Person centred reviews

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1 Person centred reviews Helen Sanderson and Ruth Mathiesen Helen Sanderson Associates 34 Broomfield Road Heaton Moor Stockport Cheshire SK4 4ND T

2 Contents Introduction... 3 The working/not working review... 8 The important to/for review The citizenship review The person centred review facilitator Person Centred Reviews 2

3 Introduction Helen Sanderson Most services have some form of regular review, to look at how we are supporting someone and what needs to happen next. There are day service reviews, care managers reviews, health professional s reviews, annual reviews, transition reviews, person centred planning reviews and individual education plan reviews. We have been looking at how reviews can be more person centred and as well as setting actions, how they can be used to gather information that can be developed into living descriptions of how people want to live. There are three kinds of person centred reviews being used with adults and children. They are: The working/not working review. The important to/for review. The citizenship review. This paper briefly describes the format and purpose of each type of review, and then summarises the difference between and person centred plan and a person centred review. The working/not working review This review is based on the person centred thinking tool working and not working from different perspectives. Purpose To explore what is working and not working from the individual s perspective, the family s perspective and the staff s perspective. This can also include other s perspective, for example, health professional, care manager or Connexions worker. To agree actions that maintain or increase what is working and change what is not working. To look at what the working and not working information tells us about what is important to and for the individual, and to begin to develop a living description. Time One hour minimum. Person Centred Reviews 3

4 People The individual. Their family. Others/staff. Examples This review process is being used by care managers to review individual contracts and placements. The important to/for review This review is based on the person centred thinking tools important to/important for and working/not working from different perspectives. Purpose To gather information about what people like and admire about the individual, what is important to them now, what is important to them for the future, and what support they want and need. To explore what is working and not working from the individual s perspective, the family s perspective and the staff s perspective. This can also include other s perspective, for example, health professional, care manager or Connexions worker. To agree actions that maintain or increase what is working and change what is not working, and what needs to happen to develop this information into a living description. Time One and a half hours minimum. People The individual. Their family. Others/staff. Examples This review is used as the Important to/for Transition review in schools and in day centres and supported accommodation services as a way to begin a person centred plan. Person Centred Reviews 4

5 The citizenship review This review is based on the Keys to Citizenship (Simon Duffy) and usually follows the important to/important for review. Purpose To explore what is possible for individuals, under the 6 keys to citizenship. To prioritise and choose which of the 6 areas to focus energy and action on. To look at what is possible locally for each of the chosen areas. To action plan next steps towards citizenship for the individual. Time One and a half hours minimum. People The individual. Their family. Others/staff. Examples This review is used as the Year 10 Transition review in schools. Person Centred Reviews 5

6 Person centred reviews and person centred planning What? Person Centred Planning A way of working out what is important to and for the person, now and in the future. Developed in partnership with family and friends, and leading to change. There are different styles of person centred planning, for example PATH, MAP and Essential Lifestyle Planning. The plan belongs to the person. Information can be used by care managers and providers, if the person agrees. Person Centred Review A different way to do reviews. Using person centred thinking tools and the principles of person centred planning to ensure that everyone is heard, and that there are shared actions with a bias towards inclusion. Fulfils statutory requirements. Information collected at a person centred review could be developed further into a person centred plan. Who? Where? When? Why? Whoever the person wants to invite. Where the person wants it. Major decision points in a person s life - whenever they want to plan. Create a shared understanding and make changes. The people who have to be there and other people the person wants to invite. Where the person wants it within the limitations required by the service. At the Year 9 review, the Year 10 review and at annual reviews. Create a shared understanding, meet service requirements and lead to change. Person Centred Reviews 6

7 The table on the previous page summarises the differences between person centred planning and person centred reviews, however, there are some fundamental similarities. Both should have the person fully at the centre, lead to change, include families, promote inclusion, and create living descriptions of how the individual wants to live. Conclusion Person centred reviews are a way of developing more person centred and responsive services, and developing living descriptions of how people want to live. These living descriptions can be developed into person centred plans. This could be an important way to begin essential lifestyle plans. By starting to gather information through a review we are able to start to change people s lives (by developing actions at a review). This person centred information can be developed further into plans that evolve and lead to ongoing change. The citizenship review stretches our ideas about what is possible, and creates a framework for people to imagine a better life. This could lead to a PATH, where the individual can bring together the people in their life to dream and plan for change. May 2006 Person Centred Reviews 7

8 The working/ not working review This review process focuses on what is working and not working from different perspectives, and results in actions. It can be used to review a person centred plan as a way to begin to gather information about what is important to and for the person. Preparation Before the review Supporting the individual to prepare It is not surprising that the more preparation that you do, the better the result. There are two main areas to consider around support for the individual: Person Centred Reviews 8

9 1 What to share at the meeting. 2 How the meeting should go. There are various booklets that supporters can use with the person to think about how they want the meeting to go. They outline who should be there, what needs to happen to make it the persons meeting, things to consider in making it a comfortable welcoming meeting, and how information will be shared. Supporting families to prepare for the review Families need to know what they can expect at the meeting and what they will be asked to contribute. This could be as simple as asking families to think about what is working and not working from their point of view. Some families have began to lead person centred plans for their family member using Families Leading Planning The person centred review meeting is an excellent opportunity to share the plan, adding others contribution and enrolling other people to support the changes that the person and their family want. Supporting other people to prepare for the review Professionals usually provide reports for meetings, and it is helpful to share the process and headings of the person centred review meeting with professionals beforehand. Ask professionals to think about what is working and not working from their perspective. If it is impossible for them to attend, ask them to send their information under the headings working and not working, so that this can be written onto the posters and shared. Preparation by the facilitator Before the meeting the facilitator needs to learn how the person can be kept at the centre of the review, who they want to invite, and how they want to be supported at the meeting. Once everyone feels prepared, the following information describes the review process in detail. Person Centred Reviews 9

10 The process With each of the three reviews, it is important that right from the beginning the meeting looks and feels different. Setting the scene When people walk into the room it should be welcoming and informal. There will be flipchart paper with headings on the wall, a semi-circle of chairs (no tables!), music playing (if the person wants it) and refreshments chosen by the individual (beyond the typical tea, coffee and biscuits). Introductions The introductions for each of the review processes is the same - the facilitator should introduce him or herself and ask people to introduce themselves and explain who they are in the person s life. This information is recorded on a who s here sheet. An alternative is to get people to sign in. Like and admire There may already be a record of what people like and admire about the person. If there is, have this up on a sheet, if there is not, gather this information at the beginning of the meeting by asking people to say something that they like and admire about the person and recording this on the flip chart. This heading should not include what we only say about people with disabilities or faint praise. Clinical descriptions such as expresses anger appropriately or can eat independently are not acceptable. Instead we are looking for positive characteristics in relation to for example how you would describe a friend or family member of the same age. Explaining the review process and agreeing ground rules The facilitator explains the purpose of the meeting, the process and headings on the paper on the wall. It s a good idea to give some examples as you go through the headings. Agree simple ground rules with the person and participants. Here are some examples: Person Centred Reviews 10

11 No jargon - use everyday language. Everyone s contribution is valuable. Take responsibility to cover what you need to cover (e.g. if you have to review a statement, or have a pressing question, put this up under questions to answer or if you have a concern, put this under what is not working etc.). Listen without interrupting. Smelling mistooks are ok. Confidentiality on a need to know basis and decided in partnership with the person. Turn mobile telephones off or on silent. There is no such thing as a silly question. Gathering information Everyone is then invited to choose a coloured pen and write information under all of the headings except the action plan. People should be encouraged to use everyday language, and pictures if they want to. Be mindful of people who need support with the writing. If the person has chosen to have music at their review it can be played in the background as people are writing. It s the role of the facilitator to support people during information gathering e.g., clarifying what the headings mean, asking questions to get more detail, and helping people to add richness to the information. During this period the facilitator must also help keep people on track. Information gathering typically lasts about 20 minutes. Check with the person at this stage if they want to take a short break. Sharing and recording information Below are the headings used in a working and not working review with some examples from Matthew s review. Although we are using this process with adults it works equally well with children. The examples included here are taken from Matthew s IEP review, in year 4, at his primary school. Person Centred Reviews 11

12 What s working/what s not working from different people s perspectives This section records what is working and not working from the perspective of: The individual. Family and friends. Staff. What s working from Matthew s perspective Playtime. Working in a group at the group table. Being involved with his peers at all times. Independence at lunch time. Rewards - stickers, smiley faces, praise. Good relationship with staff and peers. What s not working from Matthew s perspective Not wanting to concentrate in class sometimes when he finds other things more interesting (like the tadpoles). What s working from the family s perspective Extra curricular activities. Location in class - he feels part of a group and yet can still work individually. Reward system - praising positives. His home book. He enjoys school and being with his friends. Person Centred Reviews 12

13 What s not working from the family s perspective Speech and Language therapy. Obsessing over people and activities. What s working from others/staff perspective Balance of different work styles for Matthew (whole group, small group, 1:1, independent) Relationship with school around supporting Matthew s learning. Use of wider school as a potential resource - e.g. additional sessions. Plans for Matthew reflect the reflect the perspectives of those present at planning meetings (ongoing process). What s not working from others/staff perspective Only made small improvements in speech and language. Questions to answer/issues we are struggling with This section should include: Issues that people have differing views on. Where there isn t enough information about something. Areas where we need to get other people involved. Encourage people to write these as questions. These issues are addressed during the action planning stage. In Matthew s IEP Meeting, the facilitator worked with his Mum to think about these questions before the meeting, and already had them written onto the posters as people arrived. After people had written on the working and not working sheets, the facilitator asked them to add to the questions to answer sheet. Here are some of the questions from the meeting: How will Matthew be met in the morning when he moves to juniors? How can we ensure that Matthew s swimming continues each term? How can we ensure that everyone knows and uses the speech and language therapists programme? Person Centred Reviews 13

14 What Who When Continue swimming each term. What are the next steps in supporting Matthew in his development? How can we make sure that the successful practices that are used with Matthew now are taken forward into his next class? Reviewing the information and action planning After people have written their information on the posters, the next stage in the process is to review the information and to develop actions. The process for doing this is to: Read out what is going well from all the perspectives and ask what needs to happen to ensure that these continue? Look at each item on the what is not working lists and ask what needs to happen to change or address this? Go through each of the questions to answer and agree an action to answer the question. Here are some of the actions from Matthew s IEP review. Liaise with the next teacher and provide additional materials. Lesley Before next term. Incorporate successful approaches into Matthew s Helen and plan and use with next teacher. Lesley By end of July. Make additional visits in the first term to support the next teacher. Lesley During next term. To timetable speech and language therapy sessions into the day, and well as using on an ongoing basis. Sue Before next term. Ask for demonstration of new speech and language therapy programme when the SALT visits. Sue Before next visit. Try different bags for different activities to help Matthew understand what is going to happen (e.g. gym and swimming). Niki By end of July. Person Centred Reviews 14

15 This is what people said about Matthew s meeting The review became a positive experience - almost enjoyable! As a parent you often feel that the contribution you make in a review is negative because there are issues that require resolving. Using this framework allows the child s positives to be celebrated by all parties, the negatives were not the sole focus. Matthew s Mum I liked the way that we all gave our views on all of the issues Teaching Assistant I thought it was extremely positive looking at what is working and not working and setting actions Class teacher This process gave people who don t usually have a voice in reviews a chance It was good having the information on posters instead of reports - it was more accessible SCENCO What does this tell us is important to and for the person? One of the areas for actions is to think about what the information tells us is important to and for the person. An action could be for someone to work on this, to begin a living description or begin a person centred plan. Once the actions have been completed, the facilitator can then ask what the working and not working information tells us about what is important to and for the person. A further action would then be to develop a living description within services. Closing the meeting When the action plan has been completed the facilitator re-caps and checks that people understand what is going to happen next. The facilitator ensures that there is an identified person to pursue actions. It may be useful to hold another meeting within the next few weeks to review progress. Ask people to consider possibilities and if agreed, arrange the date. The facilitator also needs to identify who will write up the review and distribute the information. Other key people may need to be informed of the outcomes And finally The facilitator closes the review by asking everyone in a round what they have appreciated about the review. Offer people the opportunity to share their thoughts about the process, what worked well, didn t work well and anything they would do differently. There was an amazing dialogue, it was positive and enjoyable. Head Teacher Person Centred Reviews 15

16 Conclusion As Matthew s Mum says, the working and not working review provides an opportunity to celebrate the individual and what is working, as well as addressing what is not working. It creates an opportunity for everyone to participate equally, and everyone s contribution is valued. As the Head Teacher said this creates the possibility for a different dialogue. Crucially the process ends in actions that address what needs to change, and can be an opportunity to begin to capture information about what is important to and for the person. Person Centred Reviews 16

17 The important to/for reviews The important to/for review process was adapted from a style of person centred planning called Essential Lifestyle Planning (Smull and Sanderson 2001). It is a powerful approach that keeps the individual at the centre, supports positive and productive review outcomes and helps people go away feeling their contribution was valued. The important to/for review specifically focuses on what is important to the individual, what support they need to stay healthy and safe, what is working and not working for them and what actions we can take to change what is not working. The citizenship review builds on the information gathered at the important to/for review, and looks at what is possible for the individual, and how to make this happen. Here we describe the basic process of person centred reviews, and how a person centred review can be further developed into an Essential Lifestyle Plan. Each review will be different depending on the role the individual wants to take. This paper describes the process in general to follow. We begin with an overview of the process and aims, and Person Centred Reviews 17

18 then look at preparation for the review, the headings and the review process in detail, and how to go from information from a review to a person centred plan. A person centred review represents a significant cultural shift for many of us. The process focuses on what matters to the individual, from their point of view. This process also explicitly recognises the contributions of the family and other specialist professionals, acknowledging that the individual themselves and their families are the experts on their lives and that staff and others have specific knowledge and contributions to make. Many traditional reviews and reports began with the individual s condition and labels. This meeting turns this on its head by instead asking each member of the group what they like and admire about the individual. In this process everyone has an opportunity to acknowledge and celebrate what is working well for the individual and their role and contribution to this. This again represents a change, as often contact between services and family is focused on what is difficult and not going well. What is not going well is also addressed in this process, and results in jointly agreed actions. A person centred review meeting normally lasts around an hour and a half. In this time information that can be developed into a person centred plan is gathered and recorded. Over the years, the person centred plan can be developed and reviewed, and used to enable the individual to have the life they want. Person centred reviews can be facilitated person centred planning facilitators, family mentors or Connexions staff. Person centred review facilitators require training in person centred reviews, structured practice with coaching and regular opportunities to reflect and problem solve with others doing this work. The aim of a person centred review is to: 1 Identify and discuss what people like and admire about the person, what is important to the person (now and for the future) and what help and support the person needs. 2 Identify and discuss what is working and not working from different people s perspectives (the person, family and others). Person Centred Reviews 18

19 3. Produce agree actions that will: Support the person to get what is important to them now and in the future. Maintain what is working and change what isn t working. Build on the person centred information and develop the information into a person centred plan. The important to/for review was designed to be done with very little preparation - just ensuring that people knew what to expect and ensuring we had done what we can to make sure that the individual was comfortable and could participate as fully as possible. However, we know that more preparation can make it be better experience for everyone, and over the last two years that have been many creative ways that facilitators have helped people and families to prepare. Preparation Prior to the review there are a number of things we need to consider around preparation to make sure the review runs as smoothly and efficiently as possible. Before the review Supporting the individual to prepare It is not surprising that the more preparation that you do, the better the result. There are two main areas to consider around support for the individual: 1 What to share at the meeting. 2 How the meeting should go. There are various booklets that supporters can use with the person to think about how they want the meeting to go. They outline who should be there, what needs to happen to make it the persons meeting, things to consider in making it a comfortable welcoming meeting, and how information will be shared. Supporting the individual to think about their life, contribute and be prepared and supported to do this, is the key to person centred reviews. This means that you need to think about what will enable the individual to contribute as fully as possible, for example Person Centred Reviews 19

20 by using drawings, pictures, photographs, symbols, objects. Colin brought some pictures that he had done to his meeting. At the beginning of the meeting, Sue supported Colin to stick these onto the wall. Jamie made a person centred review clock with pictures which helped him stay up to date with where we were up to with the process during the review. Naheed s friends helped him make a positive poster with drawings and photographs which stated things they liked and admired about him, for his review. There are established ways of helping people think about their life that can be used to help prepare a person for their review. Trans-active is an example of an innovative way that people can think about and describe what their life looks like with peer support. This information is presented on computer, and can be printed off and put up under the headings at the meeting. In Multimedia Profiling, a person centred review is a good way to report on the catalogue describing the person s life. Another useful resource that can be used to record information about someone s life is Listen to Me which helps people think about what is important to and for them in their life in more detail. Many self advocacy groups and organisations have developed similar tools. Where someone has a person centred plan already, a person centred review is a great opportunity to share this information and work together on actions. In preparing for the review, the individual needs to be supported in deciding who to invite and where they have the review. As the review is a statutory process and not a person centred planning meeting, there are people who have to be there. However, many individuals have asked for friends to be part of their review as well. The individual may want music or specific treats at the review. Club Tropicana by Wham set the scene for Julie s meeting. Colin chose some music to play at his meeting, and this was on as he arrived. It was a spiritual tape, and the song he has got the whole world in his hands was played, which felt appropriate for a meeting where we were trying to put Colin firmly at the centre. Person Centred Reviews 20

21 Supporting families to prepare for the review Families have different experiences of reviews, some of which include a very passive role of simply listening to reports. We need to help families to prepare for the person centred review and give them enough information so that they are in a position to make an equal contribution. One father prepared for his daughter s review by drawing pictures that symbolised what he liked and admired about his daughter. At the review meeting he copied the pictures onto the paper as part of his contribution. A mother worked through some of the questions from Listen To Me which meant she had the opportunity to think about richer, more detailed information prior to the review. She brought this information with her to the review and wrote it under the headings. Tony s mother called family members and friends (who weren t able to attend the review) and had conversations with them, about some of the headings. This information was then shared at Tony s review. Families can also prepare specifically for the meeting, as Thomas s family did. Thomas has complex learning difficulties and has the label of behavioural difficulties who lives in Wales. Mark helped Thomas prepare for his annual review and transition meeting by inviting together the people who knew him best, including family and friends. Using poster sized paper and recording what people said through the use of pictures, they helped him map out: Person Centred Reviews 21

22 What people liked and admired about Thomas - his positive reputation. What is important to him, what he is good at and enjoys. Some ideas for the future based on his qualities, skills and interests. This was then recorded on A4 paper and presented at the annual review meeting. Some families have began to lead person centred plans for their family member using Families Leading Planning The person centred review meeting is an excellent opportunity to share the plan, adding others contribution and enrolling other people to support the changes that the person and their family want. Some facilitators shared the pocket sized person centred review booklet with professionals prior to the review so they had a good understanding of the process and the headings prior to the review. People who knew Neil well were worried that he wouldn t stay for long in his review. I had conversations with them about Neil s communication around how I would know if Neil wanted to leave, or when he needed a break. We were all amazed and delighted when he stayed for all of the review. Supporting other people to prepare for the review Professionals may be used to attending reviews and reading reports. It is therefore helpful to share the process and headings of the person centred review with professionals before the meeting so that they can think about their contribution. We must be clear that this is not an opportunity to write reports under new headings, but rather to bring their knowledge and contribution with the aim of creating a shared understanding of the person which leads to action. Preparation by the facilitator Before the meeting the facilitator needs to learn how the individual can be kept at the centre of the review, who they want to invite, and how they want to be supported at the meeting. In one of the meetings that I facilitated, I had assumed that we would share supporting the individual in the meeting. As soon as she came in, she went over to her mum, beamed, and promptly sat down beside her. She was very clear about how she wanted to be supported in the meeting, but it made it very difficult for her mum to fully participate. Next time I will think more about how the individual needs to be supported in a way that means the family can take part fully too. Once everyone feels prepared, the following information describes the review process in detail. Person Centred Reviews 22

23 The process By now, the facilitator will know how the individual wants to be supported in their review, who is coming and where it is taking place. Right from the beginning, the important to/for review process will look and feel different. Johnny had his favourite chocolate coated biscuits and apple juice. He sat on his bean-bag and listened to his favourite pop-star (Robbie Williams) before his meeting started. This gave a strong message to others about who s meeting this was! Setting the scene When people walk into the room it should look and feel different - welcoming and informal. There will be blank paper with headings on the wall, a semi-circle of chairs (no tables!), music playing (if the person wants it) and refreshments chosen by the person (beyond the typical tea, coffee and biscuits). Introductions The facilitator should introduce themselves and explain how this review differs from other reviews. Participants will then be asked to introduce themselves and explain who they are in the person s life. This information is recorded on a who s here sheet. An alternative is to get people to sign in. Like and admire The facilitator will ask people to say something that they like and admire about the person. This information is recorded in the flipchart. This heading reflects things that we like and admire about the person which includes the person s gifts, abilities, strengths and personal qualities and characteristics. It should not include what we only say about people with disabilities or faint praise. Clinical descriptions such as expresses anger appropriately or can eat independently are not acceptable. Instead we are looking for positive characteristics in relation to for example how you would describe a friend or family member of the same age. Examples: Sue has an incredible memory. Brian has an infectious laugh and a great sense of humour. Person Centred Reviews 23

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