The BILD Factsheets, from BILD, the British Institute of Learning Disabilities

The BILD Factsheets, from BILD, the British Institute of Learning Disabilities

A series of informative fact sheets from BILD which summarise items which people working in Learning Disabilities ought to know, but often don't!

In particular for those working in Elderly care can I draw your attention to the Fact Sheet on Chemical Restraint.

Study suggests that more qualifications and more support increase social worker resilience | British Association of Social Workers

Study suggests that more qualifications and more support increase social worker resilience | British Association of Social Workers

Very interesting study which we will be keeping a close eye on.  We are especially concerned with the support element of the article.  Although we are a training company, it's all too often that both training and courses fail due to lack of proper setting conditions in the workplace.

Personalisation, Positive Approaches and the role of Staff

Often when we run training, we ask staff members a simple question, with regards to their jobs.

"How do you wish to be seen by the following groups"

• Your employer?
• The people you support?
• The public?
• Your family?
• Your colleagues?"

This might seem like an obvious question, and in fact, many of the responses we get are what you'd expect.  In general the responses received would be along the lines of "professional, empathetic, competent, calm and knowledgeable".  This is pretty obvious stuff.

However, we then ask a second question.  This question often requires us to let them know it's confidential, we won't tell their managers and we won't mention any names.*

 "How do you think you are really seen by those groups?"

This is where the wish to be seen in a particular way, diverges from the reality of how they are seen.
Sadly the responses we get are often heavily negative.

1. My employer doesn't trust me, I only see my manager when I've done something wrong (or they think I have).  I'm not listened to, I don't get support and if something goes wrong I'm blamed!  My employer thinks of me as the enemy.  I get positive input when I'm asked to do an extra shift.  My ideas are never supported.
2. The people I support see me as caring but don't often understand why I'm doing things, or why I can't let them do things.
3. The public think I abuse people in my care and that I'm not really anything more than a bottom wiper.  They think that people in care are either neglected or abused and they don't realise how hard it really is.
4. My family (unless they work in the field) have no idea why I do this and don't understand why I don't work somewhere with more money.  If they work with people who challenge, they will often be asked why they don't just "hit them back".  My family can't get their heads around why I would never do that.
5. My colleagues think roughly the same as me.  We are doing our best with very few resources or often any real idea who to do things.

For us, this leads to a dilemma of massive proportions.

Most of the current training in the social care sector centres around the concept of positive approaches to the people we care for and developing services that are personalised.  We are supposed to treat people as people, not use derogatory words, and not to dehumanise them.  At least that is what the training and guidance would have us indicate.

So, why is it, that this sometimes doesn't happen?  As with all things, training is only one half of the story.  For good training to be useful or indeed for it to achieve what it's supposed to,  it needs a clear support system in place.  It needs the setting conditions for success.  It needs to be reflective of the organisations philosophies and it needs to reflect the way the organisation is run.

It cannot contradict the underpinning concept of the training.  For example, if you expect a member of staff to treat a service user with compassion, understanding, empathy and in a professional manner, but, then you treat the member of staff as if they were a child who is not able to understand, you

• dictate rather than engage,
• shout rather than speak, 
• instruct rather than explain and most importantly in this relationship, if 
• gloss over and just give them a printout or a "policy" rather than educate and get them to understand what you want.

 Then, you as an organisation are failing to continue the chain of events that needs to be followed.  We need to ensure that if Staff are going to have compassion and understanding then that really needs to be the way they are treated.  Learned behaviour is one of the most powerful tools around.
 The relationship between all the parties in care is complex, the service user should be at the heart of the chain, but, each link is only as strong as the weakest link.  These links would consist of

Owners - Managers - Staff - Families - Inspectors

All leading towards

The people that we support

So what are these setting conditions that avoid the chain becoming fragile and the process breaking down?

• Supervision which is designed to coach rather than monitor the person.  Coaching someone to be better at their job will engage the member of staff far more than telling them to be better.  Most managers are unaware (or seem to be) that most staff don't actually look forward to supervision, they see it as a time to get told off and avoid talking about what they don't know.
• Appropriate training linked to need and to policy.  Training that tests knowledge is far better than training that doesn't.  Training that just awards attendance or is so simple you don't need to do the course to pass is actually pretty pointless.  Staff drift off and don't place value in it.
• A debriefing system independent of line managers
• Managers who attend the same courses as their staff as a participant, not as a manager supervising their staff.
• Clear guidance which staff can understand and follow.  
• Don't stop learning!  Organisations who believe they know everything and they haven't got any issues are often the ones in the most trouble. 
• Use positive approaches as a theme for your organisation at every level, not just expect the staff to exhibit it when dealing with those in their care.
• Use personalisation all the way through your organisation, each person works better when they are valued irrelevant of who they are.
• Reward people for doing a good job.  Often, don't take them for granted and be nice to them. 
• People always work better for those they want to work for, not those they have to work for.
• Place value in your staff and they will place value in your organisation.
• Learn.

If you think your organisation is getting it right, then that's great. If it was my organisation I'd personally sing it from the roof tops.  Do a 360 review with hard questions asked, I'd bring in advocates and get them to ask the people we care for what they think.  I'd then put it on all my advertising and make it public information.  However, if you are worried about the outcome of a review, or you'd not want to publish the results, then, it might be an idea to do something about it.
 

Maybe a better question should be,

"Would I be comfortable with a Panorama journalist working undercover in my service?"




  *Unless of course something is happening which is illegal or unethical in which case obviously we have to pass things on.

"Don't Call Me Dear"

Recently there was  some guidance published by the Commission on Improving Dignity in Care which according to certain media suggested that if you called a person you were caring for "dear" it was belittling and you should be sacked.  I suspect that this mixing of messages was more to do with journalism than the report itself which says no such thing.  Dignity in Care Report.

The report is a sensible (if at times obvious) list of things which in should form the bases for every care home and hospital's approach to working with those in their care.  Referring to people obliquely or directly as "bed blockers" or "hip patients" dehumanises the patient and can allow for the instigation of a unintentional abusive relationship between carer and cared for.  Often the first stage of abuse is a change in the power structure, with one group starting with power and then increasing it by reducing the power continuously of the weaker group.  One simple method of doing this, is to refer to the person by a feature, attribute or condition.  None of us wish to be discussed solely as an illness or a personality disorder, we are people with an illness. 

Some of the recommendations are astonishingly obvious, but often just don't happen in the day to day running of a hospital or home.  As an example, you'd think that training staff to understand dementia is a given, but it so rarely happens even in units that are supposed to be specialists in dementia care.  It's all well and good having a senior management team who've got loads of qualifications in dementia, care, understanding behaviour and principles of personalisation, but if you're direct care staff have no idea what they're doing, then it's pointless.

Encouraging relatives and family to feedback and engage in the process is often blocked by organisations who are uncomfortable being scrutinised.  It's simple enough to do, it's hard to put into practice without becoming defensive about the service you provide. 

However, let's not lose sight of the fact that care staff are also people and need to have some form of coping mechanism in dealing with what can often be a very distressing job.  How often does a member of A&E staff have to see a dead child before it has a massive impact on their mental health?  How often does a member of staff in an Psychiatric Ward have to see a person with horrific scaring from self harm before they become immune to it?  How frequently does an Oncologist have to see a child or adult suffering and intense pain from cancer before they find a way that helps them cope and sleep at night?  All of us will use humour as a coping mechanism and medicine is no different, the problem is that this humour rarely translates outside of the job. 

The guidance given makes perfect sense, it's succinct (so rare in this day and age of guidance), logical, easily absorbed and most importantly humanises those who might be dehumanised.  But, and it's a big one, let's not change demonising patients to demonising those who care for them.