They demonstrate the result of our activity, rather than describing the activity itself. Forget about inputs (our activity - what we did), forget about outputs (often the number of ‘things’ resulting from what we did), and focus on outcomes – the impact of what we did for the individuals we support.
And what’s wrong with that I hear you say. Well, nothing I say. But there is a one key element to this that I want to focus on. That is an awareness and acknowledgement of the difference between what is important FOR individuals and what is important TO them. This has previously been highlighted by others, most significantly by Helen Sanderson in her suite of PCP tools.
Let’s describe important FOR and important TO in another way for a moment - ‘top down’ and ‘bottom up’.
Things that are important FOR me are often other people’s priorities, they come ‘down’ through various layers such as central and local government. They are usually described in guidance documents after consultation (more on that later) with the relevant sector, ideally involving people who use the service. They are generic by nature (e.g. I am treated with dignity, I belong) in an attempt to ensure they express things that are important to everyone. And who could argue about the importance of being treated with dignity or feeling you belong?
However, there are two observations I would make about this top down ‘stuff’.
Firstly, in terms of the structures and guidance that filters down to the coal face, it changes. New people come into positions of influence, organisations change (or change their name), and now and again even the legislation changes (also with new people and new organisations). People ‘package’ the messages in different ways for different reasons, and the people doing the job have to learn new terminology, go on new courses, get new qualifications. If I were really cynical, I might say that lots of good people get absorbed into ‘industries’ that are not about spending meaningful time with individuals in order to make their life better. They mainly focus on training the workforce and ensuring compliance. And the result of this ‘re-invention’ of core principles and practices (around person centred working) is that the people doing the job are often confused and suffer from information overload.
Secondly, the very individualised and nuanced things that are REALLY important TO people can, and do, get missed. A close relative of mine was admitted into a residential care home. He had Alzheimer’s. In the moment, you could have a conversation with him, but that moment was forgotten within minutes. All his life he had had a quiff in his hair; a 1950s hairstyle that involved having a long swept-back piece of hair at the front of his head. Then one day we visited him, and it had been cut off; for him, a fundamental part of ‘who he was’. There is no blame here. The home didn’t know. They didn’t think to ask. We didn’t think to tell them.
Let’s go back to the basics of person centred thinking and planning. In 2010 I wrote the Practice Guidance – ‘Supporting the Social Care Workforce to Deliver Person Centred Care for People with Dementia’. This way of working mostly emerged from Learning Disability Services during the All Wales Strategy in the early 1980s (yes that long ago). People still refer to working in a person centred ways, but so many don’t turn this into action. And the thing is, it’s not difficult!
In simple terms person centred thinking leads to person centred ways of working, leads to person centred planning – a plan that assists an Individual, and those supporting them. But… supports them to do what?
This brings us full circle back to what is important FOR and TO the Individual.
If the main focus (or sometimes the whole focus) is what is important FOR the person; perceived needs. For older adults this usually focuses on the individual’s health and personal care. For young people (and some adults), the focus is usually around behaviour, social skills, education and getting a job. For adults with a learning disability it is a mix and match of all the above.
The problem with a high level of focus on this top down stuff is that whilst it might indeed be important FOR the Individual, it is not always important TO them. And if it is not important to them, they will not have ‘ownership’ of any plans and strategies to help them improve and develop. For young people, this will result in them not fully engaging with a plan of action that is intended to help and support them. Young people who are NEET (not in education, employment or training) or in the care system are prime examples. For older people receiving care this will result in their basic care needs being met (through task driven care), but the ‘richness’ of the individual being missed.
If, however, the focus is on what’s important TO the Individual, things are turned on their head. This ‘bottom up’ approach explores support from the Individual’s perspective. And that perspective might (and usually does) throw up priorities that are completely in the ‘we don’t know what we don’t know’ zone. It might identify that to the individual the quiff on the top of their head is of over-riding importance; to an extent that it is actually part of ‘who they are’. And that’s what we need to explore – who is the person? What is it that makes them who they are and what is important TO them.
Now that is not to say we throw the proverbial baby out with the bath water. In most cases what is deemed important FOR the person will also be important TO them. They do want to be treated with dignity, they do want to feel they belong. But let those things emerge from a process of self-discovery, a discovery of that individual ‘bottom-up’, through conversations with them and/or the people who know them best.
We also know that for some individuals, they are not able to fully articulate their thoughts and wishes. In these cases, advocates or representative are needed. But be careful here. Allowing one person to undertake this highly sophisticated task can be fraught with difficulty. What can be more successful is identifying a circle of support. A range of people who all have the best interests of that individual at the fore.
Of course, all this totally misses out the critical message of (as the old song goes), ‘it’s not what you do it’s the way that you do it’. In one word this is about the important of relationships. Not any old relationships, but relationships that truly value the person, as eloquently outlined through the work of Dawn Brooker and Tom Kitwood (also earlier Carl Rogers). But that’s a whole other blog.
Within the Here2there App, we have included a template for the important TO/FOR conversation, as part of a process that leads to setting goals that the Individual can have ownership of and that can ensure others focus on what matters TO the person. In further blogs I will also talk about the place for solution focused working and Appreciative Inquiry, also key elements in terms of turning person centred thinking and working into a reality that really makes a difference TO the lives of Individuals.