Care and Support or a Fascist Plot?
Author: Norma Curran
Marc Gold made an enormous difference to people with learning difficulties by creating a whole new approach to supporting people into work and by ensuring people got the skills they needed. This approach to skill-building also has much wider applicability.
Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for a lifetime.
Confucius, Circa 551 - 479
As someone who has been involved in supported employment for many years, what struck me when I became involved in supported living services were the fundamental cultural differences between the two in their approaches to supporting people.
Historically, supported employment services are funded in such a way that they have targets to meet i.e. a number of people who must become independent in employment each year. In order to achieve this, those who support people with learning difficulties use specific techniques. Much of the supported employment world draws on the values of Dr Marc Gold who developed the Try Another Way (TAW) methodology which has been used throughout the world since the 60’s and has proven to be a highly successful way of helping people to achieve meaningful independence in employment.
Dr Marc Gold, originally a jazz musician, experienced a life changing event in the late 50’s. He and his wife to be, Ronna, went to a state institution as a part of a class and were in the audience as a group of persons with various “pathologies” were lined up and forced to endure being described by a narrator. A person from the group ran up to Ronna and embraced her in a terrified manner. Marc and Ronna were outraged enough to learn more about this field.
When Marc graduated from college in 1960, he became a special education teacher after completing a degree as a music therapist. During the late ’60’s and early ’70’s, Marc and his student colleagues began laying the foundation for the TAW approach and the strong value statements that would follow. The system is effective for everyone - but was specifically designed for people with complex and profound learning difficulties and it works!
TAW was Marc Gold’s enduring legacy. It is basically a strategy of instruction that put the onus of responsibility on the trainer instead of the learner. This shift in learning opened the door to competency and respect for all people with learning difficulties. Marc Gold and Associates was formed in 1976. Sadly, at the age of 43, Marc Gold died of cancer in 1982. His associates made the decision to carry on his work and in 1986, a group came to the UK and held the first ever Training in Systematic Instruction (TSI) workshop.
Although when developed, this concept was used to help people learn things in all aspects of their lives, its evolution, in the UK has focused much more heavily on employment. Many, in the supported living field might argue that the TSI or TAW approach is too clinical when supporting people in everyday living.
Before entering into this argument, one must look more closely at the fundamental principles which underpin the teaching technology:
- if someone isn’t learning, it is the trainers’ responsibility to try a different approach to achieve success in training
- teach, don’t test
- giving people labels does not help us to understand anything about the person and is unfair
- we can best serve people by teaching them to do things that society values and needs
- when people are respected and treated with dignity, they respond well;
- anyone can learn if training meets their needs;
- the question is how much and what type of information is needed - not whether a person can learn
- no news is good news
The last of these points is perhaps, one of the most important. Marc observed, through his work, what he referred to as the creation of reinforcement junkies amongst learners. His point is as relevant today, as it was then. How often do we hear people with learning difficulties consistently looking for reinforcement? Am I right? Did I do good? In services, we have created a situation of learned helplessness. He described this as a fascist plot and decided to build in the fundamental principle ‘No news is good news’ i.e.; ‘if you don’t hear from me, you are doing well, I’ll only step in and help you when you need it’. The strength of his feelings on this subject is perhaps best illustrated by the following quote:
How can we expect people to take their places next to us in society if so many of the ways to supposedly help get them there force them to recognize, in one way or another, their subservient positions?
For services wishing to use this approach, there comes a responsibility. To use this method, and use it effectively, the trainer, or facilitator must be present at all times during the teaching process. The good news is that by adopting a systematic approach to teaching, people learn things much more quickly than you might imagine.
Against this backdrop, it would be difficult for anyone to argue that a move towards this ideology and methodology in supported living would be a bad thing. One would have to question how many people currently involved in supporting people with learning difficulties think of themselves as trainers or facilitators. How many support staff set out to help someone to learn to do things independently or interdependently in a community setting?
It is clear that we cannot hold the individual staff members responsible for this situation. The quality of service provision is directly linked to the ethos of the organisation providing support and the staff training; supervision and direction they receive.
To illustrate this point, I refer to extracts of a Social Work Inspection Agency (SWIA) report of the key findings of the inspection of North Lanarkshire Council's social work services published in February 2009:
The social work service was achieving good outcomes for people using services and their carers. From the assessment stage staff were seeking person centred and outcome focused interventions. Staff told us they liked working in North Lanarkshire and we found them to be highly motivated. At all levels, they owned, understood and could articulate the council's vision for social work services. They felt supported by their managers and acknowledged good opportunities for professional and career development.
The council was genuinely seeking to engage with its communities and community capacity building was a particular strength. Public information was good and accessible. Partners and stakeholders felt involved and both understood and valued what the social work service was trying to achieve.
We found key processes were being delivered well and saw numerous examples of people being enabled to access personalised services. Assessment and care management was good and there had been investment in staff training [SWIA Inspection Report Feb 2009]
In Scotland responsibility to develop and manage services is devolved to the 32 local authorities operating throughout the country, and we are reliant upon the leadership and guidance of each local authority or for voluntary/private sector organisations operating throughout Scotland to set their own standards for any service provision that goes beyond the minimum requirements.
Service reviews are carried out by the Care Commission - now the Social Care and Social Work Improvement Scotland (SCSWIS) - using the National Care Standards. But these systems do not look closely enough at action planning for individuals nor do they measure their movement towards independence. Do all organisations that support people with learning difficulties focus on helping people to become independent? The following example illustrates that the answer, in many cases, is no:
John Collins (name has been changed to protect confidentiality) was supported by a supported employment agency to work 20 hours as a Kitchen Assistant in a prestigious locally run hotel in Renfrewshire, Scotland. His job was relatively varied and sometimes quite high pressured. Initially he received full job support from his Job Coach. Within 4 weeks, this was gradually faded and after a 7 week period, job site support had faded completely and he received on-going support via initially fortnightly visits reducing to quarterly visits to ensure that all was well with him and his employer. No significant issues emerged but anything that did come up was resolved quickly and relatively easily by his Job Coach by liaising with John and his employer. He worked in this particular job for a period of around 7 years, moving into his own flat 4 years after he started work. Living independently, he received 13 hours of housing support services to help him with his household chores; budgeting and shopping from a national voluntary organisation. Support at this level continues to this day. At no point has this support ever reduced; has he ever shop independently; or did we see any progress made in terms of John doing things for himself. One would have to question this if he could comfortably sustain 20 hours employment with little or no intervention after a relatively short initial training period.
I suspect that this is the tip of the iceberg. In times of real financial difficulties for local authorities and voluntary organisations throughout the country one could argue that if the TAW or TSI approach was embedded in organisational practice, the severe budgetary cuts that many individuals are currently facing would have much less of a direct impact on people’s lives. People might have to cut back slightly on the new things that they want to learn but could still do all of the activities they can do independently, without support. At its simplest, the basic ideology of TAW or TSI relates directly back to the ancient Chinese proverb with which I started this article. We need to focus much more on teaching people to do things for themselves and not continually doing things for people.
Systematic instruction was developed to help people to learn things in all aspects of their lives and we should embed the philosophy and teaching technology into core mandatory training for everyone that supports people. In partnership with Empower and Scottish Consortium for Learning Disability, we have recently delivered a pilot training project in Scotland for support workers.
The aim of the course is two fold:
- To encourage the support workers to use the TSI philosophy to help people to learn things in all aspects of their lives
- To introduce the idea of helping people to achieve employment goals to a new audience (support workers) and to encourage their active participation in helping people to make dreams a reality
The content of the five day course covered:
- outcome based support planning
- career planning
- systematic support strategies
The impact of the training will be evaluated by Dr Steve Beyer (Welsh Centre for Learning Disability) over the coming months. Early indicators are good. One participant stated that she felt that her job now had renewed purpose and another questioned why they had never had this training before. We will be following the results of the pilot closely and will use these to promote the inclusion of the principles of systematic instruction into the National Care Standards and the Scottish Health and Social Care Qualifications.
If we don’t work together to fundamentally reform the way that we approach supporting people, it may well be the fascist plot that Marc Gold referred to all those years ago.
For more information on the subject, please contact Norma Curran, Coordinator, Values Into Action Scotland.
The publisher is The Centre for Welfare Reform.
Proactive Primary Care © Norma Curran 2011.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.