24 June 2019
This week, Elly, fulfilled one of her life goals – to drive a tractor. She did more than drive a tractor actually, she spent time ploughing a field bringing together her love of vehicles and enjoyment of land-based activity (she has a flourishing allotment!) She did all this whilst working as an Expert by Experience for You First, feeding back key information, ideas and suggestions as part of a pilot project we are currently running in Devon. Her contribution is something we value very highly and she’s two weeks in on a 6-week course.
Elly will tell you that she has had quite a journey in her 30 odd years on this planet. This has included time spent in mental health secure hospitals and following that receiving social care support where she was staffed 3:1. This was obviously a massive restriction and frustration for her as well as bringing a significant cost to the Local Authority.
During this period, she had a lot of unhelpful labels attributed to her that conspired, unfortunately, to be something of a self-fulfilling prophecy. This was a very unhappy time for Elly and a very anxious one for her family. Elly is acutely aware of these labels and the fact that she was given them still hurts her and they still haunt her. You First determination to remove the labels and see the person, has supported Elly to grow the confidence and self-esteem to achieve all that she has.
This has been something of a transition for Elly, travelling from suffocating support to a life where she is continually realising personal goals and ambition; it’s a significant and on-going journey.
Elly has had other trumphs:
• She had her first holiday without her parents supported by You First. This was a big step in trust for her and her family. She had a great time and a further holiday is planned for the autumn.
• Elly now accepts an annual health check, including blood tests, something that she would not engage in before. She has also been admitted to hospital for wisdom tooth extraction, without family needing to be present, and without having to be sedated to get her through the hospital doors; and without her needing to have a 4:1 staffing ratio to achieve this, as was previously the case.
• Elly had her first boyfriend - supported by You First. We helped her manage her family's anxieties about this and to understand what a respectful, healthy relationship feels like.
Elly has a Life Plan, a plan that is formulated as part of our Design4Life! tool. This is a person-centred, outcome-based Plan that recognises that hard outcomes will only be delivered by initially focusing on softer outcomes. Before Elly was ever going to step on a tractor she had to grow in self-esteem, confidence, self-belief and being able to value herself and have a genuine belief she could actually do these things. Delivering these softer outcomes was a process, not an event and they had their beginning in one very simple practice – listening. We listened to her. Elly was used to being controlled, “done to” as opposed to “done with” and seen as a “problem” or “difficult”. We stepped back, shifted the balance of power to where it rightly belonged – her, and listened to what she had to tell us. This gave her genuine control and she began to map out a vision of what she wanted from life and what she could contribute as an active and valued citizen.
Equally key to delivering these critical soft outcomes was a high level of staff support that built resilience into individuals and therefore the team.
This support, which will be on-going, is central to Elly being supported in a way that makes sense to her and builds consistency and continuity both in terms of personnel and practice. This invaluable investment in staff ensures that Elly is supported by a dedicated team that she has chosen for herself. It’s possible to have a consistent team that deliver inconsistent support and time spent discussing, reflecting and evaluating is therefore critical. Robust de-briefs, regular one-to-ones, personalised training, team meetings – practices that again all have listening at their core have been and continue to be pivotal in supporting Elly to experience real, meaningful and purposeful outcomes.
Outcome Based Support
There’s some key theory around this that supports the delivery of progressive support and that’s about understanding the difference between Process and Outcome goals.
Outcome goals are all about the aim; what change will be generated? What is the end result the individual wants? This is about the bigger picture and here the focus is on the end result with a predictable outcome. There are, however, real risks to be aware of in this, most especially one of developing a fixed or blinkered mindset that can lead to valuing the result over the process. It’s vital we remain aware of this danger.
Process goals are all about activity; what is it we need to do in order to deliver the outcome? This is where the softer outcomes will sit as there will be key activity around supporting someone to grow in confidence and self-belief – fundamental building blocks to delivering outcomes that are genuine and sustainable. Also, with the focus on process these outcomes are the ones that build quality into the process. Process goals by definition focus on the process as opposed to the end result and are developmental by nature and far from risking a fixed mindset foster a mindset of growth. Process goals support the delivery of outcome goals and are absolutely crucial to robust, sustainable, genuine quality outcomes.
Elly had clear Outcome goals, including wanting to work, earn money, go to college and have a home of her own. Indeed, Elly is negotiating with Estate Agents to find her permanent home, via the My Safe Homes -Scheme supported by her team at this very moment.
The quality Process goals that have enabled Elly to build and grow her life focused upon Elly building resilience through gaining belief in herself, working on coping strategies, for example how to manage sensory overload. It’s easy, very easy, to lose sight of the importance and value of what are often called the “softer outcomes” but without valuing and investing in the process and building real quality into this there is a genuine risk that any resultant change will be temporary and fragile at best. At worst vulnerable people will be set up to fail.