A brief bulletin

Owing to unforseen circumstances – to strange, unexpected, and beyond your control “drink me” happenings -I am sorry to have to inform you that the White Rabbit will be unable to post for a little while ( actually I think  he is running from the Queen of Hearts – something to do with gambling debts! ) but he will return and be posting soon I promise.

STAY CURIOUS!

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White rabbit visits the east end

East End Eros - acrylic on canvas

I love to spend some Saturday afternoons in the East End taking pictures of the street art that shouts out for attention from the walls, shop-shutters, bridges and other unexpected surfaces around Brick Lane and Shoreditch . They’re snapshots – moments in time – and I’m aware that as soon as I walk away the sunshine, rain, wind, and the spray cans of other graffiti artists will alter them. They are out in the real world, not in a gallery, so they will always be works in progress. I decided to paint some of these snapshots. To capture them on canvas before they were altered.

Now that’s ok in art, but I am learning fast that a snapshot of a client is never enough to work with when doing a support plan. They are a work in progress and that must be taken into consideration. Other, far more experienced  people than me, who work in adult social care are saying the same things and looking for ways to improve the way assessements are carried out.

I was reading the post “making adult social care better 1” on the excellent blog – fighting monsters (see links). It talks about the “effect of 15 minute “spot” visits” and that they are “part of the lack of dignity present in the care of older people”. The post goes on to say that what is needed is “some sort of enterprise to focus specifically on support planning and advocacy for adults with dementia”. Alexfoxblog (see link) in his latest post makes the point that to get access to money now you must be able to prove how bad it is now – thus preventing any financial support for preventative measures that may well save money in the long run. He believes it is important “to assess the individual’s direction of travel, not just a snapshot of their current problems. How about an assessment which looked at the next 12 months of someone’s life, for instance? Where are they now, but also, where are they expected to be?”

As I’m learning to work with older people I am becoming aware that things can be more complex than they appear and cannot always be spotted on one visit. I am currently working on a support plan for an 84 year old lady. On my first visit her family said she had some cognitive issues, but they also believed she managed well enough on her own. It was only on my second and third visits that more information was forthcoming and I was able to observe situations which gave me cause for concern about my client’s ability to manage on her own. As a result one action I have taken is to ask the family to get a memory service referral from my client’s GP, so she can be professionally assessed for symptoms of dementia and then receive the appropriate support. I explained that this was necessary because – to implement a support plan that does not take into consideration some of the issues that may lie ahead for the client, really makes little sense.

A snapshot visit would not have been sufficient to ensure appropriate support was put in place. Having and spending the time required in order to see the fuller picture is essential if the personalisation process is going to work well for older people. I was surprised to discover that some local authorities are adding support planning to the workload of already overworked social workers.                                                                                                         How do social workers feel about this ?                                                                                            Is it simply about local authorities saving money?

As a full time support planner I do have more time to spend with clients. But are there enough support planners being trained nationally?

Does anybody have information about this? And what thoughts do you have on the subject discussed in this post?

Do post a comment and let me know.

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“Curiouser and curiouser”, said Alice.

I wonder what I'll find in here

I’ve worked in mental health for years and have always refered participants with financial issues around their support needs to the experts. My focus was on addressing issues of a different kind with them. As a support planner, however, I find myself very involved in the financial reality of my clients daily lives.

This is new to me. So I have become curious.

What are the financial problems around support needs that my clients face in their daily lives?                                                                                                                                            How can I improve my understanding of them and learn how to better support my clients?

My curiosity has me searching for support providers and user-led organisations that are using creativity and innovation to tackle the challenges posed by personalisation.  I want to take a good, long look at their ideas and how they are implementing them because I want to learn how to improve the support planning service I offer to my clients.

Curiosity requires time, so my search so far is not yet complete and will be ongoing. I have already found several that inspire me and I’m going to do a regular post that features each one. Then you can check them out too. You may be well ahead of me, have checked them out already, and know others I haven’t discovered. Please tell me about them and I’ll include them.

If you are one of these creative organisations then get on here and tell us about yourself – we need you.

Today I want to introduce you to : –

 RICHMOND USERS INDEPENDENT LIVING SCHEME       www.ruils.co.uk

In their own words, ” We are an independent, user-led organisation that is run and led by its peers – the people who use our services. We support older and disabled people, people with learning disabilities and people who use mental health services to live independently and to have choice and control over the support that they need”

Regarding personalisation they say :-

“We act as the champion, representative and peer supporter for anyone who has a Personal Budget and in particular a Direct Payment. Our aim is to ensure that people get the outcomes they want from their Personal Budget and Direct Payment and that it gives them maximum choice, control and independence.”

Here are some of the creative ways they do that :-

Buddy mentors – newcomers to the world of social care are assigned a trained service user volunteer as a buddy. He/she explains how the system works, including personal budgets, shares their own experiences, answers any questions they have, and generally acts as a support to them.

Direct payments pooling workshops  – Here they explore ways to ‘pool’ direct Payments so that the money will go further. They hear about real life DP pooling examples and meet the people who have done it.  The workshops take them through the ‘hot off the press’ DP Pooling guide.

 support brokers  –   clients are advised and guided on all aspects of planning and choosing their personal budget plan.

 creative opportunity events – where staff talk with clients about new ideas to make the best use of personalistion to improve their quality of life.

An on-line magazine – that outlines all of their projects and has articles on relevent issues

“Getting a social life” project – this is currently being set up

A direct payments pooling network – this is currently being set up

Go ahead and check them out – they really are worth a visit. I am arranging an actual visit so as to talk with them face to face and ask questions and listen intently. If you have any questions you might like me to ask them let me know. I shall post about the visit when it happens.                                                                                                                                                                                   STAY CURIOUS!

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The white rabbit feels his age

the white rabbit feels his age

At 53 I dont think of myself as old – most days! But yesterday, when I ordered tea and toast at my local cafe, the lovely, crusty bloomer slices that arrived gave me cause to reconsider. You see I simply couldnt eat them without first dipping them in my tea!!! The youthful ease with which I could chew through anything presented to me on a plate had gone!

What’s my point?

Getting older sometimes pushes me out of my comfort zone, and so does working with older people as a support planner. In my professional life in mental health I have never worked with older people but the support planning training I am receiving does not include support planning for people with mental health needs (more of that in a later post!) During my training, therefore, the client base I work with consists of older people, people with learning disabilities, and people with physical disabilities. Absolutely nothing wrong with that – its just not what I am used to.

The first client I was assigned was an 80 year old lady with early symptoms of dementia who could not speak a word of english – let me tell you – I wasnt just out of my comfort zone – my comfort zone left the building!!!!! But comfort zones are for cowards, right!!! So I strode head on into the challenge.

I would love to hear from anyone else who is finding that support planning is stretching them. I would love to hear from people who have experience with older people as well because I could really use the advice.

Firstly, it was a challenge because the language barrier meant it was only the daughter I spoke with, and that owing to cognitive difficulties the client did not communicate at all. Usually that would have been ok – the daughter would have articulated her mothers needs. But in this case the daughter informed me very early on that, “we are a distant, disconnected, and dysfunctional family” – a statement that appeared to be borne out by the somewhat chilly atmosphere between mother and daughter. Also what seemed like her desire to choose a personal budget package requiring she have only the minimum of responsibility for her mother’s care rather than one that truly met her mothers support needs.

Now, I helped nurse my mother through the years in which she deteriorated with vascular dementia. I know first hand the heartbreak and burn-out of looking after a sick and ageing parent. So I don’t judge a family that is experiencing the difficulties this brings on. I am simply stating that it can be a challenge for a support planner to work with a family where burn-out and sometimes resentment  has occurred. It can blur the family’s focus and make it difficult for them to see how important it is to ensure that the personal budget package they choose is the one best suited to meet their parents support needs even if it means continued involvement on their part.

The next challenge is that I am not a social worker. I am realising just what a difficult job they have. I am not used to meeting with clients in their homes, family contexts, and having to be alert to safeguarding issues there. In other words, I am not used to having to   find the delicate balance between helping the client and not pissing off the family!!!! I have already had to raise a couple of safeguarding issues with my manager, and then figure out how to diplomaticaly suggest ways of addressing them to the family – wow – way out of my comfort zone there!!

I guess I was under the misguided opinion that no matter what – a family would always do whatever it took to meet the needs of their ageing parents and be willing allies in the process of providing them with the best support on offer.  DUH!  I was wrong. Its a complicated world out there with all sorts of wierd and wonderful family dynamics going on behind closed doors. One could perhaps go as far as saying its a bit “through the looking glass”!!!!

The good news is that I have had my third visit with this family and not only am I getting much more comfortable out of my comfort zone but things are gradually improving and we seem to be making progress toward choosing the package mum really needs to have put in place.

I say again “you live and learn”

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whoops !

My secondment to support planning training means I spend 2 days a week in anunfamiliaroffice. It, therefore, takes me a while each week to re-orient myself into the role and to any new stuff thats gone on in my absence. Last tuesday I’d just sat down at my

"Noooo - I did what ?!?"

desk when the phone rang. It was a social worker wanting to speak to a support planner called Melody Harrison for an update on how her client’s support planning was going. I don’t know Melody, she trained in an earlier inset, so I told her I would find Melody’s contact details.

Since my last stint in the office a list had been put up by each computer containing all 18 or so support planners names and information. Not having had the opportunity to have a good look at this I quickly scanned it for Melody’s name. I found it, and noticed that in the next column it stated, “At home after hospital”. “Oh dear”, I thought, “poor Melody”, and proceeded to inform the social worker of Melody’s demise. I told her not to worry though as I would look up the clients case file myself and update her.

When I put her on hold I was confronted with a colleague standing next to me with a face contorted into the most peculiar expression of supressed laughter I’d seen in ages. “What?” I said, thinking I had missed something hilarious. She managed to compose herself enough to explain to me that the second column on the list is the name of where each support planner works, and that Melody has NOT recently arrived home after hospital, but, rather, she works for an organisation called, “At Home After Hospital”. “Nooooooooo !!!!!!”  I said, “your’e kidding!!” But she wasn’t! And after we had a good laugh at my mistake I had to eat humble pie and explain my faux pas to the social worker. luckily she saw the funny side, and I  gave her the contact details of the perfectly fit and healthy Melody Harrison.

You live and learn!

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The white rabbit has a beer

the white rabbit has a beer

Following my first client visit I was sitting drinking a cold beer (much deserved you must admit!) and enjoying the early evening sunshine outside a Pub in little Venice while I waited for some friends. I was musing over my day and found myself thinking about how wordy  it gets explaining the support planning process from start to finish. It causes a glazed look to come over friends who ask what I’m doing. So its no wonder that our clients, and those caring for them, who are already navigating the difficulties that come with having either a learning disability, a mental health issue, a debilitating physical disability, or being elderly, find it daunting when faced with all the information and terminology that support planners “throw at them” on the first visit  . So I began to ponder a way of simplifying the explanation in its bare bones form so that it could be more clearly understood as a start to finish process. This was the idea I came up with – make it visual. I am scanning it in here so that if anybody fancies giving it a go and seeing if it helps they can . I have found it useful. Here it is:-

The support planning process - start to finish

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Down the rabbit hole

Alice discovers its a steep learning curve

I was counting on at least six weeks classroom time before the challenging “real people” stuff began. Thats how I like it- cram me full of information before showing me a client. “Alas” and “shock – horror” though, this was no gently sloping rabbit hole but a steep, steep learning curve kind of descent into the “wonderland” of support planning. After only two days we left the classroom, I was assigned my first client, and had begun searching my A-Z for an address deep in this unfamiliar borough of London ready for my first visit.

It didn’t help my rising sense of unpreparedness that Kate, my trainer, who it turned out has a wicked,  slightly sadistic, sense of humour, informed me I would not be “shadowing” her as I had been told but that she would be observing me! Now I am no shrinking violet but remember I had not been fed enough information for my liking – I was out of my comfort zone. However, despite my polite but increasingly frantic requests that she see sense (I think I may have even threatened to vomit at one point) she remained unmovable and on the twenty minute bus journey to Mrs B at flat 7 even had me rehearse out loud what I was going to say!

I am not ashamed to admit that as I knocked on the front door of Mrs B, a frail 82 year old in the early stages of dementia, I was as close to begging as I have ever come. As the door opened, however,Kate was all smiles, swept past me, and did the entire interview herself. I didn’t know whether to kiss her or punch her in the face!

So, as Alice said  “curiouser and curiouser” –  but at least I’ve made it down the rabbit hole and survived! I have since done the second visit to Mrs B on my own and it went ok. Ive got a lot to learn – I’m still out of my comfort zone but I’m enjoying the journey – hope you’ll stay with me and, please, tell me what your own journey is like.

Oh – and Kate ? – we’ve become good friends but she’s a little jumpy cos “paybacks a bitch” ha ha!!

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