The Tidal Model: Developing an Empowering

Description of the Persons

Person 1 is a 65 year old lady suffering from autism since childhood with serious learning disability. Due to her age, her hearing senses ha
ve weakened tremendously and is not able to communicate by the use of words. She has been mostly guiding the staff members taking care of her by giving directions or specific signs. Until the early phase of her life, person 1 lived with her parents who was then sent to a hospital specifically accommodating and taking care of children with autism. As she developed as an adult, she was transferred to a different health care institute specifically accommodating and taking care of adults with autism and other IDDs. Being a female, person 1 loves to socialize with other people, even though she is not able to listen properly, she likes to observe people around her and does not prefer staying alone.

Communication Techniques for Identification of Learning Goals

The attribute regarding the Triad of Impairment along with other attributes related to autism depicted that individuals on the spectrum of autism often do not have the ability of making informed choices. Further inabilities include communicating their wishes and desires, planning for the years to come and advocating for themselves. As an individual suffering from autism, the person centred planning of person 1 was done by considering each and every aspect of the disease for which I had to address sensory needs, allow the duration spent in context with special interests and avoid situations causing unnecessary distress.

I understood the fact that person 1 used to get bored very fast and she did not like to follow exact time schedules. She expected variety in her limited life and hence, in order to promote learning I ensured using a number of different resources to communicate with her such that she put in efforts too.

I used resources such as PECS, Dynamite, Signing, Objects or Photos of Reference, Talking Mats and Videos.

PECS is referred to as the System of Picture Exchange Communication for which I exchanged picture symbols with person 1 for indicating her choices or needs, making requests and commenting. Dynamite is an electronic device that performs more or less the same functions as that of PECS (Bhui, 2009). In this resource, I built sentences as I clicked on symbols available on a specific machine and the machine read out the sentence loud. However, as the hearing senses of person 1 is extremely deteriorated, this resource was not effective. Signing is referred to as the language of signs used for the purpose of communication (Bhui, 2009). Every day was a new less for person 1 and hence, she showed huge interest in learning the signs. This was an effective resource as I do acknowledge the sign language. Further ahead, the use of objectives or photos of reference represented real activities and objects for the indication of choice in which also, person 1 showed significant interest.

Talking Mats are significant tools used with the combination of photos or symbols (Barker, 2001). In this context, I focused on the display of mat such as favourite food and I placed related symbols and photos over the mat.  I understood the significance of having two mats for ensuring person 1 was able sort individual meanings of photos or symbols among the two mats. I was aware of the fact that this resource is a skill that is to be used for development in early stage but I used this tool for helping person 1 to set her goals for the future.

Finally, the resource of video was of huge significance as well in which I and my support team came up with a video person 1’ areas of strength and favourite activities to ensure a successful engagement and interaction from her side.

Learning Opportunities and Strategies for Addressing Individual Goals

As a key aspect of this plan, my key focus was on empowering person 1 for the achievement of true and potential objectives, for obtaining an appropriate place across the community. My key focus was on the development of person- centred plan, after discussing with the individual for identification of her individual goals and assessment of her development and learning needs. I was able to communicate with her in sessions of counselling using the above mentioned tools of communication.

I ensured the collaboration of elements related to person centred focus as highlighted in the above figure. Talking Mats are significant tools used with the combination of photos or symbols. In this context, I focused on the display of mat such as favourite food and I placed related symbols and photos over the mat.  I understood the significance of having two mats for ensuring person 1 was able sort individual meanings of photos or symbols among the two mats. I was aware of the fact that this resource is a skill that is to be used for development in early stage but I used this tool for helping person 1 to set her goals for the future.

Person Centred Development Plans

When I considered presenting the plans of person centred development for person 1, I looked for her care records to analyse her current person centred planning. When I reviewed some literature on person centred planning, I identified that even though referred to as Essential Life Plan, it seemed to have the essence of fundamental components regarding what is significant for person 1, and what are her preferences regarding certain think. The fundamental base of Essential Life Plan had been indeed to support individuals like my client for moving from big institution that can be considered as a great way for gathering each and every significant information.  

There was a lack of connection and warmth in the previous person centred plan of person 1, and the documentation of routines had been done in a manner that had a feeling of organization instead of the feeling of person 1. There seemed to be an absence of support from communication and she required major understanding and support with communication. However, even though I have an experience of 2 years in the field, I could not think of ways how person 1 should be participating in ordinary activities while focusing on her development of role across the society.

For the purpose of developing this plan, I used the tool of MAPS that means Making Actions Plans. Through a series of organizations, individuals and questions, by the utilization of I was able to construct a life story or personal history of the focus person that is person 1, on the basis of personal milestones. After I obtained knowledge about my focus person, I was able to explore her dreams in a better way for setting a better future for her. And hence, we moved towards building her future plan directing person 1 to her dreams.

Part 2: Data Based Approach to Implementation Fidelity

Implementation of Learning and Maintenance Strategies

In the implementation of maintenance and learning strategies, I focused on the following steps for the change of culture and organization in order to deal with the case of person 1 (Brown, 2004):

Examining, reviewing and clarifying the understandings of each and every authority involved in the organization, related to the values and beliefs of person 1 underpinning the social inclusion.

Developing a clear vision regarding what the beliefs and value will refer to for the operations, relationships, language and action of the organization.

Ensuring that external and internal messages are in consistency with a clear combination of values and beliefs, for consistent and frequent provision.

Creating opportunities for each and every level across the organization for understanding the social inclusion involved in the case

Examining stereotypical values and beliefs related to several individuals and growth that will end up hindering the approach of person centred planning

Recognizing and responding to the diversity across groups of culture

Examining the mission and vision statements, practices and policies with respect to a deeper understanding about the social inclusion

Encouraging internal discussion regarding if my focus person is going through genuine community and social inclusion

Ensuring that there is no misinterpretation for the values of community and social inclusion

Ensuring that everyone across the organization, from the level of board to the staff of front line, understanding that the areas of key result and principles related to the Guidelines of Community Participating Program are reflected in the current practices

In addition to these steps, I considered investigating and using planning tools and approaches for truly addressing the aspect of social exclusion in the case of person 1, for further leading towards social inclusion. This was supporting for valuing the roles and expanding the friendships and relationships. I further considered recruiting people who had a sense and commitment of social inclusion that I think was a significant criteria.

Communication of Person Centred Skills Development Plan

I communicated with my supervisor for assessing the capacity of consent provided to me mentioning about the tasks I will perform with person 1. She stated that there were already a number of referrals for support of psychology in reference with pending assessments of capacity. She suggested I should be shadowing the process as significant while provided me with additional guidance.

Further ahead, I approached my line manager for obtaining consent to be present in the meeting with the psychology and she happily approved for the same. The psychologist took the role of advisory being a person who should be completing the assessment of capacity related to the decision. There was an independent advocate in the meeting who was showing resistance in leading the work. This was being done irrespective of the fact that my manager was approving to provide full support to person 1 and other 4 individuals in the group on daily basis with appropriate communication.

At the meeting, the psychologist asked a number of questions in relation with the communication skills of person 1, specifically her expressive and receptive skills of communication. The reason behind this was that they are central skills for gaining the ability of understanding certain things, weighing up disadvantages and advantages and ensuring the retention of information. I believe that everyone in the meeting was aware that she did not have the capacity. However, as per the Mental Capacity Act (2005), it has been stated that every individual holds such capacity until or unless it is proved significantly (Bhui, 2009). I further stated in the meeting about what all tools of communication I will use in the planning mentioning that I used resources such as PECS, Dynamite, Signing, Objects or Photos of Reference, Talking Mats and Videos. Some notes had been emailed by the psychologist related to the meeting while there was a provision of additional support. Person 1 has some contact with her family, and even though they do visit the institute on regular basis, they do make regular calls for seeing how she is doing with the treatment and interventions. As I though appropriate, I provided the details about the plan to her family members as well.

Facilitation of Learning Process

For the facilitation of learning process in the plan, I perceived the person centred principles. The first principle was centralizing the person with disability that is person 1. She herself chose the scope of participation in the phase of planning as per her own ability and preference, and was supported and encouraged for having maximum control over the entire process of planning. Further ahead, I showed commitment to contribute individuals with disability who lived in well- designed and accessible communities with significant opportunities for including her cultural, sporting, economic and social life. In addition to this, each and every indirect and direct activity of service delivery and design focused on the achievement of positive outcomes for person 1.  

The attribute regarding the Triad of Impairment along with other attributes related to autism depicted that individuals on the spectrum of autism often do not have the ability of making informed choices. Further inabilities include communicating their wishes and desires, planning for the years to come and advocating for themselves. As an individual suffering from autism, the person centred planning of person 1 was done by considering each and every aspect of the disease for which I had to address sensory needs, allow the duration spent in context with special interests and avoid situations causing unnecessary distress.

Reviewing and Monitoring the Plan

For the purpose of reviewing and monitoring the plan, I considered a continuous process for the introduction of significant change in the circumstances and situation of the focus individual that is person 1, a major period of transition for her, agreed actions and strategies for being considered in the unanticipated blocks or barriers. The lessons that I learned were regarding how certain things work or do not work in the plan, what should have or could have been done and how these can be considered significant for being captured and documented. I identified that adjustment, amendment or updating of this plan be done at any point of time, and there can be a continuous provision of feedback, reviewing and reflecting the process of planning as continuous learning (Carnaby, 2005).  When I considered presenting the plans of person centred development for person 1, I looked for her care records to analyse her current person centred planning. When I reviewed some literature on person centred planning, I identified that even though referred to as Essential Life Plan, it seemed to have the essence of fundamental components regarding what is significant for person 1, and what are her preferences regarding certain think.

Part 3: Evaluation of Person Centred Plan

Monitoring Progress and Providing Feedback

For monitoring progress and providing feedback, I considered using the Collaborative Goal Technology (GCT). The key objective of CGT is for assisting person 1 in progressing with the individual process of recovery. Originally, this technology had been designed for facilitation of collaboration among an individual trying to recover, and the mental health worker with respect to monitoring. This further involves the development of individualized goals of recovery and the overall vision of recovery. It involves to adapt other highly used interventions of setting goal (Cowley, 2007). I consider its development for getting better outcomes in association with the level to which person 1 showed active participation in the recovery, goal setting and treatment.

Person 1 has some contact with her family, and even though they do visit the institute on regular basis, they do make regular calls for seeing how she is doing with the treatment and interventions. As I though appropriate, I provided the details about the plan to her family members as well.

Effectiveness Evaluation for Person Centred Skills Development Plan

For the purpose of evaluating the effectiveness of this plan, I considered a continuous process for the introduction of significant change in the circumstances and situation of the focus individual that is person 1, a major period of transition for her, agreed actions and strategies for being considered in the unanticipated blocks or barriers. The lessons that I learned were regarding how certain things work or do not work in the plan, what should have or could have been done and how these can be considered significant for being captured and documented (Johnston, 2013). I identified that adjustment, amendment or updating of this plan be done at any point of time, and there can be a continuous provision of feedback, reviewing and reflecting the process of planning as continuous learning. 

As evident above, it is extremely important for knowing the level which contribution has been made by the person centred plan for the achievement of objectives with respect to the improvement of economic and social conditions of person 1. It has been stated by ILO (2008, 13) that:

“While mechanisms and processes are important, the effectiveness of such mechanisms should be assessed in terms of outcomes. Setting qualitative and quantitative indicators of success in achieving the educational and training targets in line with the Decent Work Agenda are useful in building common understanding of success, shortcomings, and lessons learnt” (-ILO, 2008; 13).

I am now aware that interventions for development of skills with person centre is mostly inclusive of evaluations for perceiving satisfaction and learning lessons from the error (MacFarlane, 2009). However, both indirect or direct outcomes, and outputs are to be considered for evaluation on less frequent basis. Person 1 has some contact with her family, and even though they do visit the institute on regular basis, they do make regular calls for seeing how she is doing with the treatment and interventions. As I thought appropriate, I provided the details about the plan to her family members as well.

Opportunities for Skills Maintenance and Enhancement

After I completed the assessment of capacity I moved on to assess my own process. According to me this task was extremely easy as I had been following my own footprint. I did not consider the need of holding a major meeting for the process of best interest, while I just had to send emails to certain individuals involved in providing care to person 1. Overall, the process involved some challenges. One of the most significant difficulty was regarding the facilitation of staff for sharing ideas with creativity. They only seemed to have the ability of telling me things that they did and did not turned their thought process of what could have been done in a better way. I obtained a number of opportunities to enhance my and person 1’ skills and learning.

For the facilitation of learning process in the plan, I perceived the person centred principles. The first principle was centralizing the person with disability that is person 1. She herself chose the scope of participation in the phase of planning as per her own ability and preference, and was supported and encouraged for having maximum control over the entire process of planning. Further ahead, I showed commitment to contribute individuals with disability who lived in well- designed and accessible communities with significant opportunities for including her cultural, sporting, economic and social life (Sanderson, 2007b). In addition to this, each and every indirect and direct activity of service delivery and design focused on the achievement of positive outcomes for person 1. 

Duty of care is said to be having an overridden dignity and the risk involved. However, it was unfortunate that effective decision making and real choice had not been the norm (Sanderson, 2007a). Provided with the environment, I found it easier in seeing why it is and was extremely important for the initiation of change. Provided with the environment, I was able to see why transitioning to service delivery and person centred planning has faced difficulty that expected. In my overall experience, I understood that for the effective delivery of this approach, there is a significant need for changing the internal ways of processes and thinking for which I communicated with a number of authorities that were basic yet revolutionary.

Conclusion

Person 1 is a 65 year old lady suffering from autism since childhood with serious learning disability. Due to her age, her hearing senses have weakened tremendously and is not able to communicate by the use of words. She has been mostly guiding the staff members taking care of her by giving directions or specific signs. I understood the fact that person 1 used to get bored very fast and she did not like to follow exact time schedules. She expected variety in her limited life and hence, in order to promote learning I ensured using a number of different resources to communicate with her such that she put in efforts too. As a key aspect of this plan, my key focus was on empowering person 1 for the achievement of true and potential objectives, for obtaining an appropriate place across the community. My key focus was on the development of person- centred plan, after discussing with the individual for identification of her individual goals and assessment of her development and learning needs. I was able to communicate with her in sessions of counselling using the above mentioned tools of communication.

For the purpose of reviewing and monitoring the plan, I considered a continuous process for the introduction of significant change in the circumstances and situation of the focus individual that is person 1. For this, I considered a major period of transition for her, agreed actions and strategies for being considered in the unanticipated blocks or barriers (Schuldheis, 2007). The lessons that I learned were regarding how certain things work or do not work in the plan, what should have or could have been done and how these can be considered significant for being captured and documented. I am now aware that interventions for development of skills with person centre is mostly inclusive of evaluations for perceiving satisfaction and learning lessons from the error (Singer, 2011). However, both indirect or direct outcomes, and outputs are to be considered for evaluation on less frequent basis. Person 1 has some contact with her family, and even though they do visit the institute on regular basis, they do make regular calls for seeing how she is doing with the treatment and interventions. As I thought appropriate, I provided the details about the plan to her family members as well.

After I completed the assessment of capacity I moved on to assess my own process. According to me this task was extremely easy as I had been following my own footprint. I did not consider the need of holding a major meeting for the process of best interest, while I just had to send emails to certain individuals involved in providing care to person 1. Overall, the process involved some challenges but I was able to deal with them.

References

Barker, P. (2001). The Tidal Model: developing an empowering, person‐centred approach to recovery within psychiatric and mental health nursing.Journal of Psychiatric and Mental Health Nursing, 8(3), 233-240.

Bhui, K. (2009). A learning and action manual to improve care pathways for mental health and recovery among BME groups. International Review of Psychiatry, 21(5), 472-481.

Brown, J. (2004). Person‐centred planning or person‐centred action? Policy and practice in intellectual disability services. Journal of Applied Research in Intellectual Disabilities, 17(1), 1-9.

Carnaby, S. (2005). Person centred planning and care management with people with learning disabilities. Jessica Kingsley Publishers.

Cowley, S. (2007). Working on person-centred planning From amber to green light? Journal of Intellectual Disabilities, 11(1), 65-82.

Johnston, C. (Eds.). (2013). Working in mental health: practice and policy in a changing environment. Routledge.

ILO (2008). Conclusions on skills for improved productivity, employment growth and development. Pp. 13. Accessed from: https://www.ilo.org/wcmsp5/groups/public/---ed_emp/---ifp_skills/documents/publication/wcms_103457.pdf

MacFarlane, A. (2009). Integration of peer support workers into community mental health teams. International Journal of Psychosocial Rehabilitation, 14(1), 99-110.

Sanderson, H. (2007a). Person‐centred planning: factors associated with successful outcomes for people with intellectual disabilities. Journal of Intellectual Disability Research, 51(3), 232-243.

Sanderson, H. (2007b). Reported Barriers to the Implementation of Person‐Centred Planning for People with Intellectual Disabilities in the UK. Journal of Applied Research in Intellectual Disabilities, 20(4), 297-307.

Schuldheis, R. N. (2007). Initiating person-centered care practices in long-term care facilities. Journal of Gerontological Nursing,33(11), 47.

Singer, G. (2011). Managing my life as a peer support worker. Psychiatric rehabilitation journal, 35(2), 149.