How a short-term reablement pilot service is encouraging people with learning disabilities to become more independent and use more community-based and natural supports. Ruth Gorman, chief executive of Imagine, Act & Succeed, tells the story.
Sometimes, great ideas and change can begin with a conversation. This was certainly the case with a pilot programme for a different model of social care service that learning disability charity Imagine, Act & Succeed (IAS) has been implementing with Oldham Council.
The kernel of the idea came from a chat I had with Paul Cassidy, adult services director at Oldham Council. We were discussing the pressures on adult social care funding and how radical thinking was needed to prevent the conveyor belt of long-term and increasingly paid-for support that often follows people with learning disabilities, which not only risked escalating expenditure, but also increasing the social exclusion of those individuals.
A key tenet of IAS’ philosophy is to provide support to further people’s independence and social inclusion. The charity always looks for ways to build on a person’s gifts and strengths, regardless of the level of disability or impairment, and encourage people to maintain existing relationships and develop new social networks in the community. It’s our aim to reduce our involvement in a person’s life by providing ‘just enough support’ but avoiding creating a dependency.
With this in mind I felt that if paid support could, in some scenarios, be replaced by richer, natural and more sustainable support networks and community connections we could enable people to enjoy a better life.
Equally important, I felt, was the need to address the issue of preventing avoidable crises. We wanted to explore opportunities for earlier intervention to avoid reactive and unnecessarily expensive service responses that would not be in the interests of the person or their family.
Cassidy liked the idea and asked IAS to develop it. The resulting pilot service, called New Reablement Journey, has now been operating for more than a year and offers short-term, person-centred support for up to six weeks.
It’s a small service that supports 10–12 people at any given time but since its inception it has enabled some 60 people to become more independent and develop community relationships, which mean that paid support can be reduced to a minimum or removed altogether.
How it works
New Reablement Journey enables people to ‘get a life’, not a service by focusing on what people can do – not just what they can’t.
Each person is taken through a high level reablement pathway and their weekly progress is recorded to keep track of outcomes and ensure that support is provided on a needs-led basis.
The step-by-step approach:
Gather information - The IAS team meet with the person within a week of their referral. All the important information about the person is captured using person-centred tools such as One Page Profiles, which encapsulates important information about a person on one sheet of paper, and What’s working/ What’s not working, which analyses what is happening in a person’s life.
Identify strengths and resources - Next we identify each person’s assets and strengths so that we can develop a short-term plan that builds on their talents. This is crucial as it makes it more likely that the person will need less paid support. We also find out what exists in the person’s own community such as organisations, clubs, groups, facilities, technology grants and so on.
Agree and implement plan - For most people a short-term plan can be put in place at this stage. We use the Support to Confidence tool – which helps a person and their supporters to plan the specific steps that matter for the person in building their confidence – to show how the person will be supported to achieve agreed outcomes. At this point we also set a timescale and a review date.
Review outcomes - Following this we use a matching tool to identify a small team to work with each person. As they get to know the person better they are able to update the individual’s One Page Profile and record what they’ve discovered in the Learning Log, a structure that captures details of learning with specific activities and experiences.
Develop a support plan or decide no further paid support needed - It’s important to review progress at least weekly and we find the 4+1 tool – which allows users to reflect and learn about what does and doesn’t work – helps to provide clarity about the next steps. In some cases the individual may have achieved their outcomes and requires no further support, while in others we organise a person-centred review with the referrer.
Review progress - At this stage, many people are able to resume their lives with renewed independence and no paid support. In these instances, we stay in touch with monthly phone calls or visits to maintain support and prevent future crises. For others, who need on-going support, we use the information we have gathered to develop a support plan in partnership with the relevant council departments.
How it is funded
The simplest arrangement for funding the pilot was for there to be a single lump sum transfer of funding from Oldham Council and for IAS to work within this resource in an accountable way. We received money from the council that we estimated would last for six months.
The staff were already trained in person-centred practice, reviews and ‘just enough support’, and specific training took place regarding the marrying of these principles in a reablement situation.
We keep detailed records for each person referred to us including the number of hours of support provided and the outcomes that have been achieved. As a result, the team leader is able to give a detailed record of each person’s progress at weekly meetings with the senior practitioner in the council’s social work team. We are able to judge the service’s future capacity ensuring that support is allocated on a needs-led basis and that it works within its funding envelope.
A good example of how the service works comes from Graham. He was living in residential care and expected to move into shared supported living when he was referred to IAS. But thanks to the reablement programme he now lives in his own flat with the minimum of support by making use of assistive technology and community connections.
Graham now has 11 hours of support per week, which costs about £7,400 per year. Without reablement Graham may have needed weekly support of 32 or more hours, which could have cost about £21,500 per year.
Graham’s advocate says: “I think communication has been excellent and everyone has worked well. Graham felt he had a say in when his support took place and feels the support meets his needs.”
What makes it successful?
Thus far, Oldham Council is pleased with the way the venture has developed. “From the council’s point of view, we believe we have developed a genuine partnership with IAS, which is focused on helping promote the independence of the learning disabled person, whilst making best use of our increasingly scarce financial resources,” Cassidy says. “Some of the improved outcomes that IAS has achieved are truly life-changing.”
Eight key factors have been identified that have helped to make the venture successful:
• Maintaining a person-centred culture and a faith in people’s capacity
• Embracing the principles of ‘just enough support’
• Taking a positive approach to risk and decision-making
• Working at speed in a six-week frame
• Preserving a small and flexible team
• Sharing a vision with Oldham Council
• Identifying a single point of contact at the council
• Recognising the importance of bold leadership.
I believe that our results demonstrate that by taking an approach to supporting adults with a learning disability that focuses on building independence and confidence, puts a much greater focus on community-based and natural supports and seeks to secure results in a short timeframe we have created a ‘win, win, win’.
Individuals are supported to choose options that sustain their own dreams and aspirations, families remain active partners in their journeys and the council benefits from shared learning and the ability to target limited resources where they are most needed.
For more information go to www.imagineactandsucceed.co.uk
This article first appeared in the January/February 2014 issue of Learning Disability Today. For more articles like this, you can subscribe to the magazine at http://www.learningdisabilitytoday.co.uk/learning-disability-today/