SCIE Guide 16: Community-based day activities and supports for people with learning disabilities

10 key tasks - Key task 4: Building support around people

Important things for commissioners and managers to do:

Read the Key Ingredients section on Individualised funding, which has more detail about making individualised support happen, including steps that day services could take.
Develop a network of brokers and independent advocates who can 'push’ services to respond to people’s individual support needs. It may not prove comfortable, but it will help get the support right for people.
Give services targets to build 'natural’ supports, but also an incentive by agreeing how savings on staff time or cost savings will be used. Allow for savings to be at least partly reinvested in the service.
Ensure services have deliberate strategies that say how they will build people’s community connections to develop more natural supports
Make sure that there is an effective, person-centred approach to managing risk, and that staff are trained and supported to implement it. Information about risk management resources can be found in the Skilled team management section in Key Ingredients.
Reorganise staffing resources to focus support according to people’s needs. In Thurrock, for example, the role of personal assistant has been created within the community day service to work with some people who have the highest support needs.
Organise and focus staff time very consciously and deliberately - see Key task 3: Organising resources. Managing community support teams requires good organisation and planning skills. Make sure that people have those skills.
Encourage and promote the development of mutual support. Advocacy groups are developing evening and weekend social opportunities in many areas. Talk to your local groups about how they might be able to contribute.
Think about the particular support requirements of people from faith communities, and the need to ensure that support workers understand and respect people’s culture. Make sure that you have a diversity strategy and that it includes action to reach and provide appropriate daytime support to people from minority ethnic communities. See Key task 9: Creating opportunities for all.
Encourage approaches that involve families in planning for individuals, so that the support they can offer is incorporated into the plan - but make sure that staff don’t just assume family members will do things. Reliance on families for transport is a particular issue. Why not work with your local family carers’ group to create a list of do’s and don’ts as guidance for staff?
Maximise use of the carers’ grant as a route to funding support for people to do things outside their home, giving their carer a break.
There are some very practical suggestions about managing staff who are charged with building natural supports in the SHS evaluation of the ELCAP GOLD (East Lothian Care and Accommodation Project Growing Older with Learning Disabilities) at the end of this section.

Important things for care managers and care coordinators to do

Commission person-centred planning for people, especially those with higher support needs, to ensure that their support plan is geared to their individual needs. Richard’s story (see Personalised planning with people) shows what a difference well-planned and skilled support can make. Buy in an external facilitator if needed.
Model your assessments on person-centred planning. Get familiar with Essential Lifestyle Planning, if you aren’t already, and use it to help you work out what support someone needs.
Seek out training opportunities and conferences about self-directed services, individualised funding, the In Control projects … and then work to make things happen for people locally.
Seek out local opportunities for young people. Too many young people still end up at schools and colleges a long way from home, family and friends. Support young people and families to approach the Learning and Skills Council (LSC) and ask for funding for individual support so that they can attend local college courses and work training schemes. Talk about Improving Choices - see Good transition planning.
If your local carers grant allows individual applications, use it as a route to funding support for people to do things outside of their home, giving their carer a break.

Important things for staff supporting people in community-based activities to do

Build 'natural’ support around people. That’s easier said than done, but there are hints and tips in the SHS evaluation at the end of this section is helpful, and see also Key Task 6: Achieving inclusion in community life.
Invite family members to participate alongside their relative, especially siblings and relatives of a similar age who may have similar interests.
Support people to get jobs - work is a great place for building connections and friendships, and through that, natural support.
Read real Practice examples to get ideas and see how other people have developed support around people. See Foundation stones: Breaking new ground for some of the websites and publications to keep an eye on for practice stories.
Assess risks and make sure that they are minimised, and that there are safeguards and back-up plans in place for people as your support is replaced by more natural support. Involve the person and their family in agreeing how risks should be managed.

Practice examples

The SHS Evaluation of the ELCAP GOLD project - In their evaluation of the ELCAP GOLD project, the SHS Trust make a number of recommendations for services and staff giving support in social settings:

Match workers to activities - Support works best when someone is supporting a person in an activity they also enjoy.

Change shift or working patterns - A service working within the community has to change its organisation to fit the timing of community activities, either by changing shift patterns or employing people for that activity.

Provide specific training - Support in social settings is a specific skill that requires strategies and facilitation. Training should include skills such as job coaching for people volunteering, methods of introducing, risk management (not just assessment) and techniques of fading.

Provide specific support for workers - Time needs to be set aside so that support staff can talk about what is working and what they find hard. It also means that progress on connecting can be monitored.

Change the nature of support - Support workers should facilitate conversation with members of the public, and either stay in the background when someone is participating in an activity or fully join in. Taking on a role, such as clearing away, helps people to become part of the group.

Participate in group etiquette - Every group has small actions that everyone follows - group etiquette. Etiquette can be adapted to individual circumstances, particularly if it is known that it may be stressful for a person, but generally people need to be doing the same thing so that they do not appear 'different’. This may mean tidying up, standing up rather than sitting down, arriving early if that’s what other participants do, and so on.

Adapt and practice activities - To support people to actively participate, activities can be practiced. Asking another participant to help someone practice can be an opportunity to facilitate relationships. If activities are hard for people, adapt them. For example, use coloured dominoes to help number recognition when playing, learn a part of a tango in advance, etc. Inclusive activities work best when they are fun.

To facilitate letting go

Train staff on assessing risks and have procedures so if something does go wrong everyone knows what should occur and the worry of blame is taken away from the support worker.
Clarify what the workers role is. If they are to facilitate independence and social support they need to be clear that this is different from personal support and involves introducing and fading.
When paid support has faded, there need to be mechanisms so that the person’s inclusion in the group and continued attendance is monitored. This ensures that no one is attending activities through habit, and that they are not alone during an activity, particularly if friends or acquaintances leave the group.

From: 'Inclusive leisure - beyond activities: an evaluation of the ELCAP GOLD project’, SHS Trust (2003).