Transcript Person Centered Thinking - DAY 1

Person Centered Thinking
Day 1
Developed by Michael Smull with Bill Allen, Marc Archembault, Sherrie Anderson, Mary Lou
Bourne, Amanda George, Cherie Goss, Julie Malette, Michael Steinbruck, and Nolda Ware
Help people get better lives
Not just better plans…
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Moving from Service Life to Community Life
Community
Life
A Good Paid
Life
Service
Life
‘Important to’ recognized
‘Important to’ present
Focus on connecting,
building relationships
and natural supports
• To and for present
• Important for
addressed
• No organized effort
to address important to
• Closest people are
paid or family
• Few real connections
• To and for present
• Active circle of support
• Included in community life
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Moving from Service Life to Community Life
Community
Life
A Good Paid
Life
Service
Life
• To and for present
• Important for
addressed
• No organized effort
to address important to
• Closest people are
paid or family
• Few real connections
• To and for present
• Active circle of support
• Included in community life
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Discontent is the engine of change
Good plans create a kind of mirror – they reflect how people
want to live
Discontent comes from comparing what is with what could be
There are 2 kinds of discontent:
• Optimistic
• Cynical
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Optimistic discontent requires trust based on-
A history of acting on things that can be changed
immediately
Honesty about those things that take time
Signs of progress in acting on the things that take time
Where change is new trust must be created
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Cynical discontent
One of the things that good plans do is hold a mirror up
to the system and create discontent with what is.
Without hope for change this level of discomfort
becomes intolerable.
Without hope for change you get denial, distortion, or
departure
 People say this is no different from what we have
always been doing
 Plans are distorted to suggest that what people want
is what is already offered
 The people who have the most passion for change
leave (depart) when they see no hope for change
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
2 levels of change
Level 1 change –
those changes that can be made without becoming a
change target –
without changing core structures, responsibilities, etc.
E.G. – helping people with their morning rituals,
honoring what is important that doesn’t require that
people move or major changes in staff responsibilities
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
2 levels of change
Level 2 changes –
Changes that make you a change target
New responsibilities, practices, structures
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Skills needed to support people
Supporting
Dreams
Supporting Relationships,
Community Connecting
Being “Mindful” & Recording Learning
• Learning Log
• The 4 Questions
• Working/Not Working
Matching Staff and
Those Using Services
Recognizing and Sorting
Important To and Important For
& Finding the Balance Between Them
Learning, Using and
Recording Communication
Defining Staff Roles and
Responsibilities
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Person Centered Thinking Skills - 1 & 2
•
Skill = Sorting important to
from important for
(and finding a better
balance between)
Important to
Tool = Important to/for
sort/table
•
Skill = Determining staff
responsibilities
Tool = The donut
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Important for
Person Centered Thinking Skills - 3
For each person – what are the…
Supports wanted
and needed
Skills needed
Personality
Characteristics
(Present/Absent)
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Shared interests
(nice to have)
Person Centered Thinking Skills - 4
Learning, using, and recording communication
What is happening
______ does
We think it means
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
We should
Person Centered Thinking Skills - 5
Three Mindful Learning Tools
Tool #1: Analyzing situations using “What works/doesn’t work”
(also known as “makes sense/doesn’t make sense”)
What doesn’t work/make sense
Staff’s
Perspective
Person’s
Perspective
What works/makes sense
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Person Centered Thinking Skills - 5
Three Mindful Learning Tools
Tool #2: Using the ‘4 Questions” to focus on
learning and acting on that learning –
• What have we tried?
• What have we learned?
• What are we pleased about?
• What are we concerned about?
And then
?
?
?
?
• What should we try/do based on what we have
learned?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Person Centered Thinking Skills - 5
Three Mindful Learning Tools
Tool #3: The Learning Log
• Using the learning log
to replace typical notes
• Creating a learning log
for the people who use
services
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Each of us want lives where we are
supported by & contribute to our communities
Have our
own dreams and
our own journeys
Have opportunities to meet new
people; try new things; change jobs;
change who we live with & where we live
Have what/who is important to us in everyday
life; people to be with; things to do, places to be
Stay healthy & safe (on our own terms)
© The Learning Community for Essential Lifestyle Planning, Inc. 2006 (with apologies to Abraham Maslow)
Terminal Irritation
* Used with permission from Dave Coverly, Speedbump Comic
Person centered planning is a set of promises
A Promise to listen
to listen to what is being said and to what is meant by
what is being said
to keep listening
A Promise to act on what we hear
to always find something that we can do today or
tomorrow
to keep acting on what we hear
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Person centered planning is a set of promises
A Promise to be honest
to let people know when what they are telling us will
take time
when we do not know how to help them get what they
are asking for
when what the person is telling us is in conflict with
staying healthy or safe and we can’t find a good
balance between important to and important for
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
What you hear depends on
what you are listening for
Listen
Understand
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Important to
What is important to a person includes only
what people are “saying”:
with their words
with their behavior
When words and behavior are in conflict, listen to
the behavior.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Important for
What is important for people, includes only those
things that we need to keep in mind regarding–
Issues of health or safety
What others see as important to help the person be
a valued member of their community
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
All and
Choice,
Health
Safety
Balance
No Responsibility
Dictate
Lifestyle
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Julie’s
perspective
What works/makes sense
What doesn’t work/make sense
• Shopping daily for favorite things • Staff don’t let me drink what I want
• Having lots of jewelry and no one • Teddy leaving me during mealtimes
getting into them without my ok
• Having no work to do at WAC, Inc.
• Having my sister Joanne in my life
• Staff not letting me buy things I
• Lots of blue, red and black clothes want
• Polished nails, many colors & layers
• Living with Teddy, the Yorkshire
 Sleeping on my bed at night
 Snacks from my plate
 In my lap when I watch TV
Staff’s
perspective
• Favorite people doing activities
with her, especially John Dandy
• Julie is less steady on her feet and
reminders to use her walker
• If you don’t make a plan with her
• Keeping Julie from falling –
• Level blood sugar - staff knowing
signs of low and high blood sugar
falling more than she used to
before shopping, she will want to buy
more than she has money for – Julie
may get very upset which can alter
her blood sugar
• Joanne is active in Julie’s life
• Planning before she goes shopping • Julie gives Teddy food off her plate.
Julie
What is important to Julie?
What is important for Julie?
What else do you need to learn/know?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Julie – Answer Slide
What is important to Julie?
Relationship with Teddy
Having some control –
• Over what happens with Teddy
• What she buys/wears
• Her things
Shopping a lot
Her sister &John Dandy in her life
Staying busy at the day service
Drinking as much as she wants
What is important for Julie?
Keeping diabetes under control
• Monitoring blood sugar, giving insulin
• Weighing her food
• Controlling amount she drinks
• Helping her stay calm
Supporting her relationship with Teddy
Keeping her from falling
Planning in advance/
budgeting in advance for shopping
What else do you need to learn/know?
• How interested/involved is Julie in her diabetes management?
• What about “no work to do at WAC, Inc bothers her?
•Is John Dandy really important to her?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
If I had an hour to
save the world, I’d
spend 55 minutes
defining the problem.
-Albert Einstein
Inside a Person’s Life
CORE
RESPONSIBILITIES
USE JUDGEMENT
& CREATIVITY
NOT OUR PAID
RESPONSIBILITY
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Examples from Inside Libby’s Life
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
Support independence:
Look for things she can
do on her own, the last
item of clothing that she
puts on must be put on
herself (she wants you
to set it up and let her
do the rest) know how
she communicates and
take the time to
communicate with her
Help her stay healthy:
Provide G-tube care and
at least 1,500 ccs of
fluid a day. She doesn’t
feel thirsty (you keep
track), an occasional
glass of wine (drinks
through the g-tube).
What you try! (e.g. put
on my sweater, cleaning
cabinet tops, etc.) Help
me find a meaningful
job. Help me find
other ways to
communicate with those
that can’t communicate
with me.
Don’t interfere with
the private time I
spend with my friends.
I don’t need an
interpreter. They are
my friends and we
communicate. Don’t
interfere with how I
choose to handle the
love interests in my
life. I will ask for any
advice I want from
whom I want.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #1
What is important to Harry?
What is important for Harry?
What else do you need to learn/know?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #1 – Answer Slide
What is important to Harry?
To attract women
What is important for Harry?
To learn what to wear with minimum
pain
To spend his money as he wants
To learn to manage his money
To have George’s permission
What else do you need to learn/know?
What does Harry understand about –
• Managing his money
• Attracting women, dating
• Where it is appropriate to wear what
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #1 – George’s Donut
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #1 – Answer Slide
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
To help Harry make
an informed choice –
What you do/try
to help Harry make
an informed choice
about –
Whether or not
he buys the shirt.
About the shirt
About his money
Starts with asking
why he wants
the shirt
The odds against
the shirt being a
“chick magnet”
Spending ½ his money
for 2 weeks on
1 purchase
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #2
What is important to Harry?
What is important for Harry?
What else do you need to learn/know?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #2 – Answer Slide
What is important to Harry?
To be around this woman, have her
“recognize” that she wants him. To
have control and power over her.
What is important for Harry?
To know the legal consequences of
stalking
To stop stalking
To understand that stalking doesn’t
work to get an intimate relationship
What else do you need to learn/know?
• More about the past history of this or similar behavior?
• How dangerous is he?
• Does he get what we think he gets out of stalking?
• Has he ever had a “regular adult” relationship
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #2 – Executive Director’s Donut
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Harry #2 – Answer Slide
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
Short term -Keep the
woman safe and in
the process keep him
safe (and out of jail)
Short term – How
you keep the woman
safe until you can get
him treatment
To help him get
sex or keep him out
of jail at all costs
Longer term – teach
relationship skills,
figure out why he is
stalking, any pattern,
and deal with it,
seeking a way for
Harry to live safely
in the community
Longer term – how
you learn, acting on
what you learn,
figuring out how he
can get what is
important enough to
him that that he
will participate in
treatment
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Bob
What is important to Bob?
What is important for Bob?
What else do you need to learn/know?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Bob – Answer Slide
What is important to Bob?
What is important for Bob?
To be one of the guys
To keep his friends
To be in charge of his own life
To have a “typical” life
To stay healthy
To stay healthy –
Take his medications as prescribed
Stay out of the hospital/not cycle
To be connected to his community
What else do you need to learn/know?
•
•
•
•
•
•
How dangerous is it for him to go off medication and have a couple of beers?
Would it be OK for him to drink 1 or 2 beers and be on his medication?
Is there another medication where 1 or 2 beers would be OK?
How well does he understand the risks that he is taking?
Would he be willing to drink non-alcoholic beer?
What role does his girlfriend play in this?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Bob
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Bob – Answer Slide
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
Helping Bob make an
informed choice
What you do to meet
your core responsibilities
around helping him make
an informed choice –
Whether or not
Bob drinks
Informing Bob of the
risks of his behavior
Informing yourself of
the actual risks and
alternatives
Making sure that Bob’s
psychiatrist knows about
Bob’s drinking
Making an effort to
explore with Bob
alternative ways to get
what is important to
and important for him
Informing Bob
of the risks
What Bob’s psychiatrist
does in response to
the information
Educating yourself
Exploring alternatives
If part of the “problem”
is the response of the
psychiatrist – helping
Bob find another
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Recording learning for Charlie
What we have learned about what is:
IMPORTANT TO
IMPORTANT FOR
INSTRUCTIONS FOR SUPPORTORS: for a good balance between
important to & important for, what other people need to know or do.
What do we need to learn or figure out?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Recording learning for Charlie
What we have learned about what is:
IMPORTANT TO
IMPORTANT FOR
Water not too hot, likes it at 105 °
The lift at the pool must be available
A long soak, floating on his back
To always have someone with him,
supporting him in the water
Not to get rain on his face
Making sure water is never over 107°
Having Aaron support him in the water
INSTRUCTIONS FOR SUPPORTORS: for a good balance between
important to & important for, what other people need to know or do.
•
•
•
•
Call ahead to make sure that the pool’s lift is available
Have a way to shield Charlie’s face when it rains
Don’t go in if water temperature is too hot (105 ° is good)
Charlie loves to ‘float’ on his back, always support him.
What do we need to learn or figure out?
How does Aaron support Charlie to float? Is it ok for others to support him?
How hot is medically ‘too hot’ for Charlie? What’s a good temperature range?
How long to soak? What’s too short for Charlie and what’s too long medically?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
As the person supporting Charlie to go hot tubbing…
Core
responsibilities
Use judgment
and creativity
Not our paid
responsibility
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
As the person supporting Charlie to go hot tubbing…
Core
responsibilities
Calling to make sure
the lift is operating,
don’t go if it is not
Making sure water
temp is less than 105°
Being trained to properly
Support Charlie in the
hot tub and do it
Use judgment
and creativity
Not our paid
responsibility
Helping Charlie meet
other people who are in
the tub while Charlie is
there
Whether or not
others in the tub
“connect” with Charlie
How you help Charlie
to enjoy himself
Whether or not
Charlie enjoyed himself
(as long as you
made an effort)
Checking weather before
you go – if rain is likely,
bring an umbrella
Making an effort to
ensure that Charlie
enjoys himself
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Julie’s
perspective
What works/makes sense
What doesn’t work/make sense
• Shopping daily for favorite things • Staff don’t let me drink what I want
• Having lots of jewelry and noone • Teddy leaving me during mealtimes
getting into them without my ok
• Having no work to do at WAC, Inc.
• Having my sister Joanne in my life
• Staff not letting me buy things I
• Lots of blue, red and black clothes want
• Polished nails, many colors & layers
• Living with Teddy, the Yorkshire
 Sleeping on my bed at night
 Snacks from my plate
 In my lap when I watch TV
Staff’s
perspective
• Favorite people doing activities
with her, especially John Dandy
• Julie is less steady on her feet and
reminders to use her walker
• If you don’t make a plan with her
• Keeping Julie from falling –
• Level blood sugar - staff knowing
signs of low and high blood sugar
falling more than she used to
before shopping, she will want to buy
more than she has money for – Julie
may get very upset which can alter
her blood sugar
• Joanne is active in Julie’s life
• Planning before she goes shopping • Julie gives Teddy food off her plate.
Person’s
perspective
What doesn’t work/make sense
USE THIS
INFORMATION
TO BUILD THE
USE THIS
INFORMATION
TO BUILD THE
A
G
E
N
D
A
A
G
E
N
D
A
Staff’s
perspective
What works/makes sense
FOR THINGS
THAT ARE TO
STAY THE SAME
FOR THINGS
THAT NEED TO
CHANGE
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Someone brings home a new puppy. Given your own experiences and those
that you have heard from others, what does and does not make sense
about having a new puppy in the house.
Perspective of New puppy’s Owner
What works/makes sense
What doesn’t work/make sense
Given the medication that someone is taking…
Staff’s Perspective
Person’s Perspective
What works/makes sense
What doesn’t work/make sense
Looking at how you are doing in your work…
Supervisor’s
perspective
Your
perspective
Perspective of
Person Supported
What works/makes sense
What doesn’t work/make sense
Staff’s
perspective
Mother’s
perspective
Kathleen’s
perspective
What works/makes sense
What doesn’t work/make sense
Relationships with friends
Having her scissors at home
Cutting Patterns
Dressing in her own style
Doing things where she stays clean
Sewing at home and making her clothes
Not getting to use HER scissors
Getting dirty & doing jobs that involve
cleaning
Having to do bearings
Having to do work that she doesn’t like
Not being listened to
Kathleen has a place to go during the
day
Spending time with Kathleen
Sewing together
Kathleen is never left alone at home or
workshop
Her schedule has to follow the workshop’s
Kathleen can’t bring her own scissors to
work
There is not enough pattern work for her
Kathleen will open the door for anyone
Staff’s
perspective
Kathleen’s
perspective
What doesn’t work/make sense
Mother’s
perspective
What works/makes sense
Kathleen does what she is told
She has a behavior program
She uses whatever scissors she gets
She follows the rules most of the time
That she meets the “criteria” before
being considered for enclave work
Kathleen will not follow the rules
consistently
That Kathleen insists on using certain
scissors
That Kathleen doesn’t want to get dirty
That Kathleen doesn’t like the other jobs
that are available
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Shared Talk
In pairs
4 minute turns for all 4 questions
Listener gives good attention
Thinker talks 4 minutes
Swap
Share ‘freshest thinking’ with the group in a round
Post 1-2 of the ‘best’ ideas per question
Adapted from Kline, Nancy. (1998). Time to Think: Listening to Ignite the Human Mind. Cassell Illustrated.
4 Questions
What did you learn?
What will you try based on what you
learned? (what will you start on right now?)
What do you think you can accomplish?
What will your challenges/obstacles be?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
for more information go to:
www.elpnet.net
or contact:
Michael Smull
[email protected]
410-626-2707
3245 Harness Creek Rd
Annapolis, MD 21403