Care UK (Provider)

Applying one page profiles to support planning across the business has been successful and welcomed by both customer, families, professionals and staff.

One page profiles for children are a valuable tool to ensure that people who support them can understand them as individuals, to know the times where they can emotionally struggle but are not able to express themselves and to support them on their learning and growing path.

This is even more vital when we are supporting teenagers. The need to understand the things that can trigger them to have a bad day is detriment to their confidence and their development, especially through school and the pressures of exams. Leah who was kind enough to demonstrate how one page profiles could look, is just one such teenager. She is a very focused young lady and needs support at certain times, with certain subjects, to keep her in the sets she aims for. Leah can become privately stressed when participating in school assessment times. Although she is in all the top sets, maths doesn't come naturally and she has to work hard to stay where she would like to be. Leah will not express in class or at home, when she is struggling with her maths. The best support for Leah is to set times every week where she can access the My Maths websites and to research other sites that can help her learn in a way that she can feel confident and work things out for herself, which she prefers to do.

Understanding Leah's health needs has been detriment to good support. She suffers from Asthma and can at times forget to take her medication out with her. As this is a condition she needs to learn to manage, to know she needs a gentle reminder ensures she doesn't get caught short, especially at vulnerable times. It was also key to inform people of her peanut allergy. This can be a life threatening allergy reaction and it is really important that all those in Leah's life, are aware to check all ingredients of all her foods.

Leah really enjoys celebrating her personality in her one page profile, especially finding pictures that says who she is as a person. As her own mother, I can say I understood my daughter a little better in terms of understanding how important her love of clothes and makeup are to her and how I need to  balance teaching her to enjoy her interests and to not grow up too fast.

Any team or group of people who work together can benefit from person centred thinking practices and developing their team plan.

As well as working with our practices leaders in developing their area and micro team plans, we have been supporting our service user action groups to use person centred thinking tools to shape their meetings, to focus the purpose of their group and to establish how they are able to communicate and celebrate the great work that they do.

The Essex 'listen to me' action group are part of a network of groups throughout England and Scotland, that advocate for other people who use Care UK services. They work in partnership with us to share their opinions and experience about receiving services and what good support services should look like.

As a group of people making decisions that helps shape the business, it was important to establish a clear purpose of the group, to know what is important to them and to know what support they need as group members, establishing the roles and responsibilities of others who support their group.

They achieved their purpose and success statements using symbols to make their poster accessible to them and to those they advocate for, as well as effectively communicating to our staff and professionals what their group is about and what they want to or have achieved.

Using person centred thinking tools has become fundamental for ensuring constructive meetings. By developing the members and facilitators one page profiles we had an understanding of how to get the best out of the group. They also agreed what the roles and responsibilities of others should be so they understand what specific support is required, to enable them to be active members.

The group regularly review what is working or not working about what they do and how they work together. This has lead to some great actions that have enabled them to evolve and became a more self facilitated action group, providing valuable contributions that lead to better outcomes for other people with disabilities.

We would like to pass on a big thank you to the Essex Listen to Me Group for sharing their purpose. Stay inspired.

For this month's blog, we would like to share Carol's story with you, and how using person centred thinking tools helped to ensure she had a successful transition.

Carol's supported living setting where she lived was pleasant, but it was unsuitable for her physical needs. Carol is wheelchair dependent and her bedroom barely had space to fit her wheelchair inside and was very challenging when providing the support she needs. Each day, it was essential to Carol to enjoy some time alone, to relax in her own space, listening to relaxing music. Having her bedroom directly onto the busy lounge, rarely provided her with the peaceful environment she wanted.

Carol found a spacious supported living house that was purpose built for wheelchair users and was located in a scenic location that was more suited to her physical needs. In addition to Carol's physical needs, with non-verbal communication and a profound learning disability, being supported by new people in a new environment would require careful planning. We worked together with Carol and her team, who had supported her for some time, who know her well prior to transition. Using person centred planning and thinking tools enabled us to ask the right questions and capture valuable information that would make Carol's transition a successful one.

By capturing a detailed description of what a good day and a bad day looks like for Carol, we are able to ensure her routines are maintained, we can learn what things are important to Carol and how best to support. It also helps us avoid the things that make her feel unhappy.

For carol, probably the most valuable information captured through person centred planning, was how she communicates.

During the transition process, we asked her support team at the time, to complete a How I communicate with you chart, explaining what Carol does to indicate her choices or express how she is feeling. They also completed a How we communicate with you chart so Carol's new support team would speak to her using familiar words and objects of reference, ensuring consistency in how she is supported.

Carol's transition went smoothly with as little disruption to her usual day as possible. Using person centred thinking tools through transition, enables people to live the life they want, that doesn't change when there are changes in their support team or environment and when communication is a challenge.

Well, we believe the people we support should be involved from the start, after all - who are we recruiting for?

As we all know person centred thinking is at the forefront of everything we do within the Learning Disability Services and therefore recruitment plays an important part of this.

This month, I would like to introduce to you our guest blogger "Gary Cunningham", one of our Enablement Leads. Gary has taken the lead on some meaningful initiatives with his colleagues on recruitment. Here he shares what they have learnt and some of the great actions they have achieved.

After a number of discussions around how we could make this procedure more personal to the individual services we were aiming to recruit for, it was both a unanimous agreement and a crucial factor that the people we support must be involved - but how?

Firstly - it was felt that it was important to understand the people we support and staff match with suitable applicants. Since all our customers have one page profiles, this seemed to be a "no brainer".

We found that by using the one page profile we could establish a framework to enhance our recruitment process as follows:

• Inform and personalise future job adverts
• New applicants to create their own one page profile
• The information identifies to the interviewer, the persons requirements and enables smart skills matching
• It is an efficient way to capture and identify interests, likes, dislikes and the skills held in order to support the individual
• Build a framework of questions to ask at interview
• Identify who wants to be involved within the interview stages and how

Secondly - it is important to involve the individual in the interview process, after all who knows their needs better than themselves.  This can be achieved by having the individual present -however we have learnt not everyone always likes to participate at the interview stage - or alternatively, we can involve people at a second informal interview and/or present their questions for them, taking into consideration the information on their one page profile. "No one shoe fits all.

Thirdly - this information is extremely valuable and therefore once collated it can be retained by both the individual and the Recruitment Support Team.

We have introduced a new section to the person centred support plan, called "How I like my support managed". A great place to ensure this information stays with the person.

To ensure the information is kept fresh and alive for future use it is updated in harmony with the Person Centred Review process.

This process has many benefits - the people we support are always part of recruitment and selection of staff from the very beginning and the foundations are resting on the individuals needs, whilst ensuring consistency of support.

"Let's get it right from the start of the recruitment process and alleviate future problems".

Think individual, think Person Centred Recruitment!!

Signing off for now and looking forward to sharing more initiatives next time.

'Let's get it right from the very beginning' - this is what started a conversation only a couple of months ago. Since starting our journey with delivering person centred thinking to Care UK's learning disability services, we have realised that to really deliver person centred services, we need to train people from the very beginning of their employment.

Our guest blogger is Teresa Preece, an Area Trainer, who shares with you her thoughts on the induction programme and how she has been introducing person centred thinking tools to ensure people get the right start.

No getting away from it, person centred support is mandatory! It's one of the common induction standards so how can we expect staff to work in a person centred way if we are not sharing our learning with them and supporting them to develop their skills from the time of induction?

So much work had already been done on induction training and ensuring that people completed all of their mandatory courses such as first aid and fire awareness but when looking a little deeper - there wasn't enough information shared about values or what it means to be person centred. In the past we have expected people to come into this role with the right values and attitudes but we have to recognise that we are a diverse group of people who hold different values dearly and our own values may not be that of the people we support.

We want our induction training to be that special cake with royal icing rather than just a plain sponge!

This took lots of conversations and discussion around the best way to do this. As with every organisation in the current climate, we had to consider cost effective ways of delivering the training without putting additional days into the induction process. The most logical way of doing this was to start weaving in the fundamental person centred thinking tools into the mandatory subjects.

Day one of induction informs people about our journey to becoming a person centred organisation and people start working on their one page profiles. It's exciting to think that on the first day staff start supporting people, they already have their work one page profile!

When delivering safeguarding training we thought it would be great to use the Doughnut tool. This really gets people thinking about their own roles and responsibilities in safeguarding the people they support from abuse. Although we are not teaching people how to use the tools, they are then exposed to them and are thinking in a more person centred way.

Now we have weaved person centred thinking in to all of our induction courses for learning disability staff from the very beginning. This is really exciting and I can't wait to see the difference in the way people are supported. This should encourage an enabling approach rather than people thinking of themselves as carer's and not encouraging people to lead the life they want.

This month we have been looking at reviews. We want to ensure that everyone we support has a person centred review and that all reviews look at a person's whole life, rather than the relationship between themselves and a particular service.

A team of Enablement Leads and Enablers spent two creative days with Jonathan Ralphs (HSA) who shared his skills and expertise in facilitating working and not working reviews for people.

Our guest blogger is Simon Torres, an Enablement Lead who shares his learning from person centred reviews.....

Having a person-centred review should be the norm for people receiving a learning disability service but in reality most reviews I have experienced tend to lean to a more traditional approach, which is often professionally led and based on sorting out problems relating to the person's condition and based on service delivery outcomes.

Even though we have seen local authorities take steps to ensure that a person-centred approach is an integral part of the review process, it still tends to be very structured and driven by a set of predetermined outcomes - and not the preferred holistic approach.

I often felt like the reviews were done and dusted before the actual review had taken place with the individual. The planning process tended to be a paper task - of me asking staff to collate a review report for me to present and discuss at their review meeting.

This has always mystified me - as the process did not always sit right with the person from whose perspective I was driving things forward for.

It is like buying a winter coat four sizes too big for the summer - it is not suitable for the season or the individual.

By using the "Important To and For Review" together with a "Working and Not Working Review", I have found a great way to facilitate a successful review that ensures that the person is truly at the centre and is a forum that enables meaningful contribution and participation.

These approaches to reviews ensure we are able to identify:

1. What is important to the person now and in the future?
2. What good support looks like for them?
3. Find out things from different people's perspective.
4. Have a greater discussion that leads to action.

It is important that we pay greater attention to each other and proactively listen to the people we support.

We have learnt that it is good to "mingle". Mingling time is a valuable way to engage people at their reviews, therefore getting great contribution and enabling everyone to have the opportunity to partake and write down information…… what a contrast to sitting around a table discussing a report!

The reviews have  become a positive experience - making the whole process lighter but still gets down to the real "nitty gritty" issues in people's lives and finds out what really matters to them.

We learnt different and exciting ways to engage people in their review:

• The importance of getting the right environment and that it does not need to be round a table in an office.
• Using pictures and photos
• That music is a great way to lighten the mood.
• Using personal objects to enable discussion.

The process is not limited to annual reviews, but can be used to revisit our team plans and informally look at "what is and isn't working" in a multitude of work and home situations.

Using reviews in this way just seems to make sense, to ensure that everyone is working towards the same outcome and that the team are clear on what matters to the individual, to make a difference.

"The contract said you will need to promote an inclusive lifestyle, independence and choice, but no suggestions on how to do or what this looked like for Jennifer".

Jennifer (name changed) is described by those who know her well to be a well organised and confident lady who enjoys spending time painting her nails, putting her make up on and takes great pride in her appearance. She lives with 2 other people in a supported living home.

Jennifer's support plan file was bursting with paper and a wealth of information from a whole wealth of people over the years and professionals, giving their recommendation on what this could look like for Jennifer. At best, this information is great in creating some ideas on how to boost Jennifer's wellbeing and give the support team some ideas to try.  

However every time a new recommendation came forward the staff team had been trying and trying their best to implement the advice. For Jennifer there seemed to be more unsuccessful events than successful ones, to the point that it felt that opportunities were becoming more and more limited, Jennifer seemed to be getting more and more unsettled and she was starting to get a negative reputation within her local community.

It was clear to the people in Jennifer's life that something had to change and fast.

By doing a review of what's working and not working from different people's perspectives, we learnt that there had been too much emphasis on the paper work and not on improving Jennifer's life and that we had not asked professionals enough why and how questions, we also needed to have a greater understanding on what is important to Jennifer and what works best for her.

What we did learn is that Jennifer is a fantastic communicator, even though she does not use words, we learnt that pictures work really well for her. By using the communication charts we were not just able to learn how Jennifer communicates, but also how we should communicate with Jennifer. The team started to work with Jennifer to gather a collection of pictures to help develop her communication, from local places, things she may like to do, food choices, housekeeping through to personal care. Putting Jennifer in the driving seat on making choices and decisions about her life.

We also learnt that being organised and planning a day ahead is really important to her. We learnt that Jennifer is very skilled at sorting things out and organising herself, but needed to know the sequence of events; she could not always remember them all or would get muddled, making her feel anxious and cross.

We introduced a tomorrow board to help Jennifer to make choices about how she wants to spend her day, she then organises the sequence of events by using pictures.

The team also spent time with Jennifer to develop her one page profile; this has formed the basis of her support plan, on what is important to Jennifer and how best to support her. We know that she loves handbags and shoes, having her hair done, real attention to detail to how her nails and make up is applied. This has been the starting point for developing great community connections. She is a regular now a regular visitor at her local health centre and hairdressers.

When out and about, she has uses a talking key-ring, so she can let people know where she wants to go and what the next steps are.

Jennifer's life is looking very different now, by knowing that she is involved in making decisions in her life, she has developed trust with the people around her, she is making her own choices, going to places she likes to be, gained new independence and has made new friends.  

The team have also learnt that it is okay to ask professionals questions to ensure that they get greater clarity on what is expected. The person centred thinking tools have not only enabled the team to sort out what inclusion, independence and choice looks like for Jennifer, but they are much clearer about how Jennifer communicates and what good support for Jennifer looks like, seeing the difference that this has made has been truly inspiring.

Over the past few months, I have been able to share with you some of the wonderful stories where person centred thinking has made a difference in the lives of the people we support. But in this blog I wanted to share with you how we have been developing person centred teams to create the right environment and ensure that person centred thinking becomes second nature in peoples work.

Back in late spring we started working with teams to co-create their team plans. We started this with whole teams of managers, as we knew that to enable effective change, it is our "leaders" that create the environment and culture that enables people to do their work and deliver what we promise.

It is intrinsic that we have teams that have a shared vision and understanding of the internal and external expectation and those managers have a leadership style that embraces a model of clear direction, coaching and role modelling to the staff teams. 

This really started to make sense to the management teams, but some fundamental questions cropped up………..

• How do we ensure that this process reached all our teams? (we have lots of different teams)
• How do we ensure all our support teams have a team plan? Taking whole support teams out for the day is not an option; this would firstly cost too much and secondly would disrupt peoples support?
• How could we also apply the principles to micro teams and project teams?

Not one to be phased by a challenge, we needed to think out of the box. There must be a practical solution to this. That is when we learnt about one page team plans. (This is what I love about the learning community - sharing best practice and finding practical solution).

The concept of a one page team plan embraces all the elements of a person centred team plan, but enables teams to develop and grow their plans at the right pace. It is a great way for micro teams and project teams to adopt the right way of thinking.

Becky Brown, an enablement lead took it for a test run and shares how her team have used the principles of team planning using a one page plan.

"To ensure person centred team work and performance staff need to be clear on their individual roles and understand the expected outcomes. The great thing about this approach is we have been able to develop our plan over several short but focused meetings.  First we used the purpose and success, and then grew the plan developing our team communication chart, roles and responsibilities and our work one page profiles. As a manager this has proved effective as we now all have:

•  A clear network of support
• Peoples roles and responsibilities clearly defined
• The team having a clear vision of what is expected
• Clear effective communication.
• Regular Meetings as a team with clear actions defined
• Effective rostering with the use of team's one page profiles, identifying skills and interests matching them to the needs of the people we support.

This can only improve the quality of the support that we provide, as the team is motivated and working together with a shared purpose that is built on a true understanding of the people we support."

We have been working together with some people to help them think about where they want to live and how they would like to live, with an emphasis on supporting them to move into their own homes, to have much more choice and control over where they live, who they live with, what kind of home they would like and what it would look like (if adapted) to ensure they can live as independently as possible.

Tracie, one of person planning lead would like to share with you, how she has worked together with people in developing their moving on plans.

There is no doubt that the person centred thinking tools have been invaluable. Communication and Decision making tools have been the foundations for the plans produced. For people who have been living for the last 15 years in a residential setting but have never had to consider the possibility of having their own home, or having friends to stay or even everyday tasks like going to the shops it can be very exciting, at times also frightening and daunting.

This work has shown me just how essential it is to fully appreciate that when we are making big decisions in our lives, not only do we need to have information given to us in a way that best works for us, but we also need time to think and consider our options in life. As one gentleman kindly reminded me, "I need time to think can you come back in 2 weeks" and another lady preferred to think about her life when she was doing her gardening. We need to go at people's pace to really make sure we get it right. Thinking about how information is produced and also about listening to people once they get the confidence to speak out about what is important to them, using the working/not working tool has highlighted many areas of peoples lives, where going forward we begin to create great support plans.

It has not all been easy going and there has been some dilemmas, some family members are worried and concerned it won't work, brothers who may not want to live together whilst everyone thinks it would be best and past experiences of broken promises, so trust has to be rebuilt. What is fabulous is the commitment to this from everyone involved obviously in these times where financial restraints are a reality for everyone, it is nice to know that good outcomes for people are just as important.

We have a long way to go to complete (if you ever do!) this process but now people have made some great plans about how they want their future to look.  

The next steps are going to be just as exciting as people are currently waiting to go and begin viewing possible new homes.   

It is important to remember that families are the most important people in developing person centred planning.

Historically, apart from an annual review, it has not been common practice to involve those who are most important to the individual in such matters as health action planning. This has been the responsibility of the support team working with professionals such as the GP and community nurse teams.   

With our enthused drive to embrace person centred approaches in all that we do and in how we support people. When Shelley, our person centred planning lead, was asked to support Sandra (name changed for this blog) to review her health action plans she naturally used the relationship circle to establish with Sandra the people that were important in her life and to establish who she wanted at her review.  We were able to learn from Sandra that her family was a big part in her life, especially her relationship with her mum. So we naturally invited her mum as well as many others to be part of her planning meeting. You may be thinking what is the "wow" moment, as for those who use person centred thinking and approaches in our everyday practice; this just seems like a common sense thing to do. But for Sandra's mum and professionals this was a totally new experience. For the past 32 years she had received regular communication with health professionals and the support team with regards to her daughters support but had never been actively involved in reviewing any health action planning with her daughter. 

We were met with a mixed response of delight and hesitation from both mum and others - this was a new experience for everyone involved as they had never really worked together with Sandra.  We learnt that before we could move forward with the review we needed to support mum and others to understand the importance of capturing the view point of the family, to ensure we had a holistic approach to supporting Sandra with her health.  It was very important to be able to support mum though this process because she had a wealth of knowledge and experience of her daughter's health. 

Once the scene was set and everyone had clear understanding of the importance of their relationship we were able to move on with the review.  Together we used the What's working and What's not working sorting tool - to review Sandra's health plan and to see and hear things from peoples different perspectives: from Sandra, her support team, professionals and her family.  We learnt a great deal from mum, about Sandra's preferences, what has worked in her life before, where she felt health professionals and the support team could improve on communication and most importantly, she felt that her opinions about her daughter where listened to and valued.

Using the What's working and What's not working tool was the most simple and effective way we could really see what was going well and should continue, what needs to change and also that everyone had a clear understanding of what is going to be happening next.

Now that we know the tools work, we have learnt that families and professional still need support in understanding person centred thinking and how valuable family involvement is.

We know that Sandra's mum found this review both very enlightening and educational. Since this review, she has regular involvement in her daughter's personal monthly reviews, daily planning and planning for the future.