Principles and Practice of Person-Centred Thinking

1 Understand the principles and practice of person-centred thinking, planning and reviews

1.1 Identify the beliefs and values on which person-centred thinking and planning is based Person-centred thinking is taking or considering the individual as being at the centre of the whole process. The Service User (SU) is involved in the whole process from start to finish. He/she will be asked which people are important to them and family and friends will form a circle of support for them, this will help to enable that SU to feel that he/she is part of the process.

Part of the process will be to have regular reviews and again, the SU will be part of the process and have creative input into any changes that need to be made to the circle of support. At all times it is very important to take into account an individual’s feelings and aspirations. It is also important to ensure the safeguarding of the Service User at all times

1.2 Define person-centred thinking, person-centred planning and person-centred reviews Person-centred thinking is separating what is important to, from what is important for The people they support and finding a balance between them, person-centred planning reflects upon a person’s capacities, what is important to a person (now and for the future) and specifies the support they require to make a valued contribution to their community. Services are delivered in the context of the life a person chooses and not about slotting people into “gaps

1.3 Describe the difference that person-centred thinking can make to individuals and their families All styles of planning require a trained person, called a person-centred planning facilitator, to support the process.

These are skilled people who involve everyone in the person's life in their 'relationship circle'. They also encourage and support the individual to take control of their own plan. They are very creative in their methods and have extensive knowledge of advocacy, finance, housing issues, working with families, and how to develop better support for people. Families can also support person-centred plans, often using tools such as 'Families Leading Planning'. They make a commitment to the person to put plans into action

1.4 Describe examples of person-centred thinking tools
There are many ways to plan with a person. What is important is that the plan must be meaningful to them and understood by them. Some planning methods (or styles) include: MAPS (Making Action Plans) - . These are very visual graphic plans that look at a person's history and their aspirations for the future. PATHS (Planning Alternative Tomorrows with Hope) - This looks at a person's 'North Star' (dream for the future) and puts it into action, reviewing the plan in one to two years' time. Personal Futures Planning - A graphic plan which maps a person's life now and changes for the future. A good style for community mapping. Essential Lifestyle Planning - This is very detailed and was developed for people with high and complex support needs. It includes a section on communication. It will usually have a health action plan as well.

1.5 Explain what a ‘one page profile’ is Learning what is important to and for someone can be recorded on one page to begin with. We call this a one-page profile. Usually, what is important for the person is framed as 'best support' or 'what we need to know or do to support the person'. A one-page profile typically has three sections: an appreciation about the person; what is important to that person from their perspective; and how to support them well. 1.6 Describe the person-centred review process

A one-page profile can also be the beginning of a more detailed
person-centred description. Once you have a one-page profile, each person-centred thinking tool used both leads to actions and further information which can be added, so that the document turns from being a one-page profile to being at least a couple of pages long (a person-centred description). After each person-centred thinking tool is used, ask:

•What does this tell us is important to the person?
•What does it tell us about how to support the person well?
•What clues does it give us about the person's gifts and contributions?

Then add this information to the original one-page profile which then starts to become a longer person-centred description. For example, using the relationship circle will lead to action by asking: 'What would it take to increase the number of people in the person's life?' Then: 'What do we need to do to start this?' The relationship circle will also provide information both on who is important to the person, and what staff need to do to support the person around their relationships. 2. Understand the context within which person-centred thinking and planning takes place 2.1Outline current legislation, policy and guidance underpinning person-centred thinking and planning In England, Scotland and Wales, policies and legislation since 2001 have led to the adoption of person-centred planning by all local authorities. In Northern Ireland, all and Social Care Trusts are expected to start moving towards this way of working by 2015.

2.2Describe the relationship between person-centred planning and personalised services All styles of planning require a trained person, called a person-centred planning facilitator, to support the process. These are skilled people who involve everyone in the person's life in their 'relationship circle'. They also encourage and support the individual to take control of their own plan. They are very creative in their methods and have extensive knowledge of advocacy, working with families, finance, housing issues and how to develop better support for people

2.3Identify ways that person-centred thinking can be used:
a)With individuals
Person-centred planning is ideal for people with autism and Asperger syndrome. Planning tools may need to be adapted and terminology often needs to be changed so that it can be understood by the person. It is essential that the person’s preferred ways of communicating are taken into account so that they can play a full part in the planning process

b)In teams
-Create an environment where team members can identify and solve problems on their own, delegating real power and responsibility - Demonstrate and articulate the values of the organization -Look for ways to use staff's interests and strengths in directly supporting people - Share decision making

-Have a clear vision and direction
-Encourage personal involvement with the people being supported.

3. Understand own role in person-centred planning, thinking and reviews 3.1Describe own role in person-centred thinking, planning and reviews when supporting individuals Plans are owned by the person. There are many ways to plan with a person. What is important is that the plan must be meaningful to them and understood by them. Some planning methods (or styles) include: MAPS (Making Action Plans) - These are very visual graphic plans that look at a person's history and their aspirations for the future. PATHS (Planning Alternative Tomorrows with Hope) - This looks at a person's 'North Star' (dream for the future) and puts it into action, reviewing the plan in one to two years' time. Personal Futures Planning - A graphic plan which maps a person's life now and changes for the future. A good style for community mapping. Essential Lifestyle Planning -This is very detailed and was developed for people with high and complex support needs. It includes a section on communication. It will usually have a health action plan as well.

3.2Identify challenges that may be faced in implementing person-centred thinking, planning and reviews in own work Challenges to person-centred planning for people with mental health problems are negative social attitudes towards them. Concerns about public fears of people with mental illness seem to take precedence over their quality of care.

1 Describe how these challenges might be overcome
The task of implementing person-centred planning for all service users across services is considerable, but this should not be considered a barrier in itself. By taking time to adopt and deliver person-centred planning and by concentrating on the quality of the work rather than the quantity, the scale of the task appears less onerous. Degree of disability, illness or complexity of need should not be considered as a barrier to person-centred planning. The ethos of person-centred planning states that it is important not to focus on a person’s impairment but on what he or she can do and who the person is. Service users may feel that they have little impact on the way that services are designed and delivered, but there is a clear call for more control on the part of service users and for people to direct their own support.

Change in the culture of services, which addresses the unequal power relations between service users and service providers, is a prerequisite to the implementation of person-centred planning. Professionals’ relationships with service users should change from ‘being the “experts on the person” to being “experts in the process of problem solving with others”’ Person-centred planning locates people in the context of their families and the wider community. The role of and the inclusion of non- professionals in the form of family and friends of service users are key components of person-centred planning. Basic challenge to working in a person-centred way is in figuring out how best to encourage and include family members, friends and chosen others to take part in the process.

The successful inclusion of family members in the implementation of person- centred planning is underpinned by providing families with information that is relevant, accessible and jargon free, and by facilitating relevant accessible training for families. Families and professionals may not always agree about what constitutes best support; however, as families are central to the process of person-centred planning, it is imperative that service providers work to develop good relationships with service users’ families 4. Be able to apply person-centred thinking in relation to own life 4.1Demonstrate how to use a person-centred thinking tool in relation to own life to identify what is working and not working I will use an example from my past job to explain better.

As a senior staff member, I helped a SU to summarise what was working and not working for her. I also talked with staff, and captured what was working and not working from their perspectives. This SU broke her hip in a fall on some ice 15 years ago. This forced her to leave her home and move to a care home. This is what I found: What was working for this SU

• Reading her books at bedtime and having a variety to choose from.
• Watching the TV and never missing her soaps.
• Knitting.
• Having a daily newspaper delivered. What was not not working for this SU
• Not being able to go out for walks (has only been out twice in the last three months to buy her patterns).

• Not having someone to link her arm to support her for the 10 minute walk up to the library.
• Using the zimmer frame to walk.
• Having to eat meals at set times, with no flexibility each day.
• Staff calling her Beattie.
• That her family do not visit her.
• Her blouses not being starched.
• Always being too hot.
• Not being able to open windows.
• Having other people’s clothes put on her and other people wearing her clothes. • Having name tags on her clothes.
• Clothes being spoiled in the laundry.
4.2 Describe own relationship circle
What is important to someone will almost always include who is important to them. We can learn and record the important people in someone's life by having conversations and using the relationship circle person-centred thinking tool. It is common practice in social work to record information about relationships and this is another way to capture this information with the person whom I am supporting. A 'relationship circle' is particularly useful for exploring: Whom a person knows

How they know them
Who knows whom
How these networks can help the person find opportunities and support to live the life they want.These relationships can be represented as a circle, or in columns, or as a spider diagram with the person at the centre. However it is represented, it is vital to be clear not just about who is in the person's life, but how important they are to that person. Typically this is done by putting their name or photo in the middle and the names of the people who are most important in their life closest to them. If you are doing this using the rings of a 'relationship circle' then the people in the closest ring would be people that the person loves; the second ring would be people the person likes; the third ring would be people the person knows; and the final ring would be people who are paid to be in that person's life, like support staff, hairdressers or GPs.

This process not only identifies who is important in the person's life, but can suggest how they can stay in contact with them and whether there is any support the person may need in keeping and developing those relationships. It can also show if there are other people with whom the person could share ideas, support or resources. If people find that their relationship circle is not as full as they would like, then it can become a focus for action by asking: 'What would it take to increase the number and depth of your relationships?' 4.3 Describe how helpful using a person-centred thinking tool was to identify actions in relation to own life This tool helps:

As a way to learn who is important to a person.
As an exploration tool to see if there are any important issues around relationships. To identify who to talk to when developing a plan.
To identify relationships that can be strengthened or supported For each of us, there are areas of our life that are working well and areas that are not working, that we would like to change. Simply asking an older person what is working and not working in their life tells us so much. This information may be used to change what can be changed and to help us understand what really matters to people. 4.4Describe how to prepare for own person-centred review

Contribute to reviews – both to understand how things are going since changes have been made; but also to pick up issues and problems in the first place 5. Be able to implement person-centred thinking and person-centred reviews 5.1 Use person-centred thinking to know and act on what is important to the individual • Help SU to step back and look at a situation – to see it and understand it from different perspectives, especially the older person’s. • Learn how a SU wants their life to look and feel in comparison to what life is actually like right now. 5.2 Establish with the individual how they want to be supported Help SU how to provide better support by seeing what is working and not working about their support now.Clarify what to build on and identify areas requiring action to change. 5.3Use person-centred thinking to know and respond to how the individual communicates An important first step in Person Centred Planning is to understand each person’s unique way of getting their message across.

This can vary from person to person, and can depend on the person’s level of spoken language, their eye contact, and their body language. It is important in getting Person Centred Planning started that each individual is recognised as having their own particular way of communicating. Without an understanding of this we will struggle to achieve a person centred approach, and to hear about people’s hopes and needs, and to achieving a better life for each person. 5.4Be responsive to how an individual makes decisions to support them to have maximum choice and control in their life Providing real choice and control for people who use social care means enabling people to take the risks they choose, particularly in the use of self-directed support and personal budgets. With the support of frontline staff, people using services should be enabled to define their own risks and to recognise, identify and report abuse, neglect and safeguarding issues. Informed choice is vital.

Practitioners may be concerned with balancing risk enablement with their professional duty of care to keep people safe. Practitioners need to be supported by local authorities/Northern Ireland health and social care trusts to incorporate safeguarding and risk enablement into relationship-based, person-centred working. Good quality, consistent and trusting relationships and good communication are particularly important. 5.5Support the individual in their relationships and in being part of their community using person-centred thinking • Engage people (e.g. family members, neighbours etc) who are important to the SU in understanding what their life is like, and how they can contribute to making a difference to that SU’s life - often in very small and simple ways.

5.6Ensure that the individual is central to the person-centred review process Understand the impact of changes in someone’s life, on that person’s quality of life and overall wellbeing. For example changes in their health, sudden onset of a disability or impairment, bereavement or other loss (e.g. moving house, and people moving away).Help resolve problems and concerns to help reduce isolation and depression. Help people manage bouts of ill health and/or depression by developing their own personal tools and techniques for self-reflection and problem solving.

5.7Explain how to ensure that actions from a review happen
The After Action Review is the basis for learning from our successes and failures. A good manager or leader does not learn in a vacuum: the people involved in an activity—those closest to it—are the ones best poised to identify the learning it offers. No one, regardless of how skilled or experienced they are, will see as much as those who actually carry out the events, program, or activity. The After Action Review is the keystone of the process of learning from successes and failures. Feedback compares the actual output of a process with the intended outcome. By focusing on the desired outcome and by describing specific observations, teams can identify strengths and weaknesses and together decide how to improve performance.

This shared learning improves team proficiency and promotes bonding, collegiality, and group cohesion. Though not a cure-all for all issues or problems, the After Action Review provides a starting point for improvements to future activities. Because After Action Review participants actively discover what happened and why, they can learn and remember more than they would from a critique or more formal evaluation. A critique only gives one viewpoint and frequently provides little opportunity for discussion of events by participants. Other observations and comments may not be encouraged. The climate of a critique, focusing on what is wrong, often prevents candid discussion and stifles opportunities for learning and team building.