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OHM & ISQSH - 4.12.02 1 Building Blocks to Best Practice: People Centred Services Maria Walls Director of Research & Membership Services.

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Presentation on theme: "OHM & ISQSH - 4.12.02 1 Building Blocks to Best Practice: People Centred Services Maria Walls Director of Research & Membership Services."— Presentation transcript:

1 OHM & ISQSH - 4.12.02 1 Building Blocks to Best Practice: People Centred Services Maria Walls Director of Research & Membership Services

2 OHM & ISQSH - 4.12.02 2 Co-Presenter Mary O’Connor Early Services Development Manager St. Michael’s House, Dublin St. Michael’s House

3 OHM & ISQSH - 4.12.02 3 Early Intervention Services Linking  Experience  Theory  Practice Levels  Child & Family  Teenager & Family  Adult  Family At  Individual  Service  Organisation Overview

4 OHM & ISQSH - 4.12.02 4 National Federation of Voluntary Bodies Providing Services to People with Intellectual Disability  Formed as Network in 1972  Secretariat established in 1998  60 Members  22,000 Service Users  In excess of 14,000 staff  80% of services to people with Intellectual Disability  Equivalent in size to two Health Boards

5 OHM & ISQSH - 4.12.02 5 Definitions  1946 World Health Organisation (WHO) Constitution –Health is a complete state of physical, mental & social well being and not merely the absence of disease and infirmity –1986 WHO Ottawa Charter embraces this broader practice positive definition and adds “Assisting the individual to increase control over and improve health, focusing on completeness and full functioning”  Social Model of Disability  Implications for Disability Services –Whole life Focus –O’Brien principles –Increase in the number of Departments funding services –Mainstreaming Agenda

6 OHM & ISQSH - 4.12.02 6 Quality and Fairness People Centred Equity Accountability Quality of Care 4 Principles

7 OHM & ISQSH - 4.12.02 7 People Centred  The right to equal citizenship/rights based approach  Social Inclusion and Integration  Promoting informed choice/equity  Respect for individual choice and respecting diversity The key principles to guide Person Centred Services are:

8 OHM & ISQSH - 4.12.02 8 This requires that:  All the resources and activities of the agency are directed at supporting what really matters to the service user.  The organisation has a reliable system of asking services users what supports they require and identifying their priority needs.  The organisation measures the extent to which it is responding to each individuals needs and priorities  The principles which direct service activities span the entire spectrum of services which an agency provides directly or in conjunction with other agencies.

9 OHM & ISQSH - 4.12.02 9 Delivery of People Centred Services Requires:  Management Commitment  Promotion of Leadership at all Levels  Partnership with Service Users and Staff  Innovation and Creativity  Effective Service Co-ordination/Teamwork  Accountability to Service Users and Funders

10 OHM & ISQSH - 4.12.02 10 Child and Family Centred Family Team Organisation Wider Society Leadership Organisation System Learning Organisation Voluntary Agency Collaboration Family system TeamPartnership Organisation Teams Participation in Decision Making Social Model Inclusion in Decision Making Conceptual Framework

11 OHM & ISQSH - 4.12.02 11 Building Blocks of the Child & Family Centred Services Partner- ship Collabo- ration Implementing Reviewing Evaluation Inter- disciplinary/ Trans- disciplinary Teams Individua l Family Service Plans Services closer to families Inclusive Community Child & Family Centered Outcomes Focused Approach Social Model Rights Based Perspectiv e

12 OHM & ISQSH - 4.12.02 12 3 Core Values Social Model Inclusive Community Rights Based Perspective

13 OHM & ISQSH - 4.12.02 13 Building Blocks of the Child & Family Centred Services Child & Family Centered 8 Key Elements Partnership Collabor- ation Inter- disciplinary/ Trans- disciplinary Teams Individual Family Service Plans Outcomes Focused Approach Implementin g Reviewing Evaluation Services closer to Families

14 OHM & ISQSH - 4.12.02 14 Child and Family Centred Services Key issues:  Parents as partners and decision makers in the early intervention process  Family in centre - Services as collaborator  Not just receiving information from parents asking to do therapy at home but acting in all parts of the process  Adaptation Process  Capacity Building Evidence:  Provision for siblings  Home visits  Involvement in all parts of assessment process in defining the issues, and devising solutions  Meeting parents together  Timing of visits  Video of intervention for father  Key worker

15 OHM & ISQSH - 4.12.02 15 Working in Collaborative Partnership Key Issues:  Dunst, Trivette and Johanson 1994 “requires abdication of paternalistic approaches to helping relationships and adoption of empowerment, participatory involvement and competency enhancement approaches to help giving”  Success intervention on quality of provider - family relationship  Dale 1996 propose Negotiated Model “that parent and professionals have separate but highly valuable contributions to make” Evidence:  Parents being asked about the level and nature of their involvement  Asking where involvement should take place  Using a problem solving format  Committing resources to enable parent involvement in advisory programmes  Facilitating parent to parent contact  Using evaluation and parent satisfaction surveys  Consulting on the planning and development of services  Family directed service

16 OHM & ISQSH - 4.12.02 16 Multi-disciplinary Teamwork Family Team

17 OHM & ISQSH - 4.12.02 17 Inter/Trans-Disciplinary Teamwork TeamFamily

18 OHM & ISQSH - 4.12.02 18 Inter-Transdisciplinary Teams Key Issues:  Team is the mechanism that makes the intervention work - Tuchman 1996  Model of Teaming Inter-disciplinary = share common goals, are committed to communicating and work through planned interaction, parental involvement, better co-ordination of tasks between members. Trans-disciplinary = share common goals, plan together using systematic process or sharing roles and crossing disciplinary boundaries. Family participation and concerns on decision making are crucial.  Tuchman TD best service to families as they integrate the principles of co-ordination and family centred service Evidence:  Dedicated Teams  Plan on needs of the child & family  Joint assessments  Joint planning - families seeing fewer therapists  Natural Environment Work - greater involvement of wider team in child’s life  Child based filing system  Parent always member of the team

19 OHM & ISQSH - 4.12.02 19 Charity Disabling Medical Expert Prescriptive Professional Driven Segregated Group Therapy Multidisciplinary Discipline Focused Standards Centre based assessment Deficit  Rights  Empowering  Social model  Child and family centred  Collaborative consultation  Consumer driven  Mainstream/Inclusive  Individual  Whole life  Inter/trans disciplinary  Age group programme based  Outcomes  Integrated real environment assessment  Strengths based Policy Change Summary Paradigm Shifts

20 OHM & ISQSH - 4.12.02 20 Implementation Issues Raised  Structure dedicated  Leadership and Co-ordination  Understanding Change  Teamwork and Time  Getting Parents involved  Move from uni-dimensional to multi- dimensional approach  It’s Complex

21 OHM & ISQSH - 4.12.02 21 Change Charles Handy 1988 in Understanding Voluntary Organisations says that: “to change the culture of an organisation from role to task based culture is one of the most difficult changes to make.”

22 OHM & ISQSH - 4.12.02 22 Case Study St. Michael’s House Mary O’Connor Early Services Development Manager St. Michael’s House, Dublin

23 OHM & ISQSH - 4.12.02 23 Moving from child centred to child & family centred services in early intervention

24 OHM & ISQSH - 4.12.02 24 The Client Older models  Child  Individual  Encapsulated  Handicapped Newer models  Family  Family system  Ecological  Universal »Wasik, 1990

25 OHM & ISQSH - 4.12.02 25 The Role of the Helper Older models  Expert  Problem solver  Decision maker Newer models  Collaborator  Facilitator  Negotiator »Wasik, 1990

26 OHM & ISQSH - 4.12.02 26 Individual Programme Plans Older ways  Developmental domains  Motor development  Communication  Cognitive development  Social and emotional development  Self-help skills

27 OHM & ISQSH - 4.12.02 27 Individual Plans - Newer Ways  Goal: James will use his hands to play  How will this goal be supported (who, when, where?) Physio and OT will do two joint home visits to show Lucy how to position James in his standing frame and in his chair. They will lend Lucy appropriate toys to try. Lucy will decide on when and how often she will be able to position James. Link worker and Laura (James’s granny) will also be shown how to position James to use his hands. Physio and OT will visit on dates arranged with Laura (6 visits each in three months). Review.

28 OHM & ISQSH - 4.12.02 28 Individual plans - newer ways  Goal: Lucy will be able to go out for one evening per week with her husband  How will this goal be supported (who, when,where?) Key worker will work with Lucy to support a family member to learn key skills for managing James’ care in the evening

29 OHM & ISQSH - 4.12.02 29 Making the Transition Using Outcomes for Families  Families are informed  Families choose child development goals  Families choose their goals  Families choose services and supports

30 OHM & ISQSH - 4.12.02 30 Providing Services in a New Way  Information giving  Key workers/co-ordination  Teams that comprise staff relevant to child and family needs as described by the family  Collaborative work/working in trans- disciplinary ways

31 OHM & ISQSH - 4.12.02 31 The Challenge “The progressive and inevitable ambiguity of disciplinary boundaries represents one of the central challenges facing the field of early childhood intervention” â Shonkoff and Meisels


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