‘TIME TO THINK’ Specialist Community LD Team Meeting 14 th May 2003
‘TIME TO THINK’
Specialist Community LD Team Meeting
14th May 2003
‘By examining and understanding the past, we can move into the future
unencumbered by it. We become free to express ourselves, rather than endlessly
trying to prove ourselves’
Warren Bennis
‘The source of all energy, passion, motivation, and an internally generated
desire to do good work is our own feeling about what we are doing’
Peter Block
Agenda
A Thinking Environment is the core of team effectiveness
Key Components Behaviour Guidelines Managing Interruptions
Recognising Achievements
LD Team Review Update New Staff appointments Commissioning priorities
Hopes & Concerns
Identifying Priorities
A Strategy for Resolving Conflict – ‘Timed talk’
Any ?s Referrals/Allocations Cross-Team referrals Team meetings Communication Role clarification Key future Health and Social
work developments
The Thinking Environment
Everything we do depends for its quality on the thinking we do first
A Thinking Partnership is a personal and professional imperative
Our thinking depends on the quality of our attention for each other
Thinking at its best is not just a cool act of celebration – It is also a thing of the heart
Critical Components of a Thinking Environment
Attention – listening with respect and interest
Incisive ?s – removing assumptions to free ideas
Equality Giving equal turns/attention Keeping agreements
Appreciation – 5:1 ratio
Ease – offering freedom from rush or urgency
Encouragement – moving beyond competition
Feelings – allowing sufficient emotional release
Information – full and accurate reality picture
Place – creating physical environments that say ‘you matter’
Diversity – adding quality because of differences between us
Behaviour Guidelines for the Thinking Partner
Pay unbelievable attention to the Thinker, even if you don’t agree with them or like them
When you are listening, keep your eyes on their eyes – Don’t look away
Look interested; or rather BE interested Make sounds only occasionally to indicate understanding
and encouragement Be at ease – Nothing horrible is about to happen Smile occasionally – when not interpreted as derision
Behaviour Guidelines for the Thinking Partner 2
Don’t even think about interrupting Don’t be picky clarifying or confirming questions unless
you are so confused you feel faint When your partner has nothing more to say – ask ‘What
more do you think or feel or want to say about this? If the Thinker becomes quiet, but their eyes are alive,
relax. They are still thinking. Leave them to it. The fact that they are not talking does not mean they are not thinking
Managing Interruptions- Challenging Unhelpful Assumptions
‘My idea is better than theirs’ ‘If I don’t interrupt them, I will never get to say my idea’ ‘I know what are about to say’ ‘They don’t need to finish their thought since mine is an
improvement’ ‘Nothing about their idea will improve with further
development’ ‘I am more important than they are’ ‘It is more important for me to be seen to have a good idea
than it is for me to be sure they complete their thought’ ‘Interrupting them will save time’
Recognising Achievements
What is going well in your work or life?
What do you think we have accomplished?
What successes have you had?
What are you most proud of? For people with ld, families, staff and the service.
What have you discovered about yourself?
Recognising Achievements 2
What do you think is going well in our local service?
What is the key thing that you want to improve?
What is stopping you?
How?
What support do you need in order to do it?
Update on the Review of the Specialist Community Team
Presentation to Halton LD Partnership Board
16th April 2003
Community LD Teams Review
The Continuum of Joint Working What is the Team Like Now? What is it set up to do? How does the Team work with other people? How the Team works
What it is like for people to get help from the team? Comparisons with other teams in the UK?
How is the Team set up? How does the Team link with others? Team systems/processes How have people in the Team been feeling?
Towards A Integrated Health and
Social Work Community LD Service The Continuum of Joint
Working Communication
Agencies work separately
Little overlap, big gaps Collaboration
Agencies work together Some overlap/separate
Full Integration Single service Almost total overlap
How Far Do We Want/ Need To Go?
Integration Issues ?s Philosophy/Systems/
Policies Roles Referrals Assessments Care Plans Placements/Packages Care Management Training Team Bases Management Employment Change Process/Time-
scales
What makes an Efficient & Effective Team?
Well defined aims and objectives Clear procedures to identify and resolve/de-
personalize problems and conflicts as they occur. This is seen as being ‘mainstream work’ and not an occasional hiccup which they were neither expecting nor prepared for
A clear pattern for team and other meetings A system for sharing information with each other
and with external bodies Agreed ways of monitoring it’s work
The Specialist Community Team - for People with LD and their Carers
The Team encourages a flexible, pragmatic and non-dogmatic approach to developing health/social care interventions, which take into account: physical issues, lifestyle factors, cognitive/emotional variables, health, relationships, and the impact of a person’s prior life experiences
The Specialist Community Team - for People with LD and their Carers
The Team works both directly with individuals and indirectly with their carers/services to: Develop accurate understandings of individual needs and
the situations they find themselves in Increase the shared understanding of the reasons for any
presenting challenges/difficulties Raise the expectations about what is possible, both for
individuals themselves and those who influence their lives Maximize people’s capabilities Minimize the unnecessary involvement of specialist
services, and increase the competence of ordinary supports
The Specialist Community Team - for People with LD and their Carers
The Team provides focused support and practical assistance to improve the quality of life of individuals with learning disabilities in Halton, in line with recognized good practice:
A wide range of co-ordinated community support services Individualized assessment & specialist health/social
interventions Advice and consultation to other learning disabilities service
staff Development of good practice policies/protocols in relation to
the promotion of positive health/social care experiences Training, development and research activities which support
the availability of effective and high quality local comprehensive integrated services
Past Issues/Questions Identified
Timetables for change Team and professional
management structures Professional supervision Relationships with LA/
PCT/HA/Joint Commissioners
Estates/IT/Admin support Financial protocols Balancing responses to
Urgent Referrals & Development/ Therapeutic work
Mixed Eligibility criteria
Case and workload allocation systems (inc. paperwork)
Regular joint working/shadows
Fairness/equity in Resource Panel decisions
Quality vs quantity targets Access to notes/info Communication Accountability/Complaints Abuse &Vulnerable People
Adult Protection Links with Providers
Key Elements for a Supportive Work Environment
Clear, common inspiring goals High level of trust Respect and appreciation A sense of team Comfortable, clean, orderly physical environment Adequate resources Opportunities for input into decisions A solutions orientation People taking responsibility Authority appropriate to responsibility A can-do, positive winning attitude as a way of life Encouragement to try new ideas High priority on growing and developing people Honesty and truthfulness culture
Key Elements for a Supportive Work Environment 2
A place where management says what it means, means what it says, and does what it says
Thorough communication based on integrity A focus on high quality standards and ability to set targets Freedom to do the job To be an example of how to be Adequate compensation and other rewards Appreciation for the service and people Stimulating, challenging work Responsive, caring leadership A supportive, warm and friendly atmosphere People willing and eager to serve A high level of professionalism Empowered people open to change A fun, prosperous, growing workplace
What is the Team Like Now?
Fully integrated team-working providing a single service with almost total overlap and New Name
Integrated training/development programme
Single point of access for health/social work referrals Common Contact Assessment/Core Client Database
Integrated health/social work team management Shared initial Single Assessment Process
Essential Info Record/Access to Info from previous records
Case Allocations meeting Common Care Plan/Review systems
Care 1st/Performance indicators
Agency Contract Reviews
What is the Team Like Now? 3
Each professional team member now takes on 3 roles Individual Named Person/Service Care Co-ordination Specialist Professional practice Training/Project/Clinical specialist development supporting
‘Valuing People’ targets Community care tasks, Day services, Housing, Respite,
Transition, Joint Training, Carers Abuse/Vulnerable witnesses, Complex challenging needs
(Challenging behaviours/Forensic/ Mental health), Multiple disabilities (Physical/Sensory/Mobility), Physical health (Health action plans/Primary care & Hospital liaison)
Developing integrated Workload Review Management systems
Examining the impact of ‘Agenda for Change’
What is the Team Like Now? 2
Inter-disciplinary team membership including: Admin. Support, Community Care Workers, Social Workers Admin. Support, Clinical Assistants, Clinical Psychologists,
Community Nurses, Community Support Workers, Occupational Therapists, Physiotherapists, Speech Therapists
Clear Professional leadership and supervision arrangements
Shared fortnightly team meetings -Revised format Referrals, Updates, Critical case/Development projects
reflection
2 developed/extended shared Team bases Fortnightly Resource Allocation Panel meetings
Revised common resource application forms
Hopes & Concerns
Divide into 5 groups Managers Professional groupings
Admin Nursing Social Work Therapists
Each person to identify up to 3 Hopes and Concerns for the development/future direction of the Team and Halton LD service
Share with other members of the group List up to 3 ‘Burning Issues’ you believe the service Write a summary list to feedback
Identifying Priorities
Each person to write down a comment/concern about a main issue that needs work (Maximum of 5 each)
Put up randomly, one person at a time
There must be NO reaction of any kind from other group members – no support, criticism, ?s or body language
Group members should not change their minds about an issue selected in view of what has gone before or say ‘I agree with Sandy’ – But use their own words
Identifying Priorities 2
Repeat until finished
Then group members can ask questions to clarify issues
Gradually merge and group issues of common concern
Vote for 5 priorities to focus on initially for resolution
A Strategy for Resolving Conflict - Timed Talk
Set timer for 3 minutes Take turns talking – 3 minutes
each Take as many turns as
necessary to resolve the issue Do not interrupt each other or
take over each other’s turn If you don’t need all of the time
in one turn, save it for your next turn
Stop talking the instant the timer goes off
Keep eye contact with the other person speaking
Focus on finding a good idea, not on winning
Remember how intelligent you both are
Remember that there is an better idea neither of you has yet thought of
Smile once in a while – appropriately
Breathe out If time runs out, schedule a
time soon to continue
LA Team Priorities (2003/04)
Increased range of services to vulnerable people Specialist Day Service development/delivery Drop-in day service options/Better use of existing facilities Shared ownership housing options
Early intervention/prevention Re-focussed respite to target ‘move-on’ experiences Housing option lists for all people living with parents aged 70+ Person-centred Transition support plans - 2004/05 leavers
Recruitment/retention Developed integrated PDP/Appraisal process/Training strategy PQ standard development/implementation New Practice Manager role
LA Priorities (2003/04) 2
Stronger/informed leadership + performance monitoring 3-monthly reflective review process for all complaints Continued team retreats/away days Joint workload management systems developed/implemented
Timely responses and reduced access waiting times Fair Access to Care training for all staff Refocused Resource Allocation Panel and meetings Reviewed Single Assessment Process ‘initial assessments’ and care
plans to ensure quality Adult Protection
Clear local procedures to translate new Adult Abuse policy Training implemented on Adult Abuse/Vulnerable Adults for all team Developed role of new Practice Managers as leads on Adult Abuse
LA Priorities (2003/04) 3
Intermediate Care Formalise joint protocols for accessing support from RARS Clarify support arrangements for clients admitted to hospital beds and
care pathways for discharge arrangements Direct Payments
Additional internal and external training Identify team champion/increase use of ‘Personal Assistants’
Service user/Carer involvement and feedback Regular user/carer–team consultation and review sessions Develop options for funding users to translate all team resources into
‘user-friendly/jargon-free/more accessible’ materials Develop ‘estate-agent/dateline’ compatibility process and review all
existing clients in supported housing to see if changes/move-on’s required
LA Priorities (2003/04) 4
Money/Resources & Planning Refine information entry processes and ‘checking it is done’
mechanisms Review/develop agency contract review meetings
Information Management Utilise new Principal Manager post to record achievements/ progress
more effectively and PR in writing Training for whole team on Care 1st to ensure ongoing data entry to ‘hit’
Performance Assessment Framework targets (especially all admin staff)
PCT Health Priorities (2003/04)
Yet to be defined and agreed ? Specialist LD resource reconfigurations (5 Boroughs
Partnership Trust) ? Health Action Plans and Facilitation ? Team-led clinics ? Complex needs ? Training/Facilitation ? Continuing health care
Additional Info
Review of Community LD Teams - The Key Questions
Update Presentation to LD Partnership Board on the Integrated Health/Social Work Specialist Community Team (May 2002)
Draft Specialist Community Team Information Flyer
Community LD Team Essential Information Record
LD Resource Panel Application Form
Community LD Team Review - Away Day notes (November 2002)