Building Blocks to Best Practice: People Centred Services

1
Building Blocks to Best PracticePeople Centred
Services

• Maria Walls
• Director of Research Membership Services

2
Co-Presenter Mary OConnor Early Services
Development Manager St. Michaels House, Dublin
3
Early Intervention Services
Overview

• Linking
• Experience
• Theory
• Practice

• Levels
• Child Family
• Teenager Family
• Adult
• Family

• At
• Individual
• Service
• Organisation

4
National Federation of Voluntary Bodies Providing
Services to People with Intellectual Disability

• Formed as Network in 1972
• Secretariat established in 1998
• 60 Members
• 22,000 Service Users
• In excess of 14,000 staff
• 80 of services to people with Intellectual
  Disability
• Equivalent in size to two Health Boards

5
Definitions

• 1946 World Health Organisation (WHO) Constitution
• Health is a complete state of physical, mental
  social well being and not merely the absence of
  disease and infirmity
• 1986 WHO Ottawa Charter embraces this broader
  practice positive definition and adds Assisting
  the individual to increase control over and
  improve health, focusing on completeness and full
  functioning
• Social Model of Disability
• Implications for Disability Services
• Whole life Focus
• OBrien principles
• Increase in the number of Departments funding
  services
• Mainstreaming Agenda

6
Quality and Fairness
Accountability
4 Principles
Quality of Care
Equity
People Centred
7
People Centred
The key principles to guide Person Centred
Services are

• The right to equal citizenship/rights based
  approach
• Social Inclusion and Integration
• Promoting informed choice/equity
• Respect for individual choice and respecting
  diversity

8
This requires that

• All the resources and activities of the agency
  are directed at supporting what really matters to
  the service user.
• The organisation has a reliable system of asking
  services users what supports they require and
  identifying their priority needs.
• The organisation measures the extent to which it
  is responding to each individuals needs and
  priorities
• The principles which direct service activities
  span the entire spectrum of services which an
  agency provides directly or in conjunction with
  other agencies.

9
Delivery of People Centred Services Requires

• Management Commitment
• Promotion of Leadership at all Levels
• Partnership with Service Users and Staff
• Innovation and Creativity
• Effective Service Co-ordination/Teamwork
• Accountability to Service Users and Funders

10
(No Transcript)
11
Building Blocks of the Child Family Centred
Services
 

 
 
 
 
 
 
 
 
 
 
 
 
  Rights Based Perspective
  Inclusive Community
  Social Model
 
 
 Services closer to families
Implementing Reviewing Evaluation  
  Outcomes Focused Approach  
 
 
Inter-disciplinary/ Trans-disciplinary Teams
Individual Family Service Plans
  Partner-ship
  Collabo-ration

•  Child
• Family
• Centered

 
 
 
 
 
 
 
 
12
3 Core Values
 
 
 
 

•  

  Rights Based Perspective
 
 
  Inclusive Community
  Social Model
 
 
 
13
Building Blocks of the Child Family Centred
Services
 

 
 
 
 
 
 
 
 
 
 
8 Key Elements
 
 
  Services closer to Families
  Outcomes Focused Approach
Implementing Reviewing Evaluation  
 
 

•  
• Child
• Family
• Centered

 
    Partnership
  Collabor-ation
  Inter-disciplinary/ Trans-disciplinary Teams
  Individual Family Service Plans
 
 
 
 
 
 
 
 
 
14
Child and Family Centred Services

• Key issues
• Parents as partners and decision makers in the
  early intervention process
• Family in centre - Services as collaborator
• Not just receiving information from parents
  asking to do therapy at home but acting in all
  parts of the process
• Adaptation Process
• Capacity Building

• Evidence
• Provision for siblings
• Home visits
• Involvement in all parts of assessment process in
  defining the issues, and devising solutions
• Meeting parents together
• Timing of visits
• Video of intervention for father
• Key worker

15
Working in Collaborative Partnership

• Key Issues
• Dunst, Trivette and Johanson 1994 requires
  abdication of paternalistic approaches to helping
  relationships and adoption of empowerment,
  participatory involvement and competency
  enhancement approaches to help giving
• Success intervention on quality of provider -
  family relationship
• Dale 1996 propose Negotiated Model that parent
  and professionals have separate but highly
  valuable contributions to make

• Evidence
• Parents being asked about the level and nature of
  their involvement
• Asking where involvement should take place
• Using a problem solving format
• Committing resources to enable parent involvement
  in advisory programmes
• Facilitating parent to parent contact
• Using evaluation and parent satisfaction surveys
• Consulting on the planning and development of
  services
• Family directed service

16
Multi-disciplinary Teamwork
Team
17
Inter/Trans-Disciplinary Teamwork
Team
Family
18
Inter-Transdisciplinary Teams

• Key Issues
• Team is the mechanism that makes the intervention
  work - Tuchman 1996
• Model of Teaming
• Inter-disciplinary share common goals, are
  committed to communicating and work through
  planned interaction, parental involvement, better
  co-ordination of tasks between members.
• Trans-disciplinary share common goals,
  plan together using systematic process or sharing
  roles and crossing disciplinary boundaries.
  Family participation and concerns on decision
  making are crucial.
• Tuchman TD best service to families as they
  integrate the principles of co-ordination and
  family centred service

• Evidence
• Dedicated Teams
• Plan on needs of the child family
• Joint assessments
• Joint planning - families seeing fewer therapists
• Natural Environment Work - greater involvement of
  wider team in childs life
• Child based filing system
• Parent always member of the team

19
Policy Change SummaryParadigm Shifts

• Charity
• Disabling
• Medical
• Expert
• Prescriptive
• Professional Driven
• Segregated
• Group
• Therapy
• Multidisciplinary
• Discipline Focused
• Standards
• Centre based assessment
• Deficit

• Rights
• Empowering
• Social model
• Child and family centred
• Collaborative consultation
• Consumer driven
• Mainstream/Inclusive
• Individual
• Whole life
• Inter/trans disciplinary
• Age group programme based
• Outcomes
• Integrated real environment assessment
• Strengths based

20
Implementation Issues Raised

• Structure dedicated
• Leadership and Co-ordination
• Understanding Change
• Teamwork and Time
• Getting Parents involved
• Move from uni-dimensional to multi-dimensional
  approach
• Its Complex

21
Change

• Charles Handy 1988 in Understanding Voluntary
  Organisations says that
• to change the culture of an organisation from
  role to task based culture is one of the most
  difficult changes to make.

22
Case Study
Mary OConnor Early Services Development
Manager St. Michaels House, Dublin
23

• Moving from child centred to child family
  centred services in early intervention

24
The Client

• Older models
• Child
• Individual
• Encapsulated
• Handicapped

• Newer models
• Family
• Family system
• Ecological
• Universal
• Wasik, 1990

25
The Role of the Helper

• Older models
• Expert
• Problem solver
• Decision maker

• Newer models
• Collaborator
• Facilitator
• Negotiator
• Wasik, 1990

26
Individual Programme PlansOlder ways

• Developmental domains
• Motor development
• Communication
• Cognitive development
• Social and emotional development
• Self-help skills

27
Individual Plans - Newer Ways

• Goal James will use his hands to play
• How will this goal be supported
• (who, when, where?) Physio and OT will do two
  joint home visits to show Lucy how to position
  James in his standing frame and in his chair.
  They will lend Lucy appropriate toys to try.
  Lucy will decide on when and how often she will
  be able to position James. Link worker and Laura
  (Jamess granny) will also be shown how to
  position James to use his hands. Physio and OT
  will visit on dates arranged with Laura (6 visits
  each in three months). Review.

28
Individual plans - newer ways

• Goal Lucy will be able to go out for one
  evening per week with her husband
• How will this goal be supported
• (who, when,where?) Key worker will work with
  Lucy to support a family member to learn key
  skills for managing James care in the evening

29
Making the Transition Using Outcomes for Families

• Families are informed
• Families choose child development goals
• Families choose their goals
• Families choose services and supports

30
Providing Services in a New Way

• Information giving
• Key workers/co-ordination
• Teams that comprise staff relevant to child and
  family needs as described by the family
• Collaborative work/working in trans-disciplinary
  ways

31
The Challenge

• The progressive and inevitable ambiguity of
  disciplinary boundaries represents one of the
  central challenges facing the field of early
  childhood intervention

• Shonkoff and Meisels