A new DVD from United Response shows the impact of person centred active support. Review by Max Neill
Promoting Person Centred Support and Positive Outcomes for People With Intellectual and Developmental Disabilities. United Response and the Tizard Centre (DVD) 2014
At two hours and 22 minutes, making this DVD must have been a truly major undertaking. It has a whole cast of people who have been involved in making it and I believe their efforts have been rewarded with what will become a valuable resource for supported living services.
This training resource will help managers and staff understand what person centred support for people with learning disabilities requires of them.
The DVD takes the form of clips from people’s everyday lives with commentary by Bev Ashman and Julie Beadle-Brown. They explain how the idea of ‘person centred action’ fits into a context of person centred thinking and planning, supported by personalised budgets and support from staff with sound values. If these staff are coached and led well, and all these elements are in place, they hope that people using such services can be enabled to live good lives and that, consequently, behaviour that challenges will decrease.
The argument is that people should be engaged ‘little and often’ in meaningful activities and relationships, “minute by minute, hour by hour and day by day” as an alternative to the current prevalent practices, shown in research, that people in supported living services receive just eight minutes of staff interaction per hour, only 2 per cent of which is actual help to take part in activity.
It is argued that person centred active support is possible without increasing the amount of staff hours because often the more staff a person has, the less support they end up getting as the staff prefer to interact with each other.
The video shows how, by using the potential available in each moment and grading their assistance, staff with the right coaching and support can fill those long periods of the day that so many people spend doing nothing with meaningful activities and interactions, whether it’s helping neighbours, cooking or even doing things traditionally seen as staff responsibilities, such as testing fire alarms.
Understanding the activity is not seen as a necessity – far more important is the experience of interaction and the relationships it leads to. The scenarios illustrate this again and again, as we see people gaining presence in their communities and beginning to connect with others while delivering leaflets or newspapers, riding the bus or ordering a meal at the chippy.
Film-makers Frameworks for Change did a great job capturing those little glances, smiles and nods that make up those subtle moments of everyday connection that human beings need, such as the easy laughter experienced when supporter and client realise together that they have broken the food mixer.
Because of the length of the DVD the best way to use it would be in a series of short bursts, perhaps during staff meetings, so that the different scenarios can be discussed in depth. In each scenario the staff being filmed are modelling positive respectful communication and interaction; ‘show’ works so much better than ‘tell’ when helping staff change their practice.
The scenario format was particularly powerful in explaining the ‘SPELL’ framework, designed to improve support for people with labels of autism. Structure, Positivity, Empathy, Low Arousal and Linkage are explained in concrete terms, bringing them to life in a way more people will be able to relate to. Pithy comments like “Low arousal does not mean no arousal” help cement the learning in the memory. It is explained that all human beings benefit from the presence of the elements of SPELL in their lives and that it is not something ‘special’ for disabled people.
This is one of the highlights of the DVD and includes a section on the crucial need to include families as much as possible in people’s support.
The section on Positive Behavioural Support (PBS) comes late in the DVD which works well because we’ve already met the people whose support is discussed so we have a sense of who they are, before the discussion on how they challenge and how these challenges are dealt with. This is revealed in the moment when a female staff member’s arm is gripped so tightly by the large strong man she is supporting that she can’t pull out. That she is holding a knife in that hand makes the scene more alarming. Because we already know the person, we see that the calm reaction of the staff member and the way she continues her support is entirely appropriate.
I feel this section should be watched in conjunction with the one on communication which sets the scene for positive support. It shows how communication is more likely to happen if people are doing something meaningful together, using physical and gestural prompts. It illustrates how communication can be used to create a positive, safe atmosphere without using words.
The section on PBS could lead to interesting discussions in people’s staff teams on the balance between humanity and objectivity, between choice and structure in people’s lives and between anxiety reduction and age appropriateness. In each case the DVD resolves the issue by considering what makes sense to the specific person in their own life.
The final section on organising and improving support does not shy away from the difficulties of managing supported living services and staff. Again, it illustrates managerial skills, such as coaching, reflection and appreciation with videoed examples in a way that makes them easily understood and therefore more useful than written coaching manuals.
Examples of how to increase choice and control are presented – those shown use dichotomous choice making between two alternatives: baking or housework. The other choice clearly illustrated was whether to stop engaging in an activity.
Overall, being able to see the natural but skilled way staff are interacting with the people being supported provides a great model for other staff. The keen eye of the filmmakers for those subtle communicative glances, and little moments of comedy that signify the difference between a boring unproductive life and a positive life rich in contribution and relationships is the other great strength of this DVD. It is one I’ll be sharing with other people in my work, and one I’d certainly recommend to others.
This DVD was developed by the Tizard Centre and United Response, working with Frameworks for Change and funded by the School for Social Care Research.
For further information on the resource, contact Lu Large at: Lu.Large@unitedresponse.org.uk
