East Ayrshire Health and Social Care Partnership

Starting a Conversation

Session objectives:

• Understanding your role towards outcomes focused practice.

• Importance of reflective practice.

• Familiarise and use of resource pack to start a conversation.

• Agreeing a SMART Care Plan.

Overview

Starting a conversation and your role

The practitioner plays an important role in making co-production possible:

The role of the professional becomes less about being a ‘fixer’ of problems and more about being a ‘facilitator’ of solutions. A facilitator will actively recognise and engage the things children are able to do or are interested in. In

doing so, they naturally focus on the things that are working well to create positive experiences and

sustainable behaviour change driven by the child’s intrinsic goals and aspirations. (

Aked and Stephens, 2009 p2).

What are outcome conversations/ assets/ coproduction?

“Assets can include life experience, knowledge, skills, talents, energy, and enthusiasm”

Key to identifying outcomes is the ‘outcomes conversation’ - these conversations are used to uncover the things that are important to people and are central to

the assessment process.

Conversations/assets/coproductionWhat is the Professional role?

• Actively listening with an open mind to the person’s ‘story’

• Avoiding ‘partial listening’ and being aware of applying ‘filters’ to the conversation.

• Data requirements can act as ‘filters’, whereby staff, particularly under time pressure, may filter what the person says to find the information which they are obliged to gather for bureaucratic purposes.

• Other filters can inhibit open minded listening, including any prejudices and tendencies to stereotype

Principles of an outcomes focused conversation

• Allowing the person to determine the order in which they want to talk about their lives.

• Moving away from a question/answer model toward an ‘exchange model’ (Smale et al 1993) whereby everyone is an expert including the child and their parents.

Source: adapted from (Miller, 2011)

Work to identify and put to use children’s assets

Starting from who children are and what their interests are•An outcomes focused approach links closely to principles of co-production, ‘support that is designed and delivered in equal partnership between people and professionals’.•Coproduction of children’s services ‘focuses less on identifying and responding to a child’s ‘need’ or ‘problem’ in favour of a reciprocal approach, which builds on a child’s interests, knowledge, experience, skills and support networks’

What makes a good life personally and work?

Whole Group Session 1

What Makes a Good Life Personally and at Work

• Treated with respect and dignity.• Viewed as a partner not a client.• Seen as having personal autonomy and control.• Treated in a warm and friendly manner.• Actively listened to.• Given clear and understandable reasons for things which can and cannot be

done.• Given information to help me decide.• Explanation of process and likely time it will take.• Honesty and explanation for delays and things not being done as planned.• Put at ease and supported through difficult times.• Encouraged and praised.• Not made to feel small when making mistakes but engaged in discussion about it.• Clear direction and challenge where required.• Treated as an individual based on strengths and challenges.

Reflective Practice

Reflective Practice

Reflection: A Definition (1)

“Reflection is an important human activity in which people recapture their experience, think about it, mull over and evaluate it. It is this working with

experience that is important in learning’”

Source: Boud, D., Keogh, R. & Walker, D. (1985) p 43 Reflection: Turning Experience into Learning. London: Kogan Page.

Reflective Practice

Reflection: A Definition (2)

“We learn through critical reflection by putting ourselves into the experience and exploring

personal & theoretical knowledge to understand it and view it in different ways”

Source: Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection in the Health Professions. London; Higher Education Authority.

Reflective Practice

Reflection: Informal and formal

Informal Reflection• Involves self questioning.• Develops our awareness of our own assumptions.

Formal Reflection• Draws on research and theory.• Provides guidance and frameworks for practice.

Reflective Practice

Models of ReflectionDewey’s (1938) 5 Stage Model

1.We identify a problem that is perplexing and ‘felt’.

2.We observe and refine the identified problem to create a fuller understanding.

3.We develop a hypothesis or an understanding about the problem, its origins and possible solutions.

4.We subject the hypothesis to scrutiny and reasoning.

5.We test the hypothesis or understanding in practice.

Source: Dewey, J. (1938) Logic: The Theory of Inquiry. Troy, MN: Rinehart & Winston.

Reflective Practice

Models of ReflectionSchon’s (1983) ‘Reflection in Action’

Reflection in action concerns thinking about something whilst engaged in doing it, having a feeling about something and practicing according to that feeling.

This model celebrates the intuitive and artistic approaches that can be brought to uncertain situations.

Source: Schon, D. (1983) The Reflective Practitioner. London: Temple Smith

Reflective Practice

Models of ReflectionKolb’s (1984) Learning Cycle

1. Concrete Experience: The event.

2. Reflective observation: Consider what has happened from a variety of perspectives e.g. own feelings, the group’s, an individual student’s view.

3. Abstract conceptualisation: Re-package and process your reflections into a theoretical understanding (use theory to analyse the event).

4. Active Experimentation: Armed with this new understanding, you do it again, differently this time.

Source: Kolb, D. (1984) Experiential Learning. New Jersey; Prentice Hall

Reflective Practice

Practical Barriers

Kolb (1984) sees that to reflect effectively on your experience, you should actively set aside part of your working day to reflect and analyse.

Source: Kolb, D. (1984) Experiential Learning. New Jersey; Prentice Hall

Reflective Practice

Psychological Barriers

Fear of judgement, fear of criticism, being closed to feedback, defensiveness, professional arrogance.

Reflective Practice

Bridges to Reflection

•Feeling ‘safe’ enough – or we may use ‘expedient’ learning and do what we expect will get us through.•A role model, e.g. a mentor who reflects on their own practice.•Knowledge of as many methods as possible.•As many opportunities as possible for engaging in reflection, e.g. pairs, groups.•Time and Energy.

Source: Ixer, G. (2003) Developing the relationship between reflective practice & social work values. Journal of Practice Teaching, 5, 1, pp 7-22.

Reflective Practice

The Importance of Reflection

Reflection enables us to:

• Be conscious of our potential for bias and discrimination. • Make the best use of the knowledge available. • Challenge and develop the existing professional knowledge

base.• Avoid past mistakes.• Maximise our own opportunities for learning.

Wellbeing Web in Angus Council

Background

• Getting it Right in Angus• Implementation of integrated assessment• Shift from task centred care planning to outcome focused child’s

planning (outputs to outcomes)• Need for a tool to support SHANARRI based outcomes focused

child’s planning across partners

• Reviewed range of outcome measurements tools• Used SHANARRI indicators as a starting point

Outcomes Conversations/Coproduction/Asset Based

Focus on strengths and assets

Balance risk and resilience

Belief in change

Opportunities to build on achievements

Support to identify hopes/aspirations

Ensure active listening

Starting a ConversationCore Resources

Conversation Negotiation Compromise

Prioritise

The Wellbeing Web - Review

Measuring change using outcomes information

• What has been successful?• When was it used?• Why was this successful?• What is the unmet need?

Aims• To empower individuals to recognise change.• Support and enhance professional judgement.• Help analyse circumstances and provide evidence of

impact.

Test Phase Evaluation (East Ayrshire)What Professionals said?

Practitioners

• 88% expressed overall, that the model is an effective engagement tool.

• 82% of the practitioners expressed that the model embedded an assets based/ reflective practice approach.

• 78% expressed that the tool assisted them to engage with the service users in day to day practice.

• 70% expressed that the tool assisted in the development of a service user owned SMART action plan.

 

Team Managers

• 96% expressed that the model enabled them in their management role to sign off SMART action plans with staff.

Test Phase Evaluation (East Ayrshire)What Professionals said?

• Facilitates high levels of service user participation and engagement.

• Provides a way to visually chart feelings and behaviours using the SHANARRI wellbeing GIRFEC national outcomes that can be easily translated into SMART personally owned outcome goals.

• Service user is also enabled to take direct ownership through the development of their own care plan actions and to keep track of timescales.

• Prompt cards and guidance booklet enables the practitioner and service user to explore and explain outcomes in a child friendly manner.

Test Phase Evaluation (East Ayrshire)What Professionals/Service Users said?

• Practitioner feedback suggested that individual work with parents “...were capable of engaging very well with the wellbeing web and the process did help them identify issues and reflect on the care plan, why it was put in place...see improvements made in their lives...” Also, “...promoted parents understanding of work being done with their children, ensuring a holistic family approach and progress...”

 

• direct quotes from children and young people in relation to the “Web” included; “I would be able to show people this...”, “It’s good to see where you are at...I can see what isn’t going well...I like that it explains the words used in meetings”

Conversation Tools

What it is in your toolkit?

IAF Paperwork SDS My Life My Plan

Signs of Safety

Talking MatsGetting Our Priorities Right

Informs and Supports – Starting a Conversation

Starting a Conversation

Group Session 2

Using the Wellbeing Web

Group Session 2 - using the web

• Take 10 minutes to read the Wellbeing Web Booklet (Practitioner, service user, observer)

• (Service User) Think about your first day at school?

• (Practitioner) introduce the outcomes tool to the service user (p4 of booklet) and apply the 3 key good practice questions and take brief notes

Group Session 2 - using the web

• Read (p5-6 of booklet) points 1-7• Complete a wellbeing web (Practitioner) apply

three key good practice questions in section 2• Remembering to use the prompt cards

(Practitioner)

STOP!

Wellbeing Web

Outcome Goals and Action Planning

Agreeing the Care Plan

Group Session 3

Benefits of being SMART

• solution oriented.• centred on, and evidenced by, holistic assessment.• clarity for all.• actions planned are focussed.• provides accountability.• shared language and understanding.• the difference a plan makes can be clearly evidenced.• the Team can learn from what works and what

doesn’t and review accordingly.• analysis of effective ways of working (implications for

future resources).

SMART Outcome GoalsSigning Off Care Plans - Checklist

Outcomes should not be too general, too vague or immeasurable.

• Tools such as the Wellbeing Web will assist workers, children and their parent/carers to work together to identify the specific outcomes they want to achieve.

• The Guide to SMART Outcomes contains some examples of SHANARRI outcomes that may feature in a Child’s Plan. The outcomes described are examples and are not meant to represent an exhaustive list.

Action Planning

• Identify issues of concern.• Name exactly what the Team sees as problematic• Avoid generic language/agency specific

language/emotive language• Check out that everyone is clear with what is being

identified

Who, What?

Who will do this• be specific• name the individual who will carry out the task, not simply the agency• ensure all Team members, including the child and parent/carer, have clear

actions.• ensure agreement.

What will be done• address the detail of the actions necessary.• say exactly what tasks/actions will be don.e

Example:• ‘Jane will attend a 6 week parenting group delivered by the Avedon Team

beginning on 1st July’.• ‘Malcolm will draw a picture for the next meeting in 2 weeks’ time to show how

he feels’ .

SMART Outcomes (Personal Goals)Signing Off Care Plans : Checklist

Specific Measurable

• What exactly are we going to do? • With/for whom? • What is the specific outcome for the

child? • This must be well-defined and clear. • At the end of the planned activities,

what will have changed for the child/family?

• How will you know when the outcome has been achieved?

• How will you measure progress towards the outcome? For example through self report/Wellbeing Web/observation of behaviour, feedback/discussion etc.

Achievable Realistic

• Can we realistically get this done in the timeframe/within available resources?

• Outcomes should not be beyond the person’s or the service’s capabilities.

• Is the outcome relevant and proportionate?

• Is it within reach and possible?

Time-limited

By when do we want to achieve change? Set specific timescales for each stage ‘in 2 weeks’, ‘ by end December 2012’ and avoid the use of ‘ongoing’ and ‘ASAP’.

Group Session 3

Group Session 3 – Action Planning

• Work through (p6 of booklet) points 8-9 (Practitioner).

• Using the 4 key points.

• Remember - Develop a jointly agreed action plan!

Next Steps

Mapping GIRFEC OutcomesWellbeing Indicators with Self Directed Support

Agreeing the Care Plan

IAF Paperwork

Care Planning Decision Making

Sign off Chairing Meetings

Agreeing

Practitioner/Senior/Line Manager

Decision Making Forums

Core Groups, LAAC Reviews

PLENARY AND CLOSE