Person-Centred Support: A Guide To Person-centred Working For . - DMU
Person-Centred Support:a guide to person-centredworking for practitionersSuzy Croft, Catherine Bewley, Peter Beresford, Fran Branfield,Jennie Fleming, Michael Glynn, Karen Postle
Person-Centred Support:a guide to person-centredworking for practitionersSuzy Croft, Catherine Bewley, Peter Beresford, Fran Branfield,Jennie Fleming, Michael Glynn, Karen PostleWe would like to thank all the service users, practitioners, managers, trainers,colleagues and friends who took part in this work and supported us to do it.Without you this Project would not have happened and this guide could nothave been written. We hope this guide is useful in making person-centredsupport happen for all service users.The Standards We Expect ConsortiumPublished byin association with
ContentsForeword5Introduction6Who is a ‘practitioner’?More about the Standards We Expect ProjectThe context for person-centred support889The eight key issuesRecognising people’s rights in lawPersonalised services101112What practitioners need to be able to provide person-centred supportSupport and training for practitionersThe characteristics of a person-centred service151616Making it happen17Dealing with problemsMy organisation is not person-centred I’d like to do it but my managers won’t support me The people I work with can’t make choices I don’t have the right information to advise people I haven’t had any training about how to do it It’s one more initiative and I don’t have the time We’re not allowed to be flexible and help people take risks The people/families/communities I work with don’t want peopleto be in control of their service The people I work with like their service as it is There’s not much choice around here We tried it and it didn’t work I don’t know how to start I feel like I’m the only one wanting to be person-centred 2122222222232323Front cover illustration Kevin Chettleand with permission from Advocacy in ActionYou can make a difference25Designed by Julie Rimmer 020 7228 7912Useful organisations27Printed by Pureprint Group LtdReports from the Project28Written, edited and produced byThe Standards We Expect ProjectPublished in 2011 byShaping Our LivesBM Box 4845,London WC1N 3XXwww.shapingourlives.org.ukIn association withThe Joseph Rowntree FoundationThe Homestead, 40 Water End,York YO30 6WPwww.jrf.org.ukAll rights reserved. No part of thispublication may be reproduced or utilizedin any form or by any means, electronicor mechanical, including photocopying,recording, or any information storage andretrieval system, without permission inwriting from the publisher. Shaping Our LivesISBN 1 874436 61 4Treat people as individualsThe quality of relationshipsKnow and understand people’s rightsDon’t make assumptionsTake a positive approachA culture change from care to supportActions not wordsHave the right attitude and approachSee it as ‘a work in progress’181819191919202020232424242424
ForewordAt a time of huge demands on services there is the temptation to impose top-downstrategies and tools. Too often the voices and experiences of service users and thosethat support them day-by-day are lost in this process.This guide is a very useful document for those working day-to-day with peoplewho need support. It values practitioners’ perspectives and is both supportive andchallenging. It offers useful practical pointers for person-centred practice without beingsimplistic or prescriptive. There are actions included that all practitioners can do,whatever their role or organisation and whether their management is person-centredor not.The fact that this document is firmly based in national research and the socialmodel of disability is a great plus. The practical pointers come out of the combinedexperience of practitioners around the country. The guide itself is easy to read and use,a straightforward read full of food for thought and action. I commend it to all practitionersand students.Moira Gibb Chief Executive, Camden Borough Council and Chair of the SocialWork Reform BoardThis guide is an invaluable tool for anyone working with service users from whatevercultural or religious background. It reinforces the importance of the core values ofrespect, inclusion, independence and choice for service users.All too often, assumptions are made about what is best practice. This guide laysout in plain English the rights of practitioners to access suitable training in order tobe person-centred and the rights of the service user to decide his or her support needsand to have control over their lives. The guide’s balance of information and advicein an accessible manner is refreshing, when such topics tend to be dealt with in a coldand clinical manner. I have no doubt that practitioners will find this guide to be anempowering tool which they can use to improve their abilities to be person-centred.The quotes from practitioners show that there are many who feel frustrated at theirinability to be person-centred. This guide offers clear and concise advice on how to goabout bridging this gap. Too often, person-centred support gets put to the back of thequeue behind the perceived necessity to meet targets and deadlines. This guide doesan excellent job of focusing attention on the importance of being person-centred.As one practitioner says, “ treat other people how you would like to be treatedyourself ”. Clearly obstacles do exist that may prevent practitioners fromimplementing this ethos to its fullest but I believe this guide will go a long way toeliminating many of these barriers and will empower practitioners to be personcentred at all times.Tariq Khaliq Advocacy Development Worker, Apna Group5
Introduction6Practitioners are a vital element in social care and play animportant role in the provision of person-centred support.This guide is for practitioners in social care services whowant to work in a more person-centred way and developperson-centred support in their practice.practitioners can be very helpful to them. But manypractitioners feel they did not always get the supportand training they need from their managers and theorganisations in which they work to be able to fullyachieve person-centred working.We know from the Standards We Expect Project that manypractitioners are very keen to work in ways that supportservice users to live their lives in the way they want. Fromthe other perspective, lots of service users told us thatWe have therefore put together this guide and hopethat by sharing some useful information with you itwill help you work in the way that people involved in theStandards We Expect Project have said is the most helpful.7
Who is a ‘practitioner’The Standards We Expect Project chose to usethe generic term ‘practitioner’. This includesall workers who provide face-to-face supportto service users on a daily basis (but are notmanagers) employed by statutory, private orvoluntary organisations. This includes socialworkers, care managers, care staff, nurses, thosewho work in residential homes and communitybased workers.More about the Standards WeExpect ProjectThe Standards We Expect Project was a researchand development project funded by the JosephRowntree Foundation between 2006 and 2010.The Project worked closely in eight partner sitesacross the UK and had links with twelve othersites. It included the perspectives of service usersand practitioners, two under-represented groupsin social care research, as well as servicemanagers.The partner services ranged from residential tooutreach services, and from services for youngadults to older people. Some people using theservices had learning difficulties; others hadphysical impairments or dementia; others wereusing end-of-life care or services for homelesspeople.The aim of the Project was to support thedevelopment of better person-centred servicesin the eight local areas. It looked at the systemsand processes which support service users to havechoice and control over how their rights andneeds are met. The Project also involved serviceusers, carers, staff and organisations in having asay about services and making things change forthe better.Much of the work was conducted individually inpartner services but the Project also ran nationalmeetings and training sessions.The Project was led by Shaping Our Lives,an independent, national, service-user-ledorganisation. The three other partners wereValues Into Action, The Centre for Social Actionat De Montfort University and the Centre forCitizen Participation at Brunel University.The Project’s consortium also included fourindividuals representing a range of perspectivesand skills, including a social work practitioner,a university lecturer, an individual from theRace Equality Unit and a person with experienceof working with older people around personcentred support.In addition to the eight partner sites, theProject worked with a network of twelve moreorganisations, providing an opportunity to takepart in shared learning and discussion at twonational get-togethers. These events involvedbringing together service users, practitioners andmanagers from all the participating organisationsto give them the opportunity to talk about whatperson-centred services are and how we can allwork together to make them happen.As well as the get-togethers, the Project rantraining for service users, practitioners andmanagers around person-centred support.The context for personcentred supportPerson-centred support means the service user is at the centre ofa service. Services should work with the service user to help themlive the life they want. It is not about the service user fitting into theexisting service and just accepting what is on offer because there isnothing else available.Many participants in our project spoke of person-centred supportas a way of thinking or something that comes from the heart. Theysaid it is an approach rather than a list of procedures or techniques.They suggested that person-centred support can only exist in asustained and effective manner when it is underpinned by certaincore values such as inclusion, respect, independence and personalchoice. It was also agreed that person-centred support is a way ofworking based on beliefs about the rights of service users andunderlying values, rather than a buzz-term or a government policy.It’s not another job, it’s the job. Person-centred support is notanother thing that you have got to do, it is what you have got to do.PractitionerParticular attention was paid to supportingthe involvement of service users in the Project,people who are often excluded from thesediscussions. However a very important partof the Project also involved meeting withpractitioners whose voice is also seldom heard indebates and policies about service development.89
The eight key issuesOur project identified eight key issues in relation to person-centred support:Choice and controlThis means people being in charge of their lives and having support tomake decisions.Setting goalsThis means enabling service users to decide what they want to do withtheir lives.Good relationshipsIt is extremely important to service users to have good relationships withfamily members, friends, the people who work with them and others.Practitioners have a valuable role to play in helping to make this happenand enabling service users to feel part of their community.ListeningService providers, and practitioners, need to listen to service users to makeperson-centred support happen.InformationService users need the right information given in an accessible form.It can be very difficult to make good choices without it.Being positiveService users need support to look at their strengths and what they can do,rather than a focus on what they can’t do. People can often make betterchoices if they feel positive about themselves.LearningPerson-centred support can give service users the confidence to go out andtry new activities and learn new skills.FlexibilityPerson-centred support is crucially about services being flexible enough tofit into people’s lives. It is not about a ‘one size fits all’ service or givingeveryone exactly the same service.The social model of disabilityOver the last 30 years disabled people have come together to fight for rightsand equality. They have started their own organisations to support each otherand campaign for change.10An important part of this campaign is thedevelopment of the social model of disability.The traditional view of disability is often called‘the medical model of disability’. It viewsdisabled people as having medical problems,and the assumption is that there will be manythings they cannot do. The social model ofdisability starts from a very different perspective.It looks at the way society, and its structures,systems and organisations, make disabledpeople’s lives difficult. It starts from the premisethat everyone is equal and shows that it is societythat puts up barriers that prevent the inclusionof disabled people and restricts their rights andopportunities. These are barriers like poor accessto buildings, lack of access to public transport, orfailing to provide the right services and supportso that people can’t participate in school, collegeor a working life.Looking at disability this way challenges the ideathat disability is about what people cannot dobecause of their condition or impairment. It liftsthe blame from the individual and makes it clearthat the blame lies with a society that does notprovide the support and services needed. Thisis also called ‘an equalities approach’ becauseit is about disabled people having the same lifechances and opportunities as everyone else.The social model of disability is part of achallenge to society to remove the barriers thatprevent the full participation of disabled people.The Standards We Expect Project looked atservices from this ‘barriers and equalities’approach and so for us person-centred servicesare about helping people to live their lives asfull members of society. To do this they needto have choice and control over the supportthey get. It is therefore extremely importantthat practitioners who want to work in aperson-centred way have an understandingof the social model of disability.We have listed some useful organisations at theend of this guide where you can learn moreabout the social model of disability.Recognising people’s rights in lawPeople’s rights are not just a matter of opinionbut are also enshrined in law. There are a numberof recent laws which are useful to know about.The Mental Capacity ActThe Mental Capacity Act (2005) is a law aboutpeople’s right to make their own choices anddecisions, to have ‘self determination’.It has five key principles:1. Assume a person has capacity unless provedotherwise.2. Do not treat people as incapable of making adecision unless all practicable steps have beentried to help them.3. A person should not be treated as incapable ofmaking a decision because their decision mayseem unwise.4. Always take decisions for people withoutcapacity in their best interests.5. A best interests decision made on someone’sbehalf must be one that is least restrictive oftheir rights and freedom.The law makes clear that no one should assumethat a person cannot make a decision based on: their age how they look how they behave if they can’t make major decisions if they were unable to make a decision in the past.The Disability Discrimination ActThe Disability Discrimination Act (1995) statesthat people should not be treated unfairlybecause they are disabled. The law is aboutaccess and services in: shops and services health and social care school and college employment housing.11
Employers and organisations that provide anykinds of goods and services are breaking the lawif they treat disabled people in a different wayto other people because of their impairment ordisability.Services must make ‘reasonable adjustments’ tomake something accessible or easier for disabledpeople to use. This might cover things like: flexible working hours for disabled staff providing disability awareness training for staff putting in a ramp to make a building accessible providing an interpreter for deaf people.All public organisations, like councils, collegesand public transport services must have a policythat says what they will do to ensure disabledpeople have equal access to their services.The Equality ActThe Equality Act is a new law in the UK whichcame into force on 1 October 2010. The EqualityAct brings together all UK laws about inequalityand discrimination.The Equality Act says that public organisationsand those undertaking services have to takeaction to make things equal for the people whowork for them and for those who use theirservices. The Equality Act talks about rights forthose who may experience direct and indirectdiscrimination, harassment and victimisation andresponsibilities on organisations to prevent andchallenge such discrimination.The Equality Act says that people who fall intothe following categories (in the language of theAct, people who have a ‘protected characteristic’)must not be discriminated against. The protectedcharacteristics are: age disability gender reassignment (the definition includesall transgendered people) marriage and civil partnership pregnancy and maternity race religion and belief sex sexual orientation.12The Equality Act also includes the Public SectorEquality Duty. The Duty says that serviceorganisations, amongst others, must: make sure discrimination, harassment andvictimisation do not happen. take positive action so there is more equalopportunity for everyone. do their best to help everyone get on better.Personalised servicesIn 2007 a government vision and strategy forservices, Putting People First, stated a commitmentto giving people more independence, choiceand control through high-quality personalisedservices. The view of this strategy was thatpeople should be able to use resources moreflexibly to suit their needs and lifestyle. Itrecognised that a wide range of services – fromtransport, leisure, education, health, housing,community safety and criminal justice – allneed to be involved in improving people’sindependence and quality of life. Putting PeopleFirst stated that the success of this approachwould be seen in improved social inclusion,empowerment and equality for people whouse services.The Human Rights ActThe Human Rights Act (1998) gives everyone rights as human beings. It putsthese rights under headings called ‘Articles’, including:Article 2 The right to lifeEveryone has the right not to be killed and to have his or her life protected.This covers protection from hate crime.Article 3 The right not to be treated in cruel, inhuman or degrading waysServices and support staff must work with people in ways that respect their dignityand humanity.Article 5 The right to freedom and to be safeServices should not unlawfully restrict service users’ freedom and should actagainst bullying or hate crime.Article 8 The right to respect for private and family lifePeople have the right to live in the same way as everyone else in the community.This is an important right for disabled people who are sometimes only offeredhousing and services with groups of other disabled people. It also covers the rightto marry, the right to support to be a parent, and the right to access your localcommunity.Article 9 The right to have a religion and to have your own ideasEveryone has the right to follow their own beliefs and have their own ideas, aslong as this does not restrict someone else’s rights to enjoy their own freedoms.Article 10 The right to say what you thinkEveryone has the right to speak out, even if other people disagree with them,as long as this does not restrict someone else’s rights to enjoy their own freedoms.Article 11 The right to freedom of associationServices should not stop people from going out and meeting other people.Article 14 The right not to be discriminated againstService users have the right not to be treated badly because of being a womanor a man, black or white, having a disability or for any other reason.The Human Rights Act also says people have the right to keep and enjoy theirown things (Protocol 1, Article 1) and the right to education (Protocol 1, Article 2).13
What practitioners need to beable to provide person-centredsupportIt is very important that practitioners receive appropriate support andtraining. You are entitled to ask for this in your work.There are standards for the registration and inspection of social careservices, most significantly in the National Care Standards Act (2000).These standards include the training and supervision of social careworkers. For example the National Minimum Standards Regulationsfor Domiciliary Care state that:Newly appointed care or support workers delivering personal care whodo not already hold a relevant care qualification are required to demonstratetheir competence and register for the relevant NVQ in care award (eitherNVQ in Care level 2 or level 3) within the first six months of employmentand complete the full award within three years.On the subject of supervision they say:All staff meet formally on a one-to-one basis with their line manager todiscuss their work at least three monthly and written records kept on thecontent and outcome of each meeting.15
Support and training for practitionersThe standard for supervision set out in theNational Minimum Standards Regulationsfor Care Homes for Adults (18-65) says thatsupervision should happen at least six times a year.Many participants in The Standards We ExpectProject spoke about the importance of trainingfor social care practitioners. Although manypractitioners felt they received good generaltraining there were a small number who felt theydid not get enough training and that this affectedthe services they worked for.We have identified the key points that were raisedabout the issue of training and support forservice workers. They are: Practitioners need to have particular skillsand knowledge when working with particulargroups of service users, for example peoplewith dementia or people approaching theend of life. Training for practitioners has a positive impacton the rest of the organisation. It enablesworkers to treat service users with more dignityand respect. Services must be prepared to commit resourcesto staff training and offer training at times thatare suitable for staff. This approach to trainingshows a commitment to the quality of serviceand demonstrates the service values itsworkforce. Involving service users as trainers is highly valuedby practitioners and service users themselves.It leads to closer and more equal relationshipsbetween practitioners and service users. It is important to encourage reflective practice,for better individual work and for a betterservice overall. Practitioners’ opinions arealso valuable in improving services.Supervisionneeds to be offered on a regular and frequent basis to practitioners. This enablespractitioners to cope with the emotionaldemands of their work as well as offering theopportunities to reflect on their work and feedinto service development.16The characteristics of aperson-centred serviceFrom the opinions of people involved in ourresearch it is possible to identify the followingcharacteristics of a service that supports andvalues practitioners so as to enable them toprovide a person-centred service:1. Regular supervision.2. Regular team meetings.3. An open and supportive atmosphere atmeetings where people feel able to expressviews and ideas.4. Valuing contributions from the whole team,irrespective of length of service or seniority.5. Practitioners’ ideas being listened to, takenseriously and acted upon by the service.6. A down to earth, approachable managementstyle.7. Practitioners empowered to make decisionswithin agreed boundaries.8. Early and open communication aboutimportant changes within a service9. Effective training, including that led by and/or involving service users.There are overlaps in what service usersidentified as key components for person-centredsupport and what practitioners need from theirorganisations in order to be able to work welland deliver person-centred support. Listening,involvement, being empowered to make decisionsand being supported are common to both groupsinvolved in our research.Making it happenIn our project it was clear that service users valued the role thatpractitioners can play in helping them achieve control in their lives.There was widespread agreement among participants that the qualityof relationships between service users and practitioners is the keybuilding block in establishing person-centred support.Many practitioners expressed real commitment to making this happenand working in equal ways with service users. So what elements mightmake up a person-centred way of working? The following list is basedon what participants said to us.There are people outside, whatever branch of care and medicine orwhatever it is you are in, who feel outside and have great needs anddon’t know how to have those needs met. Yes, those who are tryingto offer the needs can do all sorts of things, it is something to do withencouragement, affirmation, and you are probably going along thatroad and when you get to that point they will feel affirmed andempowered to come on board. Practitioner17
You start life as a person and you should end life as a person andat the end of life you often end up as somebody who is havingthings done to them. No matter how physically disabled a personmay be, they are still independent in their own head but they arenot often viewed as that. They are viewed as something to bedone to or at and for me it is about, I am in control of my lifenow and no matter how disabled I become, I still want to be incontrol of my life. For me it is about my control and that is howwe will get person-centred care because I will be in charge of itnot somebody else. Service userMany service users also emphasised theimportance of being listened to, of havingyour views and perspectives respected.Although service users wanted their importantrelationships to be recognised, they also wantedpractitioners to listen to them first, rather thanfamily members:“ I think the relationship thing is keyisn’t it because there are a lot of serviceusers who we work with who haven’t gotverbal communication and can’t voicetheir opinions and we are having to bestguess what they want and that is a realchallenge but it still is possible to buildrelationships.” Speaker unknownKnow and understand people’s rightsTreat people as individualsThe quality of relationshipsIt is very important to see service users asindividuals, as whole people with their ownstrengths and not as a set of problems.Practitioners must have a desire to understandthe connections in people’s lives and seek toact on, rather than ignore, the constraints anddiscrimination they may experience in society.This includes recognising and respectingdifference and diversity and understanding thatservice users from black and minority ethniccommunities may face specific discriminationand difficulties in the wider society.Service users can feel alienated and disempoweredby services that are not person-centred and whichthey have not had the opportunity to build goodrelationships with. One practitioner explainedthat this is a challenge to services that is best metby encouragement and building relationships:This personalisation of services enables creativityand the search for individual solutions. It helpstailor services to an individual’s goals and interests.The process helps service users to feel more incontrol and more confident in themselves. This isa basis for future learning and decision making aspart of a more independent life.18“ It has made me consider more theimportance of relationship-centredas much as person-centred If you don’t have a good workingrelationship you don’t get the best outof it, unless it’s relationship-centred theperson-centred bit doesn’t work. When you pull right back to thebones of it, it is often the relationshipthe staff have with an individual thatmakes a difference, that is the goodquality stuff and that is really difficultto pin down.” ManagerIt is very important to recognise the rightsservice users have to make their own decisionsand to be supported in that. Practitionershave a vital role in ensuring that service usershave the same rights to lead their lives asthe rest of society. Sadly, in our project wefound that some service users had their rightsrestricted in very basic ways, such as not beingable to go out when they wanted or not beingallowed to choose how to spend their money.Don’t make assumptionsA large number of service users spoke aboutother people (particularly practitioners) makingassumptions about what they want and whatthey can do. They said that these assumptionscould make it hard for them to get the thingsthey want. Service users who did not feelconfident to speak up or who experienceddifficulties with communication were particularlybadly affected. Other people’s assumptionsadversely affected both simple, everyday aspectsof service users’ daily lives and major life decisions.Take a positive approachTaking a person-centred approach also meanstaking a positive approach, which supports serviceusers to make choices and work towards goals.A culture change from care to supportA key part of working in person-centred ways ispromoting choices and developing independence.This means adopting a different approach towardswork, one based on support rather than care.An example of this might be the differencebetween a service user being in the kitchen andinvolved in preparing a meal as opposed to thepractitioner cooking a meal for the service user.Or a service user choosing what to eat and when,even if they can’t or don’t want to cook, ratherthan being given no choice over meals.Where I work with people, sometimes they don’t realise theirown ability and then suddenly th
inability to be person-centred. This guide offers clear and concise advice on how to go about bridging this gap. Too often, person-centred support gets put to the back of the queue behind the perceived necessity to meet targets and deadlines. This guide does an excellent job of focusing attention on the importance of being person-centred.
Person Centred Working (day-to-day) is informed by person centred thinking. Every aspect of your day-to-day support work is carried out in a way that is respectful of the individual's wishes and dignity. In everything you do, you strive to support the individual to take control. Person Centred Planning (for future change) is the name given to a
The emphasis is upon person centred, rather than service led, outcomes. Person centred planning tools are used to capture information that feeds in to the care and support or educational plan for a person. There are many different tools that can be used i.e. the relationship circle, communication chart. These tools allow for person centred
f and 10 (1)). We believe that person centred planning can help to achieve this objective. Person centred planning is a way of discovering how a person wants to live their life and what is required to make that possible. Person centred planning has its roots in the normalization and independent living movements. It is grounded in a social model of
Person centred support helps you try new things and learn new skills. 8.F,&8*#*,*49 Person centred support is about services being flexible enough to fit your life. It is not about Hone-size fits allI or giving everyone the same service. . 2.Take positive action so there is more equal opportunity for all service users and workers.
Fund, 2012. 15 de Silva D. Helping measure person-centred care. London: The Health Foundation 2014. 16 Collins A. Measuring what really matters. Towards a coherent measurement system to support person-centred care. London: The Health Foundation 2014. 17 Coulter A, Fitzpatrick R, Cornwell J. The Point of Care.
in early years, schools and colleges. In this publication, we describe 10 key person-centred thinking tools that can be used with learners, parents, staff and governing bodies. In addition, there are two more publications that will help any education setting to become a person-centred organisation:
AN INTRODUCTION TO PERSON-CENTRED COUNSELLING PSYCHOLOGY Professor EWAN GILLON CHAPTER 3 – A PERSON-CENTRED THEORY OF PSYCHOLOGICAL THERAPY . 2 Introduction As we saw in the previous chapter, Rogers’ (1959) theory of personality posited
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