Some years ago I became aware of a quiet yet persistent voice suggesting that we try a ‘Circle of Support’ (COS) in assisting to progress a number of complex situations around people’s lives. This prompting came at a time of change with the introduction of systems of risk management, quality assurance and Person-centred planning. At the time, I was grateful that some people were sufficiently engaged and enthused to embrace a journey of change. My immediate response was, however, that there was enough to ‘manage’ in our attempts to bring the above to fruition, without adding a fourth dimension—circles of support. This seemed reasonable, particularly since—despite our familiarity with the term COS—none of us could ascribe the precise roles and functions we shared around the concept.
Despite adopting this pragmatic position, there remained that niggling sense that there was something stemming from values here not to be dismissed. That persisting and persuasive thought had taken root from a simple reflective comment of a colleague: ‘Wouldn’t it be great to have more outside people involved?’ (‘outside’ being other people who weren’t in a paid relationship with services). That shadowy concept—one which seemed too vague and awkward to adopt in introducing new service processes of safety, quality and assurance—was to remain with me over the next three years. It grew into a tangible entity where quality, safety and, above all, dignity would in fact struggle to be a demonstrable reality in the absence of a Circle of Support.
Recent years presented me with an opportunity to work with people who wanted change in their lives. Two years were spent as a member of a small ‘action research’ team working with 46 people nationally; the last year was spent supporting one particular person, while I was completing a study on COS. The desire for change came from some people living in service settings where they were unhappy or unfulfilled, and where it was proving difficult to move to something better. Others lived at home or alone with varying degrees of support, but with a shared sense of vulnerability, isolation and aloneness as individuals, or indeed as families. The opportunity offered dedicated time to spend with people, to discover what a better future might look like, and how it might be attained.
Quite early on in our various locations as an action research group, we found ourselves converging on a shared theme—just what is the starting point in answering the questions about achieving a better life and future for people. We agreed that despite a frequent wealth of assessment material, reports and reviews around those most stuck, these were not the most helpful when it came to describing that better future.
The inclination is to step in, to review and to revise existing plans with new enthusiasm. People and their support staff are, however, quite used to this response—it is what the system does, particularly if the issues have persisted over some time. The challenge we were facing was to get that enthusiasm and belief in the possibility of real change to catch fire in a wider group than just the new face on the scene. People involved do want to tell their stories, even if it has ended in disappointments in the past— hope would appear to be one of the most resilient of human characteristics. It was actually here that the conversations on the possibilities of a different future began. This may have been because the work itself was commissioned to be a journey of discovery. The ‘tools’ that actually started that journey were not assessments or reviews of existing plans, they were occasions of listening, asking and seeking to understand. What was actually happening as a starting point was the building of a relationship based on respect and a commitment to stay in it. Conversations encompassed a degree of candour and honesty—acknowledging that the new face was not the new solution, the only commitment was to stay and support the emerging change for a different future.
Where does this fit with Person-centred planning?
We adopted a position that PCP is about delivering what is important both to and for a person now, directed by a sound vision that the person has about their future. Checking progress would therefore be against both the vision for life and current plans and actions. We embarked on a journey of discovery about what a better future might hold and how best to make progress towards it. Before describing the how and what we learned together, it is worth while giving a sense of some of the real life changes that happened. Quite a number of people described and made moves to a new type of home, one which reflected their own particular choice of where and with whom to live. These were big life changes and ones which other people had concerns or even fears about. People made very clear statements that, despite needing support in life, any such assistance needed to respect their wishes, and, most particularly, it needed to be offered in ways that would work without labelling them as belonging to ‘a service’. The second most important change reflected people being taken seriously in terms of following a career path which had status, income and social opportunities. In describing these, people were daring to trust that their dream would be taken seriously. What people sometimes proposed initially as dreams were in fact choices with real potential—which only needed the opportunity to be believed and nurtured. It was not uncommon to discover that the ambitions of people often reflected a career of a close family member or neighbour with whom the person was familiar. Some people also brought past skills and experiences which they may have lost during their life within services. Other people had played significant roles in their family and community, until the death of parents had changed their lives.
Probably the most significant aspect at this point was in respect of how these choices and wishes were emerging. These big change ambitions and personal choices were not always easy conversations. It was not always the case that parents and family shared or understood these wishes, professionals and managers may also have had particular concerns about their ability to respond. Shared clarity and commitment only emerged through building a relationship with a group of people focused on putting the life of one person at the centre. Through respect, honesty and conversations which encompassed fears and concerns as well as choices and ambition, progress was made and a shared vision person-centred planning evolved. Often the person had a particular ‘champion’ as driver and glue to ensuring that other people stayed with this initial journey of discovery. Time and respect for the need for people to reflect, question and re.engage were also necessary. The key learning was that there is a really important process that has to happen as a foundational step before progressing to building PCPs.
What this group, or COS, was actually doing was getting to know each other as people, and through a relational process evolving a new direction. This was a different direction and a very different description of life from existing interventions and support plans. As a group we made a resolution to committing to a new first principle of evolving vision as the foundation of personal planning, and as the reference point to return to with people in measuring progress.
What was emerging in adopting a COS was that valid PCP needs to be built on a vision for life and that vision building requires the right people in a relationship of trust with the person and with one another. From that, the person sets the direction with their circle and a personal support system is developed and delivered. What commenced in conversations evolved via new relationships to become effectively a new structure of accountability with the person.
Setting direction, achieving delivery
Personal Delivery plans (PCPs) are the response to direction of the COS arising from personal vision. ‘Delivery’ may well include people who have been involved in evolving the vision and in setting direction, but it is a separate piece of work. For COS to be effective structures within organisations, there needs to be clarity as to the expectation the organisation has in respect of these two key functions (ie, operational clarity of accountability for the functions of direction and delivery). Person-centred planning, its delivery and review can really only commence once this initial step has been achieved.
Leading from personal vision inevitably means broadening the network of people, places and activities that arise. In particular, it means new people engaged in the roles and functions of the Circle of Support. If direction and delivery are the two key functions of COS, then relationships of people from family, service and community are the new engine of propulsion. One of the most heartening experiences in following the lead of people into the wider community has been the positive reception by that community. If you are on a circle you are in a great place to make introductions and friendships at all levels within ordinary life settings. Aloneness cultivates reticence and timidity and a tendency to revert to the safety of the known. If the person’s group is a COS alive with a personal vision, that is a great motivator, a treasure-trove for ideas, a community network, a repository of wisdom and a refuge for the odd rebuttal. In the comfort of clearly knowing why we are doing it, I have experienced a COS surprising themselves with the opportunities that open up, because they are a group with a purpose. Examples are achieving inclusion in mainstream statutory.body programmes, joining a club, getting a foreign holiday, or making that big move so long dreamed of.
It is true, of course, that getting from achieving these goals for one person, to doing so for everyone who avails of service support cannot happen without deliberate intent on the part of services and organisations. Clarifying what the organisational intent is for COS and following this with clear supporting actions is a strategic necessity if this is to be eventually achieved. Circles of Support becomes the entity of deliberate empowerment working in partnership with the service and organisations. With such deliberate commitment, it becomes a robust and structured engagement by organisations in their leading of change reflective of people’s personal choice and of their own organisational values. This is a far cry from ‘a cosy chat’ concept of circles.
It was surprising was that our journey was not a really discovery of something new; much already existed in the literature. I believe that in our enthusiasm to lead and plan new directions in services we did just that—we led and planned. The experiences that brought some people to engage in the project would suggest that there had been a difficulty previously in our approach to personalising supports. Some people and families even described having heard about a circle and joked that they sometimes felt they were going in circles. Their message was that we will continue to go in circles (the wrong ones) if we continue to lead and plan within unclear structures. Real change comes from new relationships of leading and directing prior to delivering through PCPs.
Our own National Disability Authority, in its guidelines on PCP, sets these principles and relationships as the foundation, acknowledging the two distinct functions of ‘development’ and ‘realisation’ (page 16), analogous to the functions of direction and delivery described above. John O’Brien (Everyday lives 1992) identified the two key functions of leading from ‘the vision of the future’ (direction) to ‘make that image a reality’ (delivery).
A quick comment on UK policy is also worth mention. The apparent deficits of the good policy Valuing People (2001), in its ambition to introduce PCP, is noted in the UK Joint Houses report, A life like any other? Human rights of adults with learning disabilities. What is interesting from a COS perspective is that the review of the strategy (2007/ 2009), while making only small changes to the guiding principles, did make changes in how the system of PCP works. In addressing deficits, not in principles but in operation (the ‘how’), the revised strategy introduced and named Circles of Support as a missing element in the earlier 2001 strategy.
The challenge of people’s life ambitions, their support through the vision of organisations, their capture within national policies, not to mention our accountability as citizens to support the dignity of each of our fellow travellers in life, sets the stage for the future. If PCP is to achieve its promise we must do it the justice of building the plans for people’s lives on the foundation of dignified relationships. Fundamentally I believe this challenges us to understand the Person in PCP as being relational and interdependent as an equal citizen, with unique gifts and contributions to make. Our primary response from this perspective is to assist, with structures of empowerment and partnership, those whose voices would otherwise be unheard and who are therefore treated as less equal citizens. This is done through appropriate representation—in this case a COS. Perhaps revisiting PCP from a more developed concept of leadership through COS will achieve new rich relationships and experiences of gifts and of contribution within society.