Charlotte Kirin explains how Cambridgeshire’s integrated learning disability team has been using the ‘three conversation model’ to change the way it delivers social care support…
How does the model work?
The model was developed by Partners for Change, a social care consultancy firm that works with local authorities to deliver personalisation within the constraints of austerity. The aim is to remove the traditional ‘assessment for services’ approach and create a new culture where practice is based on three conversations:
How can I connect you to things that will help you get on with your life – based on your assets and strengths, and those of your family and neighbourhood?
What do you want to do? What can I connect you to?
Applicable to people who are at risk.
What needs to change to make you safe? How do I help to make that happen?
What offers do I have at my disposal – including small amounts of money and my knowledge of the community – to support you? How can I pull them together in an ‘emergency plan’ and stay with you to make sure it works?
What is a fair personal budget and where do the sources of funding come from?
What does a good life look like? How can I help you use your resources to support your chosen life? Who do you want to be involved in good support planning?
The Golden Rules
Always start conversations with the assets and strengths of people, families and communities.
Always exhaust conversations 1 and 2 before having conversation 3 – and test this out with your colleagues.
Never plan long-term in a crisis.
Stick to people like glue during conversation 2 – there is nothing more important than supporting someone to regain control of their life.
Listen hard to carers.
Abandon ‘assessments for services’ as an activity – forever!
How has Cambridgeshire used the model?
Team members are trusted with budgets and decisions. They have the capacity to put in support that is needed without prior agreement. They can also make decisions about whether to provide a response to conversation 1 or 2, without waiting for an access decision.
Any member of the team can agree up to £2,000 worth of spend without discussion, when they are having a conversation 2 – helping someone resolve a crisis. If a spend is made, then a tier 2 support plan is created, and is discussed and reviewed at weekly meetings until it ends. A conversation 2 plan might be for days, or it might go on for months.
If a conversation 3 package of support is needed, then involved members of the team get together as soon as possible to discuss this. They make sure that there isn’t a conversation 1 or 2 solution, and embed outcomes collectively.
At this stage, an assessment and support plan are needed and the discussion is recorded in case notes. Staff must detail the consideration that led to a tier 3 plan, i.e why this was the only appropriate course of action?
What have we found?
Using this model hasn’t always been easy or straightforward, but we believe we are doing a better job for people and their families – and for ourselves too.
We respond to all queries as quickly as possible. We don’t wait for an allocation meeting or a referral process. We have also stopped using our ‘access assessment’ model to determine whether someone can use the team (i.e. whether they have a learning disability or not). If they want to talk to us, we will talk to them. We have not been deluged.
In addition, we have stopped arguing with mental health colleagues about the status of a person and who he/she should be ‘owned’ by. Instead, we are practising a more collegiate, collaborative approach. If we have started a conversation, we keep the case, but go looking for expertise that we need from others. This is saving us a lot of time.
Our conversations are now based on what people want to tell us and what they want us to know, not what we want to ask them. We still use the knowledge we have of people (and where possible we put together team formulations to share our understanding), but listening to what people say they need from us is more important.
We have to remind ourselves that we don’t know best. Sometimes it is best to forget previous assumptions.
It’s also important that we are now establishing ourselves in community settings so people know where to find us, through drop-in clinics for example. Key to this is visiting and supporting the places that the community already uses, rather than expecting people to come to us.
Meeting, talking, challenging and sharing decisions is an essential part of this way of working. We use data to help us and meet weekly to reflect on our practice.
Some team members have found it easier to adapt than others. We’ve been asking staff to work outside established processes and in ways that haven’t been tested. It’s therefore been important to create space to talk and question, and an environment that allows challenge and uncertainty.
What have we learned?
- We think differently about situations as they arise.
- We’re far more aware of what’s happening in local communities and the sorts of events that people we know are involved with.
- We’re trying to be informed, but not led, by what we already know about people, so that we ‘don’t write a story, before we’ve had a conversation’.
- We look at risk differently – we are taking more risks, but always collectively with lots of reflection and discussion.
- There is whole-team involvement. This includes health professionals – but we’re still learning about how to make this work.
- This way of working doesn’t feel easier for the team, but it’s more interesting, more flexible, and it’s about working with people.
No one wants to go back to the way we were working before.