Support Planning in Practice

May 2011- February 2013

Key point in the personal budget process: everything between the assessment and the budget being used“I am in control of my care and support‟ (DH target, 2012)

‘How can disabled people using personal budgets get effective assistance to make decisions about their

own support?’

• People with: dementia (7), learning disabilities (9), mental health needs (11), age-related needs (3).

• Also, 14 family-led PBs for people with learning disabilities.

• Role of voluntary and user-led organisations

• This presentation focuses on observations of supporting planning The shifting sands of

Support Planning

What helped people generally to make decisions about their support?

• A focus on active citizenship and contribution.• Support planning in a spirit of equality and dignity.• Good information ‘up front’• Peer contact and/or examples of what worked for

others.• Coordination of all the systems involved in the PB.• Finances to be calculated correctly and transparently.• Clarity about their own responsibilities in managing

the budget, and about the support available.• A support plan that is flexible enough to be developed.

AND all these things happened more reliably when a user-led organisation was involved.

A note on conversation analysis (CA)

• Naturally occurring data• Interest in ‘talk as action’• How social interaction occurs: turn taking,

sequences (e.g. one turn makes a slot for another)

• Fine detail of how things are said – working from the micro to the macro

• Practical applications of CA (see Antaki et al., 2010)

The interactional problem

• How to engage and involve the PB user, when a third party is present.

• Focus here on family members and people with learning disabilities at transition

• 64% (28) of our sample had direct support from family carer

• 43% (19) of those had made all the decisions• 55% (24) were managing the budget

Encouraging someone to speakookay↓ well ehmm have you seen↑ this Kia↓ (2) you haven't seen this one have you I've got a picture quite a few pictures here that's an old one

like (.) this one I took like (.) when I first met you that photo in the car I can’t remember where we were going↓

Giving Kia an opening to speak• Using photos as a stimulus for talk• Asking Kia if she would choose a photo• Small pauses : ‘turn allocation points’• Direct question to Kia (selecting Kia as next

speaker) ‘Have you seen this Kia?’ followed by 2 sec pause

• Downplaying own knowledge – ‘I can’t remember where we were’

• BUT…. Later on mum starts answering for Kia!

What happens when things are challenged?

the reason why we're meeting here today Khalil IS (.) to do: something that's called your support↑ plan↓ (0.5) and that’s- means we're going to get together and write down (.) ho:w your

needs are going to met↓ and what activities you're going to do such as going to college↑ (.) ye:ah↑ and going to the new place (.) in Anford↓ (0.5) what do you think about that↑

I want the same place (as) Shirley before↑

°no shirleys not going to

the same place Khalil↓°

Parents and support planners’ joint work

12-13: support planner downplays importance of this girlfriend (17: Khalil persists)

18-21: ‘OK’ – used to re-direct conversation back on track. Use of ‘remember’, ‘last time’, ‘we agreed’ (22: Khalil – dispreferred response)

23- 30: Doing persuasion – through naming friends

33: you’ve not started yet but you will go (Mum) Clinches the deal

Two different agendasso this

says if my life was exactly as I wanted it to be so it’s like a perfect life↓ (.)

ermm (1) I would eat crisps, chips and roast dinner with all the trimmings

oh I think that's changed=Kia I think you like healthy food now don't you↑ and what portions do you have now↑ (.) do you have smaller↑ (0.5) smaller portions don't you and healthier fo::od

Epistemic privilege of parents15 and 17: Natalie (support planner) quite

‘subversive’ I love a roast dinner18-19, 21: Mum enlists Kia – they both know about

Kia’s progress in dieting, which Natalie does not22: Kia’s sole contribution: on Wednesday –

dowplayed to ‘once a month on a Wednesday’All resolved (27-28) the roast dinner is part of the

‘fantasy day’: parent and support planner can agree on that, and they laugh

What do we make of all this? Does it matter for support planning?

• When people with learning disabilities speak up, they don’t always say what we expect!

• CA’s contribution: how turn sequences work. For instance, social worker does ‘first turns’ in Khalil’s extract. Could that be reversed?

• ‘Recipient design’: taking care that all parties understand the basis of the talk (‘fantasy day’)

• 3-way talk has three parties: not just about professional practice - ‘No, I don’t agree. I’d like to have an advocate here’ (NFRC Voice Group suggestion)

Positive aspects of practice: training materials

Examples from the data in professional training materials from our research:

• How to focus on the person themselves

• Ways of making things ‘concrete’

• Preparation for support planning