Support staff should do everything they can to ensure that the actions agreed upon in a review happen, however in some cases a third-party may be responsible for certain actions. Support staff should chase up any third-parties and if there is still no luck, it should be reported to a senior member of staff or the service manager.
An individual has to be central to the person-centred review process because otherwise it isn’t a person-centred review. All individuals should be present at their review and,they should have had some time to prepare for it beforehand. The individual should be the primary person that is addressed during the review and others should not talk about the individual as if they are not there. Everything the individual says should be taken seriously and recorded. Assistance in communication should be provided to the individual if needed.
I use person-centred thinking to support individuals in their relationships and in being part of their community. I do this by ensuring that individuals are free to make their own choices, although I will offer advice when I deem it necessary. I encourage individuals to play an active role in their local communities by providing assistance with things like finding a job or participating in local events. I help individuals with their relationships by offering guidance if they ask me and helping them to pursue and stay connected to the relationships that are most important to them.
When an individual makes a choice, I have full respect for their decision so that they can have full control over their lives although sometimes it is necessary for me to give them some guidance as they may not have considered all the ramifications of their choice. I will offer practical advice about how an individual can proceed with their choice, no matter how difficult it may appear to achieve and am careful to ensure that my own personal bias does not interfere with the individual’s free will.
Person-centred thinking means communicating with an individual in a way that they are comfortable with and allows messages between one another to be understood. For some individuals, this may mean speaking slowly and in simple terms and for others may mean using body language and signs. I adjust the way I communicate based on the individual’s needs and preferences.
I establish with an individual how they want to be supported by asking them. If they are unsure I will try to offer some ideas so that they have choices about the support they receive. I will then work with the individual and other health and social care professionals to make this a reality.
I use person-centred thinking to know what is important to an individual by regularly conversing with them and asking them what is important to them. In some cases, I will use person-centred tools to document what is important to them. I will then work with the individual to create a plan of action regarding what we can do to pursue these things that are important and regularly review our progress paying particular attention to what is working and not working and doing my best to answer any questions they have.
I would prepare for my own person-centred review by asking myself the following questions:
- What do I like/admire about myself?
- What is important to me now and in the future?
- What additional support do I need in achieving my aims?
- What is working and not working for me and others?
- Any questions/struggles I have?
- What actions should I take?
The 4 Plus 1 Questions Tool above was very helpful in identifying what actions I should take to stop smoking completely because it outlined what I have done so far, the progress I have made in cutting down my smoking and the belief I have gained in my ability to stop smoking completely. This information allowed me to make the decision that I really can stop smoking over the coming weeks, which I never would have dreamed of a month ago.
My own relationship circle has my girlfriend and my kids at the centre. Just outside of that ring is where my mum, dad, brother and best friends are located. The next most important people to me are my auntie, cousin, grandad and other friends and the outer rim has my work colleagues and other professional acquaintances in it.
This is an example of using the 4 Plus 1 Questions Tool in my own goal to stop smoking:
- What have you tried? Cutting down on the number of cigarettes I smoke and replacing some cigarettes with an NRT inhalator
- What have you learned? I do not need to smoke as many cigarettes as I do and nothing bad happens when I don’t smoke for a prolonged period of time.
- What are you pleased about? That I am beginning to genuinely believe that I can actually stop smoking
- What are you concerned about? That I continue to smoke some cigarettes even though I know that they are not useful or good for me.
What next? Continue to try and reduce the number of cigarettes I smoke with the aim of going a whole day without a cigarette next month.
From this exercise I have learned that my process of cutting down the number of cigarettes I smoke is working and giving me more self-confident that I could stop smoking completely, however it has not worked in allowing me to stop smoking yet.
To be successful in implementing person-centred thinking, planning and reviewing requires commitment, tenacity and the ability to ‘think outside the box’. At the heart of the process is the client that you are supporting and it is your responsibility to help them reach their goals and achieve their dreams, sometimes using innovative ideas to lead to success. And if one idea fails, it is important to have the resilience to not give up and keep trying.
Challenges can come in myriad forms.
The family/friends of a client may be overprotective or disagree with the desires of the individual. Although family, friends and relations may be well-meaning and play an important part in the support a client needs, it is important to remember that it is the client’s choice about what they want to do with their lives and your job to support them in doing it. You may have to explain this to family and should do it in a sensitive and empathetic manner. Or, if the client themselves is able to speak to their family about this, you should explain that it is their choice what they do and they may need to weigh up the pros and cons of doing so with upsetting their family.
Practically Difficult or Impossible
Some things may be too dangerous or difficult for a client to participate in. For example, a client may wish to get their driving licence and buy a car but not have the physical capability to learn to drive. Of course, you should look into whether it would be possible for the individual to learn to drive and maybe have external assessors meet them to make a decision but it may be that this is not an option. You could then tell the client that getting a driving licence is impossible but they could still buy a car, maybe under the motability scheme, and their care staff or family could drive them around in it.
A client may want to go to a night club but there is a real risk of them having an epileptic seizure from the lights. In this case, you may look at specialised discos for people with epilepsy that do not have flashing lighting. Or it may be that they very rarely get seizures, in which case it may be worth risk-assessing the activity and having a contingency or safeguards in place just in case they have a seizure (for example having a member of staff accompany them).
A client may be indecisive and express a desire to do something one day and be totally against it the next. This can make person-centred planning very difficult as the wishes and plans of the individual would be constantly changing. By working with the client regularly, conversing with them and getting to know them well, you may learn to distinguish real long-term goals from flitting whims and only pursue the objectives that they regularly discuss whilst discarding the rest.
Lack of Interest
If a client is lethargic and appears to have no interest in planning their future, it is important to talk to them about the reasons why it is a good thing and encourage them to take some responsibility for their goals in life. It may be that the individual really does have no interest in achieving anything other than participating in the same routine every day until the day they die – and this is their choice – but it is a support workers job to try to motivate and offer opportunities that the individual may not be aware existed.
In my own work, a challenge that is often faced when implementing a person-centred approach is that a particular client regularly changes their mind and an idea that they love one day, they might hate the next. Another challenge that I have faced is a lethargic client that had absolutely no interest in personalising the support he receives.
My own role in person-centred thinking, planning and reviews when supporting individuals is to communicate with and observe individuals to discover their needs and what is important to them. I may then offer suggestions as to how they might want to pursue their interests or ambitions and help them to devise a plan of action to achieve them.
As I am the Key Worker for a particular individual, I will take responsibility for ensuring that their needs and interests are met and have tri-annual reviews with them to discuss their achievements, what is working and not working and if there is anything they would like to change or anything new that they would like to pursue. I also make myself available for an hour each week for them to discuss anything that is on their mind.
Person-centred thinking can be used with teams to create a shared purpose. Because the team knows what is important to its members, roles and tasks can be allocated according to a person’s strengths and interests.
Person-centred thinking can be used with individuals to allow the to have choice and control over the support that they receive and have their dreams, desires, needs and personal preferences catered for.
Person-centred planning is an approach and set of tools to gather information about what an individual requires in terms of support. Personalisation is using this information along with a personal budget to put the in place the support that an individual needs, giving them choice and control over the outcome.
Current legislation, policy and guidance underpinning person-centred thinking and planning includes:
- The governmental policy ‘Putting People First’ aims to transform social care so that it is person-centred
- The Department of Health’s white paper ‘Valuing People’ (later updated to ‘Valuing People Now’) outlines the government strategy for ensuring a person-centred approach for people with learning disabilities
- The government white paper ‘Personalisation Through Person-Centred Planning’ seeks to share learning about how person-centred thinking and planning can help the delivery of ‘Putting People First’ and Valuing People Now’
- The Disability Discrimination Act makes it unlawful for anyone to be discriminated against because they have a disability
The person-centred review process usually comprises of the following steps:
- What people like/admire about the individual
- What is important to them now and in the future
- What support they require
- What is working and not working for the individual, their family and others
- Questions to answer
- Action plan
As described earlier, a one-page profile is a brief introduction to a person, capturing key information on a single sheet of paper including appreciations about the individual, what is important to them and what support they require. They often also have a photograph of the individual. An example template has been provided below:
Person-centred thinking tools include:
- One page profiles – a single page of information about a person including what they are good at, what is important to them and what they need support with
- Relationship circle – a diagram of concentric circles showing a person’s relationships with the innermost circle representing the people closest to them (an example template of a relationship circle has been attached to this document as evidence)
- Matching tool – a method of getting a good match between individuals and their support staff by looking at the skills needed, support needed, personality characteristics and common interests.
Person centred thinking empowers individuals and their families to make their own decisions about how they lead their lives and the support they receive, resulting in a better quality of life, more independence and the ability to shape their own destiny.
Person-centred thinking is a set of values, skills and tools used to personalise the health and social care services that an individual receives and aid person-centred planning.
Person-centred planning is a set of approaches designed to help an individual plan their life and the support they receive.
Person-centred reviews are regular (usually annual but can be more frequent) reviews of an individual’s life and the support they receive and looks at what is working and what is not working and if any changes need to be made.
Person-centred thinking and planning is primarily based on:
- the social model of disability – focuses on removing barriers that are created by society rather than trying to fix an individual’s impairments
- social inclusion – all members of society have the same opportunities
- normalisation – providing the conditions for everybody to be able to live a normal life
- social role valorization – enable, establish/maintain valued social roles for everybody
- framework for accomplishment – shaping people’s everyday lives by enabling everybody to share ordinary places, make choices, develop abilities, be treated with respect and have a valued social role and grow in relationships
Person-centred thinking puts an individual at the core of all planning and decisions that affect them.