8. Conversations which Support Self
Management at Thistle
• Relationship based care –person as lead partner
• Focus on –
– working toward personal outcomes
– Identifying and building on assets
– ( person’s own resources, self management
strategies, social networks, community supports)
– Small changes
– Relapse management and enabling positive risk
taking
• Peer support
• ,
10. Choose to be the Practitioner the person
wants to work with
11. The Non- Expert Stance
• Person as expert and authority in their life
• Practitioner as expert in facilitating change
• What are the characteristics of a facilitative approach ?
12. Considerations
• Motivation
• “ Everyone is motivated for something…..”
• Find and work with that motivation
• Non – compliance
• “ Simply, two people working toward different goals -
• but, the person in power gets to call the other non
compliant”
• Resistance
• “There is no resistance - just a person’s unique way of
co-operating”
13. Meeting the Person
• What do I know about this person that tells me they
are likely to realise their hopes ?
14. How to help a person define what they
want?
• Many people know what they don’t want
• John, what are you hoping to get from us working
together ?
• “I don’t know….I’ve been so low. I’m anxious most of the
time”
• So, if our work proves to be useful for you , what would
you hope to be experiencing instead?
• “ I don’t know , a bit of hope maybe…. calmness ?”
• Ok, so a bit of hope, calmness…. what else ?
15. How to help a person define what they
want?
• What would people say if they are asked
• “ what was helpful about the practitioner asking you
what you wanted to get from the work? “
16. Negotiate Change into Being….now !
• Many concerns (and therefore hopes) can start to
change through the process of conversation
• Emotional states
• “I’ve no confidence, I feel so low , I don’t have control”
• Identity
• I used to be the main contributor
• I just want to be my old self again
• Strategy ( self management skills)
• I don’t know how to cope with the way my energy
changes
17. Why does a focus on the future rekindle
lost hope ?
• The importance of detailed description of the “outcome”
people are aspiring toward.
• Grounds the description in day to day life
• Helps people self correct if hopes appear “unrealistic”
• People start to experience the physiological states
associated with the future description
• People notice times they are already experiencing
aspects of the future they want ….
18. Identifying and building on existing
personal resources, self management
strategies , renewed identities
• Have there been any times recently when you have
noticed this ( “this” meaning the description of the
future) happening already, even in a small way ?
• and strategic questions
• How did you manage to do that ?
• and perhaps identity questions
• What does that say about you , the fact that you
managed that, give all that’s been going on for you ?
19. Micro - analysis
• Co-creating change through conversation
• One utterance at a time
• What influences what the practitioner says or does
next ?
• Eg. Traditional role - the need to fix, to do to people
• What are we trained to listen out for?
• Eg. Information we require for assessment purposes
20. Micro - analysis
• What happens in conversation when we are trained to
listen out for signs of:
• coping, resilience , survival
• what people want and
• descriptions of the future ( personal outcomes)
• resources which will enable the future to be realised
• ( assets)
• Positive risk taking
21. Micro- analysis
• There’s been times recently when I’ve hardly had any
sleep ?
• What’s different about the times when you have managed
to get some sleep?
22. Micro- analysis
• Most of the time when I have a good day, I feel so
relieved but then the next day I feel awful again - it’s the
not being able to predict how I’m going to be, day by day,
that I can’t cope with . I can’t plan anything ?
• ( practitioner picking upon “ most of the time”)
• What’s different about when you have a good day and
don’t feel awful the next day… you know - you have
another good day?
23. Micro- analysis
• I suppose I’ve had good days where I’ve taken it easy
but there’s so much to do …
• Practitioner chooses to acknowledge difficulty ( but
there’s so much to do) and focuses on the “ taking it
easy” day)
• Sure ( nodding)… and on the good days you took it easy
what happened on those days?
24. Summary
• PERSONAL OUTCOMES
• Work with what matters most to people - the personal
outcomes which are important to them
• ASSETS
• Identify and build on a person’s own-
– Resources
– Social networks
– Community supports
• RISK ENABLEMENT
• in a culture which actively promotes positive risk taking
26. Self-directed Support is in line with;
• Equally Well
• Better Health, Better Care
• Shifting the Balance of Care / Control
• Gaun Yersel!: Self Management Strategy
• The Patient Rights (Scotland) Act 2011
27. • “Self-directed support can help people to stay
healthy and independent for longer.
• Self-directed support means that people can choose
how they get support and where they get it from.”
Scottish Government SDS
Strategy Consultation Paper, 2010
28. Self-directed Support Options
• Direct payment
• Individual Service Fund
• Directly Provided Services
• A combination of options 1, 2 & 3
29. NHS Lothian Test Site - evaluation
Learning & Development requirements of NHS
staff
Support staff to be confident in having SDS
conversation, individuals are able to make an
informed choice regarding the options available.
Risk averse nature of some staff
30.
31. Risk Enablement
“Risk enablement is concerned with managing these
risks effectively and finding a balance between the
need to protect vulnerable people and promoting the
rights of the individual. Individuals will be allowed to
take informed risks if they understand their
responsibilities and the implications of their
choices.”
In Control 2011
32. Risk enablement takes a tailored approach to risk and
goes beyond the physical components (e.g. risk of
falling), to consider the psychosocial elements (e.g.
impact on self-identity).
AHPs person-centred values base and skills in
rehabilitation & reablement make them ideally placed to
take a lead role in implementing risk enablement within
acute hospital settings & throughout the journey of care.
33. Risk Enablement & Self-directed support
“Self-directed support promotes the choice and control of
an individual in making decisions about their life and
support. Providing choice and control for people who use
social care means allowing people to take the risks they
choose.”
35. “Risk Assessment
• What is Risk? Risk is in everything we do, from crossing
the road to choosing what we eat. We are all responsible for
keeping ourselves safe, and it is important we do so.
• What do I have to do? When you have a Self Directed
Support Plan, NHS Lothian needs to be sure you have
thought about how to keep safe.
• Health Risks Please write down how these services or
pieces of equipment might be bad for your health, and what
you will do to stop that happening, if there are no risks
please say so.”
NHSL SDS Planning Document
36. “If you are buying a service
When buying a service you will need to check that
the person has the right qualifications. Please
answer Yes / No to the questions below, and ask
for photocopies of their certificates.
• Is the person a member of a professional body?
• Do they have professional insurance?
• Are they qualified to deliver the service?
• Are you happy they will meet your outcomes?”
NHSL SDS Planning Document
37.
38. SDS Test Site Process
• Health professional carries out standard
assessment for patient.
• Health outcomes discussed and agreed
• Health professional discusses alternative to NHS
standard provision inc risk assessment
• Patient is supported to complete SDS plan inc Risk
Assessment section.
• Health professional signs off SDS Plan
40. Mr A – Evaluation
• “I can still walk”
• Mr A has found riding to be very beneficial,
particularly in maintaining muscle stability and
mobility
• "SDS gave me the prod to do it and try it". The fact it
was funded made Mr A more determined to get
benefits from it
44. Discussion
• We are learning that bringing practitioners together in
conversation to share good practice is one of the major
innovations in accelerating culture change …..
• In what ways does your practice support an
orientation toward :
– Outcomes
– Assets
– Risk Enablement ?
45. • Hearing the specifics of how practitioners and teams
have made these changes can help other practitioners
make similar impacts within their own services …
• What does it take to practice in this way?
• How have you overcome challenges to practicing in
this way ?
• What advice would you give practitioners on how to
shift services toward an outcomes, assets based,
risk enabling approach?
46. Reflective Practice
• What did I do differently today which:
– enhanced a person’s experience of my support
– focused my support on helping a person realise
their personal outcomes
– identified and built on a person’s assets
– Enabled postive risk taking
• What DIDN’T I do today which empowered the
person I’m supporting
47. • What would you be most pleased to notice about your
practice, following the sharing/ learning you’ve
experienced in this session ?
