Leading quality as a Responsible Individual: embedding strengths-based practice (part 1)

0:01

This is a video to capture a training programme. It can be used in a number of different ways by organisations geared at leading

0:12

quality in regulated settings so it can be used by Responsible Individuals, appointed managers, team managers.

0:20

It's also a session that is really relevant for staff to work their way through as well.

0:27

It has been developed so that you can use this resource in a number of different ways to suit the needs of the organisation.

0:35

The focus is on quality in regulated settings with a strong emphasis on embedding strengths-based practice.

0:41

But the emphasis really when we're talking about quality is really through the lens of the individual who's receiving the support.

0:49

Quality is a small word that has a very big meaning in terms of the aspects that

0:55

it covers from the quantitative elements of checks, balances,

1:01

processes, procedures that need to be in place. But there is also the qualitative element of quality in settings which is about what's the

1:10

person's daily lived experience and how are we making sure that regardless of the

1:16

service they're receiving, regardless of why they're receiving that service, as much as possible we're promoting that positive lived experience for the individual.

1:29

The sessions are split into a number of different parts. The first part of the session really is around getting into the legislative context,

1:38

starting to think about what's required in terms of person-centred practice and

1:45

weaving its way through all of this will be the focus on strengths-based practice.

1:51

In terms of the legislative context, we're concentrating primarily on the Social Services and Well-being Act and the Regulation and Inspection of Social Care Wales Act

2:00

which I'll refer to as RISCA from now on. It is important to note that as a regulated setting, you will be working to the requirements

2:09

of RISCA but it's really helpful and important to understand the context of the Social Services and Well-being Act and the way that underpins the requirements of RISCA.

2:19

So this session will be drawing out an insight into both of those pieces of legislation and where they cross over and where they both complement each other.

2:32

The structure of the session is around setting the legislative context, understanding what our roles and responsibilities are

2:39

but really putting the focus on defining quality through the lens of the individual

2:45

linking it back to the legislative context but always thinking about where the individual is

2:51

in the middle of all of the activity that we are taking forward.

2:56

Some of this focus will be on how we will be working with people in a strengths-based way.

3:04

If the resource is being used in a group environment, then the following pointers on

3:09

the slide in terms of creating that learning environment could be really useful for you.

3:16

In terms of confidentiality, the more you can draw on your experiences of working with

3:24

individuals within regulated settings, the more the training comes to life.

3:31

But it's really important that if you're facilitating this session in a group environment that you do not share any personal information about the individuals that you're talking to.

3:41

Drawing on those real lived experiences that staff and managers and leaders will have is really helpful.

3:50

In terms of the legislative context, the journey began with the Social Services and Well-being Act,

3:57

it was legislated in 2014 and came into practice in 2016 and the Social Services and Well-being

4:04

Act was heralded really as the transformation of the delivery of social care and the way in which

4:11

partner agencies come together to promote the well-being of the citizens of Wales.

4:17

There are a number of core elements of the Social Services and Well-being Act, the main

4:23

ones being those on the screen now that draw real relevance across to roles and responsibilities

4:29

and the emphasis for regulated providers. So the Act, as you can see in the title, brings a strong

4:36

emphasis on our role in improving well-being and we'll come on to talk about that a bit later.

4:43

Linked to what you see around promoting and improving well-being is a strong emphasis on early intervention and prevention and we can think of early intervention and prevention in a

4:52

number of ways. There's the element of we want to support people in their own homes, in their

4:58

own communities as much as, and for as long as possible. We want to prevent the escalation of

5:05

care and support needs, prevent the escalation of any risk associated with that individual.

5:11

But there will be occasions where individuals might need temporary care and support. So it

5:17

could be that they have a period of time in a foster placement, in a residential care placement. They might need some care at home through domiciliary support services for a short

5:27

period of time while they rehabilitate, while they get better, while they work on aspects of their well-being and care and support needs, risks that have been identified for the individual.

5:38

But if it isn't, if the intention is that this is a temporary arrangement, then we should always be focusing on how are we building the independence,

5:45

how will we build the resilience of the individual to return to their own home if that's what the desired outcome is? But at the same time, we will also have individuals who,

5:55

because of their needs, because of any risks that are identified, because of their outcomes and what matters to them they may require care and support for a longer period of time, if not indefinitely.

6:07

With the Act came the new requirements in relation to information, advice and assistance. This has been described in some places as a service, and that's often translated into

6:18

things like a single points of access or first gateway contact gateways, for example. In other

6:24

areas they very much see information, advice and assistance as an approach rather than a service.

6:30

But it links very heavily to the previous points around improving well-being and strengthening early intervention and prevention. How are

6:38

we equipping individuals to be able to self-resource, self-manage, self-access

6:45

to support what's available in communities or change their own situation themselves?

6:51

With the Act came a new approach to assessment, a new approach to eligibility and a new approach

6:57

to how we meet the care and support needs of individuals and we will come on to explore the approaches to assessment and care and support planning a bit later. But this is

7:07

the bit where the two pieces of legislation really do come together because the majority

7:12

of providers will be receiving referrals from social care and as a result of that

7:18

will be inheriting the care and support plan that has been developed for the individual. So from a provider perspective, the care and support plan that's developed by social care

7:28

provides the information you then need to be able to go on and develop the personal plan that is required by RISCA in terms of how you will then meet the care and support

7:38

needs of the individual. And it is important to remember that if an individual is receiving

7:44

support from a provider because they've been commissioned by the local authority to do that, the local authority does still retain the responsibility for

7:53

making sure the care and support needs of the individual are being met appropriately.

7:58

There is a strong focus on safeguarding within the Act and the Wales safeguarding procedures

8:04

have been issued under the Social Services and Well-being Act, and it is really important

8:10

that providers are making sure that they are fully aware of the content of the procedures,

8:17

the roles and responsibilities and the duties associated with those procedures, but also that there is an element of understanding the ethos and the

8:25

culture that sits underneath the way in which those safeguarding procedures are delivered.

8:32

Advocacy is a strong and core element of the Act. It is referred to in a particular

8:39

part within the Act, but it also gets referenced across a number of other

8:44

parts of the Social Services and Well-being Act and advocacy has a number of different aspects.

8:50

It can be delivered in a number of different ways from self-advocacy,

8:55

friends and family through to independent professional advocacy services. The bit that's really important to remember is the principle for

9:03

why we would be looking to provide advocacy support to individuals, and that's to make sure that the individual fully understands the process, fully understands the

9:13

information that is being shared with them and that they're able to retain the information for

9:18

long enough to be able to understand what's associated with receiving that information,

9:24

the discussions that are taking place, the decisions that may be being made. It is also important that we recognise that the individual we're supporting is able to

9:33

weigh up the information that's being provided in order to make an informed choice and decision

9:39

Where we identify that the individual is unable to overcome any of those barriers that's where we

9:45

need to be considering if there is a need to provide advocacy support for the individual.

9:51

And finally, there's a strong emphasis on cooperation and partnership that sits at both an operational and a strategic level. As providers, we need to be thinking about who are

10:01

the different agencies that we're working with in order to meet the care and support needs of the individual at a strategic and operational level. The local authority and its partner agencies

10:10

are continuously reviewing what well-being looks like for the individuals across Wales and across

10:16

the footprints of the health boards, and then considering how well the well-being of individuals have been met and will be making decisions in terms of service availability, services that need

10:27

to be commissioned, developed, decommissioned but constantly making sure that we're in a position to be able to meet the well-being and care and support needs of individuals in Wales.

10:38

The Regulation and Inspection of Social Care Wales Act (RISCA) came in the year after the

10:45

Social Services and Well-being Act, and that too has a very strong emphasis on improving

10:50

the well-being of individuals through the statutory guidance and regulations. You'll

10:55

see reference to the role of providers in promoting and improving well-being.

11:01

The definition of well-being for individuals actually sits within the Social Services and Well-being Act, and this is where we start to see some of

11:09

the read across really early on and we'll go on to explore the definition of well-being.

11:17

RISCA places a stronger emphasis on giving individuals a stronger voice in the discussions

11:23

that are taking place in relation to their situation, decisions that need to be made,

11:28

the development and the review of the plans that are being developed with the individual that isn't

11:34

simply that we've had a conversation with the individual, but the principle of co-production is really strong in terms of the assessments of individuals, the development of any personal

11:44

plans should be done with the individual as opposed to being written on their behalf.

11:49

There is a strong emphasis on strengthening the protection of individuals, not just from

11:54

the safeguarding agenda, but how do we making sure that we're considering all aspects of an

12:00

individual's well-being, making sure that we're responding to the companies that are identified to

12:06

and for the individual, and considering how we're managing any identified risks. But those risks

12:12

are being managed in a positive way as opposed to encouraging an ongoing risk-averse culture.

12:20

There is also a strong emphasis on increasing accountability, for example the introduction

12:26

of the role of the responsible individual. In terms of increasing accountability, it doesn't just include the emphasis on the role of the responsible individual, but it's also thinking

12:36

about how providers are ensuring that the quality of what they're providing is to the standard

12:41

that's required and we're going to explore aspects of that as we go through the session. When it comes to well-being, there are two definitions within the Social Services and

12:51

Well-being Act, which as mentioned earlier, read across to RISCA. There's a definition of well-being for adults and there's a definition of well-being for children. And

12:59

on the screen at the moment you'll see the definition of well-being for adults. The code of practice that sits under the Social Services and Well-being Act draws out the duty to promote

13:13

well-being and it is important to recognise that promoting well-being does not always mean

13:18

we have to provide a service and intervention or an allocated practitioner or professional.

13:23

A conversation with somebody about how their day has been for some people will promote their

13:28

well-being. But the spectrum of need and the spectrum of what promoting the well-being of individuals means can go from the conversation about how the day's been, how they are feeling,

13:38

is there any support they feel they require through to an assessment being undertaken by social care, through to the referral to the provider to provide support and

13:48

services through to having to complete an adult risk report because we have concerns

13:53

that the individual is experiencing or is at risk of abuse and neglect. It is really important to recognise that

13:59

well-being means different things to different people at different times. And whilst we should be making sure that we're taking a holistic approach to the

14:08

well-being of adults, we shouldn't be insisting that we're making a point of trying to fill in all of the circles and gather information about all of the

14:16

circles because they won't always be relevant or meaningful or purposeful for the individual.

14:22

So the definitions of well-being of adults is on the screen. The definition of well-being for children is very similar.

14:30

It works its way from physical and mental health and emotional well-being and goes clockwise to suitability of living accommodation

14:38

and it's the last two circles that are different. In children's well-being, we still have a duty

14:44

to promote the welfare and development of children under the Children Act 1989.

14:49

One of the things we need to consider is the need to try to remove generic terminology

14:58

when we talk about individuals in discussions or assessments. We tend to fall into the trap of using generic jargon or a catchall phrase that we all use.

15:12

But the question is, if we're really taking a person-centred approach in relation to the child or the adult do we then delve a bit deeper to understand what that

15:20

generic terminology that we use actually means for the individual? One of the key questions in practice everybody can use is the question, so what?

15:30

It allows me to delve a bit deeper into what well-being means to an individual.

15:39

So for example we will often hear what's really important for Mrs Jones is that her independence is promoted or her independence is maintained. We will all have a different

15:49

view of what we think independence means for Mrs Jones and what happens when a generic term

15:55

like that is used is we can often fall into the trap of making assumptions if we think we know what that means without asking the ‘so what’ question that delves a bit

16:03

deeper means we ask so what does independence mean to Mrs. Jones? What does independence look like for her?

16:09

How will she feel if the aspects of her independence she identifies are being promoted?

16:15

We'll see blanket phrases like ‘Mr Smith needs support with his personal care’. But what is personal care? Personal care can mean something to every single individual.

16:24

We've got to ask the ‘So what’ question to know for that individual what are the personal care needs that are important to him? Personal care needs will be identified by the

16:33

practitioner and family members but are they the same as what the individual would describe. The more I go deeper, the more I can tailor the support around the individual.

16:42

We'll hear phrases like ‘for the individual to be kept safe, for the child to be happy’.

16:47

What makes children happy differs across the board. So ask the so what question that says.

16:53

So what makes this particular child happy? How do they feel when those things are happening?

16:58

So an activity that you could do by yourself or in a group is to take your work hats off

17:05

and think about what well-being means to you as an individual. First off, think about the words

17:11

that you would use to describe well-being. Maybe jot them down, get somebody else to jot them down.

17:16

Then take a step back from that list and ask yourself or ask each other what does it really mean when the generic jargon is stripped away? Have you used words that

17:23

we use generically in our practice, or have you really described what's important to you? So if you're in a group activity doing this, for example, somebody says what's

17:34

really important to me, what well-being means to me is, is “good physical health”. The rest of the group are encouraged to ask the “So what” questions - “So what

17:42

does physical health mean to you? What does it look like? How does it make you feel?”

17:59

Challenge yourself or challenge each other using the “so what” question to be able to delve a little bit deeper and think about what does it really mean? It's almost that

18:08

you're getting into what makes you unique, what makes you individual, what makes you tick, what makes you smile compared to what makes everybody else smile.

18:21

So we've given consideration to what well-being looks like and what it means, but it is also

18:33

important that we give consideration to the principles of the two pieces of legislation that

18:38

essentially underpin the practice and the approach we should be taking to support individuals.

18:44

What you can see on the screen are the core principles, but I probably prefer to refer to them as the foundations for practice.

18:51

We have to be mindful that these can sometimes become boxes on forms. It is terminology that is being constantly used, but when we take a step back,

18:57

do we actually take the chance to describe what this actually means in

19:03

practice? Do we describe what it means through the lens of the individual? Do we describe what it means through the lens of the staff member, for example?

19:11

What's really important is that we're able to take each of these principles and translate what they mean in practice. So if you are responsible for leading quality

19:20

within your organisation, for example, you might want to give consideration to these being some of the measures of quality not in a bureaucratic

19:28

sense but more in terms of these being aspects of quality in the way that we support individuals. So if we were to take each one in terms of what they mean, let’s say choice and

19:37

control first, I want to hear what the individual's thoughts, views, wishes, experiences are as much as possible. We want to be able to promote choice and control. It is not

19:47

always possible, but that's not to suggest we shouldn't be striving to achieve it. There will be instances where individuals can't verbally share their voice. And I think

19:56

just changing our emphasis on why this is important is key because what we're wanting

20:01

to do in terms of promoting voice choice and control is really get an understanding of what life is like for the individual. How do they feel? how do they want to be?

20:11

If the person's able to verbally articulate it, great. But there might be occasions where we're reliant on other people to be able to share those insights such as siblings, parents, grandparents,

20:22

carers, neighbours, friends, potentially other practitioners. But what's important is when we're drawing on our observations of an individual, when we're drawing on the input of

20:32

other individuals that we're making sure it comes back to the individual as opposed to what we're

20:42

hearing other people saying about how they feel themselves (maybe it's their guilt about not being able to support an individual as much; maybe it's what they think the individual needs to receive).

20:52

So where we are drawing on observations in behaviour, terminology, language, body language,

20:59

for example, those observations are just as important as the words that somebody articulates

21:05

to us when we're then drawing on other people's input. And that insight into the individual,

21:10

we've really got to make sure that they're talking about the individual themselves. When it comes to co-production, that often gets described as “we work in partnership with

21:19

people” but co-production really is focused on trying to reduce the power imbalance that we sometimes have between practitioners and individuals. And if you think about

21:28

what our role is, our role is to understand what life is like for the individual in order to identify if they have any care and support needs, what are their outcomes,

21:37

what matters to them, and what risks are being identified for that individual? Our professional judgement and anybody working in a regulated setting regardless

21:45

of their role is a professional and a practitioner in their own right. Their input is important but is just as is important as the input of the individual or their carer

21:54

or their representative. So try to think of co-production as a way to get the view of

22:00

the individual through the individual's lens and through everybody else's lens. Co-production in terms of practice then is if I'm writing an assessment,

22:10

I should see evidence throughout that assessment of essentially a two-way conversation. The development of the personal plans should be done with the individual or their representative. It's

22:20

not “a we've had a lovely conversation with you so we will now go and write up the plan”. The plan is about how that person's going to be supported in their day-to-day life

22:28

so that individual should be enabled to contribute to what that plan looks like as much as possible.

22:33

Strengths-based approaches we're going to talk about as we go through the session. This isn't simply a case of writing down the good things or the nice things about an individual. There is a

22:43

difference between there is a box on a form that allows us to capture strengths versus we are adopting a strengths-based approach. When we're identifying the strengths of

22:52

an individual child or adult, it's really important that this contact gets to that,

22:57

that there's meaning and purpose. It's pointless writing in a box somewhere on a form that is headed strengths that Betty is still able to drive at 87 if when I

23:08

have a conversation with Betty and ask, When did you last drive Betty? She says,

23:13

not for a couple of years as I’ve completely lost my confidence and I doubt I'll drive again. We've noted that she can still drive but the

23:19

context isn't relevant in terms of where Betty is at the moment. I don't just identify the things that are working well for the individual, but I'm

23:28

thinking about how we are using those to develop the plan for the individual. A strengths-based

23:33

approach would mean I'm seeing personal plans that reinforce the strengths of the individual,

23:38

the things they can do themselves, the things other people can help with. Our plan shouldn't just be based on the things the person can't do or they need help with.

23:46

A good strengths-based approach means I've got a plan that reinforces, builds on the strengths of the individual.

23:53

In terms of being outcome focused what we're essentially talking about is what matters to the individual. What is it that makes them smile? What is it that makes them

24:01

feel content? What is it that gives them purpose, makes them feel unique? There is a difference in terms of this is what's really important to me versus this

24:11

is my preference about how my needs are to be met. So when somebody says I prefer to have a shower over a bath, that’s the precedence over how the personal care

24:20

needs to be met. That's very different to them saying, I want to be able to sit out

24:25

in my garden and look at the tree that my husband planted when we first got married,

24:31

because that is something that's really special to me, that's unique to the individual. Positive risk taking probably happens more than we give ourselves credit for. The question is,

24:41

are we actually explicitly describing that we are supporting positive risk taking?

24:47

Everybody's life has an element of risk associated with it. And what we need to be thinking about is the context of all of the other principles you can see on the screen,

24:56

because you can't really do one of those in isolation. But when we're thinking about positive risk taking, we're giving consideration to what

25:04

the person is telling us about the lived experience on a day-to-day basis they would be wanting to have. Where we identified that there are strengths for this individual are

25:13

there things they can do for themselves or other people who can help them. Are we doing too much for people? Are we giving too much service or are we micromanaging aspects of their

25:23

day to day lives that we don't really need to be thinking about? The key is how we then articulate,

25:29

become confident and share with each other that we are essentially promoting risk taking in

25:36

order to provide the individual child or adult with the most fulfilled life that is possible.

25:42

The key with positive risk taking is that we all collectively understand the risks, that we collectively understand the likelihood of that risk, the impact of the risk that we share,

25:53

the management of that risk in terms of planning, and that we are collectively reviewing that and measuring the impact on the person's experience in terms of being proportionate. This

26:04

is where we really need to think about how much do we end up doing for the child or for the adult.

26:09

When it comes to being proportionate I see plans that are hugely detailed in terms of almost every

26:15

movement of the individual on a day to day basis. What we have to remember is that children and

26:21

adults are in receipt of care and support services from providers because they have specific needs

26:26

that have been identified, there are risks that have been identified for the individual, the individual is telling us what matters to them. And what we should be doing is planning

26:35

an approach that responds to those three areas. We need to leave flexibility for individual to

26:42

exercise their choice, to change their mind, to do something different day to day where

26:47

it's possible. So there is something about how much do we end up doing for the person

26:52

rather than with the person, or even leaving the person to do some of that for themselves.

27:02

An activity you can do as a group or individual reflection is to think about how well we

27:09

see these principles playing out in our organisation and our setting. Think about how you can use some of these to share your descriptions and understanding of quality.

27:21

Just take a moment to reflect on what this means, how you'd describe it.

27:26

How would you know that everybody knows that this is how we work in practice? These could be features that you use to describe in a statement of purpose or in the

27:35

information guide for individuals. If you're a Responsible Individual who's measuring the

27:41

quality of assessments and plans, you might want to be looking for evidence that these principles are playing out in the practice that's being delivered by the organisation.

28:03

We’ll move on now and bring some of the things we learned about the legislative

28:08

context. We want to see how the principles for practice pull through and underpin

28:17

all the practices and processes we've got in our organisation.

28:23

We're now going to give some thought to working with people in a strengths-based way. But it is important to recognise that it is about the person-centred approach here. It's about

28:34

making sure that we're really understanding the individual in the middle of all of the activity. It's the point that was raised before around the well-being activity of delve deeper,

28:44

ask the ‘so what’ questions and really get a sense of what this means for the individual.

28:50

When considering the RISCA statutory guidance and regulations, it's really interesting when

28:57

we map out the stages of the individual's journey from the point that the referral

29:02

is received by a provider through to closing down any intervention or provision. And again,

29:09

that will vary based on an individual's circumstances. It could be that the provision was put in place for a temporary period. It could be that the needs of the individual have

29:19

escalated such that they need a different type of support or it could be that the individual

29:24

has sadly passed away and the service is no longer required for that individual.

29:30

But what we need to be thinking about is how do we actually make sure everybody understands each of the steps of the journey, getting the understanding of what does quality look like

29:41

at each of these stages and understanding of why are we promoting a person-centred strengths-based

29:47

approach throughout each of these steps of the individual's journey coming into the service.

29:54

Starting with the referral that's received (which could be a self-referral, It could be from health, it could be from social care) what's really important is through that referral as a provider,

30:05

you're gathering as much information as possible to gain an understanding of the individual.

30:19

It's important to remember that at the point the referral comes in and the point in which the provider starts to undertake their suitability assessment as required in

30:27

the regulations that we have a read across to the statement of purpose. So the referral that comes in from the person commissioning the service should

30:36

be accompanied by a care and support plan, potentially an assessment.

30:41

But the more information that you can gather at that stage about the individual allows you to do that suitability assessment, it allows you to check across to

30:50

the statement of purpose that what's been asked for is in line with what you've stated you provide as a provider. It's also your opportunity to think about

30:58

matching. So it might be a case of matching a member of staff to support the individual,

31:03

it could be matching the individual to other people who are receiving the service already.

31:14

If it's determined that as a provider you're able to provide support to the individual,

31:20

you're required to provide the Service Information Handbook. The regulations and the statutory

31:25

guidance are clear about what content needs to be included in the Service Information Handbook but

31:31

what's really important is as a provider you take a step back and really think about who is this

31:37

handbook for? Go back into that handbook and have a look for the jargon, the generic terminology,

31:45

go back into that handbook and read it as if you're the child or the adult coming into the setting or receiving the service for the first time. What difference are we making to the life of

31:53

the individual? Do you understand what's in that handbook? Does it tell you what you really want to know? So some of the best handbooks I've seen develop will be those that have been developed

32:03

with the individuals who receive the support from the organisation in children's residential homes.

32:10

I've seen children and staff produce DVDs as their version of the Service Information Handbook.

32:16

You get the staff perspective of what it's like in the home, but the children and young people are also contributing to what life is like in that home. I've seen examples where providers have

32:28

asked staff to all walk out of the building and stand at the front gates, looking back at the home, describing what they see. Describe how they feel walking down the

32:37

path. What does that look like? What does it feel like going through the front door? What do you see? What you smell, what you hear? So there's information handbooks. They do

32:45

need to satisfy the requirements of the legislation. It's also important that

32:51

we're thinking about does this provide the individual with the information that they really want to know? Ask people who were in your services already, ask people who

33:00

have left whether they received the information that was really important them from that we may through service agreements and then you will develop the personal plan for the individual.

33:10

Now, the personal plan needs to be in place before day one of the individual coming into the setting and be heavily based on the information provided by social care. But it is really important that

33:21

we are starting to give consideration to the principles of the Social Services and Well-being Act, not just the principles that underpin RISCA in terms of the development

33:29

of the plans. So am I seeing evidence of the individual's voice choice and control? Where it's appropriate? Where it's possible? Is the plan co-produced with the individual? Is it

33:39

strengths-based? Is it outcome focused? Does it promote positive risk taking? Maybe it's a bit

33:45

too early at this point to hugely delve into that area, but this is why you see the next steps in the process. Is it proportionate? We don't know the individual particularly well at

33:55

this point because they haven't even come into your setting or started to receive the service.

34:00

The individual then comes in to your service. You as a provider are required to undertake your provider assessment. Again, same set of principles apply as the individual settles into receiving

34:10

the service or settles into the new setting in which they're now living. Staff in the setting

34:16

will be developing relationships, rapport, trust will be building with the individuals, getting more comfortable potentially with their situation and living arrangements.

34:26

That's why it's really important that that personal plan is then reviewed after the first seven days using the principles we've just described. But really doing that alongside the

34:36

child or the adult who's now got a better sense of what of what's happening around them ongoing,

34:41

that will be daily, weekly records, them being kept, supervision will be taking place with staff.

34:47

And again, one of the key things to think about when we're in the ongoing delivery phase or the

34:52

review of personal plans is it can be very easy to fall into the habit of monitoring

34:57

and measuring the activity that is being delivered. They're receiving the care that they need, they're accessing the service they need, they are having the opportunities to do what's

35:06

important to them but one of the questions that rarely gets asked is, So what's the impact we're

35:12

having on the day to day life of the individual? So in those weekly or daily records, in the

35:17

supervision sessions, in the reviews of plans when they're happening, as well as making sure

35:22

that we're complying with what we should be doing in line with legislation we are making sure that we're delivering what we say will deliver in the plan and that consideration is being

35:29

given to impact and what difference are we making to the life of the individual?

35:34

To set the context of the relationship between Social Services and Well-being Act and RISCA – the Social Services and Well-being Act brought with it an assessment model that

35:43

you can see on the screen now which are the five circles on the left-hand side, a lot of assessments within social care being referred to as what matters conversations

35:52

or what matters assessments. If you've heard reference to what matters, it is essentially the assessment of the individual that's being described. And what should be happening is through

36:02

the assessment process, I'm establishing what the personal circumstances of the individual are,

36:07

the outcomes of the individual: what are they saying matters to them? But I don't want to then capture the rest of the model in separate boxes I want to make the linkages across to them.

36:18

So when an individual says these are the things that are really important to me, these are what matters to me, this is how I want to be. This is how I want to

36:24

feel my what matters conversation in my assessment approach then explores okay,

36:29

so what's stopping that from happening currently? why aren't you able to do the things that you're describing (barriers). Consideration is then given to how much of that you are able to do

36:37

for yourself? who else can help you? what can you access in the community? We then move on to exploring what the risks are if the individual is not able to do those

36:46

things that matters to them, if they're not able to feel the way they’re wanting to feel. That's what I want to be exploring and that's what I want to capture through the

36:53

care and support assessment. I equally need to be identifying what the care and support needs

36:59

of the individual are. The Social Services and Well-being Act brought with it an eligibility criteria that is now based on individual care and support needs. So through that assessment,

37:08

not only am I identifying what the outcomes of the individual are, I'm wanting to identify what

37:14

the care and support needs of the individual are equally. And I can use the same approach - these

37:19

are the circumstances which we've established and instead of personal outcomes, I change it to care and support needs. I then explore with the individual and those around and what's stopping

37:28

that need from being met. How much can they meet the needs themselves? Who can help them? What can they access in the community to meet the need? What's the risk if the need isn't being met.

37:37

All of this information collectively informs the decisions around eligibility. If it's

37:42

identified that an individual has an eligible care and support need that is then translated into the care and support plan for the

37:49

individual. The box on the right-hand slide of the is a high level description of what the care and support plan needs to capture. This is what then gets passed through to providers.

38:00

The assessment model I've just described - whilst that is one that is put onto social care in terms of their care and support assessments - as providers,

38:09

you equally need to assess the individual's needs as we've just see.

38:14

The approach that's just been described around, identify the outcomes, identify the care and

38:20

support needs, explore with the individual and those around them, what's stopping them, what's helping them, what's the risk if it's not achieved is an approach that providers

38:30

can equally use when they're undertaking their assessments and formulating plans.

38:36

Once a provider receives the care and support plan, this is where the duties

38:45

under RISCA kick in in terms of undertaking your assessments and developing the personal plan. RISCA is clear that the personal plan needs to include the individual's personal outcomes,

38:57

an understanding of their care and support needs, what their personal preferences are about how they want their needs to be met and their outcomes achieved? What are

39:06

the risks or the challenges identified for the individual and is there a need to consider specialist assessments that have been undertaken or need to be undertaken?

39:16

Think of it as the care and support plan essentially describes to you What

39:27

needs to happen and why while the personal plan is taking that a step further in terms of now getting into the detail of how we are going to be able to do that.

39:37

What you can see in the grey box is a summary of what then gets put into the personal plan for the individual. Remembering the principles we described earlier should

39:48

be underpinning the approach by which the plans are developed.

39:55

Whilst this slide looks quite busy what it is doing is focusing in on is what do

40:00

we need to be capturing through the assessment and the planning process. Now the words we often hear used in practice will be the words ‘wants and ‘needs’ spoken by

40:10

everybody around the individual, and sometimes the individual might be using those words, for example What I want you to do for me is this / What I need you to give me is/ What you need to do for my mum

40:21

is/ What we want you to do is call in four times a day to provide care/ What we want you to do is

40:27

stop the child from being exposed to risk/ What we need you to give the child is a stable placement.

40:33

Quite often the words ‘wants’ and ‘needs’ have been used to describe services, activities, interventions, things that are done ‘to’ the individual. But what we need

40:45

to be understanding and describing is what the actual care and support needs of the individual

40:50

are and not the service requirement or the intervention that's required.

40:57

This is where some of the generic jargon terminology starts to come in . For example: the care and support need will be described as ‘the person has needs in relation to their personal

41:06

care’ or ‘the person needs help with their medication’ or ‘the person needs support to be able to socialise’ – we fall into that habit of describing what it is we think we need to provide.

41:18

Whereas really describing care and support needs through the lens of why do they need something in

41:23

the first place is far more helpful. So when describing care and support needs, don't think what is it they need instead think about Why do they need it? For example if

41:32

we’re writing that someone needs help with personal care, what's the personal care they need and why do they need it? Is it because they're prone to UTI so we need to make sure

41:42

that they're clean and they're kept clean. Is it because they're prone to pressure sores so we need to keep them clean. Is it the care and support need is in relation to managing their emotional

41:51

needs, managing some of that self-regulation due to trauma that they've experienced previously.

41:57

Is their need for support around medication because their dexterity in their fingers doesn't help them to be able to pop tablets out of blister packs or is it because they

42:06

forget to take it because they've got memory challenges? So care and support these needs describe the reason why somebody needs the support as opposed to what it is they need.

42:15

And I have to combine that with what matters to the person, what are the outcomes they're saying are important to them and what are the risks that are being identified for the individual?

42:24

Remembering the principle of positive risk taking. So my assessments and plans need to encompass what's within this blue line. And the more

42:33

we're able to describe it through this lens, the better chance we've got of moving from

42:38

being fixers to facilitators of people's well-being on their lived experiences.

42:44

So again, we can see where the principles for practice lend themselves nicely and need to underpin the approaches,

42:52

the practice, the steps, the parts of the process that we should be following.

42:58

Take some time to reflect on the input that has been shared in discussions either by yourself or in groups, considering the principles of practice that you can see on the screen,

43:08

share with each other those experiences of where you have seen those principles

43:14

in practice. What do you hear when services and support is being provided that gives you

43:19

the reassurance that that is the practice and the culture of your organisation? Maybe

43:26

it's a case of what you see recorded or written down in the paperwork that needs to be produced

43:33

Do some reflection on how well you are delivering on the principles – trying

43:39

to take a strengths-based approach. Start the conversation or reflection with identifying the bits you know we do well, the things we're confident with, and this is how we know we do

43:48

them well. This is how we know we do them well is the most important part of the conversation.

43:54

And then it might be that you move on to think about maybe we need to concentrate on some of

43:59

these other ones a little bit more. Maybe there is scope for us to do things a bit differently.

44:04

So take about 15-20 minutes in your groups to really unpick what this looks like, what it sounds

44:12

like within your organisations. Share the examples of where it's working well, Share the examples of

44:18

where you're reflecting, where are there areas a bit more or something different could be done.

44:24

To summarise the element of person-centred practice, making the links across to what

44:29

we're required to have in place, and again thinking about the lens of quality,

44:35

some of the key areas in which we can really focus in on are we getting person-centred practice right? Do you describe it in your statement of purpose? Is that approach described in the

44:45

information guides in a way that the individual can understand, almost start to feel what their

44:51

experiences will be, are we thinking about the care and support needs, the outcomes, the risks?

44:57

Are we delving deeper and asking the so what question of what the terminology means when we're

45:03

considering our suitability assessments? When we're developing and producing our assessments

45:08

and personal plans and undertaking the reviews are we describing our standards of care and support,

45:16

are we recognising that actually those standards of care and support read right across to the definition of well-being in the Social Services and Well-being Act

45:24

And when it comes to being inspected by Care Inspectorate Wales, they will be focusing in on those well-being outcomes. They will be looking for the evidence of person-centred

45:34

and strengths-based practice across all of the aspects of what we're required to provide.