Certitude (Provider)

This month's blog comes from the Director of Development at Certitude, Marianne Selby-Boothroyd.

Back in October, I wrote about how we had started our journey towards Individual Service Funds, with Certitude's Leadership Team assessing support we provide against the 'I' statements. This was the start of our commitment to developing ISFs. It was also the start of our pilot of doing this with over 30 people who use both our mental health and learning disability services and who are living in shared accommodation (both supported living and registered care homes) across three London boroughs.

A couple of weeks ago, Mary Schumm, our Operations Director, gave a presentation summarising the work that has happened to date in the pilot - it was great for 'Team ISF' to come together and reflect on the work they have achieved over the past few months.

We have taken a project management approach to introducing ISFs with various phases. A lot of time has been spent on the start up phase - making sure everyone involved in Team ISF has the same level of understanding, competence and confidence about what it is we are trying to achieve - no small feat! There are over 7 staff teams involved, as well as leads from our Human Resources, Finance and Development departments.

First, we brought managers together to explain the background to the project, the key features of an ISF, the scope of the project and its benefits, objectives and outcomes. Follow up workshops with managers focused on getting to grips with the Care Funding Calculator - understanding shared support and 1:1 hours; getting an appreciation of the options for planning with people and what would work best - Planning Live? Person centred reviews? As well as understanding some of the principles behind Just Enough Support and what that means in relation to the support we currently provide.

We then started off the beginning of the year by carrying out workshops with the wider teams involved in the project. - again explaining the reasoning for the project, giving examples of how the project is working in action and doing some work around current knowledge and confidence within teams in using person centred thinking tools.

So, what have we learnt during our start up phase?

Being able to give practical examples of how one staff team started 'the personalisation journey' a few months prior to the pilot starting, having the manager of the team present at the workshops, talking about her experience and being able to answer questions based on reality has been invaluable.

Using 'frequently asked questions' to share information across the wider staff teams has been helpful. Not everyone has been able to attend the workshops, but everyone has thoughts, queries and sometimes concerns about what will happen both during the pilot and afterwards. Being able to answer some of these questions such as: If people we support are going to choose who they want to be supported by, and I don't get chosen, what are the implications for me? Will we have more paperwork? How will Individual Service Funds make things better for the people we support? And doing so in writing for people to refer back to has ensured everyone has the same information.

Using Progress for Providers has been vital in terms of establishing where teams are at, in terms of confidence and competence in using person centred thinking tools. It has enabled us to tailor ongoing support to individuals and teams based on need.

It feels like a lot has happened over the past few months and that has just been getting ready! The commitment and enthusiasm of those involved is increasingly apparent - so onwards we go…

Madeline Cooper-Ueki, Certitude's Business Development Manager talks this month about her learning around the use of personality tests and person centred tools.

A "good organisational fit", "team roles" and "employee motivation" are some of the terms you come across in the academic world of the psychology of work - or occupational psychology as the profession would call themselves. With this as my background, I have long held in esteem the "validity" and "reliability" of some of the tools used by such psychologists, such as psychometric or personality tests. These tests are often shrouded in mystery - one's personality will be magically disclosed after a series of carefully administered questions about how you feel or react in certain situations. Questions are carefully composed to catch out those of us who want to hide any less than pleasant traits and our true personality which is relatively enduring over time will shine through, so that the employer can get the right person for the job and can get the best out of us while we are at work.

With these facts in mind, I was mightily surprised to find that a great one page profile and some other team planning tools, such as staff communication charts can capture much of the same information. It has been at least 7 years since I first worked through the team planning process with the team I managed at the time, and as a manager I found it an invaluable way of getting it right for the team, so that they could get it right for the people we were supporting. Although I knew that doing a good team plan and keeping it alive could really create fabulous and person-centred team working, it never occurred to me that it may hold its own with the tools of the psychology trade.

I was delighted to be invited to facilitate some of our Human Resources Team Away day last year; to help them create their one page profiles and work based communication charts. And I was even more delighted to be able to take part in the MBTI* which the team were also doing as part of their team day, and have my own personality profile created. (*Myers Briggs personality test which is one of the most widely used and highly regarded approaches based on Jung's personality types - for those who wish to know more see www.myersbriggs.org )

What I learnt about myself however, was not really such a surprise. My ENTJ profile showed me as logical and structured, and enjoying working with others, particularly on strategic plans. My one page profile says that it is important to me to spend time with others, especially to discuss ideas and decisions. My ENTJ profile said I like participating in a wide variety of tasks - my one page profile said the same. My ENTJ profile said I may become judgemental when stressed - my communication chart says to listen but tell me where I'm wrong if needed.

Throughout the afternoon with the HR team, I could see similar parallels in the things the team members said were important to them, or how they could best be supported in work. While the personality profiles were very detailed, the points described in one page profiles were fewer and more personally worded, but the overlap was distinct.

So how do we get the valid and reliable results from our person centred planning tools? Self reflection is key and used in both approaches. Supported self reflection by working in pairs with those you trust, going through what makes a good day and a bad day, helps deduce the detail and with good questioning ensures that the underlying characteristics shine through. The experience and learning of that day, has given me even more faith in the validity of using staff one page profiles or team plans, to get the best out of people.

Oh and one final point - My personality profile says I am open to challenges and questions which help me learn; my one page profile says good support includes arguing against my point so I can re-evaluate and check I'm getting things right. That being said, I'd appreciate any challenges to my ideas and suggestions in this blog - if anything I'll be learning!

This months blog comes from May Lee, our Person Centred Development Manager.

Recently, I've been meeting with Mark, who uses our mental health services, along with a couple of members of his support team. We've used some tools to help convey who he is and to clarify the best way to support him. He's due to move into a studio flat on his own and will receive minimal support, enabling him to live his life much more independently.  We want Mark to move on from our services with the right information about how to support him as a person, not a 'mental health client'.

Mark is a lovely, warm and witty man who has a real twinkle in his eye and a cheeky grin. It's been a privilege to spend time with him, hearing his life story and I have huge admiration for his wisdom and generosity about people, which has remained intact despite the fact he's been in the 'mental health system' for 30, of his 45 years.

Mark's history and labels probably fulfills some people's negative stereotypes. He's Black, he has mental health issues, he's an ex crack user, he's been on benefits for years and he's committed a crime which means he's now on the 'Sex Offenders Register'.

However, I hope that anyone who sees what we've written together using person centred thinking tools will see beyond those stigmatised straplines, to the kind and generous person he is and understand what good support looks like to him.

For example, Mark's Decision Making Agreement states that the Police and his Psychiatrist have a say in where he lives, but that good support for him is making sure that his voice is heard.

Mark's 'What good support looks like to me' deters patronising assumptions about financial abuse whenever he gives money or cigarettes away as he tends to do this for two reasons; first, because he's a generous and sympathetic man who feels he's in a good financial position compared to many of his peers; second, because he sometimes uses these 'gifts' to negotiate errands and other favours. Mark's 'Decision Making Agreement' encourages working out a realistic budget with him which takes into account his spending on 'gifts' and scratch cards.

Medication management can be a big issue for many people with mental health issues and their supporters. Questions about whether or not someone is taking their meds and the fear of what might happen if they don't can dominate discussions. Mark's 'What good support looks like to me' gives permission to ask him if he's taking his meds, but also clearly states that he's honest if he hasn't - so therefore must be trusted if he answers 'yes'. It also details what behaviours indicate he might be relapsing and what to do if these happen.

For Mark, along with many others we support, there's a real danger of being judged solely by his case notes, labels and past, rather than who he actually is as a person.

If we've succeeded in helping people who meet him in the future see a portrait of someone who is the colourful, capable and canny man he is, then we've definitely used the right tools for the job.

"Should be more than a one off, let's make change a reality"

These were the words of one of the participants of our second Working Together for Change (WTFC) event held at the end of September. This time the focus was involving people using, commissioning and working within mental health services in the London borough of Lambeth.

In relation to the process, we undoubtedly found it harder to involve a range of external professionals in attending, however the contributions from the commissioners and the officer from the British Transport Police who did attend, highlighted the benefit of such involvement.

It is striking that carers at our first WTFC event back in June - which focused on people using, commissioning and working in learning disability services -mentioned the desire to see action rather than talk and this was again reiterated at the second event by people who use mental health services. There is a danger in doing the listening but not acting on what has been heard. The value of WTFC is the opportunity to action plan together, minimising the risk of nothing changing as a result. As one participant said "It was an eye opener: it was important to talk about it and most important to talk about what to do."

As a result of carrying out WTFC - within two London boroughs, with two very different groups of people - as an organisation, we have been given very clear messages on what needs to change and the work we need to be doing.

Across the two events, a number of key themes were identified based on information from 85 people's reviews:

• I want help to be well
• I want to choose with whom and where I live
• I want choice and control
• I want to choose how and when I am supported
• I want more things to do
• I want help to get a job
• I want someone special in my life
• I don't have enough money
• I want my family and children back.

People attending both events were creative and resourceful in identifying solutions to the themes identified above, ranging from setting up speed dating nights, to publishing findings on where to find a good GP.

Action plans were started for all the themes and Certitude has subsequently spent time firming these up and enlisting the support of those both internally and externally in making things happen.

One of our biggest commitments to making things happen as a result of WTFC has been the start of our work in developing Individual Service Funds with 48 people whom we support. Further blogs will chart our progress with this ambitious piece of work and our progress in addressing the themes above.

Over the years, as an organisation, we have tried numerous ways to involve the people we support in influencing and shaping the strategic direction of our organisation.  In doing so we have learnt a great deal about what is and what isn't meaningful to both the people involved and the organisation as a whole.

Recruitment, satisfaction surveys, user involvement groups, ambassadors and even Board membership have all been tried and have worked to greater and lesser degrees.

Our learning has helped shape Certitudes Involvement strategy for 2011-2013 and clarified for us why we are now taking the approach we are, which is ensuring that everyone has proper involvement in decision making about their own life and that as an organisation.  We are intentionally learning from people's decision making and using this individual level of involvement to influence organisational strategic development.

We believe that there are three stages of people's decision making that we as an organisation can learn from:

People Choose

People Feedback

People Review

People choosing, means having full and proper involvement in decisions around who supports them, with what, where and when. Good person centred support planning, which includes decision making agreements, is the key to ensuring this happens. We have identified a set of actions to achieve by 2013 including increasing the use of one page profiles and decision making agreements. These actions will support the firm foundation of good support planning.

People review where their lives are at all the time, precisely because people's lives do not stay the same, things change over time, skills, interests and health etc all fluctuate. We will use the person centred review process to ensure that each person is able to review what is working in their life from their own perspective. We will use this process to listen and learn from people about what is working and not working for them in their life and then use the working together for change process so that individually, people are informing strategic organisational development.

Everybody we support should be able to feedback on a regular basis how their support is or isn't working for them. This should not be restricted to the formal review process nor should it have to be linked to a formal comments/ complaints process to be heard and for improvements to be made. By 2013, our managers will seek the views of people on what support staff are doing that is working for them, as well as what is not working for them. This information will be used to provide feedback to individual members of staff through the supervision process and will feed into the annual appraisal process. It will ensure that individuals remain involved in decisions about who supports them over and beyond the recruitment process.

Of course, we also recognise that some people want greater involvement in the way the organisation develops - in different areas and at different levels and we are aiming  to ensure that people have a range of opportunities to be involved at the level that works for them. These include the development of customer standards, co-delivery of training, quality assurance work, as well as membership of task and finish groups.

Certitude's involvement strategy for 2011-2013 has been written with hindsight and with the learning that has come from years of trying out different options, at different times, with different people. Whilst we recognise that one size does not fit all and therefore that not everyone wants to be involved and certainly not in the same way and at the same time, we do see that actually everyone can and should be involved in the way the organisation affects them directly. So, the involvement in key decisions about the who's, what's, where's, why's and when's of support are a non-negotiable for everyone.

In the last few months, we have started to think about and use person centred tools with people who use our mental health support services. Sandra has been instrumental in making this happen. Sandra has been involved with Certitude for a number of years - when I first met her, a couple of years ago; she was keen to help others. She has used mental health services for most of her life and is passionate about wanting to shift the emphasis from 'done to' to 'done with'.

So, a couple of months ago, Sandra and I spent the day together to look at some of the tools. We started off by Sandra talking me through the journey of her life to date and we subsequently built up a narrative of how she has arrived at being the strong, insightful and supportive woman she is today.

In some ways, this was the most important part of our work. Often, within mental health services, support is time limited and directed by the most urgent need. It can be difficult to know or see the person as a whole and with an understanding of their strengths, skills and experiences not just their support needs.

The communication chart which Sandra completed has provoked the most amount of comment from people who have known her for a long time - the most common comment being "I never knew that!" This has been key in helping Sandra help others understand her better and as a result enable her to take more control over situations.

We are now starting to think about how these tools can be more widely used by people and following the theme of empower and enable, we are looking at skilling up a new peer support group with these tools to be able to pass on. Called Solidarity in Crisis, this group will be providing peer led out of hours support and will be able to provide first hand experience and evidence of how the use of tools like the communication chart, good day/bad day and one page profile can make a positive difference as part of someone's recovery.

To read Sandra's story, please click here or the graphic above.

                                      http://www.certitude.org.uk/

This months blog comes from the Director of Development at Certitude, Marianne Selby-Boothroyd.

Certitude's Leadership Team has spent the last couple of months exploring where the organisation currently stands in relation to Individual Service Funds.

This has been a really useful opportunity for us to take a step back and look at the diverse range of support we provide to people and how it is tailored to - and contracted for - the individual.

We have assessed our support against the following areas:

• I can use my hours / budget flexibly and can choose what I am supported with
• I am supported where it makes sense to me, at home or out and about
• I choose who I want to support me, my support worker knows me and I know them
• I get support on the days and the times that are right for me.
• I choose how I am supported and my support workers know that this is important to me
• I am fully involved in decisions about my own support and how the wider service develops
• I am supported to build and maintain friendships and be a full and active member of the community.

I am sure it will come as no surprise to hear that the answer to the question of how we are doing in each of these areas is - it varies!

It has been really interesting to see the differences in the mental health support and learning disability support we provide and to start looking at some of the reasons for this. Themes around rota's, the influence of external professionals as well as natural support are emerging and echo what people have told us through the two Working Together for Change gatherings we have held.

For us as a Leadership Team, it has also been really interesting to find out about progress that is being made on a local level throughout the organisation. Individuals and their support teams are responding to barriers and issues in their lives and real change is happening as a result. For one woman, the desire to see her father more often and build more of a social network has led to her and her support team working with her dad; her local pub and taxi firm to make sure Friday nights are spent her way - out at the pub with friends and family and not a paid member of staff in sight!

Capturing the learning of what is happening across our organisation is our first step to ensuring ISF's become more widespread. We will be mapping out work that is happening at an individual as well as organisational level and then we will carry on moving onwards and upwards!

                                     http://www.certitude.org.uk/

This blog comes from the Director of Development at Certitude, Marianne Selby-Boothroyd.

In April 2010, Support for Living and Southside Partnership - two London based organisations merged to form Certitude Support.

For both organisations, the merger very much made sense - both have over 20 years experience each in supporting people who have learning disabilities as well as people who have mental health needs. Both are focused on supporting people to have choice and control over their lives and both are committed to making sure that the support they provide is led by the individual and is of an excellent standard.

However, like any new partnership there has been a lot of learning, sharing and getting used to each other going on over the past year! The development of Certitude's strategy for the way forward has certainly helped in clarifying what is important to us as a group in supporting people to flourish, contribute and lead the life they want to lead.

One of the key issues which we have identified in our strategy is the need to be able to offer support in a personalised way. For Certitude, this means continuing to develop staff and volunteers throughout our organisation who think and work in a person centred way so that individuals feel listened to, valued for their strengths and skills and supported to identify their needs and wishes. It also means reviewing the structure of our support - particularly where we are contracted to provide block rather than individualised support.

So…with personalised support as our end goal, our work has started off in 2011 with the use of Working Together for Change.

One of the really great things about merging has been the coming together of experience and expertise in supporting and learning from two very different groups of people. Support for Living's expertise lies in supporting adults who have learning disabilities, whilst Southside Partnership are specialists in supporting people who have mental health needs and in particular people from black and minority ethnic communities. Using Working Together for Change is helping us learn together what is important to the people we support - both now and for the future.

In June we held our first Working Together for Change event in Ealing. Having gathered information on what is working, what is not working and what is important for the future from over 40 people we support in Ealing, we then brought together 30 people who live and work in Ealing and who are in some way involved in using, providing or commissioning learning disability services.

Over two days, we listened, discussed and learnt - a lot!

In terms of the process itself, we learnt that a lot of investment (time and effort) is needed in making sure the right people are in the room. Having people there who are genuinely interested and who want and have the influence to make change is really important.

It's equally as important to not make assumptions about who will be able to attend and contribute to the process. A couple of people found that the process wasn't for them and did not stay for the duration, however there were many others for whom it would have been easy to assume that two whole days of talking would be too much.  Thankfully, we didn't assume and the experience and our learning were all the greater as a result!

Without a doubt, the use of people's own words in the information used for what's working, not working and important for the future was really powerful and understandably drove the action planning for the future. Getting this information wasn't as simple as asking people for their top two issues identified in their last review.  In Support for Living, we have been facilitating person centred reviews for over two years, it has been carrying out WTFC, however that has helped us take a step back and reflect on whether the information from peoples reviews is really what they think and feel about their life and the support they have. Gathering information for WTFC has prompted us to revisit the real purpose of person centred reviews and how we can really be sure that the person themselves is leading the process. We are currently working on Top Tips for gathering information to support this to happen.

Later on this month, we are carrying out our second WTFC event with a group of people involved in mental health services in Lambeth. Already, we are seeing differences -instead of person centred reviews, recovery star meetings are being used to gather information - and some similarities in the issues being identified. Following this second process, Certitude will be in a stronger position to know and respond to what people are telling us  - we will keep you posted!

                                  http://www.certitude.org.uk/