changing directions trainer notes

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CHANGING DIRECTION…Introducing the culture and value base for

high quality service provision

Sharon Scarlett – L&D Transformation Advisor

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Welcome

• Housekeeping

• Ground rules

Additional ground rules

Confidentiality, encourage participants to use real workplace examples – current potential safeguards may require immediate response

Don’t take it personally, key point to ensure participants are clear that if they are contributing or colluding with abusive practices they will be dismissed

Mobiles, to be kept off and off the desk Respect, participate, ask questions, remind participants no ‘break off’ discussion

Honesty, relate to the theme of the day which is being honest where we need to improve

the quality of what we do

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Only Relief staff…

Stress ONLY as this is a key issue in that relief staff view themselves and are viewed by

permanent team members as an ‘add on service’ which they are not They have the same rights and responsibilities as permanent team members

The relief staff role does not differ from permanent staff – they support customers with medication

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Just Relief????

Relief staff support customers with meals

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Spot the difference…

• What’s the difference between relief and permanent staff?

In summary like the twins shown in the picture there is no difference. Encourage relief

staff to contribute ideas and opinions to the permanent team

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Who’s who?

• Name

• How many years working in Care

• Something interesting about you

Getting to know each exercise

The total of the years of experience working in Care services is used to demonstrate that in a small room of comparatively few people there are so many years of experience

This experience will help towards making our services more effective

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Icebreaker

Groups of 6-8 stand in a circle, left hand in the air, hold another person who is not next

to you Right hand in the air, hold another person who is not next to you,

Do not let go

Working as team, leading, directing, communicating, problem solving

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A Close Team…

Using an A5 sheet of paper support staff to assemble on the sheet, then invite line

management to join them All must fit on one sheet of paper

The importance of remembering exactly who is part of the team and how much support there is available is the point of this exercise

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Objectives

What do you want to get from today?

Remember be honest

To call out and put on flip charts

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Objectives

• To work towards a shared vision for services which has the customer in control

• To explore and acknowledge where current services do not reflect a positive value base

• To examine the responsibility of the individual and the team in performance and practice

• To initiate clear action plans which reflect a change in culture and embed recognised principles which value everyone’s Human Rights

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Attention…

• Do not speak to anyone

• Do not move from your seat

• Small plastic brick in front of you, you can hold it , but if you drop it do NOT pick it up

This is an exercise designed to ensure participants are able to empathise with those

customers who may spend periods of time unoccupied, not included, ignored The trainer emphasises time spent using mobile telephone, making a drink, eating

Participants show clear signs of being uncomfortable or come to the realisation that they themselves often behave like this in the workplace

After 5-10mins ask the participants what is happening – Trainer to spend time talking on

their phone, sending emails, and generally ignoring the group

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Change the mood

A quick exercise the lighten the last exercise

Show slide title only Participants asked to answer the following sums out loud

All the sums add up to six (2+4, 1+5 and so on) Then ask them to call out the name of the first vegetable they think of

Show main picture The learning point is it works, I don’t know how, and sometimes when you work with

people it feels a little bit like that

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What’s it all about?

Outline of the six month project to improve Care services and ensure that alongside cuts

in resources we are providing high quality support and people who use our services are safe

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No Going Back…

What to look out for

From our experience, we have identified a number of warning signs that might suggest institutional practice is occurring:

• Service users being described by staff as having “challenging behaviour”

• Service users with no communication skills and no way for them to make their views known;

Cont…

A summary of the Organisations report into abusive practice

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No Going Back…

• Schemes that although located in the community were still isolated from other people

• Some very dominant staff members who limited the opportunity for other staff to make their views known

• High staff turnover or, on the other hand, no staff turnover

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No Going Back…

• Obstacles put in place to prevent unannounced visits (such as “it upsets the customers”)

• Locks on doors (“for the customer’s safety”).

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Reality check

Read real examples (annonymous) of abuse that has happened in our services,

examples include those with a high shock factor and those which may not be seen as ‘abuse’

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Legislation

• Valuing People Now (2007) Rights, Independent living, Control and Inclusion

• Compassion in Practice (2012) Care, Compassion, Competence, Communication, Courage and Commitment

• No Secrets 2000, 2009, Safeguarding guidance

• GSCC (Health and Care Professions Council)

Summary of significant legislation and encourage participants to make themselves

familiar with further details located in services

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Legislation

• Safeguarding Adults at Risk (SCIE report 2011)

• Dignity Challenge Zero Tolerance

• MCA (2005) new legislation about supporting people when they lack capacity to make a decision, new criminal offence of ill treatment or wilful neglect of a person who lacks capacity

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A Day in the Life….

Using the sheets in front of you –outline an average day fora customer living in our services

An exercise for participants to document a typical day for a customer

Generally there is a lot of time spent ‘relaxing in lounge’, watching television Opportunity to point out that some people pay 1800 pounds per week to live in our

services Ask participants what they would expect for that amount of money

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From a personal perspective……

Talk about me, my history – especially forensic and challenging services and use

examples from South Ockendon to today, describe the things I have seen in FM homes – bed times, separate crockery, toilets, people being put on diets, people being told they

are good or bad. Halloween party mid October 12pm because of staff shifts Lots going on, the world of care and support is changing, commissioners want more for

less, legislation demands that people have quality services and their rights are adhered to. For people with learning disabilities, we are often in positions which mean we have a

great deal of control over their lives because we care? Today this is not good enough. It

is also about being responsible from an organisational level and a personal level.

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Acceptable Abuse

• Open the envelopes in front of you – how do you feel?

An exercise in which participants are given a series of statements (all indicate

poor/abusive practice) They are required to grade the actions in the statements from worst to least worst and

emphasise this exercise is what THEY would find acceptable Most participants will say that all of the actions are unacceptable

Emphasise that these are all unacceptable for people living in our services Discuss how they would respond if they see these actions

How would they report it

How would they feel Realistically it can be something staff struggle with

Key message if you do nothing you are colluding and may be putting your employment at risk – or even face criminal proceedings

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Being angry

Introduce participants to the term ‘challenging behaviour’

Discuss the negative impact of this label

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Furious

Discuss road rage over emphasise what this looks like;

Making rude signs, swearing, if I had a tazer… Participants laugh

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Emotional

Think about hormones, the slightest words can set off an unexpected rage

Doors slammed, cups smashed, tears and crying Participants laugh

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Frustrated

Discuss your pet hate shopping when they are little children around, the precocious child

who is demanding and stamps her feet and you wait with bated breath hoping the mum is going to chastise the child

You might even think of running the child over with your trolley

Participants laugh

Participants are asked ‘what was your response to the anecdotes you’ve just heard

Laughter

Discuss having just described real emotions, being angry, frustrated, acting out. The participants have understood and related to it

However if I was talking about a person with a learning disability no-one laughs, we give them a negative label – challenging behaviour and use medication to prevent them from

expressing their emotions

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Being angry…

• Working with a partner list the different ways in which you express emotion

• So you all have challenging behaviour! Let me get some PRN!!!

Exercise for participants to discuss different ways in which they express their emotions

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Challenging Behaviour

• What is it?

• Each group to come up with a definition of Challenging Behaviour

Exercise for participants to try to describe challenging behaviour

Learning point is that it means different things to all of us – why not simply describe the

behaviour

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A definition of behaviour

“Severe challenging behaviour refers to behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in jeopardy, or behaviour which is likely to seriously limit or delay access to the use of ordinary community facilities.”

Emerson

Widely recognised definition

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What is it really about?

"A small number of people with learning disabilities behave in ways which people without learning disabilities find difficult. For example, they may scream or hurt themselves. Some people behave like this because they are frustrated or because other people don't listen to what they have to say. The best way to help a person with a challenging behaviour is to find out from them what the problem is. Sometimes a person with challenging behaviour may need specialist help.“

CBF

A more understanding and simpler definition

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Understanding the behaviour

• What function does the behaviour serve for the person?

• What is the outcome the person achieves by their behaviour and why is it so important for them?

• What other constructive alternatives are available to achieve this?

Useful to use an example of a person using aggression to avoid being made to do

something they do not want to do because they may not have the verbal eloquence to convey this in words

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Understanding the behaviour

Conclusions generally include the following:

• There is a problem in communicating feelings about needs

• There is a skill deficit in not being able to engage in a task or an experience properly

• There is a need for attention (for varying reasons)

• There is a wish to avoid a task (for varying reasons)

• A person is feeling unwell, in pain or has an unrecognised illness

• Personal wishes and choices are being overridden

• Boredom is demonstrated

Different reasons why people may display complex behaviours, use examples to

elaborate; People who have no verbal skills

Controlling staff Being made to do something you do not want to do

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Autism

• Describe wait

Discuss how complex autism is, what it feels like to have autism

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Some facts….

• People who are on the Autistic Spectrum sometimes have problems…..

• Understand and use non-verbal and verbal communication

• Interpret social behaviour which in turn affects their ability to interact with children and adults

• Think and behave flexibly (i.e. to know how to adapt their behaviour to suit specific situations).

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More like us?

People with an autistic spectrum disorder have a different perspective and experience of the world from ours. It is important to value and develop their particular interests and activities and not to focus solely on trying to change them (to become like us), which they will find difficult and which they will not necessarily want to do. We need to ‘get into their shoes’ and try to see situations from their point of view. This will add to our own insights and understandings. In turn, they will be more relaxed in our company.

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Perceptions of Power?

• Stand up

• Sit down

• 2 to the end of the room

• Recite 2x table

• Ladies stand up

• Gents stand up

• All move one seat to the left

An exercise to demonstrate the power of the tutor

I can make you all jump up and down because the perception of you all is that I am in control, look how easy it is for me to abuse this

Think about how customers perceive us – the control we have to influence what happens in their lives

Some people we support are open to manipulation

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How did we get here?

Silent Minority

The participants will watch the film (30 mins) What are your observations of what happened in the film?

Now link history to the current day, are there similarities between what you have seen and what happens in your workplace

Participants to be encouraged to discuss the significant aspects of the film No privacy

Being bored, no stimulation

Being excluded from society Living in a hospital when you are not ill…

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What’s in a name?

“The feeble-minded are a parasitic, predatoryclass, never capable of self support, or of managing their own affairs. The great majority become public charges in some form. They cause unutterable sorrow at home and a menaceand danger to the community”.

Fernald (1912)

This quote is evidence of the historical view of people with learning disabilities

How do we view the people we support?

Participants to write down three differences between us and the people we support on scrap paper no more than one minute to do this

Ask if they have managed three or two or one difference, hold the paper up. Now tell them to tear it up.

This demonstrates that there is no difference We are all unique human beings

We cannot take a group of people and label them and treat them in a different way to the way we expect to be treated

If you see a difference – then you just don’t get it

Discuss that from 1912 society has changed Has it?

Make some links between what was shown on the film and what happens today

Staff cups and crockery and toilets

Big focus on clean homes which detracts from physical support of the person

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What’s in a name?

“I feel like I am being contaminated, the gloves are no good – they need to go right up to yourelbow, and we need face masks as well”.

Agency Worker, Family Mosaic (2012)

Discuss this statement from a staff member in 2012

What do the participants feel about this Does this reflect how support staff values really are? Or should be?

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Negative Values

GROUP WORK –

please find alternative

ways to express those

keywords listed below

– remembering that

how we communicate

is relative to how we

value people

• Feeding

• Toileting

• Challenging

• Service user

• Kicking off

• Attention seeking

• Prn’d

• Epileptic

• Down’s

Divide into groups about 4, then feedback

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Score Your Scheme

Participants complete the grid in the User Guide

Turn to books, page 8, and complete in small groups

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Score Your Scheme cont…

• Customers have a clean home

• Customers are able to access every room in their home freely

• There are some rooms which are locked to keep people safe

• Customers are supported on a one to one basis at least once per day (not personal care)

• Customers have a planned, structured programme of daily/weekly activity

Feedback from each group

Use of each point to outline good practice and show opportunities to improve on current

practice

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Score Your Scheme cont…

• Customers can have meals drinks snacks whenever they want

• All customers who are on a ‘diet’ have consented to this

• Customers who smoke do so as they require

• Customers have meaningful relationships with friends and family

• Customers have support to meet their sexual needs

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Supporting activities

• Garden

• Taken to the local supermarket for the weekly shop

• Corner shop to buy toiletries, sweets, newspaper

• Corner shop to buy a lottery ticket

• Home to visit relatives

• Cinema to watch a film

• Football match

All start by standing up for each question, remain standing if you have done this in the

last 12 weeks,

Discuss why staff have not supported people to engage in these activities Can they go back to the workplace and introduce these activities for customers

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Supporting activities

• Anywhere on a bus or train

• Out for the whole day

• Concert

• Pub

• Pub on a Friday night

• Club, pub, restaurant to meet a friend

• Disco

Could all start by standing up for each question, remain standing if you have done this in

the last 12 weeks, yes I am aware of the weather and the age of people we support. Encourage them to comment – do you feel I am being unfair

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Team Building - Exercise

What did we do well last year

What did we do less well?

What could we do differently?

Wish list:As a team, if you could create a “wish list” of things to implement in your team, it would be… (with a hint of practicality, be creative)

Whole team, team members take turns to feedback

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Change Direction - Services

ExerciseWhat does a good service look like?

In your groups use the cards to agree your top

ten

Think about it from different points of view:

• The environment

• The staff

• The support

Divide into groups and send off to do this exercise, 1 group environment, 1 group staff,

one group support and feedback

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The WOW! Factor!

• Lets spend five minutes thinking about a time when you really felt you achieved something…

• When you supported someone and felt you really made a difference…

• [email protected] (catching people doing things right)

Take turns to go round the room showing what it is possible to achieve

This can be really emotional as staff describe even the most simple situations when they

have been able to make a difference in someone’s life

Useful to use an example of your own

Every organisation has a clear avenue to complain, so many don’t have the same for

when people do well – Nando’s November 2011 joined the WOW charity, the philosophy is the WOW factor Good News

story. Go on the WOW website look at the stories, think about what you do – and get

nominating

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Photocopy this so everyone has access to look, then get them to sit in a circle and do

this exercise What do you like and admire………. About your Manager, about colleagues

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This is me

•PCP in action…

Circulate a couple of copies of the document, so participants can look at the new support

planning tool Emphasise how it is customer led

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Dignity Audit Tool

Participants are given 10 minutes to complete one page of the audit where they rate

their performance on a scale of one to five Go through each topic and ask them randomly to provide evidence for their score rating

Generally they will have little real evidence so discuss what evidence they could use

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Training/training needs analysis/matrixTRAINING TEAM

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BLACK: MANDATORY BLUE CLINICALLY SPECIFIC

Participants to familiarise themselves with the in house training grid and their

responsibility in ensuring this is updated

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Supervision

•Who

•Why

•What

•When

•Where

Get the team to agree what supervision is, how important etc..The participants can

outline what is important in the supervision meeting Basic rules:

Dress code Sickness/attendance

Rota/shifts Conduct

Attitude and values

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Change Direction - Commitment

The participants are introduced to the next exercise which is to review their own team

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Team review

• More of this…

• Less of this….

The participants are separated into support staff and managers.

The two groups will be asked to feedback on More of….. The effective/good things about the team, the manager, the support staff

And Less of…. Those issues, concerns and problems which prevent customers from getting

the best possible support

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Remember

Stop seeing the barriers

Rules, health and safety, risk these need to be viewed as positive tools to help us to

support people in meaningful life experiences

Remain focused on the outcome

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And ACTION

• Ensure your schemes provide the highest quality support and that all team members, at all times, demonstrate excellent skills, knowledge and experience.

• Contribute to embedding the most positive values which will support our Changing Direction strategy and will……

CHANGE LIVES!

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Action Plan

• Please complete the back page of your User Guide

• Hand in, we will give you a copy

• When we come to visit, we can catch up to see where you are with your commitment to service improvement

• What about your own project – show us what can you do?

• Run a group?

• Teach a class?

• Garden party?

• The world is your

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Change Direction – First Step

End with a real feelgood message

A great day Really interesting

Appreciate the honesty and sharing Positive there will be change

changing directions trainer notes

Health & Medicine