Support Autonomy

Autonomy and self-determination are both essential concepts in the health and wellbeing sector.

Tools to develop autonomy and self-determination

Generally speaking, developing autonomy and self-determination requires intentional effort and practice to achieve.

Using certain tools available can help individuals take ownership of their lives and achieve greater independence and fulfilment in themselves.

What is a personal plan?

One tool used to achieve autonomy and self-determination is the 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
• daily activities 
• 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 work frequently with the tangata being supported, it is important that you understand the processes of developing personal plans 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 the following:

• 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 the following:

• 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 the following:

• 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.

What are learning plans?

A learning plan is another tool to support autonomy and self-determination. Learning or relearning skills can be a powerful tool to encourage client autonomy. Your client may need to learn a new method, such as a different way of getting up from a chair. Or they may need to learn to use a new piece of equipment, such as a walking aid.

As people learn one thing, it can build into another. For example, people might learn how to use a new motorised scooter which enables them to go into town to do their own shopping with confidence, make their own appointments, and visit friends. By learning to use a scooter, people have gained more control over their lives and become more independent.

A learning plan is written:

• To provide a set of individual steps towards a goal or outcome.
• To help a person know what parts of a task they can undertake themselves.
• To help support workers understand their role in aspects of the task.
• For the person and support worker to know the milestones towards achieving a goal.
• To promote self-determination by writing the learning plan in conjunction with the client.

Note that a learning plan should be created and used in accordance with the personal plan.

Learning plan inputs

Multidisciplinary teams will contribute to these plans:

• An occupational therapist (OT) may design the activities the person needs to achieve their goals and maximise skills and abilities. An OT also provides adaptive equipment.
• A physiotherapist may design a functional exercise programme for the person.
• A nurse may identify the physical, social, and emotional care needs.
• The tangata’s whānau may advocate the wishes of the person. The whānau may also have skills and qualities they can offer to the person.

You will be working within the plan to achieve the outcomes identified as important by the multidisciplinary team.

Types of learning support

The support you provide could include:

• functional exercise support
• practical support
• task breakdown
• helping a person to learn or relearn a skill

Functional exercise programmes

The physiotherapist and multidisciplinary team develop the exercise programme. The programme may include increasing steps taken or walking to the letterbox. Your role is to assist people to complete their exercises and incorporate them into their activities of daily living.

Practical support

Practical support is the support you give people to learn or re-learn a task or skill. These tasks or skills could include using the vacuum cleaner, washing machine, or performing personal care tasks.

Task breakdown

When a person is trying to learn or relearn a complex task, it can be helpful to break it down into smaller subtasks. Completing each subtask may give a sense of achievement. Your role will be to identify the subtasks and help the tangata to complete as many as they can, with the objective of eventually achieving the whole task.

Learning or relearning skills and tasks

Assisting people to learn or relearn skills can be an exciting and rewarding aspect of your work, especially when people gain the confidence and skills they need to function independently. You may support people to:

• learn something new
• relearn a task that they were previously able to do independently
• modify a task so that they are able to do all or some of the task independently
• maintain function through using adaptive devices. This may mean learning, relearning, or modifying a skill if the device is to be used effectively

Developing a learning plan

1. Identify client wishes – what do they want to learn?
2. Select training strategy – what would be the best way to teach and learn?
3. Identify resources – what is needed in order for the learning to occur?
4. Prepare for learning – ensure all resources are on hand and the client is ready to learn.
5. Implement the plan – perform the learning.
6. Monitor and record progress - it is important to measure what progress has been made so you can determine whether the learning is effective.
7. Make changes – if the learning does not have the desired outcomes, or the client is not enjoying it, or finding it too hard, the learning plan will need to be updated.

Mentoring as a community 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 community 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