and Asset Based Approaches The ability to have good conversations is at the heart of engaging with people around their personal outcomes March 2017 Ross Grieve Lead External Training Consultant ID: 656798
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Introduction to Personal Outcomes and Asset Based Approaches: The ability to have good conversations is at the heart of engaging with people around their personal outcomes.
March 2017
Ross Grieve
Lead External Training Consultant,
Thistle
Foundation
Alison Linyard , Personal Outcomes Programme Manager, Fife Slide2
Session Aims What do we mean by Personal Outcomes?Techniques to support the outcomes conversations
Accessing Further Support Slide3
What do Humans need in order to experience wellbeing? Slide4
And at the heart of the approach are fundamental human needs Feeling connected, part of , sense of belonging, accepted Status, contribution , purposeLove, friendship, companionship ( and alone time )WellbeingBeing respected, valued, treated with dignity
Peace, calmness
Safe
choice, having a say Slide5
Quality of life
Process
Change
Feeling safe
Having things to do
Seeing people
Staying as well as you can
Living where you want/as you want
Dealing with stigma/discrimination Listened toHaving a sayTreated with respect Being responded to ReliabilityImproved confidence/moraleImproved skills Improved mobility Reduced symptoms
Personal outcomes Frameworks Slide6
Personal outcomes and asset based approachesA Personal Outcomes Approach is all about connecting to the person on the basis of ‘what matters to them’ as opposed to ‘what's the matter with them’. Then using what matters to help them:
identify what they hope to get from your
support
make informed decisions about their care/ treatment
make life changes which supports self management
It is an asset based approach as it asks important questions about hope and expectation, coping and resilience, person’s own knowledge, what the person is already doing that is helping them move towards where they want to be and using that information to make decisions and plan support/ treatment .Slide7
Our Questions:how might personal outcomes and asset based approaches: Enhance care experience Enhance staff experienceSupport co-productionSupport early dischargeEnhance discharge planning
Prevent hospital readmission
Support prevention/ anticipatory care, recovery and support for self management Slide8
Why do so many people value being ableTo “tell their story” ( without interruption, fear of judgement, being diagnosed, solved and fixed) To talk about “what matters”, not just “ what’s the matter”To explore their resilience ( how they coping, managing, what they are already doing to deal with their life situation) To talk about hope ( what they hope to get from working with you ) Slide9
Who do you see?Slide10
Choose the person you want to work with..... the person who has strengths, skills, resources, capacities and hopes…
(despite overwhelming evidence to the contrary)Slide11
What does a Personal Outcome focused conversation look like? Listening to problems
Person’s story
Outcomes
Resilience/ ability to
-
Get through
difficulty
Cope/ managing better Keep going (stay/ get more mobile) - Manage/ reduce symptoms- Progress toward outcomes Prompt questionsHopes ?What else ?Instead of ?What difference ? Description (who will notice? How will you know?)AcknowledgeCoping ExceptionsStrengthsSlide12
Prompt questions/ agenda settingSlide13
ACESAcknowledgeC
oping
E
xceptions
S
trengthsSlide14
What does a Personal Outcome focused conversation look like? Listening to problems
Person’s story
Outcomes
Resilience/ ability to
-
Get through
difficulty
Cope/ managing better Keep going (stay/ get more mobile) - Manage/ reduce symptoms- Progress toward outcomes Prompt questionsHopes ?What else ?Instead of ?What difference ? Description (who will notice? How will you know?)AcknowledgeCoping ExceptionsStrengthsSlide15
Micro skillsHopes ?Instead of ?What else ?What difference ? Description (who will notice? How will you know?)Slide16
Cultivating Hope and ExpectancyDevelop a repertoire of questions and prompts which help people focus on what they want. Many people typically respond with “I don’t know” and need support to think, using a range of questions:What are you hoping for?What are you wanting to get from our support/ work together?How will you know our support is making a difference to you?
What is your wife/ son (another person) hoping you’ll get from....?
What matters to you? What’s important to you?
What do want to be different in your life?Slide17
Toward Desired Outcomes. Instead of ? ( pages 63,64)Many people know what they don’t want but may not know what they want.Why is it important to work toward something desired rather than wat from something undesired? Try it out ( worksheet p63 and co-coaching exercise p124) Evoking Calmness - try this………… Slide18
What else?This question recognises the wholeness of people’s lives - most people have many interconnected issues / difficulties and hopes for change which cover a wide range of life domains Slide19
What else?Discovering a range of hopes allows for the possibility of getting change started somewhere…. anywhere….which then impacts across the systemSlide20
What else ?Useful technique to work with unrealisable hopes Slide21
What differenceIncreases motivation to act
.
This
question helps people explore the
“ripple effect”
- how small changes can have large effects Slide22
What differenceFrom output to outcome. Some people want things which are actually the “means to the end” to achieving outcomes which are important to them Unrealisable Hopes. Another technique where the practitioner can agree on the outcome (the end) then negotiate the means by which the outcome is reached Slide23
Description Described in rich, detail of day to day living, the outcomes are experienced by both the person and practitioner as realisable. It is also likely that some aspects of this future description are already being experienced at times.Helping people describe the detail of what they want increases motivation to act and be involved. This rich description becomes “well formed” - the practitioner supports the person to also describe their future through the eyes of others and brings others’ perspectives into the description, allowing practitioner and person to address possible conflicts of interest between family members and carer’s hopes,
practitioner’s
attentiveness to duty of care and safety issues, and their responsibilities to their agency (see exchange model).
This detail also helps support workers to NOT assume they know what people want and can plan support which fits much more closely with what people specifically want. Slide24
Unrealisable hopes Moving towards ( for more aspirational hopes)Signposting ( hopes are not within your remit)Go with it ( person self corrects)Means to an end questioning ( then negotiate more realistic means)Refer to an authoritative other
Embed into a range of other hopes
Ask “how likely is this to happen?”
Finally….
c
onfront directly if its your role to do so Slide25Slide26
Conversational FrameworkENGAGEMENTPLANNING negotiating and agreeing plan to achieve outcomecompetency based assessmentclinical reasoning
identifying whether professional input is required
what is my duty to act ? ,
what is the risk of acting?
what is the risk of not?
What is the appropriate level of input (*)?Slide27
(*)Levels of Inputreassurance, compliments, skillful disclosure,shared decision making
,
s
uggestions,
advice,
education
,
signposting
, referralintervention, formal risk assessment, escalationSlide28
What keeps you well? 10 - as well as you can be , given your life situations0 – oppositeX - where we all are just nowHow come you are an x and not lower? (what are you doing to keep you as well as you are keeping just now?)What else, what else? Slide29
What’s the difference betweenNext steps Next signs What do you need to do toHow will you know whenSlide30
EARS E - elicitA – amplifyR – resourceS – start again (or next Signs of change) Slide31
When things are worseWhat was better after we last met?How did you maintain?What happened? (strengths/ resilience based listening)
How did you stop things being worse?
How did you turn it around so quickly?
What have you already been doing to get back on track?
What will the next signs of getting back on track be ?