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Fee for Service and Strengths based Practice are not mutually exclusive

The introduction of the National Disability Insurance Scheme (NDIS) raised questions for many key workers in Early Childhood Intervention Services and other disability services about how a Strengths-based Approach could fit into the new fee for service model. Clients pay for every minute of service delivery which typically involved ‘therapy’ when face to face, so how could sometimes lengthy conversations be justified?

“I’m not sure we can use The Strengths Approach any more”, these were the comments heard in the early intervention sector. “How can we charge people for conversations that don’t include therapy?”

These concerns and questions simply highlighted a gap in understanding about The Strengths Approach. The name, The Strengths Approach is self-explanatory, so what is/was the confusion or doubt about?

An approach is a way of doing something or a style in which you carry out your role. It does not change according to the definition of the role. For example, if I cook pizzas as a job on Tuesdays and Wednesdays and also hold a job as a chef in fine dining restaurant on the weekends, I would not change my approach to preparing food, just because the context of my work. I may have to adjust to the setting in which the service is delivered; however, the quality of the service does not need to change.

So too with using The Strengths Approach in the context of fee for service in the disability sector. Whether you are calculating the cost of a home visit or worrying about charging for a visit when the client was not home after your 30 minutes travel, the quality within which you express yourself as a practitioner and the equality with which you hold your client does not change.

Supporting people who are suddenly faced with a reality that turns their life upside down, involves relationship tension, disturbs their pictures of parenthood and can leave parents totally at a loss as to how they will navigate the care and needs of their child, let alone other responsibilities like work, siblings and financial costs. Much more than allied health ‘therapies’ is often required to engage a family to instil confidence in their abilities and to learn to embrace their lives inclusive of their child with additional needs.

The truth is that we all innately feel a level of surrender, a melting of tension in our bodies when we are treated with respect, decency care and understanding. It is a universal gift to another. The tension caused by not feeling these very qualities in world around us and can cause us to become protective, self-doubting, withdrawn and untrusting. Our wellbeing is affected by this state of being. At times this level of protection will remain throughout the service.

The Strengths Approach is about who we are as professionals, how we express our respect and care with our clients and our colleagues in a consistent and reliable manner. It is about the quality of our relationships, our ability to observe and not to absorb the emotions of our clients. The Strengths Approach is standing steady, noticing the moves and changes that indicate acceptance and the small steps of inclusion in families. It is about how we listen to our clients, how we express ourselves, without imposition or judgement. These qualities are not a chargeable ‘add on’ to an invoice, they are the ‘bread and butter’ of each and every conversation, whether we are changing and appointment time, accompanying a client to consult, doing hands on therapy – all of it.

Relationships are universal and their quality can heal or harm. The Strengths approach is all, and only about connecting with others in a way that confirms their capacity and empowers them to respond to the circumstances and opportunities that have been presented. It is our role and responsibility to encourage others and witnesses them grow their capacity to embrace their lives once their strengths and innate caring capacities have been tapped and confirmed. The Strengths Approach can be sewn in to every part of today’s fee for service model.

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