Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Research Project Report Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Asunción Snow, Sense Residential Services Manager, Leeds Anne Telling, Melton House Resource Centre Manager, Rotherham October 2011 Page 1 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Abstract The purpose of this research is to investigate if the use of video analysis, in conjunction with a framework of seven principles, improves the skills development and expertise of staff who support people who have sensory impairments and limited communication skills. Several leading Sense staff working across a number of Residential and Communities services were approached and subsequently took part in the research project. Meetings took place to introduce the project and the roles of each staff and participants. A series of prepared documents were explained for the purpose of the project, and how to analyse practice using video evidence was outlined. Questionnaires were completed by all of the staff who took part in the project for analysis by the research team. Feedback from questionnaires of all staff involved showed that the Framework of the Seven Principles, in conjunction with video analysis, improved staff practice, raised staff confidence, improved staff recognition of participants’’ expressive communication, and developed the independence of the participants. The limitation of the research project was that it was based on a small number of staff and participants. No literature can be found that brings together all of the seven principles that we refer to, and there is no literature Page 2 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. where the seven principles are used as a tool for staff development. Therefore video analysis in conjunction with the seven principles is an original and innovative approach, both within Sense and in other similar organisations. The findings have identified priorities for the organisation with regard to dissemination and training. Keywords – Video Analysis; Framework of Seven Principles; Practice Supervision; Skill Development; Self-Reflective Practice; Interaction; Limited Communication Skills; Deafblind; Practitioners; Staff; Paper type – Research Paper Page 3 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Acknowledgements This research was made possible by Sense recognising and supporting this work in its earliest stages, and the keen interest of highly skilled practitioners Janice Greatrex, Linda Upson, Alex Oram, Claire Webb and Gary Hyndman to be involved in the project. This support encouraged the research team to pursue the project. The research team would also like to give their special thanks to all the staff involved for their enthusiasm and commitment to this project: Peter Frost, Jane Pinfield, Joanne Marrison, Kelly Wayman, Kerry Smith, Ben Nichols, Diane Clarke, Neil Angel, Vikki Richardson, Sarah Oliver, Alyson Fox, Sarah Lee, Georgina Wildwood, Rebecca Wilson, Rebecca David, Bob Dixon, Emily Gelder, Steve Powell, Heather Powell, Andrea Crimes, Rebecca Norbury, Maxine Cullum, Zoe Maxwell, Ann Day. The research team would also like to give very special thanks to the participants who made the research possible: Anthony Earp, John Noonan, Sassia Hussain, Suzanne Hirst, Amanda Bodley, Rosamund Thorpe, Peter Morrell, Arminder Mann, Nathaniel Byron and Dean Jennings. Page 4 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Contents Aims page 6 Background page 8 Literature Review page 15 Methodology page 20 Results page 26 Discussion page 35 Conclusion page 38 Reference List page 38 Page 5 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Aims The project considered the use of video and a framework of seven principles as a staff development tool to aid staff working with people who are deafblind and who have limited communication skills. Expectations of Sense staff, in terms of the development of specialist skills, are very high. When staff begin working within services, they don’t usually have much experience working with this client group. The research team felt that video analysis gave visual feedback of practice and removed the staff member from ‘in the moment’ memories replacing those with valuable self-evaluated, precise feedback, whilst supporting reflection in order to maximise the engagement of staff. The Research Team strongly believed that a combination of the use of video for self-reflection and the framework of the seven principles for analysis was key to the development of staff skills. The aim of this Research was to compare: a) the development of staff skills using video and as part of the staff skill development process using the framework of the seven principles, with b) the development of staff skills using the framework of the seven principles without the use of video. Page 6 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. The Research Team have a responsibility to Sense staff and deafblind people who use Sense services. This responsibility is to ensure that support staff have the necessary practical skills to interact with each person they work with, and to provide relevant and appropriate support for the development of communication, independence and other relevant skills. Page 7 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Background To provide high quality services, it is important to empower staff with a high level of skills and knowledge, and for them to feel confident within their role. Owing to the diverse range of people who work in Sense services to support deafblind people, it has been essential to find a tool that staff understand and that they can use to become skilled in interacting with deafblind people. The use of video and the framework of the seven principles is a non-academic, practical tool that gives visual feedback and removes the staff from ‘in the moment’ memories, replacing them with valuable and precise feedback which can be evaluated using the seven principles. It is a self-reflective practical tool that supports practitioners independent of their academic level, i.e. it is useful for staff with or without an academic background. The development of the principles has evolved over a period of many years from the experiences of the research team working with congenitally deafblind and acquired deafblind people. It is from these experiences that people with acquired deafblindness clarified what ‘good staff practice’ meant for them; this vital information contributed to the development of the framework of the seven principles. Additionally, from observation of congenitally deafblind people, the difficulties that teachers and assistants had in interacting and supporting deafblind people were clear. This led to the belief that a framework for developing staff skills was needed to support positive interactions. It was recognised that some principles were needed, and from Page 8 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. these experiences and desire to meet deafblind people’s support needs, the framework of principles began to develop. The Seven Key Principles that formed the Framework were: 1. What are the aims of the Activity? 2. How did I tell the deafblind person that the activity had commenced and did the person anticipate? 3. How did the person and I interact during the Activity? 4. How I used Sign, Speech , objects of reference, pictures, etc 5. How I used physical guidance, physical prompts and verbal prompts? 6. Had I given the deafblind person time to complete the task? 7. What was my role in the task? Have I done things for the deafblind person that they could do? Page 9 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. A more thorough description of each principle is examined below: 1) What are the aims of the Activity? This was the last principle added to this core. This was devised from observing the difficulties that staff had in planning and adapting an activity to suit the individual’s personal development. The learning conditions for deafblind people remain difficult when staff are not clear of the aim of the activity; this is because the deafblind people whom we support rely on the staff to know the aim of the interaction. Knowing the aim of the activity brings clarity and consistency to the interaction and without clarity and consistency, there is likelihood that challenging behaviour will be provoked as a result of frustration or disengagement. 3) How did I tell the deafblind person that the activity had commenced and what did the person anticipate? This principle came from the theory of developing communication and from working with acquired deafblind people who have informed on how important anticipation is for helping them to have control of their life. This principle is also supported from experiences of working with congenitally deafblind people who appear to be resistant to interactions when they aren’t given the opportunity to anticipate, which can often lead to challenging behaviour. Hearing and sighted people take for granted the emotion of anticipation and having control of events, but providing deafblind people with the knowledge and information in the Page 10 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. correct format is a skill that staff find difficult to apply when they are working. Video analysis provides an excellent tool for looking for, and looking at, the bodily emotions relating to anticipation that are displayed by deafblind people. 4) How did the person and I interact during the Activity? This principle is essential to develop the observational skills that staff needs to be able to listen to the deafblind person and to be able to be attentive to any reaction that they receive as a result of their own behaviours. Any action, movement or behaviour has the potential to be turned into an interaction. From experience, we have found that staff don’t always have the skills to be responsive to these actions, movements or behaviours, and so need to develop these communication skills. Video is a key element for staff to be able to ‘see’ the interactions. Possibly staff can only learn this by observing their own practice and seeing how they can ‘listen’ to the person. The key to listening to people who are deafblind is by observing. 5) How I used Sign, Speech , Objects of Reference, Pictures, etc This is an obvious principle to have, because when working with people with limited formal communication skills it is fundamental to know the different modes of communication to be able to present to the deafblind person. Page 11 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Rødbroe and Janssen (2006) emphasize that “A high level of communication skills in the partners is essential”. They include many different ways of communication. The partner must be able to interact bodily and to master sign language to a degree, which allows signs to be introduced fluently, whenever there is a possibility to match the mind of the deafblind person with an appropriate expression. By referring to modes of communication as a principle, we aim to achieve a high level of skill, by supporting staff on how and when to use and adapt communication modes to each individual. 6) How I used physical guidance, physical prompts and verbal prompts Verbal and physical prompts are a key part of this principle because they are used to fill in the gap between the individual’s skills and the skills needed to complete the task. Vygotsky (1978) referred to this as the Zone of Proximal Development”; that is “the distance between the actual developmental level as determined by the independent problem solving and the level of potential development as determined through problem solving under … guidance or in collaboration with more capable peers”. Physical guidance is a complex skill as it is a mode of communication developed through movement that teaches skills and communication. It is fundamental for deafblind people’s skill development to use a tactile approach that Page 12 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. shares bodily movement to enable them to learn functional and practical skills. For example, supporting the deafblind person to open the kitchen drawer is not only communicating the action but also teaching the action of how to open the kitchen drawer. Physical guidance is a technique which needs to be developed by staff to enable deafblind people to learn and develop practical and functional skills. The staff need to understand the position of their hand during this communication technique as this is a complex skill. 7) Had I given the deafblind person time to complete the task? ‘Giving time for the deafblind person to do or understand something’, and ‘not doing things for them’, were expressed by people with acquired deafblindness as fundamental staff skills needed to be able to reflect to the deafblind person that they had potential to succeed in the task. This was one of the first elements of supporting people with deafblindness that became a principle. ‘Giving time’ and ‘not doing things for people’ are interrelated skills, however they still differ: The principle of “giving time” is mentioned frequently in the literature on deafblindness in different contexts. For example Rødbroe and Janssen (2006) state that, “the tempo and the reactions during sustained interaction have to be modified to suit each individual. If this does not happen, then interaction and communication will often be disrupted”. Page 13 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. This principle is also mentioned by Murdoch (1992): “allowing time for deafblind people to receive and respond to stimuli”. From frequently observing staff practice, it is clear that staff miss many opportunities to involve the deafblind person because they tend to give very little time or too much time. In our experience, it is only through the use of video analysis, that staff realise their actual involvement and the importance of these skills. 8) What was my role in the task? Have I done things for the deafblind person that they could do? This principle helps to confirm the role of the staff when supporting people who are deafblind. The principle was included because from the experiences of acquired deafblind people, and supporting staff working with acquired and congenitally deafblind people, there is confusion as to what level of support staff should give. By giving too much support staff can deny a deafblind person the opportunity to learn or develop, or to try new experiences, and frequently doing things for the deafblind person can lead to passive behaviours. This can lead to frustration because, for example, a person with acquired deafblindness will know how and will want to do things for themselves. This could then result in conflict between staff and the deafblind person and a breakdown of the relationship. Page 14 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Literature Review No published literature could be found that brings together all of the seven principles that are referred to, and therefore in no literature are the seven principles used as a tool for staff development. However, most literature on developing communication with people who are deafblind relates to what we refer to as the seven principles. This is used in the context of how to provide good practice when interacting with people who are deafblind. For example, the booklet by Janssen & Rodbroe (2007) includes many references to professionals and institutions working in the field of deafblindness, and they enter into great detail on the importance of: ‘Rituals and routines’; ‘Shared experiences’; ‘Scaffolding and modelling’; ‘Turn taking, turn keeping, turn giving’; ‘Co-regulation of modality; attention and proximity’; ‘Joint Attention’; ‘Introducing yourself as a good companion’; ‘Time to Explore’; ’Sensitive responsiveness’; ‘Open interpretations’, and ‘Negotiating about meaning’. Theorists, Researchers and Practitioners in the field of deafblindness express the importance of the role of support staff in the development of skills in interaction and independence for people who are deafblind. The Deafblind International Communication Network, whose goal it is to make knowledge more available for as many communication partners of persons with deafblindness as possible emphasise this when they explain that: “the partners [support staff] of the deafblind person are the most important factor for his development and well-being. All human beings develop in relationships with other Page 15 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. persons. For deafblind persons it is essential that they meet partners who are willing and skilled in interacting with them on their terms.” (Rødbroe & and Janssen, 2006) This view is also supported by Janssen (2009), who reports that “there are fewer support staff well trained in working with adults than there are for children and adolescents, even though the need for communication only increases with age”. Staff development that supports the interactions and skills of working with people who are deafblind is therefore a significant area. One of the key staff development tools that the lead researchers currently use in their services is Video Practice Supervision. Staff practice is videoed and then analysed by the staff member with the support of an experienced practitioner. The analysis is self-reflective, and follows the framework of the seven principles. These principles have been gradually developed over many years of experience and practice in the field of deafblindness and have been used in the services managed by the research team to improve the practical skills and interaction techniques of staff in their services. The Sense services that the research team are involved in have successfully used video analysis and the seven principles as a staff development tool for many years. This led to the development of a workshop presentation by the research team which was delivered at the European Deafblind Conference in Italy in 2009 on the subject of improving staff skills through the use of video analysis. The Page 16 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. feedback from the workshop was very positive; the overwhelming message being that this method of staff development should be more widely available. The research team hope to gain confirmation through the current research project that video analysis using the seven principles can improve staff skills. The use of video to assess practice has become part of the culture in the services that the research team manage. Although the use of video can be time-consuming, requires some degree of knowledge and understanding of the use of technology and, to some extent, be viewed as invasive to some people, it allows staff to gain a better understanding of their practice, and of how they ‘actually’ interact with the deafblind people they support, rather than how they ‘perceive’ themselves to interact. This is because the practice follows a coaching style, rather than a teaching style. The interaction between the staff member/communication partner and the deafblind person is videoed, and then the piece of video is analysed by the staff member and their senior practitioner. The interaction could be anything from a conversation, to making a cup of coffee, to offering a foot massage. Each interaction is dependent upon the deafblind person and the staff member who supports them. In support of this theory, there is a training pack available from the University of Dundee (2010). This intervention uses video to record interactions, and then analyses the footage with communication partners to “enhance communication within relationships” and “to develop greater awareness of how [partners] can respond in an attuned way “. Page 17 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Furthermore, the information on ‘video interaction guidance’ supports our theory that: “in the process of standing back and looking at themselves on screen, [partners] are able to analyse what they were doing when things were going 'better than usual'. In this way they are empowered to make an informed decision about how they would like to improve situations that are more problematic.” Whilst the pilot study indicated that video analysis using the seven principles improved staff skills, the research team expect: Video Practice Supervision and the Framework of the Seven Principles to be recognised as a tool that can be used as part of supervision for staff development and improving staff practice. To be able to demonstrate evidenced based practice within our services. To confirm the effect of this tool on staff practice development (which in turn impacts on the lives of the people that Sense supports). To confirm the effectiveness and efficiency of this staff development tool. To develop a culture of using video to analyse and develop staff practices. Page 18 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. To produce a marketable Booklet and DVD that will support Video Practice Supervision and the Framework of the Seven Principles as a staff development tool for wider use. To be recognised as a contribution to development in the field of deafblindness by presenting the research internationally. Page 19 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Methodology The participants in the project were people who use Sense services. They require specialist support to meet their individual needs owing to their sensory impairments, any related additional disabilities, and limited communication and independence skills. The participants in the research project were adults who had sensory impairments and limited communication skills, and did not have the mental capacity to give consent to participate in the research project. This posed an ethical dilemma as people need to give consent for participation in research. However, in this project, the participants were not assessed even though they were present; it was the behaviour of the staff supporting them that was being evaluated so it was decided that the staff should give informed consent to participate. Several leading Sense staff working across a number of services were approached to take part in the research project. An initial meeting was held to introduce the project and the role of the Supporting Practitioner, the role that these staff took on. The meeting guided them through their key role in the project and the process of how to use the framework of the seven principles, as well as the reasoning behind each principle. All of the Appendices were explained and clarified as the pilot study highlighted that these were complex for Supporting Practitioners to understand. All services had video cameras, some people had used a video camera before, and, some people hadn’t and were sceptical. However, feedback from the first video practice supervisions Page 20 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. in the pilot study were very positive, for both the staff and the Supporting Practitioners. Feedback from the pilot study revealed that staff were quite apprehensive on the first practice supervision, but afterwards, couldn’t wait for the next one! A series of documents were developed and/or included for the purpose of the project: the Mental Capacity Act (Appendix 1) document to establish whether or not each person had capacity, Best Interests document (Appendix 2), a baseline Assessment for the Staff (Appendix 3), a baseline Assessment for the Participant (Appendix 4) and a baseline Assessment for the Supporting Practitioner (Appendix 5). The standard Practice Supervision Record (Appendix 6) was adapted for the staff to score their initial Practice Supervision (Appendix 7) and for the Supporting Practitioner to score it (Appendix 8); it was also adapted for the staff to score their final Practice Supervision (Appendix 9) and for the Supporting Practitioner to score the final Practice Supervision (Appendix 10). To achieve the findings of the research, a series of questionnaires were developed for staff who used video analysis (Appendix 11), staff who didn’t use video analysis (Appendix 12) and Supporting Practitioners (Appendix 13). Apart from the questionnaires, the documents were arranged as appendices. It became evident in the pilot study, that there was some confusion over what some of the documents referred to, and so a ‘Guide to the Appendices’ (Appendix 14) was created to give clarity to the Supporting Practitioners. An original document, created to offer the Supporting Practitioners a timescale for the project, was also revised as a result of the pilot study; it was simplified and made reference to each of the Appendices, and was titled Page 21 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. ‘Guide for Supporting Practitioners’ (Appendix 15). Feedback from the pilot study also prompted the Research Team to provide the documentation in the form of an Information Pack (Appendix 16) to enable the Supporting Practitioners to follow the project more easily. This pack was separated into two sections: Section 1 for the staff using video and the framework of the seven principles, and Section 2 for staff just using the framework of the seven principles. The role of the Supporting Practitioner was to engage staff in the project, either for the video analysis group or the control group. The Supporting Practitioner supported the staff to complete Baseline Assessments. They facilitated the completion of the Capacity to Consent and the Best Interests documents, and the Baseline Assessment for the participants. The Supporting Practitioner also completed a Baseline Assessment for themselves. It was intended that outcomes could be analysed further by considering any anomalies between the background of the participants, staff members and Supporting Practitioners. For instance, it could be argued that a more experienced Supporting Practitioner may have been able to impart more knowledge, than one with less experience. Once these documents were completed, the Supporting Practitioner observed the staff member supporting the participant doing a chosen activity. Afterwards, the Supporting Practitioner and the staff member reflected on, and analysed the practice following the framework of the seven principles (Practice Supervision Record). The Supporting Practitioner was provided with a series of Page 22 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. questions (Appendix 17) which acted as a prompt for each of the seven principles and was intended to support them during the analysis. Feedback from the pilot study identified that these prompting questions were very useful. It was the staff member’s responsibility to complete the Practice Supervision Record document and, in discussion with the Supporting Practitioner, decide upon necessary developments from the analysis. There were two groups of staff: one group had their practice videoed by the Supporting Practitioner, whilst the control group had their practice observed by the Supporting Practitioner. The group who were videoed were able to use the video to reflect on their practice during the review of the seven principles, whilst the control group had to rely on memory and perception. In the pilot study, staff within the same service who didn’t use video analysis, questioned why they were not being videoed. Interestingly, it was believed by the Supporting Practitioner that the staff felt that they were at a disadvantage by ‘not’ using video. For the staff using video analysis, the Supporting Practitioners were asked to choose a piece of video between five and fifteen minutes long. They were asked to watch the video with the staff member once without any comments, and then follow the framework of the seven principles using the video to reflect upon the interaction. The Supporting Practitioners were made aware that staff often refer to the actions of the deafblind person they are supporting when they should be reflecting on their own practice. Supporting Practitioners were asked to re-focus the staff member’s Page 23 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. attention back to their own practice if and when this occurred. It was also pointed out that during the analysis, the conversation may divert onto another of the principles, and that the Supporting Practitioner should react to this, and indicate the appropriate comment / action against the relevant principle. To achieve an idea of how long the process took, a Time Recording Sheet for staff using video analysis (Appendix 18) and a Time Recording Sheet for staff without the use of video (Appendix 19) was devised. The Supporting Practitioners were asked to record the amount of time it took for each person to complete the practice supervision and the framework of the seven principles for all of the four practice supervision sessions. It was felt that having the comparable information would be valuable when considering the effectiveness and efficiency of the process as a staff development tool as it could be argued that the process was too time consuming. Supporting Practitioners were also asked to comment on the time element within the questionnaires. From the experience of the research team, practice supervisions impact positively on staff practice. For the purpose of the research project, there were four practice supervisions over a period of eight months: Month 1 - the baseline practice supervision will take place Month 2 - the second practice supervision Month 5 - the third practice supervision Page 24 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. Month 8 - the final practice supervision. To assist in achieving the answer to the question of whether or not staff skills had improved over the duration of the project, staff members were asked to score their practice at the beginning and end of the project. The scoring of each principle was done after discussion with the Supporting Practitioner. Similarly, the Supporting Practitioners scored the staff member’s practice, but this was done in isolation from the staff member, so as not to influence the staff member’s analysis of self-reflection. These scores highlighted the reflections of staff practice from both parties. The final practice supervisions were also scored in the same way to allow comparison between the first and last scores. During this final meeting, the Supporting Practitioners gave questionnaires to the staff to complete in order to gain a good understanding of their perspective of the process. Staff were also asked to give consent for Sense to use their videos for staff training and development purposes. The Data Protection Act 1998 states that everyone over 18 years of age (parental / guardian consent for under 18’s) must give consent for the taking of photographs and video photography. This meant that the Research Team had to gain the consent of the staff and the participants prior to being videoed. Following the pilot study that found staff to be sceptical about having their practice videoed, the Consent forms (Appendix Page 25 of 39 Sense October 2011 Developing Good Working Practice using a Framework of Seven Principles and Video Analysis with People who have Sensory Impairments and Limited Communication Skills. 20) didn’t ask for permission to use staff’s videos for training and development purposes. It was felt that consent for this would be better achieved after the project was completed when staff had a better understanding of the process and its likely benefits. The staff gave consent to be videoed. At the end of the project, another Consent form (Appendix 21) was used to ask staff if they would consent to allowing video footage to be used for staff development and training purposes. The service users, all of whom were unable to give consent because the impact of their disabilities preventing them acting autonomously, needed to have a Mental Capacity Assessment. Where this Assessment determined that the person didn’t have the capacity to understand why and how the video would be used, and that they could change their mind if they wished, then a Best Interests Assessment was completed. Each of the Best Interests Assessment were completed by a group of people who knew the person well, who would act in their best interests, and who would answer a set of questions to determine whether or not participating in being videoed was in the best interests of the person concerned. Results Although the research included a relatively small number of Sense staff, the results came from ten projects across Residential and Community Services, and the findings showed no disparity between services. Twenty-nine Sense staff were involved in ten projects from Sense Residential Page 26 of 39 Sense October 2011 and Community Services: twelve Supporting Practitioners, experienced in working in the field of deafblindness, supported the analysis of seventeen staff working directly with participants. Staff being supported using Video Analysis and the Framework of the Seven Principles were the ‘Research Group’ and the ‘Control Group’ were those who were supported using the Framework of the Seven Principles Without Using Video Analysis. Activities were led by twelve highly skilled and experienced practitioners. It is felt by the research team that this has a positive impact of the robustness of the findings owing to the comments made by the Supporting Practitioners stating how their own practice had improved and developed from their experiences in participating in this project. Overwhelmingly, staff felt that their skills had improved when using video analysis in conjunction with the Framework of the Seven Principles. This showed that staff skill development improved, thus having a positive impact upon the quality of life of the people with limited communication skills they support. The control group who didn’t use video analysis felt that although their practice improved, it improved slowly, and that video analysis would have enabled a better self-reflection on their practice if video evidence had been available. Instead, these staff relied upon the sole recollections of the Supporting Practitioners. This demonstrates how video analysis can be used to improve staff skill development. The time taken for the control and research groups was marginally different, and was felt a reasonable time to use for Page 27 of 39 Sense October 2011 staff development, therefore this staff development tool should not have a financial or time implication on the services or organisation. 96 % of staff concluded that Sense should adopt this development tool to enhance staff practice within the organisation. To further evidence the results, verbal feedback from Supporting Practitioners and staff who took part in the project, was captured on DVD, and used as supporting evidence in an alternative format. The perspectives of the project gained from the questionnaires gave the following information: Responses from the Questionnaires of Supporting Practitioners using Video and the Seven Principles 100% felt that staff skills improved using video analysis and the Seven Principles; 100% felt that it improved and developed staff skills; 10% felt that the improvement wasn’t a result of the process alone; Comment: “They were able to ‘see’ and ‘analyse’ their working practice and look to develop the areas to improve their skills, and skills of the participants” Page 28 of 39 Sense October 2011 All Supporting Practitioners felt that video analysis enabled staff to re-call and reflect on their practice: This resulted in: Increased staff confidence; Developing skills to improve their practice; Improving staff skills in communication; Improving the recognition of the participants’ expressive communication; Developing the independence of the participants; Better organisation of the environment; Sharing new skills with other staff to influence their practice; Impact of Staff Skill Development and the Quality of Life of the Participants: 96% of all staff taking part felt that the skills of the staff impacted a lot on the quality of life of the people they support. Some comments were: “Using Video Analysis and the Seven Principles enabled ‘the deafblind people and the quality of interaction to become the focus, and not the outcome”. “The Seven Principles provide a structure and process by analysis to apply and develop skills to benefit the participants”. Page 29 of 39 Sense October 2011 Responses from Staff using the Seven Principles Without Video Analysis 83% felt that their skills had improved a little; 80% felt that their skills would have improved more if they had used Video Analysis. When asked why, they answered: “I would see if I was doing things differently without me knowing”; “I would have been able to scrutinise my actual practice”; “It’s possible to miss details or exaggerate details that didn’t actually happen”; Over 66% of the staff felt that the use of the framework of the seven principles without video analysis: Raised staff confidence; Developed skills to improve their practice; Improved staff skills in communicating with deafblind people; Developed the independence of deafblind people; But, without video for reflection when analysing practice, 33% of staff commented how they had to rely upon the observing Supporting Practitioner for information relating to their practice. Page 30 of 39 Sense October 2011 Responses from Staff using Video Analysis and the Seven Principles All staff felt their skills improved using Video Analysis and the Seven Principles: 88% felt that their skills had improved a lot, whilst 77% felt that if they had NOT used Video Analysis their skills would not have improved; The remaining 23% felt that skills would improve, but not as much and not as quickly; Comments: “We can see how we ‘listen’ and how well our communication is understood” “I’ve learned how to better understand the person, so I can give them what they want and need”; When asked how using the Seven Principles and Video Analysis had improved their practice, over 77% felt that this process had: Developed skills to improve their practice, and the independence of the participants; Improved their recognition of the participants’ expressive communication; Page 31 of 39 Sense October 2011 Enabled them to improve how the environment was organised to meet the person’s needs; The project showed that the Seven Principles is a useful staff development tool, but when used in conjunction with Video Analysis, it was far better. Staff who used Video Analysis were asked…Why? Comments: “Without Video Analysis I wouldn’t be able to reflect on my practice and improve my work;” “I am able to watch, pause, and replay sections, enabling me to dissect my own working practice”; “Video Analysis has added enthusiasm to my work”; “Because my skill improved, so did the skill of the deafblind person;” Is the time taken to use Video Analysis and the Framework of the Seven Principles Reasonable? 92% of all staff taking part felt that the time spent was reasonable for staff development and to benefit the people they support. The average time taken using Video Analysis and the Seven Principles was 1.5 hours compared to 1.25 hours without using Video Page 32 of 39 Sense October 2011 Comment: “The video takes time to watch, but without video it takes time to explain – I prefer video”. Did Staff Feel Comfortable being Videoed? Felt Uncomfortable Felt Comfortable at at the Start of the the End of the project project Views of the Supporting Practitioners 91% 91% Views of Staff who were Videoed 67% 77% 66% of Staff who didn’t use Video felt that they would feel comfortable being videoed. Views on Sense Using This Tool for Staff Development 96% of all staff stated that they would like Sense to use the Seven Principles with Video Analysis as a Staff Development Tool across services. These were some of their comments. “It makes my work more meaningful, not just using Signs and Objects, but also Body Language and Touch” Page 33 of 39 Sense October 2011 “Staff are encouraged to think for themselves and to lead improvement” “Analysing ‘actual’ practice will always be the most useful way of developing practical skills in an organisation that works ‘hands on’ with people”; “It is effective in developing my skills” “It develops a consistent approach” Page 34 of 39 Sense October 2011 Discussion The findings were consistent with what the research team expected. There were very positive reflections from all the staff who took part, in addition to there being significant improvements in the skills of the staff involved. In discussion with Supporting Practitioners, they recognised that using video analysis had improved how staff team members worked together; this was a result of a better understanding of the importance of the development of staff practice. This appeared to be because they were exposed to Supporting Practitioners who were experienced and skilled in the field of deafblind practice, and therefore able to positively influence practice. From discussion with the Supporting Practitioners, it appears that a culture of using video analysis has been developed within the services that have taken part in the project. In addition to using video analysis to develop staff practice, video has been used for other purposes to benefit people who are deafblind. In some services, this additional usage of video has been instigated by people who use the service, and had been well-used in Person Centred Planning meetings. The research was presented at the XV Deafblind International Conference in Brazil. The feedback from the conference workshop confirmed that the production of a marketable Booklet and a DVD illustrating some of the principles to support Video Practice Supervision and the Framework of the Seven Principles as a staff development Page 35 of 39 Sense October 2011 tool for wider use, nationally and internationally would be beneficial. This would not only benefit other organisations, but would identify Sense as a contributor in providing an innovative staff development tool for marketing. A draft of the proposed booklet has already been produced, and it is the intention of the Research Team to involve senior practitioners within Sense in the final production of this booklet. It could be argued that the research project was small-scale. However, the research team feel, from their experience, that because the population Sense supports is quite unique, the results provide a true reflection of how staff skills can be developed, using video analysis and the framework of the seven principles, to improve the support offered. Further research could be undertaken to measure the impact of the frequency of practice supervisions on the development of staff practice. Consideration could be given to whether or not new staff need a higher frequency of practice supervisions compared to more experienced staff. The Sense Executive Board will review the research project and decide whether or not to implement Video Practice Supervision and the Framework of the Seven Principles as a tool that could be used as part of supervision for staff development and improving staff practice. The results confirmed that the tool is effective and efficient. As a result of taking part in the project, there are now services within Sense that are able to demonstrate evidencebased practice within their services. Currently, evidencePage 36 of 39 Sense October 2011 based practice is highly sought, and the Commission for Quality Care should view this practice favourably. Page 37 of 39 Sense October 2011 Conclusion The expectations of Sense staff working in operational services supporting people who are deafblind and who have limited communication skills is extremely high. The staff who have taken part in the project have confirmed that the use of video analysis in conjunction with the Framework of the Seven Principles is highly beneficial to enhance their skills in supporting people who use Sense services. Reference List http://www.cpdeducation/veroc (accessed October 2010) Continuing Professional Development Centre, Video Enhancement Reflection on Communication, University of Dundee Janssen M & Rødbroe I (2006) Communication and Congenital Deafblindness, ‘Contact and Social Interaction’ p18,19,22,26,27,34,35,42,48,49. Janssen M, & Rødbroe I, (2007) Communication and Congenital Deafblindness, Contact and Social Interaction Janssen, (2009) ‘The Dynamics in Deafblindness. Towards Evidence Based Practice’, 7th Deafblind European conference programme 2009 p33 Murdoch, H. (1992). Multi-sensory impairments. In: R. Gulliford and G. Upton (Eds.) Special educational Needs. London: Routledge. Page 38 of 39 Sense October 2011 Rodbroe I and Janssen M (2006) Communication and Congenital Deafblindness, ‘Congenital deafblindness and the core principles of intervention’ p20 , p19 Snow A, Telling A & Howell P (2009) ‘A Model for Staff Development’ workshop, 7th Deafblind European Conference, Italy Vygotsky, L S, (1978) Mind in Society: The Development Of Higher Psychological Processes, p86 Page 39 of 39 Sense October 2011