Person-centred family practitioner wanted

Last night I met with Emma and Suzie. Alan, Emma's friend who is also a local Minister joined us as we followed up our actions about finding a cleaner and yoga classes. We learned how difficult it is to get a cleaner who is happy to provide receipts! Next steps, on my to-do list, is to explore cleaning agencies. We have a ground rule about this - Emma can only agree to tasks where she is the only person who could possibly do it - all other actions the three of us are sharing between us.
Since we last met in the pub in March, we have been working on a job description for the support that Emma needs. We used the person-centred thinking tool 'matching support'. Most job descriptions only look at the skills or experience required and this means that the likelihood of ending up with people who like each other, with interests in common is at best random! Our job description describes the support Emma wants and needs; the skills and knowledge that the person would need to have; but also what kind of person we are looking for; and the bonus of what interests it would be great if they shared. We settled on the job title 'Person-centred family practitioner' and here is the description:

This role is to provide around 10 hours a month support to Emma, as she implements their family support plan. Days and times flexible. We are looking for someone with knowledge and experience of social work/social care.


Skills and Knowledge needed

• Excellent organisational skills and communication skill
• Understanding of the social care system
• Negotiation skills
• Great use of initiative

Support needed and wanted

• Investigate options and advice to enable Debbie to make decisions with her family
• Negotiate opportunities for her sons to be included in mainstream options as require
• Support Debbie in implementing the family support plan

Personality Characteristics – we are looking for someone who is:

• A ‘completer finisher
• Passionate about social justice
• Quietly determined

Shared common interests - hobbies that it would be nice to have in common

• Reading
• Walking
• Yoga and mindfulness

To make it as clear as possible, we then included some examples of the kinds of tasks that would be involved:

Jon

- contact the local university and find out about particular courses, visitor days
- apply for Disabled Students Allowance
- chase paediatrician for his medical report to send with DSA application form
- investigate made to measure walking books as Jon cannot find any that fit
- resume trying to get Jon to try new foods


Max

- find at least 2 new people to join the direct payments team to support Max after school on Tues and Weds
- find options for suitable 6th form provision


Next steps are to share this within our networks. Suzie has a colleague who she thinks might be interested, and Emma has some ideas as well, and then we need to think about informal interviews.

Is this the same role as a good broker? Does it look more like a social worker? Or does it simply need to be designed individually each time? We will let you know how we get on.

Freelance Social Work?

Over the last couple of months I have noticed Emma feeling more and more stressed.  Looking back I should have seen it coming.

Getting the family budget agreed was fantastic. Now we are busy making sure that all the actions within the support plan are happening. The only person who can make this happen in the family is Emma.  One of the reasons for going for a family budget is to enable Emma to keep supporting her sons living at home  - rather than the hugely costly and potentially devastating out-of-county placements that the social worker says are the only other option. Building Emma’s reliance is central to the success of the family budget. Yet, at the moment it seems to be having the opposite effect. Life is more stressful, trying to co-ordinate and implement the actions from the plan.

So last night, we met in the pub with another friend, Suzie, to see what we could do together, to help Emma manage what feels like an endless to-do list?  Like most of us, her ‘to-do’ list has a multitude of ‘small’ tasks that it feels impossible to find the time to get round to (for example, getting a cleaner once a week and booking onto a yoga course) and some bigger ‘projects’. The ones that are keeping Emma up at night are the ones about transition – looking at college placement possibilities, finding out about disability benefit, finding out whether a medical report will be done on time.

We explored whether having some personal assistant hours, to crack the ‘little’ jobs would make the difference, or whether it was tackling the bigger issues that would make the difference to Emma’s stress levels.

“What I really need,” said Emma, “Is someone who can do what social workers used to do.”

I couldn’t believe it, here we were thinking about buying in ‘old fashioned social work’, which is still so much needed by families, but simply no longer available where Emma lives.

So that is what we are doing. Emma is sending me the list of tasks that need to happen to make transition go smoothly for the family. I am putting this into a ‘job description’ for someone with social work skills, to start off doing about 15 hours a month ‘freelance’ work, so support Emma.

In the meantime, Suzie and I are sorting out a cleaner, and looking at yoga courses, so we can move ahead with the smaller jobs too.

Jon's first Circle meeting

Circles of support are important in creating person centred change - not just for an individual but for the families and people who support them in their community. Facilitating Jon's first Circle meeting got me thinking - what can we do to ensure more people and communities benefit from them?

I have been facilitating Circles for over 12 years but I always get a little nervous beforehand as each new Circle has a different character.  My challenge - as facilitator - was to keep Jon firmly at the centre.

Jon is described as having 'high functioning autism' and the original reason for setting up the Circle was to gently support and encourage him to try new things and meet new people. Eventually, Jon would need more people in his life who can support him, rather than just his Mum and Dad. Feeling comfortable with other people in his life was going to take a while and he was very cautious and nervous about the Circle.

The local church minister where Emma and Jon attend, agreed to come, as too Matt, who supports Jon's Brother Tom for a few hours each week. They were joined by long-time family friend Patricia and her son Robert, who is a few years older than Jon but who had known each other as children.

I put my pinboard up in Emma's lounge and after tea, mince-pies and introductions, I asked Emma to explain what we hoped for the Circle and the evening's meeting (knowing Jon would not want to do that himself).

"Teeny-weeny steps" was how Emma described what we wanted to achieve.

I started by drawing three interlocking circles (a Venn diagram). One was 'new people'; one was 'new places' and the other 'new things to do'. I explained how where the three circles overlapped in the middle - a new thing to do, with new people in a new place - was a big step and not what we were after right now. A 'teeny-weeny' but important step was either a new thing to do, but with familiar people in a familiar place, or a new place, but with familiar people, doing a familiar thing.

I suggested that our roles tonight were to act like an 'ideas team' for Jon to come up with possible new places and things to do. Jon would then evaluate each of them and let us know which ones he was interested in taking forward.  Then together, we could see what we could do to take these forward.

We then did several rounds where everyone contributed their ideas, based on how they knew Jon, their best guesses at what he could be interested in and also sharing their own hobbies and interests, in case he wanted to share them. The list included  playing chess;  going to a book club,  bible study group or astronomy club; obtaining National Trust membership and doing walks; going to movie nights, photography course, philosophy classes, Tai Chi  or meditation Group; bird watching and playing Monopoly.

So that Jon did not feel on the spot, I asked him to evaluate each of them over a break for more tea and mince pies. Emma explained, with Jon's agreement, that he could do complex evaluations, so we asked him  to evaluate each of them in relation to how interesting they were to him (1 - 10 using an orange pen) and how scary they felt (1 - 10 with a purple pen).

We took the two with the highest scores for interest, and the lowest scary scores, and started there.

At the end of the evening, we had agreed actions based on Jon's evaluations for him to start playing chess with Alan, the church minister every week and for the family to buy a National Trust membership, plan walks in different places and invite Circle members to join them. We have another three possibilities that Jon was interested in thinking about more - meditation, a book club and a philosophy course.

Jon looked quietly pleased and relieved. Emma was delighted. As the meeting finished, people started to talk about how great it would be to start a book club together and whether Jon starting chess, could lead to a chess group where some of us played each other. It was clear that the Circle was creating opportunities for all of us to try new things together, find other ways of connecting together and enrich our lives, in a way we probably did not expect.

It reminded me of this New Economics Foundation report that says evidence shows that when people feel they have control over what happens to them and can take action on their own behalf, their physical and mental well-being improves. When individuals and groups get together in their neighbourhoods, get to know each other, work together and help each other, there are usually lasting benefits for everyone involved. Networks and groups grow stronger so that people who belong to them tend to feel less isolated, more secure, more powerful and happier.

So if Circles are a good thing, that benefits not just individuals but communities as well, what would it take to have more of them in the UK?  I've listed some possibilities - not all new nor without their challenges and some controversial - but I would be interested in your thoughts:

1) All social work, community and health courses have an opportunity for people to learn about Circles of Support and learn the skills to facilitate or contribute to them as a core part of their curriculum. Some may be able to contribute to Circles in their own time, as I do.

2) There is an expectation that social work students (and those from other related courses) are matched with an individual or family (family chooses!) to support them as part of a Circle of Support in a commitment that lasts three years. The best way to learn about personalisation is to be part of creating it with a family or individual.

3) Providers and other organisations explore contributing to Circles of Support as part of their Corporate Social Responsibility. For example, banks could fund training for Circle facilitators; providers could release some staff for four hours per month to contribute to a Circle.

4) Partners in Policy Making courses and their graduates enable people to both have a Circle of Support but also to contribute to someone else's Circle.

5) People buy Circle facilitation with their personal budgets - facilitators provided through social enterprises (where did all those person-centred planning facilitators go?)

What else could we do? Can we move forward on any of these? Please let me know what you think.

In the meantime, I'll let you know how Jon gets on with trying his new activities.

How Jon's Circle got started - the family support plan

I have been helping a friend of mine - Emma - with developing a support plan that takes into account the needs of her whole family, but only costs £20,000 per year.

Emma has two sons with autism - Jon and Max.  Max is 15, and beginning his transition from school to adult life. Jon is 17 and attends mainstream secondary school with full time support. Emma is separated from Mike, the boys' father, but he shares the childcare and support with her.

Balancing work and supporting her sons is challenging and exhausting. The way that services are set up adds a significant degree of frustration. As far as Emma is concerned, it makes no sense to solely focus on each son's individual needs without looking at this in the context of the family. Services working together to support the family are the only sensible way forward.

If Emma and Mike were no longer able to support their sons, and they had to be supported in a different way, they would be prime candidates for out of county placements, costing the Local Authority in excess of £200k per year. The additional cost to relationships and quality of life far exceeds this. Surely it makes sense to invest in supporting the family to stay together and stay strong?

I attended Jon's review with Emma, as a friend to offer support. It was not a person-centred review as we know them, and I can see how powerless families must feel when faced with a room of professionals around the table. I found it very uncomfortable.

Emma and I decided to see how we could look at a family support plan, bringing together the direct payment funding that Max receives from children's services, and the budget that Jon would be eligible for from adult services. Stockport's Director of Social Services, Terry Dafter, was interested in exploring this, and so the relevant assessments were set up and then Emma and I got started on the support plan.

The support plan needed to address the seven criteria used in Stockport;  reflect the whole family; and be something that other families would be able to replicate. Many years ago, Emma had been on a 'Families Leading Planning' course, and was familiar with one-page profiles and 'working and not working'.

This is what the family support plan looks like:

The first page introduces the family and describes the purpose of the support plan, what people like and admire about each individual in the family, and summarises what is important to the family and how to support the family.

Then came one page profiles for each of the family - Jon, Max, Emma and Mike.

The next section is what needs to change. To do this there is 'what is working and not working' from the perspective of each family member (and the best guesses about Max as he cannot tell us directly). This working and not working from the different perspectives is then summarised into what the family wants the support plan to achieve - their outcomes.

There is a table with each person's outcomes, and how they plan to achieve them.

Jon's outcomes include being supported by people that he chooses, extending what he does outside of the home, and slowly building a social circle. For Max, his outcomes are to get involved in more leisure activities, particularly physical activities like swimming, trampolining and the gym. Mike's outcomes are to be able to continue his voluntary work at the Citizens Advice Bureaus, and to have regular short breaks. For Emma, the changes that she is seeking are to decrease her stress, have regular breaks and improve her health.

The support plan then describes how the budget will be used to achieve this. This means extra support for Jon and Max, particularly to support the activities outside of the home, to enable Mike to continue with his voluntary work, and for both of the parents to have regular short breaks, and a course of mindfulness and regular yoga for Emma.

The total cost per year is £20k.

The support plan ends with how they will stay in control - this means whole family person-centred reviews - another first for Emma and her family.

This is what Emma said to me about the process:

' I always knew that it didn't work to look at Jon and Max in isolation as their needs significantly impact on each other, and on me and Mike as carers. To make matters worse, services often only want to address one area of difficulty of one member of a highly stressed family of four… Consequently, interventions and supports are a lot less helpful than they might be, if the real life context of our family and lives was properly taken into account. 

'Direct payments help as they provide a degree of flexibility around meeting the boys social care needs, but with Jon's transfer to adult services looming, it was clear that we were going to lose that small flexibility as now funding and assessments for Jon and Max would be provided by different directorates with very different practices and cultures. We wouldn't be seen as a family at all any more, despite the fact that both Jon and Max are still very dependent on us. When Terry and Helen suggested a family-centred plan and budget, I knew that this was the answer for keeping our family working, and ensuring we all have some quality of life. 

' I'm really excited about the possibilities of this new way of working - particularly for the increasing number of families where more than one person has significant health or social care needs.'