As I sat scrolling through Twitter a few weeks ago, I came across a conversation that set me thinking. Kath Evans (Head of Patient Experience at NHS England) was asking if people preferred an image showing “the ladder of participation” or “the circle of involvement”.
Circle, Ladder or Venn?
Initially I sat and thought “definitely a circle” - much more inclusive. I didn't like the ladder, ladders feel hierarchical, you have to climb a ladder and you can fall off one too. The general chatter agreed with the circle idea, although a few liked the idea of the ladder and aiming for the top rung. Then someone threw a spoke in the wheel , they suggested that it should be a venn type diagram, not a circle and not a ladder. It provided more individuality. I thought “yes, that’s true” but then as it was the Easter Holidays and my children were insisting I practised real involvement with them, I turned Twitter off and went to discuss a much more important topic for my son - why had George Lucas sold his company to Disney when Disney had turned down Star Wars originally (*). This conversation took rather a lot of brain (and Google) power so the chat about circles, ladders and venn diagrams had to take a back space.
That evening though, once hubby (or “re-enforcement” as I call him during the holidays) arrived home, I went back to thinking about the diagrams and I really struggled to decide which worked best. Was it the circle – all inclusive, surrounding the child, person centred; was it the Ladder - a climb or was it the Venn diagram – individual, different routes for different people?
The diagrams aren't wrong
I just couldn’t decide. However, it suddenly hit me. The reason I couldn’t decide wasn’t because the diagrams were wrong, it was just that they have to be used together.
On a stand alone basis, the diagrams tick a box and say “hey look what we are doing, we’re inclusive and encourage participation, we even have a diagram to show you how it works”. Throughout the SEND reforms, I sat in numerous meetings and I am fairly certain that a circle diagram was used in almost every one. “We need parents to be listened to, let’s put them in the centre of the circle. “ “We need the child to be the focus, let’s put them in the centre of a circle.” Even better “let’s put the family at the centre of the circle.
Diagrams are great, they can help people to visualize what something should look like. So why don't they work alone?
Have you ever had a kitchen designer come up with plans for a new kitchen? They send you lots of lovely images of what your dream kitchen could look like but when you get it installed, it looks nothing like the diagram you were sent? Why not? It's because the designers add lots of little extras (lampshades, ceramic bowls, mirrors, picture frames, flooring, etc) to the images to make you look at them and think “wow, yes I must have that one”. That’s what the Circle and Venn Diagram does for me. It shows the ideal, it sells itself to me by creating a feeling within me, it makes me want it. It becomes a must have, a goal. However, goals involve details. The goal is the final outcome, the way we get there involves effort and working together. The ethos behind the Children and Families Bill is the goal, but we're no where near it yet.
A Ladder to the Circle?
So, maybe, we need everyone to be realistic and the diagram should be a Ladder to the Circle. The circle is the final goal, it’s what we want but we need to climb a ladder to get there.
The ladder will have numerous steps and each school, therapist, Local Authority, CCG, Primary Care Trust and Social Services team will be starting on a different rung. As we know, there are some great practitioners out there so they will make the journey easier but staff often leave so we have to be prepared to possibly fall back a rung or two. Perhaps we need to think of it as Snakes and Ladders. Get a good practitioner, LA and rush up a few rungs of the ladder. Hit a “jobsworth” and slide back down.
So many people are telling us how great the new system is but the culture change needed to ensure that participation and inclusion is available (and actually doing what it says on the tin) needs a lot more work. We have to climb a ladder of participation to get to the Circle of Involvement. Some practitioners and LA’s are climbing faster than others, they want to reach the top. However, many are afraid of heights so they are holding on to their current rung for dear life and refusing to budge. Others are just exhausted and trying to juggle as they climb.
As a parent, we need others to be a rung ahead of us to give us a lift up. We don’t want to be pushed up and we don’t want to push others up; we want to work together as a team. We want to be able to help parents behind us on the ladder to get to the top. We want to show practitioners the way up. We also need practitioners and parents to show us the way up too.
All Change
We need to realise that “involvement” or “participation” is a goal that scares many practitioners because it’s new and different. Many of us don’t like change, especially when we can’t see the benefit, so we need encouragement from others to help everyone understand why true Participation works.
Some people will question moving up every rung of the ladder, some will just get on with the climb because they know they have to; some will rebel totally against change and others will be excited about reaching the top because they truly believe the benefits of being there are worth the climb.
So let’s get rid of the diagrams that just show the ideal, the goal and let's acknowledge that we have work ahead of us. It won't be quick (although we all know it needs to be), but let's think of it as a marathon rather than a sprint.
Thanks to Kath Evans for getting me thinking about this. It was a welcome change during the Easter holidays.
George Lucas
* We eventually decided to write to George and ask him why he sold to Disney when they turned down projects years ago – watch this space to see if we get a reply.
- Accountability: the number one change you would like - March 7, 2016
- Life Skills – are children with VI missing out? - March 2, 2016
- Tests:Do you and your child find them testing? - February 3, 2016
The answer to the Lucas question was probably to teach Disney a lesson and make Disney pay huge amounts for a brand that is so global and international when if they had done some research and participated in the conversation in the 70’s then on the back of Close encounters of the third kind then Buying the star wars brand was a bit of a no brainer.
Bizarrely maybe the answer to the ladder or circle solution is in the Film Close Encounters of the Third kind.
Instead of being afraid of the unknown people just engaged, participated and communicated to the point where the aliens made music and common ground was found around a joint outcome. As one of the telecom ads said it’s good to talk
As I am 45 On Monday and been a parent carer for nearly 16 years this year with now three models of children to tinker with my parenting skills even in our small environment no specific model suits all my kids in the same situation. All my kids have special needs on a huge spectrum. One is medical and learning difficulties whilst the other two are thankfully but equally tough on the other end of the spectrum where they are out achieving their peers. Then the two at this end are chalk and cheese in their methods they employ and there is only 14 months between them.
Equally all three kids have their frustrations in one way and another but normally its a nice challenge to have on how to balance the books with all three.
They all get to where they want to be in different routes. But I found conversation in a relaxed atmosphere will get us all where we all need to be.
Maybe the solution is to set a starting point and an end point and draw the route in the middle together. Supporting each other along the way as neither the parent/carer nor the child nor the professional in front of you has all the knowledge or personal experience to hand.
Where this simple solution fails is when we the parent/carers are let down and it affects our children.
Therefore before we can continue the journey we have to fill the pot holes only sometimes the pot holes become so big we don’t trust the repair nor the repairer.
I am fortunate that I also spent 11 years the other side of the fence as a commissioner of housing support for 21 client groups. In ten years we simplified the conversation to the following:
Single person with complex needs (i.e Learning disability, Mental health, homelessness and drug and alcohol and offenders etc) and they all wanted one thing their own home and a life.
Older people
Domestic violence and families.
WE worked a complex model into a simple concept on the basis that what happened back at the ranch with our fancy diagrams and evidence wasn’t important to the user.
What was important was what could we deliver to met the identified needs and how soon could they have the keys.
This important process then engaged and got the service user taking control with the professional there to offer professional help and guidance.
As a result we led the personalisation agenda in supported housing as the model was based on solution led dialogue on a simple conversation.
The difficulty is that the “professional feels threatened and almost redundant. What they haven’t realised it frees up so much of their time to achieve those other things they are required to do such as protect vulnerable people and their carers from harm.
I think you’re spot on with the Snakes & Ladders analogy !