Co-production Catalogue

7/31/2019 Co-production Catalogue

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HealtHCo-ProduCtionCatalogue


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Foreword

At Nesta were interested in testing radical solutions to social and economic challenges.We think co-production is potentially transormative and its power comes romre-raming the problem and re-establishing relationships to enable more holistic andpeople-centred approaches. Co-production can also tackle the lack o trust betweensome users and proessionals, a dependency culture where people look to the state tosolve their problems and a culture o expertise where proessionals are trained to be thesole source o solutions. At its best, co-production can build peoples capacity to live thelie they want, in the community where they live.

This catalogue o co-production has been created as part o Nestas People PoweredHealth programme run with the Innovation Unit. People Powered Health is a practicalinnovation programme, to explore how co-production can support people living with longterm conditions. Were particularly interested in how to move co-production rom themargins to the mainstream. Part o achieving that shit will involve a better understandingo what co-production can achieve and what it looks and eels like on the ground.

The catalogue, thereore, brings together some inspiring examples o collaborative publicservices in action, with a particular ocus on health and social care. Each case study hasbeen assessed against the Nesta and n principles o co-production. This is done in the

spirit o exploration rather than judgement many o the case studies were never meantto represent co-production so it is no surprise they are stronger on some principlesthan others. The idea is to use these pioneering examples to increase our collectiveunderstanding o what co-production is and to raise our sights o what is possible.

To realise the potential o co-production we need to be able to explain it clearly and tobuild the evidence o what it can achieve. Our hope is that this catalogue contributes tothese aims and stimulates some new ideas about how to use co-production to developtruly people powered public services.

Hm Khn

Director, Public Services Lab, Nesta


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ContentS

ic 4

How to use this catalogue 4

What co-production is and isnt 5

Achieving depth and transormation through co-production 6

Recognising the extent o co-production 6

Critical learning questions 7

Depth o co-production 8Acknowledgements 8

Cs Ss 9

Cs S 1: Richmond Users Independent Living Scheme (RUILS) 14

Cs S 2: Service User Network (SUN) 17

Cs S 3: Comas recovery coaching 20

Cs S 4: p Solutions 24

Cs S 5: Shared Lives ormerly adult placement 27

Cs S 6: KeyRing Living Support 31Cs S 7: Local Area Coordination (LAC) 34

Cs S 8: Nurse Family Partnerships 37

Cs S 9: Partnerships or Older People Projects 40

Cs S 10: Families and Schools Together (FAST) 43

Cs S 11: Homeless Health Peer Advocacy (HHPA) 46

Cs S 12: Flexicare at the Holy Cross Centre Trust (HCCT) 49

Cs S 13: Headway East London 52

Cs S 14: Skillnet Group, Kent 55

Cs S 15: Waverley Care Lie Coaching Programme 58

Cs S 16: Routes out o Prison (RooP) 61

Cs S 17: The Leicestershire and Rutland Probation Service

Health Trainers (LRPT) 64

Cs S 18: The Bradord Health Trainer and Social Prescribing Service 67

Cs S 19: The Recovery Education Centre (REC) Nottinghamshire 70

Cs S 20: The Chronic Disease Sel-Management Program 73

rsch Pcs 76

Pcc gc ts 84

Mm 86


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introduCtion

This catalogue was commissioned by Nesta to support the People Powered health

programme sites and produced by n. It brings together a range o case studies,resources and other inormation on co-production in health settings as well as inother sectors, in the UK and internationally. The purpose o the catalogue is to enablepractitioners to reect on their own practice and the extent to which that represents co-production; and to enable them to learn about co-production practice. The introductionis structured to help you to navigate the catalogue and provides some materials andquestions or you to think about when you read through the case studies.

H s hs c

The catalogue has been designed to present a range o successul and inspiring co-

production activities. There are a number o ways to access the case studies.

The frst page o the Case Studies section presents a brie summary o each case study soyou can see what they are about at a glance. We have also used a visual wedge to showthe depth o co-production and the extent to which the case study is showing progressagainst the six principles o co-production.

At the beginning o each case study we have included some Keywords. These are wordsassociated with existing proessional practices being developed by the People PoweredHealth sites or example, health trainers, sel-management, time banks and navigators.At the end o each case study we recommend other examples o related practice thatmight also be o interest to you.

Though you can navigate by approaches that you are amiliar with, we have sought with

each case study to draw out key learning, opportunities or replication and broaderrelevance to co-production. Given sufcient time, reading the case studies in their entiretywill help strengthen and deepen your understanding o co-production.

The n that covers the last three tabs is designed to provide a shortlisto the best websites, reports, evaluations, implementation guidance, short flms andtools relevant to co-production, and the proessional practices outlined by each othe keywords throughout the case studies. This is organised by the type o resource;Research and publications; Practical guidance and tools; Multimedia.


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The ollowing defnition o co-production was developed by n and Nesta, in partnershipwith the co-production practitioners network:

Co-production means delivering public services in an equal and reciprocal relationship

between proessionals, people using services, their amilies and their neighbours. Whereactivities are co-produced in this way, both services and neighbourhoods become ar

more eective agents o change.

Along with this defnition, it was also recognised that co-production is underpinned bysix principles. These are common eatures o much co-produced support, and whereall o them come together in one organisation they represent truly transormative co-production.

1. a: transorming the perception o people rom passive recipients o servicesand burdens on the system into one where they are equal partners in designing anddelivering services.

2. cpy: altering the delivery model o public services rom a defcit approach to

one that recognises and grows peoples capabilities and actively supports them toput them to use at an individual and community level.

3. My: oering people a range o incentives to engage with, enabling them towork in reciprocal relationships with proessionals and with each other, where thereare mutual responsibilities and expectations.

4. Nwk: engaging peer and personal networks alongside proessionals as the bestway o transerring knowledge.

5. B : removing tightly defned boundaries between proessionals andrecipients, and between producers and consumers o services, by reconfguring theways in which services are developed and delivered.

6. cy: enabling public service agencies to become acilitators rather than centralproviders themselves.

Many o these principles are distinct practices in their own right, and some such as peersupport and asset-based approaches also have their own emerging evidence base.Although we will explore each o these principles within the catalogue, we recognise thatits only when they come together that the service is ully co-produced.

Another helpul way o thinking about what co-production means in practice is tobe clear about what co-production is not. Co-production has emerged rom a richand diverse literature and practice; today it has parallels, or example, in asset-basedcommunity development. However, there has been some conusion between co-production and service-user design, user voice initiatives and consultation exercises.Although co-production encompasses all o these things, it cannot be reduced to any one

o these approaches. To all back on a well-worn clich, the whole is greater than the sumo its parts.

At its most basic, co-production o public services is about action, or example people(including proessionals and people who use services) coming together and producing aservice or an outcome through the medium o public services.

As the basic grid on page 5 depicts, voice-based initiatives involve people expressingopinions and ideas to planning processes, but ultimately still only recognise proessionalsas capable o doing the work needed to deliver a service. Voice-based initiatives may beable to design better services than those that dont engage with people, but ultimatelythey are not aimed at unlocking the practical skills and capacities o people who receiveservices.

It is also important to note here the dierence between co-production and sel-organised provision o support. Co-production requires a contribution in terms o timeand resources rom public service proessionals as well as people who use services.


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The way in which time and resources are contributed may well look dierent rom moretraditional service provision but it is essential that this contribution is present. In this wayco-production is not a cover by which it becomes possible to withdraw proessionalsentirely rom services.

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The term co-production is being applied to many dierent practices, including user-involvement in decision making, partnership-working across organisations, personalbudgets and service consultation. Some o the ways in which the term is being useddetract rom the ull potential that co-production can achieve as an approach which cantransorm the capacity, equity, and impact o public services. The ph o co-productioncan all along a scale rom airly tokenistic user-involvement all the way through to acomplete transormation o power relationships within services.

On the ollowing pages we oer two ways o conceptualising co-production to help youdetermine a) the extent to which a service or project is being co-produced and b) thedepth and transormative nature o co-production on a case-by-case basis.

We have also developed a series o critical learning questions that help you to reect onyour own practice; giving you the confdence to assess the current depth and extent oco-production in your service and to envisage how it might be developed even urther.

These questions appear on page 7 and are echoed in the case studies where relevant.

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We have incorporated a visual representation o the six principles to make it easy toassess the extent to which co-production is taking place across them. This visual is basedon an assessment tool, the co-production sel-reection tool, which sets out a series opolicy and practice statements across the six principles. The case studies are reviewed tosee to what extent they are engaging in all o the principles. Strength o engagement isindicated by depth o colour, so those areas where less activity is taking place will appearaded, and where no activity is taking place, the segment will be white. The sel-reection

tool is included here. The example on page 7 is one where a project or organisationexemplifes all the principles o co-production well. Where one or more o the principlesare weak in the case study, we will point to how this could be developed in the text.

Co-PlanProFeSSionalS

Plan

ProFeSSionalS

deliver

Co-delivery

CoMMunitieSdeliver

CoMMunitieSPlan

traditional

ServiCeS Co-deSigned

Co-delivered Co-ProduCed

Co-oPted SelF-organiSed

Grid adapted rom The Challenge o Co-production, David Boyle and Michael Harris
http://api.ning.com/files/Ub6y1Cqcgwfnt0vDAwX*WoTW6LSu0Pe6-Yf3lbJX3zp8Qal3epzy0HHyGjh1btWEAT9QXAsPde1Vq*TsDKeTKajdaIN9czsi/nefCoproductionselfreflectiontool.pdfhttp://api.ning.com/files/Ub6y1Cqcgwfnt0vDAwX*WoTW6LSu0Pe6-Yf3lbJX3zp8Qal3epzy0HHyGjh1btWEAT9QXAsPde1Vq*TsDKeTKajdaIN9czsi/nefCoproductionselfreflectiontool.pdf


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Cc qss

This series o questions is intended to help you critically reect on and assess the deptho co-production in the service you work in, and others you may come across. Theyhave been adapted rom the principles o co-production and colour coded to mirror thecolouring o the visual tool. The questions are intended to support practitioners to directtheir activities towards the most powerul application o co-production.

1. aAre people (and their amilies/carers) direct experiences, skills and aspirationsintegral to all services? Does all service design and delivery seek to build on andgrow individual and community assets? Is progress against this tracked?

2. cpbAre peoples contributions vital to success? Does the activity and work requiredwithin the project get shaped to ft the skills and responsibilities o everyoneinvolved? Is personal development a common expectation or everyone involved?

3. B Do people have an active part in initiating, running, evaluating, directing anddelivering projects? Do people work alongside proessionals with their skills andopinions having equal weighting? Are people are able to identiy rewards that are

valuable to them (not just money)?

4. NwkDo projects see supporting peer networks that enable transer o knowledge andskills as core work to be invested in? Do sta and people engage in activities thatconnect to local networks and activities beyond the remit o the service? Is growingnetworks outside the project seen as a core activity?

MyDo people and sta know that it is their project? Do they each have an equalresponsibility or it to run well? Is asking explicitly or and providing help romothers is seen as positive and expected o sta and people? Are expectations omutuality discussed when people become involved? Is a wide range o skills and

experiences valued?5. cy

The purpose o interactions is supporting people to live a good lie. Do staroles ocus on connecting people to networks and resources to do this, removing

a: Transorming the perception o peoplerom passive recipients to equal partners.

cpb: Building on what people can do andsupporting them to put this to work.

My: Reciprocal relationships with mutualresponsibilities and expectations.

Nwk: Engaging a range o networks, insideand outside services including peersupport, to transer knowledge.

B : Removing tightly defned boundariesbetween proessionals and recipients toenable shared responsibility and control.

cy: Shiting rom delivering servicesto supporting things to happen andcatalysing other action.


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barriers where necessary and developing skills and confdence? Are people activelysupported to do more?

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Another useul typology o co-production has been developed by Catherine Needhamand Sarah Carr. It suggests it is possible to understand co-production on three dierentlevels; descriptive, intermediate and transormative. These descriptions represent a scaleo how ambitious and transormative co-production can be.

1. dpAt its least transormative, co-production is used simply as a description o howall services already rely on some productive input rom users. This input may justinvolve compliance with legal or social norms such as taking medication, or notdropping litter. A descriptive approach to co-production simply describes theexisting elements o public services that are co-produced, and thereore ails toacknowledge the potential or more eective use o the productive capacity o

service users or communities.

2. inmIntermediate approaches to co-production oer a way to acknowledge and supportthe contributions o service stakeholders, although without necessarily changing

undamental delivery systems. Co-production may be used as a tool o recognitionor the service users and their carers acknowledging ot undervalued input andcreating better eedback channels or people to shape services. The key dierencebetween this and truly transormative co-production is that organisational culturesare unchanged. Indeed, this orm o co-production is oten led by a key member osta, rather than being embraced by all members o sta equally.

3. tnm

At its most transormative, co-production requires a relocation o power and control.New structures o delivery entrench co-production, and bring proessionals andservice users together to identiy and manage opportunities to develop and deliverservices. The culture o an organisation changes, embedding mutual trust andreciprocity between proessionals and communities. The impact o public services isamplifed as latent assets within the community, such as peer support, inormal carenetworks, and aith and civil society groups, are supported to ourish.

We have used this typology in each case study to indicate where we think the examplesare really transorming the service, and also where some o the principles could bedeveloped urther to really transorm the service.

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This report was researched and written by Joe Penny, Julia Slay and Lucie Stephens.We are particularly grateul to Matthew Horne or all his guidance and support, and to allo the organisations who have given their time so reely in helping us with the research.

I you have any questions on the case studies please [email protected]
http://www.scie.org.uk/publications/briefings/briefing31/references.asphttp://www.scie.org.uk/publications/briefings/briefing31/references.asp


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e Studies

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CaSe StudieS

riCHMond uSerS indePendent living SCHeMe (ruilS)

ServiCe uSer network (Sun)

CoMaS reCovery CoaCHing

link

link

link

A user-run and led organisation providing adult social careservices in Richmond, London. RUILS helps rom taking thefrst steps, to employing a Personal Assistant through topooling personal budgets collectively with others.

keywordS

A support network developed or and by people who havelong-standing emotional and behavioral problems (personalitydisorders) in Croydon. The SUN model sees the community as adoctor and aims to expand peoples coping strategies by bringingpeers together to support one another through a crisis.

keywordS

Comas recovery coaching links a person with experience o recoveryto someone in recovery rom severe alcohol or drug problems. Thecoach is in recovery themselves, enabling them to oer insight andto understand the context o the individual they are mentoring.

keywordS

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eCdP SolutionS (ForMerly eSSex Coalition oF diSabled PeoPle) link

A user-led organisation delivering, and inuencing local authoritypolicies about support planning and promoting the activeinvolvement o people in their own support planning.

keywordS

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C P | Pss | Ps bs

C : acpbMyNwkB cy


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SHared liveS PluS (Sl+)

keyring living SuPPort

link

link

SL+ organisations match vetted and trained Shared Lives carers withadults looking or practical and emotional help to live ulflling livesin an ordinary amily household. Participants are matched to ensure

compatibility and shared interests.

keyword

KeyRing Living Support sets up a series o local networks whichprovide mutual support or independent living, and links into

other local networks and resources.

keywordS

Pss

Pss | n | im | ac gc

loCal area Coordination (laC) link

The LAC approach helps keep people strong, rather than waiting or acrisis beore intervening. Rather than defning people by their needs

and the services they use, LAC asks people what sort o lives theywant to lead and then supports them to achieve their aspirations.

keywordS

im | ac gc | P

nurSe FaMily PartnerSHiPS (nFP) link

NFP pairs young frst-time mothers in high-risk groups with

nurses to improve the well-being o mothers and their children.By developing strong relationships, and providing eectivesupport and coaching on an wide range o issues, NFPs havedemonstrated impressive short-term and longitudinal results.

keywordS

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PartnerSHiPS For older PeoPle ProjeCtS (PoPPS)

FaMilieS and SCHoolS togetHer (FaSt)

link

link

POPPS aimed to promote the health, well-being andindependence o older people, and prevent or delay their needor higher intensity or institutional care.

keywordS

FAST is a programme with a strong assets ocus that explicitlyencourages reciprocity between participants. It is based onbuilding relationships across amily, schools and community and has

addressed issues including teenage pregnancy and troubled amilies.

keyword

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S-hp gps

HoMeleSS HealtH Peer advoCaCy (HHPa) link

HHPA recognises the importance o using the lived experience opeople who have been previously homeless in improving access

to health services. Westminster PCT, in partnership with others, isrecruiting, training and working with peer advocates to improvehomeless peoples experience o health services.

keywordS

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FlexiCare at tHe Holy CroSS Centre truSt (HCCt) link

HCCT has extended an existing time bank at the Centre toincorporate the provision o a exicare service, which supportspeople to stay independent in their own homes by providing low-level care and support.

keywordS

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C : acpbMyNwkB cy


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Headway eaSt london

Skillnet grouP, kent

link

link

Headway East London is a leading centre o support or peoplewith an acquired brain injury (ABI). Everyone is encouraged todefne meaningul roles and responsibilities that they can make

their own; their skills, capabilities and interests are given space toourish through proessional and peer support.

keyword

The Skillnet Group supports people with and without learningdifculties to work together equally to make a dierence. Their aimis to support people to make independent and inormed choicesabout their lives, and work together with sta to develop projectsand support networks which build on peoples own interests, skillsand capabilities.

keyword

tm b

Pss

waverley Care liFe CoaCHing PrograMMe link

Waverley Care Lie Coaching Programme provides support or peopleliving with Hepatitis C and HIV, based on a lie coaching model.The programme has demonstrated improvements in outcomes orparticipants across health and well-being measures.

keywordS

M Cch | w- Cch

routeS out oF PriSon (rooP) link

RooP is a peer support project or returning prisoners.RooP oers participants access to lie coaches whosupport them in linking to services in the community.

keyword

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C : acpbMyNwkB cy


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tHe leiCeSterSHire & rutland Probation ServiCe HealtH trainerS

tHe bradFord HealtH trainer and SoCial PreSCribing ServiCe

link

link

The Leicestershire & Rutland Probation Service Health Trainers is orex-oenders and aims to improve take up o health services andpromote behaviour change among the ex-oender community. The

health trainers have personal experience o the criminal justice system.

keywordS

BHTSP unds health trainers who spend time in local GP

practices, supporting people to gain skills and employment,and fnd community-based solutions or a range o conditions.

keywordS

tHe reCovery eduCation Centre (reC) nottingHaMSHire

tHe CHroniC diSeaSe SelF-ManageMent PrograM (CdSM)

link

link

REC enables people to become experts in sel-care andrecognise their role and experience as equal to that o mentalhealth proessionals. There is a strong assets-based approachthat has what people can do at its heart.

keywordS

The Chronic Disease Sel-Management Program (CDSM)was set upby Stanord Universitys School o Medicine, and is a communitybased sel-management programme or people with a chronicillness. People with chronic conditions are involved in designingand delivering the training at all levels o the programme.

keywordS

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Richmond UsersIndependent LivingScheme (RUILS)

CaSe Study 1

SuMMary

key learning

RUILS is a user-run and led organisation, providing adult social care services inRichmond, London. RUILS supports older people, and people with learning difcultiesand mental health challenges, to live independent lives in their communities. They workin particular to ensure that people who receive direct payments and personal budgetsget the best possible outcomes rom the care they purchase. RUILS helps people in arange o dierent ways, rom taking the frst steps to employing a Personal Assistant,to getting involved in peer support networks, to pooling personal budgets collectivelywith others.

RUILS has developed a particular structure that enables people to make keystrategic decisions that shape the development o the organisation at the highestlevels.Are service users able to make important organisational decisions in the

service you work in?

RUILS provides services which bring people together to pool their skills,knowledge and resources. Do the services you work or enable people to link upand support one another?Are people supported to collaborate with one anotherto improve their health or social care outcomes?

c-gn Pnn

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More about ruilS

wHy iS tHiS Co-ProduCtion?

RUILS began lie as a grass roots organisation lobbying or direct payments in adultsocial care. Today it is a well-organised charity and co-producer o services. It provides

its users and their riends and amilies with opportunities to take an active part in howits services are run and led through its membership scheme. Although people canaccess RUILS services without being a member, membership enables people to havea greater say in how the organisation is run. Currently, over 70 per cent o the board odirectors is made up o service users.

There are three levels o membership. The frst level, ull membership, is available toolder people, people with disabilities, people accessing mental health services, parentso disabled children and carers eligible or their own social care support. Full membershave voting rights and can be elected onto the board o directors. The second level,associate membership, is available to non-disabled relatives, riends, advocates andclose supporters o a ull member or the RUILS organisation. Associate members donot have a right to vote but may serve as a co-opted Trustee. The fnal level, corporate

membership, is available to all other user-led organisations working with similar groupsin the Richmond area.

From this strongly user-oriented platorm, RUILS provides a range o social careservices or adults, ocusing on groups that receive direct payments and personalbudgets. These range rom typical services which you might expect to fnd rom anadult social care organisation, such as inormation and guidance, and advocacy andbrokerage, to more developed and collective services such as the peer-to-peer supportscheme and the pooling direct payments service.

The peer-to-peer support scheme was set up by RUILS as a way to better involve usersin the running o services, and to tap into the skills, knowledge and expertise o theirmembers which go beyond what members o sta can oer. In the peer-to-peer scheme,buddies act as one-to-one coaches, helping the person they support to overcome

challenges and/or achieve a goal that is important to them. RUILS makes it clear thatpeer supporters are not there to take over or act as advocates; their role is acilitative.

RUILS also helps its users and members to pool their personal budgets. This enablespeople with personal budgets to increase their purchasing power, and also helps themto expand their social networks by bringing people together around activities that theyenjoy. Pooling personal budgets is a good example o how a relatively individualisticpolicy can be made more cooperative, more co-produced and achieve better outcomesor people.

RUILS is a good example o how co-production can be embedded at both theorganisational level and the service provision level. People who use the services,alongside their amilies and riends, are able to shape key strategic decisionsthrough their membership, and are also supported to help deliver services throughvolunteering, peer support and collective purchasing. This ensures that distinctionsbetween people who provide and receive services are blurred; the majority o keydecision makers are themselves service users. RUILS also makes sure that non-members have their say in how the organisation and its services develop. Qualitativeworkshops and listening exercises are regularly held to inorm member decision makingand generate opportunities or personal development. Members are also encouraged

to support one another and build mutual and reciprocal relationships, based ontheir skills and capabilities. This is clearly evident in the peer support and collectivepurchasing projects. RUILS is a good example o transormational co-production.


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evidenCe oF iMPaCt

intereSted in tHiS aPProaCH?

linkS

To date there has been no ormal evaluation o RUILS.

Then see also: p

http://www.ruils.co.uk/

RUILS publishes a number o practical and policy manuals, guides and reports. Thesecan be ound here

This case study rom the NCVO describes the development o RUILS relationship withRichmond Council.
http://www.ruils.co.uk/http://www.ruils.co.uk/Publications/10/http://www.ncvo-vol.org.uk/uploadedFiles/NCVO/What_we_do/Sustainable_Funding/Public_Service_Delivery/NC442%20RUILs%20PSDN%20CS%20PDF%2003.pdfhttp://www.ncvo-vol.org.uk/uploadedFiles/NCVO/What_we_do/Sustainable_Funding/Public_Service_Delivery/NC442%20RUILs%20PSDN%20CS%20PDF%2003.pdfhttp://www.ruils.co.uk/Publications/10/http://www.ruils.co.uk/


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Service UserNetwork (SUN)

CaSe Study 2

SuMMary

key learning

SUN is a support network developed or and by people who have long-standingemotional and behavioral problems (personality disorders) in Croydon. SUN aims tohelp those who eel isolated and let down by mainstream services by bringing togetherpeople who share the same experiences to support one another in ormal and inormalways. SUN members have the opportunity to:

Attend social contact groups, meet new people and take part in leisure activities.

Give support to, and receive support rom, other members, learn new skills andfnd better ways o managing difcult experiences.

Help inuence the development o services in Croydon.

At the heart o the SUN model is the idea o the community-as-a-doctor, and anaim to expand peoples coping strategies by bringing peers together to supportone another through a crisis.

Involving people in the design o services rom the start is key to ostering a senseo collective ownership. In what ways do people help design new services where

you work?How could existing services begin to incorporate co-design techniquesand methods?

Peer networks can provide additional and dierent capacity rom proessionalsupport that is oten more exible and accessible to community members. Do staand people involved in the your activities see investing in peer and local networks

as part o their core activity?

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More about Sun


The rationale behind SUN is that more support is needed or people experiencingperiodical emotional and behavioral problems, and that service users themselves, or

experts by experience, are best placed to oer this support. Too oten people fndthemselves in periods o crisis which end in visits to A&E, where they receive littleollow-up support and ew attempts are made at fnding alternative strategies orcoping.

SUN uses peer-support networks to improve peoples coping strategies, bringingtogether groups o people who have similar emotional and behavioral problems andwho can help each other during times o crisis. This works because within a groupcrises rarely occur simultaneously, so there are always people on hand to help.

SUN is open to anyone with an emotional or behavioral problem, provided that theyreer themselves to the service. Once they have decided to join, people create Crisisand Support Plans (CASPs) with a member o sta and other members o the group.These are tailored to the individual, but draw on everyones common resources. The

plans, held and owned by members o the group, provide a clear course o action oron call members o the group in the event o a crisis.

Whereas a typical crisis situation might see a person progressing rom the cause oa crisis (relationship troubles, or an argument) to the crisis itsel (sel-harming) andon to A&E ater that with little, i any, support along the way a member o SUN issupported rom the outset. In times o crisis they know to ollow the procedures set outin their CASP and will have access a member o SUN by telephone or in person.

Members o SUN meet in support groups held several times a week. These areacilitated by proessionals, but the emphasis is very much on people learning romeach other. Everyones experiences and opinions are valued, making these sessionsopen and understanding. Support outside o the network is also encouraged as people

exchange personal phone numbers. This brings an element o inormality to the group,which experience shows can be very eective, and means members can access out-o-hours support rom their peers. Members have reported in evaluations that textmessages rom others during difcult times can make a big dierence in how they eel.Knowing that there are people in the local area thinking about them when they arestruggling is valued a great deal.

Because o SUNs ormal and inormal support people are better able to manage theircrises, helping them to avoid harmul situations and reducing admittances to A&E.

SUN is designed and delivered in close partnership with its members. The continualdevelopment o the service is shaped through episodic orums where serviceprocedures and rules are amended incrementally by members, enabling regular re-design o services. Members are also central to delivering the care provided throughSUN. All members play their part in being there or each other in times o crisis, andin challenging peoples responses to crises in the acilitated sessions. They can alsoreceive training in how to acilitate the group sessions. There are now plans to roll outthe SUN model to other areas and it is hoped that current members o the Croydonnetwork will become paid members o sta in these networks. As such, the SUN modelis moving towards nmn co-production.


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SUN has evidence to show that its model greatly decreases planned andunplanned hospital visits; rom 725 to 596, and rom 414 to 286.

An audit looking at the impact o SUN on hospital bed day use ater six months omembers being a part o the network, showed a total decrease rom 330 days to162 days.

A&E attendance was also down by 30 per cent or members ater six months inthe network.

Then see also: rhmn u inpnn lng shm, F Hcct

http://www.hear-us.org/aboutthem/croydonsupportgroups/othersupportgroupssun.html

A useul overview with key contacts can be ound here.
http://www.hear-us.org/aboutthem/croydonsupportgroups/othersupportgroupssun.htmlhttp://www.hear-us.org/aboutthem/croydonslam/slamsservices/touchstoneansthesunproject/pdf/CroydonSunProject.pdfhttp://www.hear-us.org/aboutthem/croydonslam/slamsservices/touchstoneansthesunproject/pdf/CroydonSunProject.pdfhttp://www.hear-us.org/aboutthem/croydonsupportgroups/othersupportgroupssun.html


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Comas recoverycoaching

CaSe Study 3

SuMMary

key learning

Coaching is based on the premise that human beings are capable o change, and thatwhen we want to change, the key resource is within us. A coach does not change us. A

coach helps us work out what change we want, and how to make change in our lives

that will last. A recovery coach is not a therapist, advisor, counsellor or teacher. Their

role is to help people in recovery learn about themselves and nd their own answers.1

The recovery coach approach links a person with experience o recovery to someonein recovery rom severe alcohol or drug problems. The recovery coach is in recoverythemselves, enabling them to oer insight and to understand the context o the individualthey are mentoring. The role o the recovery coach is to support the person with whomthey are linked towards a happy, ulflled and sustained recovery2 in a way that ismeaningul to the individual that they are supporting. The recovery coaching model isbased on the learning rom people in recovery that people want to fnd ways to occupy

their time and think positively about the uture, as well as learn to manage their addiction.3

Innovative approaches can be developed in partnership with people using services in this example Comas learned rom people recovering rom addiction that therewas limited support or them to look at their whole lie, beyond their addiction andthat existing treatment programmes, once completed, could only provide limitedongoing support.4How does your work invest in peer and community networksbeyond your service oer?

Comas has used accredited training as a way o recognising the contribution thatpeople who are in recovery make to shaping the course. How do you recogniseand celebrate the contirbution o people who use and support the service?

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More about reCovery CoaCHing

The recovery coach training has been piloted at Comas, a charity based in Edinburgh,Scotland, whose purpose is to liberate potential, connect people and empower

communities.5

The pilot was unded by the Sel Management Fund with money romthe Scottish Government. Comas also supports Circles o Care and the Serenity Caas community-based recovery networks.

The recovery coach training evolved due to the close working between sta andpeople with experience o recovery in establishing the Serenity Ca. From theserelationships, insights into the benefts o sharing experience and sel-managementskills led to developing the coaching approach. The course was developed using anaction learning approach with people in recovery helping to shape the content and thedelivery. The Scottish Government then supported Comas to accredit the training withthe Scottish Qualifcations Agency, enabling participants to achieve valid qualifcations,whilst contributing to their recovery community. The course is a thorough introductionto coaching, including sel-reection, applied coaching and exercises to demonstrate

coaching in practice. The course is designed to be thorough but also to be accessibleto people with no previous experience o coaching and possibly no recent learningexperience.6

The approach was also shaped in order to make the programme relevant to recoveryrom addiction itsel, using a recovery capital ramework or the coach/client selassessment tools.7 Recovery capital is described as the strength o internal andexternal resources that can be drawn upon to initiate and sustain recovery rom severealcohol or drug problems. These include: hope in recovery; supportive relationships;secure and stable housing; learning and personal growth; connections to a community;making a contribution to the community.8

Ater initial piloting, the course has evolved into two modules. The frst module isocused largely on sel-coaching: sel-awareness and sel-management; and the

second module more specifcally targeted on recovery coaching. This is because itbecame apparent that not everyone putting themselves orward or the training wasnecessarily ready to take on the role o coach. The sel-coaching training is opento everyone and rom this group people are identifed who are ready to go ontothe coaching component. The timescales and structure around how the training isdelivered have been kept intentionally exible in order to make it most accessibleto the diverse people taking part. Dierent learning approaches are incorporated toensure successul outcomes or people involved with dierent levels o learning orliteracy and dierent experiences o recovery.

At Comas, the recovery coach training has been delivered to a mix o helpingproessionals and service users who were all learning about coaching approachtogether. Some proessionals remarked on this being challenging, because o the[personal] inormation that they were sharing with the group9 as part o the learningprocess. Comas learned rom an early pilot to avoid engaging proessionals in groupswith their own clients; however, it was acknowledged that a joint learning approachcould lead to a shared culture between sta and service users that embedded acommon culture within the organisation.

Access and involvement in the recovery training has come largely through peoplespeer and personal networks, rather than ormal reerral mechanisms, as the coachingis embedded within a recovery community o social activities, learning programmes,positive relations with mutual aid Fellowships and links with other recovery initiatives.


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Recovery coaches are adding to the capacity o the community to help each other,and people coming orward or the coaching are able to access support in a exible

way that many services cannot manage. Coaching between peers is oten during thehours that other services are closed, because this support is now available rom withinthe community.10 This approach actively and explicitly seeks to grow and sustainpeoples social networks beyond their condition, recognising they have assets and thecapacity to support others.

Delivering training to helping proessionals and service users together helped theproessionals to recognise the variety o skills, experience and expertise that peoplein recovery can bring, and gave the training credibility. It also enabled some people inrecovery to see that proessionals can also have deep insights into the experience orecovery, drawing on their own lie and proessional experience.

It is clear that this approach is transormative in its approach to supporting people inrecovery. However, it is only now beginning to explore how to work more closely with

mainstream providers to inuence culture and practice.

Evaluations o the approach highlight that it is essentially solution-ocused as opposedto problem-ocused and gives people personal responsibility and ownership.11Participants evaluating the scheme have commented that this is dierent rom theFellowship (AA, NA or CA) . and it was good to get a dierent perspective onthings.12 Others identifed that it is a way o helping people to identiy themselves,

rather than a proessional point out what is wrong.13

People being coached by peers have been positive about the experience, identiyingthat recovery coaching helps individuals with their ocus; gives people an overallpicture o where they are in their lie; was a good opportunity to learn aboutthemselves; was motivational but challenging; had a positive structure that was quick,simplifed and broken down into small steps. The participants all highlighted that theircoachs awareness o recovery was a really important actor but [coaches] did notnecessarily have to be in recovery themselves.14

The Comas recovery coaching evaluation suggests that those in early recovery seemto need the most experienced coaches (i.e. in longer-term recovery) as their lives aremore complex, and emotions and thinking patterns are still very raw in the monthsater treatment. However, the approach has been ound to be benefcial by people in

early recovery and in longer-term recovery, whenever a person wants help to considertheir well-being and their direction.

The United Nations Ofce on Drugs and Crime (UNODC) have reported on SustainedRecovery Management (UNODC, 2008) and included an evaluation o a recoveringcoaching and personal recovery planning project in Illinois.http://www.sdrconsortium.org/assets/fles/DigestingTheEvidenceResearch.pd

linkS

www.comas.org.uk
http://www.sdrconsortium.org/assets/files/DigestingTheEvidenceResearch.pdfhttp://www.comas.org.uk/http://www.comas.org.uk/http://www.sdrconsortium.org/assets/files/DigestingTheEvidenceResearch.pdf


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endnoteS

Then see also: h Wy c l chng Pgmm, Hm Hh Pa (HHPa)

1. http://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.html

2. http://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.html

3. Sel Management Fund Special Report Communities and Community Assets, March 2011.


5. http://www.comas.org.uk/index.php/our-vision.html

6. The pilot.

7. Ibid.

8. http://www/comas.org.uk/index.php/recovery/97-recovery-capital.html

9. Recovery coaching eedback.


11. Recovery coaching eedback.

12. Recovery Coaching eedback fnal report 31st July 2011.

13. Ibid.

14. Ibid.
http://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.htmlhttp://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.htmlhttp://www.comas.org.uk/index.php/our-vision.htmlhttp://www/comas.org.uk/index.php/recovery/97-recovery-capital.htmlhttp://www/comas.org.uk/index.php/recovery/97-recovery-capital.htmlhttp://www.comas.org.uk/index.php/our-vision.htmlhttp://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.htmlhttp://www.comas.org.uk/index.php/recovery/recovery-coaching/102-peer-to-peer.html


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ecdp solutions(ormerly Essex Coalitiono Disabled People)

CaSe Study 4

SuMMary

key learning

More about eCdP SolutionS

p solutions is an example o a user-led organisation delivering and inuencinglocal authority policies about support planning. p won an open tender in 2009 tocomplete 300 support plans or people qualiying or personal budgets each year at acost o around 500 per completed plan (2009 prices). The organisations approachpromoted the active involvement o people themselves in their own support planning,to the extent that over 90 per cent o people need just one visit rom a supportplanner. So ar, every person who has used the support planning service has taken upa direct payment or all or part o their support package.1 This compares well withthe national average take-up o direct payments o 6.5 per cent in 2008-092 and withfgures in the Eastern region o approximately 17 per cent.

Interventions that devote time upront to increasing peoples skills, confdence andunderstanding are successully increasing peoples capacity to manage their ownsupport.Are peoples own contributions vital to the success o your activity?Is personal development a common expectation or everyone involved?

p solutions has a track record o enabling both the individual and collective voice odisabled people and also in directly delivering services including: sel-directed support;

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direct payment support; independent support planning; a personal assistant supportservice and a criminal records bureau administration service.3

On winning the contract to deliver support planning in Essex, p brought userstogether and asked them what problems had previously arisen and what good wouldlook like to them. This provided the basis to develop a set o qualitative measures touse as Key Perormance Indicators, which users are now involved in monitoring.4pworks with all user groups in Essex, except adults with mental health support needs.

p approach to support planning is ramed by them as an empowermentapproach. Their team (1.8 ull-time equivalent, all with lived experience) provides abrie but intensive intervention aimed at enabling the individual to develop the skillsand confdence to negotiate the remainder o the support planning process themselves in most cases without urther ace-to-ace input rom p. p support to themincludes double-checking that there is sufcient inormation within the support plan toallow the local authority to make its decision.5

The average time taken to develop a support plan was just over nine hours. On average,

around two hours o this was ace-to-ace contact with the individual, an hour-and-a-hal on travelling to them and almost six hours spent on the writing o associatedreports.6 Only one in six cases involved two or more home visits.7

The service was co-designed by the people who would be uture recipients, due tothe ability o p to connect to networks o people with an experience o existingservices.

People with an experience o support planning themselves have an active part indesigning, running, evaluating and delivering the activity.

The service actively seeks to blur the boundaries between proessionals and service-users by ensuring people with a lived experience are comortable to share this insightwith the people they are supporting. This has been identifed as extremely valuable bypeople receiving support.

In evaluating the p approach to support planning, the Norah Fry Research Centreound that those in the ULO group [people receiving support planning rom user ledorganisations] tended to know much more about what was happening, and couldregularly fnd and talk about their own support plan.8

Those who had been involved with ULO support planners described a range o positivecharacteristics, including their genuine quality, the way they loosened the proessionalboundary and the act that they acted in a more personal and relaxed way than theirtraditional local authority counterpart. These participants reported that they elt theirlives actually mattered to the support planner as a result.9 On the whole, people usingULO services described the ULO as open and riendly, and its support planners asefcient, active, available, knowledgeable and proessional.

The amount o time spent on support planning visits appeared to be less important topeople than the availablility and efciency o the support planner. Where people wereaware o the lived experience o the support planner, they elt that it helped them,specifcally because they elt the support planner would have personal knowledge and


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inormation about personal budgets.10 Where individuals had a lielong impairment,they reported it was important or support planners to draw on the expertise oboth service users and amily carers, and to enable them to think about ordinary liesolutions to their support needs, rather than restricting themselves to service-led

solutions. Those who had peer support rom other disabled people ared better in thePB process.


endnoteS

linkS

Then see also: rhmn u inpnn lng shm

1. SCIE personalisation briefng, at a glance 35, personalisation, productivity and efciency, January 2011.

2. Practical Approaches to Improving Productivity through personalisation in adult social care, RachelAyling, Martin Cattermole, Dec 2010.

3. National Skills Academy, ULOs and Comminissioning: 18 good practice learning recommendations,January 2011.

4. Ibid.

5. Final report rom the support planning and brokerage demonstration project, May 2011.

6. Ibid.

7. Ibid.

8. Ibid.

9. Ibid.

10. Ibid.

www.ecdp.org.uk

Making Personalisation Happen: ULOs on SCIE TV, eaturing p
http://www.ecdp.org.uk/http://www.ecdp.org.uk/home/2011/2/1/making-personalisation-happen-user-led-organisations-on-scie.htmlhttp://www.ecdp.org.uk/home/2011/2/1/making-personalisation-happen-user-led-organisations-on-scie.htmlhttp://www.ecdp.org.uk/


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Shared Lives

CaSe Study 5

SuMMary

key learning

Local Shared Lives organisations match vetted and trained Shared Lives carers withadults looking or practical and emotional help to live ulflling lives in an ordinaryamily household. Individuals and amilies in local communities provide support andoten accommodation, or people who need some help to live the lives they choose.Participants are matched to ensure compatibility and shared interests. Thosesupported by Shared Lives include older people, people with mental ill-health, peoplewith physical and learning disabilities. Shared Lives can be used or long-term live-in arrangements, or the individual can visit the Shared Lives carer or day support orovernight breaks.

Shared Lives shows how a micro-service model that builds relationships withinthe community can be replicated at scale, across England. This is done through anetwork-based approach, with a comprehensive package o support, training andregulation or Shared Lives carers. Does your approach think about scale, and howmicro-service models might work or people?

Family, riends and the wider community can be engaged to contribute to a highquality, low-cost alternative to traditional care home and day care services. Do youinvest in mutual support networks as a core activity?

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More about SHared liveS

Shared Lives is about a household amily, couple or single person includinganother individual in their amily and community lie. The majority o Shared Lives

schemes are run by local authorities (86 per cent) but an increasing number are beingrun independently (14 per cent)1 as councils outsource their social care provision.Increasing numbers o people und their care using a direct payment.

Shared Lives carers are careully selected and trained by regulated Shared Livesschemes, with the goal o enabling people to beneft rom a highly personalisedservice which depends on achieving a good match between the individual requiringsupport and the Shared Lives carer who wishes to support them.2 The national SharedLives Plus network supports schemes and carers. Traditionally Shared Lives schemesocused on supporting adults with learning disabilities, but over recent years they havebroadened to include older people, people with physical disabilities and people withmental health problems. The exibility o the model means that the schemes can workin a variety o ways including:

Providing a shorter-term arrangement or people with mental health problemsrecently discharged rom hospital, which can also help prevent readmission.

Providing day support and short breaks or people with dementia, as a small-scale,amily-based alternative to large day centres or care homes.

Providing respite to unpaid amily carers, an arrangement which can also help withlong-term succession planning or older amily carers.3

Whilst there is exibility in the application o the Shared Lives approach, there are anumber o constants that distinguish the Shared Lives approach:

The recruitment and approval process or Shared Lives carers is thorough anddoes not just look at the individual applicant(s) but at the whole amily and its

place in the community. Arrangements are subject to a careul matching process and support agreements

which ensure that the individual has maximum choice and control.

Arrangements provide committed and consistent relationships where allparticipants are seen as having something to contribute. Relationships can belielong.

People living in Shared Lives households are more able to be active citizens,contributing to the lie o their local community and all have the opportunity to bepart o the Shared Lives carers amily and social networks.4

Because Shared Lives is regulated as a community rather than a residential careservice, it enables the supported person to maximise their benefts. This ensures that

the person retains a larger amount o their income than i they were in residential careand this increases their choices and opportunities to use their money as they wish.5

Payment levels to Shared Lives carers comprise the ollowing:

Rent, which is paid direct to the Shared Lives carer, usually unded by housingbeneft.

Food and utilities costs, which are usually an agreed fxed amount, paid direct tothe carer by the person.

Care and support needs and management costs or the scheme which are undedrom the Community Care budget increasingly via a personal budget or directpayment.

Shared Lives carers are classed as sel-employed. Payment levels to Shared Lives carersare usually decided according to the level o support required: carers are not paid bythe hour. There are specifc (avourable) tax arrangements or Shared Lives carers.6


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Shared Lives mixes paid and unpaid caring contributions. It shows how the assetswithin the core economy peoples time, skills and empathy can be used to support

the delivery o services. Relationships are reciprocal ensuring everyone involved isvalued as an individual and makes a contribution to the lie o the household and theircommunity. By supporting people to live in a community setting, the wider networks othe community are engaged in providing support and riendships.

The approach is transormational; by working in the way it does, some local authoritiesare shiting their models o support rom traditional supported housing options intocommunity settings, enabling greater access or individuals into inormal supportnetworks and wider community and civil society activities.

Shared Lives is a cost eective way o supporting people to continue living in thecommunity. Shared Lives schemes deliver savings o between 35 and 640 a weekper person in comparison to traditional services. A scheme supporting 85 people couldrecoup 13 million or an initial investment o 620,000.7 The Care Quality Commission(CQC) in England rated 57 per cent o schemes as good, 38 per cent as excellent andnone poor. Thirty-eight per cent is nearly double the percentages o other orms oregulated care.8

People involved in Shared Lives have identifed benefts including: increasedcontrol and choice or users; developed user confdence, sel-esteem, skills andindependence; developing stronger reciprocal relationships with others, widening

social networks and integrating better into local communities; improved physical andemotional well-being; reduced likelihood o abuse; increased community awarenessand involvement.9

There is evidence that Shared Lives is highly valued by service users andcommissioners. Its ocus on the individual and their relationships, it helps councilsgive service users more choice and control and develop the capacity o the wholecommunity to support its more vulnerable members.10

http://www.sharedlivesplus.org.uk/

A Business case or Shared Lives (2009) NAAPS/ Improvement and Efciency SouthEast

A Shared Lie o My choice (2011) Shared Lives Plus. (www.SharedLivesPlus.org.uk)

Cuts or Putting People First (2010) NAAPS (www.SharedLivesPlus.org.uk)

Supporting Micromarket development: A practical guide or local authorities (2009) NAAPS/ DoH

http://www.youtube.com/user/sharedcarenetwork

linkS
http://www.sharedlivesplus.org.uk/http://www.sharedlivesplus.org.uk/http://www.sharedlivesplus.org.uk/http://www.youtube.com/user/sharedcarenetworkhttp://www.youtube.com/user/sharedcarenetworkhttp://www.sharedlivesplus.org.uk/http://www.sharedlivesplus.org.uk/http://www.sharedlivesplus.org.uk/


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endnoteS

Then see also: Kyrng, lac

1. Shared Lives Models or care and support, John Dickinson, Head o Shared Lives. Unit Costs o Healthand Social Care 2011.

2. Ibid.

3. Ibid.

4. Ibid.

5. Ibid.

6. Ibid.

7. Ibid.

8. www.scvo.org.uk

9. Slay, J. (2011) Budgets and Beyond: A review o the literature on personalisation and a ramework orunderstanding co-production in the Budgets and Beyond project, new economics oundation and theSocial Care Institute or Excellence.

10. www.communitycare.co.uk
http://www.scvo.org.uk/http://www.neweconomics.org/projects/budgets-and-beyond-what-co-production-can-offer-personalisationhttp://www.neweconomics.org/projects/budgets-and-beyond-what-co-production-can-offer-personalisationhttp://www.communitycare.co.uk/http://www.communitycare.co.uk/http://www.neweconomics.org/projects/budgets-and-beyond-what-co-production-can-offer-personalisationhttp://www.neweconomics.org/projects/budgets-and-beyond-what-co-production-can-offer-personalisationhttp://www.scvo.org.uk/


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KeyRingLiving Support

CaSe Study 6

SuMMary

key learning

KeyRing is a supported living service or vulnerable adults. There are 899 membersin over 105 networks nationally. The biggest is in Oldham. The approach is to set up aseries o local networks, o which each has nine adult members and one volunteer (thenavigator), all living independently, usually within a 10-15 minute walk o each other.The networks provide mutual support or independent living and links people intoother local networks and resources.

Peer support networks improve outcomes or people and increase the scopeand eectiveness o services. How could the people you work with be broughttogether with the explicit intention o helping, and learning rom, each other?

Peer support networks need careul nurturing, so the navigator role is critical insignposting people to ormal and inormal support. Does your service make use o

service navigators? Do they look beyond the service to help people link up with

inormal, community networks, resources and assets?

Local communities are an oten-neglected resource. Does your service treatpatients in isolation rom their amilies, riends and local communities? What might

a community asset mapping exercise tell you about the under the radar resources

that you and the people you work with might be able to tap into?

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More about keyring

KeyRings support is based on people living in their own homes, but sharing theirskills and talents with each other and with their communities. It is about helping

people to live independently by building networks o interdependence with otherKeyRing members and the broader community. Building these networks is the role othe community living volunteer. KeyRing networks draw on community developmentphilosophies, which emphasise the importance o social networks to good living.

Volunteers are much like good neighbours who help people out when challenges arise;such as helping to read and pay bills, or organising necessary housing maintenance.But volunteers also help members make links with each other and with the widercommunity. One o the frst things that members o a new network start to work onis a personal and community map which highlights peoples networks o riends andacquaintances and draw out ormal resources and amenities, and inormal networksand assets within the community. Because the volunteer lives in the community, theyknow whats going on and are able to help members make the most o where they live.

Community connections are very important to KeyRing. KeyRing members campaignedor streetlights, have saved lives and run neighbourhood improvement campaigns.

Once networks have matured, the support becomes more mutual within the network,and the volunteer role is reduced as members turn to each other. The volunteer is otenperceived as a peer by members: in the 2008 oods in Gloucester, the local networkvolunteers at was ooded and all the members arrived to help clear the water and

debris away.


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Elements o transormational co-production are evident across the service. It is amembers organisation developed and driven by and or the members. At least two

members are involved in the recruitment o new KeyRing sta and members aretrustees on the board. This helps to blur the boundaries between people receiving aservice and peopleproviding a service. Mutual support is an explicit component omembership. Critically the networks developed are not simply or vulnerable adults,but instead inormally incorporate a wide range o people rom the local community.Assets and resources rom within the membership base and beyond are careullyidentifed, in some cases nurtured, and then mobilised to maximise the networks scopeand impact.

KeyRings business case has shown that it can:

Reduce costs in a sustainable way.

Eectively meet the needs o people with a range o complex needs, rom diversebackgrounds.

Help the shit towards personalisation in care services.

http://www.keyring.org/Home

KeyRing also oer a ree DVD explaining how what they do works. You can order acopy here

This document demonstrates KeyRings ability to save costs http://www.keyring.org/DocumentDownload.axd?documentresourceid=19

Then see also: sh l, lac
http://www.youtube.com/user/sharedcarenetworkhttp://www.keyring.org/Homehttp://www.keyring.org/site/KEYR/Templates/General.aspx?pageid=143&cc=GBhttp://www.keyring.org/DocumentDownload.axd?documentresourceid=19http://www.keyring.org/DocumentDownload.axd?documentresourceid=19http://www.keyring.org/DocumentDownload.axd?documentresourceid=19http://www.keyring.org/DocumentDownload.axd?documentresourceid=19http://www.keyring.org/site/KEYR/Templates/General.aspx?pageid=143&cc=GBhttp://www.keyring.org/Homehttp://www.youtube.com/user/sharedcarenetwork


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Local AreaCoordination (LAC)

CaSe Study 7

SuMMary

key learning

Local Area Coordination (LAC) is an approach to supporting people with disabilitiesto live good lives in their communities. Rather than defning people by their needsand the services they use, LAC asks people what sort o lives they want to lead andthen supports them to achieve their aspirations. It does this through Local AreaCoordinators, who act as a single point o contact or people with disabilities and theiramilies in a defned area; enabling them to develop their own skills and capabilities;helping them to tap into existing local resources and networks, and, where it does notexist, building community inclusivity and capacity. In so doing, the LAC approach helpskeep people strong, rather than waiting or a crisis beore intervening.

The LAC approach can be seen as an advanced orm o the navigator model; itdoes not just simpliy a complicated system, it transorms the system. How isnavigation conceived o where you work?

Despite working with people with complex needs, LAC reuses to treat people aspassive benefciaries o services. Everyone is seen as capable. How do you work toidentiy and build on peoples existing capabilities?

The LAC model ully utilises local capacity, resources and assets to improveoutcomes or the people it supports. How much do you know about the resourcesand assets in the local communities where you work? Have you considered how

asset mapping exercises might help in identiying under the radar activity that can

be inormally accessed?

P spp a n Gninmn


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More about laC


The LAC model was frst developed and implemented in Western Australia in 1988.Since then, reecting its success, the approach has been adopted across Australasia, in

Canada, Ireland, Scotland and now parts o the UK too.The approach works by employing Local Area Coordinators, who act as single points ocontact in a defned local area, supporting between 50-60 individuals and their amiliesin their local communities.

A key part o the Coordinators role is to get to know the people (individuals and theiramilies) with whom they are working, and the communities within which they live, verywell. This is because the Coordinators job is to enable people to make the most o theirindividual skills and capabilities and the resources and assets within their community. Ithese capabilities, resources and assets are weak, the Coordinator will seek to developthem.

Another key element o the Coordinators role is to build and develop personal and

community networks. These networks support people through difcult times, providepractical responses to their needs and help them to achieve their aspirations.

LAC actually helps people to move away rom seeing ormal services as being theinevitable frst port o call, by developing inormal and more personal orms o supportover which they have a much greater degree o control and ownership.

In the UK, the most developed model o LAC is being implemented in Middlesbrough.Here, the approach is very similar to its Australian predecessor; the same principlesand ways o working are all adhered to. However, whereas in Australia LAC is ocusedaround people with disabilities, in Middlesbrough, everyone is eligible or at least somesupport even though most support is still given to people with disabilities and olderpeople. This has meant that a broad range o people with low-level needs have beenable to access help to prevent problems rom escalating down the line and adding

strain to children and adult social care services.

This universality o coverage has also meant that certain people have been supported,who are not picked up by traditional services because their specifc service needs arenot seen as being high enough, but who nonetheless experience multiple low-levelchallenges which cumulatively make their lives very difcult.

The LAC model is a strong example o co-production or a number o reasons. Thephilosophy behind it is explicitly assets-based; personal and community assetsare drawn upon, developed and made an integral part o the service. The role othe coordinator is very important in this. Much o the success o the model can beattributed to the relationships that coordinators orge with the people they work with.Time and eort goes into making sure that the coordinators get to know people andtheir local areas well. This means they are trusted, and are seen to be allies o thepeople, not o the service they represent. LAC also encourages the development andstrengthening o networks o reciprocal relationships between the individual and theiramilies, riends and the wider community.


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Australian evaluations o the LAC programme demonstrated:

High levels o user-satisaction: users, amilies and the coordinators all scored the

service highly in surveys conducted.

Responsive and exible service provision: the service has proven a strong ability toadapt with the changing needs o the service users.

Good value or money: the LAC model provides value-or-money outcomes notmatched by any other areas o disability service delivery (in Australia) LACprovides more support to more people, with a high level o satisaction, at a costthat is more likely to be able to be aorded by (the Australian) Government.1

Signifcantly, evaluations o the LAC service in Australia have demonstrated a 30per cent reduction in costs as part o a move towards a preventative service withmuch lower levels o acute interventions and much higher levels o participation andenthusiasm rom the people who use the service.2 This is costed on the basis that the

LAC model keeps people rom using costly, specialised state services by using morelight touch and inormal orms o support.

In Middlesbrough, although the programme has been running or much less time,and thereore the results are still tentative, similar conclusions are being drawn.Conversations with service users in particular have been very encouraging.

linkS


For a more detailed summary o the LAC model and why it is a good example o co-production, see Nesta and n report Public Services Inside Out

For the most authoritative evaluation o LAC in Western Australia see the Review o theLocal Area Coordination Program Western Australia (2003).

For more inormation on LAC in Middlesbrough.

Then see also: sh l, Kyrng

endnoteS

1. Review o the Local Area Coordination Program Western Australia (2003) http://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pd/fnal_report_lac_review1_ per cent28id_369_ver_1.0.2 percent29.pd

2. Right Here, Right Now http://www.nesta.org.uk/library/documents/coproduction_right_here_right_now.pd
http://www.neweconomics.org/publications/public-services-inside-outhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.middlesbrough.gov.uk/ccm/navigation/health-and-social-care/local-area-co-ordination/http://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.nesta.org.uk/library/documents/coproduction_right_here_right_now.pdfhttp://www.nesta.org.uk/library/documents/coproduction_right_here_right_now.pdfhttp://www.nesta.org.uk/library/documents/coproduction_right_here_right_now.pdfhttp://www.nesta.org.uk/library/documents/coproduction_right_here_right_now.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.middlesbrough.gov.uk/ccm/navigation/health-and-social-care/local-area-co-ordination/http://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.disability.wa.gov.au/dscwr/_assets/main/report/documents/pdf/final_report_lac_review1_%20per%20cent28id_369_ver_1.0.2%20per%20cent29.pdfhttp://www.neweconomics.org/publications/public-services-inside-out


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Nurse FamilyPartnerships (NFP)

CaSe Study 8

Pn Mnng W-bng chng

SuMMary

key learning

Nurse Family Partnership (NFP) is an evidence-based community health model whichpairs young frst-time mothers in high-risk groups with nurses, to improve the well-being o mothers and their children. By developing strong relationships betweennurses, mothers and inants, and providing eective support and coaching on issuesranging rom eeding, nutrition and literacy, to sexual health, employment and saety,NFPs have demonstrated impressive short-term and longitudinal results. These include:

Improved pre-natal care and health.

Reduced instances o child neglect and abuse.

Improved sel-sufciency and economic activity amongst mothers.

Higher rates o literacy.

Lower rates o obesity.

Fewer interactions with the criminal justice system.

Better grades in school and a higher chance o graduation.

The models success has seen it spread throughout the USA with high-levelgovernment backing. In 2006 the model was also trialled in the UK, where itcontinues under the slightly dierent name Family Nurse Partnership.

The proessionals ocus is to encourage and support people to take control over

their own lives, giving them greater sel-esteem and agency. Do you generally dothings or people? Or with them? How could you work to help others develop theirown capabilities and agency?


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More about nFP


Nurse Family Partnerships were developed in the 1970s by David Olds specialistin paediatrics and preventative medicine who was struck by the avoidable risks

acing children born into deprived communities whilst working in an inner-city daycare centre. He realised that i children rom these backgrounds were to have a betterchance in lie, more attention needed to be paid to their health and developmentrom the outset. This, he believed, required a change in their home environment, andcrucially in the social, emotional and economic context o the expectant mothers lie.

The NFP is grounded in three complementary theories based on years odevelopmental research; ecological theory, emphasising the links between behaviourand social context; sel-efcacy theory, concerning a persons belie that they canchange their lives; and, attachment theory, which looks at the importance o long term,sustained human relationships.

Underpinned by these theories, the NFP model partners young frst-time mothers-to-be with trained visiting nurses. Nurses are given specialist training in motivational

interviewing and behaviour change methodology. The nurses role is to build lastingtherapeutic relationships with the mothers, and between the mother and child. This isdone through a structured curriculum o home visits, where nurses help the motherbuild on her existing capabilities, develop new skills and improve their confdence.

Ideally these visits begin early in the second trimester, on a weekly basis or a monthand then every other week until the child is born. Home visits then take place weeklyor six weeks, ortnightly up unto the age o 20 months, and monthly thereater untilthe childs second birthday.

During pregnancy the programme addresses modiable risks or poor birth outcomes

and child neurodevelopment impairment such as prenatal exposure to tobacco, alcohol,

illicit substances, inadequate maternal diet and low take-up o antenatal care that might

address obstetric complications. Following the birth, the ocus is more on developingsensitive, competent care o the child to avoid abuse and neglect or injuries, while

ostering secure attachment bonds.

In the USA, the NFP programme assigns 25 mothers to each nurse, with a part-timesupervisor supporting teams o our nurses at a time. Teams o our nurses meetregularly with their supervisors to reect on their practice and seek out areas toimprove their work and the lives o the mothers they are working with. Team meetingsare also designed to help nurses deal with the emotional strain o working withmothers and children in difcult situations.

The Nurse Family Partnership programme draws on a number o the principles oco-production, and these can be seen to be instrumental to its impact. In particular,because NFP is grounded in sel-efcacy theory and attachment theory, it stresses theimportance o individual agency and relationships. The NFP model recognises mothersas agents o change in their own lives, and the uture lives o their child. With thisin mind, much o the training provided by nurses concerns building on the mothersexisting capabilities and developing new skills. Therapeutic relationships, which areat the core o the NFP model, are about sustained, two-way engagement, trust andsupport. Nurses work with the mothers to acilitate a process o change; they do not

or work them, dictating terms and providing answers.Perhaps one o the only areas where the NFP model could be developed rom a co-production perspective is in relation to peer support. Currently there is little emphasis


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Co-production Catalogue

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Transcript of Co-production Catalogue