Who defines a positive outcome The development of a client directed service

1
Who defines a positive outcome?The development
of a client directed service

• Karen Phipps
• Mobility Solutions
• ADHB
• 2005

2
New Zealand Disability Strategy

• Aim
• to change New Zealand from a disabling, to a
  fully inclusive society
• 15 key objectives
• Empowerment
• Leadership
• Education
• Protecting the rights of Disabled Maori, Pacific
  Islanders, Women and Children

3
What is a Client Directed Service?
4
(No Transcript)
5
CLIENT FOCUSSED
CLIENT DIRECTED
6
What is it?

• a mechanism by which individuals with
  disabilities can develop the skills to take
  control of their lives and their environment.
  (Kosciulek 1999)
• Consumer direction enables the consumer to voice
  what they want to do, where they want to do it
  and what they need to allow them to do it. (Mills
  et all 2002)
• a way to empower consumers, affording them more
  choice and an increased role in making the
  decisions that directly effect them. (Stone 2000)

7
Principles

• Clients determine
• their own role in the process
• the role of the therapist in the process

8
Clients need to be

• aware of their options
• supported to make informed choices
• aware of the implications of the choices they
  make
• encouraged and supported to take responsibility
  for their choices
• safe to question and negotiate changes in the
  process

9
Therapist Competency

• Clinical assessment and reasoning
• Risk assessment
• Needs identification
• Criteria matching
• Option/Solution generation
• Negotiation and bargaining

10
Listening Skills

• ESSENTIAL

11
Client Comments

• Client needs to be heard
• The professional will listen and understand.
• The therapist would understand you.

12
Client Comments

• I know my body better than anybody else.
• I have the skills and ability to recognise my
  own needs.
• The client knows what suits them.
• I can define my own needs.
• I can advise the professional
• the therapist would understand you and the
  equipment obtained would address your needs.

13
Consumer Direction

• Consumer direction should be based on the
  presumption that consumers with disabilities are
  the experts on their service needs.
• Kosciulek (1999)

14
What client direction isnt!

• Clients getting exactly what they want
• Clients determining their own priority
• Clients having to lead the process

15
Measuring Success

• Increased consumer satisfaction
• Improved quality of services
• Decreased operational costs/resources

16
Value of a Client Directed service?

• From therapists perspective
• interactive process, not one sided, allows for
  better relationship.
• satisfaction from the client, good for us.
• encourages creativity

17
Staff Comments

• A positive outcome of working in a Client
  Directed manner was it enabled consumers to get
  what they wanted
• Clinicians described a positive outcome as one in
  which the client was happy
• Consumers define quality differently from
  professional and other stakeholders (Stone 200)

18
Perceptions

• much of the opposition to consumer direction
  emerges from concerns about lack of
  accountability and the inability to adequately
  protect long-term-care consumers from physical
  and emotional harm.
• consumer direction poses challenges to
  traditional assumptions held by many
  practitioners who consider that professional
  intervention is not only appropriate, but
  required, based on the client's disability, age,
  or functional status.
• Stone (2000)

19
Client Satisfaction Survey Results

• 90 felt they, and their carers were involved in
  the decision making process
• 85 felt their contribution was valued and
  respected
• 80 felt their needs were fully explored
• 90 were satisfied with the overall service
• 65 felt they were able to influence the process

20
Disadvantages

• The face to face assessment under client
  directed took longer, as the therapist and others
  were always coming back and checking with me if
  it was alright to do this or that.
• the flexibility allowed by the client based
  service is offset by the delay in intervention.
• great potential for this relationship to wrong
  if either the client or the therapist were not
  fulfilling their roles.

21
Other Issues

• no opportunities given for the service
  consumers to understand the immense changes that
  have and are taking place
• there are people who have had their lives
  managed by service providers, and all of a sudden
  come across this term and have no real idea of
  what it means and more importantly no idea of how
  to put it into practice.
• A number of people have no idea of what client
  directed services are because for the whole of
  their lives the service providers have just taken
  over.

22
Impact on Service Delivery

• Length of stay is decreasing
• Direct client contact has increased
• The need for follow is decreasing
• However, the overall process remains lengthy

23
Client Comments

• I found the initial experience of using a
  client directed service very stressful and
  frightening. I was faced with a totally new
  experience that I was unprepared for and found
  quite overwhelming.
• The advantages eventually outweighed my
  trepidation..

24
In Summation

• Client direction is about partnership and
  participation
• Therapist clinical knowledge is considered
  valuable
• It can have a positive impact on service delivery
  and consumer satisfaction

25
Final Client Comments

• the role of the therapist in this relationship
  is to provide expertise and guidance.
• (you) need knowledgeable and experienced staff,
  (to deliver a client directed service).
• We are the experts in what disables us and we do
  need to be heard at all levels of decision making
  when it concerns our health and welfare.
• Increased client input is a big responsibility.

26
Final Thoughts
the key to non-disabled decision-makers truly
understanding disability issues and culture is
more than organisations fostering partnership
it is through individuals making a personal
commitment to developing mutual trust, sharing
power and facing fear. (Annual Pacific Rim
Conference on Disabilities, March 2002)
27
References

• AccessAble. Specialise assessors equipment
  manual For the Auckland, Hamilton, Wellington
  and Southern localities of the health Funding
  Authority.
• Annual Pacific Rim Conference on Disabilities.
  (2002) Beyond Partnership A story of individual
  Journeys. Honolulu
• Beatty, Richmond, Tepper, DeJong. (1998) Personal
  Assistance for People with Physical Disabilities
  Consumer-Direction and Satisfaction with
  Services. Arch Phys Med Rehabil 79(6)674-677.
• Disability Issues Directorate. (2001)
  Implementation of the New Zealand Disability
  Strategy Auckland Region Draft plan for comment.
  Auckland Ministry of Health.
• Disability Resource Centre. (2004). Review of
  Wheelchair and Seating Services Auckland and
  Northland conducted December 2003 March 2004.
  Auckland Ministry of Health
• Kosciulek. (1999) Consumer Direction in
  Disability Policy Formulation and Rehabilitation
  Service Delivery. Journal of Rehabilitation
  65(2)4-9.
• Marrone (1994) If Everybody Is Doing It, How Come
  It Doesnt Get Done? Psychosocial Rehabilitation
  Journal Vol18(1)
• Mills, Holm, Trefler, Schmeler, Fitzgerald,
  Boninger (2002) Development and consumer
  validation of the Functional Evaluation in a
  Wheelchair (FEW) instrument. Disabil Rehabil
  24(1/3)38-46.
• Ministry of Health. (2001) The New Zealand
  Disability Strategy Making a world of difference
  Whakanui Oranga. Wellington Ministry of
  Health.
• Stone (2000) Consumer Direction in
  Long-Term-Care. Generations 24(3)5-9.
• Whitcombe-Shingler (2004) A qualitative Research
  Paper Wheels within Wheels. Auckland