Workshop 6Unit 513 and 515

Theories, ModelsAnd Legislation

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.

• 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.

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

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)

What is a theory

A theory helps us to explain a situation:

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?

Range

• A theory can be formal or informal

• Individual or very broad.

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?

Progression of theories

Past Ways of Working• Institutional care• Service Led • Medical Model

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).

Progression in Practice

• Normalisation/social role valorisation(Wolfensberger 1980’s)

• Service Accomplishments:Status and respect, choice, competence,

community presence, relationships, individuality, continuity.

• Role Expectancy

Progression in Practice

Criticisms: very complex, and so not accessible to professionals.

Focus on professional behaviour and service.(Cafferty

2014)

Needs led assessment

• Bradshaw’s Taxonomy of Need (1972)• Maslow – Hierarchy of Needs (1970)

Maslow

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?

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.

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)

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.

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.

Example Glynn Vernon

• Cerebral Palsy – Spastic quadriplegic• Difficulties with speech and movement• Family advised at age four to find a home for

him.

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."

Legislation

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.

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.

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

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.

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.

• 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 payments22 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.

6p’s

• Personalisation• Partnership• Plurality• Protection• Productivity• People

Recap

• Progression of care/progression of legislation

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

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

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)

Dementia Specific models

• banishment (removing from the company of others)

• objectification, treating them like lumps of meat