Founder of LivesthroughFriends, Bob Rhodes, discusses their framework for working to create bespoke care solutions in the community for people who are locked away in hospitals, and how the LivesthroughFriends team works collaboratively to get people their 'Good Lives.'
When asked to explain the LivesthroughFriends ‘model,’ we usually reply that we don’t have one. In reality, we probably do. But we have learned the hard way that what we do is not ‘painting by numbers’.
Over decades of not only doing, but studying; properly understanding what needs to be done – which is different for every person – and then exploring and exploiting every possibility for realising that vision without compromise; we’ve identified a way of approaching our work with individuals who are institutionalised, secluded, and excluded. We’ve gotten many things wrong as we’ve tried different approaches, but we have learnt and always taken responsibility for remedying our misjudgements.
The main conclusion from this experiential learning has been that there is no single way to achieve a good life. There is no step-by-step guide, no ‘do this, then this’ playbook to follow: there is no model to spread and scale.
Human lives are messy, complicated, complex and unique. Our engagement needs to be similarly fluid and flexible. However in order to be ‘loose’ there are a number of activities and principles that must be ‘tight’ and conscientiously adhered to.
We look to share all this with those who commission us, such that adopting the LivesthroughFriends way of working is, in its most successful manifestation, an opportunity to acquire insight, knowledge and methods through experiencing new ways of thinking and practicing.
So, while we won’t offer up a fixed model of working, we are happy to share the continually evolving list of practice and principle imperatives that provide a reference framework for our interventions.
For clarity, when we use the term ‘our,’ we mean everyone with a role and influence in the life of a person – family and friends, service providers, commissioners, and MDT professionals.
1. Ask how people want to live: what’s the best we can envisage?
Everything starts by getting alongside a person, those who love them, and professionals who really know them to paint a picture of the person’s best possible life; a direction of travel to which we all aspire. Fully engaging with the person to understand the particular life they want to live is grounded in the building of a trusting relationship. It is blatantly disingenuous to undertake this inquiry on the basis of a pre-ordained questionnaire.
Impoverished and, in the case of the work LivesthroughFriends tackles, often traumatised experience does not provide a solid foundation for informed choices. In setting a vision for how life could be, we believe passionately that there is a need to be ambitious. Our job is to help the person to dream, imagine, and ideally experience the possibilities that might be realised which go beyond their lived experience, and to encourage those around them to be ambitious contributors to the venture. This is about starting at the opposite end to where traditional ‘needs assessments’ begin. It’s about centering all subsequent planning on creating a life worth living (not on allocating a narrow menu of services).
2. Start with the ‘core or relational economy’ – Supplement & Complement
Rather than beginning with paid services, we advocate starting with the ‘core economy’ (the resources of family, neighbourhood; kith and kin) and how these can contribute to achieving the person’s good life. Engaging and bolstering this should come first as the core economy is a fundamental and ever-present part of life.
The addition of paid-for services and support should then be designed to supplement and complement this – to fill the gaps that the core economy cannot provide, to fit alongside and not to replace. Too often, service inputs dominate and the core economy is ignored or stifled. This is an inevitable consequence of the commoditisation of services.
Where Social Services are structured and organised to support strong and resourceful families and communities, Social Care promotes dependence, stimulates demand that it is ill-equipped to meet, and redirects valuable professional resources away from relationship-based work to administer counter-productive transactions.
3. Strengthen and build reciprocal relationships and social capital for and with the person
The heart of the core economy is the engaged commitment of other people freely giving their love, care and support to fellow citizens. We all need relationships with others who can sustain us, nourish us, and allow us to fully experience being human. The fundamental hurdle faced by almost everyone we work with is the absence of naturally occurring relationships in their life – relationships that create opportunities for them to be reciprocal, contributing members of a community.
Without a range of connections, a life will always be limited. As such, we put the intentional development of relationships as a top priority in developing and implementing every plan for a Good Life, and provide opportunities for all involved to develop their knowledge and skills in this crucial area of practice. Our approach has been heavily influenced by our three-decade long relationship with PLAN – www.planinstitute.ca. This is why we are called LivesthroughFriends: because relationships are pivotal!
4. Promote Effective and Creative Thinking, Possibilities & Problem-Solving
The lives of people with complex needs are rarely straightforward or easy. There will be challenges, barriers, and continual changes. For this reason, we champion the development of creative problem-solving within the support networks around a person.
At the centre of problem-solving and creativity resides both a capacity for and commitment to generating a wealth of possible courses of action prior to prioritising the most promising, and a bias for reflective action. In our potential partners we look for adroitness in not just taking, but also making opportunities.
The Go Make A Difference (Go MAD) approach developed by Andy Gilbert is one we find effective. Equipping supporters around vulnerable people with these skills, and encouraging them to invest time in imagining possibilities, prepares them to face these challenges with hope, resilience, and the tools to identify solutions.
5. Contribute to, receive from, and build ‘community’
A good life involves being a contributing citizen. We passionately believe that everybody has gifts – their intrinsic characteristics, strengths, abilities that enhance the world around them. Crucially, gifts have to be given. Those with complex lives are too often seen only as people with needs. When we focus on people’s gifts and how they are able to share those with the wider community, we transform lives.
Our plans always consider how the person can contribute to the community they live in, as that is the path to connection, a sense of purpose and well-being. Experience tells us that inclusion and citizenship are everybody’s business. Hence, we ensure that education in strengths-based practice underpins induction and on-going training for support providers.
6. Address behavioural issues from a very skilled ‘Low Arousal’ perspective
The challenging reputations that we encounter are essentially about the behaviours people exhibit. These behaviours dominate how the person is seen and energy gets directed solely on managing – or controlling – that behaviour. Often we are changing people’s perceptions of behaviour by developing a deeper understanding of a person’s life journey.
We understand behaviours as being responses to how the person experiences the world. Stress, sensory overload, frustration and trauma can all trigger behaviours that lead to increases in seclusion, physical restraint, and other restrictions.
Working with our clinical partners at Studio 3, we promote Low Arousal Approaches that are non-restrictive. Operating in this way with traumatised and complex individuals requires high levels of training and skilled supervision in order that practitioners gain and sustain the confidence and skills needed. Working in this way is fundamental to enabling the focus to remain on supporting participation, inclusion, and relationship building for the person.
7. Everyone is different – bespoke works; the service ‘menu’ usually doesn’t
We don’t have confidence that placements and the menu of service solutions often put forward can always respond to the unique circumstances that the people we support bring. Many carry long lists of ‘placement breakdown’ as evidence that ‘off the shelf’ options do not attend to the right things. We design and implement bespoke options that are built around the person and their specific circumstances.
8. It’s a Journey – not an episode
We are interested in people having a life. Some of the shifts and opportunities we can imagine for someone will take a long time to achieve. That is not a problem when you are thinking about someone’s lifetime, not just their next placement.
When we implement a plan we anticipate periods of turbulence, and the need to modify and adapt plans. That is life – we need to respond accordingly; and our statutory partners need to be structured to sustain lifelong local, relationship-grounded, and professionally competent support that is focused on progressing the journey in the direction of a better life.
9. Remember, it’s not (only) about the money!
Costs loiter like elephants in a room when talking about bespoke packages of support. The question of “How much?” looms as an ultimate arbiter. We never start with the money; we start with what is needed – remembering that we’re looking for funded services to be supplementary and complementary.
The focus should always be on value, not cost. We encounter too many situations where people are in institutional settings at extortionate public cost, living an awful existence. The cost is high, the value is low. We need to look at the value that public money is getting: aiming for those with complex needs to become contributing members of their communities, rather than passive recipients of services is always a better value proposition.
In reality, we can also point to bespoke packages of support that typically cost less than institutional alternatives. In general, support costs decrease the better and more included a person’s life becomes. Justifiable trust is required between commissioning organisations and support providers if resources are to be best applied. The current system rarely achieves this.
10. Show another way – It’s about LEADERSHIP
We talk a lot about leadership. In particular, when identifying support providers to work with individuals, we know that success is dependent on excellent leadership. Leaders create the conditions for their teams to do the right thing: leaders beget leaders. They do this by showing how to behave, how to think creatively, how to turn values into actions, and how to take responsibility. When we are selecting providers, we are looking first and foremost for evidence of leadership and we invest in developing leadership in those we work with.
11. BE TENACIOUS – there’s rarely a compromise that works!
Crucially, in this work, effective leaders demonstrate and exemplify tenacity! Helping someone with a ‘reputation’ to get a real life is not an easy undertaking, but the prize is worth the hard graft needed to secure it.
We encounter lots of barriers – largely from systems and processes that struggle with the flexibility and creativity needed to be truly person-centred. Refusing to give up, to seek to bring problem-solving thinking to get around obstacles, to keep the human being at the centre of a plan at front of things, and to take thought-out risks in a too punitive world – that is critical.
12. Organise and systematise to serve these aspirations
Ultimately, we believe that systems need to change to reflect these lessons. Whether we work on individual cases or interventions involving a number of people, we constantly strive to influence local statutory systems to recognise that they could achieve better outcomes for people, more easily and efficiently, if they abandoned some of their unhelpful structures and procedures. However, we are very alive to the fact that, while we help to bring about much improved lives for the folk we are privileged to assist, our example is having negligible impact upon the national system that serves to unjustifiably incarcerate and traumatise some of the most vulnerable citizens in our society. Our framework helps keep our noses to the grindstone, whilst our practice keeps us connected and alert. It is shameful that those who prescribe the systems stay aloof from the day-to-day experiences of those the claim to help.
Written by Bob Rhodes
CEO of LivesthroughFriends
To find out more about our work, or to discuss how we could work with you or a person you support to imaginatively reach bespoke solutions to complex care problems, please find out more about us by visiting our website www.livesthroughfriends.org. You can also get in touch with us through Studio 3 by contacting their office at 01225 334 111, and by emailing info@studio3.org.