Key decisions community agencies need to make if they are to individualise supports

by Michael J. Kendrick, PhD

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Introduction

Though many community service-providing agencies are fond of describing themselves as being ‘person-centred’, it is sometimes hard to know what precisely is meant by such claims. This is particularly true when one notes that these agencies do not systematically offer their service users individualised options of support. Obviously, for some agencies, ‘person-centered’ must mean something other than creating, at a minimum, authentically individualised services. At the same time, it is also true that many wellmeaning community service providing agencies may very much want to be able to offer their service users increasingly individualised support options and lifestyles, but may lack an organised theory or approach to achieving this.

In this respect, they are more certain of the goal of becoming ‘person-centred’ than they are of finding the means of achieving it. Consequently, it may be helpful to recommend a set of key decisions to such organisations that will help them start a process of systematic individualisation of service options for their service users. The following recommendations are offered as food for thought, rather than as an inviolable checklist.

Setting the goal as an official agency priority

It is not likely that a process as significant as the intended systematic individualisation of services could proceed in an organisation without placing it as an official organisational goal and priority. And that level of authorisation is unlikely unless there has been sufficient consensus obtained amongst the various constituencies within the organisation. While some degree of progress is possible without a consensus, it would clearly only be a much lesser version of individualisation. Similarly, having the goal of individualisation, but not having it as a priority, might well signal its optional nature, thereby delaying its implementation until other priorities are achieved.

Not expanding group or fixed models of service

It is counterproductive to continue to expand group or fixed models of service if the aim is to generate more individual options. The reason for this is that such group models of service are essentially contrary to individualised services in that they are based on groups rather than on designing ‘one person at a time’ arrangements of support. Consequently, expanding their proportions as a total of agency offerings will take the agency in precisely the opposite direction it intends. It will also act to divert resources from individualised options, thereby undercutting such efforts. On the other hand, freezing the expansion of group models sets the stage for converting such configurations into individualised ones.
The precise pace of transformation from group to individual support arrangements will vary depending upon many factors, but it can be assumed that a measure of perseverance will yield increasing numbers of individualised support options as a percentage of total agency offerings.

Assigning key organisational leadership responsibility

If goals are set without anyone being assigned to follow through on them, there is always a risk that uncertainty about leadership will weaken performance on those goals. If there are not key staff and board members specifically authorised to lead an effort at individualisation, then there is always the chance that the effort will be leaderless. It takes considerable leadership ability to initiate and sustain forward progress, particularly if the arena at play is an unfamiliar one.

Consequently, by carefully selecting the right leadership for the task, it substantially increases the probability of making progress on the individualisation agenda. Further, by resolving the question of leadership, it generates greater clarity of roles and responsibilities and makes it easy to hold the leaders accountable for their performance on this dimension of service.

Creating specific organisational component(s) to shepherd individualisation

If the effort at individualisation does not have a distinct organisational ‘home’, the general culture that preceded it could act to hold back progress. It is always more difficult to establish a new culture and practice than it is to go along with what is already in place. Also, assigning the agenda to its own organisational sphere of authority and leadership makes it more likely that those involved can move more quickly in getting the individualisation effort underway. There is no great value in assigning individualisation responsibilities to the same management system and officials who oversee the current group models, because their comfort with those models will dilute the individualisation attempted. The scale of the effort at individualisation may eventually require more than one organisational component as the numbers receiving person-by-person support grow to a greater proportion of the people served and overall resources.

Not ‘back-filling’ group models

As each person leaves a group setting to take on an individualised support arrangement, there will be a ‘vacancy’ in that group. This will temporarily add costs to the organisation which will lose that person’s revenue to help offset the overall costs of the group model. (This is premised on the assumption that the individual’s funding has moved with the person for the new individualised support arrangement.) Under such circumstances, organisations may be tempted to replace this ‘lost’ revenue by filling the vacancy with another ‘revenue-producing’ service user. While this may solve the immediate revenue problem, it only serves to delay the individualisation of services process by further reinforcing group models. The temporary burden for the organisation is to absorb this added cost while gradually reducing the numbers in the group setting. Once this has been completed, averaged costs should remain equal or less on a comparative basis for the individualised arrangements relative to the group settings, unless the individualised arrangements have been made excessively expensive.

Making the components of individualised support options negotiable person-by-person The creation of flexible individualised support options designed and implemented solely by the agency may have some advantages over the agency-dominated service design of group settings. Nonetheless, it would seem inconsistent to claim that an individualised arrangement is intended to be ‘person-centered’, if it is designed without the person being a key decision-maker in the design of their own individual lifestyle and support options. In order to enable such persons to be designers and overseers of their personalised support arrangement, they need to be advised about precisely what service, administrative and financial features the agency has designated as being potentially negotiable. By making these components of individualised service as explicit as possible and by ensuring that service users and their families and networks are confident of their authority to negotiate service design and implementation, the stage is set for their empowered role. All that then remains will be to establish a clear programmatic process for such negotiations and to assist each person and their network to become as effective as possible in their efforts at negotiating and governing their personalised support options.

Evaluating and improving upon previous agency attempts at individualisation

In most instances, community agencies will have tried to offer individualised supports for at least some of the people they have been supporting. Often, these attempts will have been exploratory in nature and may be able to be improved upon in terms of future efforts at individualisation. However, such potential learning will have been wasted if there is not a deliberate attempt to retrospectively study what was positive and not-so-positive about previous attempts at individualisation. The original intentions, although sound, may not have been fully realised in the precise manner in which they were pursued. Apart from it being prudent and conscientious practice to look back and learn, it can also be proactive and preventive if such learning helps generate thoughtful recommendations for improved future practices.

Learning from other organisations

There are many organisations on a worldwide basis that began their efforts at individualisation over a generation ago, and who have accomplished a great deal in the depth and quality of individual options they have created over that time. They may differ from each other, but they have valuable insights and advice to share with others. There are, of course, organisations that will overstate their depth, quality and competency and it is important for those seeking guidance to be able to sort out those that are genuinely successful in terms of quality and those who are not. To assess this properly an agency will need to have carefully worked out what it means by quality and individualisation, and apply their criteria rigorously.

Creating nominal internal individualised funding accounts

Though many people may mistakenly believe that funding needs to be individualised by the key funders of services, in practice many agencies have found that can set up their own internal individual financial accounts, so that each service user is nominally allocated a unique budget based upon their personal needs and the resources available. This process can be largely independent of whatever system of accounts a funder may require, though the information from the individualised internal funding accounts may have to be translated into forms recognisable to the funder. These individual accounts need not be actual accounts, but rather a means by which the individual and their supporters can plan, negotiate and track the details of their personalised supports arrangements. Such accounts allow better decisions to be made as to value-for-money since they are directly connected to the specific supports given to the person.

Engaging and supporting service users to explore their dreams and potential

Though some may assume that service users will entirely appreciate their life-potential and have well developed dreams for ‘a good life’, this would certainly not be the case for many individuals. On the contrary, they may well have been schooled to give up their longings and explorations for a better life, until they become resigned to an unquestioning compliance with whatever has become the status quo. Whatever a person’s present circumstances, it is crucial that they be given ongoing support to continue to ‘imagine better’ in their lives, so that they can maximise the advantages from using an individualised approach to their support and personal lifestyle. Typically, those persons who are encouraged and supported, in an ongoing way, tend to be strengthened in eventually making progress with their dreams and hopes.

Proactively reaching out and partnering with key funders and external bureaucracies

Although the record to date does not indicate that funders or other key regulatory bureaucracies are a permanent obstacle to progress with individualisation at a community agency level, they can be problematic at times, unless there are efforts to educate them as to what is being attempted by a given agency and to seek their cooperation. Much of this will revolve around agreement as to goals and purposes and to the agency’s good-faith attempts to conform to the funder’s requirements regarding quality, financing and legal obligations. It does not mean that agencies must blindly and uncritically comply with every detail, but rather that they prefer to cooperate wherever possible and to minimise conflicts if feasible. By being proactive, the agency can seize the initiative and make progress in shaping the relationship in constructive terms.

Defining the dimensions of quality in individualisation

There are many quality-of-life dimensions relevant to a person’s lifestyle—their economic security, their ability to pursue their vital interests, and their degree of community membership and relationships. The supports to the person’s lifestyle can vary in quality and it is important to identify what quality is in this regard—the dependability and relevance of service or supports, staffing competence and attitudes. It is important to determine what is crucial to quality and to track this in daily practice, if the results in people’s lives are to measure up to all that is hoped for. Normally, quality will be defined from the core values enlisted and upheld to support a vision of a good life for the people supported.

Selecting the right people

It is unproductive to set and attempt to meet challenging goals for quality and individualisation without staff who exhibit the necessary insight and commitment to quality. Staff and key persons in voluntary roles are a principal means by which agency intentions and priorities are translated into practical engagements with the lives of the people they support. Should these persons fail to rise to the challenges involved, a gap emerges between what the agency intends to achieve and what it achieves in practice. This once again underlines the importance of ensuring that the agency places the best possible people into central roles in terms of supporting individuals with their lives.

Investing continually in values-based learning and reflection

Since being congruent in practice with their stated values is crucial to ensuring quality, community agencies must create repeated occasions to take stock on whether behavior and values diverge in practice and whether they need strengthening and better application in the work of the organisation. Naturally, given their metaphysical nature, values are not something that one ‘has’ or ‘has not’, but rather they are standards that should challenge as much as they confirm. So, there is merit in revisiting them and stimulating thought, reflection and decision-making on their best application. This is particularly true in regards to values that help people identify with the worth, humanity and potential of the people being supported—their well-being is central to the agency’s ostensible and ultimate purposes. When focus begins to drift from these concerns, other agendas may arise that may not be centered on the well-being of the people served. These potentially competing agendas must be detected and evaluated as to their merit. This is best done frequently and searchingly with ample reference to the highest values of the agency.

Starting small and emphasising depth and quality

Though there is an understandable temptation to want progress with large numbers of people as quickly as is possible toward individualisation, this intention may presume a greater degree of competency in the agency than may have actually been obtained. It is much better not to move prematurely onto expanding individualisation to more service users until quality has been achieved for the small number of people who started the process. If the agency is not doing a good job with individualisation, why go on to disappoint even more people! The foundations of quality must be well developed so that when replication does occur it involves passing along depth on quality, not the shallowness and overreaching that typically accompanies well-meaning inexperience. This is not an argument to delay growth in individualisation indefinitely, but rather to link it directly to actual achievements in quality that can be sustained for the long term.

Investing in self-conscious renewal, from the beginning

People and organisations are subject to all manner of forces that may lead to depletion, fatigue, decay and loss of purpose and focus. These factors are unavoidable; they accompany any intense effort to achieve something of value. Nonetheless, it is also important to recognise that they can be offset by various means in order to keep the organisation and its people continuously renewed in the face of the many challenges that come with attempting an ambitious program of supporting people to make far-reaching progress with their lives. The means and pace of renewal can be calibrated to the degree to which the challenges deplete those involved, as well as be precisely targeted to the specific needs or dimensions of renewal that are being generated. Should renewal not become a ‘built-in’, agency-led response to the challenges posed by highly relevant person-centered work, then it is predictable that such efforts will decline in merit and quality. However, if renewal is thoughtfully and regularly addressed, both the people and the organisation can be rebuilt and revitalised.

Conclusion

These recommendations for key initial decisions for community agencies that aspire to developing a greater degree of individualisation of their services and supports are most useful if an agency is considering this prospect from the point of view of the eventual quality of what ensues. Little is achieved and much harm can be created if individualisation simply becomes a means of letting people down one-at-a-time. These recommendations highlight the fact that quality can be ‘built in’ as a preoccupation from day one, though clearly varying degrees of quality are conceivable, from dismal to exceptional. So, the key decision is not whether to individualise supports, but whether to do this properly.

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