Transcript Document

Person Centred
Active Support
It ain’t what we do it’s ‘just’ the way that we
do it !
Promoting Active Engagement
Background to Active Support
1980’s
• Residents in fifteen supported housing
services in Wales received contact from staff
for an average of 15% of the time. (Felce & Perry 1995)
• Amount of support received is about 9
minutes in every hour facilitative assistance
1-4 minutes an hour on average (Mansell 2007)
• Staff do not generally interact with the people
they support in a way that enables people to
achieve greater levels of independence,
participation or integration Mansell 2007
A Vicious Circle of Disempowerment
The Hotel Model
Staff do most things for
service users rather
than create
opportunities for service
users to participate
Staff cannot think of
goals or activities
service users could
do. They see their
role as a ‘domestic
worker’ rather than
as an ‘enabler’
Service users do not
participate in valued
activities and spend
most of their time doing
nothing
Staff perceive service users as
dependent. They do not spend
time interacting with or assisting
service
users
and
are
apprehensive about trying new
things
(Mansell et al 05)
The ‘Hotel Model’ has a number of
negative results .....
• The skill level of the person being supported will
drop.
• The opportunity for new skill development will not
develop
• The person will not automatically be encouraged
and supported to participate in activities that
directly relate to their own lives
• The person will loose motivation and confidence
• Behaviour that we find challenging is likely to
occur
What is Active Support?
• A method of supporting
people with
learning disability to engage in meaningful
activities and relationships as active
participants.
• Based on using ordinary everyday activities
to encourage choice and engagement, and
to increase independence.
• Involves working with people in order to
promote optimal engagement, irrespective
of degree of disability.
• Particularly beneficial to people with complex
needs, including challenging behaviour.
• Addresses the way staff teams are organised.
• Active Support addresses the complementary
relationship between person-centred action
and person centred planning
• Works well with people with learning
disabilities, sensory impairment, autism and for
people who have no behaviour that challenges
.
Active Support enables Services to
look at.............
How a person spends their time.
How a person is taking part in activities and
their own lives.
How staff are enabling a person to participate in
activities
........not just relying on the paperwork alone!
Active Support,
Supports Services to :
Look at every moment having potential –
how to look for opportunities – involving in
the right now!
Try little and often approaches to activities
Monitor and review team consistency
Tizard
Remember............
It is always easier for 10 members of staff
without a learning disabilities to learn one
way of doing the same activity, than it is
for one service user with learning
disabilities to learn 10 different ways of
doing the same activity
Positive Staff Interaction:
1. Hierarchy of Assistance – How We Support – Graded assistance
ASK - INSTRUCT - PROMPT- SHOW- GUIDE
The level of support increases.....
2. Thinking in Steps – Task Analysis – How we Support
Breaking activities down into steps and doing
one step at a time every activity has some
easier components
3. Reinforcing Participation – Positively reinforcing
maximising naturally occurring rewards – backward chaining
Backward Chaining
Getting a natural reward more immediately eg
making toast and eating it!
•
•
•
•
•
Rather than starting with get the bread from the
packet, start at the point where you are cutting
the toast:
e.g.
Open lid of jar
Pick up spoon and put in jar
Take spoonful of jam
Put jam on toast and spread with knife
Cut toast in half
A Virtuous Circle of Positive Interaction
& Empowerment - engagement
Staff interact positively
with service users and
provide opportunities
for participation
Staff think of new
ideas for more goals
and activities.
Staff
see themselves as
enablers
Service users participate
successfully in part of
the activities
Staff perceive service users as
more competent. Give more
respect control & attention &
consequently
feel
more
confident, successful & eager to
try new things
(Mansell et al 05)
Active Support Training DVD
Active Support is not ‘just’ about
training !
Not relying on
the paperwork
Organisational commitment is essential
Linking all elements of the organisations activity –
Health & Safety, Risk Management, Learning &
Development, Human Resources, Quality
Assurance
Streamlining approaches to support Person
Centred Planning , Positive Behaviour Support,
Total Communication, approaches to Mental
Health, Autism & sensory impairments
Job Descriptions/Person specifications questions
at interviews
Induction and Probation Frameworks
Quality Assurance
Challenges
• Lack of perceived need
• Reluctance to change
• Training not linking together
• Lack of skilled practice managers
• Communication
• Values, attitudes, motivation and skills
Staff feedback:
• 76% reported an increase in motivation in the
people being supported
• 84% reported an increase in participation in
everyday activities
• 65% reported a decrease in behaviour that was
challenging the team
• 73% of managers said that their teams were
more motivated
• 84% of managers said that they would benefit from
further support
The implementation and effect of person
centred active support in the Avenues Trust
• Increase of 94% in engagement in meaningful
activities
• Increase of 300% in assistance from staff
• Increases not just in participation at home but
also in the community and in choice-making
(e.g. ironing up from 3-22%, gardening up from
9-62%)
• Decrease of 24% in repetitive/self-stimulatory
behaviour
• Decrease of 53% in self-injurious behaviour
Tizard Learning Disability Review March 2009
Association for Real Change UK
• Continuing the promotion of Active
Support - E Forum, website, National
Conferences, Seminars,
• Supporting with the development of the
Active Support Units for the
Qualification Credit Framework – Skills
for Care & Development.
• Active Support training and Interactive
training and consultancy
• Active Support Handbook
Further Reading:
Challenging Behaviour a Unified Approach 2007 by
the Royal College of Psychiatrists, British
Psychological Society and Royal College of Speech &
Language Therapists Approved by Central Executive Committee
The Mansell ll Report 2008 September
Services for people with learning disabilities and
challenging behaviour or mental health needs
(Revised)
Ethical Approaches to Physical Interventions 2009
David Allen November
Raising Our Sights 2010 Services for adults with profound
intellectual and multiple disabilities Prof Jim Mansell March 2010
www.arcuk.org.uk
[email protected]
Telephone 07701099861