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What Makes a Good Conversation? Be Mindful Mindful of the facts … Be curious Mindful of self Feel engaged Mindful of role … Be aware of your privileged advantage, so do the prep Mindful of others Dignify and value their participation Mindful of time/situation Listen without prejudice Mindful of place Respect and appreciate their environment Mindful of being Practice cultural competency Mindful of connectivity Strive to build positive relationships Mindful that Co-Design is founded on Empathy and Trust Slide 2

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Video 1 – This shows a meeting between Jessica and her social worker as Jessica’s GP has just requested home care support for her. Jessica who has broken her ankle whilst out in her garden feeding the birds.

What was good about the conversation? Exercise: What was good about the conversation? What do you think could have been improved? What else would you like to ask Jessica? How do you think Jessica felt? Slide 4

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Video 2: A different conversation As you watch think whether it is service led or outcome focused.

How do you think this compares with the first Conversation? Exercise: How do you think this compares with the first Conversation? Is the conversation service led or outcome focused? How is Jessica being treated in this conversation? Slide 6

Key points Positives: Some positive aspects, ‘describe a good day’ timebanking What’s important to you? Better listening Negatives: Still very service led in places _OT/ Physio/Alarm A good number of closed questions Some areas cut across, for example Jessica’s raising of driving was ignored Still focussed on deficits. E.g. in respect of confidence Slide 7

The Exchange Model of Assessment1 Slide 8 Figure 1: Smale and Tuson’s exchange model (adapted)

Negotiate and agree outcomes Hopes: What else... Instead of... What difference... Describe: Negotiate and agree outcomes (exchange model) Prompt questions; T.E.D Person’s story Acknowledge: Exceptions: Coping: Listen to issues Slide 9

Techniques- see handout Prompt Questions- typically open, “conversational approach- T.E.D. e.g.: Tell me about your health; Explain to me, what’s a typical day for you?; Describe for me, with as much detail as possible, what you need support with?”. Acknowledging- acknowledge concerns without needing to fix it. Exceptions- There are always exceptions to a description of problems (When is the problem not happening?; When is the problem different?) Coping- Asking questions which support people to reflect on their strengths, abilities to cope, endure, get through (how are you managing to get through all this?) Slide 10

Techniques Hopes- Many people generally respond with “I don’t know” and need support to think, using a range of questions. What else?- Look for what can change to cover a wide range of outcomes. Restore hope, that the person can work towards or achieve something similar to what they had done before. Instead of? - Establish what the person wants, not what they don’t want. What difference- will support with.... make to you? Description- lays the foundation of the planning process. Help the person describe in detail the life they want to be living- identifying outcomes, as this increases motivation to act and be involved. Slide 11

Exercise: So what difference will this action make?

Exercise: Can people become dependent on care services? Discuss in groups

Improving your confidence Being treated as an individual Being able to see friends and family Being listened to Reducing your symptoms Having a say/ choices Living where you want to Feeling safe Being treated with dignity and respect Getting involved in your community Improving your mobility Having people to rely on Having things to do Being in control and responded to Staying well Improved skills Slide 12

What is important to you in your life Focusing on outcomes means that you (the person) are supported to identify: What is important to you in your life Why these things are important (outcomes) How to go about achieving these things Who will be involved, including you, other people in your life and community, and services? Also when and where etc Therefore the outputs (use of services, if required) come at the end, once clarity is achieved. Slide 13

As part of assessment/ support planning, utilise ROPES: Resources- Family & Friends; Organisational; Community; Services. Options- Present focus- Emphasis on choice: What can be accessed now? What is available and has not been tried or utilised? What’s already working? What’s already been changing? Possibilities- Future focus; Imagination; Creativity; Vision of the future: In three months time, what would you want your life to look like? Exceptions-: When is the problem not happening? When is the problem different? How have you survived, coped, endured, thrived? Solutions- Focus on constructing solutions, not solving problems; Learning from the past- What’s working now? What are your successes? What are you doing that you would like to continue doing? Slide 14

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Exercise: What skills could I bank? Work in pairs to identify your skills and what you could swop with each other.

SMART Principles S - Specific (or Significant). M - Measurable (or Meaningful). A - Attainable (or Action-Oriented). R - Relevant (or Rewarding). T - Time-bound (or Trackable) Slide 16

SMART Proposed Mrs Williams wants to be supported to attend a social activity of her choice. What social activities?- Assessment Can you measure it?- review Is there any barrier?- Assessment Agreed Outcome Mrs Williams wants to attend the Fairfield Social Club every Wednesday, as she wants to maintain contact with her friends. When would she like to go?- Assess/plan Transport/ who’ll take her?- planning Slide 17

Exercise: Identify SMART outcomes