Autonomy, Hope, Recovery, Resilience

Some of the ways you can help your tangata include:

• supporting their autonomy
• fostering their hope in recovery
• supporting them in their recovery
• helping them build resilience

Supporting autonomy

Autonomy means being independent and not relying on others. Depending on their circumstances, people may need differing degrees of support throughout their lives. The three degrees of support that everyone will experience at some time in their life are:

1. Dependence – a person relies on others for support for day-to-day tasks.
2. Interdependence – a person looks to another person for mutual support, usually from whānau or friends.
3. Independence – a person doesn’t need any support for day-to-day tasks.

Several key factors lead to independence, such as:

• supportive social networks
• choices
• stable health
• security and income
• good fitness levels
• informal supports
• timely packages of care
• community involvement
• goals
• preventative health measures in place
• responsiveness to changes in condition
• assessment and early intervention/treatment of conditions

Fostering hope

Foster means to nurture or look after. Hope is the belief that challenges and conditions can be overcome in the future. Therefore, fostering hope is to support hope in recovery. In recovery from addiction, hope is often the force that motivates people enough to start making concrete changes. Mental illnesses such as depression may lead to feelings of hopelessness. However, having hope that the illness can be treated can be an important part of recovery.

Supporting recovery

Recovery is different for every person and refers to living a satisfying, hopeful and meaningful life as each person defines that for themselves. Regardless of whether you are supporting someone with mental illness or addiction issues, recovery will be a sometimes challenging process. You can support the tangata’s journey of recovery through physical and emotional support.

Building resilience

Resilience is the ability to bounce back from adversity. Building resilience requires taking care of yourself both physically and emotionally. To help your tangata build resilience, you can support them to build connections with friends and whānau and look after their physical health, e.g. with a good diet and exercise.

Advocacy

You may need to advocate for the tangata you are supporting. Advocacy is putting forward views or requests on behalf of another person to reach a desired outcome.

An issue requiring advocacy could be cultural, economic, social, legal, or related to support or care issues. It may involve whānau, communities affected by the issue, or other agencies or organisations providing support.

You may use a series of strategies to facilitate hope, independence, resilience and recovery. These may include the following:

• Avoiding judgement and discrimination.
• Using personal plans.
• Using communication skills.
• Using mentoring and facilitation.

It is crucial for support workers to maintain a non-judgmental approach. The tangata you are helping will have experiences and values that are different to your own. Rather than judging them for these differences, you should seek to understand and accept them. As you learn about your client and their needs, you may learn about ideas or beliefs which you are unfamiliar with. Embrace this new knowledge and use it in your care role.

The Human Rights Act 1993 is designed to protect New Zealanders from unlawful discrimination. The Code of Rights also protects the right to freedom from discrimination. It is unlawful to discriminate based on the following grounds: 

• age
• race/colour/national origins
• sex 
• sexual orientation
• disability
• religious beliefs
• employment status
• political opinion
• marital/family status

It is important to ensure that you do not change your level of care based purely on these grounds. Similarly, do not make assumptions about people based on these grounds. Talk to the tangata and their whānau to understand their individual needs.

If you see discrimination occurring in the workplace, report it to your supervisor 

What is a personal plan?

All people receiving support in a health and wellbeing setting will have a personal plan (sometimes referred to as a personal wellbeing or personal care plan). This plan will have been developed in consultation with the person and their whānau.

Personal plans outline how an organisation will support the person’s:

• treatment, rehabilitation, medications
• needs and goals
• activities of daily life
• independence
• quality of life and wellbeing

The personal plan will outline the tasks and activities with which the person needs support. Support may be:

• physical
• social
• emotional
• health-related

The plan will include details of the planned interventions and care and support practices. Creating and implementing a personal plan will likely involve an interdisciplinary team. The skills and knowledge of each team member will combine to provide coordinated and holistic support for a person.

As a member of that team and as someone who may frequently work with the tangata being supported, it is important that you understand the processes of developing personal plans and goals and the part you play in implementing the plan.

Developing a personal plan

Organisations have differing policies and procedures around developing personal plans. What follows is a generalised example.

Seeking help from a support organisation

The tangata may present themselves to a health or support organisation or be referred to one. Referrals can come from a number of sources, including a GP or hospital, whānau, or another agency already providing support.

Assessment

The assessment may be undertaken by a healthcare professional, an assessment unit within a healthcare provider or a Needs Assessment Service Coordination organisation (NASC). The assessor will determine the appropriate support and identify organisations that can provide that support.

Support provider plan development

Once the person has been referred to a support provider, that provider will perform its own assessment. This will identify the needs to be met and the best ways to provide that support. The personal plan is created based on this analysis.

Implementation

Implementation refers to putting the personal plan into action. It involves executing the strategies, interventions, and services outlined in the plan to address the person's identified needs. This phase requires collaboration among healthcare professionals, caregivers, and the care recipient to ensure the plan's components are properly executed. Implementation may involve:

• Providing medical treatments, therapies, and medications as prescribed.
• Assisting with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
• Facilitating social interactions, engagement in hobbies, and community activities.
• Monitoring and recording progress, changes, or challenges.
• Adapting the care environment for safety and accessibility.
• Communicating and coordinating with all relevant parties to ensure seamless execution.

Review

Regular reviews are essential to assess the effectiveness of the implemented strategies and interventions. Reviews involve evaluating whether the personal plan's goals are being achieved and if any adjustments or modifications are necessary. The review process may include:

• Periodic assessments of the person's physical, emotional, cognitive, and social wellbeing.
• Gathering input from the tangata, whānau, and involved professionals.
• Analysing any changes in the person's condition, preferences, or circumstances.
• Identifying areas of success and areas requiring improvement.
• Considering feedback and insights from caregivers and healthcare providers.

Update

Updating the personal plan involves making necessary changes based on the review's findings. Plans should be flexible and adaptable to accommodate the person's changing needs. Updates may include:

• Modifying interventions or services to better align with the person's evolving requirements.
• Setting new goals or adjusting existing ones.
• Incorporating new medical information, treatments, or medications.
• Altering the care environment to address safety concerns or changing mobility needs.
• Revising the plan to reflect the person's preferences and choices.

Incorporating these stages ensures that care remains responsive, customised, and effective over time. Regularly implementing, reviewing, and updating personal plans improves the person's quality of life and demonstrates a commitment to providing compassionate and comprehensive care that evolves along with their needs.

Effective communication is key to building positive, supportive relationships with tangata and their whānau.

Communication occurs in physical space, cultural and social values and psychological conditions. Communication happens with and without words.

• the words you're trying to convey only accounts for less than 10%
• the tone of voice or how you say what you say accounts for nearly 40%
• and body language plays the most important role. This accounts for over half of the overall experience, 55% or more.

Communication processes

Every time some form of communication occurs, there is a specific process that takes place. We can break this process down into its different parts so that we can see exactly what is happening and identify any problems that can occur. By doing this we can try to eliminate these problems and become better communicators.

The message is encoded, with the code being the language used by the sender. This may refer to the actual language the person is speaking, or it can refer to spoken and written language (verbal) or body-language, facial expression and signals (non-verbal). It can also mean tone of voice.

The recipient then needs to decode the message so they can understand what is being communicated to them. They need to hear the message and then convert it into meaning. Sometimes errors can occur in the process, meaning the correct message is not transmitted.

Warning signs 

These are some warning signs you may notice when a person you are communicating with does not understand you.

• Leaned forward to hear you 
• Asked you to repeat something you had just said 
• Repeated a word (of yours) incorrectly 
• Reacted (especially visibly) to inappropriate slang you used

Your role as a health and wellbeing support worker is to support tangata/clients to achieve autonomy (independence) and self-determination (be in control of their own decisions/life) and foster hope. To do this you will need effective communication skills.

Improve your basic communication skills

Start with the basics of speaking and listening. When speaking:

• Adopt a friendly tone of voice.
• Ensure you speak at a speed and volume that is suited to the tangata.
• Ensure the language you use is clear and professional, but not filled with medical jargon. Remember shorter sentences are easier to process and understand. Simpler words are also easier to understand.
  • This is particularly important if the tangata and their whānau do not have English as their first language.
  • If you cannot explain something in simple terms, you have probably not understood it yourself.
• Learn to seek feedback or clarification to ensure your message has been understood.

Listening is not the same as hearing. It is important to take the time to listen carefully to what people are saying, considering both their verbal and non-verbal communication.

• Using questioning and reflection when communicating demonstrates that you are both listening and interested in what is being said.
• By using questions effectively, you can both check others’ understanding, and also learn more from them.

Non-verbal communication

Non-verbal signals reinforce or contradict the message of our words and are much harder to fake than words. They are therefore a much more reliable signal. Learning to read body language is a vital part of effective communication.

All of these elements can be used on their own or together to create a package of communication that helps the other person to truly understand the message.

Non-verbal communication is only useful when there is a shared understanding of what a gesture or movement means. Sometimes people from different cultural backgrounds have differing expectations of non-verbal communication. They might use gestures more often when they speak, avoid eye contact with groups of people or use facial expressions in particular ways to emphasise a point or express an emotion.

Communication techniques

The techniques described in the presentation below can be useful when communicating with tangata and their whānau.

Use the arrow buttons to move through the presentation and complete the activities on the last two slides.

Giving effective instructions

Having the ability to provide clear and comprehensive instructions is a crucial skill. You may be required to provide instructions both to your client and to members of the interdisciplinary team. You need to ensure that the instructions you provide deliver the information required clearly while providing the level of detail appropriate to the situation. Too much information can be as confusing as too little. Try to include only the important details.

To give instructions effectively, try these useful factors:

Mentoring as a mental health and addiction support worker

Mentoring means imparting your skills and knowledge to another person. A mentor guides, motivates, encourages, informs, and gives feedback to the person they are supporting. They do this by:

• demonstrating the best way to perform tasks
• providing information and sharing their knowledge
• supporting community connections
• investigating the tangata‘s goals and ensuring they support their autonomy
• exploring and valuing the person’s life story
• asking questions and taking the time to listen to the answers
• providing opportunities for self-determination, allowing participants to make decisions about their own care
• listening to a tangata’s views about the services they want and need

A good mentor:

• is trustworthy
• acts professionally and responsibly
• encourages the client in all their endeavours
• displays a positive attitude
• sees the big picture and the other person’s point of view
• respects the dignity of each person
• is interested in helping the tangata to achieve their goals
• celebrates every success

Mentoring and goals

When mentoring, a support worker should always be mindful of the client’s goals. Mentoring is a way of demonstrating ways of achieving those goals. This may include breaking down a complex task or a long-term goal into small, achievable steps. The mastery of each step should be a cause for celebration. The mentor needs to be a cheerleader, motivating the tangata to try the activities being demonstrated.

You may need to encourage the tangata to attempt things they find difficult or are reluctant to try. Be patient and encourage them to try. However, it is important to be flexible and recognise when a new strategy is needed. Keep talking to your client and review their plans and goals. As goals change, your approach to mentoring will also change.

The mentoring provided must be in accordance with the tangata’s personal plan and within the boundaries of the support worker’s role.

Facilitation as a mental health and addiction support worker

Facilitation involves helping a person and making it possible for them to achieve their goals. The tangata’s personal plan will outline the tasks and activities that they need help with. Facilitation may be:

• physical
• social
• emotional
• health-related

As with mentoring, facilitation is very goal-oriented. A facilitator needs to identify a goal and determine what help the tangata needs to allow them to achieve that goal. As a facilitator, you will need to follow the tangata’s care plan and take note of progress towards goals. Person-centred feedback should be provided on how the tangata is progressing.

A facilitator can suggest ways to achieve goals, but self-determination is fostered by encouraging the tangata to make decisions about which tasks they want to attempt. Once tasks have been identified, the support worker will facilitate the client to perform that task. The support worker needs to provide encouragement and keep the tangata focused and on track. The idea is not to perform tasks for the tangata. Rather, it is to help them perform the tasks, improving their autonomy and fostering hope for further achievements.

A facilitator will help people identify any barriers to goal achievement and assist them with working out how to overcome them. In some cases, this may mean a re-evaluation of goals or the timeframe to achieve the goals.

A facilitator may have to liaise with the tangata’s whānau and other members of the team who are supporting the tangata. This will ensure that the entire support network can help with the facilitation as appropriate. A good facilitator:

• actively listens to their client, repeating what has been said to demonstrate understanding
• works as a member of a team, sharing all important information
• notes and celebrates all progress
• is people-focused, positive, and encouraging