People who use Substances

We have worked with Lifeline and Manchester Methodist Housing Association to explore ways of using person centred planning and advance directives in the UK.

Podcasts

A really inspiring film, sharing how using the Working Together for Change process can make a positive difference in the lives of people who uses substances.

 

Here are some stories from the work done with Lifeline and Manchester Methodist Housing Association.

Kerry

Kerry is twenty-four, tall with long, thick wavy hair and is always trendily dressed. She is a very empathetic person. Kerry used heroin and crack. She has started a maintenance prescription through the criminal justice system. She is doing really well sticking to this. She is highly motivated and keen to learn new things. She wanted to fill her time constructively, and started to do an ELP to think about what was important to her, understand how she was feeling and to bring some structure to her erratic lifestyle and to think about how others could help support her.

Because she is older, and doing well on her maintenance programme workers assumed that she was OK. Doing her plan revealed that this was not the case; Kerry needed support to continue with her maintenance and to structure her days. Kerry had found other ways of letting people know that she is needy, for example she throws her rubbish out of the window instead of the bin. Through the plan Kerry is identifying how she wants workers to support her not to relapse.

Workers have seen changes in the ways that Kerry has responded to different situations. Kerry had her mobile phone stolen by other girls in the hostel. Rather than contacting the police, and having a warning issued, Kerry talked to the girls, and talked about how she understood the temptation, but clearly said that her phone needed to be replaced (with a new one) within the week. This happened.

Doing the plan has helped Kerry reflect on her life, and understand what is important to her. This has helped her gain in confidence. Through doing the like and admire section, she is beginning to move from seeing herself as a victim, and needy, so someone who has things to offer other people. She has started a psychology course, and is going to join the Princes Trust mentoring scheme.

Emma

Emma is 19, tall and fair, well liked with a brilliant sense of humour. She has been homeless for about three years, living in various hostels as well as short stays in rehab units in Scarborough and Preston. She has been asked to leave most places because of her behaviour when she is under the influence of alcohol. When Emma is very drunk she is can be loud, verbally abusive, appears aggressive, breaks and throws things. The following day Emma will be mortified and tearful about her behaviour.

Emma has been at Manchester Methodists supported housing for a couple of months, and was finding it difficult to settle in. She got drunk one night. The two agency workers on duty heard her smashing things in her room and felt that they should check that she was OK. Emma threw a glass at one of the workers. Alarmed, and very concerned the staff contacted Dotty, the manager. Emma wanted to leave the building, and staff tried to stop her, fearing for her safety. In her frustration, Emma broke two windows.

The next day Dotty, the manager came to see Emma. Emma expected to be shouted at and possibly be thrown out. Dotty used the ideas behind the communication chart from ELP to learn how workers could better support Emma when she is very drunk. Dotty talked to Emma about what made her want to smash her room, and how she wanted staff to respond to her.

This can be recorded as a communication chart that says; At the time: Anytime Emma does this: Smashes her room We think it means: She has been drinking and is frustrated, and angry And we should: Go to room, knock on door, "Emma, we can hear that you are smashing things up - are you OK?" Emma usually responds with "fuck off" Tell Emma that you will be downstairs if you need her and that you will come and check on her in half an hour.

Emma and Dotty talked about her drinking and Emma explained about drinking when she frustrated and lonely.

"Drinking is like being scared. When I am drunk I am frightened. If I think about something that upsets me when I am sober, when I drink it takes it away for a bit, but then makes me worse" Dotty asked how workers could support her when she feels bored or frustrated. Emma said she loves to do art, but has not been able to afford art materials. Dotty arranged for a worker to go with Emma and choose art materials - she chose beautiful silks and coloured fabrics. Emma knew that this was not a 'reward', but because she has been listened to. There have not been any similar incidents since then.

Workers are also supporting Emma to find out about art classes and use her talent in other ways. Sue has asked her to produce some posters about harm reduction and advice. Instead of photos of staff, the manager has asked Emma to draw caricatures of the staff. They have also commissioned local arts group to come in and work with Emma and another girl to design banner for the opening of the refurbishment.

Christine is Emma's key worker. Christine's son wrote her a poem, saying how his Mum had made him the person she was. On the course, people explored the power of sharing some personal information rather than keeping a 'professional distance'. Christine shared this personal poem with Emma. Emma surprised Christine with a beautiful silk poster, with the poem written on in silver fabric paint on silk fabric. Christine is having this framed.

Working in this person centred way is a cultural change for staff at Head Office. Head Office felt that a more appropriate response would be to make Emma pay for the windows, and that supporting her to pursue art 'brushed this under the carpet'. They wanted Emma to have a written warning about her behaviour, signed by Emma. The approach taken by the staff was different. What has been learned about Emma can be recorded as part of an Essential Lifestyle Plan. Agency staff could read this to know how best to support Emma.

Sue, the manager, said "Our approach is to help Emma to have meaningful occupation to minimise getting drunk and violet outbursts. We saw her as a frustrated young woman, not an 'incident'. We recognise that if staff had responded differently, Emma would not have had this responded that way."

Roxanne

Roxanne is a beautiful, twenty two year old with dark brown eyes. She had been in care since she was twelve. She is a sex street worker and was charged with soliciting earlier this year. She was given an antisocial behaviour order, the first one in Blackburn, which means that there were certain streets that she must not visit. As she left court, a local newspaper journalist took photos and her story was splashed across the front page of the newspaper.

Dottie and her staff team are using a person centred approach with Roxanne. They work at Roxanne's pace, giving her control over discussions, and helping her to think about her life differently. This gave her confidence to talk about how she was treated to a police officer that was involved in her case. This resulted in an apology and the beginning of two-way respect.

Roxanne has two children of her own, the first has been adopted, and she is going through the painful process of her second child, Jodie, being adopted. Workers talk to her about how she wanted to approach the adoption, did she want to go in the box? What support does she want? Dottie is helping Roxanne create a life storybook for her daughter Jodie, so that she can read it when she is older.

Dottie, the manager explained that person centred approaches have been very helpful in working with other agencies, and helping them see who Roxanne is and listen to her.

Dottie - do we have an example of how other agencies have treated Roxanne differently?

Dottie (1st line manager)

Dottie is using person centred approaches in reviews, coaching staff to keep reflecting on how they work and looking at alternative strategies. One example is helping Christine think differently about when girl swears at her. Christine's initial reaction was to give her a warning. Dottie encouraged her to look at this differently, and talk to her about the impact this has and negotiate from there, or for staff to write down how they feel, and find an appropriate time to talk to the girl about that.

"I have used person centred approaches as a tool with everyone since the training - think about how to do things better as a team, rather than saying how I think things should be - I have got a much better response" Dottie.

"It has had a profound impact on me - it has made me stop and think. Everyday I think about what impact our actions can have on the residents or staff" Dottie "It gave us a confidence to work in a way that made sense to us, and practical tools for doing this" Dottie.

"It was important to do the training as a whole staff team. It brought issues to the surface that we are now dealing with, which is better for the team" Dottie.

Dottie - is there anything you can say about the difference the training has made to her?

Margaret (staff)

A girl told Margaret to "Fuck off." So Margaret did…and was invited back by the same girl for a cup of tea half an hour later. Some other workers thought that she should have handled this differently, and talked to the girl about not swearing at staff, but Margaret chose to respond differently.

"Over the weeks I had to speak out more, I was glad that I did the training with all the team" Margaret.

Sue (manager)

"The ethos has not been a big change for us, but we now use more of a 'softly, softly' approach which is more effective. We are investing in the woman, instead of just responding. Before we would ask people what their problems are, and then advise them, now we listen to them and enable them to find their answers"

One of the staff said that doing her own ELP has helped with her stress levels. She looked at her plan, and made some changes in her life that have made a difference. She recognises that she is important enough to have time for herself, she now reads for fun, has joined weight watchers, changed her approach with her son encouraging him to take more responsibility for his own behaviour"

Sue W (person centred worker)

"Person centred planning has made my work more focused. I have used it to really, really get to know my client. It has enabled me to bond the relationship, build a trusting relationship and work better and closer with the person. Clients want to come and see you and it is not just a job, but you are really interested in the person and care about them." Sue W