METODA BRAINSTORMING

Unit 7: PERSON-CENTRED APPROACHES....!!!!! Ce e scris cu negru e din carte, si cu alte culori alte surseDaca ti se par prea ample raspunsurile, mai taie din ele, ca ai de unde .

1. Understand person centred approaches for care and support

define person centred valuesPerson-centred care is a philosophy of providing care that is centred around the person, and not just their health needs. We are all individual, no two people are the same hence it is not appropriate to say that because two people have dementia that they both have the same care and support needs. The values which one person feels are important in their life may not be so to another. To provide the best support to a person, their values must be taken into account and by doing so you will be empowering that person, increase their self determination and improve their independence. A persons values will include their individuality, rights, choices, privacy, independence, dignity and respect. Person-centred values are about providing care and support that is focused on a specific individual and their needs. It must be noted that just because two individuals both have dementia there treatment and needs may be dramatically different. In order to work to a person-centred approach you must understand the values that surround it, there are eight person centred values that underpin person-centred care and support. These are:

Individuality: service users should be allowed to make their own choices. Care and support should be tailored to suit the individual with their personal beliefs being respected.

Independence: A service user should be encouraged to do as much for themselves as possible. Independence makes people feel in control of their lives and gives them a sense of self-worth.

Privacy: It is essential that you respect a service users need for privacy and support this in the way you work.

Partnership: a service users care will normally involve other professionals and colleagues and it is that you maintain a good communication with all parties involved. Person-centred care and support requires all key parties to be on board.

Choice: Each service user should be given a choice in relation to their care, in order to make an informed choice it is essential that all the facts are available to the service user.

Dignity; You must maintain a service users dignity at all time, address them in their chosen format, try not to rush and take care to listen to their requirements. Use a towel to cover them when performing personal care in order to maintain their dignity and remember not to stereotype, treat every service user as an individual.

Respect: is showing an individual you will support them in their decisions with regard to culture,...Person-centred planning involves the individual receiving the service, with family members, neighbours, employers, community members, and friends, and professionals (such as physician/ doctors, psychiatrists, nurses, support workers, care managers, therapists, and social workers) developing a plan on community participation and quality of life with the individual. In contrast, traditional models of planning have focussed on the person's deficits and negative behaviours, labelling the person and creating a disempowering mindset from the start.Person-centred planning offers an alternative to traditional models, striving to place the individual at the centre of decision-making, treating family members as partners. The process focuses on discovering the person's gifts, skills and capacities, and on listening for what is really important to the person (O'Brien & Mount). It is based on the values of human rights, inter-dependence, choice and social inclusion, and can be designed to enable people to direct their own services and supports, in a personalised way.Person-centred values ->>> this is to ensure that an individual are at the centre of planning and support, upholding and promoting individuality; choice; dignity; privacy; rights; respect; independence and partnership. explain why it is important to work in a way that embeds person-centred valuesImportance of working in a way that embeds person-centred values: Allows individuals to say what is important, gives more control over the individuals own life, improves quality of life; values include: individuality, rights, choice, privacy, independence, dignity, respect and partnership; applicable to all individuals including those with learning difficulties, special educational needs, physical/sensory impairments etc. The care you carry out on a day to day basis should always be centred around the person you are caring for. You are not there just to meet their physical needs but to maintain their sense of being a person and their identity. This involves you establishing a supportive relationship with the person, involving respect and trust. You should be listening to the service user, despite any difficulties, understand their emotional needs and preferences and learn about their history. By doing this you help maintain the service users identity, independence and self esteem .

It is important we work in this way in order to promote individuality, this allow individuals to make informed decisions and choices, as well as understand the consequences as well as possible risks of such decisions and choice that may well relate to their own health and wellbeing. We must do this within the appreciation of rights within the care value base. We can uphold this by empowering individuals to maintain their own independence. Each individual should have the right to privacy which encourages that person to maintain dignity and self-respect. Whilst respecting the individuals diversity cultures and values.

Person-centred values and approaches demonstrate the practical outcome of the social model of disability and inclusion. For this reason they must influence all aspects of health and social care .Models of disability:For many decades the medical model of disability was the dominant influence on attitudes in society towards disability. As a result, the focus in health and social care services was on the disalbility and what the individual was uable to do as a result. The disabled person was viewed as being the problem needing professional experts to determine what was best for them. This resulted in things being done to them, creating a disempowering learned helplessness.

The social model of disability views the attitudes and structures of society as the problem. The way society is structured is instrumental in disabling people and creating helplessness rather than being an inevitable consequence of disability.

The social model of disability has had a significant influence on attitudes to disability. People with disabilities are no longer hidden away and separated from society. Equal rights have led to improved access to education, employment and all aspects of life. These changes have resulted in higher expectations and an improved quality of life and outcomes for disabled people. Changes in attitude have also chllenged health and social care providers to work in a different way wich puts the individual more in control. The social model of disability and social inclusion are now the foundations of health and social care provision.

Person-centred approaches are about sharing power. The emphasis is on doingh things with the individual and that means including the individual in decision-making. Person-centred approaches focus on:

-who the person is

-who the important people are in their lives

-what they can do together to achieve a better life for the person- in the present and in the future

Empowering individuals

If people with disabilities are to be empowered and seen as equal partners, then person-centred values have to be embedded into every aspect of provision. Inclusion and involvement needs to be meaningful: individuals may require independent support to express their views or to fully understand the implications of decisions. Care workers need to understand the individual in depth: their preferred means of communication as well as their perspective on their life.

The focus in a person-centred approach is on finding ways to enable the individual to achieve their potential. To achieve this it is important to listen to individuals, to ensure they are involved in developing solutions to meet their needs as well as their ideas for their future. If a solution is agreed, it is more likely to succeed.

Extract from Written Questioning: Written Question: Define person-centred values and explain why it is important to work in a way that embeds person-centred values: Response: The underlying purpose of Person-centred values is to ensure that the individual needing care is placed at the very centre of the decision making process about their life, the services and support they want and need.

Therefore, under this strict system, the person is always placed at the very centre of the planning of the care programme required, in that he or she will always be consulted and that his or her views will always come first. Therefore the plan is tailor-made to that particular person, and it should include all aspects of care, from the Social and Health Services, from that individuals family and from the voluntary sector.

This is the current policy and it applies to those people with learning disabilities, mental health problems, and physical disabilities, to older people who need support, and to young people making their transition to adulthood

To place the person at the centre certain values must be upheld: Individuality (everyones differences must be recognised and respected), Choice (for individuals to be able to make own choices and be in control of own life), Privacy (information and activities must be kept confidential), Independence (empowering individuals to do activities for themselves) and dignity (be treated in a respectful way).

It is vital for the social care worker to work using these precise methods to establish the needs and wishes of the individual. This will also mean that individuals will feel empowered and in control of their lives, be more confident about making decisions, will feel valued and respected. explain why risk-taking can be part of a person centred approachRisk is part of everyday life and is part of almost everything we do. Risk should not exclude a person from participating. The ability to recognise, assess and manage risks is essential to a persons physical safety. It is the duty of a care provider to support the independence of the service user and manage any associated risks.

Extract from Oral Questioning:

Oral Question: Tell me why risk-taking can be part of a person-centred approach: Response: The person-centred approach to risk includes making an assessment with the people involved in the plan such as the individual, their relatives and other professionals. Risk taking is part of a person-centred approach as this empowers individuals to have choices about what they want to do in their lives as well as to be part of their community. Not allowing individuals to take risks can have a negative impact on an individuals life to not live it as they wish. explain how using an individuals care plan contributes to working in a person-centred wayEvaluating care plans: .pg 166

Person-centred care plans:

All too care plans reflect a service approach to care or support with needs identified in terms of what can be provided rather than what the individual really needs. The care plan presents a key opportunity for developing a person-centred approach. This can be achieved by involving the individual at every step to ensure it reflects thair individuality.

A person-centred care plan will include the individuals:

-views about their needs and circumstances

-priorities, and the needs and circumstances

-strengths

-interests, likes and dislikes

-ideas about how they want their life to be

-ideas about how to have their needs met(balancing desired and required outcomes)

-support network people who are important to and contribute to their lifeExtract from Oral Questioning: Written Question: Explain how using an individuals care plan contributes to working in a person-centred way: Response: To be person-centred the person must always be at the centre of their care plan. This means that individuals must always to be consulted and their views must always come first. Therefore, no two care plans are alike because each individual is different from another. Each individual should be involved at every stage of their care plan; from deciding who to involve, how to meet the individuals needs, the support required and how to feedback on how the care plan is working. 2. Be able to work in a person-centred way

find out the history, preferences, wishes and needs of the individualFinding out an individuals history, preferences, wishes and needs: Asking the individual, consulting care, support or individual plans, next of kin, other care staff, doctors, nurses etc. We could find out such information relating to an individual by working in a way that puts the individual at the centre of any planning and support, we can do this be communicating with them to find out about their history, preferences and wishes. It is important that we appear and work in a non judgemental way in order to eliminate any prejudices and / or personal feelings as to not discriminate in any way against the individual. By promoting independence and autonomy, we can also ensure equality and inclusive practice; we can do this by actively encouraging and thus empowering individuals to use their strengths and potentials. Effective communication is also vitally important as this ensures equality. Working in a person-centred way means placing the individual at the centre of all your thinking and activities. To do this effectively you first need to really understand the individual. This means finding out about them, their life story and their personal history. This will involve spending time with them as well as the other people who are important to them within their social network. This could include family and friends as well as other professionals who support them.

Life historyToo often the emphasis is placed on their current situation. However, past experiences are a strong influence and so it is important to understand these too if care or support is to be appropriate and beneficial.

Individuals who require care or support are often described only by the labels that accompany them for example, a medical dignosis or current need. However, their present circumstance is only a part of who they are, not the whole picture. Finding out about an individuals life, their experiences, culture and values will help you to understand what is important to them, their likes and dislikes. It may also provide important information to help you understand how past experiences have influenced their current behaviour. This can be done by:

- talking and listening to the individual to gain insights into who they are and what makes them unique

- asking the people who are significant to them, in particular their family and friends

- listening to other pleoples recollections of the individual

- looking at photographs, mementos etc

- observing behaviour especially if the individual has limited verbal communication

- finding out about their interests and past experiences to help plan meaningful activities

- collating a life story book to help others get to know them

- offering choices and observing and testing out responses especially if they have communication difficulties

- reading case notes and information from other

It is useful to remember that preferences, wishes and needs change. Never assume that because an individual liked something a month ago they still do. So, if in doubt, ask, watch and listen. apply person-centred values in day-to-day work, taking into account the history, preferences, wishes and needs of the individualTaking into account history, wishes and needs: Engaging with the individual, taking their views into account; planning a personalised approach appropriate to each individual. When planning individual support, it is necessary to document and record day to - day requirements of the individuals preferences for care and support. We can do this by addressing individual needs and preferences within a care plan, as well as individual support plans. Having a holistic approach to meeting the needs and preferences of each individual is also a key skill.Working in health and social care means that you are often supporting individuals to deal with issues and situations wich are distressing, traumatic or very personal. The key to a helping role is to build a relationship with individuals whom you support. As you will be supproting individuals at times in their life that they may find very difficult to cope with, you need to establish trust and respect. At these times they will need you to work sensitively with them and to be clear about your role, responsibilities, professional boundaries and confidentiality.

Situations that may be considered complex or sensitive could include:

distressing events such as bereavement, family or relationship breakup, illness, dying

traumatic situations such as sudden death, accident or abuse

threattening or frightening situations, such as abuse, assault, family dispute or violence

personal crises, such as ill health or relationship problems

situations where there are complex communication or cognitive needs; for example, where the individual has multiple profound disabilities.

Applying person-centred values to practice

Applying person-centred values to your day-to-day work may require you to make some changes in your practice. In order to support individuals in ways that promote their rights, choices, preferencesm wishes and dignnity you will need always to listen, learn and act upon what you learn.

You will need to:

think about your role in the individuals life

think about and analyse what life is like for the person now, what is working for them, what is not working for them, what needs to change so that it does work for them,

When the situation is complex or sensitive this will require you to be even more alert, not only to verbal but also non-verbal communication. Individuals in these situations are often experiencing a range of emotions wich they may communicate through behaviour more than in speech. Communication can be more difficult due to a heightened emotional state. You may need to repeat information several times before it is understood and acted upon.

->Adapting to changing needs and preferences:

When an individual;s needs are assessed this is statement of the situation at that point in time. However, needs and circumstances will change. For some individuals change may occur frequently, while for others change may be more gradual or occur suddenly without warning.

Examples of changes that may occur are:

>poor/limited mobility in the morning for an individual with arthritis

>frequent fluctuations in cognitive ability for an individual with dementia

>frequent mood swing due to mental illness affecting behaviour and capacity

>changes due to pain or discomfort

>sudden change due to illness or an accident for ex, an acute infection, a fall or medical emergency

>gradual change due to deteriorating health- for ex, failing eyesight or hearing

Change of any kind will impact on an individuals ability to function, and you will need to be able to adapt your approach to accommodate those changes. For example, if when you went to move an individual you found they were in pain, you should deal with this first and wait until the pain relief had taken effect before supporting them to move.

An individuals preferences may also change frequently as a result of their mood, situation, interests, new information or experiences. It is therefore important to never assume that just because they liked something yesterday they will like it today. Always make a habit of asking and check their prefereces before acting.

We are able to work in a person centred way with the contribution of using an individuals care plane by consulting the individuals, ensuring needs are met, and they maintain empowerment by doing so. We can do this by documenting and recording individual needs, attending to any details of treatment and individualised provisions as set out in care plans. Implementing non discriminatory practice and applying a person centred approach whilst doing so.3. Be able to establish consent when providing care or supportDefinition of consent: Informed agreement to an action or decision; the process of establishing consent will vary according to an individuals assessed capacity to consent. Means of consent: including implied, written, verbal, through a parent, guardian or other representative.

Consent is the informed agreement to an action and / or decision. To establish consent would be to be given permission and / or approval on such actions and / or decisions. This would vary depending on the individuals assessed capacity to consent.->explain the importance or establishing consent when providing care or supportImportance of gaining consent: Observing ethical and legal requirements/ guidelines; knowing when consent must be gained; how consent should be provided (written, verbal etc.); consequences of not having proper consent (performing certain actions without consent could be viewed as breach of confidentiality, physical/ emotional abuse etc.).

It is important to uphold an individuals rights to be fully involved in their own care, whilst adhering to legal requirements; as it is also the individuals right to refuse such care or treatment, and ensuring the individual are aware and comply with legal requirements.Our mental capacity that is, the ability to think and reason develops as we grow, given the right opportunities and conditions. These abilities enable us to understand complex and abstract ideas or concepts without requiring direct evidence. They enable us to qeigh up the arguments for and against a course of action and then reach a decision. For example, we can think about situations and assess what the risks might be. We can imagine a situation and use our judgement to consider the potential benefits and harms of actions wich involve risk. Our ability to think and reason is a significant factor in being able to consent.

Other factors include:

>understanding the situation and any risk and benefits

>being free to express thoughts and to ask questions

>personal values and beliefs

>being given time to understand any and all implications

>education level- i.e. poor educational attainment may have resulted in a lack of opportunity to develop higher thinking skills

>communication skill i.e. being able to make others understand and/or access to advocacy

>the quality and quantity of information available to inform the decision

>being treated with respect by those requiring a decision

>having privacy and dignity respected

>being free from coercion and fear of retribution

What is capacity and consent?

When an individual gives consent, this means they agree to an action or decision that affects them, having been made aware of the full implications of the issue in question. The process of establishing consent will vary according to an individuals assessed capacity i.e. their ability to give their consent.

Having capacity means being able to undertake the four stages of decision-making. This means the individual is able to:

>understand the information they are being given that is relevant to the decision

>retain that information long enough to make a decision

>analyse (use and weigh up) that information

>communicate their decision to others (verbally, using sign language, or pictures).

There are different types of consent that apply within health and social care work. These are:

> informed consent the individual has capacity , has access to all relevant information, and is fully aware of the implications of the decision. There is a formal agreement, usually in writing.

>implied consent the actions of the individual give the impression that they are consenting. There is no formal agreement. An example is an individual attending their GP. The implication is they are consenting to the GP making a diagnosis and offering treatment.

>continued consent- informed consent is ongoing during a period of tretment, care or support

>consent by proxy if the individual is unable to provide informed consent there may be times when decisions are made in their best interests by an appropriate person e.g. a family member, next of kin

Practitioners have a legal and moral obligation to establish consent prior to any intervention, not only those that are viewed as nvasive. Consent is frequently sought through a verbal exchange for example, asking an individual if they are ready to be moved or have a bath.

Establishing consent also shows respect for the individuals dignity and is likely to establish their trust and cooperation, so that the individual is more likely to work ith you to achieve the intended action. Doing something to n individual without their consent is an infringement of their rights and if it involves physical contact may be viewed as assault.Extract from Oral Questioning:

Oral Question: Tell me about the importance of establishing consent when providing care or support and what steps to take if consent cannot readily be established: Response: It is always very important to establish the consent of the individual when providing any care or support programme or procedure. This is essential so as to include that individual with any decision-making, in order to ensure that they do not feel left out, ignored; in this way they can understand and agree to that element of their care or support. I would discuss the problem, that consent cannot be established, with the supervisor or manager of the home, and, if necessary, the individuals doctor and advocate. I would also make a record of this, which I would sign and date. ->establish consent for an activity or actionEstablishing consent for an activity/ action: Informed consent: ensuring the individual has access to information, alternatives, time to decide; communication: use of active listening, two-way discussions, questions/ answers, writing, avoiding/ defusing conflict and seeking further advice. Good communication skills, verbal and non verbal as well as written consent, as well as active listening, play a key role when gaining consent. The use of appropriate informationPart of your role and responsibility is to make sure you support individuals to make informed decisions. To establish consent to undertake an action affecting an individual you must ensure that you:

>understand their individual needs and circumstances in relation to capacity and decision-making

>have all the relevant information available regarding the decision, including all the available options

>understand nad can clearly explain the different options and any potential or actual risks

If an individual lacks the capacity to make informed decisions alone then you will need to establish who else needs to be involved. This information is usually found in their car plan or a communication chart, having been previously established to cover a range of circumstances.

To establish consent to an action or activity:

>explain what the action is using language familiar to the individual

>describe what it involves

>explain the benefits to the individual

>explain any potential or actual risks involved in carrying out the action

>explain any potential or acual risks involved in not carrying it out

>listen and observe the individuals response

>encourage them to ask questions

>give them time to process the information

>confirm consent again immediately prior to commencing the action

In day-to-day activities consent is very often verbal and informal e.g consent to taking part in daily living activities. If the action is more invasive fro example, a treatment, medical procedure or legal process consent is genrally formal and therefore recorded in writing a conset form. ->explain what steps to take if consent cannot readily be establishedSteps to take when consent cannot be established: Ceasing/ not starting the action, remaining calm and empathetic, consulting supervisors/ managers, maintaining a record. Whilst complying with legal requirements, and abiding by relevant legislation we must act in the best interests of the individual, work towards solving conflicts, with the use of extra support, such as an advocate if necessary. And where appropriate to contact the person whom has legal responsibility. We also must record such information. Gaining consent from the individualIt is usefull to remember that if the individual is tired, in pain or discomfort, hungry, thirsty or anxious they may find the information everwhelming. The individuals response in these circumstances may not be a reflection of their true feelings.

If the individual has dementia, for example, their ability to make decisions may fluctuate due to their disease. In this case strategies may be required that do not assume the individuals inability to make a decision or provide consent, but seek to respond to a changing situation: for example, there may be a best time of the day to gain consentor the individual may need to be asked several times and be given time to process the information.

Finding out about the individuals past history may also help. For example, the individual may associate giving consent with negative consequences, or they may not previously have been given the opportunity to make decisions for themselves and so find it overwhelming or fear the consequences.

Gaining consent from a responsible personIn some circumstances individuals are assessed as being unable to give consent. This can be a result of congenital or childhood problems for example, a learning disability, injuries(e.g. a head injury), illness or disease(e.g. dementia). An individual may temporarly or permanently lack capacity and in either case it may be difficult to establish consent.

The Mental Capacity Act(MCA) 2005 outlines the citcumstances in wich another person can make a decision or take action on behalf of the individual who lacks capacity. The action or decision must relate to the care or treatment of the individual concerned. The principles of the MCA then require that:

>the responsible person reasonably believes that the individual lacks the capacity to make a decision in the circumstances and at that time

>the action or decision is in the individualls best interests

>the action or decision is the least restrictive alternative.

In these circumstances details regarding what has been consented to will be formally recorded in the individual;s care plan or another document within their records.

In many circumstances in wich consent cannot readily established, it is useful to ask a family member about the individuals preferences and wishes.

4. Be able to encourage active participationActive participation: Is a way of working that recognises an individuals right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient.

By empowering and encouraging each individual to actively participate in everyday life events, such as activities and relationships, whilst doing so maintaining as much independence as possible. Also to understand the importance of the individual as an active partner in their own care and / or support rather than a passive recipient.->describe how active participation benefits an individualBenefits of active participation to individual: Feeling of self-empowerment rather than being passive, improves mental and emotional health/ stimulation, greater social interaction encourages relationship-building.

Again by empowering and encouraging individuals to participate in their own care, this then promotes other physical benefits such as; increases their independence and self-confidence, as well as autonomy and wellbeing. It may well also give them a good sense of purpose.How can active participation be applied to meet individual needs?Active participation focuses on the individual, their wishes and abilities, and uses these to design ways of working that maximise their independence, as shown above.

How active participation meets a persons needs

*It is all about me and what I want to achieve

*I am involved in decisions

*My support is arranged to suit me and my needs

* I feel listened to and valued

* Goals are set to reflect my chosen pace

*It focuses on the things I enjoy

*It is built around the things I do wekk

*It makes me fell in control of my life

*It builds my self-confidence and self-esteem

Finding out an individuals history , likes, dislikes, abilities and wishes is an important starting point in encouraging active participation.

Taking a person-centred approach to care or suppoert means looking for ways to fulfil and meet the individuals needs and wishes. This is quite different from trying to make them fit in to available services whether they are right for them or not.

Being made to fit into something that isnt shaped for you means you are unlikely to enjoy it and want to make it work. To show your unhappiness you are likely to fight against itm object if you are able to, be unhappy and un-cooperative. The chances of failure are high. You are likely to feel unimportant or a burden and this will make the situation worse.

Matching something to create a best fit or tailoring it to fit specifically is more likely to result in a positive outcome for all involved.

->identify possible barriers to active participationActive participation in practice

Active participation can be applied in many ways. For some it might involve managing their own care though self-directed support or an individual budger. Putting active participation into practive means being able to recognise and reduce the potential barriers to implementation. It also means ensuring that everyone involved is committed to working with the individual to achieve the best possible outcomes.Implementing active participation

Active participation is more likely to enable individuals to achieve their potential and improve their life experience. However, it can require a significant shift in thinking. Encouraging active participation challenges:

>the individual to believe they can be active rather than passive

>family friends to view the individual as an equal

>health and social care workers to work with the individual as equal partner in care or support

>society to view people with disailities as givers , i.e. able to contribute, and not takers, i.e. dependent.->demonstrate ways to reduce the barriers and encourage active participationReducing barriers to active participation: Organising and providing opportunities for involvement in social activities, offering praise, motivation and constructive comments, active listening, treating individuals equally while recognising differences, using communication/ mobility aids etc. By promoting and encouraging active participation, as well as inclusion, positive outcomes can be achieved, upon these we can be creative in the sense of promoting opportunities, enhancing and building confidence amongst individuals. Also by increasing staff training, and awareness of possible communication barriers, such as the use of makaton, and sign language would certainly reduce communication barriers whereby verbal communication is a barrier.Changing attitudes is the key to reducing the barriers to active participation. Improving societys attitudes to and expectations of people ith disabilities is an imporatnt part of that. The social model of disability has already created a shift in thinking information, education and training will help to move that further. Involving the individual and all those people who are significant to them is also crucial to success. For active participation to be implemented, organisations need to:

>review their policies, procedures and ways of working

>ensure the involve the individual in all processes that have a direct impact on them

>provide staff training to support understanding and commitment

>monitor and review processes to ensure consistency

>learn from successes and failures

Ways of encouraging active participation: Explaining the benefits of participation e.g. feeling at home, improving fitness etc., using clear language, via friends/ family of individual, ensuring activities cater to the abilities/ needs of the individual. It is important to engage the individual, and maybe appropriate to use physical as well as visual communication aids. Enabling and support individuals to access community resources and facilities; perhaps by way of design of suitable events. Inclusion of family members as well as friends would also encourage active participation.DACA MAI VREI,..PROMOTING ACTIVE PARTICIPATION, PG 187

Extract from Written Questioning: Written Question: Describe how active participation benefits an individual and the possible barriers to active participation: Response: Active participation benefits the individual because that person is always made to feel that he or she is continually important, and that things are done for their benefit, with their consent. This ensures a positive approach for the individual that makes them an active part of how they choose to live and puts them first as the focus. Barriers can take several forms the emotions, the disabilities, and the attitudes of the individual concerned, any or all of which can deter active participation by that individual in any activity or action. Similarly barriers exist if social care workers attitudes and approaches do not value active participation, strict routines and lack of training on using the active participation approach can also be barriers.

5. Be able to support the individuals right to make choices

->support an individual to make informed choicesSupporting an individual to make informed choices: Providing information which is complete, objective and understandable; seeking advice from the individuals next of kin; consulting expert advice. There are many ways we can support individuals make informed choices; it is important that we are non judgemental when communicating, empowering and encourage the individual to make informed choices, while respecting their choices as well as supporting them to challenge and / or question decisions concerning that are made on their behalf.Having the oportunity to make choices is something most of us take for granted, However, for manu of people you support, being presented with choices may be a confusing or new experience for them.

Being able to make a choice assumes an understanding of the options available and the potential consequences of those options. There is always the danger that care workers make assumptions about individuals ability to understand, in the past such individuals may have had little oopportunity to be involved in making choices. However, everyonr has a right to make their own choices about their life and this is an essential care principle.

Making an informed choice means knowing what will be gained as well as potentially lost with each option. It is important, when supporting an individual to make a choice, to:

>understant the individuals needs and abilities

>provide relevant information in the way the individual prefers

>explain how each choice may benefit/suit the individual

>explain what they may lose by making each choice

>use an even tone of voice without emphasising the choice you prefer

>ensure there is no bias and that you are objective in the way you preppsent each choice

>give the individual time to consider

>check they understant each choice

>repeat if this is what they prefer or is what weks for them.

Why risk-taking can be part of an individuals choices: Provides the individual with more options and empowerment; making sure the individual is aware of the risks before they commence/ carry on the activity. It is important that individuals are aware of the risks and / or hazards as well as potential hazards that maybe involved when making decision and / or choices. We can do this by discussions, providing information, with use of risk assessments.->use agreed risk-assessment processes to support the right to make choicesHow agreed risk assessment processes are used to support the right to make choices: Covering: care methods, timetables/ dates, range of treatments available etc.; risks: likelihood of occurring, potential implications, how to avoid/ limit them.

A risk assessment is a process made up of identifying and evaluating a risk and its possible consequences, we do this by identifying the risk involved when partaking in an activity for example, we then decide if the risk is worth taking, we evaluate and record our findings as well as review. These can be decisions that can be used to support make informed lifestyle choices, whether it be decisions about treatment or care, and the impact it may have on treatment or recovery. In identifying the potential benefits as well as hazards we create awareness of actual and likelihood of danger and / or harm that may arise from choices made. Whether it increases or decreases that persons vulnerability.

Risk assessments are often viewed in a negative way, as a means to justify stopping an individual from doing something . Viewed in a positive way, however, they are about assessing risk to support choices and enabling an individual to do something.

Person-centred risk assessements:

>explore the risks to an individual in an area of their life

>help to manage the risk and enable the individual to carry out a task or activity

>positively enable safe independence for individuals to carry out tasks and activities

>looks at the possible risks and hazards for the individual

>minimise possible risks and hazards using guidelines and measures to enhance the skills and abilities of the individual

The folloowing people need to be involved:

- the individual

- other people within their circle of support

- anyone involved in the task or activity

Attitudes to riskEveryone has had past experiences of risk and this tends to influence out attitude towards it. Some people are risk takers and thrive on the challenge this presents. Other people are more conservative and like to play it safe by weighing up every aspect of an action or activity before committing themselves to it.

If past experience has taught us that there is a great deal to be gained by taking a risk then we are more likely to view risk as something to welcome it, however, taking a risk has resulted in negative experiences and memories then it is likely to be viewed as something to be wary of and avoided it at all possible.

Making informed choicesOnce a risk assessment has been undertaken it is essential that the identified risks are discussed and understood by all those involved. It is important to ensure that the individual is able to make an informed choice. Excluding the individual or anyone involved is likely to increase the risk as they have no investment in managing the risk to avoid harm or danger.

It is therefore essential that you remember that when ionvolving the individual in the management of risk the will need:

>accesible information about the potential risks i.e. information that is communicated in a way that meets their needs and preferences

>time and appropriate support to understand the implications of any potential risk

>the oportunity to ask questions, clarity and challenge the risk assessment

>a clearly reasoned argument for any decisions made

>the oportunity to suggest acceptable control measures

>the oportunity to take an informed risk

If the individual wishes tochallenge the risk assessment outcome they will also need:

*access to an independent advocate, if appropriate and requested

*the oporunity to have a second, opinion i.e. a repeated risk assessment

In most cases, if the individual is involved in any risk assessment and the discussion reguarding appropriate safeguards and control measures, these can generally be agreed. Often, once the risk is analysed and evaluated, this increases awarness recues the risk and this, along with safeguards, enables activities to proceed.

In some cases, however, the best way to manage risk is to take things in incremental steps as this reduces the overall risk whilst maintainig an individuals choice.

On occasions maintaining an individuals right to choice may not be possible if the risk is considered to be too great i.e it may result in significant harm, injury, death or is illegal, or in some other ways is in conflict with the duty of care. At these times the individuals right to be protected from harm overrides their choice. In this case, you will need to undertake negocioations with all involved to determine if safer and acceptable alternatives can be found.

->explain why a workers personal views should not influence an individuals choicesImportance of personal views not influencing an individuals choices: The individual may have lack confidence/ have sensory impairments etc. leading to unfair decisions; individuals should be empowered; the individual knows best what they are comfortable with; personal views may be subjective/ based upon experiences different to the individual; people have unique values. Workers own personal views, and therefore opinions, not facts, so can be discriminatory against the individuals choices, therefore may prevent empowerment and hinder encouragement as well as self confidence.Within your role you will have a responsibility not only to promote an individuals rights and choices but to support them to make choices.

To the individuals you work with, and their families or friends as well as other professionals, your role signifies that you have knowledge, understanding ans skills as well as experience. Your role therefore brings with it a certain amount of authority and power to make things happen. There are, potentially, three types of power that can be excercised within your role. These are:

- legitimate power-> which results from your role

-expert power-> which results from your knowledge and skills

-referent power->which results from your personality, worthness and right to respect from others

When used appropriately this authority and mpower will enable you to influence the reactions of others and compel them to listen to wht you have to say. As a result you will be able to advocate for individuals you support and ensure their views and options are heard.Extract from Written Questioning:

Written Question: Explain why a workers personal views should not influence an individuals choices: Response: The care workers personal views may well simply rule things out for the individual being cared for, because the worker might take a subjective position rather than looking to find creative solutions for that individual. Such a stance could prevent the individual from making informed choices about their care. Therefore, personal views should never influence the choices of any individual as this also goes against their rights and can make an individual feel pressurised to agree. ->describe how to support an individual to question or challenge decisions concerning them that are made by othersSupporting an individual to question/ challenge decisions made by others: Includes: colleagues, social workers, occupational/ speech and language therapists, physiotherapists, doctors, nurses, psychologists, psychiatrists, advocates, care advisors and next of kin; support: directing individuals to alternative sources of information, referral to senior/ expert staff as appropriate, assisting them to follow complaints procedures, offering to be present during discussions with others. It is important to encourage questions, through discussions, and being prepared to listen. Ensuring each individual is aware of policies and procedures as well as complaints procedures. Awareness of advocates that may be available, and the options of second opinions. It is also important they are aware of their own individual rights.There may be times when an individual is unhappy about decisions that have been made about them or for them. This may be when:

*others believe the individual is not capable of making complex decisions

*others do not agree with the individuals decision

*others use duty of care and risk assessment to override individual choice

*others believe it is their right to make the decision on the individuals behalf for ex, a parent, carer

*others believe their decision is in the individuals best interests

*the individuals decision does not suit other people i.e. they feel it creates more work for them

*it is the norm for others to make decisions without really involving the individual

*others have coerced the individual into making a decision that suits them and not the individual

In situations where individuals right to make their own choices and decisions has been infringed, they have a right to question or challenge these decisions.

Ways of supporting a challengeIn situations where an individual wishes to question or challenge decisions concerning them that have been made by others, there are a number of ways that they can be supported. These include:

*helping the individual decide what they want to do, how they want to raise their concerns, and who they wish to involve

*supporting the individual to identify and think through their reasons for questioning or challenging the decision

*identifying how the individuals views were not considered

*identifying others who can support the individuals view

*aranging an informal meeting to raise the concerns

*using the complaints procedure if informal processes dont work

*involving an independent advocate if this is the best optionExtract from Oral Questioning:

Oral Question: Tell me how to support an individual to question or challenge decisions concerning them that are made by others: Response: When others make decisions for the individual, the care worker should talk to the individual to ask that person whether he or she understands what has been decided for them. Once the individual understands those decisions, he or she should be encouraged to state whether they agree with them. If not, then that individual should be enabled to question and challenge them either themselves, through the social care worker or an advocate.

6. Be able to promote individuals wellbeingExtract from Personal Statement:

Personal Statement: Promoting Individuals Well-being Response: Maintaining an individuals identity is done by always recognising that person as a human being, not a number identity is who the person is. Ensuring that the individual IS important and that their views and concerns are always dealt with in a positive and caring manner will always ensure that person is valued and has a high self-esteem. All this will contribute to their sense of well-being. By always ensuring that the individual is treated in a professional, kind, caring and courteous way, their sense of well-being is always assured. Care workers can also make sure that they use a number of different approaches - empowering approaches that enable the individual to take control, a positive approach that encourages the individual to feel good, working in a trusting and professional way enables a good relationship to build between the care worker and individual and promoting a sense of well-being. ->explain how individual identify and self-esteem are linked with wellbeingHow individual identity and self-esteem are linked with well-being: Including aspects that are: spiritual, emotional, cultural, religious, social, political, sexual, physical or mental. Self Identity is how we recognise an individuals potential and own personal qualities.

Self-esteem is how people value themselves.

Well-being is the general mental and physical health of an individual, and these needs being met, on physical, emotional, social and intellectual basis. The links between the two can fragment personal identity, this can include effects of possible discrimination, abuse, lack of access to services, and therefore reduces levels of confidence and self esteem, affecting emotional health. Our identify is more than our name and our picture in a passport. Identify is what makes us stand out in a crowd as an individual.

Self-image is how we view ourselves our worth and value is more often bound up with our attractiveness to others and our inteligence. Self- esteem is about having confidence in who we are and our worth and value to others and to society.

Identify self-image and self-esteem are therefore all closely linked, with one dependent on the other. If an individual has little sense of who they are as an individual then they are likely to struggle with a sense of low worth and value and this creates a negative self-image and low-self-esteem.

Many people who grew up in large institutions struggle with their sense of identify, as all the time they lived they were never treated as an individual only as part of a group. They were never treated as if they had unique value or worth and so had low self-esteem and a poor self-image. This meant they found it difficult to express themselves or to exercise choice, even over simple everyday matters.

Our identify self-image and self-esteem are influenced by the following factors:

*inherited characteristics

*family, upbringing, shared history- including ow we were treated, or mistreated, as children

*primary care givers

*friends

*educational and life experiences

*culture , religion, nationality

*the media and images and representations of beauty, perfection and what is ideal(eg size 0 models)

*feedback we get from other people about who we are, our nature and worth as individuals.

Many people who were abused as children grow up with a very poor self-image and low self-esteem, generally, any abuse evolves an element of emotional abuse as the individual is repeatedly told they are worhtless and a bad person, and that is why they are being abused. This poor self-image and low-self-esteem makes it diffucult for the individual to have a realistic idea of their own identify and this can lead to behaviours that are in many ways self-distructive. This can mainforce the cognitive views they already have about themselves.

Which factors contribute to wellbeing?

Wellbeing is often described as a state of feeling that you are doing well and feeling good. These feelings create a wellness cycle in which the individual does well because they are feeling good, and so on, factors that influence well-being include the following:

-> practical aspects of life

*education and skills

*empoloyment

*income

*psysical and mental health

*access to services and amenities

*quality of the twing environment

-> personal and social relationships

*intimate relationships, involving love and care

*support networks

*relationships with wider society

->values and attitudes

*ideas about self and personality

*hopes, fears and aspirations

*moral and/for spiritual codes of behaviour

*sense of purpose and meaning to life

*levels of satisfaction and dissatisfaction with life

*levels of trust and confidence in life and relationships.

Understanding who we are, our values and worth to ourselves, to people we respect and care about, and to society as a whole, are important aspects of our sense of wellbeing. The way that other people and the systems within society treat an individual will reinforce other their sense of worth and value or their sense of worthlessness. For example, discrimination an abuse damage self-esteem because they make the individual feel they are worth less than others. In the past, people with disabilities were excluded from education and employment. The result was a reduced ability to participate in society and a feeling of having less importance and worth because of that disadvantage.

The recognition, acceptance and promotion of the cultural and spiritual aspects of an individual are also important. For some, these will be central to their identify and every aspect of their life. For others, they may play a lesser role. It is important to find out what each means to the individual and not make assumptions.->describe attitudes and approaches that are likely to promote an individuals wellbeing

Attitudes/ approaches likely to promote well-being of individual: Treating individuals with empathy and respect; being open-minded and considering options/ ideas of the individual; offering additional support when asked/ appropriate. It is important that we treat each person as an individual, making us as a social care worker aware of the individuals feelings, whilst upholding the importance of privacy in order to maintain dignity as well as respect; including respect for the individuals spiritual, cultural and religious beliefs. We must work in partnership with other organisations as well as own to set and enable to achieve realistic goals, and therefore encourage empowerment for individuals to gain self esteem and gain confidence. Active listening will also encourage and develop independence as well as assertiveness.If an individual feels worthless i.e has low self-esteem or a poor self-image this will affect how they interract with others. A lack of self-worth and self-esteem will issue motivation and reduce the individuals ability to develop their .pg 196 + figura(nu inteleg)->support an individual in a way that promotes a sense of identify and self-esteem

By encouraging inclusion within a social environment to promote the well-being of individuals, personal attitudes, and involvement in activities. Being aware of surroundings, own personal space and possessions.->demonstrate ways to contribute to an environment that promotes well-being

Contributing to an environment that promotes well-being: Includes: physical environments (bedroom, handbag, personal belongings etc.) and social/ emotional environments (subjective feelings, personal boundaries etc.). An individuals wellbeing will be promoted if they are surrounded by people with positive care attitudes . However, the physucal living environment and the systems that operate within this are also important to promoting wellbeing.

The physical environment can contribute to wellbeing by being:

-accesible

-welcoming

-well maintained

-comfortable

-light and airy

-appealing to the senses-e.g colours, smells, textures, low noise levels

-designed to accommodate individuality

-temperature controlled

-safe and secure

-well equipped to meet individual needs

-equipped with areas that provide privacy and quiet as well as space for large groups

Systems and structures within an environment can contribute to wellbeing by using:

>person-centred approaches to care or support

>risk assessments which focus on enabling activities

>creative and flexible approaches to meeting needs and enabling individuals

>user feedback and involvement to make decisions about how and what services are provided

>good evidence-based practice to develop services

>staff supervision and training to develop positive attitudes to care or support

>monitoring and review processes to make chanes and improvements