Category Archives: Project process

Generations together…

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Hello there folks. It has been a while (16 months) since we last posted from this blog – but sometimes it takes a while for mighty oaks to grow from tiny acorns!

Our last post highlighted that we were working together with the Glasgow School of Art to develop new and innovative approaches to meet the social, economic and environmental difficulties we are currently facing around reshaping care for older people. Since then, we’ve seen the innovation in this sector developing rapidly. Responses have been emerging from across the public, private and voluntary and community sectors. Frequently, these innovations have involved new technologies or making better use of previously under-utilised assets and resources. And these innovations are not all small (or tiny, to use the previous analogy!).

When we left you last, the ideas that had been developed between people who use services, practitioners and design students, had been showcased and received well at the IRISS forum.  However,  we weren’t sure who/how/when they would be taken forward.

We are delighted to tell you that since those early stages, two of the ideas developed through the project have been taken up and developed by different partnerships in the local area.

  • The Hub (idea originally developed by the partnership working and communications team) has been taken forward by Cornerstone Care (blog post to follow) and,
  • Intergenerational work (idea originally developed by the anticipatory care team), which will be the focus of this blog.

Generations together…

In partnership, a group of staff (comprising the Health Improvement Team, social work and NHS) approached Blackfriers Primary School in the Gorbals to set up a pilot initiative that would bring generations together. The programme is in the early stages of design, but has the aim of improving perceptions and challenging stereotypes, and the overall programme will be co-produced by the children and older people.

Monday 20th May, saw the launch of this programme. Attended by over 80 older people, carers, grandparents and parents and the children from primary 1 and primary 7 from Blackfriars school, there was a buzz in the air, song in our hearts and plenty of cake to go around (just!)

Headteacher introduced the day, and welcomed everyone to the school. She explained that she wanted the school to embrace everyone in the community and that the children wanted to open up a new onversation with the older members of the community.

To get everyone in the mood, the children from Primary 1 sang a song to welcome everyone together. Then, children from Primary 7 performed and sang along to the sounds of the sixties – treating the group to a trip down memory lane. There was laughter, cheers, signing and dancing from audience – true audience participation!

Then, the children and older people had a chance to get better acquainted. We had borrowed some ‘Reminiscence Kits‘ from the Open Museum to help stimulate conversation – as well as games and toys from Playbusters. There was soon lots of chatter, laughter and discussion. We then asked the group to answer the following questions:

- what interests or skills could you share with older/younger people?
- what would you like to learn from older/younger people?
- what would you like to do for a project?
- would you like to participate in the project
- what benefits do you feel you would gain from participating in the project?

The answers were varied! People wanted to share skills and experiences from old Glasgow street songs, to rap, dancing, self-care to computer and technology skills. So, we’ve lots to work with! The next stage of the process will be to analyse the different skills and activities that people have and are interested in and to match them up. Overall, there was encouraging enthusiasm and willingness from the children and older people to learn and do things together.

What we are beginning to see is that the process of developing this idea is just as important as the final outcome. These processes have the capacity to create new roles and relationships, develop assets and capabilities and/or better use assets and resources.

Here are some comments from the evaluation forms:
I learned:
“that I belong to a whole community”
“that the children are as enthusiastic as I am”
“rather than learn, I was reminded of lots of things I had forgotten”
“that kids enjoyed joining in with older people”
More photographs from the day available here: http://www.flickr.com/photos/openlx/sets/72157633528622735/
Thanks to all those who helped to organise, get involved and make the day a success. In particular, thanks to all the children at Blackfriars Primary School, the older people who attended, Dixon Carer’s Centre and the organising committee (Victoria McAlpine, Mrs McCleary, Mrs Collins and Rhoda MacLeod).

Student presentations 29/11

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Yesterday the students presented their ideas in their finality to the practitioners and others from the sector that attended. This was an opportunity for the students to trail their presentations before they meet a larger audience at the IRISS Forum and also to receive feedback on these ideas and how they have fleshed them out with relevance to the South side of Glasgow and the communities there.

We won’t go into too much detail about the presentations here as it will be a spoiler for the presentation next Tuesday – suffice to say there will be a live blog following the presentations and the presentation will be made available online – address to follow after Tuesday.

Thanks to the students who have had a difficult task, not only in understanding their theme, getting to grips with the local context but also for trying to integrate the information from four different sectors who think about care and support quite differently from one another. No mean feat!

The ideas that were created have been grounded in the research that they’ve undertaken with older people, carers and practitioners. They seek to complement the other work going on locally, linking in to what already exists to make their implementation more viable.

Student Presentations 14/11

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Presentation of concepts – fleshing out and refining

In the intervening two weeks the students and their practitioner counter-parts have been refining their ideas, better understanding how they might be implemented, and testing out the viability of their concepts in the south side of Glasgow.

Monday was the student’s last opportunity to present formally to both people who use services and practitioners and to get relevant feedback on the concepts that respond to the project themes. This took place at the Dixon Community Centre on Cathcart Road to make it more likely that older people and their carers could share their thoughts, ideas and perspectives on the concepts. We also changed the timings of the presentation from a full day to an afternoon as we received feedback that it can be difficult for practitioners to negotiate Monday morning sessions.

The presentations

On the day 5 practitioners and 23 older people/carers were able to attend. Although the change of venue was aimed to integrate and include older people and carers views we learned very quickly that the formal presentation format we have been using each week wasn’t working in the hall due to the acoustics in the venue. In order to remedy this, we changed the format asking the students at very short notice to present (in rotation) to small groups of people who had attended. Although the noise level was still difficult to control, people were able to converse and hear better which afforded the students constructive feedback from those in each of the groups.

Anticipatory Care

The anticipatory care team have taken a different view of ‘anticipatory care’ and have defined the difference between ‘prevent’ and ‘anticipate’. Their idea takes a very broad view of anticipation that focuses on increasing awareness of ‘older life’ in younger and middle aged people.

Essentially, the approach is an inter-generational one, which aims to innovate policy as well as make practical changes on the ground in the local context. The crux of the idea is using schools as a place for meeting and introducing the topic of older life, to break down preconceived judgments and allowing young and older people to begin to associate one with another. This would be implemented through the Curriculum for Excellence and carried on into high school and university – with the range of activities being undertaken changing to suit ages and interests.

The idea is to create a partnership between schools and elderly community centres/projects, as a starting point to build values of respect and empathy in the community, as well as awareness of different health related issues.

The students have effectively linked their idea in to current policy areas including curriculum for excellence, prevention, education and community development. In addition, the idea also links in to what currently exists locally and seeks to complement it by making enhancements.

Partnership working and communication

This team has been working on their location based ‘hub’ idea which received positive feedback from the last session.

The hub idea is centred around the idea of peer to peer learning and support, based on the idea that people are experts in their own lives and that the collective knowledge of a community is a large untapped resource. Based within the hub is the ‘service expert’. This individual would be someone who acts as a first point of contact into the system – representing both health and social care. They are able to fulfill a number of different roles including making appointments, helping individuals to complete forms and also giving general advice and guidance.

However the key to the hub idea is that it is first and foremost it is an important part of the community providing services such as a post office, toilet facilities, pharmacy etc (a place to go for pensions, benefits and prescriptions). Its secondary role is as a base for well-being services and contact with the service expert.

The team has developed a manifesto and physical model to showcase their idea and are in the process of developing a business plan to accompany it – based on a social enterprise model.

Social Isolation

This team has come a long way since the last presentation – really beginning to drill down into the type of isolation that older people might experience.

Much of the teams thinking is based on their knowledge of different cultures as well as looking at historically how people used to have a sense of community cohesiveness and interest in one another. As such, the challenge for this group is to devise something that is implicit in its approach i.e. it doesn’t explicitly try to integrate people more into the community or activities, but rather, softly approaches the idea of linking people into areas of interest.

The idea being developed in this group is around the role of a community champion. The community champion would be someone who acts like a neighbour by looking out for older people in the community as well as informing the older people about different activities that are going on. The idea being developed was about this specific role, but also complementary tools that the individual would be able to use within that role.

For instance, the team had considered developing a database (that would be owned by the community) that would list the different resources, services and activities that were ongoing in the community. This could be used by the community champion (and others) as a signposting tool. This idea was really positively received by the group of older people and their carers – many of them commenting that it would be very useful to have access to a one-stop-shop of information about whats on in the local area. The focus group also gave the students a chance to talk to some real-life community connectors (!) and to focus their attention on the types of information they supply, how they get access to it, and how they transmit it to others.

The group still has to make some decisions about whether or not this role is volunteer based, or is paid for. Also, they are going to consider the type of skills, knowledge and aptitudes that the ideal community champion should possess.

Reablement

The reablement group had various different concepts that they represented two weeks ago and since then have narrowed these down to focus upon the idea of a reablement buddy. After looking at Edinburgh City Council’s review of reablement services as a basis for their ideas they are aiming to share the experience of someone who has  been through a service with someone who is about to enter a service; similar to ideas on the ALISS project and the Me2 concept from RED ‘s Diabetes project). However this group are still working out how this might work out in the South side of Glasgow – would it be a volunteer service? How would people be checked to make sure they wanted to support someone else  rather than talk about their own experience?

Interestingly the debate in this group between practitioners and cares was interesting. Practitioners wanted to make sure the buddies would have all the information and knowledge they needed to support a person, however the carers view was that a personal experience can be enough, and as well as learning from another experience of a service and navigating through it, it may possibly not not be as intimidating as a professional contact. Two different interpretations of who who is the ‘expert’ and how these perspectives could work together to better support someone.

One of the key points made by carers in this group was people ability to get to services or to other people as transportation can be difficult whilst in the process of enabling oneself.

Reflections

Overall, the feedback was positive for each of the concepts. Where views differed the conversation constructively contextualised the ideas to the South side of Glasgow, current experiences of services or how services are provided.

The teams have come a long way in terms of their understanding and vision, which really must be commended, given the tight time frame, new social and health sector learning as well as contextualising this within Glasgow. What is left now is to drill down into the ideas with specifics about how these concepts could be taken forward in practice – some of the teams are already underway with this task.

What I like is that the ideas build on one another and are complementary with the teams referencing ideas from other teams within their own concepts. Hopefully, this will mean that a comprehensive picture can be created for Glasgow south. Very much looking forward to seeing what comes next.

In terms of our reflections about the project, there are definitely things that we might have done differently with the benefit of hindsight. A future blog to come on this, detailing the benefits and challenges of undertaking a project such as this with some insights as to what the lessons IRISS have learned as facilitators.

Thanks

We’d just like to extend an extra thank you to our friends at Dixon Community Centre for the use of their venue, hospitality and all-round helpfulness. Also, we realise that it can be difficult to take time out of the caring role to attend events like these, and we really are thankful to all of the carers and older people who took time out of their day to help us with the project – your time, patience, sensitivity and sense of humour are much appreciated. The project would have far less meaning without your involvement.

Initial concepts and ideas – Student presentations – 31/10/11

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Initial concepts and ideas

Yesterday was the second set of student presentation at The Glasgow School of Art. The purpose of this session was for the students to present their initial concepts  in relation to their themes (social isolation, anticipatory care, re-enablement and partnership and communication). They were looking for feedback from practitioners, older people and and carers about how close these concepts are to creating the life older people would like, the suitability of the concepts in responding to the theme, and their practicality in the south side of Glasgow.

We had a full house of students, a few practitioners in the morning session and more in the afternoon. This meant feedback was limited in the morning and become more fruitful in the afternoon – reiterating that this project really is a collaboration/co-design project – without feedback and practitioners ideas and perspectives it is hard to evolve the concepts into relevant and practical ideas.

Work in the interm

Since the last presentations some of the students have been to visit the Nan McKay Hall where older people get together (see previous blog post), a GP at Midlock Medical Center, practitioners and older people at Cornerstone, and kept in touch with practitioners by email or phone.

Presentations

Each group presented and asked for feedback. We will make the presentations available on the blog asap so you can see the visual presentation of the concepts and how they would fit into a scenario that an older person may experience.

Social Isolation

The first group up was the social isolation group, they presented 3 ‘low technology’ ideas about engagement in the community when you are socially isolated, but are finding this a hard topic to address because it can be quite vast. Following this presentation this group are going to focus on narrowing the scope of the theme and develop concepts that respond directly to the older people’s profiles they have developed.

Furthermore, IRISS are providing some evidence support to assist the group in conceptualizing this issue – focusing on what the literature says about what is useful in overcoming social isolation and loneliness, what meaningful interactions might be as well as the use of technology.

View the presentation: 31_10_ Social Isolation

Anticipatory care

The anticipatory care group have decided to focus upon one area of anticipation – this being thinking, talking and being in contact with ‘old age’ in early years. This group believe that as a culture we don’t think about or anticipate our old age until it is imminent – this is not helped by poor representation of older people in the media and negative portrayals of older people as vulnerable, frail and isolated.

To address this, the group is interested in developing an awareness raising campaign,  which would include activities that bring older people and younger people together through primary and secondary school settings. The aim of this being to break down barriers around knowledge and appreciation of old age, as well as possible inhibitions and fear between these two age groups. This approach really pushes the perspective of anticipatory care back to when people are growing up and what young people want their life to be like when they are older. So although not addressing anticipatory care needs right now, this team are looking more at a futures and generational perspective so the problem experienced at the moment could be alleviated in the future.

Reablement

This group presented 7 concepts called:

  1. Swapping and sharing
  2. Reablement buddy
  3. House swapping
  4. Guerrilla gardening
  5. Audio recording
  6. Generation mixer
  7. Skills sharing

One of the things this group has found difficult is getting to grips with what reablement means in a health setting as we were unable to pursue access to older people who are working with the NHS to enable themselves due to time an ethical constraints.

Therefore this groups has focused on ideas with people who still need support but are possibly not at the acute end of this issue. As a result, most of their ideas are community based – a factor they are going to take into consideration when developing these ideas further (concepts are currently too close to the social isolation group).

View the presentation: layout pres. lunedi.2

Partnership working and communication

This group presented 3 concepts:

  1. Link -  referred to placing someone who has both health and social care knowledge in a GP’s surgery to act as a first point of contact and support a person to navigate the service landscape.
  2. Core team database – looked at combining the social work and health databases but making them person centered so that each person was able to have access and contribute to their records. It also considered employing a team of staff to make sure no one fell through the possible cracks between the two databases.
  3. The Hub – was the less developed of the three ideas but the one idea that most practitioners became quite excited about! The practitioners shared lots of ideas with the students as to what could be in the Hub, how it could work, and what would be there. The concept refers to a local area (hub) that people already use to go about their daily tasks – such as collecting their pension or buying food. The idea involves incorporating representatives from health and social work (or people with this kind of knowledge) than can signpost people to services that can support them or take them as these services would be in the Hub. What was stressed in this concept is that is is more of a community approach to people’s needs with health and social care a secondary (albeit important) element.

View the presentation: Concept_Ideas Partnership working and communication group

 Summary

All of the groups have taken a community perspective when developing these concepts rather than a health or social service based response. This chimes with the underlying approach which focuses on the inclusion of the experiences and aspirations of older people and carers -  it is these factors that the students are able to design for or towards, rather than the services expectations.

More work needs to be done by the students and practitioners to understand how the concepts could possibly complement existing networks, behaviours, actions or services and reconstitute them in some way. They also need to be made contextually relevant to the south side of Glasgow.

In the interim (2)

Ian Grout (the course leader) summarised and visualised how each of the theme’s concepts could sit together into a whole proposal for the future of care. The students need to consider this proposal and decide if they see their themes taking this kind of overall shape. As well as refining the concepts that gained positive feedback, they will work on the overall story of their ideas at the next group session on Wednesday.

 Next presentation

The next presentation session will be held in one of the cares centers the south side.

We are keen to ensure that people who use services and their carers are engaged in the project as much as possible – especially now that ideas are beginning to form. As such we hope that the change of venue will encourage as many people to attend as possible to provide feedback that will help shape and refine the concepts – and so that we can ensure that the concepts are of most relevance to the people that count the most – older people and their carers.

 

 

 

Meeting at the Nan MacKay Centre

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Today a group of students and I set off to meet with a group of older people who regularly attend the Nan MacKay Memorial Centre in Pollocksheilds.

The centre is tucked away at the end of St John’s Road – and was set up after one of the original tenants to move into the area, Nan, realised that many of the tenants were lonely and elderly and that the new council estate did not have a lot to offer.

With help from other enthusiastic residents, Nan went on to organise trips, parties and eventually started a campaign for a Hall. The hall has now been running for 30 years, continuing to serve older people and arranging a variety of daily activities.

We arrived at the centre at 9.30, just as the art class was about to start. As well as talking to the older people there about their lives, we were able to get a better feel for the centre and its importance to the local community. It was great to meet the people who were at the centre today – many of them commented that they’d be lost without such handy community facilities and many of them attended over 3 times a week.

We have been encouraging the students to take a more posivitist approach to their service design and this was a useful opportunity for them to learn from an example that is working well, where people are happy and content – rather than focusing on issues that need to be fixed.

Also, the older people that attended are fit, well and independent and commented that they often participated in the activities for the social rewards of engagement in that activity, rather than for its own sake. As such I reflected that we might begin to think about different strategies for promoting healthy activities and keeping people well/ independent that might use this social element as a hook.

Among other things, it was clear from today that:
• On the whole, ageing is a positive experience for the majority of people
• The majority of people did not think of themselves as old.
• Future health status seems to be the most important concern

All comments and thoughts welcome.

Summary of presentations – 17/10/11

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Summary of the day

Practitioners said that the design students had a really good grasp of the issues, services, sectors and people’s experiences and there was a great deal of healthy discussion and debate after the presentations. Things for the students to think about for the next presentation included finding out more information about financial, experiential and practical possibilities with their design ideas, as well as looking at research and evidence sources to validate their ideas.

Between now and the next presentations on 31st October each group is going to:

- Focus on a specific area in their theme.
- Start thinking about ‘what if’ this, or that, was introduced into current systems, visualise this and share it with practitioners, older people and carers to get feedback.
- Speak to a GP to include this perspective in their research.
- Bring in their knowledge about how older people are cared for in other countries (over half of the students are from overseas).

If older people or carers would like to attend the presentations on 31st October and 14th/28th November, please get in contact with Gayle Rice or Lisa Pattoni at IRISS on 0141 559 5059.

Social isolation presentation – 17/10/11

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This group shared that they viewed social isolation as someone who is lonely in their house, but identified many factors that contribute to isolation, and many different situations, that they are now of the opinion that every case of social isolation is incredibly individual. However, this group also set out their stall by saying that it can be difficult to identify social isolation before it happens and people may not believe that they are isolated.

What this group learned:

- Money and legalities are always a factor.
- Some services can approach social isolation quite bureaucratically and more flexibility may be needed in service provision.
- Workers are given tasks when they are working in people’s homes, which tends not to involve engaging socially with people, generally due to time constraints.
- How different sectors engage with people and other services.
- Identified lots of different problems (see slides) and realised that lots of people’s first port of call is a GP.
- There does not seem to be a consistent way of keeping people active and engaged in their community to prevent social isolation in the first place.
- The group saw one way BUPA address social isolation by bringing older people and children together in a garden.

So what does social isolation mean and feel like?

Working with older people and carers, this group also built profiles of people and what social isolation means to them. They mapped who they were connecting with, how they did this, and what the purpose of these connections were (see slides). The group identified archetypes of people who become socially isolated: these were self managed, physical isolation, mental, fear based, care induced and knowledge (for more information see slides).

It was also interesting to see that when carers and older people were asked to choose which thematic group to talk to in the afternoon, the carers mainly wanted to talk about this issue.

Insights from this group included:

- There isn’t a way to identify people who are at risk of social isolation.
- One of the causes of isolation is a lack of confidence.
- There is a lack of knowledge about services available to people.

Feedback from the audience included:

This is an incredibly hard issue to address in terms of identifying who is socially isolated.

The group need to look at how the voluntary sector is involved in social isolation.

Develop the process to support someone who is socially isolated ready, rather than focus on the person. There are bits missing in the current system to have this process ready.

Something that already exists is the HUB which gives advice about services that support people not to become socially isolated.

Police and housing are obliged to report instances of social isolation.

You need to consider whether a person has capacity to be able to be provided services that deal with social isolation.’Capacity’ can be difficult to identify.

It can be difficult for all GPs to know what is available in their community, but if they are able to pass on information, the person still needs the confidence to phone or attend a service.

Remember older people are the same as all of us – they want friends not services.

Some people choose to be isolated and personal choices also need to be respected.

Reablement presentation – 17/10/11

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This group explained how they have interpreted this issue – to give a person the support they need to live an independent life; and what it means – giving people the skills and support to look after themselves with the right amount of support. They identified that the main professionals involved in reablement are: occupational therapists, reablement coordinators, reablement home carers, a team leader, and an area operations manager.

They worked with a health sector practitioner to identify routes towards reablement and identified two which they called a fast track and community (or non fast track) and mapped these routes (see slides). What was of note about this group was the use of the word ‘rehabilitation’ as opposed to ‘reablement’ in the health sector.

Working with older people and carers, the groups set up a series of tasks to find out what kind of activities, transportation and chores older people are able or want to do in their community. Similar to other groups, the reablement group also created a series of profiles of older people and built scenarios around them to reflect the personal information and experiences they learned about (see slides). Interestingly, they recognised that where a person lives in the south of Glasgow, wealth and ethnic origin impacted on access and expectations when it came to reablement. They followed this by creating a SWAT analysis for other people around reablement (see slides).

Key findings:

- Housing can be an obstacle
- Lack of awareness for practitioners in this area
- Lack of motivation from both service providers and users
- A time gap between services can create problems for reablement

Opportunities this group identified:

- Prioritise housing
- Promote effective methods for carers
- Look at success stories to motivate clients and providers

Feedback from the audience:

Housing is key, people regard where they live as their home but cannot always stay there.

Edinburgh City Council have done a financial appraisal of their reablement service that could be used.

As well as people needing services as they come out of hospital, home support also needs to be addressed.

Needs on paper can be crammed into a 15 minute time slot on the basis that something is better than nothing – there is not a great deal of variety in what people could be provided with.

Travel time can squeeze the time staff they get to spend with people. Ideally, services should be localised rather than having to travel all over Glasgow.

Some services are moving away from a task based service to something that is more flexible.

Is reablement the otherside of anticipatory care?

Firstly, staff need to reable/enable staff. The managerial hierarchies have the vision but the staff have to deal with what is going on on the ground.

Is reablement a social issue or a resource issue?

What is the perception of independence of the people who are receiving services and how do you link that to the type of service and the resources of that service.

Do you think it is an evolutionary or revolutionary thing you need to do here?

Sometimes it is thought that being on your own can be incredibly scary and sometimes it can be easier to work in a group, to be part of a network. The perception of losing a safety net can be the biggest fear.

Biggest fear can be being alone – ‘ I can make a cup of tea when someone else is there but on my own…’

Sometimes it can be about saying it’s ok to fail, you’ll do it the next time.

Sometimes the carers of people you are assessing can form a barrier.

Communication and partnership presentation – 17/10/11

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This group defined their approach as ‘Interaction between different stakeholders in the system’. These stakeholders include older people, carers, service staff and family and friends. The group tried to map this system (see slides) but conceded that doing that created a ‘mess’ and stated that the system is incredibly complex for someone who has never experienced the system. Not only was there complexity in the navigation of services, but also confusion around identifying where to enter the system. The implications of this were difficult to comprehend. It seems the students, on looking at the system for the first time, are actually experiencing what it would be like for anyone else trying to navigate their way through the system for the first time.

This group went to a BUPA care home for people who have dementia – a NHS unit and a social work services – to consider partnership working and communication from different perspectives. They also met with older people and carers, which they said was useful because it revealed that older people were not all that different from themselves. They wanted basic things the student believed they would want when they are older, such as being safe, and being independent enough to take a shower on their own (‘the shower of life’ as one older person called it).

The group created detailed maps of how people have approached and experienced services, and how they have navigated through them (see slides). The group extrapolated this to look at how this interaction might impact upon a person’s life and their health.

Problems expressed by people in these experiences were that navigating the system was quite intimidating, especially when people didn’t understand who, what and why services were involved in their lives. They asked people where they thought the problems lay in the services they had experienced and took their lead from the insights they gathered. One issue that was specifically mentioned was around how pride can affect people’s willingness to engage with services.

Key problems the group identified:

- Lack of a transparent system or service structure for people
- No obvious first point of contact
- That carers suitability and support was not always assessed
- Connection between social work and health is problematic
- Conflicting pace of work

This group presented the bud of a few ideas, which included: the development of a ‘super social worker’ which still needed to be thought about and fleshed out, trying to reduce the gap between certain stakeholders and providing a clear view of the system and its connection to other services, resources and people.

There was a lot of discussion about assessments after this group presented, as well as feedback from the audience which included:

Super social worker – could be a GP, someone who is already naturally connected in the community to people.

Patients – clients – people: need to think about how these words are used. One practitioner shared that she does not think of people as sick, but rather that they are her clients that she is providing an assessment for so they can access a service.

Pride and respect need to be considered – knowing what your entitlement is and how you prefer to learn about this.