Partners4Change have been asked a number of times – how does the P4C 3Conversation model work within a provider setting?
Susan Ripton from ECL Sensory Service stepped forward to share the organisation’s experience of taking the P4C 3Conversation model forward as part of Essex County Council Good Lives programme as a Trusted Assessor.
The Good lives model creates a new relationship between professionals and the people they are working with. So when ECC asked for volunteers to become an innovation site, ECL Sensory Service stepped forward. The innovation site focussed on a cohort of people who were newly certified with sight impairments by a hospital consultant and whom we contacted to offer information and support. This role was previously carried out in a very structured and scripted process undertaken by a generic ‘front door’ where the emphasis was on providing information, advice and referring on to specialist workers for any other work. This involved waiting lists and people having to tell their story more than once. ECL Sensory Service had already identified that this approach did not work for people who had been newly certified with sight impairments, so this was the first thing to go and to instead be replaced with P4C 3Conversation model.
So, how did this look, practically?
Conversation 1: initial contact
“How can I connect you to things that will help you get on with your life – based on your assets, strengths and those of your family and neighbourhood? What do you want to do? What can I connect you to?”
Conversation 2: when people are at risk
“What needs to change to make you safe and regain control? How can I help make that happen? What do I have at my disposal – including small amounts of money – and using my knowledge of the community, to support you? How can I pull them together in an emergency plan and stay with you to make sure it works?”
Conversation 3: when long-term support is needed
“What does a good life look like? What is a fair personal budget and what are the sources of funding? How can I help you use your resources to support your chosen life? Who do you want to be involved in support planning?”
Each of these conversations alone supports a proportionate assessment. The ability to have a ‘conversation’ without a ‘script’ opens up the dialogue between the person and the professional, enabling us to gain an all-encompassing and detailed understanding of the difficulties people are experiencing.
By working in this way, we very quickly discovered that the outcomes we achieved are rarely possible through a scripted conversation. Sometimes after a short conversation we realise that we need to move to conversation 2, but we never move to 3 without a conversation 1. It is important to understand: this is not a linear process and people can move between each of the conversations as circumstances change.
From day one, the dialogues have been open, friendly and aimed at resolving issues. To start with we look at what support they already have and build up a picture of their daily life. Together we look at the aspects of their life in which they feel they are lacking, be it social networking, getting out to talk to friends, visiting the church or getting to hospital appointments, and we then use our local knowledge and resources to help them manage this themselves, or guide them to people who can help them. There are no time-scales for conversations and no targets for how long we may spend talking to people: the only criteria we are working towards is that no one has to wait to have a conversation. We are led by the person and work to their pace, even if this needs to be a conversation over several calls.
As part of working in this new way, we stopped sending out a standard pack of information leaflets to every person contacted and now send information tailored to the individual, after which point we guide the person to where they can find the information for themselves. It was identified by people on receiving the packs, that they did not want reams of paper – often unrelated to the issues they are facing, and in inaccessible formats. We discovered that not only was this way of communicating a waste of resource and time for all, but was in some cases distressing since people had to wait until they had a visitor who could read the contents to them only to find it wasn’t personalised and much of it not useful. This new way of working gives people the opportunity to read through the information and make an informed decision to contact specific agencies for themselves, instead of being passed around via a referral or triage service through other professionals which is in no way empowering to the person. WE are of course on hand to help make these connections if need be.
Another process that we stopped from day one, was blanket referring to all sensory organisations. Whilst the idea behind this was initially a supportive one, it ended up becoming more of a hindrance to people who were bombarded with a variety of agencies calling and visiting them regarding the same issue causing confusion and duplication. The individual’s journey involved answering the same questions over and over again to organisations who didn’t communicate to each other.
We now have a flow of information constantly moving in line with the person’s changing needs. This is what really gives people a “good life”.
We gathered detailed daily data so we could accurately look at the outcomes of the different approach. It was evident from week 1 that changing the culture of speaking to people would greatly and very positively impact them, and the way the staff were working. It was difficult though to identify where the financial benefit fell because it spanned across the health and social care system and there was no whole system data to bench mark. For example, I had a conversation with one gentleman about his newly certified as sight impaired, initially he stated things were fine, but through having a good conversation 1 it transpired that he had stopped going to the shops to get his newspaper every morning, and felt unsafe out on his own. This conversation resulted in him having a connection made to a rehab worker for white cane training which supports him with his mobility and orientation and confidence in being able to get out independently. If this conversation was ended at the point he stated he was ok, it could of resulted him having a trip or fall outside and having a hospital admission, or a decline in his mental health from being socially isolated from his community. The benefit in the long term through this connection was that the gentleman stated he felt “more confident being out and about now, he was able to access his local community”
- Reduction in social isolation.
- Reduction in trips and falls.
- 100% satisfaction with the service – with comments such “involvement with ECL Sensory Service has been life changing”.
- Staff reported feeling valued and enjoy coming to work each day.
- Increased number of Adults volunteering as sensory champions, contributing to speaking at conferences and sensory awareness training.
- Improved working relationship with ECC colleagues as we work together to build on people’s strengths and involvement within their communities.
- Improved communication between professionals within specialist sensory services, reducing the need for people to tell their story twice (or more!).
- Reduced formal packages of care whilst still evidencing we are supporting people’s needs.
- Sharing of access to ECC IT system, which reflect the Good Lives model.
- Development of Trusted Assessor role within a specialist service.
So, I hear you asking, is it more work to start with? Yes it probably is, but the long term benefits to all involved far outweighs the fact you need a slightly longer conversation to start with. It makes the job far more enjoyable and you know that you are really making a difference to people’s lives.
What people are saying…
“I considered the lady who visited me extremely helpful. Her advice and suggestions were first rate and the fact that she too has a hearing disability, like myself – she was mindful of my problems” – Mrs W, Rochford
“It was wonderful to have been able to be supported by the same lady as last time. Thank you SC – you are a treasure” – anon
“L who visited me at home was very good on explaining to me the help I could get if I needed. She has made me a little more confident and part of the community by attending classes that are available for me. As I live on my own, I do not communicate easily. Looking forward to a brighter future” – Mrs SM, Basildon
Susan Ripton – Sensory Customer Service Administrator
ECL Sensory Service