Person centred reviews - Dorset

PersoncentredreviewsHelen Sanderson

and Ruth Mathiesen

Helen Sanderson Associates34 Broomfield RoadHeaton MoorStockportCheshireSK4 4ND

T. 0161 442 8271www.helensandersonassociates.co.uk

Person Centred Reviews • 2

ContentsIntroduction........................................................................ 3

The working/not working review ........................................ 8

The important to/for review.............................................. 17

The citizenship review ..................................................... 37

The person centred review facilitator............................... 57


IntroductionHelen SandersonMost services have some form of regular review, to look at how we are supporting someone and what needs to happen next. There are day service reviews, care managers reviews, health professional’s reviews, annual reviews, transition reviews, person centred planning reviews and individual education plan reviews. We have been looking at how reviews can be more person centred and as well as setting actions, how they can be used to gather information that can be developed into ‘living descriptions’ of how people want to live.

There are three kinds of person centred reviews being used with adults and children. They are:

• The working/not working review.

• The important to/for review.

• The citizenship review.

This paper briefly describes the format and purpose of each type of review, and then summarises the difference between and person centred plan and a person centred review.

The working/not working reviewThis review is based on the person centred thinking tool ‘working and not working from different perspectives’.

Purpose• To explore what is ‘working and not working’ from the

individual’s perspective, the family’s perspective and the staff’s perspective. This can also include ‘other’s’ perspective, for example, health professional, care manager or Connexions worker.

• To agree actions that maintain or increase what is ‘working’ and change what is ‘not working’.

• To look at what the ‘working and not working’ information tells us about what is ‘important to and for’ the individual, and to begin to develop a living description.

Time• One hour minimum.


People• The individual.

• Their family.

• Others/staff.

Examples• This review process is being used by care managers to

review individual contracts and placements.

The important to/for reviewThis review is based on the person centred thinking tools ‘important to/important for’ and ‘working/not working from different perspectives’.

Purpose• To gather information about what people like and admire

about the individual, what is important to them now, what is important to them for the future, and what support they want and need.

• To explore what is ‘working and not working’ from the individual’s perspective, the family’s perspective and the staff’s perspective. This can also include ‘other’s’ perspective, for example, health professional, care manager or Connexions worker.

• To agree actions that maintain or increase what is ‘working’ and change what is ‘not working’, and what needs to happen to develop this information into a living description.

Time• One and a half hours minimum.


• Their family.

• Others/staff.

Examples• This review is used as the Important to/for Transition

review in schools and in day centres and supported accommodation services as a way to begin a person centred plan.


The citizenship reviewThis review is based on the Keys to Citizenship (Simon Duffy) and usually follows the ‘important to/important for’ review.

Purpose• To explore what is possible for individuals, under the 6

keys to citizenship.

• To prioritise and choose which of the 6 areas to focus energy and action on.

• To look at what is possible locally for each of the chosen areas.

• To action plan next steps towards citizenship for the individual.

Time• One and a half hours minimum.


• Their family.

• Others/staff.

Examples• This review is used as the Year 10 Transition review in

schools.


Person centred reviews and person centred planning

What?

Who?

Where?

When?

Why?

Person Centred Planning

A way of working out what is important to and for the person, now and in the future. Developedin partnership with family and friends, and leading to change.

There are different styles of person centred planning, for example PATH, MAP and Essential Lifestyle Planning.

The plan belongs to the person.Information can be used by care managers and providers, if the person agrees.

Whoever the person wants to invite.

Where the person wants it.

Major decision points in a person’s life - whenever they want to plan.

Create a shared understanding and make changes.

Person Centred Review

A different way to do reviews.

Using person centred thinking tools and the principles of person centred planning to ensure that everyone is heard, and that there are shared actions with a bias towards inclusion.

Fulfils statutory requirements.

Information collected at a person centred review could be developed further into a person centred plan.

The people who ‘have’ to be there and other people the person wants to invite.

Where the person wants it within the limitations required by the service.

At the Year 9 review, the Year 10 review and at annual reviews.

Create a shared understanding, meet service requirements and lead to change.


The table on the previous page summarises the differences between person centred planning and person centred reviews, however, there are some fundamental similarities. Both should have the person fully at the centre, lead to change, include families, promote inclusion, and create living descriptions of how the individual wants to live.

ConclusionPerson centred reviews are a way of developing more person centred and responsive services, and developing living descriptions of how people want to live. These living descriptions can be developed into person centred plans.

This could be an important way to begin essential lifestyle plans. By starting to gather information through a review we are able to start to change people’s lives (by developing actions at a review). This person centred information can be developed further into plans that evolve and lead to ongoing change. The citizenship review stretches our ideas about what is possible, and creates a framework for people to imagine a better life. This could lead to a PATH, where the individual can bring together the people in their life to dream and plan for change.

May 2006


Theworking/notworkingreviewThis review process focuses on what is working and not working from different perspectives, and results in actions. It can be used to review a person centred plan as a way to begin to gather information about what is important to and for the person.

PreparationBefore the reviewSupporting the individual to prepareIt is not surprising that the more preparation that you do, the better the result. There are two main areas to consider around support for the individual:


1 What to share at the meeting.

2 How the meeting should go.

There are various booklets that supporters can use with the person to think about how they want the meeting to go.They outline who should be there, what needs to happen to make it the persons meeting, things to consider in making it a comfortable welcoming meeting, and how information will be shared.

Supporting families to prepare for the reviewFamilies need to know what they can expect at the meeting and what they will be asked to contribute. This could be as simple as asking families to think about what is working and not working from their point of view.

Some families have began to lead person centred plans for their family member using ‘Families Leading Planning’ The person centred review meeting is an excellent opportunity to share the plan, adding others contribution and enrolling other people to support the changes that the person and their family want.

Supporting other people to prepare for the reviewProfessionals usually provide reports for meetings, and it is helpful to share the process and headings of the person centred review meeting with professionals beforehand.

Ask professionals to think about what is working and not working from their perspective. If it is impossible for them to attend, ask them to send their information under the headings ‘working and not working’, so that this can be written onto the posters and shared.

Preparation by the facilitatorBefore the meeting the facilitator needs to learn how the person can be kept at the centre of the review, who they want to invite, and how they want to be supported at the meeting.

Once everyone feels prepared, the following information describes the review process in detail.


The processWith each of the three reviews, it is important that right from the beginning the meeting looks and feels different.

Setting the sceneWhen people walk into the room it should be welcoming and informal. There will be flipchart paper with headings on the wall, a semi-circle of chairs (no tables!), music playing (if the person wants it) and refreshments chosen by the individual (beyond the typical tea, coffee and biscuits).

IntroductionsThe introductions for each of the review processes is the same - the facilitator should introduce him or herself and ask people to introduce themselves and explain who they are in the person’s life.

This information is recorded on a ‘who’s here’ sheet. An alternative is to get people to ‘sign in’.

Like and admireThere may already be a record of what people like and admire about the person. If there is, have this up on a sheet, if there is not, gather this information at the beginning of the meeting by asking people to say something that they like and admire about the person and recording this on the flip chart.

This heading should not include what we only say about people with disabilities or ‘faint praise’. Clinical descriptions such as ‘expresses anger appropriately’ or ‘can eat independently’ are not acceptable. Instead we are looking for positive characteristics in relation to for example how you would describe a friend or family member of the same age.

Explaining the review process and agreeing ground rulesThe facilitator explains the purpose of the meeting, the process and headings on the paper on the wall. It’s a good idea to give some examples as you go through the headings.

Agree simple ground rules with the person and participants.Here are some examples:


• No jargon - use everyday language.

• Everyone’s contribution is valuable.

• Take responsibility to cover what you need to cover (e.g. if you have to review a statement, or have a pressing question, put this up under ‘questions to answer’ or if you have a concern, put this under ‘what is not working’ etc.).

• Listen without interrupting.

• Smelling mistooks are ok.

• Confidentiality – on a need to know basis and decided in partnership with the person.

• Turn mobile telephones off or on silent.

• There is no such thing as a silly question.

Gathering informationEveryone is then invited to choose a coloured pen and write information under all of the headings except the action plan. People should be encouraged to use everyday language, and pictures if they want to. Be mindful of people who need support with the writing. If the person has chosen to have music at their review it can be played in the background as people are writing.

It’s the role of the facilitator to support people during information gathering e.g., clarifying what the headings mean, asking questions to get more detail, and helping people to add richness to the information.

During this period the facilitator must also help keep people on track. Information gathering typically lasts about 20 minutes. Check with the person at this stage if they want to take a short break.

Sharing and recording informationBelow are the headings used in a working and not working review with some examples from Matthew’s review. Although we are using this process with adults it works equally well with children. The examples included here are taken from Matthew’s IEP review, in year 4, at his primary school.


What’s working/what’s not working from different people’s perspectivesThis section records what is working and not working from the perspective of:

• The individual.

• Family and friends.

• Staff.

What’s working from Matthew’s perspective• Playtime.

• Working in a group at the group table.

• Being involved with his peers at all times.

• Independence at lunch time.

• Rewards - stickers, smiley faces, praise.

• Good relationship with staff and peers.

What’s not working from Matthew’s perspective• Not wanting to concentrate in class sometimes when he

finds other things more interesting (like the tadpoles).

What’s working from the family’s perspective• Extra curricular activities.

• Location in class - he feels part of a group and yet can still work individually.

• Reward system - praising positives.

• His home book.

• He enjoys school and being with his friends.


What’s not working from the family’s perspective• Speech and Language therapy.

• Obsessing over people and activities.

What’s working from others/staff perspective• Balance of different work styles for Matthew (whole group,

small group, 1:1, independent)

• Relationship with school around supporting Matthew’s learning.

• Use of wider school as a potential resource - e.g. additional sessions.

• Plans for Matthew reflect the reflect the perspectives of those present at planning meetings (ongoing process).

What’s not working from others/staff perspective• Only made small improvements in speech and language.

Questions to answer/issues we are struggling withThis section should include:• Issues that people have differing views on.

• Where there isn’t enough information about something.

• Areas where we need to get other people involved.

Encourage people to write these as questions. These issues are addressed during the action planning stage.

In Matthew’s IEP Meeting, the facilitator worked with his Mum to think about these questions before the meeting, and already had them written onto the posters as people arrived. After people had written on the working and not working sheets, the facilitator asked them to add to the questions to answer sheet. Here are some of the questions from the meeting:

• How will Matthew be met in the morning when he moves to juniors?

• How can we ensure that Matthew’s swimming continues each term?

• How can we ensure that everyone knows and uses the speech and language therapists programme?


What Who When

Continue swimming each term.

Liaise with the next teacher and provide additional materials. Lesley Before next term.

Incorporate ‘successful approaches’ into Matthew’s 9 - 3.15 Helen andplan and use with next teacher. Lesley By end of July.

Make additional visits in the first term to support the next teacher. Lesley During next term.

To timetable speech and language therapy sessions into the day, and well as using on an ongoing basis. Sue Before next term.

Ask for demonstration of new speech and language therapy programme when the SALT visits. Sue Before next visit.

Try different bags for different activities to help Matthew understand what is going to happen (e.g. gym and swimming). Niki By end of July.

• What are the next steps in supporting Matthew in his development?

• How can we make sure that the successful practices that are used with Matthew now are taken forward into his next class?

Reviewing the information and action planningAfter people have written their information on the posters, the next stage in the process is to review the information and to develop actions.

The process for doing this is to:• Read out what is going well from all the perspectives and

ask what needs to happen to ensure that these continue?

• Look at each item on the what is not working lists and ask what needs to happen to change or address this?

• Go through each of the questions to answer and agree an action to answer the question.

Here are some of the actions from Matthew’s IEP review.


What does this tell us is important to and for the person?One of the areas for actions is to think about what the information tells us is important to and for the person. An action could be for someone to work on this, to begin a ‘living description’ or begin a person centred plan.

Once the actions have been completed, the facilitator can then ask what the working and not working information tells us about what is important to and for the person. A further action would then be to develop a ‘living description’ within services.

Closing the meetingWhen the action plan has been completed the facilitator re-caps and checks that people understand what is going to happen next.

The facilitator ensures that there is an identified person to pursue actions.

It may be useful to hold another meeting within the next few weeks to review progress. Ask people to consider possibilities and if agreed, arrange the date.

The facilitator also needs to identify who will write up the review and distribute the information. Other key people may need to be informed of the outcomes

And finallyThe facilitator closes the review by asking everyone in a round what they have appreciated about the review. Offer people the opportunity to share their thoughts about the process, what worked well, didn’t work well and anything they would do differently.

This is what people said about Matthew’s meeting

“The review became a positive experience - almost enjoyable! As a parent you often feel that the contribution you make in a review is negative because there are issues that require resolving. Using this framework allows the child’s positives to be celebrated by all parties, the negatives were not the sole focus.” Matthew’s Mum

“I liked the way that we all gave our views on all of the issues” Teaching Assistant

“I thought it was extremely positive looking at what is working and not working and setting actions” Class teacher

“This process gave people who don’t usually have a voice in reviews a chance

“It was good having the information on posters instead of reports - it was more accessible” SCENCO

“There was an amazing dialogue, it was positive and enjoyable.” Head Teacher


ConclusionAs Matthew’s Mum says, the working and not working review provides an opportunity to celebrate the individual and what is working, as well as addressing what is not working. It creates an opportunity for everyone to participate equally, and everyone’s contribution is valued. As the Head Teacher said this creates the possibility for a different dialogue. Crucially the process ends in actions that address what needs to change, and can be an opportunity to begin to capture information about what is important to and for the person.


Theimportantto/forreviewsThe important to/for review process was adapted from a style of person centred planning called Essential Lifestyle Planning (Smull and Sanderson 2001). It is a powerful approach that keeps the individual at the centre, supports positive and productive review outcomes and helps people go away feeling their contribution was valued. The important to/for review specifically focuses on what is important to the individual, what support they need to stay healthy and safe, what is working and not working for them and what actions we can take to change what is not working. The citizenship review builds on the information gathered at the important to/for review, and looks at what is possible for the individual, and how to make this happen.

Here we describe the basic process of person centred reviews, and how a person centred review can be further developed into an Essential Lifestyle Plan. Each review will be different depending on the role the individual wants to take. This paper describes the process in general to follow. We begin with an overview of the process and aims, and


then look at preparation for the review, the headings and the review process in detail, and how to go from information from a review to a person centred plan.

A person centred review represents a significant cultural shift for many of us. The process focuses on what matters to the individual, from their point of view. This process also explicitly recognises the contributions of the family and other specialist professionals, acknowledging that the individual themselves and their families are the ‘experts’ on their lives and that staff and others have specific knowledge and contributions to make.

Many traditional reviews and reports began with the individual’s condition and labels. This meeting turns this on its head by instead asking each member of the group what they like and admire about the individual.

In this process everyone has an opportunity to acknowledge and celebrate what is working well for the individual and their role and contribution to this. This again represents a change, as often contact between services and family is focused on what is difficult and not going well.

What is not going well is also addressed in this process, and results in jointly agreed actions. A person centred review meeting normally lasts around an hour and a half. In this time information that can be developed into a person centred plan is gathered and recorded. Over the years, the person centred plan can be developed and reviewed, and used to enable the individual to have the life they want.

Person centred reviews can be facilitated person centred planning facilitators, family mentors or Connexions staff. Person centred review facilitators require training in person centred reviews, structured practice with coaching and regular opportunities to reflect and problem solve with others doing this work.

The aim of a person centred review is to:

1 Identify and discuss what people like and admire about the person, what is important to the person (now and for the future) and what help and support the person needs.

2 Identify and discuss what is working and not working from different people’s perspectives (the person, family and others).


3. Produce agree actions that will:

Support the person to get what is important to them now and in the future.

Maintain what is working and change what isn’t working.

Build on the person centred information and develop the information into a person centred plan.

The important to/for review was designed to be done with very little preparation - just ensuring that people knew what to expect and ensuring we had done what we can to make sure that the individual was comfortable and could participate as fully as possible. However, we know that more preparation can make it be better experience for everyone, and over the last two years that have been many creative ways that facilitators have helped people and families to prepare.

PreparationPrior to the review there are a number of things we need to consider around preparation to make sure the review runs as smoothly and efficiently as possible.

Before the reviewSupporting the individual to prepareIt is not surprising that the more preparation that you do, the better the result. There are two main areas to consider around support for the individual:

1 What to share at the meeting.

2 How the meeting should go.

There are various booklets that supporters can use with the person to think about how they want the meeting to go.They outline who should be there, what needs to happen to make it the persons meeting, things to consider in making it a comfortable welcoming meeting, and how information will be shared.

Supporting the individual to think about their life, contribute and be prepared and supported to do this, is the key to person centred reviews.

This means that you need to think about what will enable the individual to contribute as fully as possible, for example


by using drawings, pictures, photographs, symbols, objects.Colin brought some pictures that he had done to his meeting. At the beginning of the meeting, Sue supported Colin to stick these onto the wall.

Jamie made a ‘person centred review clock’ with pictures which helped him stay up to date with where we were up to with the process during the review.

Naheed’s friends helped him make a positive poster with drawings and photographs which stated things they liked and admired about him, for his review.

There are established ways of helping people think about their life that can be used to help prepare a person for their review. Trans-active is an example of an innovative way that people can think about and describe what their life looks like with peer support. This information is presented on computer, and can be printed off and put up under the headings at the meeting. In Multimedia Profiling, a person centred review is a good way to report on the ‘catalogue’ describing the person’s life. Another useful resource that can be used to record information about someone’s life is ‘Listen to Me’ which helps people think about what is important to and for them in their life in more detail. Many self advocacy groups and organisations have developed similar tools.

Where someone has a person centred plan already, a person centred review is a great opportunity to share this information and work together on actions.

In preparing for the review, the individual needs to be supported in deciding who to invite and where they have the review. As the review is a statutory process and not a person centred planning meeting, there are people who have to be there. However, many individuals have asked for friends to be part of their review as well. The individual may want music or specific treats at the review.

‘Club Tropicana’ by Wham set the scene for Julie’s meeting.

Colin chose some music to play at his meeting, and this was on as he arrived. It was a spiritual tape, and the song he has got the whole world in his hands’ was played, which felt appropriate for a meeting where we were trying to put Colin firmly at the centre.


Supporting families to prepare for the reviewFamilies have different experiences of reviews, some of which include a very passive role of simply listening to reports. We need to help families to prepare for the person centred review and give them enough information so that they are in a position to make an equal contribution.

One father prepared for his daughter’s review by drawing pictures that symbolised what he liked and admired about his daughter. At the review meeting he copied the pictures onto the paper as part of his contribution.

A mother worked through some of the questions from ‘Listen To Me’ which meant she had the opportunity to think about richer, more detailed information prior to the review. She brought this information with her to the review and wrote it under the headings.

Tony’s mother called family members and friends (who weren’t able to attend the review) and had conversations with them, about some of the headings . This information was then shared at Tony’s review.

Families can also prepare specifically for the meeting, as Thomas’s family did.

Thomas has complex learning difficulties and has the label of ‘behavioural difficulties’ who lives in Wales. Mark helped Thomas prepare for his annual review and transition meeting by inviting together the people who knew him best, including family and friends. Using poster sized paper and recording what people said through the use of pictures, they helped him map out:


• What people liked and admired about Thomas - his positive reputation.

• What is important to him, what he is good at and enjoys.

• Some ideas for the future based on his qualities, skills and interests.

This was then recorded on A4 paper and presented at the annual review meeting.

Some families have began to lead person centred plans for their family member using ‘Families Leading Planning’ The person centred review meeting is an excellent opportunity to share the plan, adding others contribution and enrolling other people to support the changes that the person and their family want.

Supporting other people to prepare for the reviewProfessionals may be used to attending reviews and reading reports. It is therefore helpful to share the process and headings of the person centred review with professionals before the meeting so that they can think about their contribution. We must be clear that this is not an opportunity to write reports under new headings, but rather to bring their knowledge and contribution with the aim of creating a shared understanding of the person which leads to action.

Preparation by the facilitatorBefore the meeting the facilitator needs to learn how the individual can be kept at the centre of the review, who they want to invite, and how they want to be supported at the meeting.

In one of the meetings that I facilitated, I had assumed that we would share supporting the individual in the meeting. As soon as she came in, she went over to her mum, beamed, and promptly sat down beside her. She was very clear about how she wanted to be supported in the meeting, but it made it very difficult for her mum to fully participate. Next time I will think more about how the individual needs to be supported in a way that means the family can take part fully too.

Once everyone feels prepared, the following information describes the review process in detail.

“Some facilitators shared the pocket sized person centred review booklet with professionals prior to the review so they had a good understanding of the process and the headings prior to the review”.

“People who knew Neil well were worried that he wouldn’t stay for long in his review. I had conversations with them about Neil’s communication around how I would know if Neil wanted to leave, or when he needed a break. We were all amazed and delighted when he stayed for all of the review”.


The processBy now, the facilitator will know how the individual wants to be supported in their review, who is coming and where it is taking place. Right from the beginning, the important to/forreview process will look and feel different.

Setting the sceneWhen people walk into the room it should look and feel different - welcoming and informal. There will be blank paper with headings on the wall, a semi-circle of chairs (no tables!), music playing (if the person wants it) and refreshments chosen by the person (beyond the typical tea, coffee and biscuits).

IntroductionsThe facilitator should introduce themselves and explain how this review differs from other reviews. Participants will then be asked to introduce themselves and explain who they are in the person’s life.

This information is recorded on a ‘who’s here’ sheet. An alternative is to get people to sign in.

Like and admireThe facilitator will ask people to say something that they like and admire about the person. This information is recorded in the flipchart.

This heading reflects things that we like and admire about the person which includes the person’s gifts, abilities, strengths and personal qualities and characteristics. It should not include what we only say about people with disabilities or ‘faint praise’. Clinical descriptions such as ‘expresses anger appropriately’ or ‘can eat independently’ are not acceptable. Instead we are looking for positive characteristics in relation to for example how you would describe a friend or family member of the same age.

Examples:

• Sue has an incredible memory.

• Brian has an infectious laugh and a great sense of humour.

“Johnny had his favourite chocolate coated biscuits and apple juice. He sat on his bean-bag and listened to his favourite pop-star (Robbie Williams) before his meeting started. This gave a strong message to others about who’s meeting this was!”


• Pauline is generous with hugs.

• Claire is a groovy dancer.

Explaining the review process and agreeing ground rulesThe facilitator will then explain the purpose of the meeting, the process and headings on the wall. It’s a good idea to give some examples at this point as you go through the headings.

It is important that people know how the review fits with other meetings and processes and how information will be used. It is also useful at this point to outline for example where in the review process a ‘statement’ can be reviewed that is under the ‘what’s working/not working’ and ‘what support (the person) needs to stay healthy and safe’ headings.

It may also be helpful to briefly outline the role of the facilitator, and tell people that you are here to:

• Help people make realistic and positive decisions and take them forward.

• Help people stay on track.

• Make sure that all information is recorded including actions.

Then agree simple ground rules with the person and participants.

Here are some examples:







• Confidentiality – on a need to know basis and decided in partnership with the person.



The important thing to remember is that the facilitator is the ‘process expert’ (and therefore has expertise in the way that the reviews go) the individual, family members and other professionals involved in the review are the ‘content experts’ (and therefore have expertise and knowledge about the individual).

There is more detailed information about the ‘roles and responsibilities of a facilitator’ later in this pack.

Sharing and recording informationEveryone is then invited to choose a coloured pen and write information under all of the headings except the action plan. People should be encouraged to use everyday language and pictures if they want to. Be mindful of people who need support with the writing. If the person has chosen to have music at their review it can be played in the background as people are writing.


It’s the role of the facilitator to support people during information gathering e.g., clarifying what the headings mean, asking questions to get more detail, and/or helping people to add richness to the information.

During this period the facilitator must also help keep people on track. Information gathering typically lasts about 20 minutes. Check with the person at this stage if they want to take a short break. The facilitator then begins to identify the important priorities and themes in the person’s life

Below are the headings used in a person centred review with some examples.

What is important to (the person) now This section should only include:

• What the person perceives as being important to him or her.

• Those things that the person tells us are important (with words or behaviour).

It must not include:

• What is important to others.

• What people think should be important to the person.

For example, Tina told us through her behaviour that having her food pureed was important to her. People who knew and cared for her learned this as she hated to choke or cough when eating. However it is also very important around Tina staying healthy and safe that her food is pureed.


Therefore having her food pureed was listed under ‘what support Tina needs to stay healthy and safe’ and not to cough or choke when eating was listed under ‘what’s important to Tina now’.Information is generally related to the following areas so it may be useful to offer subheadings.

Examples:

In relationships with others • Not being supported by people who are over-bearing,

loud, aggressive or in my face.

• People must take time to listen to me when I talk to them and not argue with me or nag.

• Not being let down - people should let me know if they are going to be late.

• People must not answer questions for me as I can make my own decisions.

• That my physiotherapist is always a female.

• To see my best friend Mark at weekends.

In rhythm and pace of life• Not to have to get up as soon as she has just sat down.

• Not to be rushed in anything.

• Getting up at my own pace - about two hours before I need to leave the house so things are calm and relaxed.

• To have lots of things I love to do at the weekend like shopping or going to visit Auntie Margaret.

In positive rituals or routines• Someone I can trust being there for me to talk to for about

half an hour when I come back home, if I’ve had a bad day.

• To always sit in the front seat of the car or bus.

• A long walk every day.

Things to avoid• Parrots at all times.

• Hot weather (anything over 70 degrees).

• Fights and arguments of any kind.

• Being around dogs at any time.


• Meat of any kind.

• Loud squealing noises.

What is important to (the person) in the future This sections aims to capture the person’s hopes, dreams and aspirations for the future. Good reviews identify what opportunities the person might like to try and what skills they would like to develop. People’s hopes, dreams and aspirations need to be explored and commitment gained to help people achieve them.

Examples:

• To go out and meet friends without my family.

• To go abroad on holiday - somewhere warm and not too hot.

• To do a gardening course - then find a job.

• I want to be a train driver.

• To live in a flat with blue carpets and curtains.

• To look after animals especially cats.

• To find a husband and eventually have children.

• To go to lots of concerts of my favourite bands.

What support and help the person needs to stay healthy and safeThis section describes what is important for the person to stay healthy and safe and identify what others need to know and do:


• So that the person has what is important to him or her.

• To make sure the person stays healthy and safe.

• To support the person to be a valued member of their community.

It generally should not include things that the person can do for themselves only the support that the person needs.

It is also useful to use subheadings, for example, ‘characteristics of people who best support me’ or ‘support around communication’.

It’s important to remember that vital information around health and safety may not be important to the person. When this is the case this information should be listed under ‘what support and help the person needs to stay healthy and safe’ and not ‘what is important to the person’.

Where there are issues of health and safety that are sensitive and/or personal there needs to be a judgement about how much detail this is discussed in the review and recorded. If this is the case an action needs to be set regarding addressing these issues in a more respectful forum. Good review notes may identify that certain information is only available to people on a ‘need to know’ basis. Where the person is sensitive about an issue that needs to be widely known, such as complex epilepsy, the people at the meeting


must work out with the person that most respectful way of sharing the information to make sure the person stays healthy and safe. This should be in consultation with the person and with their permission as far as possible.

Examples:

• John needs support with safety in the kitchen and keeping his money secure.

• Lucy will vote with her feet’ very often as this is the easiest way for her to express her dislike of a situation. She must always have the chance to leave a room, return home or get some extra space to make sure she doesn’t feel trapped.

• Always acknowledge what Peter is saying or doing. NEVER ignore him.

• Duncan will often take what you say literally and may find metaphors, sarcasm or jokes hard to understand.

• Make sure that Michael always knows in advance where he is going, how, when and for how long and what he needs to take with him.

Questions to Answer/issues we are struggling withThis section should include:

• Issues that people have differing views on.



Encourage people to write these as questions. These issues are addressed during the action planning stage.


Examples:

• How do we improve the quality of information being passed between home and short break staff?

• Julie is uncomfortable in her chair - what do we need to do about this immediately?

• Lack of transport means problems getting to the social club. What do we need to do about this?

• How can we support Craig to do more of what he loves doing at weekends?

• Paul loves quad-biking - what opportunities are available to him in his local area and how can we best support him to do this?

What’s working/not working from different peoples perspectivesThis section records what is working and not working from the perspective of:

• The individual.

• Family and friends.

• Staff.

Examples:

What’s working• Paul enjoys his short breaks and has made some new

friends. He loves going to discos.


• Paul’s family are happy with the transport arrangements.

• Paul’s has made progress in using his communication book and learnt how to send emails to his friends.

• Seeing his friend Fred at the weekends.

What’s not working• Paul finds travelling in the bus very stressful and

uncomfortable.

• Paul’s family feel he is isolated from his friends and family and would like to offer him new social opportunities.

• Paul’s community nurse thinks he misses out on outings because of the inflexibility of his feeding routine.

• Not everyone who supports Paul understands how he communicates.

Reviewing the informationWhen people have written up information (after about 20 minutes), review the information and then develop actions.

To make best use of time it is important to firstly identify and gain consensus about the priorities for discussion. Priorities for discussion and action should be a balance between the person’s priorities and other issues. A really good way of doing this is to ask people to vote on the priority areas by for example ‘tick voting’ or ‘multi-dot voting’.

The facilitator then supports participants to review, discuss and action the information gathered by working through the information in the following order:

1. Working/not working.

2. Questions to answer/issues we are struggling with.

3. Any other information recorded under the other headings that is ‘what is important to the person now and in the future’ and ‘what help and support is needed’.

It’s also important to check that everything has been covered from the ‘What’s important to (the person) in the future’ heading.


Action planningThe action plan outlines who is going to do what, by when to help people move towards what is important to them, whilst staying healthy and safe. It describes what needs to be maintained (what’s working) and what needs to change (what’s not working).

The same information/issue may appear under the same heading several times. This usually indicates a priority for discussion and action.

Actions should be specific and identify who is responsible for implementation. It is also important to date actions, giving an indication as to when the actions are to be reviewed regarding progress.

Some of the responsibilities of the facilitator around action planning are to:

• Ensure the best interests of the person are at the heart of the decision making.

• Help people decide whether or not there needs to be actions set to maintain or improve things.

• Catch items that come up in discussion and look for common areas of understanding and agreement.

• Check on a regular basis with the person that they are agreeable to the actions being set.

• Clarify and summarise points for people.

• Request further explanation where necessary.

• Build a sense of commitment and gently push people to actions which include dates.

• Facilitate ‘blue skying sessions’ if necessary to identify possibilities.

• Make sure everyone is involved and are equally contributing.

• Record agreed actions on the action plan.

• Ensure actions are assigned to particular people.

• ‘Tick off’ actioned information.

At this point, it is also important to explore with the person and family members whether they would like to develop the information gathered at the review into a person centred plan.


What Who When

Explore direct payments for Jean and family. Social worker Tomorrow

Explore the provision of communication equipmentfor use at home. Julie By end of month

Find out what social activities (clubs, football) go on Support workerlocally in the evening. and Dad Next week

Make sure George continues to talk to his sister Mum andthe telephone every weekend. George

Discuss Fiona’s health needs (mobility, stamina, Key workereyesight) with the nurse. and Mum Next week

Referral to the wheel chair service for reassessment Mum Next week

Explore the possibility of a gardening course and Key workerallotment. and Dad Next week

Examples of areas of actions that would then be developed into specific ‘who’, ‘will do what’, ‘by when’ actions:


Closing the meetingWhen the action plan has been completed the facilitator recaps and checks commitment and understanding of what is going to happen next.

The facilitator ensures that there is an identified person to pursue actions.


The facilitator also needs to identify who will write up the review and distribute the information. Other key people may need to be informed of the outcomes.

And finallyThe facilitator closes the review by asking everyone in a round what they have appreciated about the review. Offer people the opportunity to share their thoughts about the process, what worked well, didn’t work well and anything they would do differently next time.


ConclusionOver the last four years we have seen this process used as a highly effective way of helping people to listen, learn and engage with each other.

The success of the meeting relies on everyone’s preparation, participation and the skills of the facilitator. However, it is vital to remember that however successful the meeting is, if every effort is not made to complete the actions we are exercising an unacceptable breach of trust. Better meetings need to lead to better outcomes, and our paramount objective is a positive change for the individual.

An exciting consequence of the person centred review process is that people are asking for positive and flexible outcomes that challenge current patterns of provision. It is important that this is shared with the people who can act on this through implementation groups, Partnership Boards, senior managers and that facilitators have information about direct payments and individualised funding. Through person centred reviews we can offer people the opportunity to take this information and develop it into a person centred plan. This could form the basis of a costed support plan, job description for workers, and individual service funds. Simply changing the way we do reviews, could lead to change at many levels.


The important to/for review is designed to focus on what is important to the individual, what support they need (what is important for them) and what is working and not working in their life. The citizenship review process takes this further by looking at what is possible (best possible examples of what other people have achieved) and prioritising which ones the individual wants to focus on.

Therefore the citizenship review process has been designed to develop and carry forward what was learnt in the important to/for review. The key intention of the citizenship process is that the individual should be supported in discovering what they really want for their future.

Thinking about the futurePeople with learning disabilities have similar expectations to other people. Consultation with individuals with learning disabilities concluded that they “had expectations similar to their non disabled peers or recognised in the literature

Thecitizenshipreview


as markers of adulthood. They expected to go to work or college, have a social life, continue their hobbies, make friends and have relationships. The young people did not mention use of services in the future; but they did want very practical information and support that would enable them ‘to be in charge of their lives and live more independently.” (SCIE, 2004)

We believe that supporting people to achieve citizenship on their terms will best fulfil these expectations. We have based this review process on citizenship, and have used as headings the Keys to Citizenship described by Simon Duffy.

The process has been successfully used in review meetings held in Stockport and in 4 London boroughs: Newham; Barking and Dagenham; Lambeth and Bexley. This paper describes the purpose and the format of the citizenship person centred review and contains real examples from these boroughs (the names have been changed).

The purpose of the reviewA citizenship review builds on the important to/for review. In the earlier review we looked at what was important to and for the individual and what was working and not working and set actions from these.

If we only learn what is important to the individual without knowing what is possible, then we will see them simply fitting in with what is available, for example, residential college or a place in the day service. We need to go further than this and learn what is the best that can happen for people and then work together to make this happen locally.

The citizenship review process takes this further by looking at what is possible (best possible examples of what other people have achieved) and prioritising which ones the individual wants to focus on. In this review we now look at:

• What is possible for the individual, under the 6 keys to citizenship.

• Prioritising and choosing which of the 6 areas to focus energy and action on.

• What is possible nationally and locally for each of the chosen areas.

• How to make this happen for the individual (action plan).

Keys to Citizenship: A guide to getting good support services for people with learning difficulties, Simon Duffy, 2003. Published by Paradigm Consultancy and Development Agency Ltd.)


Below are the headings used in a citizenship review, to address what is possible and how to make that happen locally.

• Who’s here?• What we like and admire about (the person)

(taken from the important to/for review).• Purpose of the meeting.• Ground rules.• Good things that have happened since the last

review.• Questions to answer.• Self determination - advocacy, communication,

circle of support .Direction - person centred plan.Money - my own money (individual budget), getting a job.Home - have my own place, live with my family.Support - have my own staff, supported living.Community life - build on existing relationships, join in community life.

• Action plan.

PreparationA person centred review meeting normally lasts between one and one and a half hours and there are a number of things we need to consider before the meeting to make sure the review runs as smoothly and efficiently as possible.

Many of the ways to prepare for a citizenship review are the same as the important to/for review.

Before the reviewSupporting the individual to prepareThere are two areas to support the individual:

1. What to share at the meeting.

2. How the meeting should go.


Some people find it helpful to talk to someone close to them whilst others may find it more helpful to have an ‘independent’ supporter.

The individual might need some help in understanding the headings.

A DVD has been produced in relation to the ‘Keys to Citizenship’ which shows examples of best practice nationally and helps people to think about what is possible for them. It would be very helpful if the individual and their family could watch the DVD before the review, as a way of understanding the headings and knowing some of what is possible.

Prior to the review it is be helpful to identify good things that have happened in the person’s life since the last review, including things at home, with friends and any important places they go.

There are established ways of helping people think about their life that can be used to prepare a person for their review. Trans-active is an example of an innovative way that people can think about and describe what their life looks like with peer support. This information is presented on computer. In multimedia profiling, a person centred review is a good way to report on the ‘catalogue’ describing the person’s life. Another useful resource that can be used to record information about someone’s life is ‘Listen to Me’ which helps people think about what is important to and for them in their life in more detail. Many self advocacy groups and organisations have developed other similar tools.

Information gathered should be brought to the meeting and presented in a way the person can understand. This might be as pictures, photographs or symbols.

Where someone has a person centred plan already, a person centred review is a great opportunity to share this information and work together on actions.

The individual and their family should have a copy of any of the written reports beforehand and know who else is attending the meeting.

Supporting families to prepare for the reviewFamilies have different experiences of reviews, some of which include a very passive role or hearing reports. Families should be given enough information to allow them to make an equal contribution.

Darren bought a personal statement that he had put together with the help of his support worker. This was read out at the beginning of the meeting and then placed on the wall.

Amy brought some paintings that she had done and these were used to decorate the room.

Alana brought some drawings and photographs that showed things that she wanted to tell people about. She also invited her best friend to the meeting.


Families have a vital role in collecting information for the review because they know what is important in the individual’s life. They also know what they may be able to do to help in the future and to understand some of the choices available. It is helpful for families to think about their input as a carers, how they can support the individual’s development and how the individual’s social and care needs might change, as they get older.

Some families have used a book called ‘Families Leading Planning’ to help them develop a plan for their family member. The person centred review meeting is a good time to share the plan, adding others contributions and enrolling other people to support the changes that the person wants.

Supporting other people to prepare for the reviewProfessionals may be used to attending reviews and reading reports. It is therefore helpful to share the process and headings of the person centred review with professionals before the meeting so that they can think about their contribution. This is an opportunity to bring their knowledge and contribution with the aim of creating a shared understanding of the person, which leads to action.

Preparation by the facilitatorBefore the meeting the facilitator needs to find out what needs to happen to keep the person at the centre of the review to ensure the person’s contribution is equal to that of others and how they can be best supported during the meeting. They also need to think about who to invite and discuss this with the person.

“In one of the meetings that I facilitated, several people described themselves as a ‘supporter’ of the individual. At the end of the meeting the several participants suggested that the individual did not receive enough support during the meeting and was therefore not sufficiently involved. I had wrongly assumed that the ‘supporters’ would carry out this role and had not identified any individual support for the meeting. In the future I will always ensure that where necessary, one person has the role of supporting the individual.”

It may be useful to have a co facilitator to write up the actions and keep track of the time.

Ensure you arrive in enough time to put the paper is on the walls before people arrive. Make sure the paper is accessible

Marcella used the guide to citizenship person centred review minibook to help her consider the various headings, and what they would mean to her son. “A few days before the review meeting, I prepared him by telling him what would happen at the meeting and showing him examples, with words, of what each heading meant. Preparation was very important. I made a list of all the things that my son and I wanted to talk about and things I didn’t understand had a question mark. I was concerned as to who would attend and made sure all the people my son and I wanted to be there were personally invited by my son. He wrote the invitation out in Widgit [showing pictures and words].”


for everyone, obviously, especially the person. Place all the headings on the flipchart but not the sub headings to the six keys. These will be explained and placed under the relevant heading during the meeting. Any explanatory images should also be put up before participants enter the room.

Aim to create a relaxed and informal atmosphere. Think about refreshments and music with the individual beforehand.

Setting the scene Before the review, supporters should have already worked with the person to find out how they want the review to go, who they want to invite and what role they would like to have at the meeting.

The review should take place where the person wants it (within the limitations required by the service).

As soon as people enter the room it should look and feel different - welcoming and informal. There will be blank paper on the wall with coloured headings, a semi-circle of chairs (no tables!), music playing (if that’s what the person wants) and refreshments chosen by the person (beyond the typical tea, coffee and biscuits!)

The processOutlined below is the step-by-step guide to the citizenship person centred review process.

IntroductionsThe facilitator should introduce himself or herself and briefly explain how this review builds on the important to/for review.

Participants will then be asked to introduce themselves and explain who they are in the person’s life. This information is recorded on a ‘Who’s Here’ sheet. An alternative is to get people to ‘sign in’ as they enter the room.

Like and admireThe list that was gathered at the important to/for review will be displayed on the wall at the beginning of the meeting. The facilitator will read out the list and record any new contributions.

“Supporters had made sure that Leila’s favourite food and toys were in the meeting room and space was available for her to ‘do her own thing’. There was a TV playing quietly in the corner of the room so Leila could watch her favourite video, if she wished.”


This list should reflect things what we might like or admire about anyone of roughly the same age and include their gifts, abilities, strengths and personal qualities. This includes things about the person that makes them smile, laugh or feel proud.

The list should not include what we only say about people with disabilities or faint praise. Clinical descriptions such as ‘expresses anger appropriately’ or ‘can eat independently’ are not acceptable. Instead we are looking for positive characteristics in relation to for example how you would describe a friend or family member of the same age.

Examples:

• Mason is friendly and polite, a very talented artist, always smiling and very smart.

• Leila is friendly, a joy to be with, spreads love and makes you feel loved, is energetic, curious and has a good sense of humour.

• Amin is cheerful, patient, brings out the best in others and has a calm manner.

• Adam is hard working, knows his mind and what he wants, is a wicked dancer, is warm and friendly, a good cook and has a good memory for dates and birthdays.

Explaining the review process and agreeing groundrulesThe facilitator explains why people are meeting and describes what it going to happen. It is important that people know where the review fits with any other meetings and processes and how information will be used. The facilitator will refer to the headings but will not fully explain them at this point.

The ground rules for the meeting will be discussed and agreed. These could include:







• Confidentiality - on a need to know basis and decided in partnership with the person.



It’s also important to point out that everyone takes responsibility to ensure they get what they need from the meeting and to make sure the persons ground rules (and any others) are recorded and adhered to.

It may also be useful to briefly outline the role of the facilitator. The important thing to remember is that the facilitator is the ‘process expert’ and the individual, family members and other professionals involved in the review are the ‘content experts’.

The facilitator’s role is to:

• Encourage people to get involved and share their views.

• Ensure the individual receives the support they need.

• Help people make realistic and positive decisions and take them forward.

• Help people stay on track.

• Make sure that all information is recorded including actions.

There is more detailed information around ‘roles and responsibilities of a facilitator’ later in this paper.

Good things that have happened since the last reviewEveryone will be asked to contribute something that has gone well for the individual since the important to/for review. Feedback should reflect the views of the individual, the family and any others involved with the individual and include:

• Things that have gone well across all aspects of the individual’s life.

• The targets that have been met and statement objectives achieved.


We are looking for positive experiences, events and statements that capture what the person has achieved, particularly enjoyed and is pleased or proud about. All contributions will be written up.

Examples:

Adam has dealt with some difficult situations very well, he is travelling independently on the bus, has grown in confidence and can now use a mobile telephone.

Leila has had good year for health, is settled, is communicating with us more, is more confident with people in meetings and is enjoying physical activities.

Checking the action plan from the last reviewThe action plan from the last meeting will be checked to identify what has been achieved. Completed actions will be added to the ‘good things that have happened’ sheet. Any incomplete but still relevant actions (and any issues to be resolved) will be placed under the ‘questions to answer’ heading.

Explaining the review process The facilitator will then explain the citizenship headings one by one: self determination; direction; money; home; support and community life.

After each main heading is introduced each sub heading will be briefly explained (in general terms) and in turn placed under the relevant main heading. The facilitator should briefly explain what is practical and possible (and best practice) for each sub heading. If possible people attending the review should have watched the citizenship DVD in advance which gives helpful background to each heading.

Self DeterminationThis is about the people being in charge of their own life, being listened to and making decisions.

AdvocacyAdvocacy is one of the ways people can have more control and choice in their life. They may choose to join a local self advocacy group, such as a People First group or have a

“At Adam’s important to/for review it was agreed that he would visit the local Connexions office and this had not yet happened. It was still felt to be a relevant issue and so was placed on the ‘questions to answer’ list and was discussed then actioned at the end of the meeting.”


citizen advocate. A citizen advocate is someone who usually unpaid who supports and speaks up for the individual in some aspects of their life.

CommunicationHow people make themselves understood affects how they make choices, have control and enjoy relationships. There are several possibilities for supporting communication. These include; person total communication, electronic support, developing a communication chart, decision making matrix chart or decision making agreement.

Circle of supportA Circle of Support is a group of people who know and care about the person who meet together to explore possibilities, share responsibilities, create a plan and put it into action.

DirectionThis is about setting goals and making changes in the person’s life.

Person centred planPerson centred planning helps people to think about what they want in their lives now and in the future. Family and other important people work together with the person to make the plan happen.

Planning can be led by the person, (using Listen to Me), led by the family (using Families Leading Planning) or led by a facilitator supporting the person to plan.

MoneyThis is about the individual having control and choice over their money.

Having my own money (personal budget)Possibilities to consider include; having an individualised budget (where Local Authorities are part of In Control) the individual having a direct payment, family managing a direct payment, having an Individual Service Fund held by a provider, support from the Independent Living Fund, setting up a trust fund, maximising benefits and grants.

Get a jobIs about having paid work. It is also about developing work and life skills.


There are various options for training that might increase the possibilities of getting a job. There are various opportunities for work including; open employment, supported employment and paid and unpaid opportunities.

HomeThis is about having choice and control over where people live, who they live with and how they are supported.

Live on my ownIs about living alone or sharing with friends. There is a range of housing options including; private rent/housing association/supported housing, council house, family buying to let, getting a mortgage independent living scheme.

Live with my own familyIs about continuing to live with family. Possibilities to consider include; home adaptations and advice, Family Link or befriending schemes, short break and holiday options and support for carers.

SupportThis is about people getting the help they need to do things they want, or need to do, or want to achieve.

There are several possibilities to look at including; support offered by natural supporters/friends/family, service brokers, job coaches, specialist service provision, health therapies, advisors, come in supporters, skills trainer, developing a support timetable, support policies and plans.

Have my own staff, Is about having individually tailored support and having financial control over it for example with the use of direct payments and personal assistants.

Supported LivingThis is where you have support staff who help you in your home or tenancy.

Community lifeThis is about enjoying social and leisure activities and being part of the community.


Build on existing relationshipsThis is about developing a range of relationships and friends.Possibilities include keeping in touch with friends, catching up with family members, doing a relationship circle.

Join in community lifeThis is about being included, leading a full life doing interesting things and making a contribution.

Possibilities include; exploring hopes, dreams and aspirations for the future, opportunities for activities and learning, developing hobbies and interests, spirituality, volunteering and community mapping.

At this point it may be useful to offer some examples of which headings to place their information under in order to ensure the review meets their specific requirements.

Some pieces of information may fit under several headings including ‘questions to answer’.

In choosing where to place the information it helps to think about the purpose of the target and what the individual is expected to gain from it.

Examples:

Della’s targets:• To read newspapers and magazines of interest to build

upon reading skills and create more awareness and understanding of things happening in the community (e.g. communication, get a job, join in community life).

• To increase vocabulary and improve spelling and punctuation (e.g. communication, get a job).

• To develop problem solving involving time and to roughly estimate the value of different items (e.g. communication, have my own money).

• To develop social skills and confidence with adults and peers (e.g. communication, build on existing relationships, join in community life).

Sharing and prioritising informationEveryone is then invited to choose a coloured pen and write comments and possibilities under all of the headings except


the action plan. People should be encouraged to keep their comments brief and use everyday language and graphics. Be mindful of people who need support with writing. If the person has chosen to have music at their review it could be playing in the background as people are writing.

During information sharing the facilitator should assist people to place their information under the relevant heading, clarify what the headings mean and ask questions to get more detail. They may need to stress that if important information isn’t recorded it won’t be discussed. Professionals should ensure that key points from reports are entered as appropriate.

The facilitator must also help keep people on track. Information sharing typically lasts about 20 minutes. Check with the person at this stage if they want to take a short break.

The facilitator now begins to identify the important priorities and themes in the person’s life.

Information is likely to be written in bullet points and the facilitator may need to ask people to put enough detail so that it is clear what the issues are. This also helps make the meeting notes more useful.

Examples of information listed under the ‘key’ headings:

Self determination• Maintaining relationships with peers - Leila.

• Difficult to find volunteers to care for or take Leila out. Lack of engaged neighbours/friends.

• Explore possibilities around sensory integration and develop a communication passport for Leila.

Direction• Have a plan for when Adam starts work.

• Work on a plan for now and later in Leila’s life.

• Include what we know Leila likes and benefits from in planning.

Money• To go to college and do a carpentry course and then find

a job - Adam.


• Look at the possibility of own money - check benefits are right for Adam.

• Are there any opportunities for appropriate work experience in reception and office work? - Jennifer.

• Della would like to look after animals especially horses.

• Need for information and advice on Direct Payments, benefits and grants - Leila.

Home• Have a place of my own in the future, to live in London.

Supported living, add name on housing waiting list - Adam.

• Can we create a purpose designed home for Leila? Staffed appropriately for her? Are modifications to the family home needed? Providing support within the home?

Support• Direct payment - awaiting an assessment for a long time

- Leila.

• How to recruit a person assistant or befriender for my son.

• To swim, to go out and about, to go on holiday - all these require 24/7 support - Leila.

• Direct payment, In Control, Independent Living fund - can these help Paul?

• Do a ‘characteristics of people who best support me’ or ‘support around communication’ for David.

Community life• What will Leila do? What activities can she engage in?

• Life and independence skills, work skills, independent travel and making friends, social skills and confidence building - Della.

• What is Leila’s dream?

• Widen experiences for Paul particularly at the weekend and offer him new social opportunities.

• Help Paul to be more independently mobile in the community.

• Would Paul like to go abroad on holiday?


• Adam wants to make more friends. What opportunities are available to him in his local area and how can we best support him to do this?

• More opportunities and activities with peer group outside of school on holidays, weekends. Looking at summer schemes - Leila.

Questions to answer/issues we are struggling withDuring the information sharing period everyone is invited to add information to the ‘questions to answer’ list. The list should include issues:

• Issues that people have differing views on.



These issues are discussed during the action planning stage.

Examples:

• How can we help my daughter to achieve her hopes and dreams?

• What local opportunities are available to help her get the job she wants?

• How can the John to become part of the community?

• Lack of transport means problems getting to the social club. What do we need to do about this?

• Are there any specific health, safety or care issues/needs that need support now or in the future?

After the comments have been gathered everyone will be asked to identify priorities for discussion by placing stickers next to the areas they consider to be most important to the person. Each person will be given 3 stickers (no more than 2 stickers to be placed on the same area).

Reviewing the informationThe number of stickers placed on each area will be counted and the facilitator will support participants to review, discuss and action the priorities. Those items marked with most

“After we had placed our dots and sat down, the facilitator counted the dots and gave each one a ‘score’. We then started to work through each one,

agreed on actions that we wanted to take. Some of the actions that came from Jennie’s review were; increasing leisure opportunities, forming a circle of support and thinking about future living arrangements.”


stickers are dealt with first. Areas with a small number of stickers will only be discussed if there is enough time. The same information/issue may appear under the same heading several times. This usually indicates a priority for discussion and action.

As each area of discussion is introduced, the facilitator will explain local possibilities, options and opportunities. Participants will also be asked to contribute their local knowledge of resources and best practice in people getting people the lives they want (where they live, work and education, social lives etc.).

The facilitator will support everyone to take part in the discussion and support people to develop actions that are practical, positive and realistic.

Action planningThe action plan outlines who is going to do what, by when to help people move towards what is important to them. It will include action to maintain things that are working well and those things that need to develop and/or change.

Actions should be specific and identify who is responsible for implementation and include a completion date when progress is to be reviewed.

Some of the responsibilities of the facilitator around action planning are to:

• Ensure the best interests of the person are at the heart of the decision making.

• Help people decide whether or not there needs to be actions set to maintain or improve things.

• Catch items that come up in discussion and look for common areas of understanding and agreement.

• Check on a regular basis with the person that they are agreeable to the actions being set.

• Clarify and summarise points for people.

• Request further explanation where necessary.

• Build a sense of commitment and gently push people to actions which include dates.

• Facilitate ‘blue skying sessions’ if necessary to identify possibilities.


• Make sure everyone is involved and are equally contributing.

• Record agreed actions on the action plan.

• Ensure actions are assigned to particular people.

• ‘Tick off’ actioned information.

During action planning it is important to ensure that:

• Priority is given to addressing the things the individual is saying is important to them.

• Any issues of health and safety are discussed and actioned if necessary. For many people this is where the balance between happy and safe/healthy is explored. It’s about finding a balance between ‘health’ through the eyes of the person and professionals.

• Where issues of health and safety are raised which are sensitive and/or personal, a judgement is made about how much detail is discussed and recorded in the review and whether it is more appropriate to discuss the issues at another time. The decision should be made in consultation with the person and with their permission as far as possible.

Participants should have the opportunity to review all the items from the questions to answer list (within time limitations).

It is important to explore with the person and family members if they would like to develop the information gathered at the review into a person centred plan and whether they would like a facilitator to support this process.

David said he wanted to go to college to study IT so he could get a job. Although there wasn’t a suitable local course, there were other courses that may have been of interest. The subject was discussed and an action agreed to explore the possibility of attending an IT course in a neighbouring borough.

“I think it’s good I can talk about what I want to do” “The meeting was well structured and it was excellent to hear Adam’s views.” “The openness of the meeting allowed for a detailed action plan to be developed.” “The forum enabled Adam to

to express his wishes and hopes for his future.” “It honestly highlighted

feeling threatening.” “It’s

to a form”. Feedback from Adam’s meeting.

“A really good opportunity for everyone to work together for Jennie’s future.” “Good to meet others working with and supporting Jennie”. Feedback from Jennie’s meeting.


Examples:

What Who When

Explore the availability of carpentry courses and Support worker This monthplacement opportunities for Adam.

Share videos about housing options with Adamand his family. By end of March

Find out what social activities are available locally for Support worker By end ofAmin and explore opportunities and support needs. and Mum January

Develop a circle of support for Amin. Alan, Samand Joe 2 months

Support Mason to develop his communication skills. Mum

Contact social services to discuss direct payments for Leila and explore the possibility of grants. Mum Next 2 weeks

Leila’s mum to keep a check on review outcomes.


Closing the meetingWhen the action plan has been completed the facilitator recaps and checks the commitment and understanding of what is going to happen next.

The facilitator ensures that one person is identified to pursue outcomes and check that the ‘citizenship action plan’ is being actively followed.


The facilitator needs to check who will be responsible for putting the meeting notes together and who will distribute them. Other key people may need to be informed of the outcomes

And finallyThe facilitator closes the review by asking everyone in a round what they have appreciated about the person and the review. People will be offered the chance to share their thoughts about the review process and make any suggestions for improvement.

“I also noticed that the group (at Jennie’s review)

in a more person centred way which is quite a positive shift from the way many support workers, service providers and managers have thought and practised in the past.”

“Contributions people made were extremely helpful in planning for my son’s future. One of the things that came from the citizenship review meeting was the need for my son to have a buddy to help with his communication. Within a day I had set up a buddy for him, and he now comes once a month. As our review meeting was in March, the buddy has assisted my son in April and May. Social services will now take over financing the buddy, providing for three hours per week through direct payments.” Marcella.


ConclusionOur experience so far is that this process can be a highly effective way of helping people to listen, learn and engage with each other.

The success of the meeting relies on everyone’s preparation, participation and the skills of the facilitator. It is therefore crucial that facilitators receive appropriate training and support and are fully aware of relevant national and local possibilities. However, it is vital to remember that however successful the meeting is, if every effort is not made to complete the actions we are exercising an unacceptable breach of trust. Our paramount objective is a positive change for the individual.

An exciting consequence of the person centred review process is that people are asking for positive and flexible outcomes that challenge current patterns of provision.

The process helps people to think beyond traditional placements and traditional services to develop a more individual, creative and flexible approach for each individual.

It is important that the learning from citizenship reviews is shared with the people who can act on this through implementation groups, Partnership Boards, senior managers and facilitators. Information shared at a person centred reviews also offers people a springboard to developing person centred plans.

The citizenship review stretches our ideas about what is possible, and creates a framework for people to imagine a better life. This could lead to a PATH, where the individual can bring together the people in their life to dream and plan for change.

“We asked a Connexions worker to leave the meeting as they didn’t know Leila and would

contribute”


This section outlines some top tips for facilitators which includes some of the roles and responsibilities of a facilitator, i.e. what are core responsibilities of person centred review facilitators and what are the areas a facilitator can use judgement and creativity .

The best people to facilitate are people who:

• Who truly listen, not only people’s words but also to what people are telling us through their behaviour.

• Avoid putting words into peoples mouths and promoting your own views and preferences - make sure all actions are checked with the person and their family.

• Encourage others to generate ideas.

• Exercise ‘power with’ people rather than ‘power over’ people.

• Help people to stay on track and stay focused on the process.

• Help people to make connections.

• Are comfortable with ideas that challenge the service.

Roles and responsibilities of a facilitatorCore responsibilitiesIn preparation for the review ensure that:

• You have attended all three days of the training.

• The individual and their family and other key people in their life are there (with no limits on family invites).

• When booking venues ask what room size, wall space and noise level will be like at time of review and ensure the room is suitable.

The person centredreviewfacilitator


• The room is prepared before people arrive. Be aware of the way posters are displayed. Sometimes, if this is on top of other school posters, it can be distracting for people.

• The environment is comfortable and informal

• The individual and their family have enough information for them to play an equal role.

• That ‘just observers’ are not attending reviews. Everyone at a review should be contributing. If you are unable to stop them attending make sure they are clear of ground rules.

• You ask the individual and others when preparing meeting when they would like a break. There are logical points in the process to do this.

During the reviewYou go through and stick to the ground rules. Commonly used ground rules are:






• Confidentiality - on a need to know basis and decided in partnership with the person.



As facilitator you should also:

• Make sure that everyone is clear about the new style of review process.

• Read out the ‘what people like and admire about (the person). This can be very powerful.

• Follow the process.

• Check that the individual is prepared and fully supported throughout.


• Make sure you are aware of how the individual communicates and you are working with people the person knows well so that they are able to contribute as fully as possible.

• Be mindful of non verbal language and use this well to help people who have complex needs really get involved.

• Ensure that important information, raised in discussion, is added to the relevant list.

• Complete an action plan at each review, with names and dates included.

• Explore, with the individual and their family, whether or not they want to develop the information from the review into a person centred plan and agree actions for this to happen.

Be aware of time available and avoid over running.

After the reviewThe review is written up and shared with the people who attended. You do not cascade the training and try and train others to do these reviews. Person centred review training is facilitated by an accredited person centred review trainer.

In preparing for the reviewYou can use your judgement and creativity as a facilitator:

• You don’t have to facilitate a review alone. You can enlist some help if you need to.

• When helping the individual think about who they would like to invite and how to invite them.

• In how you prepare the individual and their family.

• When supporting the individual in making the meeting space comfortable, informal, fun and relaxed (sweets, refreshments, music etc.).

Other responsibilities:

• Check with the individual if and when they would like a short break during their review.

• Have photographs of all the people who will be there in advance of the meeting and then the individual can put these up as people sign in against their pictures.

• Look at existing reviews and show how headings match up - show how the information will be collected in the review.


• Pre prepare information sheet(s) to stick on the charts.

• Avoid using felt pens with small nibs as the writing can be difficult to read.

During the reviewDuring the actual meeting think about how you enable the individual and their family to feel empowered and involved. Using ‘timed talk’ prior to information gathering can really helped with people’s confidence and getting people’s thoughts together.

After the reviewHere too you can be creative about how the review is written up but make sure it is easy to read. It is important that you support the individual to present the information in a way they understand. This could be with the use of video and photographs.

One of the real opportunities that the person centred review process offers is the opportunity to develop the information gathered at a person centred review into a person centred plan.

Documents

Person centred reviews - Dorset