The goal wasn't that as such but the small steps along the way has enabled me to feel more confident about myself, less isolated, have more trust in my ability to communicate with people. Words whether written or spoken don't sink in, I can be told repetitively 'well done' or praised but meaningless.  However, visual media such as photographs do convey a message so I created my own life path using my photographs and now i think wow I done that, I achieved that and it makes me feel positive. If I feel down I stay focused on negatives but if I look at my visual path it changes my view point to a more positive state of mind.

Ian n Hettie

By David Victor Dilkes(in his own words)

My Name David and I have support from Action on Hearing Loss. I live my own home self from when I born 1945 same house!

On my support plan I have goal for make garden nice again. Problem my garden what? I been do 'Working and Not Working' with my support worker show what wrong my garden.  Since I been have stroke 2007 I find hard keep garden nice. It have big lawn and all over grow and like jungle, I can't go in garden now because it make me sad see all mess. This Photo page from my book see garden before. Me and my support worker do 'My Journey' for just garden, show me steps on way to fix garden finish. We as well make book with photos, stickers and letters from council for sort out my garden. This good. I learn how take my photos can print myself in photo shop. I like make book creative with my support worker. It remind me what garden look like when start and how garden progress. Now Council agree clear my garden and I been ask for pave in garden. Easier for me keep nice, not grass, I'm too tired. I write letter and put copy in book means keep all information together safe. When pave I will buy table and chairs for sit outside, I also want get flash doorbell light for outside so if have person come I know they here when me outside. I want get rid of shed old mouldy danger now in wind it shake. I'm buy new shed or maybe glass house for grow flowers and tomatoes. I am enjoy my path to get new garden, we only slow start, when steps along path finish me we put sticker footprint on 'My Journey', but when finish will become lovely and relax. I like my 'Garden Path' book. It means I see remember future how garden before from photo and show how change will.

Managers of the service commented that they found the template easy to use as it provided reflective questions which were easily understood by people in the service and the staff team.  This then helped them to concentrate on what the barriers may be and to plan their next steps.

The services involved in the pilot regularly review their progress using the  4+1 questions tool, and have recently adapted a template to provide a six month review of their action plan which is to be up-loaded on the Making it Real website soon.

This project has created some real changes for people - new accessible information has been created with the support of the people using services, which provides them with more choice and control over their lives. Some services are building stronger relationships with other providers by sharing information/resources, and all 4 services have downloaded the making it real kite mark which confirms their commitment to providing personalised services.

Rosemary moved to a residential home in Birmingham 6 years ago, and worked with staff on her life and interaction skills. Rosemary worked so hard on this that in 2008, she moved into a flat above the residential home to continue her journey to independent life. Rosemary did a college course in flower arranging and started a course at BID Services.

Rosemary's mother sadly passed away in 2010. Rosemary inherited some money which allowed her to re-think her circumstances and her aims and goals. She decided her dream was to live in her own house.

We used person centred thinking tools with Rosemary throughout the moving on process, to make sure that the support package was exactly what Rosemary wanted from her service. We used the "right move 4 you" tool in the early stages to establish where Rosemary wanted to live and the sort of support package she would be looking to receive.

We then helped her create a support plan under outcome areas, which people using Action on Hearing Loss services have identified as being important to them. This refreshed things we needed to be aware of that were important to and for Rosemary when building the support package.

Rosemary achieved her dream in November and was delighted and proud to be moving to her own house.

Rosemary chooses to have some continued support from Action on Hearing Loss. She has been able to have some familiarity in her new life, as she has support from the staff from her previous service.

With very little help, Rosemary cooks, pays her bills, cleans, manages her finances, maintains her personal hygiene and plans her own daily activities. Rosemary has come on leaps and bounds since moving and with her own will power and skills, will succeed in her goals. She appears very happy and content with her new life and still continues to strive to reach her goals in life!

We use person-centred review tools every 6 months, to review how Rosemary is feeling with her support package, and what support she wants to help her to achieve the new goals she has set herself!