Active Support: moving away from the ‘hotel model’

We have been implementing the Active Support approach here at Yarrow for more than a year now. But what is Active Support, and how does it work?

Active Support is essentially supporting people to play a more active role in their own lives and develop skills to enable them to do more things for themselves. In times past, adults with learning disabilities or complex needs were most often supported with the ‘hotel model’, where anything and everything was done for them, from laundry and cooking to brushing their teeth and combing their hair. Although this was done for caring and genuine reasons, this approach disempowered people and made the assumption that they could not learn to do any of these things for themselves.

When things are being done to you and for you every step of the day, it can be frustrating and boring. When you are not being involved in key moments of your day, or having to live to someone else’s timetable, it can be annoying. It is the very opposite of “nothing about me without me”, which is a maxim we live by here at Yarrow!

In 2018, two members of Yarrow’s management team had Active Support training with an external team from ARC (the Association for Real Change). Initially, we implemented the Active Support approach at two of our services. We quickly saw positive and encouraging changes among the people that we support, and heard positive feedback from our teams, so we decided to roll out Active Support across the whole organisation. Staff training sessions have taken place throughout 2019.

What is Active Support?

Active Support is about giving people autonomy over their lives. It’s about working with people as an enabler and giving them opportunities to learn new skills at every turn. It’s about involving people in every part of their day and giving them the chance to initiate things, from the moment they wake up until they go to bed.

Yarrow has always been person-centred, and active support has enabled us to build on this approach taking it further. Active Support means we are now continuously looking for new ways to engage and support people in every aspect of their lives.

Small changes make a big difference

When you empower people to take the lead their self-esteem and confidence grows. We could see the change in people straight away. For example, empowering people to be able to choose and make their own drinks means they no longer have to wait or ask, and they can then do this for their own family and friends too.
Another example is about individuals taking ownership of their homes, carrying out health and safety checks, answering the phone, overseeing security, even using keys to open their own front doors.

A tailored approach

Active Support is tailored to the individual, breaking tasks down into achievable steps which are regularly reviewed to see if they need adapting. This may mean separating a task such as loading the washing machine into multiple actions, and just working on the first – opening the door – for a while. Then once that has been mastered, moving on to the next – loading the laundry into the drum – and so on. Progress might be slow, but it is still progress! Each and every effort is praised, with the emphasis on effort rather than achievement. Continuous reinforcement is really key to success.

Support workers use support that is appropriate to the individual. For example, they might give a physical prompt (such as miming using the vacuum cleaner), a verbal prompt, or hand-to-hand support.

Active Support also means making sure we have the right equipment for the task. Perhaps a person struggles to eat with standard cutlery. Would a different spoon make it more manageable?

We developed a monitoring sheet so that we could evidence the personal development of each individual. The monitoring is recorded in colours so that it is also accessible for the people we support. It enables individuals to identify areas where the person is developing and allows us to review and adjust in areas where additional support may be needed. This could be because the specific skill the individual is focusing on needs to be broken down into smaller steps or that the environment needs to be adapted.

Every three months we summarise the monitoring and the outcomes are then fed back into the individual’s care plans, risk assessment and planning books. There is an evidence trail of where the person started and how they progressed, ensuring that they continue to use the learnt skill and continue to develop it.

Active Support in action

The effects of the Active Support approach have been amazing. We have seen many positive changes in the lives of the people that we support, including a decline in challenging behaviour.

Bogdan is visually impaired, and we used to do most things for him. Active support has really changed his day: with careful planning and hand-to-hand support Bogdan has developed lots of new skills. He was a little reluctant initially, but staff gently persisted: being consistent is important and it has really paid off. He now changes his own bedding, puts his laundry in the washing machine, unloads and transfers it to the dryer and then helps to put it away after it has been ironed. But by far the best part is how happy he is doing these tasks: he is fully engaged and has a big smile on his face. His self-confidence has grown, and we believe this has been a factor in him trying other new things – for example he attended a Ukrainian meeting for the first time recently which he really enjoyed. Now Bogdan is involved in every part of his day, and he is really thriving.

Wayne has made big strides in his independence thanks to Active Support. He now does his own vacuuming, makes his bed and prepares some of his own meals. He can do these activities independently and often does not need to be reminded – miming using the vacuum cleaner will be the only prompt he needs to get up and do it. He’s also done travel training and can now go into a shop alone with his money and choose and buy items while his support worker waits outside. These new skills have seen his confidence blossom. He also writes poetry and helps to train staff in Makaton signs, and is able to support Bogdan all the way around their local park.

Other success stories include Diane, who now makes her own tea and toast for breakfast, William who cleans his own room, Sean who makes his own drinks and can now flush the toilet and wash his hands, John who is able to self-medicate and Mary, who is learning the days of the week so that she can use her medication blister pack.

Active Support has been transformative for the people that we support. When we work closely together and make reasonable adjustments to ensure that their objectives are accessible and achievable, great things happen! Seeing people take more control over their own lives is wonderful.

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