Transcript Living Descriptions - Learning Community

Person Centered Thinking
Day 2
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
7 questions that you should be able to
answer for each person you support
1. What is important to the person?
2. What is important for the person?
3. Is important for addressed in the context of what is important to?
4. Is there a “good” balance between important to and important for?
5. What does the person want to learn, what do we need to learn?
If the person is to get the balance described and we are to learn:
6. What needs to stay the same (be maintained or enhanced)?
7. What needs to change?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Help people get better lives
Not just better plans…
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Developing and using plans in 5 stages
1. Why and how - develop the purpose and the process
2. Gather information
3. Develop a first description –
• how the person wants to live/needs to be supported
• what we are going to do to make it happen
4. Use the description and
5. Record what you learn
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Think before you plan
QUESTIONS TO CONSIDER:
•
•
•
•
What would you like the
description to accomplish?
How can the person best
participate?
Who is in the person’s life?
What is the most effective way
to learn from those closest to
the person?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Gathering information
Questions to consider:
• Who should you talk to; who should you listen to?
• Who knows what?
• What is the best way to get their information?
• How can you best support the person and those closest to the
person in doing this work?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Developing your own person centered description
Look for the paper that says ________ ‘s Person Centered
Description and put your name and date on the face page
__________’s Person Centered Description
Date of the 1st plan
________________________________________________
Dates description changed
__________________________________________
Purpose of the description
To learn how structured conversations and looking at reputations can
be used to develop a person centered description.
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Find your “Relationship Map” and fill it out
1. Put your name in
the center
2. Fill out each
section based on
how close you
feel to family
members,
friends, etc.
3. Who is paid to
support you?
Your doctor,
whoever cuts
your hair, etc.
How close do you
feel to them?
Three ways to have a conversation
Linear:
Branching:
Meandering:
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Morning Ritual
Amanda’s Morning Ritual
7:00 am Alarm goes off, clock says 7:15 a.m. Music ONLY no buzzer hit
snooze once or twice (depending on how late I went to sleep)
get up at 7:09 or 7:18 a.m. If up late skip breakfast
Stand in closet, with door shut so light won’t wake husband and
decide what I’m going to wear for the day.
7:15 am Take clothes to bathroom, turn on water in shower-must be
hot, remove pj’s, get in shower, 1st wash body with MILD soap,
then wash hair-mild shampoo, rinse, sometimes shave legs
7:25 am Get out of shower, use 100% cotton towel that is not ‘slick’, dry
off hair 1st work down to ankles. Feet dry on their own. Spray
conditioner (Paul Mitchell) leave in and comb through
Wash face with Clinique-mild soap, no wash cloth, use clarifying
lotion and remove eye make-up with Clinique make-up remover
Put on deodorant and powder-antiperspirant (only if really
hot). Put on underwear, then top. put on eye liner and mascaraNo other make-up! (hurts face) Put mousse in hair.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Amanda’s Morning Ritual, con’t…
7:45 am Go into kitchen fix breakfast: Bran cereal w/skim milk, banana,
OJ. Eat breakfast in living room while watching the Today Show
and the Weather Channel on the 8’s sometimes
7:48 am Give cereal bowl to Oreo the cat
8:00 am Go back to bathroom, blow dry hair: Use big brush and spray gel
to hold
8:17 am Brush teeth, put on slacks or skirt. Find shoes
8:23 am Quickly kiss husband good-bye and decide if coming home for
lunch. Look for keys and purse, run out the door get in car,
leave for work
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Morning Ritual – Part 1
•
Write down your morning ritual –
•
Include as much detail as you are comfortable with
•
•
Start with how you wake up and end with leaving or when you
feel the morning is over
Tell us how long it takes – indicate what time it starts and
what time it ends
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Morning Ritual – Part 2
•
•
•
Work in pairs, look at each others morning ritual and learn
what is important to your partner
Take the sheet of paper that has “what is important to
(name)” at the top
Read your partner’s routine and then –
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Our Mantra for the Exercises
Guess:
Ask:
look at what your partner
wrote and guess in your head
ask your partner if your guess
is correct, have a conversation
Write:
write down what you learn
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Other Rituals
• Going to bed
• Transition
• Birthday
• Cultural/Holiday
• Spiritual
• Vacation
• Comfort
• Celebration
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Good Day
Bad Day
Good Day/Bad Day – Part 1
Take a new sheet of paper, divide it in half so it looks like this:
Good day
Bad day
It is a work day, start with getting up, end with going to bed.
Write down a composite of all the good moments you have had on
a work day and all of the bad moments.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Good Day/Bad Day – Part 2
Work with your partner. Read their good day/bad day list.
Arrange your papers to look like this:
Good Day/Bad Day
Important to
What other people
need to know or do
Then using the “guess, ask, write” process, add to the what is
important list. As you add each item, ask “Is there something
that other people need to know or do to support you with that?”
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Reputation
Exercise
Reputation Exercise – Part 1
Divide a sheet of paper in half and write ‘Positive Reputation’ on
the top-left side and ‘Negative Reputation’ on the top-right.
POSITIVE REPUTATION
Do not write on this – you can write on another
person’s positive reputation, but not your own.
NEGATIVE REPUTATION
Write down 3 mild negatives, for example:
•Stubborn
•Directionally impaired
•Workaholic
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Reputation Exercise – Part 2
For each negative, ask 3 questions:
1. Are their circumstances in which the negative is a positive?
If yes, add the positive to the list.
2. Does the negative reflect something that is important to
the person?
If yes, add it to the important list.
3. Is the negative sometimes really a negative?
If yes, what do other people need to know or do to support
the person when it is a negative? Add it to the “what
others need to know or do to support list”.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
An example using ‘stubborn’
Restated
as a
positive
Determined
What is
Important to
To work where
my values are
supported
Support
strategy when
it is negative
Get in my
face, tell me,
then back off
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Reputation Exercise – Part 3
Look at what others wrote on your positive list
• What would you like to see listed on your description as
your introduction?
• Move those items that make sense to you to your plan
• Add or change things as it makes sense to you
• How did that process feel?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Characteristics of people
I like to work with
Characteristics of people
I like to hang out with
Characteristics of people
I don’t like to work with
Characteristics of people
I don’t like to hang out with
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
MOSQUITO
Imagine you have contracted a new disease from a mosquito bite
• The bite causes a rash and then 2 weeks of paralysis
• During the paralysis you will need personal care for everything
Now you are looking for the person to provide your care, so you
send me a list of characteristics to look for and to avoid
•
•
•
•
Look at your list of characteristics
Circle those that must be present and those that must be absent
Add any that are missing
Clarify any that are too general to allow me to match you with
the person providing the care
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
MOSQUITO
Because there are a lot of people who have been
bitten, the demand for personal care services is high.
I tell you that you will just have to accept whoever I
send.
The person that comes will keep you healthy and safe
but has the characteristics that you said needed to be
absent. Remember, except for being able to talk, you
are paralyzed.
What would you do?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
CHARACTERISTICS I WANT IN
PEOPLE WHO SUPPORT ME
Look at the list that you created –
•
•
•
What are those characteristics that need to be present?
What are those characteristics that need to be absent?
Write those that need to be present and those that need to
be absent in your description
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Looking at your description
•
•
•
•
Take a look at what you and your partner wrote, your description
Put the pages in the following order –
• Cover page, relationship map, introduction, important to,
characteristics, and know and do to support
How does it look?
Would someone who has never met you know –
• Who you are?
• What is important to you?
• How you need to be supported?
• Who you would want to provide that support?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Learning personality ‘characteristics’ that
need to be Present or Absent in supporters
To learn the characteristics
To learn the characteristics
that need to be present, ask: that need to be absent, ask:
• Who is closest to the person?
• Who does the person avoid?
• Who enjoys spending time with
• Who dislikes spending time with
• Who helps make good days
• Who helps the person have bad
the person?
happen for the person?
the person?
days?
• What characteristics do these • What characteristics to these
people have in common?
people have in common?
Matching Staff
Supports wanted
and needed
Skills needed
Personality
Characteristics
Needed
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Shared interests
(nice to have)
Brittany’s Communication Plan
What is happening
______ does
Sad song is playing
or slow melody
Puckering her lips
People are talking
around her
Screaming out loud
Someone is doing
something she
wants to try
Eating
Cramping or cannot
Sleep
(other possibility)
Meal time
Tight reflex
(tight fists or head
turning)
Pushing her spoon
away and turning
her head
Kicking side of
bed or pulls pillow
over head
Grabbing at
things around hermessing things up
Spitting food
Someone is trying to
show or tell her
something
Looking off –out
window- no
attention person
Cramping or cannot
sleep
We think it means
We should
She doesn’t like
the song-making
her sad/feel bad
Frustrated-people
aren’t talking to
her
She is mad or
upset
Change the
station or song
Full-wants a
different food
Help her try
something else or
give choice
Move to different
bed or to floor
Need different
position-need to
move
Need something
better to do-she
is bored
Talk to me as I
eat
Boredom-already
heard this,
already know this
Go back to last
sentence and tell
her –direct to her
Involve her or
lead her away
Be creative-make
fun activities
Tell funny stories, or
share her memories
with her
Be creative, new
ideas and activities,
involve a friend
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
What is Happening
Rhonda does
We Think It Means
And We Should
You are
Locks her chair I don’t want to Figure out with
Rhonda where
pushing Rhonda
go there
she wants to
go
Rhonda is at
Help her
Kicks the door I want to go
outside (unless
the front door
out
there is too
much pollen,
about to rain,
etc.)
Rhonda has
Catches your
I’m done eating Take leftovers
stopped eating eye, pulls down
away now
napkin
You didn’t
Rhonda sweeps I told you I
Clean up and do
remove her
the food off
was finished
better next
and you didn’t time
food
her tray
listen
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Communication Plan
What is happening
______ does
We think it means
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We should
Communication Plan
When this is happens
I do this
It ususally means
And I want you to
#3
#1
(or
2)
#2
(or
1)
#4
 In the
environment
 What’s just
gone on
 The “trigger”
 The behavior
 What others
notice
 Meaning of the
behavior
 What other
people should do
in response
 What the
emotions and
feelings are
 Or not do…..
 Can be seen,
heard, and felt
 What’s going on
by others
inside
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
THINGS WE NEED TO COMMUNICATE WITH KYLE
We want to let Kyle know
To do this we
Then support/encourage Kyle to
It’s time to get up (if Kyle is not
already awake).
Knock on Kyle’s bedroom door and then
open it.
Continue Kyle’s morning routine. See “to
be successful”.
It’s time to have a bath.
Run bath while Kyle is in his bedroom
and when bath is run open his door.
Kyle will get into the bath unsupported.
It’s time to have a shave.
Show Kyle his razor and shaving cream.
Apply shaving cream and have a shave.
It’s time to have hair washed.
Show Kyle shampoo.
Apply shampoo and have his hair washed.
It’s time to get dressed.
Show Kyle his clothes.
To dressed by letting him know what he
needs to do. For example, pointing and
tapping his leg to lift, etc.
Breakfast/lunch/dinner is ready.
Show Kyle his meal. Encourage Eric to
go into dining room.
Sit at the table and eat his meal.
It’s time to take medication.
Show Kyle the syringe.
Sip his medication.
It’s time to have teeth cleaned.
Show Kyle his toothbrush.
Come and sit in the kitchen and have
his teeth cleaned.
It’s time to go to the toilet.
Show Kyle incontinence pad/leg
bags/enema.
Walk to the bathroom by pointing and
guiding him by his elbow.
It’s time to go out.
Show Kyle his boots.
Put his boots on and walk to the door.
It’s time to go for a walk.
Guide Kyle past the car to the gate.
Walk at his own pace.
It’s time to go out in the car.
Show Kyle the car keys or rattle the
car keys.
Walk to the car.
It’s time to go to the pub.
Show Kyle his pint pot glass.
Support Kyle to go to the pub.
It’s time to buy chocolates.
Show Kyle a chocolate wrapper.
Support Kyle to shop and buy chocolate.
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
What works/makes sense
What doesn’t work/make sense
Communication
Communication
• People who support Eric listen and
Eric’s Perspective
try to understand what he is saying
• People who support Eric can’t quickly
understand what he’s saying
• When Eric talks people don’t
understand what he’s saying
• Eric sending and receiving e-mail to • Having to answer “yes” and “no” when
family
Eric has so much more to say
Being Comfortable
• People try and make Eric think of
something else when he is not
comfortable in his different
positions
• It’s quiet where he lives, no sudden
or loud noises that surprise him
• New people take a long time to learn
how Eric communicates
Being Comfortable
• Wearing wrist splints that he hates,
are uncomfortable, may hurt
• Having to spend time out of his chair
• Having to stay on a positioning
schedule when he wants to do other
things
• Having to be in that crawligator
What works/makes sense
Communication
Communication
•Eric’s continued patience as we try to
•Eric’s got a lot to say and no really clear,
learn better ways to understand him
•Eric loves computers, maybe that will be a
Perspective of Eric’s Staff
What doesn’t work/make sense
way he can tell us more clearly what he
wants to say
•Helping him be in contact with his family
and friends using e-mail
•Ruth and “other staff” fitting in and
figuring out how to make the computer
work for Eric “when they can”.
Being Comfortable
•Spending time with Eric when he’s in his
crawligator. Helps keep his mind on more
pleasant things
fast way to say it (in a way that lots of
people can understand)
•Eric hates and won’t use the
communication system that he’s “supposed”
to use
•There ARE communication systems out
that that Eric would love to learn to use
and we don’t know how to get one
Being Comfortable
•Eric hates his wrist splints so much that
he will scratch his wrists and hands so he
won’t have to wear them
•He yells and cries when he’s in the
crawligator and we have to tell him that he
has to be in it
•Most of the time Eric is comfortable
•We’re trying to get someone to look at his •Having to do things to Eric that make him
wrist splints
uncomfortable and hurt him
Recording learning for Eric
IMPORTANT TO
What we have learned about what is:
IMPORTANT FOR
INSTRUCTIONS FOR SUPPORTORS: If Eric is to have a good balance between
important to and important for, what do 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 Eric
IMPORTANT TO
What we have learned about what is:
IMPORTANT FOR
For people to listen/understand what he says Help Eric maintain and enhance his
current range of motion by wearing
To not wear his splints
splints, using crawligator, spending time
Family (staying in touch with them via email) out of his chair, and following his
To be part of what’s happening, not miss out positioning schedule
Stay in his chair, not on the crawligator
A quiet life (without sudden/loud noises)
INSTRUCTIONS FOR SUPPORTORS: If Eric is to have a good balance between
important to and important for, what do other people need to know or do?
Distract/entertain him while in crawligator or doing work out of his chair. Help Eric
with computer (sending/receiving email from family). When you do not understand what
Eric is saying, take the time to figure it out, ask others, don’t give up.
What do we need to learn or figure out?
How to help him have and wear splints that are comfortable or at least less
uncomfortable. What works to distract/entertain him when out of his chair? Can we
have a positioning schedule that works for better for Eric and is more flexible?
How do we help him communicate better? Is there a communication device that will
work for him? How to help new people learn how he communicates faster? Is there a
way for him to use the computer more independently?
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Tools for building Person Centered Descriptions
Communication
Chart
Matching
Staff
Relationship
Map
4 + 1 ?s
Learning Logs
Rituals
Reputation
Working/
Good Day/
Not Working
Bad Day
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Person Centered Description
Like and
Admire
Important
for
Important
to
Person
Centered
Description
Instruction
s for
Supporters
Things to
Figure
Out
Characteristics
of Supporters
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
Learning Wheel
What needs to stay the same?
What needs to change?
Person
Centered
Description
Action
Planning
PCT Tools
Implementation
& Learning
© The Learning Community for Essential Lifestyle Planning, Inc. 2006
© 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