Working with Strengths

At a strategic level we are continually expanding the language, but essentially using new words and phrases to say the same thing... recovery, personalisation, self-directed support, person-centred planning, re-ablement/re-enablement. Nobody can seriously disagree with the premise that service users should be given a voice in order to say what they need and want, to reflect on how best to meet their wishes and aspirations, to exercise choice and feel supported in their decision-making. However, there is often a gap between what we are saying we are doing as services, and what service users are experiencing on the receiving end.

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A review of the Assertive Outreach Strengths Approach textbook

February 2004 saw the publication of a textbook written by myself and Peter Ryan, with a foreword by Professor Charlie Rapp. It is primarily aimed at developing assertive outreach, but its focus on a strengths approach is applicable to all parts of the mental health system.

Why not check it out at Amazon (or read an excellent user review from Amazon below) and Elsevier Health or click on the image for more information.

4.0 out of 5 stars 'A funky approach to mental health care' by "beauchampbooks"

"In 2000, two Swedish business gurus wrote a book called Funky Business. The concept was that the corporate world had become a more interesting place in which people could be creative, risk-taking entrepreneurs. Assertive Outreach (subtitled A strengths approach to policy and practice) could be the Funky Business of mental health care; it could almost have been called Funky Mental Health Care! This is not to suggest that it lacks seriousness or depth. The design of the book does suggest a... funkier approach, but the book is a sincere and important contribution to changing policy and practice."

"Paradoxically, in some ways, it is not particularly about assertive outreach. It is really about a strengths approach which could (and arguably should) influence mental health care generally. The Strengths Model of Case Management (developed in the USA by Charles Rapp since the early 1980s) is the organising principle of the book and, indeed, Rapp contributes a foreword which describes it as "a clarion call for policy and practice to be intelligent and coherent, and anchored by the well-being of the people we serve."

"Assertive Outreach is a breath of fresh air for nurses bogged down in the mire of risk-averse, box-ticking, mechanistic organisations. It provides a perfectly clear and comprehensive account of the history, the evidence base and the present day practice of what, in the UK, is called assertive outreach and what the differences are between this and the related concept of case management. It was a delight to see a whole chapter devoted to risk-taking (instead of risk management). Throughout, the reductionism of care coordination is put in its place with the emphasis being on creative collaboration, with excellent sections on true team-working and an argument for, not just evidence-based practice, but practice-based evidence - all necessarily funky."



Developing a Strengths Approach in Practice

Through continuing work with Granta Housing Society a number of questions have arisen, such as how did the approach emerge and is it based in contemporary UK policies? The Strengths Overview gives a potted, but not exhaustive response to this question. As a set of positive principles, and as a way of thinking and working, the Strengths Approach pre-dates the concepts of recovery and personalisation... Strengths Approach and Recovery contrasts the development of the two concepts. What messages can be taken from applying the Strengths Approach to specific conditions? The lessons learned document outlines a few important insights from work with mental health, personality disorder and substance misuse conditions.

Strengths Leadership Programme

Developing your key staff

The managers of the teams who directly deliver services to service users and carers in health and social care organisations are in a pivotal role for influencing the success of an organisation. They are the people who manage the demands of the teams they are charged to lead, and the expectations of the organisation’s management structure. The quality of support and development offered to these people is critical to their morale and motivation in the job.

The Practice Based Evidence consultancy for mental health services has developed a programme based in a ‘Strengths Approach’ and the extensive strengths business research of the Gallup organisation, specifically focused on this group of key staff.

In discussion with the programme’s author, Hugh Griffiths (Deputy National Clinical Director for Mental Health, Department of Health) expressed the view that “it is very important to focus attention on developing the needs of the clinical team leaders and managers.”

This programme is now recognised through its inclusion on the CSIP ‘New Ways of Working’ website as a resource for organisation’s to consider as an option for the development of Team Managers/Leaders.

In an initial trial of the programme structure and content the following comments were made:

“This is a very practical programme that gives tools to help me understand and lead the team. It applies to the real situation I work in, and ties in closely to how I feel and what I need.” Sue Jugon (Assertive Outreach Team Manager).

“This is so different from any other management courses or approaches I have experienced. It is focused very much on personal reflection from a very positive perspective.” Geoffrey Smith (CMHT Manager).

“This programme meets the needs of team managers, and is full of very challenging exercises.” Kirt Hunte (CRHT Manager).

The following linked pages outline the structure, content, delivery and intended outcomes of the programme. Contact Steve Morgan if you wish to consider commissioning such a programme of development in your organisation.

Team Managers/Leaders Programme.

Responses to Questions.

Relevant C.V. for facilitating the programme

• Working with a ‘strengths approach’ since 1991
• Writing textbooks, articles and materials incorporating strengths working since 1993
• Training in strengths since 1995
• Strengths practice within team development since 2001
• Mentoring from a strengths perspective since 2001
• Conference presentations on aspects of strengths working since 2003
• Personal development through textbooks and online resources since 2003

Strengths Assessment Tools & Guidelines

Click below to download this form as a PDF.

PDF: Strengths Assessment tool: for developing working priorities and care/support planning

To read the report above you will need free software called Adobe Reader. This software can be downloaded here.

Guidelines for developing strengths working

Click here to download these guidelines as a PDF document.

Purpose

To provide guidance for encouraging the identification of strengths as an essential part of all assessments in practice across the local services. Reflecting the need for a flexible approach that is individually tailored to service users needs on a case-by-case basis. It is intended to be a 'method of working' that supports client-led practice, not a service driven need for auditing standards. A strengths assessment tool may help the process, but is not considered essential for ensuring a unique picture of the person is being developed through a unique process. Strengths working forms a radically different basis with which to resolve problems and work with risk.

Who is it for?

• Everyone who comes into contact with all services should have a balanced assessment that includes recognition of their 'strengths and abilities', not just a summary of 'problems'.
• All service users should have an assessment of their strengths at least in a process of completion, documented in whatever way is most appropriate to ensuring they strongly influence the on-going work of the team.
• Wants, aims, and aspirations are important anchors to drive plans forward, to clarify what resources are needed from whom in order to achieve them, and to identify what barriers or difficulties may need to be overcome.

When is it used?

• From the first point of referral, direct contact and thinking about a person determined to be in need of the local services.
• It is not a specialist assessment only to be drawn on in special cases.

How is it used?

• There is no single way of doing it, or documenting it; but the outcome should be a positive inventory of achievements, resources and aspirations individualised to the experience of the person themselves.
• In many cases a tool may simply act as the prompt for this aspect of assessment to take place, and to influence decisions in plans.
• 'Strengths working' is a continuous process that develops over time. It is not something that is done to someone, but rather an outcome of mutual dialogue. Circumstances change, as may the service user's aspirations; therefore the assessment is not fixed, and new facets of a person continuously emerge.
• The ultimate aim is for the assessment to be completed collaboratively, with or without an example of a form being introduced into the conversations. Paperwork in meetings can have a habit of formalising the situation, and thus getting in the way of the intended purpose.
• In rare instances, the whole process could be described to the service user, and where appropriate, a strengths assessment format left with them to ponder and complete in their own time. This may then form a basis for the service user to lead a subsequent discussion of their strengths and aspirations with the practitioner.
• The assessment is best conducted in an informal, conversational manner, rather than a structured interview. It is best conducted so far as is possible on the client's own 'territory' and in places where the user feels comfortable, rather than in formal service or institutional settings (e.g. the service user's home).
• It develops at each service user's pace and comfort level, and adapts to change.
• As 'strengths working' will be developed in response to the individual's circumstances, it is not relevant to set a standard time period for monitoring when it is completed and reviewed. Some assessments will be completed relatively quickly, and can reasonably be reviewed on a regular basis e.g. 6-monthly timescales. Some assessments will take many months or years to build up, and therefore do not fit a regular review cycle.

Structure of the process

• The assessment is focused on gathering information relevant to a range of 'life domains' e.g. housing, finance, health, occupation, social relationships, cultural and spiritual beliefs. Therefore, it should paint a holistic picture of the service user's life.
• It should be a positive, hopeful, and constructive process - the act of looking at strengths, possibilities and motivations is in itself constructive.
• It provides the essential positive information and resources needed to work constructively with risk.
• The format fits well with the local training on WRAP (Wellness Recovery Action Plan), and with Brief Solution Focused Therapy.