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City of Parramatta Council

Implementing Person centred approaches
City of Parramatta Council NSW 

Home Care - Metropolitan, 80 + beds

Award descriptors:
Leadership and culture, Enablement, Communication and engagement

About the program
 Based on Social Role Valorisation (SRV) research and best practice evidence we restructured services in 2012 implementing the innovative person centred (PCA) and wellness approaches. The extraordinary results achieved led to our publication 'Take Another Look' in 2015 which in turn led to industry invitations to create and deliver training to other service providers in 2016. The training is innovative as it is delivered from a service who has embraced PCA and made it everyday practice. Attendees receive real practical tips and directions on how to make the first steps in changing their mindset and meeting the challenges in this model. 

The approach focuses on and measures people's achievement of personal goals, meaningful relationships, new skills, valued roles and access to mainstream community.

Before the service change Robert and Lisa (a married couple) attended traditional group support once a fortnight. Both had previously been institutionalised and Lisa was classed as non-verbal. Within 12 months of individual support under this new model Lisa now communicates via IPAD and is verbalising therefore expressing her wishes clearly for the first time; she has a bank account in her name now and goes swimming with a volunteer regularly. The improved communication has lead to less service intervention with everyday living. They are both very happy and Robert stated that this support has been the first time he felt listened to in his 70 years. Robert is on record as having said 'it is the first time I have felt people are fighting for me.'

What we did
The new model:

  • working with each person individually and their family to get to know them, build trust, reinstate their power, build confidence and design a unique personal plan about what's important to them based on their strengths and interests.
  • Focussing on and measuring people's achievement of personal goals, new meaningful relationships, new skills and valued roles. The research tells us that focussing on these areas leads to the good life. 
  • Removing a service menu and being flexible enough to co-design a personalised approach. We focus on utilising mainstream and natural supports which the research again tells us is the most effective way for people to reengage in the community with quality relationships and roles. 

To implement:

  • Embraced and encouraged innovative, thinking outside of the box and not accepting the status quo
  • Used SRV research and undertook research to analyse our service delivery, what was working and not working to meet the individual needs of people in our diverse community
  • Engaged an external mentor highly skilled in PCA and SRV to guide all teams over 2 years 
  • Communicating the benefits of the new model and increasing buy-in from Senior Management and funders. Information session for people we support and families about the new model.
  • Employing staff and volunteers with the right values and mindset 
  • Ongoing training of 30 staff and 140 volunteers in SRV (including half day, 2 day and 5 day training), strengths based, emotional intelligence and solution focused training for all staff and volunteers
  • changed language from deficit to strength based
  • modified the data base to measure and capture information on the new outcomes of person goals achieved, valued roles, meaningful relationship, skills learnt and case stories.
  • Embracing learning culture: budgeted training time, built in reflection, mentoring and encouragement to question and ensure continuous improvement
  • Restructure that reduced silos and developed the new holistic approach
  • Implemented a quality assurance system including an advisory committee made of people we support, utilising surveys and quality assurance calling to maintain quality of service. These form part of our annual business planning, are measured regularly and lead to service improvements.
  • Celebrate successes (even the small ones) and share learnings.
  • Ongoing focus on staff engagement and maintaining a constructive culture 

In the weekly review of people's progress we realised the power behind these stories and the need to share what can happen with the industry. Our staff's passion about the outcomes they were seeing lead to the idea of a book to share with the industry the possibilities which would also include the steps to how we achieved this. This in turn lead to our publication 'Take Another Look' which was launched by MP Geoff Lee at our 20 year celebration in 2015. The offer to train in 2016 has been an endorsement that this approach not only has merit but really is the only to deliver a quality service.

Our journey to high quality services is ongoing.

Why we did it
Our vision is for all people to have the good life in mainstream community.
The traditional deficit model is not working and is not sustainable for our growing population. The old model focuses on people's problems and always being a service recipient. For Council to be involved it needs to be on the forefront of best practice. We challenge everyone to ask do you wish to give up the good things in life as you age. How important is independence and choice throughout your life. Is it reasonable for you to be forced to let these go.
Embracing SRV research has set a benchmark to deliver high quality individual support and driven us to implement wellness and PCA. This means our people begin to 'want' again, to 'dream' again and have the courage and confidence to co-design their support.
The more we learnt and implemented PCA the clearer it became that the majority of service providers who claim to provide PCA do not; the subtleties were missed and the focus was still on the service not the people. What makes our PCA work is it is based on research.
Our training unlocks the unconscious assumptions services make about people which limit their capacity to think innovatively about people's lives.
Although initially intensive our delivery model is more sustainable long term as many people will reduce reliance on services throughout the industry as they gain new skills and reconnect to the community.  We can serve more people on this model.

Who worked with us
Our new PCA model relies on strong partnerships as our role is not to be everything to everyone. 
The primary partnership in delivering the model is with people we support and their families to co-design the service.
We worked with Australian Catholic University to undertake research to inform design of services.
Engaged an external mentor from the Person Centred Consortium over two years to work with the team.
Collaborated with Foundations Forum who run SRV training and engaged Senior SRV trainers to tailor training for volunteers and do planning.
Developed a workshop on the Take Another Look book for the Western Sydney Community Managers Forum.
Work with Community Capacity Building team to deliver PCA training to community workers.
Worked closely with the Regional Assessment Team to understand the new model and broaden the options available.
Delivered a paper at the National Volunteer Conference 2016 on inspiring culture change and delivering high quality services (based on the book).
To highlight all our partnership efforts, we published an industry book called, "Take Another Look - A journey towards person centred and wellness models." This has been received well and is worth a read to fully understand what and why we do what we do.  It has been distributed widely for free.
http://www.parracity.nsw.gov.au/__data/assets/pdf_file/0008/163817/HSCS…
We partnered with the people we support to create several videos to demonstrate the model.  One interview is with a couple we support.  To hear it straight from them, “it is the first time they have ever felt listened to.”

What we learned
The most important feedback is from our people and their families. This and the outcomes of our support have largely guided our learning about what works and what doesn't.

  • a male who through building trust was comfortable to tell us that he is a cross dresser. He said it was the first time anyone really listened to him.
  • a woman with dementia whose family only wanted walking. We discovered her love of art. Before she passed away in 2015 she published 3 books. Her family proudly remember her as an accomplished artist not someone who suffered with dementia. 
  • a man who remained at home for 12 months longer due to our social lunch service.

A bi-annual survey. Results are reviewed for actions required and taken – confirmed in recent third party audit. Customers are given feedback eg. In discovering that people couldn’t tell us what their goals were, we changed our language and took 2-5 visits to develop plans to allow for time to build trust and getting to know the person.

We worked with Social Role Valorization (SRV) experts and used SRV to set base lines and monitor progress, including measuring valued roles, new skills learnt and new meaningful relationships. We partnered in research with the Australian Catholic University about Social Support services. These highlighted our strengths and areas for improvement which formed actions then taken to improve service.

Research was undertaken about responding to vulnerable people's dietary needs. As a result the Social Lunch service was created. The social aspect of the lunch has improved people's nutrition, communication, general wellbeing and enjoyment as evidenced by the person and their family.

It is more cost effective in the long term to work with people individually to build their skills, confidence and connect with mainstream community rather than continue to provide services at the same level, higher or transition to residential care. As people become more resilient, connected and skilled we are able to reduce their support or take them off the service entirely, making room for more people to be supported. Evidence page 11. http://www.parracity.nsw.gov.au/__data/assets/pdf_file/0008/163817/HSCS…

Now staff and volunteers have unlocked their unconscious mind and judgements they say it would be impossible to go back to the traditional deficit model of service. Since 2012 there has been a staff turnover of less 0.22% and a positive growth of 5 new staff members. The service had an average of 140 volunteers through the process and has attracted new passionate, higher skilled people with the right mindset and values. This low turnover assists with embedding the change and its long term sustainability.

In 2014 we measured the understanding of volunteers before and after PCA training and saw a significant improvement. Video available.

In May 2016, upon request we facilitated the first session (with a waiting list) on person centred approaches focusing on the values and mindset needed for community workers. 85% said they felt more informed about PCA with 100% satisfaction on content on relevance. Interesting comment from participant: “I always believed that we were person-centred, however, we do always bring programs back to our goals over the clients. We are an individualized program however. We aren't as open/ flexible for our clients due to policy.”

Recently a service we work closely with has modified the support they provide through a CDC package to be in line with our Home Maintenance as they have seen the benefits. The comment was they had never thought to think about it this way but it works (being aware of the power of unconscious assumptions and a need to take another look with fresh eyes is the basis of our training.) This was reinforced by a regional assessor who commented that they do not understand why all services do not deliver home maintenance in this way, this approach can be transferable.

May 2016 we were found to be 100% compliant against the Disability Service Standards.  The report stated "It was highly evident that people are the centre of all decision making processes at all levels of service operation. The promotion and delivery of ‘Person Centred Practices’ in particular Social Role Valorisation across all funded programs reviewed was exceptional.

  • Management need to be highly commended for the development and review of quality management documentation.
  • Overall, management, and staff (including volunteers) need to be highly commended for their commitment to people with disability, by having a documented management system’, that showed service practices are being implemented, that underpin the NSW disability service standards."
     

More information on this program: 
Julie Williams, or phone (02) 9806 5701

Changed
Friday, 21 December 2018 - 6:46am