1. Workshop 6 Unit 513 and 515 Theories, Models And Legislation

2. Case study You are going to identify a Care Plan/Support Plan that you use in your practice. You should make sure it is anonymous so that it can be uploaded to your portfolio.

3. You are going to prepare a document that explains, as if to a new member of staff, the reasoning and good practice behind your plan.

4. 513 – Outcome based practice. 517 – person centred practice

5. What is a theory? Practice without theory is to sail an uncharted sea. Theory without practice is not to set sail at all’ (Leonardo Da Vinci)

6. What is a theory A theory helps us to explain a situation:

7. Using a theory  Describe – what is happening?  Explain – why is it happening?  Predict – what is likely to happen next?  Control and bring about change – how can I influence this situation?

8. Range A theory can be formal or informal Individual or very broad.

9. Theory Cycle Stage 1 Presenting issue Stage 2 Choice of theory Stage 3 Intervention plan Stage 4 Change and review

10. Theory Cycle Stage 1 Behaviour which challenges Stage 2 Medical model Stage 3 Stage 4 Change and review

11. Theory Cycle Stage 1 Behaviour which challenges Stage 2 Resulting from misuse of power and oppression Stage 3 Stage 4 Change and review

12. Theory Cycle Stage 1 Behaviour which challenges Stage 2 Bereavement and loss Stage 3 Stage 4 Change and review

13. Using a theory  Describe – what is happening?  Explain – why is it happening?  Predict – what is likely to happen next?  Control and bring about change – how can I influence this situation?

14. Progression of theories Past Ways of Working Institutional care Service Led Medical Model

15. Medical model Professionals are the expert “Problem” lies with the person Person should comply with treatment plan Treatment (eg drugs or training) should aim to cure or correct the problem Deviation from the “norm” or ideal leads to exclusion from society. (Specialist resources).

16. Progression in Practice Normalisation/social role valorisation (Wolfensberger 1980’s) Service Accomplishments: Status and respect, choice, competence, community presence, relationships, individuality, continuity. Role Expectancy

17. Progression in Practice Criticisms: very complex, and so not accessible to professionals. Focus on professional behaviour and service. (Cafferty 2014)

18. Needs led assessment Bradshaw’s Taxonomy of Need (1972) Maslow – Hierarchy of Needs (1970)

19. Maslow

20. Criticisms Where do you stop seeing need? Can you ever achieve, as a service? Services have limited resources Does use of labels and interaction with staff impact on self esteem?

21. Outcome Based Practice Involves a combinations of teamwork, quality improvement (continually evaluated) and process and outcome measurement. Tailored to the individual, it meets the personalisation agenda.

22. Outcome Based Practice Outcomes involving change – (self-confidence, self- care, or access) Outcomes that maintain quality of life (or slow down deterioration Outcomes that relate to services (feeling valued, respected, listened to).. Harris et al (2005)

23. Person Centred Practice Person Centred Care is not a theory; it is more an application of values into practice. » (Siobhan Maclean) It places the person at the centre of the care service. It’s about allowing individuals to build a system of care and support tailored to meet their own needs and designed with their full involvement.

24. Social model of disabilty Person is the expert in their condition The “problem” is rooted in society’s response to disability. Action should remove barriers to inclusion Celebrates diversity Professionals role is empowerment and action for access.

25. Example Glynn Vernon Cerebral Palsy – Spastic quadriplegic Difficulties with speech and movement Family advised at age four to find a home for him.

26. Glynn Vernon “I don’t have enough money and I don’t have enough sex”. "I am not disabled other than by the way others see and relate to me."

27. Legislation

28. National Assistance Act (1948) Local Authority has a duty to provide or arrange for residential care for anyone (18+) by reason of age, illness, or disability or other circumstance are in need of such care.

29. Chronically Sick and Disabled Persons Act 1970 Duty on Local Authority to ascertain the numbers in its area and provide: Practical assistance in the home, recreation and education outside the home, assistance in travel to those facilities, adaptations in the home for safety, comfort and convenience, facilitate the taking of holidays, facilitate meals, and a telephone or equipment to enable use of a phone.

30. Legislation Carers (Recognition and Services) Act 1995 – duty to carry out an assessment of carer’s needs. NHS and community Care Act(1990) made LA duty bound to carry out assessments of need, developing the needs led approach

31. Personalisation Agenda 2001 – Valuing People – A new strategy for learning disability. 2007 Putting People first – A shared vision and commitment to transformation of Adult Social Care – supporting social model of disability.

32. A vision for health and social care (2010) 3.3 A Big Society approach to social care means unleashing the creativity and enthusiasm of local communities to maintain independence and prevent dependency.

33. Our vision starts with securing the best outcomes for people. People, not service providers or systems, should hold the choice and control about their care. Personal budgets and direct payments 22 are a powerful way to give people control. Care is a uniquely personal service. It supports people at their most vulnerable, and often covers the most intimate and private aspects of their lives. With choice and control, people’s dignity and freedom is protected and their quality of life is enhanced. Our vision is to make sure everyone can get the personalised support they deserve.

34. 6p’s Personalisation Partnership Plurality Protection Productivity People

35. Recap Progression of care/progression of legislation

36. Dementia specific models Kitwood – psychological needs Attachment – to give + receive love Comfort- to be soothed Identity- self esteem boosted Inclusion- not excluded Occupation – to feel useful

37. Dementia specific models Aging and Later Life – (Kitwood) conducted an audit of behaviours commonly directed at those with dementia by carers in homes: treachery (deception to obtain compliance) disempowerment (doing things that the individual can do given time and encouragement) infantilisation

38. Dementia specific models condemnation (blaming them for "wilful" behaviour) Intimidation Stigmatisation delivering information faster than can be taken in invalidation (ignoring or discounting what they say)

39. Dementia Specific models banishment (removing from the company of others) objectification, treating them like lumps of meat