Resettlement and support plans
It is important that following an assessment and a review of the housing options, that the way forward to achieve the most appropriate housing for the client is clearly planned, and is client-centred.
Often a client may have mental health, drug or alcohol needs. They may have, or need to have, help from specialist workers in these fields. It is paramount that all of the workers involved with a client work together. Resettlement may well have the co-ordinating role in all of this as it applies to getting the most appropriate housing for the client. One way of accomplishing this is to have regular multi-disciplinary meetings with all of the workers involved with the client present. A protocol regarding confidentiality needs to be established and understood by the client, and relevant information shared as it impinges on the housing needs of the client.
- To identify and clarify goals and determine effective means of achieving them.
- To set milestones in the process.
- To agree achievable goals with the client, and decide the person responsible.
- To set an achievable timescale for the work.
A useful tool in formulation is the SMART (or SMARTER) models of task planning. Tasks should be Specific, Measurable, Achievable, Realistic and Timeframed.
- Specific - goals such as 'feel better about myself' may be the result of lots of little things, in which case you need to be looking at the little things first. Is it specifically - have something to get up for in the mornings? - look after my physical health better? - drink fewer cans in a day? - get in touch with friends/family?
- Measurable - how will you know when you feel better about yourself? You may feel ups and downs. But you can measure having something to get up for - enrolling in a class, or attending art workshops at the day centre, etc. Equally you can measure looking after your health better - by number of square meals, seeing a dentist/chiropodist etc.
- Achievable - big changes may not be achievable before you have worked on the small issues. It is the myth that 'just get me a flat and it will all be ok'. You can achieve changes in self esteem, motivation, resources, training and opportunities, but start small, especially in the first instance.
- Realistic - It may not be realistic to get someone a career as a star footballer. You could however, arrange for a trip to the local team, or stadium for example...
- Time-framed - to maintain motivation, and keep a check on progress, goals need to be time-framed. If you say you want to achieve a reduction in drinking say, agree to try and achieve it in the next couple of weeks, and you will look at achievements and obstacles again in two weeks time.
SMART and SMARTER....
- E-valuate progress regularly - both at each session (since the last session) and more generally (achievements and changes since the person started attending the centre for example, or since they began keyworking)
... and Re-evaluate!
or plans could be:
D Dynamic
A Achievable
F Flexible
T Transferable
There needs to be an active and evolving programme of work, both for the client and the worker.
The goals and milestones in the plan need to be achievable, never setting the client up to fail.
It should not be too rigid allowing client and worker room to constantly review the plan and make changes.
E.g. it is important that should the client go into supported housing for a while prior to moving into self-contained, that the plan goes with the client and links are made with the housing support worker.
- To review the milestones (the main stages of the plan) towards the fulfilment of the resettlement plan.
A key aspect of the planning process is in identifying the areas of support needed that fall outside the remit of the resettlement process. This requires understanding of the limits of the service provided (see aims of resettlement in the theory section) and a knowledge of the range of services available in the local area to your clients.
It may well be that your client requires specialist medical support to cope with a long term health problem, or that they are entitled to further support because of a learning difficulty. The assessment may reveal that they have a history in the armed forces, in which case they may be able to access specialist services for veterans
In other cases, you may need to refer the client to specialist drug or alcohol services, or to a counsellor or therapist. In all these cases, good interagency work and knowledge is key to providing a holistic plan of support and resettlement and the worker should read this in conjunction with the next section on referral on
- Enable the client and perhaps other specialist workers in achieving the goals.
- Set clear review dates e.g. monthly, three monthly etc. for reviews of the resettlement plan/care plan, ensuring that the client and everyone else involved is clear about the date and time.
- Depending on the timescale and endings policy of the service, the plan may include the 'exit strategy' from an early stage. Good practice is to request an exit interview or questionnaire
- Enable everyone to be present at the reviews, and keep the relevant notes and agree them with the client.
- To empower the client to speak out in the resettlement process.
- To ensure that there are opportunities for reviewing the client and worker's progress.
- To represent and effectively advocate on the part of the client, when partner organisations do not fulfil their obligations to the client.
Produce standard resettlement plans in line with the examples given.
Ensure that every client has a resettlement plan that is dynamic, achievable, flexible and transferable.
- Knowledge of the work of the partnership organisations who are needed to support the client throughout the process of change.
- Good practice in care planning.
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Created by
beth.coyne
Last modified
2007-05-01 04:47 PM