A person does not have to be just as they seem.
They can be more, in the light of understanding.
Anon.

For people born with a disability, support is concentrated on helping them achieve the essential elements for a meaningful and comfortable life. For those who acquire a disability through an unexpected accident or health regression, the emphasis will be on regaining and protecting the things that have held that life together. As we age, many of us will need support to retain the things that have made life worthwhile and enjoyable.

These guidelines are designed to help supervisors and support workers explore the primary life areas of the people we support to identify vulnerable and missing elements. The people being supported and, with their permission, their families and advocates will all be involved in the process.

The Questions for Exploring Life Areas in Appendix No 1 at the end of this document, while by no means a definitive list, will help reveal the quality of a person’s life.

The needs that arise from this exploration will become the focus for support.

To assist this process a Guide for Prioritising Needs can be found in Appendix No 2 at the end of this document.

 

Once a prioritised list of needs has been identified, supervisors will work with the person, as well as the important people in their life, to find ways to attend to their unmet needs.

 

1. If a need is within the service’s purview and can be attended to, supervisors will:
   • Ensure that support workers understand that need.
   • Plan and implement strategies to have that need met.
   • Ensure that the agreed strategies are understood and adhered to by support workers and all parties involved.
2. If a need is within the service’s purview but difficult to meet, supervisors will consult with fellow supervisors and the manager to find a course of action.
3. If the need is not within the service’s purview, supervisors will consult with fellow supervisors and the manager to confirm who should be helping with that need. The government department, Disability Services, will be notified of all referrals for service coordination.

 

The supervisors will keep working notes in a Life Area Exploration Folder for each of the people they support.

 

From the Life Area Exploration Folder, each supervisor will transfer the results of the exploration into a Life Enrichment Journal that belongs to the person being supported. This journal will provide directions for supporting and enriching the person’s life, summarise progress and hold critical information such as:

• Essential personal information.
• Personal care plans.
• A health care diary.
• Seizure management plans.
• A behaviour interpretation dictionary.
• Meal plans.
• An inventory of personal possessions.
• The use of restriction and restraint.
• Money management arrangements.
• Communication methods.

The Life Enrichment Journal is kept in the person’s home, preferably in their room. New support workers must read and sign off on the information in a person’s journal before working with them. Time to read journals will be provided during orientation shifts.

 

Evidence of life enrichment will be reflected in the decoration of the person’s home and room and recorded or kept in their:

 

• Photo albums.
• Video tapes.
• Treasured items box.
• Personal diary.
• Travel diary.

Old records and items will be carefully archived for each person.

For people who are independently responsible for their own lives, the life building process will be determined by:

• The details of the support contract they have agreed to with the source of their support funds. Support may be confined to very specific needs only.
• Negotiation and written consent on the level of involvement they wish from NWRSS. This will include a Life Area Exploration Folder and Life Enrichment Journal if they wish.

If irreconcilable differences of opinion about needs and ways to meet them arise between the important people in the person’s life, mediation will be sought through Disability Services’ service coordination process. Mediation will be guided by law, legislation and professional opinion.

 

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Appendix No 1

QUESTIONS FOR EXPLORING LIFE AREAS

Introduction

• What is the best time and way to introduce this person to support workers and others?
• What are the stories that will best introduce this person, in a positive way, to support workers and others?
• What is the best way to help foster a meaningful relationship between this person’s support workers and others?
• Should there be a written introductory profile for this person? If so, what form should it take?

Past

• What were the first impressions of this person?
• What basic factual information is available about this person?
• What are the stories that make up this person’s life?
• What was this person’s life like at the time of referral?
• Is there anything from this person’s past that needs to be considered or attended to?

Health

• Has this person got their own Medicare card?
• Has this person got the most suitable GP of their choice?
• How is this person’s general health?
• Has this person got any special health problems/considerations?
• How is this person’s dental hygiene?
• How is this person’s mental health?
• Is this person’s medication being regularly reviewed?
• Are there any side effects from any medication that should be investigated or considered?
• How is this person’s spiritual health?
• Does this person understand their sexuality and sexual responsibilities?
• Is this person grieving for/missing someone they have lost or whose presence in their life has diminished?
• How does this person manage their general living problems including medication?
• What privacy compromises are there in this person’s personal care and why?
• Has this person got any characteristics for which they might be rejected by others?
• Has anybody hurt this person physically, verbally, emotionally or sexually? Is this ongoing?
• Are there any difficulties between this person and others?
• Should this person be considering any form of cover with a Health Benefit Fund?
• What support arrangements are required if this person is hospitalised?
• What safety requirements need to be considered for this person?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to health?

Communication

• How does this person generally communicate?
• Should this person have a behaviour dictionary to help people interpret and respond to their behaviour?
• Are there other people in this person’s life who should contribute to their communication systems?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to communication?

Accommodation

• Where has this person lived in the past?
• Where is this person living now?
• What factors determine how and where this person lives?
• Who is this person living with and why?
• Does this person have adequate privacy where they live?
• How much does this person’s accommodation cost?
• What domestic responsibilities does this person have where they live?
• Where and how would this person like to live?
• What are the most uncomfortable aspects of this person’s current living situation?
• What are the accommodation options for this person?
• Does this person’s house have a warm, homely feel about it? Does it reflect their personality, particularly with regard to their room?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to accommodation?

Financial

• What is this person’s income source?
• How are this person’s financial affairs managed?
• What are the signatory arrangements to this person’s bank accounts?
• What are the details of this person’s current budget?
• Does this person have their own cash to spend?
• Is this person developing a credit rating?
• When was this person’s last pay rise/review?
• What possessions has this person gathered?
• What possessions does this person wish/need to gather?
• What impact does this person’s economic situation have on their life?
• How does this person’s disability impact on their financial situation?
• Does this person contribute to a maintenance fund if they live in a shared home?
• Does this person have an inventory of their personal possessions?
• Would this person like to make a will?
• Does this person need investment advice/assistance?
• Is this person’s financial status with Centrelink correct?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to finances.

Mobility

• How does this person get around?
• Has this person got a driver’s license?
• Could this person get a driver’s license?
• Can this person use public transport and/or taxis?
• Is this person eligible for the Mobility Allowance?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to mobility?

Relationships

• What is/was this person’s relationship with their natural family?
• Who are this person’s family and where are they now?
• Who are this person’s friends at home/work?
• Who are this person’s friends outside home/work?
• What relationships does this person have with people who don’t have identifiable disabilities?
• What is the depth and duration of this person’s friendships?
• How many friends of the opposite sex does this person have?
• Has this person ever had a pet? Would they like to have a pet?
• How does this person make friends?
• What sorts of things does this person do with their friends?
• How is this person viewed by their friends?
• Is this person happy with the number and type of friends they have?
• What personal/seasonal dates does this person want/need to remember and acknowledge?
• Does this person need/have an advocate?
• Is there anyone this person would like to help/represent them with personal matters?
• Who would this person like to live with?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to relationships?

Roles

• What negative, devaluing roles has this person gathered and why?
• What should be done to counteract these negative, devaluing roles?
• What positive, valued roles has this person gathered and why?
• What positive, valued roles could be gathered and developed for this person?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to roles?

Responsibility

• What types of decisions/choices does this person make?
• What values does this person seem to relate to in making decisions?
• Does this person need help in being assertive?
• Does this person need help in exercising their rights against the contrary opinions of family members?
• Would this person like to represent fellow clients on the service’s board of management?
• Is there someone this person would like to represent them on the service’s board of management?
• Is this person well represented on the service’s board of management?
• Is this person a registered voter [National, State, Local]?
• Has this person made a will?
• Are there any changes or proposed changes to service operation/procedure/policy/development that this person should be informed about?
• Is there anything this person would like to discuss with support workers, supervisors, manager or board of management?
• Does this person know how to raise grievances/complaints?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to responsibility?

Reputation

• How do the members of the general public see this person?
• How does this person’s family see them?
• How do support workers see this person?
• How do fellow residents and others see this person?
• Is this person vulnerable to any negative stereotypes?
• If this person is described in negative terms what are the origins and exact meanings of these terms?
• Do we need a more intensive/in-depth analysis of this person’s behaviour?
• Is there a mismatch between this person and any support workers?
• What support worker personality and temperament factors should be considered when choosing support workers for this person?
• What are the most significant/important roles that this person has?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to roles?

Gifts & Talents

• What are this person’s most endearing ‘heart’ qualities?
• What are this person’s most endearing ‘other’ qualities?
• How would you describe this person’s personality?
• How would you describe this person’s sense of humour?
• What are the words/statements you could use to describe this person to help them attract interest and friendship?
• What is this person teaching/showing us?
• What contribution does this person make to other people’s lives?
• What are this person’s greatest competencies?
• Which of this person’s skills and attributes are needed and wanted by others?
• How can we best further develop/display this person’s gifts and talents?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to gifts and talents?

Education

• Where was this person educated?
• What level did this person achieve?
• What did this person’s educators think about their potential future?
• How does this person feel about their past educational opportunities and experiences?
• What has this person’s actual educational and general experiences prepared them for?
• Has this person missed any important common life experiences?
• Does this person want to recommence or continue their education?
• Is there anything this person wants/needs to learn?
• Are there any special requirements to help this person learn?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to education?

Leisure

• What does this person do in the evenings?
• What does this person do on weekends/public holidays/rostered days off?
• What does this person do during annual holidays?
• What are this person’s interests and hobbies?
• What are this person’s most enjoyable leisure time activities at the moment?
• How is this person involved in the culture of their community and country?
• What sporting activities is this person involved in?
• Does this person have any dislikes or fears that should be known with regard to leisure pursuits?
• What would this person like to be doing in leisure time?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to leisure?

Lifestyle

• Does this person want to work?
• If this person wants to work, what type of work do they want to do?
• What sorts of work has this person done?
• Who should this person see with regard to their vocational aspirations?
• If this person does not want to work what are the reasons?
• If this person does not want to work what would they like their non-working life style to be like?
• Who should help this person develop a non-working life style?
• If this person is not working, what are their daily routines and activities?
• If this person spends some day time at home, detail the purpose and nature of this home time.
• If this person spends some time in a program providing or managing daily activities what does this program consist of in detail?
• What support should be provided and what skills should we help this person learn/develop/reinforce in regard to lifestyle?

Future

• What are this person’s dreams and aspirations?
• What does this person want their life to be like in 2 years, 5 years, 10 years etc?
• If this person cannot articulate their future aspirations, what would be an optimal future for them?
• Which are the life situations that pose the greatest challenges/risk to this person’s future?

Milestones

• From information gathered plot and list the chronological milestones in this person’s life.
• What important milestones has this person missed?
• How would you best describe this person’s life in a sentence?
• What are the worst ‘wounds’ this person has suffered?
• What life experiences have followed from this ‘wounding’?

Conclusion

• Are there any special experiences arising from working with this person?
• Are there any special acknowledgments that should be made amongst those working with this person?
• Is there anything we are losing sight of in this process with this person?
• Is this process representing this person accurately and well?
• Who are the people who confirmed the information in this process?
• Is this person happy with the services they receive?

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Appendix No 2

GUIDE FOR PRIORITISING NEEDS

Many of these areas are, of course, closely entwined and often need simultaneous attention.

1. Bodily well-being:Personal development and repair to one’s life is very difficult if we are feeling unwell and worried about our health. We need to feel well most of the time and if not, at least, understand why.
2. Sense of safety and security: A true sense of safety and security begins with a place to live where there are no threats to tenure, life or possessions. The minimal requirement is a comfortable home without threat of loss.
3. Belongingness: A genuine sense of belongingness starts with family and then extends to friends, workplace relationships and other group associations. We all need at least one authentic friend.
4. Esteem: To gain self-esteem we need to know that other people value us for something. We need to be either respected, well-regarded or have a good reputation for something that matters to others. We all need at least one person who is interested in listening to us.
5. Aesthetic and cognitive: We all need opportunities to develop, to share our knowledge and use our skills to engage with our community. At the very least we need to be able to give something back to others.
6. Self actualisation: We all strive to know who we are and to have a place in the world and be at peace with it. We, at least, need to be at peace enough to co-exist with others.

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