‘TIME TO THINK’

Specialist Community LD Team Meeting

14th May 2003

‘By examining and understanding the past, we can move into the future

unencumbered by it. We become free to express ourselves, rather than endlessly

trying to prove ourselves’

Warren Bennis

‘The source of all energy, passion, motivation, and an internally generated

desire to do good work is our own feeling about what we are doing’

Peter Block

Agenda

A Thinking Environment is the core of team effectiveness

Key Components Behaviour Guidelines Managing Interruptions

Recognising Achievements

LD Team Review Update New Staff appointments Commissioning priorities

Hopes & Concerns

Identifying Priorities

A Strategy for Resolving Conflict – ‘Timed talk’

Any ?s Referrals/Allocations Cross-Team referrals Team meetings Communication Role clarification Key future Health and Social

work developments

The Thinking Environment

Everything we do depends for its quality on the thinking we do first

A Thinking Partnership is a personal and professional imperative

Our thinking depends on the quality of our attention for each other

Thinking at its best is not just a cool act of celebration – It is also a thing of the heart

Critical Components of a Thinking Environment

Attention – listening with respect and interest

Incisive ?s – removing assumptions to free ideas

Equality Giving equal turns/attention Keeping agreements

Appreciation – 5:1 ratio

Ease – offering freedom from rush or urgency

Encouragement – moving beyond competition

Feelings – allowing sufficient emotional release

Information – full and accurate reality picture

Place – creating physical environments that say ‘you matter’

Diversity – adding quality because of differences between us

Behaviour Guidelines for the Thinking Partner

Pay unbelievable attention to the Thinker, even if you don’t agree with them or like them

When you are listening, keep your eyes on their eyes – Don’t look away

Look interested; or rather BE interested Make sounds only occasionally to indicate understanding

and encouragement Be at ease – Nothing horrible is about to happen Smile occasionally – when not interpreted as derision

Behaviour Guidelines for the Thinking Partner 2

Don’t even think about interrupting Don’t be picky clarifying or confirming questions unless

you are so confused you feel faint When your partner has nothing more to say – ask ‘What

more do you think or feel or want to say about this? If the Thinker becomes quiet, but their eyes are alive,

relax. They are still thinking. Leave them to it. The fact that they are not talking does not mean they are not thinking

Managing Interruptions- Challenging Unhelpful Assumptions

‘My idea is better than theirs’ ‘If I don’t interrupt them, I will never get to say my idea’ ‘I know what are about to say’ ‘They don’t need to finish their thought since mine is an

improvement’ ‘Nothing about their idea will improve with further

development’ ‘I am more important than they are’ ‘It is more important for me to be seen to have a good idea

than it is for me to be sure they complete their thought’ ‘Interrupting them will save time’

Recognising Achievements

What is going well in your work or life?

What do you think we have accomplished?

What successes have you had?

What are you most proud of? For people with ld, families, staff and the service.

What have you discovered about yourself?

Recognising Achievements 2

What do you think is going well in our local service?

What is the key thing that you want to improve?

What is stopping you?

How?

What support do you need in order to do it?

Update on the Review of the Specialist Community Team

Presentation to Halton LD Partnership Board

16th April 2003

Community LD Teams Review

The Continuum of Joint Working What is the Team Like Now? What is it set up to do? How does the Team work with other people? How the Team works

What it is like for people to get help from the team? Comparisons with other teams in the UK?

How is the Team set up? How does the Team link with others? Team systems/processes How have people in the Team been feeling?

Towards A Integrated Health and

Social Work Community LD Service The Continuum of Joint

Working Communication

Agencies work separately

Little overlap, big gaps Collaboration

Agencies work together Some overlap/separate

Full Integration Single service Almost total overlap

How Far Do We Want/ Need To Go?

Integration Issues ?s Philosophy/Systems/

Policies Roles Referrals Assessments Care Plans Placements/Packages Care Management Training Team Bases Management Employment Change Process/Time-

scales

What makes an Efficient & Effective Team?

Well defined aims and objectives Clear procedures to identify and resolve/de-

personalize problems and conflicts as they occur. This is seen as being ‘mainstream work’ and not an occasional hiccup which they were neither expecting nor prepared for

A clear pattern for team and other meetings A system for sharing information with each other

and with external bodies Agreed ways of monitoring it’s work

The Specialist Community Team - for People with LD and their Carers

The Team encourages a flexible, pragmatic and non-dogmatic approach to developing health/social care interventions, which take into account: physical issues, lifestyle factors, cognitive/emotional variables, health, relationships, and the impact of a person’s prior life experiences

The Specialist Community Team - for People with LD and their Carers

The Team works both directly with individuals and indirectly with their carers/services to: Develop accurate understandings of individual needs and

the situations they find themselves in Increase the shared understanding of the reasons for any

presenting challenges/difficulties Raise the expectations about what is possible, both for

individuals themselves and those who influence their lives Maximize people’s capabilities Minimize the unnecessary involvement of specialist

services, and increase the competence of ordinary supports

The Specialist Community Team - for People with LD and their Carers

The Team provides focused support and practical assistance to improve the quality of life of individuals with learning disabilities in Halton, in line with recognized good practice:

A wide range of co-ordinated community support services Individualized assessment & specialist health/social

interventions Advice and consultation to other learning disabilities service

staff Development of good practice policies/protocols in relation to

the promotion of positive health/social care experiences Training, development and research activities which support

the availability of effective and high quality local comprehensive integrated services

Past Issues/Questions Identified

Timetables for change Team and professional

management structures Professional supervision Relationships with LA/

PCT/HA/Joint Commissioners

Estates/IT/Admin support Financial protocols Balancing responses to

Urgent Referrals & Development/ Therapeutic work

Mixed Eligibility criteria

Case and workload allocation systems (inc. paperwork)

Regular joint working/shadows

Fairness/equity in Resource Panel decisions

Quality vs quantity targets Access to notes/info Communication Accountability/Complaints Abuse &Vulnerable People

Adult Protection Links with Providers

Key Elements for a Supportive Work Environment

Clear, common inspiring goals High level of trust Respect and appreciation A sense of team Comfortable, clean, orderly physical environment Adequate resources Opportunities for input into decisions A solutions orientation People taking responsibility Authority appropriate to responsibility A can-do, positive winning attitude as a way of life Encouragement to try new ideas High priority on growing and developing people Honesty and truthfulness culture

Key Elements for a Supportive Work Environment 2

A place where management says what it means, means what it says, and does what it says

Thorough communication based on integrity A focus on high quality standards and ability to set targets Freedom to do the job To be an example of how to be Adequate compensation and other rewards Appreciation for the service and people Stimulating, challenging work Responsive, caring leadership A supportive, warm and friendly atmosphere People willing and eager to serve A high level of professionalism Empowered people open to change A fun, prosperous, growing workplace

What is the Team Like Now?

Fully integrated team-working providing a single service with almost total overlap and New Name

Integrated training/development programme

Single point of access for health/social work referrals Common Contact Assessment/Core Client Database

Integrated health/social work team management Shared initial Single Assessment Process

Essential Info Record/Access to Info from previous records

Case Allocations meeting Common Care Plan/Review systems

Care 1st/Performance indicators

Agency Contract Reviews

What is the Team Like Now? 3

Each professional team member now takes on 3 roles Individual Named Person/Service Care Co-ordination Specialist Professional practice Training/Project/Clinical specialist development supporting

‘Valuing People’ targets Community care tasks, Day services, Housing, Respite,

Transition, Joint Training, Carers Abuse/Vulnerable witnesses, Complex challenging needs

(Challenging behaviours/Forensic/ Mental health), Multiple disabilities (Physical/Sensory/Mobility), Physical health (Health action plans/Primary care & Hospital liaison)

Developing integrated Workload Review Management systems

Examining the impact of ‘Agenda for Change’

What is the Team Like Now? 2

Inter-disciplinary team membership including: Admin. Support, Community Care Workers, Social Workers Admin. Support, Clinical Assistants, Clinical Psychologists,

Community Nurses, Community Support Workers, Occupational Therapists, Physiotherapists, Speech Therapists

Clear Professional leadership and supervision arrangements

Shared fortnightly team meetings -Revised format Referrals, Updates, Critical case/Development projects

reflection

2 developed/extended shared Team bases Fortnightly Resource Allocation Panel meetings

Revised common resource application forms

Hopes & Concerns

Divide into 5 groups Managers Professional groupings

Admin Nursing Social Work Therapists

Each person to identify up to 3 Hopes and Concerns for the development/future direction of the Team and Halton LD service

Share with other members of the group List up to 3 ‘Burning Issues’ you believe the service Write a summary list to feedback

Identifying Priorities

Each person to write down a comment/concern about a main issue that needs work (Maximum of 5 each)

Put up randomly, one person at a time

There must be NO reaction of any kind from other group members – no support, criticism, ?s or body language

Group members should not change their minds about an issue selected in view of what has gone before or say ‘I agree with Sandy’ – But use their own words

Identifying Priorities 2

Repeat until finished

Then group members can ask questions to clarify issues

Gradually merge and group issues of common concern

Vote for 5 priorities to focus on initially for resolution

A Strategy for Resolving Conflict - Timed Talk

Set timer for 3 minutes Take turns talking – 3 minutes

each Take as many turns as

necessary to resolve the issue Do not interrupt each other or

take over each other’s turn If you don’t need all of the time

in one turn, save it for your next turn

Stop talking the instant the timer goes off

Keep eye contact with the other person speaking

Focus on finding a good idea, not on winning

Remember how intelligent you both are

Remember that there is an better idea neither of you has yet thought of

Smile once in a while – appropriately

Breathe out If time runs out, schedule a

time soon to continue

LA Team Priorities (2003/04)

Increased range of services to vulnerable people Specialist Day Service development/delivery Drop-in day service options/Better use of existing facilities Shared ownership housing options

Early intervention/prevention Re-focussed respite to target ‘move-on’ experiences Housing option lists for all people living with parents aged 70+ Person-centred Transition support plans - 2004/05 leavers

Recruitment/retention Developed integrated PDP/Appraisal process/Training strategy PQ standard development/implementation New Practice Manager role

LA Priorities (2003/04) 2

Stronger/informed leadership + performance monitoring 3-monthly reflective review process for all complaints Continued team retreats/away days Joint workload management systems developed/implemented

Timely responses and reduced access waiting times Fair Access to Care training for all staff Refocused Resource Allocation Panel and meetings Reviewed Single Assessment Process ‘initial assessments’ and care

plans to ensure quality Adult Protection

Clear local procedures to translate new Adult Abuse policy Training implemented on Adult Abuse/Vulnerable Adults for all team Developed role of new Practice Managers as leads on Adult Abuse

LA Priorities (2003/04) 3

Intermediate Care Formalise joint protocols for accessing support from RARS Clarify support arrangements for clients admitted to hospital beds and

care pathways for discharge arrangements Direct Payments

Additional internal and external training Identify team champion/increase use of ‘Personal Assistants’

Service user/Carer involvement and feedback Regular user/carer–team consultation and review sessions Develop options for funding users to translate all team resources into

‘user-friendly/jargon-free/more accessible’ materials Develop ‘estate-agent/dateline’ compatibility process and review all

existing clients in supported housing to see if changes/move-on’s required

LA Priorities (2003/04) 4

Money/Resources & Planning Refine information entry processes and ‘checking it is done’

mechanisms Review/develop agency contract review meetings

Information Management Utilise new Principal Manager post to record achievements/ progress

more effectively and PR in writing Training for whole team on Care 1st to ensure ongoing data entry to ‘hit’

Performance Assessment Framework targets (especially all admin staff)

PCT Health Priorities (2003/04)

Yet to be defined and agreed ? Specialist LD resource reconfigurations (5 Boroughs

Partnership Trust) ? Health Action Plans and Facilitation ? Team-led clinics ? Complex needs ? Training/Facilitation ? Continuing health care

Additional Info

Review of Community LD Teams - The Key Questions

Update Presentation to LD Partnership Board on the Integrated Health/Social Work Specialist Community Team (May 2002)

Draft Specialist Community Team Information Flyer

Community LD Team Essential Information Record

LD Resource Panel Application Form

Community LD Team Review - Away Day notes (November 2002)