Saturday, 30 November 2013

One Page Profiles: Just Garnish?

One page profiles are a simple person centred thinking tool that sum up what people like and admire about a person, what's important to that person, and the best ways to support that person on a single sheet of paper. Their simplicity and practicality means that they are becoming very popular, they are an easy first step in the person-centred journey. The growing uptake of these tools however  has inevitably meant that they have also invited criticism, criticism which gives us an opportunity to think more deeply about the best ways to use one page profiles, their benefits and their limits.

Last week Simon Duffy tweeted what looks like a quote from Peter Kinsella at a big everyday living conference "One Page Profiles are just garnish, they make no difference".

This is a 'black swan' statement. Find one black swan and you prove that the statement 'there is no such thing as a black swan' is pretty unfounded.

As a black swan statement, all that's required to prove that particular tweet wrong is one example of a One Page Profile that has made a difference for somebody. And of course there are many more than just one example, all kinds of examples and stories of one page profiles that made a difference are posted on the '100 One Page Profiles' blog. Stories are statistics with souls, and the list of stories on that blog is only growing longer and richer.

Sweeping statements that dismiss One Page Profiles and other pieces of person centred thinking as 'just garnish' are therefore pretty unhelpful and easily disproved, though to be fair to Simon and Peter, maybe the statement would have been phrased better if it was not constrained by the 140 character limit set by twitter.
 A more helpful statement would have been 'some one page profiles are just garnish and make no difference'. We could then investigate what makes the difference between one page profiles that achieve change in people's lives, and those that don't, so that we can work to create the conditions where more of the first kind are produced. This is the purpose of the Learning Community for Person Centred Practices, which develops person centred thinking tools, shares them and then gathers learning about the best ways to use them to ensure that people win more choice and control in their lives. You can also find TLCPCP on facebook and twitter.

There are however some more thoughtful criticisms of One Page Profiles out there that we need to consider seriously because they will help us work better at increasing choice and control in people's lives. Below I'm listing some of these criticisms, and giving what I hope are some  equally thoughtful and constructive responses, the beginning of a respectful learning conversation:

1.    "One Page Profiles are only for disabled people, so having one labels you as disabled"

We would argue that one page profiles have many many uses, with applications for many diverse people, including non-disabled people and situations that are nothing to do with health or social care.
On the 100 One Page Profiles website, there are examples of one page profiles used in mainstream schools, in a couple's birthing plan, to find a nursery, to help people know how to speak to a recently bereaved woman, as a way of applying for a job, as a method that an employer can support their staff. People are inventing new ways to use one page profiles in almost every aspect of their lives.
We also use one page profiles in our own work as trainers and planners, we share our own profiles with the people we serve, and their families before we ask them to share anything with us. We see one page profiles as being useful in many different people's lives and work, and not as something exclusively for disabled people.
Because they increase the amount of choice and control in people's lives however, we're do find one page profiles particularly useful in the lives of people who have less choice and control in their lives as a consequence of society's attitude to the presence of ill health or disability.

2.    We shouldn't use any predetermined tools or scripts. If we properly listen to people we can improvise and adapt our approaches in a way that suits that person.


There are a few, absolutely brilliant and charismatic facilitators out there who have the ability to facilitate person centred thinking and practice 'on the hoof'.

The rest of us however don't share this level of confidence in our abilities, many of us may be new, inexperienced and nervous, and therefore find tools that prompt and structure our discussions in a direction that inquires into a person's gifts and skills and that seeks out what really matters to them very useful.

 Having such simple tools means many more people can practice and experience person centred thinking. They democratise the practice rather than leaving it in the hands of a small and gifted elite, and mean that many more people get to benefit from more person-centred support in their lives.

 We also hope One Page Profiles will replace those much more complex and negative tools that services traditionally (and many still currently) use. Assessments and approaches that focus on what a person can't do, that inquire into people's incapacities rather than their capacities, that consider health and safety without also considering what really matters to a person and which implicitly regard the person as a problem to be solved are doing great damage to people, saddle them with negative reputations, and lead us to support them in paternalistic and overprotective ways.
Replacing such segregating deficit model tools with simple tools that focus on gifts and capacities and on connecting a person into the community is part of shifting the whole culture of health and social care toward a different way of regarding people.

 Of course we must endeavour when we use one page profiles, to do so in a way that respects the person's preferred methods of communication to be sensitive to what really matters to that person. We need to keep learning about what helps this work best.


3.    Sometimes One Page Profiles are just superficial lists of likes and dislikes.


Like any tool, there are useful ways of using them and ways that are less useful. I don't prove that my screwdriver is useless just because my shelves fall down, I prove that I need some help and advice to use my tools better.

 Using a one page profile well, to structure a meaningful conversation and to delvier change, requires a real intention to discover what's strong and valuable about the person, and a determination to find ways to support that person that make sense for the person, as well as a genuine will to act on whatever is learned.
To be able to write one page profiles with others, we therefore require that people have first written and used one page profiles themselves in their own lives, to gain an appreciation of their potential to make a difference when used well, and to ensure that we don't ask people questions that we have not been prepared to answer ourselves.


4.    Introducing One Page Profiles En Masse would lead to tickbox planning.

This is a real risk if one page profiles are implemented by people or systems that don’t care about one page profiles or the people they are supposed to be supporting, and don’t endeavour to train people well in how to use them. Such people implement changes to 'meet targets' without thinking more deeply about the purpose of such changes.
In such a scenario, we’d be likely to see plans that are just superficial lists of likes and dislikes. This would be far less harmful than continuing the implementation of tools that focus on deficits, but would not lead to the change we wish to see. Just like any other approach, one page profiles rely on genuine intent to listen well and to act on what is learned, and if change is to happen this intent must be reflected at every level.
Where people really are stuck in structures and systems so deeply imbued with this target-driven cynicism, then measures like personal budgets that enable people to seek support from outside such systems are going to be helpful. Good person centred thinking helps with good support planning and helps people use their personal budgets most effectively.
We'd also advocate other methods of cultural change within these structures, that shift the conversation away from targets toward the meaning and purpose of the work, and toward practical ways of bringing about system change.


5.    There are some things we don't wish to share about ourselves

Don’t share those things then!
It’s up to the person what they choose to share in their one page profile. It helps to think about what the purpose of the one page profile is, and therefore who needs to see it, as well as what they need to know and do to support you well. These questions help focus us on what needs to be included in a one page profile, and which people it would be shown to.


6.    One Page Profiles are not a panacea

One page profiles will not solve all the problems inherent in health and social care or in our disablist society. If you’re looking for something that does, keep working hard! We’re right with you! In the meantime people still need better lives that mean something to them, and better supports delivered in a way that makes sense to them. In an imperfect and confusing system and a society rife with unjust power and resource distribution, every tiny bit of choice and control we can win back in our lives is precious.


7.    One Page Profiles could become a substitute for doing more detailed person centred planning.


There’s definitely a risk that someone could write a one page profile and say “And now my work here is done”. However as we explain in this paper, the one page profile is just a first step in the person centred journey. There are many other tools that do equally useful jobs: communication charts, staff matching tools, tools that help us explain to staff their different roles and responsibilities, learning tools, community connecting tools, tools that help us move toward our dreams and avoid our nightmares. These tools are there to try out and experiment with. Find ways to use them that make sense to you. Share what you're learning while you do!
Please don’t stop thinking together just because you’ve completed a one page profile! There is so much more to discover, and it could be great fun discovering it!


1 comment:

  1. I believe that one page profiles can be a powerful tool but how successful they are depends entirely on how they are used. I would say exactly the same about my charts ( Different scenarios call for different approaches, and most environments can benefit from a variety of tools, but if people do not use them as intended they're not going to deliver the potential benefits. Perhaps the biggest risk is one you mention, that one tool is adopted as a blanket solution and the thinking stops there. Good management is required to avoid that trap.