Person Centred Active Support It ain’t what we do it’s ‘just’ the way that we do it ! Promoting Active Engagement

Background to Active Support 1980’s

Residents in fifteen supported housing services in Wales received contact from staff for an average of 15% of the time. (Felce & Perry 1995) Amount of support received is about 9 minutes in every hour facilitative assistance 1-4 minutes an hour on average (Mansell 2007) Staff do not generally interact with the people they support in a way that enables people to achieve greater levels of independence, participation or integration Mansell 2007

A Vicious Circle of Disempowerment The Hotel Model Staff perceive service users as dependent. They do not spend time interacting with or assisting service users and are apprehensive about trying new things Staff cannot think of goals or activities service users could do. They see their role as a ‘domestic worker’ rather than as an ‘enabler ’ (Mansell et al 05) Staff do most things for service users rather than create opportunities for service users to participate Service users do not participate in valued activities and spend most of their time doing nothing

The ‘Hotel Model’ has a number of negative results..... The skill level of the person being supported will drop. The opportunity for new skill development will not develop The person will not automatically be encouraged and supported to participate in activities that directly relate to their own lives The person will loose motivation and confidence Behaviour that we find challenging is likely to occur

What is Active Support? A method of supporting people with learning disability to engage in meaningful activities and relationships as active participants. Based on using ordinary everyday activities to encourage choice and engagement, and to increase independence. Involves working with people in order to promote optimal engagement, irrespective of degree of disability.

Particularly beneficial to people with complex needs, including challenging behaviour. Addresses the way staff teams are organised. Active Support addresses the complementary relationship between person-centred action and person centred planning Works well with people with learning disabilities, sensory impairment, autism and for people who have no behaviour that challenges.

How a person spends their time. taking part How a person is taking part in activities and their own lives. How staff are enabling a person to participate How staff are enabling a person to participate in activities not just relying on the paperwork alone! Active Support enables Services to look at

Look at every moment having potential – how to look for opportunities – involving in the right now! Try little and often approaches to activities Monitor and review team consistency Tizard Active Support, Supports Services to :

It is always easier for 10 members of staff without a learning disabilities to learn one way of doing the same activity, than it is for one service user with learning disabilities to learn 10 different ways of doing the same activity Remember

Positive Staff Interaction: 1.Hierarchy of Assistance – How We Support – Graded assistance ASK - INSTRUCT - PROMPT - SHOW- GUIDE The level of support increases Thinking in Steps – Task Analysis – How we Support Breaking activities down into steps and doing one step at a time every activity has some easier components 3. Reinforcing Participation – Positively reinforcing maximising naturally occurring rewards – backward chaining

Backward Chaining Getting a natural reward more immediately eg making toast and eating it! Rather than starting with get the bread from the packet, start at the point where you are cutting the toast: e.g. Open lid of jar Pick up spoon and put in jar Take spoonful of jam Put jam on toast and spread with knife Cut toast in half

A Virtuous Circle of Positive Interaction & Empowerment - engagement Staff interact positively with service users and provide opportunities for participation Service users participate successfully in part of the activities Staff perceive service users as more competent. Give more respect control & attention & consequently feel more confident, successful & eager to try new things Staff think of new ideas for more goals and activities. Staff see themselves as enablers (Mansell et al 05)

Active Support Training DVD

Active Support is not ‘just’ about training ! Not relying on the paperwork

Linking all elements of the organisations activity – Health & Safety, Risk Management, Learning & Development, Human Resources, Quality Assurance Streamlining approaches to support Person Centred Planning, Positive Behaviour Support, Total Communication, approaches to Mental Health, Autism & sensory impairments Job Descriptions/Person specifications questions at interviews Induction and Probation Frameworks Quality Assurance Organisational commitment is essential

Challenges Lack of perceived need Reluctance to change Training not linking together Lack of skilled practice managers Communication Values, attitudes, motivation and skills

76% reported an increase in motivation in the people being supported 84% reported an increase in participation in everyday activities 65% reported a decrease in behaviour that was challenging the team 73% of managers said that their teams were more motivated 84% of managers said that they would benefit from further support Staff feedback:

Increase of 94% in engagement in meaningful activities Increase of 300% in assistance from staff Increases not just in participation at home but also in the community and in choice-making (e.g. ironing up from 3-22%, gardening up from 9-62%) Decrease of 24% in repetitive/self-stimulatory behaviour Decrease of 53% in self-injurious behaviour Tizard Learning Disability Review March 2009 Tizard Learning Disability Review March 2009 The implementation and effect of person centred active support in the Avenues Trust

Association for Real Change UK Continuing the promotion of Active Support - E Forum, website, National Conferences, Seminars, Supporting with the development of the Active Support Units for the Qualification Credit Framework – Skills for Care & Development. Active Support training and Interactive training and consultancy Active Support HandbookActive Support Handbook

Challenging Behaviour a Unified Approach 2007 by the Royal College of Psychiatrists, British Psychological Society and Royal College of Speech & Language Therapists Approved by Central Executive Committee The Mansell ll Report 2008 September Services for people with learning disabilities and challenging behaviour or mental health needs (Revised) Ethical Approaches to Physical Interventions 2009 David Allen November Further Reading Further Reading: Raising Our Sights 2010 Services for adults with profound intellectual and multiple disabilities Prof Jim Mansell March 2010

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