Support Planning in Practice: looking
back and looking forwards
Val Williams
[email protected]
Sue Porter and Steve
Strong
May 2011- February 2013
This research was funded
by the NIHR SSCR but the
views expressed in this
presentation do not
necessarily reflect the
views of the SSCR.
This presentation
• Going beyond data which is ‘collected’ or
constructed: what is ‘naturally occurring
data’?
• What issues and practice problems are
noticeable in such data?
• How to analyse this type of data
• Can this be useful and practical?
• A look beyond interactions to social practices
generally
Interactional problems?
62
Pip what about (.) JOBS Henry↑
what other jobs did you have
apart from apart from the
one you’re doing now (.) in
reception↑
((looking up at Henry, eyebrows raised))
63 Fred
Woofit’s ((Pippa looks
towards Fred))
64 Ann
Woofit’s Garage cleaning cars
((Pippa writes on form)) Ann
((clears throat)) very good
↑at that↓ (4)
65 Pip
was it just cleaning cars
there or did he have any
more =
Pip selects Henry; Fred (then Ann) take up the turn;
Pip then drawn in to a follow-on question to Ann.
A note on conversation analysis (CA)
• Naturally occurring data
• Interest in ‘talk as action’
• How social interaction
occurs: turn taking,
sequences (e.g. one turn
makes a slot for another)
• Fine detail of how things
are said – working from
the micro to the macro
• The move from ‘pure’ CA
to applied or
‘institutional’ CA
‘How can disabled people using personal budgets get
effective assistance to make decisions about their own
support?’
• People with: dementia (7),
learning disabilities (9),
mental health needs (11),
age-related needs (3).
• Also, 14 family-led PBs for
people with learning
disabilities.
• Role of voluntary and userled organisations
• This presentation focuses
on observations of
supporting planning
The shifting sands of
Support Planning
What is support planning?
• Central point of personal budget process.
• Everything between the indicative budget being set, and
the support being in place.
• We will ensure that people have control over their budget
and their care and support plan…. (DH, 2012: 19) (see
also Leece & Leece, 2011: (questioned) ‘the necessity for
the provision of social services and social work, stressing
that people were able to do things for themselves’
• Mental Capacity Act: does the person have capacity to
make the decision? May need best interests decision,
but should also involve the disabled person.
A “person-centred” focus on the voice of the
disabled person: from ‘hand-in-hand’ to ‘handing
over’ (Williams et al., 2014).
What helped people generally to
make decisions about their support?
•
•
•
•
•
•
•
•
A focus on active citizenship and contribution.
Support planning in a spirit of equality and dignity.
Good information ‘up front’
Peer contact and/or examples of what worked for
others.
Coordination of all the systems involved in the PB.
Finances to be calculated correctly and transparently.
Clarity about their own responsibilities in managing the
budget, and about the support available.
A support plan that is flexible enough to be developed.
AND all these things happened more reliably when a user-led
organisation was involved.
How do we support people with learning
disabilities to take control of their own lives?
• I used ‘conversation
analysis’ (CA)
• I’m interested in “personcentred situations”, to
help a person with
intellectual disabilities
(ID) to make a decision.
• Often there is someone
else there too (a ‘third
party’). What role do
they play in the talk?
Participants in this presentation
Support
Third
Data
planning
person
practitioner present in
the session
Kia: young
woman of 18
living with
foster mum
Khalil: young
man of 17.
Lives with
mum
Natalie: from Foster
voluntary
mother
sector
organisation
Jon:
Mother
transition
social
worker
65.2 minutes
audio data
with
observation
3 sessions,
on average
61 minutes;
1 selfrecorded, 2
observed
Prompting someone to speak
What sort of
photos do you
want me to try
and find?
I know what
photos you
liked – the
ones from the
Fun Run
didn’t you?
Kia says
nothing
Oh yeah,
OK. Yeah
Clarifying what someone has said
so you're going to
see them next
March?
yeah
next
March
park
fantastic
Are you looking
forward to that?
I’m
going
park
He’s
going
to the
park
He’s going
to where?
Challenges, corrections, taking over?
•
•
•
Routine self-selection by 3rd party not remarkable.
60-80% of self-selected turns by 3rd party in the planning meetings were
‘supportive’ of disabled person (prompts, filling gaps. Generally taken as
clarifications.
Third party can also correct or contradict what person with ID has said:
A: So what do you do at work then
B: Lessons mm English mathsC: not at work
•
•
•
Precedence given to accuracy, progressing the business of the occasion.
In CA terms, we talk about ‘epistemics’: the way in which one party might
have knowledge, or share knowledge with each other.
Shared knowledge can act as a support, but also on some occasions as a
trap.
Open disagreement: two different
agendas
1.
2.
Dispreferred
response
SPP to Khalil:
contradicts.
Based on
shared
knowledge
3.
4.
5.
6.
7.
8.
9.
10.
11.
Jon the reason why we're meeting here today Khalil IS (.) to do:
something that's called your support↑ plan↓ (0.5) and
that’s- means we're going to get together and write down
(.) ho:w your needs are going to be met↓ and what activities
you're going to do such as going to college↑ (.) ye:ah↑ and
going to the new place (.) in Anford↓ (0.5) what do you
think about that↑
→ Kha I want the same place (as) Shirley before↑
Jon shirley↑
Reb °no shirleys not going to the same place Khalil↓°
Jon eerr I don’t know who Shirley is is that a friend of yours↑
Kha it’s my girlfriend =
Jon’s SPP is a clarification
request, expanded in line 10.
Enables Khalil to get back in
at line 11
Pattern 1: asking
for clarification
Pattern 2: other
speaker takes turn
allocated to Khalil,
using it to
contradict his
previous turn
25. Jon
26.
27.
28. Reb
29. Jon
30.
31. Kha
32. Jon
33. Reb
no↑ ( ) what’s his name↑ (0.5) we’ll get
your mum to help out with that
answer
( ) and (
)
so you going to go to the same place as
them↑
no
no↑ why not↑ (0.5)
°you haven’t started yet but you’re
going to go°
• Interactional consequences of third speaker’s turntaking
• Khalil’s epistemic privilege undermined? Foregrounding
of shared knowledge, previous interactions
• Following this, Jon then openly takes up parent’s script,
while continuing to address Khalil: persuasion work
How to escape the epistemic trap:
ideas from interactive role play
1. M: No, Shirley's not going to the same place.
2. Kha: Why?
3. M: Why? I don't know Khalil. Shall we ask
Shirley ourselves?
4. Kha: But Shirley's not here.
5. M: We could perhaps phone Shirley's carers
and ask them why.
How to speak up in your support plan
So, can CA be useful for practice?
• Charles Antaki & others in the field (including
myself)
Interventionist CA
• But who is it useful for?
• Heritage (2007): doctor-patient
Interaction: intervention tested quantitatively
Have you got any more problems?
Have you got some more problems?
Heritage et al. (2007) J Gen Intern Med. 22(10): 1429–
1433.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2305862/
Issues about CA
• Can CA throw up ‘good’ and ‘bad’ practice?
• Or should we look towards CA as one of a range of
ways of thinking about social practices and change?
• If we jump too quickly to think of something as ‘good’
or ‘bad’, then we are immediately taking sides – and
that could be problematic.
• Whose side are we on?
• Liebling, A. (2001) Whose side are we on? Theory,
practice and allegiances in prison research. British
Journal of Criminology, 41: 472-484.
The turn towards social practices
Cultural theories,
including practice theory,
are founded upon a
different form of
explaining and
understanding action,
namely by having recourse
to symbolic structures of
meaning. (Reckwitz, 2002:
p 244)
Elizabeth Shove’s Social Practice
Theory
• Analysis of wider
elements of social
practices – (not
individual psychology)
• Types of routine
behaviour – elements
from 3 domains:
competence; material
objects; meaning.
Elements – coming together to form
practices
• CHANGE???????
Competence
Materials
Meaning
‘George’ and his review
• George has a direct
payment.
• He is a man with autism,
and he does not want to see
‘official’ people from the
local authority.
• But the social worker wants
to see George.
• Should we be ‘tweaking’ or
changing the practice – or
radically overhauling it?
• What would George’s own
solution be?
Some of the elements in the social
practice as it involves George
• CHANGE???????
Competence
Practitioner
knowledge, facilitation
techniques
the budget itself;
the assessment
tools?
Materials
local policies of
personalisation;
being ‘personcentred’
Meaning
The three types of elements in this
practice
• Competence: social care manager assesses who is
eligible? What outcomes should be addressed?
Practitioner knowledge, facilitation techniques
• Material objects: the budget itself; the assessment
tools?
• Meaning: local policies of personalisation; being
‘person-centred’ ……
BUT all of these can look very different from the
perspective of the practitioner and that of the disabled
person!
Change, social practice and coproduction?
• Making change happen through co-production
– disabled people making a difference?
“We used to be part of the picture – but
now we are the artists of our own lives.”
(Stacey Gramlich, 2002)
References
Val Williams Sue Porter Steve Strong, (2013),"The shifting sands of support planning",
Journal of Integrated Care, Vol. 21 Iss 3 pp. 139 – 14
Williams, V. (2011) Disability and Discourse: analysing inclusive conversation with
people with intellectual disabilities. Wiley-Blackwell.
Williams, V., Porter, S. and Strong, S. (2014) Your Life, Your Choice; Support Planning
led by Disabled People’s Organisations. British Journal of Social Work,
doi:10.1093/bjsw/bct005
Liebling, A. (2001) Whose side are we on? Theory, practice and allegiances in prison
research. British Journal of Criminology, 41: 472-484.
Reckwitz, Andreas (2002) Toward a Theory of Social Practices: a development in
culturalist theorizing. European Journal of Social Theory 5 (2): 243-63.
Shove, E., Pantzar, M. & Watson, M. (2012) The Dynamics of Social Practice: everyday
life and how it changes. London: Sage Publications.
Gramlich, S., Mc.Bride, G. and Snelham, N. (2002) Journey to Independence: what selfadvocates tell us about direct payments. Kidderminster: BILD.