Emergent learning, targets and support

I developed the model above about a year ago, but last week found a practical application for it.  You may notice I adapted it from Mintzberg and Waters model for a planned vs. an emergent strategy, with Nonaka and Takeuchi’s idea of combination thrown in.

I was discussing ways of engaging with homeless and vulnerable clients, in a workshop for managers of a not for profit organisation.  The model helped us think about how planned targets (expressed in the “Supporting People” world as “outcomes”) were very difficult to plan for.

The process is expected to run like this:

Client meets professional and an assessment is carried out.  The client expresses aspirations and they set goals together.  Over a period of time those goals are achieved through a series of small steps, and the outcomes desired are achieved.

What often happens is this:

Client meets professional and an assessment is carried out.  The client expresses aspirations and they set goals together.   At the next meeting the client has done nothing towards these and instead expresses other aspirations.  This happens a few times, the professional expresses frustration and begins to nag the client to do stuff.  The client begins to feel bad and votes with their feet.  Personal change is even further off for the client.

This happens for two reasons.  First, the insistence on setting targets and having a plan early on, before the client has explored their current situation enough.  Secondly, the professionals involved are normally generalists, not trained therapists or coaches, and they have targets to meet, so their urgency is to get action and results at the expense of exploration.

Back to the model.  If you realise that a lot of value comes from what emerges unforseen, you may be less likely to grab the first plan that comes along and try to stick to it.  Where achieving targets and outcomes are concerned, this suggests that the right target can only be identified late on in the process and that trying to nail it early may be counter productive.

Conflicting roles in managing risk with service users in supported housing

Last week, while delivering training, the model below occurred to me.  It represents the two roles that a Supported Housing Worker or similar professional has in relation to managing risk with service users.

Most of the time an empowering approach works best to reduce risk. Often risk taking is an attempt by the service user to assert independence and take control, so supporting and empowering a service user may work to reduce their need to take risks. Being positive about them and their lives, allowing learning from risk taking through adult dialogue, and building a non controlling and trusting relationship will also work to reduce the service user’s desire to take risks.

However, some risks are so significant (such as an immediate risk of suicide or abuse), that the service user or other people must be protected. Failure to do so may lead to charges of negligence or worse against the worker. At this point a protection agenda kicks in, which is almost the opposite of the enabling one.

The judgement of the professional involved is required to decide which approach to take in which situation, and the border between the two is unclear. In most cases protection wins when there is doubt, as people naturally act to assert control when they fear a risk.

Tendering, TUPE and staff motivation

For not for profit organisations the commitment of their staff to the cause has always been important.  In the best cases this commitment results in powerful added value from staff going the extra mile, and this can show especially in the way they work with service users.  The downside of this is when that commitment causes mutual dependency with the service user.

Well motivated staff is something that every organisation searches for.  In the Supporting People world services and staff now regularly change organisations as slices of business are lost or won, or organisations merge and consolidate to cope with the competitive landscape.

This makes managing the distress caused by change important – organisations can expend enormous effort on TUPE or mergers.  The distress that any change causes is part of that, but I think it is made considerably worse for not for profit organisations as staff are there to make a difference to a cause, not just to earn a wage.  The psychological contract includes some measure of security and commitment to them and the service users from the organisation, which is harder to demonstrate when the organisation keeps changing.

In addition, the staff TUPE transfers result in everyone having to learn a new set of relationships and behaviours, which is both positive and negative.  Positive because it prevents the “rust out” frequently found in the sector, but negative because of the cost in time, training, relationship building and period of sub-optimal performance as staff and organisation learn about each other.

Being positive

Happy new year!

The standard new year’s resolutions can be quite negative – lose weight, stop smoking, drink less – and lead to negative self image.  So choose something positive.  Mine is “go dancing once a week”.

And just for a moment, apply this to leadership, or Supporting People services.  Start from need and deficiency (supporting people) or competency based assessments at the end of the year (“here’s where your weaknesses are, lets try and do better, eh”)?  Reinforce poor self image?  Lead on to feelings of hopelessness and perhaps mild depression?  Create dependency?  Create confirmation bias?

So happy new year, be all you can, and let those you lead or support dream, and tell them, “yes you can!”

Star Struck – outcomes measurement, distance travelled, and proving the value of support

I was reading a back issue (May 2008 ) of the SITRA bulletin, where I found an article on the latest metamorphosis of the Outcomes Star developed by Triangle Consulting.  This was the mental health version, the Recovery Star.

The Outcomes Star has been used in the Homelessness field for some time, and has gone through various versions.  All of them measure, usually on a scale of 1-10, a ten dimensions that represent areas of a client’s life.  The Recovery Star includes Work, Relationships, Addictions, Trust and Hope and similar.  The original measured different areas, such as offending, managing money and meaningful use of time.

This is a fine shot at measuring what is often thought of as unmeasurable, and it has become popular with several large homeless charities, some local authorities and been adapted as an idea by others, including to measure needs according to the Supporting People Outcomes areas. One point of doing this is to evidence the work done in supported housing by capturing “softer” outcomes, to justify grants and government expenditure.  Another is to provide a basis to work with clients to help them set targets and record the achievements they make.

However, I’d like to express some reservations about the basis of the underlying idea.

First, the model is based on identifying deficiencies, or needs.  What about a person’s strengths, assets and aspirations?  These can be worked in, but the need comes first.  To my mind this continues an old voluntary sector theme of seeing clients as a bundle of needs to be helped, creating dependency. It also provides labels that can be self fulfilling – if a client thinks they rate poorly in an area then it is likely they will act in that way.  Also, from any kind of performance measurement perspective it can be a nightmare, as ratings will go up and down depending not on progress, but on how much is disclosed or known at the time of a particular assessment.

Second, what you measure is what you get.  Although dressed up as a star, essentially it is a series of disconnected linear measurements.  While a skilled worker will help a service user see the links between the different areas, and be aware that going forwards can contain many dead ends and needs to go back, the model does not promote this.  As this is what we are measuring the areas identified will be what we get.  The danger is that the complexity of individual behaviour is reduced to fixing particular areas specified not by the service users themselves, but by the monitoring system.

I would argue for alternatives.  Brief Therapy ideas provide an alternative as do most coaching models.  Starting with aspirations and what a client can do, rather than on the past and needs, can form a more positive way of moving forwards.  Otherwise clients may stay stuck in the past, may pay more attention to what is stopping them than what they can do, and not achieve the outcomes that we so desperately want to measure.

Tendering vs Partnerships – the credit crunch extends government power over charities?

I’ve always preferred partnerships to competitive tendering as a model for supply to not for profit organisations, or for their relationship with their funders.  The relationship horizon with competitive tendering is a few years, not long enough to develop real, deep and trusting relationships between supplier and supplied.  You certainly cannot develop a system such as Toyota’s famous JIT (just in time) that relies on integrating suppliers, or M&S’s relationship with their suppliers (or that of Zara, or a host of others) when every 3 years you know it all might change due to an imperfect and cost driven tendering system.

This is not anti-competition and value for money: the appropriateness of competitive tendering versus partnerships depends on the type of service you are buying.  If you buy a commodity you search for the cheapest price.  If you are buying something complex that takes situated knowledge and commitment to deliver, such as a mental health support service, you might want to use other criteria.  While you might argue that such knowledge and commitment can be bought, I’d argue that the situated knowledge required to run such services is better developed over time.

To give some examples from the supported housing sector.  The search for staff to cover shifts in hostels is endless, and normally organisations go to employment agencies for this.  Some are specialised, and many of those working for them are skilled, but often the reverse is the case.  The agency staff employed lack knowledge specific to the sites they are asked to work at or the organisations they are asked to work for.  However, a longer term partnership between agency and organisation can develop, with specific training and better knowledge of the sites by all concerned, including those at the agency responsible for placements.  The result is improved quality of service to clients.  It can even keep costs down.

Perhaps my biggest beef with the current state of Supporting People services, is that we have a competitive market where all the power lies with the one purchaser (the local authority) while many potential suppliers compete.  This makes the charities involved mistrust each other, spend a lot of time on complex tendering, then spend time on taking over services, remodelling them, TUPE, re-budgeting and negotiating, and then going through it all again.  Until the 3 year settlement, the funding horizon was year by year, hardly a safe environment to encourage investment in services by charities.  It means constant reorganisation, taking on services or staff with different cultures and practices.  This works against any organisation learning how to run a particular type of service, and sees some larger charities tendering for everything in sight.

The up side to this is that quality has improved and poor performers have been driven out of the market.  It promotes flexibility and the ability to adapt quickly to change.  The down side is the slow consolidation of organisations, as smaller more specialist ones are driven under, with the local authorities able to call the shots and specify what they want, sometimes to a crazy level of detail (considering they often lack specialist knowledge of the services they are commissioning).

The credit crunch can only make this worse – donations to charities can enable them to undertake ground breaking and specialist work that local authorities won’t initially buy.  As voluntary donations dry up, those charities that contract with Supporting People will increasingly rely on those contracts, which are continually squeezed.  Slowly some sectors will turn into extensions of local authorities, with all the ills that led to the government outsourcing to charities in the first place.

The private sector has proved that both competitive tendering and long term partnerships have their place in business.  My fear is that the supporting people regime, and what is to follow through Local Area Agreements, will focus only on tendering.  However, I am grateful that in some places relationships still count and there is learning and development that circumvents the “lets tender everything” approach of some local authorities.

The rhetoric of “lets work together” can be lost somewhere between a tender and a hard place.  Where complex services are concerned, more partnership development and less tendering might work better.

Client risk management – the paradox of control

When you are working with vulnerable people in a service paid for by the Local Authority Supporting People team, you have a directive paymaster who wants to see certain things for their money. Other stakeholders include the organisation you work for and the client themselves.  What the 3 want or need can be quite different.

The paradox I see is this:  when we provide support to vulnerable people, we are expected to control risk, yet by trying to control that risk we often create it or enlarge it.

Clients take risks – its a normal part of being an adult, and you may want to encourage the client to be an independent adult.  A lot of risk taking relates to wanting to feel in control – and may mean breaking rules.  The more they are under control, or feel they have lost control, the more risky behaviour may become.  For example, someone who cuts themself may be doing this to feel in control of their body.  Tell them to stop, and the risk is they will cut more.  Nag them some more, try to control them more, and they’ll withdraw from you, show their control in other ways.  Maybe all you can do is support them to explore alternatives and understand why they are cutting.

Yet the duty of care kicks in – organisations, and Local Authorities, are scared of risk, with good cause.  They would like things to be safe, predictable and controlled.  They don’t want clients to cut themselves.  You don’t either, but how can you show this without exerting the control that may make things worse?  It takes bravery to hand control to the client.

Compound this with the common psychology of those working with vulnerable people, who want to “help” – to rescue people.  This can lead to inappropriate offers of help, which can become either somethering or controlling.

Yet even if you are brave and self aware enough to step back and support the empowered client, you run risks.  Have you judged it right?  At some points you do have to step in and take control, especially if there is a risk of suicide.  Dead is dead – and stopping someone from killing themselves or others if the first of your duties.  With that in the back of your mind, how do you know if the cutting is just the tip of an iceberg you have failed to uncover.  What about all those other risk factors…..

As with most paradox, I think we can only hope to manage as best we can, bearing the weight of expectation from our 3 main stakeholders, taking our own risks.