A change of approach

In late 2015, I moved services to oversee a supported living home. The staff came across as caring, supportive and wanting to help people with their daily activities and life skills. The staff team is mostly female staff- which is not a problem at all, however I did notice that their approach to the people we support was more motherly than adult to adult support.

It took some time to explain to the staff what I was expecting to change and to see that change happen. It took a good year to chip away at this approach of over supporting as I really did not want to break the relationships that had grown over the years between the people we support and staff, but I wanted to make it an equal relationship: adult to adult.

How change happened-
When I came across to work at St James, I was asked by the compliance team if Bernard required support with personal tasks. If he could not do certain personal tasks for himself it would mean that he would be regulated under CQC.

I could see that Bernard was being supported with things like zipping his coat up, lacing his shoes, brushing his teeth and shaving and I thought to myself “Why this is happening? Could Bernard do the tasks himself? How could I make the tasks achievable for Bernard?”

I carried on observing the staff supporting Bernard, asking questions when certain personal tasks were taking place. “Why did you lace his shoes up?” I would be informed “He can’t do it”. I would ask “Why don’t we buy shoes that have Velcro across them?” Staff would reply “I suppose we can”.

I could see the warmth staff had towards Bernard, how much they made sure that he was healthy and looking well, but I began to challenge the way things were being done. I made sure I did not overwhelm the staff who were carrying out tasks, by carefully using the facilitation skills to support them to stop and reflect on what they were doing and how things could be different.

Due to staff shortage I had to cover shifts and I started to encourage Bernard to do certain tasks for himself. I was amazed! I would stand back and say “Lace your shoes Bernard” and you can imagine my surprise when he did this with ease. I would say “Zip your coat up please” and Bernard did it, no problem at all.

I began to encourage more stepping back from the staff team, explaining that I understood the care and the support they were giving, but we needed to start to empower Bernard to do more for himself.

I spoke about the 10 facilitation skills with each member of staff; breaking it down and relating the skills to the support that member of staff was giving. Now, after a good year and a half, I can see a big difference. Things have changed… a lot!

Staff are asking themselves questions before supporting people and also reflecting afterwards. They are thinking “Why am I doing this for this person?” “What can I do or change so this person is able to do the task themselves?”

Staff are being more creative- one example pops to mind. Bernard’s money is kept in his safe which is located in his room. Bernard can at times say “no” to staff entering his room, so it was difficult to access the safe for his money. To cut down on his anxiety when staff go into his room, staff now give Bernard the safe keys and he will get his money box out of the safe and bring it to the staff and also return it.

I am pleased to say that Bernard now laces his shoes- staff have stopped doing this. He is encouraged to brush his teeth and has an electric shave with just some verbal prompts. Staff are being responsive, stepping back a lot more and only stepping in when needed.

Taking the approach of ‘we are all adults, let’s treat each other equally’ has had a big impact in the house: paperwork we would normally fill out, like best interest, we are encouraging the person to do it themselves; arranging holidays, where possible the person is booking it over the phone themselves.

The support we provide has changed from ‘motherly’ to using the 10 facilitation skills: we now encourage people to take control.

Sandra Hughes
Frontline Leader
Wirral

Comments

  • Carol Groom says:

    well done Sandy

  • Kate Webb says:

    I always have to remind myself to step back, over supporting is all too easy and can lead to a ‘learned helplessness’ well done to everyone for making the changes. A lovely blog, thankyou!

  • Emma Killick says:

    Excellent Blog Sandy – you’ve described very clearly the difference between caring support and facilitating, empowering support. You’re recognition of the mutual value of the relationships that existed was very important as was your long term approach to gently challenging the balance of power that inadvertently had been created.
    Encouraging a reflective culture – asking the question “why do we do things this way and is there a different way?” is a great leadership skill – well done to you, to the staff team and to the tenants.

  • Marina Clark says:

    What a great blog Sandy – and fantastic achievement in a year! sometimes it takes a pair of fresh eyes to see what can be improved, and it’s important to be tactful so that people are empowered and don’t feel they have been doing it all wrong! thank you for sharing!

  • Laura Selby says:

    What a great read Sandy !! Its so good to see how your approach and support to the team has given real empowerment and independance to Bernard.

  • Leander says:

    Hi Sandy

    Lovely reflection and great approach – well done to all involved.

  • Tess Marshall says:

    Great to read this, Sandy. I know from my own family experience how easy it is to over-support. It’s never done intentionally or without the best intentions and it can be difficult to step back. Full marks to your team for doing this.

  • Sandra says:

    Hi All
    Thank you so much for the feedback- I will make sure that all the comments are shared with the team.

  • Anthony Tull says:

    I am trying this approach with some of my friends and have told them that Failure is what you make it, it can either be Doom or it can be an opportunity learn and get help. Personally I prefer the latter.

  • Anthony Tull says:

    I remember going to a house where one of the People we Support lived and saw that he did not have his tea cooled so when I went back to Y-base the following Monday, I asked my line manager “why are we cooling [Name’s] drinks, he does not have it cooled at home?

    I also took the same approach when I started working at Beanhill for the drinks at break times, The Y-Base was too small to safely move around people.

  • Alicia Dominguez says:

    This written blog is totally right, I become from Spain and there in mostly place people who support adult with learning disabilities treating them as children and always I thought that they may treated them as adult to adults.

    Thank you for your reflection,
    I really appreciated.

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