One way instead of ten
It has been 2 years since our CEO approached me and told me all about an initiative that she had seen at an ARC Conference. It was called Active Support and it was, in a nutshell, about 10 people showing a person how to do things 1 way instead of 10 different ways.
It was felt that Active Support would benefit our tenants who lived in Supported Living. I was asked my views on what I had been told and if I thought that it would be something that we could sign up to. From this initial conversation I couldn’t see any reason why not. If anything, the least it could do was to give our tenants a more ‘structured’ approach to learning how to do things. Now here we are, 2 years later and it doesn’t seem that long ago that we all did the training day!
The Supported Living side of our organisation consists of 5 houses, 15 tenants with Learning Disabilities and 16 staff. As we didn’t know what house we would start at we arranged for all of our staff, who were available, to attend the training day. As it was something that no one had done before there was both excitement and anxiety floating around the room. Christine soon made everyone feel at home and the training was both informative and enjoyable. Trying to get someone to peel a carrot, who couldn’t see was funny, frustrating and thought provoking. The videos also made you stop and think about the things that we could do to help make our tenants that bit more independent. I’ve got to say that the staff group all enjoyed the day and they all took something specific away from the day.
Then the hard work started. What house would we use as the pilot? What would be the best thing for the tenants to work towards? What paperwork should we use? The list goes on. Needless to say, after a few meetings with my Senior Staff and many hours contemplating what to do, we had a plan!
We chose to pilot the project at the house that had 3 male tenants. Mr J is blind, Mr D is very partially sighted and Mr R has Downs Syndrome. This was due to the obvious differences between the 3 tenants and the fact that they could be reluctant to try new things. It is also one of our houses that has the highest number of staff on the rota.
First Steps
The first thing that we did was to have a tenants meeting to discuss Active Support. Both myself and the lead Champion went to talk to them. We went into as much detail as possible, at an appropriate level for the tenants, to explain what the project was about, how it would improve their independence, what it would involve, what they would need to do and what the staff would need to do. As expected, they threw the first barrier our way – they weren’t very keen on the idea but the more we talked about it, the more they seemed to embrace the opportunities that this would give them. It was felt that the first activity should be something that they would all do. This was so that they could see each other doing it and didn’t feel as though it was just them. It was also because they couldn’t think of what they wanted to do. Mr D actually said ‘how can I choose when I don’t know how it works yet?’ – fair point! After a while it was felt that mopping the laundry, kitchen and dining room floor would be a good starting point, as non of the tenants did that, at the time.
We needed to change OUR way of thinking
Next came the paperwork! What should we use? Should we backward chain? What are the individual stages to the activity? Who’d have thought mopping a floor was so complex? That is when I had my personal ‘light bulb’ moment. To me mopping a floor is like getting out of bed. But I was only shown how to do it by my Mother. I also had the added advantage that I didn’t have any kind of disability. Although we always break things down for our tenants we weren’t actually breaking them down enough. Yes they were learning how to do things and, in the process, becoming more independent but we needed to change OUR way of thinking to give the tenants the best possible chances. We wrote down all of the individual stages of the task, even the smallest things, and from there we developed the opportunity plans for the tenants. Although they have their various disabilities they are all quite capable of doing a lot of things. With this in mind we decided that it would be best for them to do this from the beginning of the task. We did speak to the tenants about this and they agreed that they would like to start at ‘the very beginning’ – Mr J.
By the time that we had held the meetings, sorted the paperwork out and were ready to start, some of the staff had started to have little, niggling doubts, as to if it would work at that house. The main barrier that the staff thought would prevent Mr J & Mr D from getting anything out of the project was the issues with their lack of sight. It wasn’t that they weren’t willing to try but there were concerns about how they would feel if they ‘failed’. I explained to them that this isn’t a pass or fail situation and that Mr J & Mr D were both aware of this. It is also not a pass or fail for the staff. No one was going to be spoken to if the floor wasn’t perfectly clean. It is more important that the tenants are being supported in this activity.
Tenants – Apprehension and excitement
The tenants were a little apprehensive, but also excited, when they started the task. They had 2 days each that were designated for them to do the floor. It started off slowly and they moved onto the next stage of the task when they were ready to do so. They were always praised for their hard work, encouraged to keep at it and explained things that were not quite right. They were never made to feel bad if one of their housemates had moved onto another stage. If anything, they were genuinely pleased for each other. We only used Opportunity Plans, which the staff completed every time the task was done. These were used for about 3 months. The only reason that they were stopped was because the tenants were now doing the task from start to finish and they always had smiling faces on their plans. The activity continued though.
Through doing the project it has given the tenants more control over their home and they have achieved not only a new skill but some other, important life skills. They now feel that they have a little more ownership of their home. This is because they are able to do a task that was once something that was done for them. It was always a struggle, especially with Mr J, to get them to ask the staff to help them to do things for themselves. This has improved greatly during this time. They will now ask the staff when they want help with something. They will also ask me if there is something that they want to know, or do, instead of passing it through other staff members, or even tenants. Their self esteem has also improved. Mr R hasn’t got very good communication skills. He does communicate verbally but it can be extremely hard to understand what he is saying. He will now communicate with the staff more. This has been noticed by all of the staff. They have also commented that he tends to communicate more when he is with you 1 to 1 and when he is in the kitchen. It has given them a little more confidence. Although there haven’t done any ‘new’ things they are more confident in the things that they do do.
I have spoken to the tenants, at various times throughout the project, and we have talked about Active Support at their tenants meetings. All 3 said that they liked doing what they had done. Mr D & Mr J both said that they felt that they had learnt something from it.
During the course of the project Mr J has decreased the amount of medication that he takes and Mr D has improved oral hygiene. We don’t know if this is directly related to the project but it certainly hasn’t done any harm.
For the last few months we have been trying to get the tenants to choose something else that they would like to do. This has proven to be quite difficult. Mr R said ‘Nothing. Mopping will do’. We have explained that it doesn’t have to be a household activity but could be something fun. [I think the reason for the hesitation is due to the fact that they already do daytime and evening activities, and they struggle to have some ‘me’ time] This has made them think and they have, eventually, come up with some things that they would like to look at. Mr J wants to do some exercise at home, Mr D wants help with his personal hygiene routine and Mr R is going to have a go at cooking.
Staff – Concerns
When the tenants started to do the project activities the staff did have some concerns. What if the tenants hurt themselves? What if the floor wasn’t clean? What if the tenants refused to do it? These things were discussed with the staff and they realised that there was no issues. If the tenants hurt themselves we would look at what needed changing. If the floor wasn’t clean it could be done again. If they refused to do it, it wasn’t a problem, just document it. Once they got into the new routine they all ‘ran’ with it. They realised that there were things that the tenants could be doing more of and they encouraged them to do it.
Our company Mission Statement is divided into 2 sections – Our Values and Our Attitude. The phrases in these two sections spell out 2 very powerful statements – Our Values = STRIVE, Our Attitude = CAN DO. I think that this is something that the staff have been demonstrating whilst doing this project. They STRIVE to assist the tenants to take part in their tasks. They have also reinforced their attitude towards the tenants as they now know that the tenants CAN DO more for themselves and the staff CAN DO something to help the tenants achieve more.
The culture of our Supported Living has always been to assist the tenants to lead fulfilled lives and become as independent as possible. This is done in various ways and includes various things. The project has helped to reinforce this way of thinking among the staff because it is all about the tenants doing things independently, or with the assistance that they really need and not what we think they need.
We are quite lucky in regard to staffing. We don’t have a huge staff turnover & most of the staff have worked with us for years. We have a rigorous ‘vetting’ procedure and we like to ensure that we are employing the right person for the job and not just the first person who comes along. With this in mind we have not had to include Active Support onto any Staff Inductions. However, our induction pack is under review at present and it is something that will be added into it. Active Support is discussed at all staff meetings and we have also used it as a staff supervision topic.
Case Study
Mr J is a 66 year old man with learning disabilities and has been blind from birth. He lives in Supported Living. He shares his home with 2 other gentlemen and has daily staff input.
Although Mr J lives in supported living he tends to do as little as possible. He will quite happily wait for someone else to make him a drink, call him for meals, clean the house etc. He had worked out who would give into him quicker than others and used this to his advantage. If you asked him why this was he would say that he didn’t know or that the staff liked to do things for him. He has, over the years, got a little better at doing things but he can still be very reluctant. He also doesn’t like asking people to help him do things. However, when he does things for himself, with help, he is extremely proud of himself.
When we first talked about the project he was very excited to be doing it. He agreed that mopping the floor was a good idea and he had a big smile on his face.
When all of the paperwork was done and the project could actually start, he couldn’t wait for his day. However, like most of us, the excitement soon diminished when it can to his first attempt. He seemed to hold back a little and the smile had suddenly disappeared. This was his way of saying that he was worried about it, although he wouldn’t admit it!
He started off with 3 easy steps – get the mop and bucket from the shed, get the detergent out of the cupboard, add the detergent to the bucket. The staff were by his side for every stage. They talked him through each step and got him to feel the different objects so that he would be able to recognise them again. When he realised that this was all he had to do he relaxed. This continued until he was ready to move onto the next stage.
Then came the cause of both excitement and anxiety for Mr J. He now had to remember the things that he was already doing and also learn some new things. He now needed to go through the stages of – putting the bucket in the sink, half filling the bucket with hot water, putting the bucket back on the floor. Again, this was done with full support from the staff. They explained to him which the hot tap was and how he would be able to tell if there was enough water in the bucket. Mr J continued to do these 2 parts of the task until he was ready to move on.
Finally, when he was ready to move on, came the actual mopping stage. He was more cautious with this stage. He couldn’t wait to give it a go but he was also a little worried. The staff were with him all the way. They explained that he couldn’t harm anything as the flooring went up the wall so he didn’t need to worry about knocking the skirting board.
Mr J thought this part of the task was great. He said ‘I like the feel of swinging the mop’.
Over time he moved on from just mopping the laundry room to include the kitchen and eventually the dining room. He still does this activity now. He doesn’t do it as often as before but that is due to the other activities that he does throughout the week.
At the start of the project he was taking medication for depression. This was mainly due to the effect that closing the local authority centres had on him. Whether coincidence, or not, he has now reduced his medication and is looking to come off it completely.
Mr J will now make a point of asking the staff to help him do things and he will also try to do more for himself. I was there recently and noticed that he had done his own breakfast. In the past he wouldn’t have attempted to pour milk onto his cereal unless he had asked someone to stand by him in case he spilled it! Well done Mr J.
AND
. . . . just for you all to see – Mr D & Mr R
Moving On
Our plan had always been to move the project onto our other houses, one at a time. This hasn’t proved to be quite as easy as we had hoped. The first house that we looked at moving this onto was to help assist a lady who was showing signs of dementia. Following an assessment that she had done we noticed that the paperwork we needed to complete for it could be adapted for the Active Support. However, by the time that this was ready to be started she had become too poorly to do it. Due to all the other trappings, which came with the illness and subsequent passing, we felt that it wasn’t fair on the other tenant, or the staff, to look at starting something new.
We then looked at moving it onto another house. This house had been chosen next as they had a lady who was becoming very forgetful and we wanted to make her life that little bit more easy. We had to start off with explaining what Active Support was to the 3 tenants living there and had a few discussions on what they would like to do. Again we hit another problem. The lady that we wanted to do this for suddenly became ill and subsequently passed away. We felt that it wasn’t appropriate to continue with moving the project on, at that time. Both of her housemates, and all of our tenants and staff, needed time to grieve.
We are now in a new year and, fingers crossed, we will be able to move the project on. The 3 tenants from our pilot scheme now seem more comfortable in starting something new. Everyone has had time to grieve the loss of our 2 friends so we will be looking at moving it along to the second house mentioned. You may be wondering why we have chosen this specific house. The reason for this is because we are hoping to have a new tenant, in the near future, and what better way to help her get into a new routine?
CEO
Having attended an ARC meeting where there was a very clear presentation explaining the benefits of Active Support and the processes used I felt this could be beneficial to the tenants and staff whom we support at Halas Homes.
The presentation video shown demonstrated the advantages of a clear and consistent approach to daily tasks that could be overlooked within anyone’s daily life. Whilst this was a little while ago I remember thinking at the time, how fundamental it is to ensure that we don’t confuse people when we are in fact only trying to help.
The video showed tenants and support staff preparing a meal and peeling vegetables.
There was a small clip or discussion about how to put a duvet cover on a quilt which when broken down revealed just how many combinations there are to this seemingly ordinary task we all perform.
I met with Joanne our Support Manager upon my return and we discussed the ‘duvet’ dilemma and other scenarios. We agreed that whilst we have 16 staff who are all inducted thoroughly into their roles we could potentially have 16 variations of supporting various tasks such as changing duvets, peeling vegetables or indeed any other variety of activities!
It became obvious that Joanne felt Active Support would be a beneficial programme to pursue and she has worked hard with her team of staff to keep it live and relevant. Unfortunately last year was a particularly difficult year within our support arm with staff having to face bereavement for the first time and this impacted on the implementation somewhat. However, the project did continue and outcomes were achieved and we learnt through the programme. Joanne and her team have utilised, adapted implemented paperwork and cascaded the project via planned supervisions and discussions.
Clearly there is evidence that the programme may have had positive health and wellbeing results and the preparation time resulted in good team work and problem solving techniques. Tenants benefitted through having further opportunities to take choice and control within their daily lives and even challenge their own and staff attitudes allowing personal development and growth.
The future of Active Support
Joanne and I have discussed how this programme will go forward. Joanne has met with tenants and staff and it is agreed that there is scope to move forward given the change of circumstances with particular clients and locations. Clients have already chosen their activities and as we update our inductions for support we intend to expand to include Active support with ‘Champions’ inducting Active Support.
Overall we are grateful to have been part of this project and consider it to have added value to our organisation.
Alison Sayer
CEO
Halas Homes