Support Planning with People with Disabilities

This episode is based upon the chapter of the same name by Dr Tal Araten-Bergman, in the book Disability Practice Safeguarding Quality Service Delivery (Bigby & Hough, 2023).

Link to read and free download:

https://bit.ly/41Z6F36

The episode reviews the purposes of support planning for people with disabilities.

It addresses the different types of plans, the common principles and processes of good planning and considers some of the complexities of putting these principles into practice to ensure plans are implemented and inform action.

Transcript

SPEAKER_02 0:00

I'm Chris Bigby. I'm one of the editors of Disability Practice, Safeguarding Quality and Service Delivery. And this afternoon I'm talking to Tao Ariton Bergman, who was the author of Chapter 10, Support Planning with People with Intellectual Disabilities. So welcome Tao and thanks for coming. Thank you for having me. So the first thing I want to ask you is just can you give us a sort of overview of what did you aim to do with this chapter?

SPEAKER_01 0:26

So I think that we are right now witnessing a huge reform and putting people with uh disabilities in the center of decision making and aiming to get more choice, maximizing their choice and control and quality of life. And if you're looking and um if you're looking at that, you would understand that the the center of it is how to actually, our job is now how to understand and how to um assist people. Today the disability policy um actually aim to um help people live the best life they can and have a better quality of life and uh maximize their choice. Then um our job as support workers would be to help them find out what is their um best way to live their life and how they want to live it and how to achieve it receiving support.

SPEAKER_02 1:25

So there's many different types of support plans that you're likely to come across if you're working in in disability. Um can you explain some of the differences between support plans?

SPEAKER_01 1:36

I think it needs to we need to step back a little and think about what is a support plan and what is support planning before we think about the different um support plan that are there. So support planning is uh a systematic process where people with disabilities, people that are important to them, and um professionals work together to identify what is important uh for and to the person to achieve a good life, to achieve the to live the life that they want. Um if we think about that, then we can think about different uh levels of support plan that exists. So if we're looking at support plan, we can think about planning how people want to get to work, planning how people are going to the services are going to be funded, we can think about um meal plans. So there are many levels of support planning that we can think about. Um, and then depending on the purpose, we can think about different support plans.

SPEAKER_02 2:43

So there's a sort of overall like how much funding you might need to get broad services, and then what some of those services might look like in particular, and then a very micro level, like how somebody might support you to to eat well so that you're not choking, for example. Yeah. Okay. So why is it so important um in this individualized system that we're in now?

SPEAKER_01 3:09

So the individualized system means, again, we need to think about what does that mean? It means that people are getting funding to purchase their own support according to their choice. It means that people can purchase different support uh according to their different goals. People live different lives. So it means that people want and and and desire and require different things and different kinds of support. And then helping them figure out how to achieve it with supports and resources from their um environment and how to think about, again, how to break those big goals into little strategies and how to achieve them.

SPEAKER_02 4:36

So it's an enormous task, isn't it, really, trying to understand how somebody wants to live their life. So are there some common sort of principles that are applied to support planning?

SPEAKER_01 4:47

So as we said, support planning is being done by many people, many in different levels and and for different purposes. But if you look back in all of the, all of support planning and to look at the process, you would see that there are some common principles that um overarch all, underpin all of those um planning processes. And um these are, first of all, it's about it's a collaborative process. It means that person um and professionals work together in order to understand how people want to live the life, what is important for and to them, and then break it down into what kind of supports would help them to achieve those goals. Another one is um support planning is about outcomes, but it's about um the outcomes that matters to the person, how they're going to live their life. It's not about putting people into um services or certain um um meeting their certain needs. It's about understanding what is important to them, what isn't important to them in order to live a good life, and then putting it into practice. Support planning is useless if it stays on on a page. It's about how to achieve the outcomes that are important to the person. And finally, if we look at support planning, and here I think it's the biggest mispercent uh misunderstanding about support planning, which is it's not a one-off event. It's a flexible and ongoing and complex process that means that if a person's life changes, if they're um if they're, you know, change their mind, if they have different circumstances, if their environment change, we need to, it's an ongoing process to always find what is important to the person and try to find the best fit in the source resources and services to meet um those needs, changing needs.

SPEAKER_02 7:30

So if you apply those those principles, it means then that no two plans are ever going to be the same. So you can't just take a plan from somebody and roll it over to somebody else, and that plans will change over time as well.

SPEAKER_01 7:45

So when you are coming to a person, working with a person and you're seeing a plan that was made five years ago, might not make sense anymore. So again, it goes back, and I think this is the reason that I really wanted to write this um this chapter, is that it's complex it's it's it's a complicated task, it changes, but most of all, it's not just a document. Support plan are actually a blueprint of how we do our job, how we communicate with the person, and what are we trying to achieve.

SPEAKER_02 8:18

So they're live documents that inform action, they're not just things in the means. And they're a means to an end rather than just an end in themselves, would you say?

SPEAKER_01 8:27

Absolutely, and I think this is the most important. If if if there's a one-take-off message here, is this this it's a mean for an end.

SPEAKER_02 8:35

So in the chapter you write about three big processes that should be followed in developing any type of plan. And the first of these are getting to know the person, or which is sometimes called pre-planning. Can you explain that why that's so important and some of the strategies that that uh support coordinators or planners might might use to get to know the person?

SPEAKER_01 8:59

So I think that getting to know the person is the is the part that often so often gets missed. If we want to plan, if we want to understand what who is the person, how they communicate, and work together with them, we need to understand who is standing with us. We need to understand who are important people in their life. How do they and how is this person communicate? Sometimes, surprise, surprise, not everybody communicate verbally. It does not mean that people cannot express what they want and what they like or dislike. So it's really important to understand how to communicate with that person. How do we know when they're happy, when they're sad, if if they like something, they don't like something? We need to know their environments. So what services they already used and what worked and what didn't work. How are you going to, um who are people that are helping that person? All of those things, and most of all, again, we are building partnership. So building partnership means that when we are coming into the planning process, we need to, everybody in the planning process, if we're talking about shared power, everybody should know who is doing what and why and what's the purpose of it. So we need to make sure that everybody that's sitting in the room or doing the planning actually know what is the purpose of this planning, what is the focus of it, who am I as the professional, and how do I communicate with the person and make sure that um to assist them in the way that they need in order to make the decisions that they need on their planning, on their supports.

SPEAKER_02 10:40

The second process is about assessing support needs. That sounds very professional as opposed to the first one, which is finding out about a person and asking them what's important to them. So what does assess assessing support needs mean?

SPEAKER_01 10:56

So assessing support needs is not diagnostic. We're not diagnosing people. It's about taking information from various um perspectives and trying to understand again what does the person want and what do they need? What is important to them in order to live a good life, and what is important for them in order to be safe and to live the life that they want. So it means that we again need to spend some time with the person and uh try to understand specifically what do they want out of life, what has worked with them for them um in the in the past, what didn't work, what is important to them now, um, what are the resources in their environment? It really is about um anal analyzing data from different ways, from different perspective, um from different services to understand the person, the situation that they live in, and what are the available and resources in their environment.

SPEAKER_02 12:03

So how might you really try and understand what somebody's support needs are when they can't tell you about them?

SPEAKER_01 12:12

Again, it goes back into relationship. It goes back to what why are we doing it? We need to understand, again, individualized, what is important to that person. So let's think about how can we, if we're going, we spend the time at the beginning getting to know the person and the situation, it would be good to maybe um spend some time with them, see how they communicate with other people, um, spend uh some time with people that are important to them and to and knows the person well and can some shed light on what is important, what do they enjoy doing. It could be interesting and important to speak with service providers or people that know people, uh that person in different contexts, um, to see, again, what works for them, what doesn't, and what they seem to enjoy and important to them and what doesn't.

SPEAKER_02 13:04

And the th the the the third process is about formulating a plan. Can you talk about maybe the different parts of in of formulating a plan?

SPEAKER_01 13:14

So I think that again, if we're thinking about planning as a as a process, as an ongoing process, we need to think about it. And and I just want to again step back and say that planning process does not look all this neat and clear with those process with the with the very nice and defined um processes. It is muddled up, but again, it is always about thinking about what we're trying to achieve and how to do that. So maybe the stages are not well defined, but when you're spending some time with the person and you're working through the planning process, um then you would reach the end game, which is a document that is actually or a plan that is actually important documents, important thing for the person and what and how to achieve it. So just stepping back a little bit about what is the again um the planning process, but I think that every planning process starts uh or is what is the person's goals? So the person's goals is not um unfortunately, it doesn't work as if um some people think that we're just not going to ask people what do you want? Chris, what do you want what do you want in life?

SPEAKER_02 14:28

I don't know.

SPEAKER_01 14:29

I work it out as I go along. Exactly. So the thing is that what do you want, or what are the goals that we are working on, is something that you need to work out together. You need to ask questions, you need to actually um spend some time and and explore some options. Think about um different again, achieving the same thing, but uh what do you mean when you say you want to be more active, socially active? What do you mean when you say you want to go to um you want to see whatever? Okay? So it's it's about that and it's about negotiating with the person. So thinking about what would help you to to to live a good life? What do you want in order to give what is important to you? What would you like to do? Sometimes we need to break it up to small questions. Um so tell me about a good day. What does a good day look like? Why is that good? What do you do? What will you want to do? Where do you want to live? Where do you want to work? Who do you want to spend time with? Okay? All of those things are things that we can think, start to engage with the person to think about what is important in their life and what would they like to achieve. At the end of the day, goals, setting goals is not about getting, you know, big, broad statement that I want to be happy and I want to be fit. It's more about I want to do stuff, and we need to unpack what specifically is that stuff that you want to do, or who do you want to be? It could be about relationship, it could be about activities, or it could be about something that would make you more independent or to have more choice and control about your life.

SPEAKER_02 16:16

So it's really sort of digging down to sort of those big ideas and getting down to some more detail. If you want to have relationships, what sort of relationships who with, what type of people, and and then once you've set some goals, what what do you do then?

SPEAKER_01 16:32

Before you set goals, you y we all have a lot of goals. So if we have that kind of conversation when we're figuring out a lot of things that are important to us, um it's always about then prioritizing, okay, which of these goals are important for you to work on this part of the plan? So again, it's about setting goals that are realistic, but again, important to the person. Again. So after we set up goals and we have some priorities, and oh, and one thing that we really have to consider is again that people have different goals that might be sometimes conflicting to what other people think that that person's goal should be. Um and then we need to negotiate that. And we need to have an open discussion with everybody involved about what goals are we going to pursue in this plan. Having a set of goals, again, realistic but important to the person, then we have to go into develop strategies. How are we going to achieve those goals? Who is going to do what? What kind of services are we going to need? How much of those services are you going to need? Looking for for each goal, there's many ways to achieve it. But looking at those at these goals, we have to think again, now we have to be realistic to look what is the available funding we need to look at. What are the um alternative services that we can use? We can look, we have to look at, again, in a holistic way of what are the resources in the person's environment, what are their skills, who are people, um, you know, um informal people that could provide mainstream services. It doesn't need to be only if I want to go, I don't know, to the pool or to the gym three times a week, it doesn't mean that I need to have a support worker to take me to the gym three times a week. It could be that I'm going with my brother to the gym. But it could be that I'm going with my brother to the gym once a week, and I need a support worker to take me there twice a week. Okay? And I would need some funding for a personal trainer to help me work with the different machinery in the gym. God knows what they're doing.

SPEAKER_02 18:54

So you've got goals and then you've got a set of strategies. And what what's the last part of the planning process?

SPEAKER_01 19:00

So I think the most important thing is to remember that again, it's a living document. So people change. Um maybe you tried something and it didn't work. Maybe you want now different things. So it's about setting up from the get-go who is going to be responsible for what and how are you going to review and monitor that the plan is actually working and actually achieving the outcomes that the person wants. So who is going to actually monitor that, okay, execute and work with the plan? And how are you going to communicate that? Um it's about tying up all the loose ends to make sure that that plan is going to work for the person. And then it's about setting up uh review meetings or or uh processes of monitoring and review to make sure that the plan is actually still reflective of what the person wants six months from now, that it's actually working, and if not, then we can change it or think about how to change it, or to change different strategies or goals in order to make sure that again we will achieve the ultimate goal, which is making the person live the life that they want.

SPEAKER_02 20:17

So we seem to spend a lot of time now talking about goals. Um if you think about somebody who's living in a group home, for instance, they might have a goal, as you said, about going to the gym three times a week. But that's only three times a week for maybe three hours. So what's the connection then between that goal and what you might expect a support worker to do in the rest of the time?

SPEAKER_01 20:42

Are they connected in any way? Well, I think that again, if you're looking at, for instance, an NDIS goals or NDI plan goal, it's about what does the person want to achieve and the strategies are the way that the person are going to achieve it. So going to the gym are the strategies. We need to think about looking at those goals and those big goals and trying to understand what other strategies in the different services, in the different life domains, in the different um ways are going to be achieved through the goals. So again, what what other activities could we offer or services could we offer to actually help the fur person fulfill the goal that they want? So going to the gym is one way, but there are many other ways. But if we look at a plan, we can think about, okay, this is actually what the person put forward. It's important for them to be more independent. How can I support them in any way in the way that I work with them, in the capacity that I work with them, in order to be more independent in different areas of their lives?

SPEAKER_02 21:51

Or to be fitter, so instead of getting in the car to go shopping, we might walk. Because that would contribute then to towards that bigger goal. So big goals are important to everyday things, aren't they?

SPEAKER_01 22:04

Yeah, and I think again it's always about a relationship and thinking about we as support workers thinking about how can we actually support the person, what is important to them, and okay, if we have a goal, we have good clues of what is important to them because somebody has set and helped them unpack what is important to them. Let's think about how we can support them to do that as well in different ways.

SPEAKER_02 22:29

The chapter covers uh uh a lot of uh detail about the principles and the processes of planning. Um but for those people who maybe won't read the book um and are just listening to you, what are the four things that you really want them to take away from either listening or reading the chapter?

SPEAKER_01 22:51

I think the most important part is that it is a living and breathing document. It's not just a bureaucratic exercise. Planning is about spending some time understanding and analyzing, working with the person to help them live the life that they want. So that is the essence of it. How we do it, what are the principles of it, and all of those things are things that you can read a lot about in our book, but it's you and us are working, these are the sh our values, this is the way we should work. And I think that what this chapter tried to say is hang on, um, it's not about producing papers, it's about working with people and thinking what is important, and it's actually about unpacking what is all this person-centered uh practice all about. And I think this is what we are required to do today by policy, we'll this is what we're required to do today by the value of our professions. And I think it's really, really important to think about how we can unpack that, how can we put it into practice? And support planning is the way to put it into practice, to my belief. Okay, thank you very much. Thank you.