Adult placements and person-centred approaches
Standard 2 states that the adult placement scheme accepts a referral only on the basis of a full assessment of the individual, undertaken by people trained to do so, involving the person using appropriate communication methods, and with an independent advocate as appropriate.
Standard 3.5.1 states that the adult placement scheme should ensure the service user is informed about independent advocacy / self advocacy schemes.
- the service users saw their adult placement carer (and occasionally a birth family member) as the person who would carry out the advocate's role of speaking up for them and representing their interests. Advocacy services were limited in all four participating schemes.
- only one service user interviewed belonged to an advocacy group and was actively supported by an advocate, and this was through her day service, not the scheme or social services.
- one person had had a short-term advocate to help with a complaint.
- no service user appeared to have any other 'named individual'.
- service users named their adult placement carer as the person they would go to for help.
- a few people used a family member as their 'advocate'.
Diane is a member of the Speaking Up Group at her day centre, facilitated by the local advocacy organisation. Diane's advocate, Sue, worked with Diane to decide the agenda for her annual review, making sure that the issues important to her were discussed, and that enough time was taken to deal with them. Sue also supported Diane to make a formal complaint about a problem at her short-break home. Diane says, 'If someone bullies you, Sue will speak up for you.' Diane is helping to make a film about self-advocacy to help other people with learning disabilities.
Why do we need advocacy?
' Valuing people' (4) said advocacy was one of the ways people with learning disabilities could get more choice and control in their lives.
It said there should be more advocacy, so that people could choose which type suited their needs.
Some of the different kinds of advocacy are:
- self advocacy-speaking up for yourself
- citizen advocacy-people who get to know someone with a learning disability so that they can help get their wishes understood and heard
- short-term, issue-based or crisis advocacy-where people are (usually) paid to speak up for someone about a particular issue, or when they are in a crisis.
Independent advocacy can ensure that service users have the support they need to express their views and make decisions. The advantage of being independent is that they are not subject to the demands of statutory roles and responsibilities, and can focus solely on the service user's needs and wishes.
This means that, over time, the service user will develop a relationship with someone who can get to know them really well, and who should have their best interests at heart.
An advocate should, ideally, not be the adult placement carer or a family member. The former is not able to be independent where problems concern service provision, and the latter may have views that conflict with the user's interests.
Schemes may assume that care managers take this role, but this is clearly unsatisfactory where they do not know the person well. The role of the care manager is not to be the advocate, but to facilitate access to the advocate. As with family members, the role is open to a conflict of interest and a blurring of boundaries if done by the care manager.
The adult placement scheme, with the care manager, should therefore endeavour to ensure that independent support is available for service users. Where possible, they should put service users in contact with advocacy groups or help them to find peer support from someone who shares the service user's disability, heritage or aspirations.
Why doesn't it happen very often?
There is limited access to independent advocates in many areas.
Where formal advocacy is not available, the scheme and care manager should work with the service user to identify a person independent of the scheme to act as their advocate. This should be someone who knows them well and whom they trust to represent their views.
Dean is very close to his cousin, who acts as his advocate, and is the person he would turn to first for help. Dean enjoys visits and phone chats with her, and with Pat's family. They made clear they do not make plans and then tell Dean, but discuss with him beforehand what they might do and when; they also talk to Dean's cousin before making a firm plan, to make sure they are meeting his preferences. Dean has a short break two days each month. His current social worker is very supportive, visiting three times yearly and attending his care plan reviews (which Dean attends along with his cousin), and is very helpful in arranging and rearranging respite and transport quite speedily to suit Dean's plans.