East Ayrshire Health and Social Care Partnership
Starting a Conversation
Overview
Session objectives:
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Understanding your role towards outcomes focused practice.
Importance of reflective practice.
Familiarise and use of resource pack to start a conversation.
Agreeing a SMART Care Plan.
Starting a conversation and your role
The practitioner plays an important role in making coproduction possible:
The role of the professional becomes less about being a
‘fixer’ of problems and more about being a ‘facilitator’
of solutions. A facilitator will actively recognise and
engage the things children are able to do or are
interested in. In doing so, they naturally focus on the
things that are working well to create positive
experiences and sustainable behaviour change driven
by the child’s intrinsic goals and aspirations. (
Aked and Stephens, 2009 p2).
What are outcome conversations/ assets/
coproduction?
“Assets can include life experience, knowledge, skills,
talents, energy, and enthusiasm”
Key to identifying outcomes is the ‘outcomes
conversation’ - these conversations are used to uncover
the things that are important to people and are central to
the assessment process.
Conversations/assets/coproduction
What is the Professional role?
• Actively listening with an open mind to the person’s
‘story’
• Avoiding ‘partial listening’ and being aware of applying
‘filters’ to the conversation.
• Data requirements can act as ‘filters’, whereby staff,
particularly under time pressure, may filter what the
person says to find the information which they are
obliged to gather for bureaucratic purposes.
• Other filters can inhibit open minded listening,
including any prejudices and tendencies to stereotype
Principles of an outcomes focused conversation
• Allowing the person to determine the order in which
they want to talk about their lives.
• Moving away from a question/answer model toward an
‘exchange model’ (Smale et al 1993) whereby
everyone is an expert including the child and their
parents.
Source: adapted from (Miller, 2011)
Work to identify and put to use children’s assets
Starting from who children are and what their interests
are
• An outcomes focused approach links closely to
principles of co-production, ‘support that is designed
and delivered in equal partnership between people
and professionals’.
• Coproduction of children’s services ‘focuses less on
identifying and responding to a child’s ‘need’ or
‘problem’ in favour of a reciprocal approach, which
builds on a child’s interests, knowledge, experience,
skills and support networks’
What makes a good life
personally and work?
Whole Group Session 1
What Makes a Good Life Personally and at Work
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Treated with respect and dignity.
Viewed as a partner not a client.
Seen as having personal autonomy and control.
Treated in a warm and friendly manner.
Actively listened to.
Given clear and understandable reasons for things which can and cannot be
done.
Given information to help me decide.
Explanation of process and likely time it will take.
Honesty and explanation for delays and things not being done as planned.
Put at ease and supported through difficult times.
Encouraged and praised.
Not made to feel small when making mistakes but engaged in discussion
about it.
Clear direction and challenge where required.
Treated as an individual based on strengths and challenges.
Reflective Practice
Reflective Practice
Reflection: A Definition (1)
“Reflection is an important human activity in which
people recapture their experience, think about it,
mull over and evaluate it. It is this working with
experience that is important in learning’”
Source: Boud, D., Keogh, R. & Walker, D. (1985) p 43 Reflection: Turning Experience into Learning. London: Kogan Page.
Reflective Practice
Reflection: A Definition (2)
“We learn through critical reflection by putting
ourselves into the experience and exploring
personal & theoretical knowledge to understand it
and view it in different ways”
Source: Tate, S. & Sills, M. (eds) (2004) p 126 The Development of Critical Reflection in the Health Professions. London; Higher Education
Authority.
Reflective Practice
Reflection: Informal and formal
Informal Reflection
• Involves self questioning.
• Develops our awareness of our own assumptions.
Formal Reflection
• Draws on research and theory.
• Provides guidance and frameworks for practice.
Reflective Practice
Models of Reflection
Dewey’s (1938) 5 Stage Model
1.We identify a problem that is perplexing and ‘felt’.
2.We observe and refine the identified problem to create a
fuller understanding.
3.We develop a hypothesis or an understanding about the
problem, its origins and possible solutions.
4.We subject the hypothesis to scrutiny and reasoning.
5.We test the hypothesis or understanding in practice.
Source: Dewey, J. (1938) Logic: The Theory of Inquiry. Troy, MN: Rinehart & Winston.
Reflective Practice
Models of Reflection
Schon’s (1983) ‘Reflection in Action’
Reflection in action concerns thinking about something
whilst engaged in doing it, having a feeling about
something and practicing according to that feeling.
This model celebrates the intuitive and artistic
approaches that can be brought to uncertain
situations.
Source: Schon, D. (1983) The Reflective Practitioner. London: Temple Smith
Reflective Practice
Models of Reflection
Kolb’s (1984) Learning Cycle
1. Concrete Experience: The event.
2. Reflective observation: Consider what has happened from a
variety of perspectives e.g. own feelings, the group’s, an individual
student’s view.
3. Abstract conceptualisation: Re-package and process your
reflections into a theoretical understanding (use theory to analyse
the event).
4. Active Experimentation: Armed with this new understanding,
you do it again, differently this time.
Source: Kolb, D. (1984) Experiential Learning. New Jersey; Prentice Hall
Reflective Practice
Practical Barriers
Kolb (1984) sees that to reflect effectively on your
experience, you should actively set aside part of
your working day to reflect and analyse.
Source: Kolb, D. (1984) Experiential Learning. New Jersey; Prentice Hall
Reflective Practice
Psychological Barriers
Fear of judgement, fear of criticism, being closed to
feedback, defensiveness, professional arrogance.
Reflective Practice
Bridges to Reflection
• Feeling ‘safe’ enough – or we may use ‘expedient’
learning and do what we expect will get us through.
• A role model, e.g. a mentor who reflects on their own
practice.
• Knowledge of as many methods as possible.
• As many opportunities as possible for engaging in
reflection, e.g. pairs, groups.
• Time and Energy.
Source: Ixer, G. (2003) Developing the relationship between reflective practice & social work values. Journal of Practice Teaching, 5, 1, pp 7-22.
Reflective Practice
The Importance of Reflection
Reflection enables us to:
• Be conscious of our potential for bias and discrimination.
• Make the best use of the knowledge available.
• Challenge and develop the existing professional
knowledge base.
• Avoid past mistakes.
• Maximise our own opportunities for learning.
Wellbeing Web
Child Focused Conversation
Wellbeing Web in Angus Council
Background
• Getting it Right in Angus
• Implementation of integrated assessment
• Shift from task centred care planning to outcome
focused child’s planning (outputs to outcomes)
• Need for a tool to support SHANARRI based
outcomes focused child’s planning across partners
• Reviewed range of outcome measurements tools
• Used SHANARRI indicators as a starting point
Outcomes Conversations/Coproduction/Asset Based
Ensure active listening
Focus on strengths and
assets
Belief in change
Support to identify
hopes/aspirations
Balance risk and
resilience
Opportunities to
build on
achievements
Starting a Conversation
Core Resources
Conversation
Negotiation
Prioritise
Compromise
The Wellbeing Web - Review
Measuring change using outcomes information
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What has been successful?
When was it used?
Why was this successful?
What is the unmet need?
Aims
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To empower individuals to recognise change.
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Support and enhance professional judgement.
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Help analyse circumstances and provide evidence of
impact.
Test Phase Evaluation (East Ayrshire)
What Professionals said?
Practitioners
• 88% expressed overall, that the model is an effective engagement tool.
• 82% of the practitioners expressed that the model embedded an assets
based/ reflective practice approach.
• 78% expressed that the tool assisted them to engage with the service
users in day to day practice.
• 70% expressed that the tool assisted in the development of a service
user owned SMART action plan.
Team Managers
• 96% expressed that the model enabled them in their management role to
sign off SMART action plans with staff.
Test Phase Evaluation (East Ayrshire)
What Professionals said?
• Facilitates high levels of service user participation and
engagement.
• Provides a way to visually chart feelings and behaviours using the
SHANARRI wellbeing GIRFEC national outcomes that can be
easily translated into SMART personally owned outcome goals.
• Service user is also enabled to take direct ownership through the
development of their own care plan actions and to keep track of
timescales.
• Prompt cards and guidance booklet enables the practitioner and
service user to explore and explain outcomes in a child friendly
manner.
Test Phase Evaluation (East Ayrshire)
What Professionals/Service Users said?
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Practitioner feedback suggested that individual work with parents “...were
capable of engaging very well with the wellbeing web and the process did help
them identify issues and reflect on the care plan, why it was put in place...see
improvements made in their lives...” Also, “...promoted parents understanding of
work being done with their children, ensuring a holistic family approach and
progress...”
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direct quotes from children and young people in relation to the “Web” included; “I
would be able to show people this...”, “It’s good to see where you are at...I can
see what isn’t going well...I like that it explains the words used in meetings”
Conversation Tools
What it is in your toolkit?
Starting a Conversation
Signs of Safety
Talking Mats
Getting Our Priorities Right
Informs and Supports – Starting a Conversation
IAF Paperwork
SDS My Life My Plan
Group Session 2
Using the Wellbeing Web
Group Session 2 - using the web
• Take 10 minutes to read the Wellbeing Web
Booklet (Practitioner, service user, observer)
• (Service User) Think about your first day at
school?
• (Practitioner) introduce the outcomes tool to
the service user (p4 of booklet) and apply the
3 key good practice questions and take brief
notes
Group Session 2 - using the web
• Read (p5-6 of booklet) points 1-7
• Complete a wellbeing web (Practitioner) apply
three key good practice questions in section 2
• Remembering to use the prompt cards
(Practitioner)
STOP!
Wellbeing Web
Outcome Goals and Action Planning
Agreeing the Care Plan
Group Session 3
Benefits of being SMART
• solution oriented.
• centred on, and evidenced by, holistic assessment.
• clarity for all.
• actions planned are focussed.
• provides accountability.
• shared language and understanding.
• the difference a plan makes can be clearly evidenced.
• the Team can learn from what works and what
doesn’t and review accordingly.
• analysis of effective ways of working (implications for
future resources).
SMART Outcome Goals
Signing Off Care Plans - Checklist
Outcomes should not be too general, too vague or
immeasurable.
• Tools such as the Wellbeing Web will assist workers,
children and their parent/carers to work together to
identify the specific outcomes they want to achieve.
• The Guide to SMART Outcomes contains some
examples of SHANARRI outcomes that may feature in
a Child’s Plan. The outcomes described are examples
and are not meant to represent an exhaustive list.
Action Planning
• Identify issues of concern.
• Name exactly what the Team sees as problematic
• Avoid generic language/agency specific
language/emotive language
• Check out that everyone is clear with what is being
identified
Who, What?
Who will do this
• be specific
• name the individual who will carry out the task, not simply the agency
• ensure all Team members, including the child and parent/carer, have
clear actions.
• ensure agreement.
What will be done
• address the detail of the actions necessary.
• say exactly what tasks/actions will be don.e
Example:
• ‘Jane will attend a 6 week parenting group delivered by the Avedon
Team beginning on 1st July’.
• ‘Malcolm will draw a picture for the next meeting in 2 weeks’ time to
show how he feels’ .
SMART Outcomes (Personal Goals)
Signing Off Care Plans : Checklist
Specific
Measurable
• What exactly are we going to do?
• With/for whom?
• What is the specific outcome for the
child?
• This must be well-defined and clear.
• At the end of the planned activities,
what will have changed for the
child/family?
• How will you know when the outcome
has been achieved?
• How will you measure progress
towards the outcome? For example
through self report/Wellbeing
Web/observation of behaviour,
feedback/discussion etc.
Achievable
Realistic
• Can we realistically get this done in
the timeframe/within available
resources?
• Outcomes should not be beyond the
person’s or the service’s capabilities.
• Is the outcome relevant and
proportionate?
• Is it within reach and possible?
Time-limited
By when do we want to achieve change? Set specific timescales for each stage
‘in 2 weeks’, ‘ by end December 2012’ and avoid the use of ‘ongoing’ and ‘ASAP’.
Group Session 3
Group Session 3 – Action Planning
• Work through (p6 of booklet) points 8-9
(Practitioner).
• Using the 4 key points.
• Remember - Develop a jointly agreed action
plan!
Next Steps
Mapping GIRFEC Outcomes
Wellbeing Indicators with Self Directed Support
Agreeing the Care Plan
Agreeing
Practitioner/Senior/Line Manager
Care Planning
Decision Making
Sign off
Chairing Meetings
Decision Making Forums
Core Groups, LAAC Reviews
IAF
Paperwork
PLENARY AND CLOSE