- Sometimes the assertion “I’m a practical person” can be a not-so-subtle way of implying that anyone promoting an alternative view resides in the zone of impracticality. Sometimes it is also a way of advertising oneself as having a monopoly of practicality and commonsense. (Occasionally what is offered as passing for commonsense is actually common rigidity.) Read the rest of this post »
EFFECTIVE SUPPORT, 04/06/2008 (Some thoughts prompted by Mary Kealy, CEO, Brothers of Charity, Clare presentation to Offaly Association for the Intellectual Disabled, Tullamore, May 13th 2008)January 27th, 2009
Mary Kealy had outlined their exclusive emphasis on “one person at a time” and had discussed at some length how the unfolding of opportunities (both role opportunities and opportunities in respect of developing natural networks of support) tended to happen spontaneously – often serendipitously – on a “we don’t really try and orchestrate things… but we are noticing that if we place ourselves in the right kind of situations one thing seems to lead to another.”
This general precept of Mary’s was linked to the view that “the way to become lucky in business is to get in the traffic.” By “getting in the traffic” was meant putting oneself about, introducing oneself to a range of people, soliciting advice, attending conferences and seminars, making connections, developing networks, writing letters, returning phone calls, et cetera. Things happen, opportunities surface, possibilities become evident when one is in the traffic. One of the really unhelpful consequences of the traditional service-provider model of support is that people are segregated from the normal opportunity-carrying traffic flows.
This in turn led on to a discussion on models of supporting people. What lies at the heart of successful applications of the person-centred ethos is a very intentional focus on
- Supporting the person to access the normal traffic flows, the zone where opportunities bubble up, where “one thing leads to another”,
- Very consciously scanning for such opportunities and ensuring that they are taken. This involves a high level of awareness about what is happening – and what might happen if sensitively supported. It also involves a high level of self-awareness about not over-supporting the person – we do not want to end up acting as an invisible membrane-barrier between the person and the opportunity.
The particular challenge for staff members whose orientation has been formed within the traditional system is to recognise such opportunity and to adroitly step back, get out of the way, so that the opportunity may “take.” The concept of “a service with holes” was discussed. If we don’t consciously create spaces, gaps in which we need and require a response, a dig-out from people in the neighbourhood or community, it will never happen. (As I am writing up these notes, I recall a conversation with a colleague who uses a wheelchair. After a recent evening time meeting in Dublin, I offered to walk him back to his car so that I could transfer his wheelchair to his boot. He insisted that there was no need for me to do this as some passer-by would be happy to oblige. Worried that it was getting dark and that the area mightn’t be that safe, I asked “But supposing there is nobody there?” His immediate response was “Brendan, there is always somebody there.” Reflecting on his comments and relating it to the ingredients of effective support, one of the things he is saying is that not only do we have to create the opportunity, we also have to have a certain trust and confidence that others will respond. Often those of us who have been steeped in services are very pessimistic about the general public. We need to put our pessimism to the test or, to steal one of Michael Kendrick’s comments, maybe we just need to maintain “a vaguely open mind” about the responsiveness and no-big-deal generosity of others to respond if approached and asked in the right way.)
Signed: Brendan Broderick, CEO
Person-centredness is not simply a matter of doing whatever is wanted by the person or those around them at a given moment. It is a struggle trying to discover what is best for people, as this is not something that is always so obvious.
Great comfort and reassurance is taken from the slogan “one person at a time.” One must also remember that it is possible to neglect and disappoint people “one person at a time” (Michael Kenderick). Sometimes what people seem to want for themselves, at least initially, is self-destructive and/or ill-advised in other ways. When this becomes evident [to whoever is authentically participating in the process] the focal person needs to be challenged on such stated preferences and goals. Often, there is a reluctance to challenge focal people on such views for fear that they [the person viewing the challenge/request for clarification] will be seen as controlling or paternalistic. There is a tension, an inherent tension, that we have to stay with and work through rather than short-circuit if we are to stay true to the promotion of best interests-based person-centred planning.
The particular balance is captured very well by Pat Fratangelo from Onondaga Community Living in upstate New York: “We see our role as that of being committed to people and their best interests while at the same time letting the person be as central as possible to how this question gets answered.”
Signed: Brendan Broderick, CEO.
RISK – an essential ingredient of opportunity and quality, 04/11/2008
§ A margin of uncertainty lies at the core of pursuing currently relevant and quality arrangements. Uncertainty in this context is an open-ended orientation to the unfolding possibilities which life presents. Planning for certainty is an exercise in designing in stagnation, rigidity, non-responsiveness.
Parents, especially in their latter years, are often drawn by the need to copperfasten a secure future for their son or daughter. Security and safety can out-trump all other considerations. An exclusive locking on to security and safety can padlock the possibility of growth, development and a more rewarding vision of the future.
The challenge for us is to reframe uncertainty as an entwining of both positive and negative.
§ Safety is a bottom-line. However, it is not the ultimate aspiration and should not be the ultimate point of reference in helping to plan for a good life. (Safety first, by all means – but not safety only.)
§ Uncertainty and risk are ever-present. If one tries to eradicate them one inadvertently cuts off the oxygen of life. Moreover, there is a deep-seated paradox at the heart of the safety-at-all-costs quest. Risk cannot be eradicated. When we group people in congregate settings and segregate them from the world to provide them with a cordon sanitaire against risk, we end up introducing enormous opportunity-cost risks; we also end up introducing a whole host of other poorly recognised risks: life-wasting, increased risk to different kinds of neglect and abuse, even increased risks to particular kinds of infections (some of which can be life threatening).
§ At a certain point in their lives, parents yearn for guarantees. Responsible service providers cannot offer guarantees. They can however offer significant assurances. The confidence which parents can place in these assurances will depend upon the degree of preparation and care which the service provider has taken in trying to optimally balance the pursuit of opportunities and the safeguarding of the person.
§ One does need to be prepared thoroughly but one also needs to arrive at a point where one is open-endedly facing the future and engaging the moment. Until that point of engagement, one will not know if one is prepared enough. It is important to have confidence in our capacity to adapt to unanticipated twists and turns. However, it is only reasonable to ask parents to place this kind of confidence in service providers if they already have had manifest evidence of the service provider’s commitment to painstaking preparation.
§ Where parents and family members seek guarantees and vetoes a) they are either acting in the belief that a risk-free outcome can be secured or b) their experience to date of their service provider is such that they lack a reasonable basis for placing such trust in the service provider. (The onus is on the service provider to earn the trust and confidence of parents and families. It should never be presumed.)
If the service provider has made an appropriate and adequate investment in this kind of preparation, it may lead them to a point where they may need to say to the families: “trust us even though you are not convinced and still nervous”.
§ It is noteworthy that parents and family members often seek higher quality assurances when their son or daughter is an inclusive rather than a segregated setting. Perhaps this derives from an assumption that the segregated environment, for all its lack of dynamism, offers a safe and risk-sanitised setting. (Service providers are probably complicit to a point in allowing this erroneous view of the segregated setting to rest unchallenged. Generally, we are very reluctant to do anything that would shake the confidence of parents in an arrangement in which they are so heavily invested, particularly as they enter their later years.)
Signed: Brendan Broderick, CEO.