When I was told that we had been selected to participate in a new Pilot Scheme called Active Support I was excited to find out what it was all about and how it was going to work in our Service.

The whole staff team attended the Active Support training. During the training everyone began to realise that we tended to take over and do far too much for the person we support. We did not always think about what he could do, or how we could involve him to become more independent and learn new skills.

The staff team have adapted well and are working better together – more consistent. One of the biggest mountains to climb was the team tended to be carers. Now they are support workers/enablers and have changed their approach to support. We have introduced simple Opportunity Plans and Activity Support Plans.

Using tools from the training the person we support is given the opportunity to learn new life skills and is becoming more independent. He now gets up in the morning makes his own bed opens the curtains without any prompting makes his own breakfast and makes himself and staff a cup of tea with minimal support.

He makes his own lunch, normally a sandwich, with minimal support. Before we either did it for him or gave far too much prompting.

He also is now involved in the preparation of his dinner. He now peels, washes and cuts the vegetables and places into the pans ready to cook. When cooked he will help to dish out the dinner, wash, dry and put away his own dishes.

He has made himself an omelette with minimal support and now takes part in cleaning his bathroom, bedroom and living room.

He is now less focussed on watching TV as he is now more involved with the day to day running of his home. As his confidence improves he is now wants to access the community on a regular basis.

I am looking forward to the year ahead as the progress already made in the last few months for the person we support, and the staff team has been fantastic. This has been down to a lot of hard work and determination from the staff team and support from the Project.

Paul Cooke
Community Support Manager
Mansfield

We are really pleased to be involved in ARC’s Active Support project as we are always looking for new and creative ways to be more person centred and to deliver on our four key outcomes of ‘happiness’, ‘dignity’, ‘achievement’ and ‘inclusion’.

So far, we have found that Active Support fits these important outcomes like a glove!

Autism Care Yorkshire provides support to individuals with Autistic Spectrum Conditions and other associated conditions. At ACUK Yorkshire, a pathway of support is provided for individuals in residential services, supported living and day opportunities. Two of our residential services, “Fence” and “Vale” were chosen to be our pilot sites for embedding Active Support.

We are just a few months in and can already report positive outcomes, as well as some challenges along the way. Rose Gray, our training manager reports that;

“The Project so far has been both an enlightening and thought provoking process which has enabled the staff teams to really look at how they are supporting individuals to be active participants in their support at all times”

Here is an update on progress with two individuals supported at ‘Fence’.

After the team, and managers training, there were some initial questions and discussions around how we could implement Active Support. Some staff felt that the people being we support at Fence were already very able and they could not see how a different approach to support would be of benefit. After further thinking, the team took a step back and reflected on the goals they were working towards with the people we support. They started to look at their support provision with fresh eyes by thinking about important ‘small steps’. The little, sometimes unnoticed, things that can offer the people we support an opportunity to be more engaged in all aspects of their daily lives and routines. From this position, the Opportunity Plans were developed.

The first person lacked confidence in undertaking daily life tasks.

We first looked at ironing as an area he told us he wanted to be more involved with. Support was initially offered by giving verbal prompts throughout the task with lots of encouragement and confidence building! Through being supported in a safe and consistent way – this young man now safely irons 5 garments each day as part of the fixed routine that he needs due to his Autism. He is now at the point where he does not need any prompts at all!

The ‘small steps’ involved here have demonstrated to staff that the goals do not have to be achieved independently or all at once. There was a steady clear progression through a consistent approach from the team, who are now seeking out other small steps from which more Active Support plans can be developed with this person.

The second person had little motivation to undertake daily living tasks.

Through reviewing the Person Centred Plan, we agreed areas to work on with him. The team then broke down these activities to ensure that these could be achieved with the right level of support . This enabled the person to be more engaged in the activities which we saw to have a really positive impact on his motivation. This was noticeable almost immediately. The team reinforced how well he had progressed which in turn made him feel really good about things he had previously not wanted to be involved with!

So far we have three important learning points in terms of implementing Active Support with people on the Autistic Spectrum:

• All the activities were centred around what was important, or ‘of issue’, to the person we support in some way. This was always a good starting point.
• It was also key that all staff contributed to the Active Support interventions.
• The Activity Support Plan helped staff to see instantly where progress had been made and what support is needed ‘at a glance’. It was important for managers to make sure that everyone involved knew about the new plans as they were developed.

We are really keen to keep learning more about how Active Support can help support people with complex Autism. For people on the spectrum the ‘small things’ can often be the hugely important things and so far we have found Active Support to be a really powerful tool – as Sandra Fathers, Support Manager at ‘Fence’ describes:

“Staff are enjoying the Project and Active Support as they can now see how with often small steps a person can be enabled to move forward and be more in control. Each step, however small, is an achievement for someone and very important to promoting independence, choice and happiness. The new tools work well alongside our existing Person Centred Plans”

We look forward working further with Christine and the rest of the team to explore what Active Support can achieve for people with complex Autism!

Autism Care UK Yorkshire

Cherry Tree is a care home that supports five adults with learning disability to improve life skills and further education and support their needs, hobbies and wishes.

The staff at Cherry Tree at first found it hard to stand back and let service user take their time and be more involved within every day activities. The team also found the Active Support paperwork a little confusing to start with.

It was clear to the team that the current paperwork we had did not make it clear what clients were doing, who was supporting, how we were supporting as a team and areas around evaluation. We devised our own Activity Support Plan which now gives clear outlines as to who is doing what, where the individual’s skill need improving, what support is required and what skills a person already has.

What has really helped the staff team and the people we support has been the picture prompts and the factual writing prompt cards. This has helped with staff consistency. The people being supported require less support and fewer prompts within a simple activity, for example making toast.

The team also looked at what other activities service users within the house were not involved with, for example food preparation. We noticed that we (staff) tended to do most of the activity. This has now changed. The people we support are now fully involved from shopping to food preparation, to cooking and cleaning up after. People we support are now taking part in vehicle checks and putting petrol in the car. This particular activity is done by a gentleman who really enjoys taking part. We have progressed at shopping by giving the power back to the service user and they have control of their purse, finding the right money to pay with support and packing their own shopping and putting their change and receipt away back into their own purse/wallet.

Like the other Service within Broadoaks we are at the early stages of implementing Active Support. With the support of the Creating an Ordinary Life – Active Support Project Cherry Tree looks forward to sharing with you how the Service develops.

Amanda Connelly
Cherry Tree Manager

We are a Service of four registered small group homes consisting of  three adults with learning disabilities in each house.  All receive 24 hour care.  Four of the houses are lone working and have ‘sleep-in’ staff. The fifth house has two staff and a ‘waking night staff’ to reflect the needs of the service users.

Livability have been fortunate to be taking part in the Creating an Ordinary Life Project delivered and supported by the Association for Real Change. The initial training took place in October 2012

We decided on two candidates from two separate homes who would most benefit from some of the tools from the training.

The first person has seizures and a good deal of the time is spent where he is in need of having things done for him, including being fed and encouraged to drink. However, when well, he lets staff continue to ‘look after’ him and staff continue to, ‘look after’ him.  It’s a self fulfilling prophecy, ‘Staff think I can’t so therefore I can’t….. or don’t need to’.

We have two opportunity plans in place, one for days that aren’t so good, which may only include encouraging him to open his own curtains, but on better days, encouragement is given to put daily washing into the machine as well as working in the kitchen. It was previously thought that the cooker and kettle are dangerous places when he is unstable, but staff are now thinking more of hand on hand support,  encouraging him to be more involved in the cooking, which he is thoroughly enjoying. This includes getting food ready and having hand on hand support in peeling potatoes and stirring the food which is being cooked on the cooker.  He is also encouraged to tidy up afterwards.

The second candidate is someone who came to the service with very little history and did very little for herself and had behaviours which are challenging. However, it has been noted that the more active support she is receiving, that is the more she is engaged in everyday activities, the happier she is! Not only is she receiving attention from the staff, but at the same time is learning to do more tasks for herself with just staff prompting her.

Active Support is now included in staff meetings with discussion on how best to communicate and support each of the Service Users.  It has been noted that consistency is the key to all plans, especially when it comes to detail and staff are noting which suits the Service User best.

Although some staff were already providing Active Support, I think it fair to say that it was not the whole team and the hand on hand/hand over hand approach was not being used. This has made the difference for thinking of working with some kitchen appliances as a safe and acceptable risk.

Staff meetings and supervisions play an important part in ensuring all staff work consistently and along with Service User meetings, new activities are discussed, introduced and monitored.  As the whole staff team has been involved in the Active Support training, I am expecting everyone to be receiving person centred support by using Active Support with an Activity Support Plan and updated Opportunity Plans as the Service progresses. I have not monitored all staff interacting with Service Users as many staff are lone working, but will discuss, organise and plan observations again as the Service continues with the Project.

Jill Lammond
Service Manager
Brackley Residential Services

Active Support is an inspiring concept although not by any means new, as workers in social care we always want to do the best for people and there in lies the danger. We ‘look after’, ‘care’ and ‘do the best’ we can for the people we support and sometimes lose sight of the fact that our roles are to enable, instruct, show, prompt and guide people to do things themselves. When we start to get our heads around this concept and let go of the ‘doing for’ we really start to see people grow and develop their independence which in turn increases their wellbeing and confidence.

After the staff received the training they were motivated to try and use some of the techniques they had learnt. Staff started to take on board that they were not responsible for the cleaning and doing things for people and their role was to enable the tenants to do this. Some examples of where this has worked really well are:

• One gentleman was not peeling potatoes, the staff used hand on hand to show him, then instructed until he got used to it.
• Staff were ironing one persons clothes and he engaged by putting ironing away which before staff would have done
• One gentleman was not buttering his own toast independently, with encouragement he now is and was so proud that he got all the staff to look at what he had achieved.

As a manager visiting the service I have noticed that the environment is no longer pristine (particularly the kitchen!) and is much more like my house or how my friends house would be – not dirty but a little lived in! It is hard for staff to let go and change their mind set and it does take time for them to be comfortable with this but when it happens we suddenly go from giving ‘good’ support to giving ‘great’ support that can be life changing for our customers.

Mandy Himpson
Service Manager Residential Services Livability

Main Road is a property which four adults share, they each have a tenancy and Livability provide the day to day support for their individual hours.

As I write this article, a tenant is in the kitchen making his own lunch. I am in the dining room so he can call me if he needs any support. He is now buttering his own toast with prompts and I currently support him with the buttons on the microwave by pointing and he will push the button. He enjoys the praise when he is engaged and taking part. Only a month ago he would not have attempted to use the microwave.

Anna Mansfield
Main Road Service Manager Livability

Our team provides a range of care and support services to individuals with learning disabilities and complex health needs living within their own homes and also within their local communities.

NCHA Personalised Support Team have been fortunate to be able to take part in the Creating an Ordinary Life – Active Support Project and are now focusing on adapting and using the tools from the training within our Service.

Below are some of the areas we have been working on and have made changes in the short time we have been involved with the Project:

• Review of all job adverts how they are written looking at terminology to include actively supporting and enabling clients within their support tasks rather than assisting or completing tasks for clients.
• Reviewed with the Quality Supervisor the supervision forms which are used for on the job supervisions of staff, to discuss and capture how staff are enabling and actively supporting clients to achieve their goals or meet their needs.
• Active Support and enabling clients is now an item for discussion during one to one staff supervisions.
• Staff are now documenting how they supported and enabled their clients to become more independent. These notes are documented on a computerised support system which is accessed by all. Support Workers and Care Assistants complete written daily logs within the clients homes at each support sessions.
• If there is a team of carers working with a particular client they now receive regular contact from myself and the Quality Supervisor to look at any changes to how or what support is required and discuss further goals, this maybe via a team meeting or on the job training, shadowing and supervision.
• We now have regular meetings with clients and social workers to review and re-assess goals and objectives as required, this can be weekly, monthly etc

There are still areas as a Service we are developing and will continue to update progress in the next Newsletter.

Sam Woodward
Assistant Manager
Nottingham Community Housing Association
Personalised Support Team

‘Orchard Street’ a Nottingham Community Housing Association project, is a registered care home for 12 people with enduring mental health needs. The people who live at Orchard Street have varying levels of ability, most have good life skills which are not utilised due to lack of motivation and low self esteem. From a manager’s perspective I could see that the service which we offered definitely came under the Hotel Model culture. The expectations from those who lived and worked here was staff do the jobs and service users sit and opt out of the daily day to day tasks, further promoting their low self esteem. Being a more mature manager who had received Active support training and seen the benefits it could bring not only to the service user group but to the staff as well.

I knew we had to act when staff were saying:

‘I feel like a cook and cleaner, it’s not what I came to be a support worker for.’

‘All I do is cook and clean.’

‘x is just sitting around fast asleep in front of the TV.’

‘Most of these service users before they became ill had really responsible jobs now they do nothing.’

‘ I am finding it really hard to engage with x he usually tells me it’s a staff job, that’s why they are here.’

We were lucky to obtain funding and get included in the Department of Health Project Creating an Ordinary Life. The staff team (all of us) received the initial Active Support Training (October 12) and on going support for one year from Christine and her team at ARC. This is giving us a real opportunity to promote active support and it gives me the additional resource to be able to pick up the phone to get ideas to really keep active support at the front of every thing which we do. And it’s a real boost to have Christine come along to the service and give encouragement, ideas and feedback on our progress as a team.

And what a difference we are beginning to see. As a Mental Health service I wanted to include Active Support with the principles of Recovery Star (World Health Organisation) and have developed the participation record around the recovery star.

We have changed the handover and task sheet to a daily activities sheet which has a real service user focus and not a staff tick list to say that jobs have been done. We now say that jobs have been completed but also who helped! It promotes a shift from the culture of staff do and service users receive. We still have a long way to go to develop individual plans but we are already seeing some real improvements and everyone is really looking much happier. It’s already starting to look natural although some staff are finding it easier than others and some service users are more willing to embrace the change. But every service user has started to do more for themselves.

Here are just a few examples:

• One lady will now peel potatoes for tea completely independently and on one occasion informed me in the office that she was going to do them on her own because the staff were busy and she was fed up of waiting.
• One gentleman when asked to help mop his floor informed the staff that he had already done that and was so pleased with himself that he spent the rest of the day telling everyone.
• One lady who receives self catering money of £30.00 from the office would spend it on anything other than food now spends £27.00 on food.
• One lady is now making her own bed each morning without being asked.
• One lady who did not interact with staff helped to prepare the party food on Xmas Eve.

There are many more achievements from everyone, getting their own breakfast, making drinks, washing up, laundry and so on.

These are significant changes and we are only two months into the project. I am really looking forward to the next stage and now that Xmas is out of the way we can start to develop staff skills and confidence. Active Support is on every staff member’s supervision agenda and we are committed to using Interactive Feedback Forms to promote positive Active Support discussions.

Staff have made comments like it’s making the shift go quicker, it’s really good to see service users involved and how happy they are when they have done something. Although service users have not grasped that they are not helping staff but they are doing it for themselves one of the main principles of the Recovery Star, but it’s a positive move in the right direction.

Marion Jennison
Project Manager
NCHA

Broadoak Park is a residential home supporting 30 people with learning disabilities based in Kirkby in Ashfield Nottingham.

The Creating an Ordinary Life Project has given managers and staff at Broadoak an opportunity to review current support and team working.

The success and achievements of one of our service users in the rehabilitation flat has been based on using person-centred support by staff using a variety of support methods e.g. verbal and physical prompts and showing her how to engage in parts or the whole activity. She had the skills but was refusing to use them in her previous environment and at Broadoaks. A change of ‘home’ and an increase in expectations from staff who have a positive relationship with her have lead to an increase in involvement in all areas of her life e.g. self-help domestic skills etc. Being occupied and support has also increased her confidence to want to be more involved in everything that is going on.

Evaluation in this case has been difficult as Active Support was not in use prior to her moving. Now that staff use the model of Active Support she is much more involved in her own life both inside her home and in the community. We have a daily routine for her which has been in place for some time which was quite rigid based on the ASD needs but has proved positive and effective both for the client and the staff.

We are working on daily schedules and opportunity plans for other individuals we are supporting. Staff are using ask, hand-on-hand techniques and guiding to enable service users to develop skills and confidence to take more of a role in everything that goes on.

Currently evaluation is based on monitoring sheets and independent skills assessments.

We are at the early stages of formally monitoring staff interaction but this is something that the managers will be focusing on in the next few weeks. We will also be concentrating on areas around consistency and being specific with even the very small outcomes for people that we may not have recorded before. We will continue to monitor how the Project is supporting Broadoaks and let you know how we move forward.

Noel Allcock
Senior Service Manager
Broadoak Park

22 November 2012
10.00am – 12.30pm
Sutton Coldfield Fire Service, Lichfield Road, Sutton Coldfield, West Midlands B74 2NT

What is Active Support?

Active Support is an evidence based model of support that shows staff how to support people with intellectual disabilities to be more engaged and included in everyday activities that make up ‘an ordinary life’.

Active Support is a person-centred approach of support for people with learning disabilities and behaviour which challenges services.

This approach:

• supports people to have an ordinary life
• promotes inclusion, independence and choice in everyday activities
• improves staff team confidence and morale
• turns person-centred support into person-centred action
• supports services to show quality of life outcomes.

For further information and to book your place please contact Liz Soames, quoting ref: AS/WM2012

• Email: liz.soames@arcuk.org.uk
• Telephone: 01246 555 043

Active Support is an evidence based model of support that increases participation in everyday life for people with learning disabilities, at home and in the community. There is a considerable amount of evidence that shows that where Active Support is embedded within a service it has effectively increased the amount and quality of support provided by staff, to people with moderate to severe learning disabilities, enabling a person to have a better quality of life. People are supported to take part in their own lives with just the right amount of support to achieve successful outcomes.

The ‘Creating an Ordinary Life’ Project is a great opportunity to be kept informed, and supported to be at the forefront of service development in the learning disability sector.

During this three year Project, ‘Creating an Ordinary Life’,  ARC will be working with 30 ARC Members across England and will offer five days support to each service, which includes Active Support training and on-site Interactive Training, as well as support with outcome monitoring and evaluation.

The main aim of the ‘Creating an Ordinary Life’ Project is:

To focus on improving the quality of support for people with learning disabilities, working with the individual and support staff to deliver a more person-centred approach to living more independently.

To achieve the aim of the ‘Creating an Ordinary Life’ Project we will:

• Deliver five days training and support to 30 services across England to embed and sustain Active Support within their practice.
• Develop an Active Support Induction package for services to use as part of their induction process.
• Design a promotional pack aimed at parents and carers showing what Active Support looks like in practice and how it empowers people to have an ‘ordinary life’.
• Arrange for a national conference, aimed at providers, clients, policy makers and commissioners promoting the benefits of Active Support and the outcomes of the Project.  The conference will include presentations from clients, parents, carers and providers and launch both the Active Support Induction and the Active Support Family’s Packs.

Latest Project information:

• Two Promotional days were delivered to promote the ‘Creating an Ordinary Life’ Project and we now have ten pilot services already signed up in the East Midlands to year one of the Project and have been received their support from the project team.
• A further 20 Services for Year Two of the project have now been selected and are being contacted to arrange the training.
• An Advisory Group has been formed and the first face to face meeting was on 24 September 2012 at the Chesterfield office, with  representation from The Department of Health, Mencap, Autism Care UK Ltd, The Challenging Behaviour Foundation, Perthyn, The Avenues Trust, Nottingham Community Housing Association, Derbyshire County Council, Helen Sanderson and Dr Edwin Jones. A further teleconference meeting was held on with the Advisory Group on 14 January 2013.
• An e-forum has been set up for those working in the project pilot services, enabling them to keep in touch and to share the ideas and issues that arise as they are implementing Active Support, and to receive on-going input from the Project Team.

Future Plans:

We are now in the process of contacting the further 20 Services who applied to join Year Two of the project.

These 20 services will again receive four days of free support, and will only need to cover the Project Officer’s expenses. Training and support will be starting in April 2013. Throughout the project, and after the grant funding ends, ARC members can benefit through buying in the expertise of the Project Team.

Creating an Ordinary Life Newsletters:

We are sending out newsletters to our members with updates about the project which can be downloaded here:

• Creating an Ordinary Life Newsletter Issue 1 (October 2012)
• Creating an Ordinary Life Newsletter Issue 2 (January 2013)