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Building Blocks to Best Practice:People Centred Services
Maria Walls
Director of Research & Membership Services
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Co-Presenter
Mary O’Connor
Early Services Development Manager
St. Michael’s House, Dublin
St. Michael’s House
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Early Intervention Services
Linking Experience Theory Practice
Levels Child & Family Teenager &
Family Adult Family
At Individual Service Organisation
Overview
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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
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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
– O’Brien principles
– Increase in the number of Departments funding services
– Mainstreaming Agenda
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Quality and Fairness
People Centred
Equity
Accountability
Quality of Care
4
Principles
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People Centred
The right to equal citizenship/rights based approach
Social Inclusion and Integration
Promoting informed choice/equity
Respect for individual choice and respecting diversity
The key principles to guide Person Centred Services are:
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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.
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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
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Child and Family Centred
Family
Team
Organisation
Wider Society
LeadershipOrganisation
System
Learning Organisation
Voluntary Agency
Collaboration Family system
Team Partnership
Organisation Teams
Participation in Decision Making
Social Model Inclusion in Decision Making
Conceptual Framework
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Building Blocks of the Child & Family Centred Services
Partner-ship
Collabo-ration
ImplementingReviewing Evaluation
Inter-disciplinary/Trans-disciplinaryTeams
Individual Family Service Plans
Services closer to families
Inclusive Community
Child &FamilyCentered
Outcomes Focused Approach
Social Model
Rights BasedPerspective
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Building Blocks of the Child & Family Centred Services
Child &Family
Centered
8 Key Elements
Partnership
Collabor-ation
Inter-
disciplinary/Trans-
disciplinaryTeams
Individual
Family Service
Plans
Outcomes Focused
Approach
Implementing Reviewing Evaluation
Services closer to Families
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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
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Working in Collaborative PartnershipKey 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
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Inter-Transdisciplinary TeamsKey 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 child’s life
Child based filing system
Parent always member of the team
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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
Policy Change SummaryParadigm Shifts
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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
It’s Complex
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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.”
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Case Study
St. Michael’s House
Mary O’Connor
Early Services Development Manager
St. Michael’s House,
Dublin
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Moving from child centred to child
& family centred services in early
intervention
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The Client
Older models Child
Individual
Encapsulated
Handicapped
Newer models Family
Family system
Ecological
Universal» Wasik, 1990
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The Role of the Helper
Older models
Expert
Problem solver
Decision maker
Newer models
Collaborator
Facilitator
Negotiator» Wasik, 1990
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Individual Programme PlansOlder ways
Developmental domains
Motor development
Communication
Cognitive development
Social and emotional development
Self-help skills
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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 (James’s 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.
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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
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Making the Transition Using Outcomes for Families
Families are informed
Families choose child development goals
Families choose their goals
Families choose services and supports
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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
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