Are you being served?

by Brian McClean

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Nowadays people describe every service as ‘person-centred’. But what does Person-centred actually mean? What kind of service do you have? Specialised, individualised or person-centred? Do this quiz to find out if your support system is cruisin’ or snoozin’.

It’s pay time!

1. My Disability Allowance goes into a central fund, and is spent on holidays and other outings.

2. I get €10 pocket money. I would not know how to manage the rest.

3. I am learning money management and coin recognition. I go to the local shop to buy what I like!

4. My keyworker helps me to budget my money across the week. Some goes on food and clothes; some I keep towards the holiday!

5. My biggest problem each week is to limit what I spend on cds so I have enough to survive! I need a job with more pay!

I have been aggressive. What does my service do?

1. Up my medication for a while.

2. Verbal reprimand.

3. Reward contract.

4. Try to figure out what is the function of my behaviour. Teach me to communicate in a more effective and appropriate way.

5. Try to figure out what sources of satisfaction are missing in my life, and how I can be better connected with people. Why am I on the outside of what is in?

It’s my birthday!

1. Careful not to overdo it on the birthday cake. The dietician would not be pleased with me!

2. They bought a cake for me at the training centre and I got to give everyone a slice!

3. I am learning about sharing, so at my party there will be lots of opportunities for turn-taking games.

4. My IPP says I get to go out for a Chinese tonight. Yippee!

5. I have organised a reggae theme party. I have invited the neighbours around and Jago is the DJ.

I am getting a job

1. The service says I need a job to occupy my time and improve my manual dexterity.

2. Down at the day centre I pack shampoo bottles onto crates.

3. The psychologist and OT have recommended a programme of training.

4. My keyworker found me a job cutting lawns.

5. I love acting. My mother says it will never pay, but the service has located an acting workshop in the Temple Bar and I’m going on the 20th!

I am moving house

1. The house for people with challenging behaviour has a better staff–client ratio and I am lucky to have a placement there. The staff who look after me are wonderful.

2. We need some training programmes to learn to do cooking, cleaning and other household chores more independently.

3. The house is autism-specific, so there are other lads who need visual schedules and low arousal approaches as well as me.

4. In my new house I have a person-centred plan. With the support of my keyworker, my time is divided between working on a neighbour’s farm, collecting old engines and learning to make the perfect pizza.

5. Tony and I have decided to rent a house together for a while. My parents have been in to train my support staff in what I need.

Dinner time!

1. Dinner is cooked centrally. It is so much more economical that way, and the service can ensure that nutritional requirements are being met.

2. I am learning to set the table.

3. I helped cook the dinner.

4. My keyworker is teaching me to make the perfect pizza. I decided to squeeze some fresh lemon juice onto it this time.

5. Dad is coming over to dinner in my house tonight.

It’s the weekend

1. Outreach does not work on Saturdays.

2. The five of us went for a walk and fed the ducks. It was lovely.

3. We are going out for lunch.

4. In the morning I have my recycling job, then in the afternoon I am heading into town on the bus to buy some clothes. Tonight my keyworker and I are going to the cinema.

5. Pat wants me to go over to his house to help with painting. But Sarah and I were supposed to go out to lunch together today. So much to do, so little time!

Answers:

Mostly 1: This is a very traditional model of service. Based on charity, its primary goal is to care and protect people. People with disabilities are seen as needing sympathetic treatment. Often the understanding of disability is medicalised. The person has something wrong with him or her. As a result others are in control of the life of the person.

Mostly 2: This is a developmental model of disability. Intellectual disability is not an illness. It is a developmental delay. With the right training people can be taught simple skills. The emphasis on what people can do independently, rather than with supports, limits the range of skills that are taught.

Mostly 3: This could be called special needs model. People with disabilities need specialist advice and training in order to integrate into ordinary living. The difficulties with this model are subtle. There is often an unwitting disparity between the service’s mission statement and what happens in practice. The model professes that everyone is an individual, but often ends in group-based, segregated activities. Services become log-jammed because there are not enough specialists to go around. Parents and frontline staff are often inadvertently undermined because they are not seen to have the specialists’ expertise.

Mostly 4: Community participation. Living in the community is not enough. Specific training and interventions are required to ensure that the environment fosters as many opportunities for learning and community participation as possible. Typically, a keyworker is empowered to take decisions with the person, and to ensure that the person’s choices and preferences are taken on board. The model is person-centred, but only up to a point. People participate in the community often, but sometimes it feels like ‘community tourism’, rather than real belonging.

Mostly 5: This is a person-centred service. It is not just the schedules and opportunities that are adapted to meet the person’s needs, but the entire service is designed to meet individual need. Here the effort is to follow the person’s choices, whatever they may be, and to incorporate these into a real lifestyle in which the person is needed and belongs. Because inclusion is the goal, inevitably family, friends and neighbours are centrally involved. Both the advantage and the risk are that responsibility can easily fall back on families. It is important to ensure that reliance on natural support is not a rationalisation of failure to provide paid or specialist support.

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