Building Better Lives

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Guide to Building Better Lives & Active Support

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Contents Section 1

4

Engagement for all

Section 2

7

Building Better Lives Process

Section 3

8

Getting Started Using the Goal Setting Form

Section 4

10

MANS-LD

Section 5

12

Person Planning The BBL Booklet

Section 6

14

Achievements and Positive Outcomes

Section 7

17

Reflection; What Worked, What Needs to Change…

Section 8

18

Active Support

Section 9

22

Obstacles

Section 10 Resources

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Introduction Our Building Better Lives programme is delivered in Ocean Community Services as a ‘whole-person’ approach to improving our service users’ quality of life.

A focus on four different themes enables every individual to set goals, working towards measurable outcomes, promoting personal wellbeing, choice and meaningful activity as part of community life from the very outset.

This handbook provides our staff with all the tools they will need to support our service users to set their goals and work towards their chosen outcomes.

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Section 1

Engagement for all We know that engagement in meaningful activity helps people feel valued and promotes positive physical and mental health and wellbeing. Meaningful activity includes:

Having good relationships with friends and family

Having the opportunity to learn new skills

Being involved in a range of different activities

Having control and choice over their own lives

Being part of the community

Being treated with respect and as an individual

These elements of support help us feel valuable as people and help us feel that our lives are meaningful.

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So how do we help our service users achieve this in a community setting?

Active Support Through positive opportunity planning

Goal Setting And maximising choice

Building Better Lives is a framework that supports individuals, with our assistance, to identify the skills and activities they want to participate in.

It also monitors their progress as they work to develop their skills.

Building Better Lives is our way of ensuring that we use the principles of active support when we are trying to help people. Active support is a way of helping people learn new skills that will help them live the life that they want to live.

Building Better Lives has 4 skill building themes:

Looking after myself

This is about physical health and wellbeing

Keeping myself safe

This is about developing the skills to live with others safely and appropriately

Getting on with others

This is about supporting individuals to be both interested and involved in making new friends and having positive relationships

Getting involved

This is about supporting individuals to take an interest in and being involved in making decisions about their activities and opportunities within the home and community

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How does Building Better Lives fit into Active Support?

•

Positive Behavioural Support is a way of ensuring that we clearly write down, in a behaviour support plan, the things that we must do to keep the person safe and help them manage their lives without needing to use challenging behaviour. Everything we do for the person must be written in the behaviour support plan and it is the main guide to working with each person in our care.

•

Active Support creates a clear approach when working with an individual.

•

Person-centred Practice means that we ensure everyone’s care is based on their own unique needs.

This is a philosophy and approach to care more than a set of tasks. For example, we are not being person-centred if we decide to take everyone out to the same place without asking each person if that is what they want to do, or without checking whether the activity will benefit them as an individual.

Treating and communicating with the service user respectfully using proactive approaches through Positive Behavioural Support Building Better Lives and Active Participation

Active support

CLIENT GOAL

Active Participation and Active Support are terms that mean we focus on detailed plans to help people learn new skills, and that we ensure that our services work with a clear purpose for the individual. When we actively support someone, we know why we are doing something as well as the ‘what’ and the ‘how’.

For example, when we take someone to the shops applying Active Support, we will have already determined what skills we want to help them develop through this activity.

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Section 2

Building Better Lives Process

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Gather goals using the Building Better Lives easy read form • Complete the Building Better Lives booklet with person-centred goals based on individual feedback and MDT guidance • Personalise Building Better Lives Booklet if client chooses • Main document is held on q: drive for access and updating

save in client’s file

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• Complete the MANS-LD Quality of Life tool • Create a goal participation checklist • Store information in correct sections of individual’s file and copy to individual’s

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• Each weekly checklist of active participation is scored and saved for evaluation • At the end of each four-week period the weekly scores are made into a summary graph and imported into an MDT report • Report is shared with service user’s MDT and with the client

5 6

• The Building Better Lives booklet goal section is reviewed in monthly MDT • Complete as Stage 1 & 2

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• After 6 months Building Better Lives Goals and MANS-LD will be reviewed • Graphs and goals met validate outcome measures for the individual

• Recording evidence of weekly progress towards Building Better Lives Goals is made in care partner.

• Activity Planners can also reflect Building Better Lives meaningful activities that are linked to the goals set.

• All meaningful activities are incorporated into Building Better Lives planner and includes contact with external agencies such as dentists, doctors, advocacy, occupational therapy, psychology etc.

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Section 3

Getting Started Using the Goal Setting Form Gather client’s goals using Building Better Lives Easy Read form.

Examples of activities and skills in this area.

In this section individuals are supported in their skills and their needs and goals agreed.

These goals can also be based on the knowledge of the person and agreed in MDT. This is the What and the How of completing a task.

These sections are repeated for all the themes.

From these forms, goals can be established from the ‘I want to be able to’ sections.

The goals from the individual goal form from each skill building area can be used for the Building Better Lives booklet and written in a SMART person-centred format.

So, what do we need to know about goal setting?

• We know that having goals is important for motivation and self-confidence.

• They give us a sense of purpose, something to achieve and something to continue to improve upon.

• They help people to organise and manage their time in their own way.

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SMART Goals When working together with individuals, they need to feel like their goals are achievable. A way of doing this is by using SMART goals. This means:

SPECIFIC

MEASURABLE

RELEVANT

ATTAINABLE

TIME-FRAMED

For example, Mary wants to have a shower every morning. This goal would need to be: Specific

One task, e.g. Mary is only having a shower, not also going to the toilet

Measurable

Daily, Weekly, Monthly

Attainable

Realistic, so this must be within Mary’s abilities

Relevant

Connected to the client’s goals, so supporting Mary’s personal hygiene needs

Time-bound

Deadline for achieving the goal e.g. Mary will shower every morning at 9 a.m. for the next two weeks

Goals need to be personalised I would like to have support on a daily basis to shower at 9 a.m. so that my confidence can increase. I will discuss my progress in my Building Better Lives booklet and in my next MDT.

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Section 4

MANS-LD Quality indicators are tools and questionnaires that allow people to tell us what they think about the care we provide. The quality indicator that is used for this system is the MANS-LD.

Our most basic needs, known as our physiological needs, are shown at the bottom of the pyramid. These are our survival skills, and are often the first things that motivate us.

The Maslow Assessment of Needs Scales – Learning Disabilities (MANS-LD) is a Quality of Life indicator based on Maslow’s (1943, 1954) Hierarchy of Needs.

An adaptation of the Maslow scale produced by Paul Skirrow and Ewan Perry from Mersey Care NHS is shown below.

Maslow states that our basic needs are the foundation stone to be achieved before moving up the pyramid e.g., once one level is fulfilled, the needs in the level above are what motivate us next.

Maslow’s theory states that people are motivated to achieve certain needs, but some needs take priority over others.

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• Complete the MANS-LD as a Quality of Life indicator • Complete the Problem Behaviour Checklist • Populate the client’s goal sheet with MANS-LD result • Create a weekly checklist of active participation

save in client’s file

The Maslow Assessment of Needs Scales represent a value-driven approach to assessing outcomes for services for people with learning disabilities and is firmly rooted in the ideas of Social Validity (Wolfersberger, 1978; Emerson et al., 1998) and person-centred goal planning (e.g. Lyle O’Brien, O’Brien & Mount, 1998; O’Brien, 1989).

The MANS-LD form for collecting information that is used in Building Better Lives looks like this one below.

It has been adapted to make it as easy as possible to follow.

To complete the form the person can tick or circle the face tha t they feel best suits their answer to each question.

“I am happy with how I spend my time (e.g. jobs, college)”

Hardly ever 1

Sometimes 2

Often 3

Most of the time 4

Nearly always 5

Often 3

Most of the time 4

Nearly always 5

“I am happy with where I live”

Hardly ever 1

Sometimes 2

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Section 5

Person Planning: The BBL Booklet The BBL booklet is person-centred and accessible to the individual. The booklet can be decorated however a person wishes.

It is very important that this booklet holds meaning and is updated and reviewed on a monthly basis.

It is important to create a shared folder so that staff can update and access printable master sheets.

At the individual’s MDT Building Better Lives should be reviewed and changed in line with the person’s progress.

It is important that all staff know how to access the folder. If staff don’t use the folder then it is very hard for them to deliver proper person-centred care.

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In this section Individuals can write their own person portrait. This section may be completed by the person’s circle of support / MDT.

The goals are written in these areas under the headings. The goals need to be clear, factual and have a time frame on them. The goals need to be achievable and specific to the person.

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Section 6

Achievements and Positive Outcomes Engagement can be recorded in two ways: what is happening on the day, and if the activity was completed.

Activity timetables are used to record the activities for the day, whilst also slotting in other relevant information, such as appointments and self-care activities. This is useful for establishing a flexible, yet manageable, routine.

Looking after myself

I will brush my teeth in the morning and evening

Participation checklists are used to record engagement in self-care activities, such as brushing teeth in the morning and night, showering, cleaning bedroom, etc. They can be written as goals.

Goal met: Mon

Tues

Weds

Thurs

Fri

Sat

Sun

Fully

Partially

Not at all

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People with learning disabilities need support to participate Good support can help to fill this gap. This means planning for the best use of time and giving people as much support as they need to get things done for themselves. With sufficient planning and support, and in line with guidelines*, everybody can: • participate in activities and have a full day regardless of their disability • contribute even if they haven’t got all the skills needed for a particular activity • take on their share of responsibility ... and ....

• be involved in things they like to do and make informed choices Each week the participation checklist data MUST be inputted onto an Excel spreadsheet like this one.

A graph can then be created which shows us how an individual has worked towards meeting their goals.

To turn this spreadsheet into a graph, follow these steps: 1. Click and drag to select the data…

2. Click Insert…

3. Click Recommended Charts, which opens up a dialogue box

*https://arcuk.org.uk/publications/files/2011/11/Active-Support-Handbook.pdf

Met

Partially

Not at all

Week 1

3

2

6

Week 2

3

4

4

Week 3

5

4

2

Week 4

7

3

1

16

This will open up a dialogue box…

4. Click All Charts…

5. Click Column…

6. Select the option which shows each week in a different colour, grouped as Met, Partially and Not at All

7. Select OK when prompted and the graph will appear in the spreadsheet 8. Give the graph a title 9. Copy and paste it into the MDT report

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Section 7

Reflection; What Worked, What Needs to Change…

At the end of every month, we want to ensure that we encourage people to reflect on their progress. They can do this by discussing their Building Better Lives booklet with staff and agreeing on what they would like to continue working towards. Goals achieved must be changed once they have been completed.

The reflection sections in the Building Better Lives booklet must be completed at the end of every month.

This tells the person that we are interested in their achievements and we care about how they are moving forward in their life.

Individuals can fill out this page with the support of staff or on their own. It’s really up to the individual to communicate how the month has been.

Working with me, not over me

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Section 8

Active Support Active Support is an approach that is fundamental to providing effective person-centred practice.

According to ‘United Response’ providers of active support resources:

The essential outcome of Active Support is engagement, so the way it looks in practice will vary depending on the individual requirements of the person being supported, the situation and the skills of the people around them.

The Four components of Active Support: •

Every moment has potential

•

Little and often

•

Graded assistance

•

Maximising choice and control

Active Support suggests that when individuals are not engaging over a period of time we need to review the situation… and try a new approach.

Within our daily lives our activities are made up of small steps.

When we work together with individuals in our care, we need to help them identify the steps that make up an activity.

By going at the individual’s own pace, using small steps, a goal becomes more manageable.

Individuals own pace

Small Steps

GOAL

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Supporting an individual to achieve a new skill, or setting up a situation where someone can try a new skill is what Active Support is all about.

We all need different levels and approaches of being supported. This can be done using a number of different methods.

Below is an outline of this approach;

Ask

Letting someone know that it’s time to do something or that something needs to be done.

Instruct

A series of statements that tell the person what to do one step at a time and helps guide a person through the activity.

Prompt

A clear gesture or sign to tell the person what to do next, for example, miming an act can provide a lot of information for the person to follow.

Show

Demonstrating what needs to be done by doing the activity ourselves so that the person can see. This gives more support that prompt because it is showing the person what to do.

Guide

Giving direct physical assistance to do something. Such as supporting someone’s hand with ours, to turn the washing machine on,

ASK For some individuals, this level of support may be all they need to do the activity.

Here are some different ways of using this level of support: “Would you like to start peeling the potatoes for dinner now?”

“How about peeling the potatoes for dinner now?”

“It’s time to peel the potatoes for dinner now, OK?”

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INSTRUCT Instruct works well when a person can physically do the activity but just needs to be reminded about the steps.

Here’s an example of making toast: “Put the bread in the toaster… Push down the lever… Wait… Watch the toaster… (the toast pops up) …

Take out the toast.”

PROMPT Prompt works well when a person does not know what to do but is able to interpret and follow gestures or respond to signs of what to do next. Here are some examples: Point to the potato peeler and then mime peeling a potato.

Pointing at a cup that needs to be put away and then to the place in the cupboard where it needs to go and saying, “Put it here”.

Gently nudging the person’s arm behind the elbow to indicate the need to move the arm forward to pick up a spoon.

SHOW Show works well when a person does not know what to do but is able to imitate. Here are some examples: Putting one fork away in a drawer, handing the next fork to the client and pointing to the right compartment in the drawer to put it in.

With the client holding a potato and potato peeler, putting the potato in a bowl of water, pulling it out and saying, “Do that”. Then showing how to position the peeler to start and waiting until the individual has copied.

Then pulling the peeler to take of a strip of peel, saying, “Like this”.

GUIDE Guide works well when a person needs a lot of support. Here are some examples: Guiding a person’s hand at the wrist to align the bread over the slot of the toaster, saying, “Put in the bread.”

Putting one fork away in a drawer, handing the next fork to the client and guiding their hand so that the fork is over the right compartment in the drawer, letting go so the client can finish the step unaided.

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Taking steps to engage in an activity The degree to which a task is broken down can vary, from a few larger steps to many smaller steps. Talk with the individual when establishing the steps and figure out how large or small the initial steps need to be.

Once in place, support can be given to lessen the number of steps as they improve. Each step can be supported using Ask, Instruct, Prompt, Show, Guide.

When setting goals within Building Better Lives, activities within the themes can be broken down. For example, in taking care of myself, showering can be broken down as in the example below.

Fewer, larger steps

More, smaller steps

1) Tell staff you are going to have a shower

1) Tell staff you are going to have a shower

2) Collect things you will need (towel, shower gel, shampoo, etc.)

2) Collect things you will need (towel, shower gel, shampoo, etc.)

3) Take these things to the bathroom

3) Go to the bathroom and prepare for showering

4) Go to the bathroom 5) Take off your clothes only in the bathroom

4) Turn shower on and adjust the heat

6) Turn on the shower and adjust the heat

5) Get in the shower and get your body and hair wet

7) Get in the shower and get your body and hair wet 8) Pick up shampoo 9) Put a blob of shampoo on your hand 10) Put down shampoo

6) Put shampoo in your hair

11) Put shampoo in your hair

7) Rinse shampoo out of your hair

12) Rinse shampoo out of your hair

8) Use shower gel to wash your body

13) Pick up shower gel 14) Put a blob of shower gel in your hand 15) Put down shower gel 16) Use shower gel to wash your body

9) Rinse shower gel off body

17) Rinse shower gel off body

10)Turn off water

18) Turn off water

11) Get out of the shower

19) Get out of the shower

12) Dry your body with the towel

20) Dry your body with a towel

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Section 9

Obstacles When an individual has a goal, for example, ‘I want to shower every morning’, there may be obstacles that might prevent the individual from performing this task.

What obstacles might they encounter?

WATER TOO COLD/HOT

CLIENT LIKES THEIR OWN SMELL AND DOESN’T WANT TO LOSE IT BY SHOWERING…

ANOTHER CLIENT ALREADY IN THE BATHROOM

We’re aware of these obstacles. But how do we encourage individuals to problem solve and take the first steps?

1) Communication

Prompting questions and Ask, Instruct, Prompt, Show and Guide can be used to say that a task needs to be completed.

2) Preparation

Thinking in steps can be used for preparing the individual for a task so that they understand how to do it.

3) Setting the scene

Planning the activity with the individual, like agreeing a time, making sure they have everything they need, e.g. shower gel for a shower.

4) Motivational feedback on completing tasks

Discussing with the individual how often they want to do the task and adjusting according to their progress. Also reviewing the goal regularly to see if it is something the individual still wants to achieve using the BUILDING BETTER LIVES booklet.

5) Reviewing goals and adjustments with individual

Reviewing the goal and the agreements made in their MDT meeting as well as assessing any risks associated with the goal. Establish any changes that need to be made to their BUILDING BETTER LIVES booklet.

6) Review risk processes and achievement/ participation in MDT

Reviewing the goal and the agreements made in their MDT meeting as well as assessing any risks associated with the goal. Establish any changes that need to be made to their BUILDING BETTER LIVES booklet.

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Section 10

Resources Resources are available regarding Active Support as detailed below. Learning Disabilities England provides a very useful resource for supporting individuals with daily tasks such as doing laundry, going shopping, road safety, reading and writing, and managing money, which are all accessible from the internet.

Here are some examples of prompting questions you can download to help with road safety and using public transport.

Do you need help to keep safe on the roads?

Do you need support to use public transport?

Do you want to learn road safety for yourself?

Do you want to learn how to get about by yourself?

These questions can be used to establish how much support a client needs when participating in an activity.

Check out these websites for more ideas about what prompting questions you can use:

Also, there are amazing resources online for step-by-step recipes with pictures:

http://lde-hsa.site/easy-read http://www.unitedresponse.org.uk https://www.everymomenthaspotential.com.au

http://lookandcook.com

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References Jones, E., Perry, J., Lowe, K., Allen, D., Toogood, S., & Felce, D. (2009). Active Support. A handbook for supporting people with learning disabilities to lead full lives.

Maslow, A. (1943). A Theory of Human Motivation.

Psychological Review, 50(4), 370-396.

Skirrow, P. (2014). The Maslow Assessment of Needs Scales (MANS): An Outcome Measure and Planning Tool for People with Intellectual Disabilities. Mersey Care NHS Trust.

Tizard (University of Kent) and United Response.

Active Support An essential component to the way we work.

Ocean Community Services Unit 1, Castleton Court, Fortran Road, St Mellons, Cardiff CF3 0LT 03300 567 888 www.iriscaregroup.co.uk