Presentation on theme: "Safeguarding Networking Event"— Presentation transcript:
1Safeguarding Networking Event Back to Basics: Mental CapacityTuesday 25 February 2014
2Back to Basics: Mental Capacity Act 2005 Awareness of Human Rights, Safeguarding Adults and the use of the Mental Capacity Act 2005Maria O’Connell – Mental Capacity Act Professional Lead
3Human Rights Act 1998 The HRA 1998 applies to all Public Authorities Article 2- The Right to LifeArticle 3-The right to freedom from torture and degrading treatmentArticle 5- The Right to LibertyArticle 8- The right to respect for private and family life & correspondence.
4Article 5 ECHRNo one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by lawEGRelating to a criminal offence.Mental Health ActImmigration LawsDeprivation of Liberty Safeguards
5Autonomy, Freedom , Independence & Unwise Decisions Human nature and behaviour is not exclusively rational.We have freedom to make decisions and choices which may be for the better or for the worse.We enjoy free will and as result have personal responsibility for those decisions.So why is it that these unwise decisions are not as readily acceptable for individuals who are deemed as “vulnerable” by virtue or nature of their particular disability and/ or lack of capacity?
6Background to MCA The Common Law lacked consistency. People’s Autonomy not always respected.No Legal framework/ authority for people who act on behalf of a person lacking capacity.
7Mental Capacity Act 2005The MCA 2005 affects people who are over 16 years old in England and Wales. The Act sets out clear safeguards to empower and protect a person who is assessed as not having mental capacity. The Act makes it clear that any assessment of a person’s capacity must be decision specific.Assessment of capacity must be about a particular decision that has to be made at a particular time and is not about a range of decisions.If someone cannot make complex decisions this does not mean they cannot make simple decisionsYou cannot decide that someone cannot make a decision upon his/her age, appearance, condition, or behaviour.
8MCA KEY PRINCIPLESPerson is assumed to have capacity. A lack of capacity has to be clearly determinedNobody should be treated as unable to make a decision unless all reasonable steps have been taken to assist them and shown not to work maximising capacity.Nobody should be stopped from making a decision just because others think it may be unwise / eccentric.Anything done for or on behalf of a person must be in their best interests. A decision is arrived at by working through a checklist.When anything is done or decided for a person who lacks capacity it must take in to account their basic rights and freedoms. Any decision/action should show that the least restrictive option / intervention is achieved.
9What does the act do?It sets out a single test of capacity assessment which is decision specific covering emergency decisions, day to day decisions, and complex decisions.Introduced a new criminal offence “Ill treatment and willful neglect”.It allows for advanced decisions to refuse treatment.Established the role of the IMCA service.New Court of Protection.Established Lasting Power of Attorney and Court appointed Deputy.Office of Public Guardian.
10What does the Act mean?It puts in place a Code of Practice to give guidance. The code of practice must be followed by those working in a Professional capacity e.g. Social Workers, Dr’s Nurses, and Police Officers.The Act offers appropriate protection for carer’s, as well as health and social care professionals, who act in the reasonable belief that they are doing so in the person’s best interest. They need to demonstrate that the principles of the MCA were followed.
11MCA 2005Provides a statutory framework to empower and protect Adults and Young People who are not able to make decisions for themselves.Codifies Common Law.It makes it clear who can take decisions, in what circumstances and how this should be done.It enables individuals to plan for the future for a time when they may lose capacity in relation to treatment.Been in force since October 2007.
12MCA 2005 Code of PracticeIf you provide care and treatment or support to a person who lacks capacity you are legally obliged“Have regard to the code.”The Code has statutory force but is guidance not instruction.Must be aware of the code when working with a person lacking capacity you cannot follow it by accident (by not knowing what is says).Failure to comply with the code would be referred to in any criminal / civil proceedings.
13What is meant by Mental Capacity? Capacity means the ability a person has to make specific decisions or take actions that influence their life this can be from very simple ( what to wear) to complex decisions (consent to medical treatment where to reside) Section 2 (1) of MCA states that “ A person lacks capacity in relation to a matter, if at the material time, he is unable to make a decision in relation to the matter because of an impairment of or a disturbance in the functioning of the mind or brain”
14Impairment or disturbance could be caused by Stroke or Brain InjuryMental Health ProblemsDementiaLearning DisabilityConfusion, drowsiness unconsciousness because of physical illness or treatmentShock, PainSubstance misuse (including Alcohol)Anything else which may be causing an impairment or disturbance!
15Assessing Capacity There is now a 2 stage test you should follow Is there an impairment of or disturbance in the functioning of the person’s or brain?It does not have to be permanent it can be temporary.Stage 2Does the impairment or disturbance cause the person to be unable to make a specific decision at the time it needs to be made?Being unable to make a decision is defined in the Act by considering these four factorsUnderstanding the informationRetaining the informationWeighing the informationCommunicating the decision. – by verbal and/or non- verbal means. A nod / blink/ squeeze of a hand is communication!If the disturbance in the person’s mind or brain is causing them not to do any of the four functions then they do not have the ability to make the decision in question.
16Assessing CapacityYou cannot decide that a person lacks capacity based on their age, appearance, condition or behaviour alone. Assess never assume.Assessments are made on the balance of probabilities. Is it more likely than not that they lack capacity to make that decision. Record your rationale/ reason. You as the assessor have “burden of proof”.
17How is Capacity Assessed in your work place? Who carries out an assessment?What kind of decisions are people assessed for?Who makes the decision?
18Decision MakerThe person who assesses for capacity is usually the person who requires the decision to be made. Dr’s Nurses, Social Workers, care home staff, domiciliary care workers, and informal cares, LPA’s Deputies, Police officers, Judges.More complex the decision there may be a need for an expert / specialist opinion to inform or may require a “Best Interest meeting”Decisions could include residency, medical treatment, managing finances, what to eat / wear etc.Carer’s both qualified and informal may need to assess capacity- but not expected to be an expert. Need to demonstrate they have a reasonable belief that they lack capacity.
19Best Interest Checklist There is a checklist that you must follow within the Act summarised as followsEqual consideration and non-discrimination- Make no assumptions based on age, appearance ability etc.All relevant circumstances- The information that the person making the decision is aware of and would be reasonable to consider as relevant. E.g. the best clinical / medical option given the persons condition prognosis.Regaining Capacity-Permitting and encouraging participationThe person’s wishes, feelings, beliefs, and valuesThe views of other people (professionals, family, carer’s, LPA’s Deputy appointed by the court.
20New Criminal Offence (Section 44) Willful neglect or ill treatment of a person who lacks capacity.Punishable by imprisonment of up to 5 years and / or an unlimited fine.Consider the impact and recognise accountability for your decision making and actions.Police are already considering cases.
21Protection from Liability Have you applied the code?You will be protected from liability from either civil or criminal penalties provided;OBSERVED THE 5 PRINCIPLESCARRIED OUT AN ASSESSMENTREASONABLY BELIEVED THE PERSON LACKED CAPACITYREASONABLY BELIEVE THE ACTION IS IN THE PERSON’S BEST INTERESTS
22Rights v RisksBalancing Rights, Needs and Risks will always be a challenging process for workers. Positive Risk Assessment and Risk management is essential in safeguarding Adults in both promoting and protecting their Human Rights. Get to know the MCA Code!
23Case Study: AnnieMandi Gay and Darren Richardson
24Annie Diagnosis of Alzheimer’s for five years Now in advanced stage Lodger for last ten yearsLodger is main carer (reluctant) and there is no other support in placeCrossing boundaries as friendLodger wishes to leave the property and move into his own place.
25Alzheimer’s Progressive illness Most common type of dementia Affects around 465,000 in UKLoss of memoryMood changesProblems with communication and reasoning(Alzheimer’s Society, 2012)
26Referral Referral received through GP GP felt Annie needed residential careGP stated that he believed Annie would decline support and if she did he intended to have her removed by initiating MHA (1983)Agreed to visit Annie and discuss concerns raised with her and the lodger.
27Issues Raised During Visit Visit to assess under s.47 of community care act (1990) and gain more informationAnnie was 92 years old and had never marriedWorked all her life on public transport and spent many years as a conductor before going into the offices and management
28Issues Raised During Visit Very independent woman and had authority in her job, reflected in her home lifePopular woman in the local area in younger days, though now isolatedLodger reports a steady decline in cognitive function over recent yearsNo family members
29Risks Unable to show awareness of condition Doubly incontinent Needs all care anticipatingNutrition needs not been met as lodger out much of the timeDrinks whiskey daily-facilitated unwittingly by the lodgerChain smoker and does not dispose of cigarettes properly
30Risks Lives on 8th floor of a tower block Poor mobility and unable to walk safelyDisoriented to time and placeRisk of sores and had sore on buttockIsolation and dignity issuesNo support in placeUnable to recognise importance of personal care and hygiene needs compounding skin tissue risks
31RisksWhere there is a difference of gender, race or class between social worker and service user, there seems to be a tendency to focus unduly on deficit and/or risk rather than on strengths and seeking to establish how peoples’ control over aspects of their own lives can be increased. (Milner and O’ Byrne, 2002, p36)
32Annie’s behaviour posed significant risks to herself and others
33Easy solution? GP’s viewpoint was of diagnosis and treatment Believed residential care to be solution to problem as a “quick fix”Could be seen as a prescriptive viewpoint (one size fits all)
34Easy solution? Problem focused Residential care would be solution to Annie’s circumstancesAccurate diagnosis allows prognosisCan signal a cause to illness and look towards treatmentsNot seen to recognise individuality
35Avoiding ageist practice Rather than the specific medical or social issues that give rise to need being perceived as “the problem” it is old age itself which is seen as needing to be addressed and, as a consequence, the link in peoples’ minds between old age and decline is strengthened.(Thompson, 2005, p20)
36Annie’s Viewpoint Annie had lived in property for many years Oriented to environmentWished to remain at home (stated that she would never leave)Was aware that lodger lived with her and felt that he was trying to have her removedHowever, unable to ascertain her own needs
37Lodger’s Viewpoint No longer wished to be involved with care Wished to leave the property as soon as possibleRole as friend/lodger had become blurred with that of carerRespect for Annie had made him feel duty to continueCarers assessment offered under Carers Act 1995/2004, but declined (tokenistic gesture?)
38Social Model Society disables individuals who are not of the majority Places emphasis on environment and/or labelling; factors that often compound mental health difficultiesSystemic approach should be utilised in order to see the whole picture
39Social ModelProviding opportunities increases quality of life and alleviates mental health difficultiesModel does not stigmatise and rests on foundation of equalityPromotes and works jointly with a strengths perspectiveNot seen as a cure, but rather helps people manage difficult experiences
40Mental Health ActAnnie was not suffering in nature or degree that warranted detention (MHA 1983)Was at risk due to disorder and mental illnessAlthough she declined services, it was felt that she lacked capacity to make decision on her own well being needs and the likelihood of harm was high
41Mental Capacity ActAnnie had impairment/disorder of the mind and brainCapacity assessment carried out under s2-3 on MCAConfirmed that she lacked capacity to support own well being needsUnable to understand her situation, retain the information given in order to make decision or weigh and balance her options
42Mental Capacity ActBest interests discussed with both Annie and her lodger. Allowed reduction of power imbalances and promoted ADPFelt that least restrictive principle could keep Annie in her own homeServices put in place at home rather than remove Annie from her property under s.5 MCA (2005)
43Services Utilised/Partnership Working Urgent package of care in placeDay centre implemented due to isolation. Previous community involvement and popular personContinence support via continence nurseOccupational Therapy referralAssistive technology put in place (arguments that this infringes people’s Article 8 rights)
44Services Utilised/Partnership Working Referral to district nursing team for support with skin soresReferral to memory services through GP with feed back that Annie would remain in her own homeFollow up visit jointly with CPNFire retardant blankets given by fire service due to risks with smoking.Smoking restricted to times when Annie could be monitored. Annie complied with this.
45Reducing risk?Many older or disabled service users…are more exposed to risk than others because more people have intimate access to them in their daily lives. There may be different homecarers coming into their private space every day, perhaps someone they don’t know coming in to wash, bathe and dress them.(Thompson, 2005, p53)
46OutcomeAnnie not too resistive of care and quickly adjusted to routine with encouragement and few restrictions.Improvement in Annie’s emotional health observedMaintenance of safety within the homeMonitoring of well being with care package in placeLodger was able to move to another propertyAnnie remained in her own home
49Independent Mental Capacity Advocate Service April 2007 the Department of Health brought in the first part of the Mental Capacity Act part of the Act made provision for a new statutory service called the ‘Independent Mental Capacity Advocate’ Service‘Together for Mental Wellbeing’ were awarded a 3 year contract by Kirklees and Wakefield Councils to provide their IMCA service. The contract was extended for 2 years and was further extended for a another 3 years‘Together for Mental Wellbeing’ now hold the contract until September 2015
50The 5 Core Principles of the MCA A person must be assumed to have capacity unless it is established that they lack capacityA person is not to be treated as unable to make a decision unless all practicable (do-able) steps to help them to do so have been taken without successA person is not to be treated as unable to make a decision merely because they make an unwise decisionAn act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in their best interestsBefore the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
51WHAT IS THE CRITERIA FOR IMCA ? It must be proven that an individual lacks capacity to make the specific life changing decision for themselvesANDThe individual must have no family or friend willing to be involved in the specific decision (paid carers are not regarded as family or friend) ****
52When can you involve an IMCA When can you involve an IMCA? Changes of accommodation Serious Medical Treatment or the withdrawal of Serious Medical Treatment. End of life care planning and decision making. Gold Standard framework. Safeguarding cases Care Reviews
53Independent Mental Capacity Advocate The DOH specified two ways that Social and Medical services would engage the IMCA serviceA STATUTORY DUTYA DISCRETIONARY POWER
54Statutory DutyThe Statutory Duty to involve an IMCA applies to anyone providing a service for an individual who lacks the capacity and has no family or friends, that want to be involved, while facing a specific life changing decision concerning:The provision of, withholding or withdrawing of serious medical treatment, orWhen a long term accommodation or move to hospital, for longer than 28 days, or to a residential care home, for more than 8 weeks is proposed
55Discretionary PowerThe Discretionary Power to involve an IMCA applies to anyone involved in decisions concerning:Safeguarding Adults cases *** FAMILY CAN BE INVOLVED!Only exception!A care review following an accommodation decisionIf the Decision Maker believes that the individual will benefit from IMCA involvement in the above circumstances
57What is a Decision Maker ? Under the Act, many different people may be required to make decisions or act on behalf of someone that lacks capacity to make decisions for themselves. The person making the decision is referred to throughout the Mental Capacity Act 2005 Code of Practice as the ‘Decision Maker’, and it is the decision maker’s responsibility to work out what would be in the best interests of the person who lacks capacity Mental Capacity Act 2005 Code of Practice 5.8 page 69A Decision Maker must be identified for all cases, especially where a Multi Disciplinary Team is involved
58Generic Advocate or IMCA ? …. The Difference Individuals must be accredited by the Department of Health and the Local Authority to work as an IMCAGeneric advocates take instruction from the person they are working withIMCA’s work to a ‘best interest’ decision for the personGeneric advocates can support individuals with multiple issuesIMCA’s need a referral for each appropriate decisionThere are statutory rules about when to involve an IMCAAn IMCA can access and copy medical and social care notes
59RECAP Independent Mental Capacity Advocate An IMCA should only be involved if there is no appropriate family member or friend willing to be included in the specific decision. This does not apply to paid CarersThe exception to this is Safeguarding Adults cases which may involve a Deputy, a named person or the holder of a Lasting Power of Attorney.An IMCA works with individuals who lack the capacity to make a specific life changing decision for themselves
60The IMCA does not make the decision The Role Of The IMCAThe IMCA provides independent representation by gathering information from any relevant sources about the individual’s current or past wishes, cultural, religious and/or known needs.The IMCA provides points for consideration before the best interest decision is madeThe IMCA does not make the decision
61The Role Of The IMCA The IMCA can request a second capacity assessment The IMCA can request further medical opinions if they believe this will help them gain a clearer understanding of the individual’s needs, available treatments or best interest outcomesThe IMCA can request access to, and make copies of, records about the individual that are deemed by the holder to be relevant to the decision
62Common Issues Be decision specific – not a mini mental test Common Issues Be decision specific – not a mini mental test! Does the Decision Maker know they are the decision maker? We don’t make decisions! Decision specific! 2 decisions = 2 referrals! We need to be involved before the decision is made! Please give us time to do our job! We don’t mediate between decision maker and family!
63The Role Of The IMCAThe IMCA has a duty to submit a written report to the decision makerThe report presented by the IMCA must be taken into consideration by the Decision Maker. The Decision Maker may disagree with the IMCA and it is important that any areas of disagreement are discussedThe decision must be reported to the IMCA.The IMCA can challenge the decision through the relevant complaints procedure, Ombudsman or Court of Protection
64How Do You Make A Referral ? Anyone can referDiscuss with your team the decision needed and whether it is a Statutory Duty or Discretionary Power to referTelephone the Together IMCA Service to discuss your referral and/or any questions you may haveIf your referral meets the Mental Capacity Act criteria a referral form will be ed or faxed to you. The referral will be acknowledged upon receipt and the case opened within 3 working days based on priority
65Referral Form Checklist What is the Decision required ?Does the individual lack Capacity for the decision ?Are there any family or friends willing to be involved ?Who will be the named Referrer ?Who is the appropriate Decision Maker ?What are the Contact Details of the person that will arrange meetings ?What Date do you need the decision by ?Every box on the Referral Form needs be completed or it may slow down your referral and/or the decision
66Deprivation of Liberty 39A Imca – Standard or urgent 39C Imca – No RPR 39D Imca – support to RPR or relevant person D can be requested by RPR, relevant person or Supervisory Body. Paid RPR
67Paid RPR Maintain regular contact Comply with Code of Practise Ensure DoL is legal Support the Relevant Person through the process. Challenge the DoL on behalf of relevant person Challenge the DoL as RPR Call for a review if things change.
69Deprivation of Liberty Safeguards Overview of the BIA RoleMandi Gay and Darren Richardson
70History of Deprivation of Liberty Safeguards (DoLS)
71History of DoLS/MCA (2005)Mental Capacity Act (2005) came into force in 2007Mental Health Act (1983) only other legal framework before this time.Amendment in 2007 introduced the MCAMental Capacity Act applies to everyone over 16 yearsNeeded due to ‘Bournewood Gap” and lack of rights for those detained.HL Case highlighted need for change
72History of DoLS/MCA (2005)Within s 4 (A) and (B) Mental Capacity Act (2005) and became effective from April 2009.Allows for a person over 18 years to be deprived of liberty as long as certain criteria are metCompliant with the relevant Articles of European Convention of Human Rights (ECHR)
73Criteria for someone to be deprived of liberty under DoLS Must be over 18 yearsMust be experiencing an impairment of, or a disturbance in the functioning of, the mind or brain (s.2 MCA)Must not have the ability to make THE decision that needs to be made at the time it needs to be made, through lacking the ability to either understand, retain, weigh and balance, or communicate.Must be placed within a registered care home or hospital.Only the CoP has authority to deprive someone of liberty outside of this environment.
74Who is the Best Interests Assessor? NurseOccupational TherapistPsychologistSocial WorkerSpecifically trained for this purpose with an accredited qualification
75What is a Deprivation of Liberty? No legal definition for a DoL Depends on number of restrictions in placeFrequency and intensity of restrictions and effect on P’s quality of lifeThe impact on the restriction of the individual’s liberty must be considered whether that individual resists or not (s.6 MCA)What is the ‘Norm?’ - over and above those to be expected as normal in the case of a person of similar age, capabilities and experiencing the same level of disability?
76DoLS Terms and Meanings Managing Authority – Hospital or Care Home that person resides withinSupervisory Body – Local Authority that oversees and regulates the care home or hospitalWithin DoL Safeguards there are two authorisations given.Urgent Authorisation – Allowable for seven full days. Time begins when the request is made to the Supervisory Body by the Managing Authority.Standard Authorisation – Assessments must be completed within 21 days.DoLS assessment must be completed within these time frames with a recommended outcome for the person.
77BIA Role within DoLSTo decide whether a person is deprived of liberty within the meaning of the Act.To determine whether this deprivation is legalTo determine whether the deprivation should continue in P’s best interestsTo give a recommendation on future careIf necessary, to make a determination on whether a deprivation of someone’s liberty should continue and for how long.
78BIA Role within DoLS To Follow the principles of the Act: A person must always be assumed to have capacity unless established that they do notAll practicable steps must be taken to help them make the decisionA person must not be treated as lacking capacity simply for making unwise decisionsAny act done, or decision made on behalf of a person lacking capacity must be made in that person’s best interestsThe least restrictive option must always be used
79BIA Role within DoLSConsult with the Managing Authority (hospital or care home)Consult with any person suggested by those detained where possibleMust have regard to the findings of the Mental Health AssessorTo examine the care plan, needs assessment of PWhere practicable and appropriate to consult anyone named by P, or anyone engaged in the caring role or interested in his welfareAnyone done of Lasting Power of Attorney or a Court Appointed Deputy
81Unfortunately Annie had a chest infection and this was not responding to treatment at home. Due to her health deteriorating she was admitted in hospital.Annie following her hospital treatment was recovering and deemed medically fit for discharge, but not well enough to return to her home. Assessments showed she still required significant care and support from a nurse over 24 hrs.
82A Capacity Assessment and Best Interest meeting was held at the hospital and the decision was made for Annie to be discharged from hospital to the Apple Care Nursing Home.Initially Annie was compliant with all aspects of her care – however this may have been as she was still recovering. When Annie came to be at her optimum she was continually asking to go home, stating that staff are keeping her prisoner and that they wouldn’t let her out.
83Annie, when asking to go home was banging doors and when staff from the Apple Care home approached her she became agitated, resistive and aggressive towards them. These incidents happened frequently and lasted for some time which caused her some distress.Annie was under close supervision throughout a 24 hours period as she was still smoking heavily but not disposing of her cigarettes safely.
84Staff had genuine concerns for her safety and had to prevent her from leaving the care home without an escort and felt that they were now depriving her of her liberty. The Care Home Manager contacted the local authority requesting an urgent DoL’s Authorisation.
85Assessment Process 6 Assessments in all: Age Assessment No refusals AssessmentEligibility AssessmentMental Health AssessmentMental Capacity AssessmentBest Interests AssessmentCarried out by BIA and S.12 (MHA) Doctor
86What will the BIA do as part of their duties? Visit the care home or hospitalInterview the person deprivedScrutinise care plans and medical notes – important that case notes and care plans are as detailed and informative as possibleInterview staff membersInterview family membersInterview the Relevant Person’s Representative if this is not a family memberInterview anyone that the deprived person asks us to speak with, so long as this is practicableSeek past information via alternative technological databases via health and social care agencies.
87Outcome of BIA Decisions BIA must reports as to whether a DoL is occurring and whether this is legal – must not be implemented for the convenience of, or due to lack of servicesMust record every interested person that has been consultedMust decide whether the DoL should remain in place and record the reasons why this is in the best interests of the personMust give a maximum authorisation period (maximum of 12 months)Must give any recommendations or conditions that they feel appropriate to ensure P’s best interests are metMust recommend a Relevant Person’s Representative if the person lacks the capacity to do so independently.
88Relevant Person’s Representative (RPR) RPR needs to be over 18 years of ageMust be able to visit the person regularlyMust be willing to take on the RPR roleMust have the ability to act in the best interests of the person in line with section 4 of the MCA.RPR must not be:financially interested in the relevant person's managing authoritya relative of a person who is excluded in the above pointemployed by, or providing services to, the care home in which the person relevant is residingemployed by the hospital in a role that is, or could be, related to the treatment or care of the relevant personemployed to work in the relevant person's supervisory body in a role that is, or could be, related to the relevant person's case
89Duties and Rights of the RPR RPR could also be an IMCA if there are concerns and risks to P, or if there is nobody to take on this role informallyRPR has the right to access information regarding the care and welfare of the person within the care home/hospitalHas the right to put forward a complaint to the supervisory body or request a review of the DoLThe right to appeal the DoL on the person’s behalf to the Court of Protection if they remain unhappy with the reason for the DoL.
90Final important points In order for a fair and just outcome to any DoL assessment it is essential that the following are in place:Availability and engagement with BIA, particularly home manager/key worker/staff nurse/ward sisterCare plans/risk assessments and all paperwork are up to date and as detailed as possibleSeek advice as soon as possible regarding DoL to avoid unnecessary referrals for restrictions that would not meet DoLS criteria – Contact DoL Team officeBest interests of the person to be upheld at all timesIncorporate family within the person’s care plan and keep them involved as much as possible