An alternative
model
of service
delivery for people with disability
An
alternative model of support for disadvantaged people in each community
that they are a part of.
Contents
Outlined
below
is meant to act as a guide only in offering
an alternative model for service delivery for people with disability.
Summary: Top
Is primarily concerned with people who have high support needs and
limited personal support mechanisms.
The needs of people that have a severe physical or intellectual
disability are
generally met within the organisation/service (institutional)
framework. Organisations and services such as Activ, Rocky Bay, TCCP,
Brightwater, i.d.entity.wa etc provide services that support
disadvantaged people in the community.
While
conditions have improved for people with disability,
generally, these organisations have fulfilled the same role in society
as the buildings
that
used to house them. By providing valued
roles for each
community that
they participate in, as well as
using the
principles of Social Role Valorisation (SRV) at the personal level,
people with high
support needs have a better opportunity to
become a part of their community. By
shifting
the organisation to a supportive role, rather than direct
intervention, the community can take an active role.
This will not
be an easy task, there are a lot if issues to
be addressed, but I believe that something needs to be done and the
rewards are
worth it.
Damage
control: Top
Generally,
the
human services are lurching from one crisis
to the next.
Disability
services
Health
care
Justice
system
Education
Aged
care
Indigenous
services
Rehabilitation
services
Refuge
services (poor, destitute, refugees etc)
Etc
All
suffer
from the same problem …
the growing
economy
the growing population
the
existing
resources are being stretched to the max
a
smaller work
force to draw on
higher
cost
for goods and services
increasing
population pressures on existing services
While the
human services cannot change the above, I believe
that we (collectively) can adapt to the new situation.
Disability
services, aged care:
The
current
model of service delivery was appropriate for
the circumstances at the time, where the conditions for disadvantaged
people were terrible.
Today, people
with
disability generally have the same
rights etc as others in the community, and conditions have improved.
I
believe that
it is now time to take the next step and
evolve (so to speak) to meet the changing needs of the community within
the
current social framework. While there are things we cannot change,
there are
things that can, and I believe that we (collectively) need a new
perspective on
our role in supporting people with disability.
I
believe
something needs to be done, as things cannot
continue as they are now.
Yes,
there
will be some pain along the way, but I think
there will be a lot more pain the way things are going at the moment.
History: Top
People
with
disability were housed in large buildings because it was
convenient
and
economical.
1)
these people were
seen as a
threat to society etc
2)
the community
generally did
not have the skills/resources to look
after
their needs
These
buildings were known as institutions.
In
the late
1900’s a number of people wrote about the
conditions of people with disability and tried to do something.
People like
Narje and Wolfsnsberger advocated a set of principles
and objectives, which were designed to integrate people with disability
into
the community.
The
principles
of normalisation, social integration,
empowerment, SRV
etc
evolved to provide
better conditions for
disadvantaged people. SRV is designed to
overcome the
initial
barriers that
disadvantaged people have in developing relationships in different
communities, so that they have an opportunity to
participate
in
the activities and share experiences and be a part of those
communities. The concept of
De-institutionalisation was born.
Today: Top
People
with
disability today: Top
No
longer seen
as a threat to society.
People
with
disability have a much better quality of life
than 100 years ago.
They
have
access to a number of resources that you and I
take for granted that was not available to them, such as proper
housing,
medical care, education etc.
While the
current model of service delivery has been
effective in providing a better quality of life for people with
disability,
these people are generally in the same situation as before (in a sense
that the
organisation has replaced the building), through the very mechanisms
put in
place, that are designed to do the opposite. These
organisations often provide accommodation, daily care, recreation,
employment
etc, or it is provided within the service framework. People with
disability
often live, work and socialise with the same staff and others, and are
referred to as clients, by the organisation. People
with disability who
live in community facilities run by the organisation are subject to the
various
policies and procedures put in place to provide a safe environment for
clients
and staff etc. Client independence is often compromised by these
various
policies and procedures.
There are people with disability who work in shops etc in the community
that do have
valued roles within their work place.
Yes,
people with disability do live and work in the community, BUT,
are they a part of their community ??????
Rather than building new communities around
people with disability, we should be building existing communities
(living,
recreation, education and employment)
that have
the skills, resources and valued roles, where people with disability
are a part
of each community.
The
organisation today: Top
Organisation: refers to any service that is provided by a service group
or
organisation that
specialise
in looking after the needs of people with disability. The
organisation may specalise in a particular area of care
(accommodation,
recreation,
education or employment), or provide services that include all aspects
of a person's life. Organisations are generally funded by the
Disability
Services Commission (DSC) and contracted to provide the service within
the policies of the DSC.
The
organisation evolved according to a set of standards
and principles designed to support people with disability.
The
organisation’s role:
… to actively
promote the
needs of people with disability through the
principles of normalisation, social
integration, empowerment and SRV,
…
to
actively support, through direct
intervention (accommodation,
recreation,
education or employment), people with
disability
in the community.
Typical
structure of current service delivery (within the
disability service framework) in providing for the needs of people with
disability.
The
organisation also has its own needs in fulfilling its
role in providing for the needs of people with disability.
It can be seen
that there
are two broad functions that the
organisation has:
1) Supporting and
maintaining the needs of the clients
2)
Supporting
and maintaining the needs of the organisation
Sometimes
the
needs of the organisation become greater that
the need of the clients supported by the organisation:
… income, The
organisation
cannot function with out
donations, Gov funding, etc.
…
qualified
staff, Lack of competent staff means that the
clients are not getting the proper support, etc.
…
maintenance,
The organisation needs to maintain the
facilities, equipment to a standard that is required by the service
uses (staff
and clients) to maintain service delivery.
…
management,
the management hierarchy increases to cope
with its own needs.
Etc.
Other factors
also impact on the organisation’s ability to
provide for the needs of its clients.
… current
workforce: the
organisation is limited to the
available workforce to draw on.
…
costs of
goods and services (electricity, petrol,
external labour costs etc) all impact on the organisation’s ability to
function.
…
reliance on
the community to support the organisation
through Gov funding, donations etc.
…
increasing
community demand for services also put a
strain on the ability of the organisation to provide the proper support.
…
services
are
designed to target specific groups that fulfil
the criteria of the service (specialised). This means that where there
are no
services available for the person, that person does not get the support
needed.
…
organisations also
have a limited capacity, which means that people that
qualify for the service can not receive
the
service if there is no
room. People who
share a characteristic that is rare in the community often become
marginalised because of a lack of services or resources to support
their needs. This is a problem in country areas where resources are
limited.
Etc.
As the
organisation grows, the demands of the organisation
increase and put an increasing strain on existing internal and external
resources to the point where the organisation cannot provide the care
needed in
supporting its client base.
The
community today: Top
Some organisations that provide for the needs of people with
disability function as a community within the wider community.
... have their own
policies and support
structures etc.
... provide live
in accomodation staffed by the organisation.
... provide work, accomodation, education, recreation and
profesional services.
... provide volunteers and home support services.
Organisations
also actively engage in supporting and
promoting the needs of people with disability in the wider community. Generally, the
community is approached by the organisation
to support the activities of the organisation through:
… advertising
their various
development programs and
promoting people with disability generally.
…
volunteer
programs.
…
sponsorship
programs through business and company support.
…
community
events organised by the organisation.
The community’s
role is
supportive in participating in the
programs and activities provided by the organisation. As
a
consequence, there may be two or three organisations providing the same
services (accommodation,
work, recreation etc) within their own
community, within the wider community. These organisations are also in
a competitive market with other organisations for staff, donations, sponsorships,
research etc, in the wider community.
Organisations
that provide
services
for people with disability can be seen as communities within the
broader community.
These
organisations sometimes
provide
duplicate services etc.
The stakeholders today: Top
Currently,
the
organisation
provides the link between people with disability (and families) and the
wider community through various
activities.
The role of
government policy and practice
in the community: Top
Government
policy and practice (the institutions
of government, and
how these institutions determine the decision making process towards
interventions in community practice).
The various programs or
strategies designed to
support disadvantaged
people in society have evolved through a process that could be best
describes as "trial and error" in response to various social issues
within society. Government resopnds to an issue by creating a
department to deal with the issue.
Universities and institutions use historical and evedance
based research
related to the issue within that arena.
People with an
intellectual disability
are supported within the
psychiatric/developmental arena
People with a physical disability are supported within the
physical/occupational arena
The aged are supported within the gerontology arena
Each Government,
state,
department or locality has a different approach
to supporting disadvantaged people in society..
There are a number of reasons for this
... Historical
development
of government policy: Each government has a different economic and
social structure and a different politicial framework that fulfills the
needs of the state.
... Political agenda: While
a particular political party sets the agenda in policy and practice
within a state, it is the social institutions of the various
departments that determine how the policy and practice is used in wider
community.
... Community
needs: Each
policy has evolved to suite the needs of the state. Because each has
different needs, these policies will be different.
GOVERNMENT
INSTITUTION
Community
disability services: an evidence-based approach to practice : 2006 :
Ian James Dempsey, Karen Nankervis
Supporting
the housing of people with complex needs : September 2007, AHURI Final
Report No. 104
Future: Top
People
with disability in the future: Top
People
with disability (inclusive definition):
The current definition is based on a medical model, and while
appropriate for
medical and legal purposes, only highlights
(reinforces community perceptions) the
fact that people that have a physical or intellectual disability are
different from others. I propose to use a more inclusive (social)
definition.
Any
person
that has a particular
characteristic that disadvantages
their ability to fulfil their needs, actively partake in the normal
activities
of their community, or devalues their identity within their
community.
(Peter Anderson 2008)
Having a disability does not
necessarly mean that the person is
disadvantaged. The Blind and Deaf are examples of communities do
not see themselves as disadvantaged. There are also people that are
amputees that have their own communities and are able to live
independent and fulfiled lives.
The above also sugests that it is possible for any person to be
disadvantaged for any reason in any community. Some studies were done
with school children a few years ago where the class was divided into
groups (
Blue eyes
Brown eyes).
The results clearly showed that people
become disadvantaged quite easily. Just as Muslems were targeted a few
years ago because they may be terrorists, all Muslems became
disadvantaged. The same thing happened to the Jews and any number of
other groups of people. The same thing can happen in any community. If
I wear my P.J's to work (which has happened in America) I am seen as
someone who is different. In some communities a particular
characteristic can be an advantage. While I was travelling around the
Northern Territory I certianily felt like a second class person in the
shops. I spent some time living in an Aboriginal community and it took
a while to become accepted as a part of their community.
The
needs of people with disability are as varied as the people themselves. Some
are mostly independent,
have their own community networks and only need a small amount of
support.
Others are highly dependant and need full time support. Just
as
a group of school children are associated with a particular school, or
a group
nurses people are associated with a particular hospital etc, people
with a
particular disability become associated with a particular organisation
that promotes and support their needs, Eg: Activ support people who
have an intellectual disability, TCCP support people who have cerebral
palsy etc. I
know
that when I see a person with an intellectual disability, the first
thing I think
of is the disability. I may also think about the organisation that
actively
supports and promotes them, as well as the slogan and the logo of the
organisation, and the glossy brochures and advertising remind me that
this
person is just like me. I also know that the organisation is looking
after
their needs.
Most
of
us only spend a short amount of time in institutional care (school, or
hospital
etc), and we have our own families and lives to return to. However,
there is a
percentage of people that spend their whole lives in institutional
care, and
that is all they have. Some have even been abandoned by their families
and have
no personal support mechanisms. There
will always be people with disability that need part / full time care,
respite, specialised services etc.
Institutionalisation
generally referred to the conditions that people with disability lived
in,
within the facility. Historically, institutions were established to
look after
disadvantaged people. While conditions have changed, today, we see
organisations fulfilling the same role. I
believe that we should move away from the paradigm (that people with
disability
are institutionalised, and our goal is to De institutionalise them)
that
underpins disability services. (The
concept of De-institutionalisation
as
applied to today)
(Beyond
De-institutionalisation)
An
institution could be describes as:
(
Institutions)
(
What
Are Institutions)
Any club, facility,
organisation or
gactivity that:
... has more than one member that actively participates in the club,
facility, organisation or community activity.
... is organised within a defined set of formal and informal beliefs,
values, roles and behaviours,
... may be highly structured within these formal and informal beliefs,
values, roles and behaviours,
... shares a set of objectives.
Institutionalisation:
Institutions
are a fundamental part of our culture and
society.
They
are a
necessary part of our everyday life.
Every
culture
has its individual customs and institutions.
We
are all
institutionalised from birth to death.
So, to try to
De institutionalise someone seems a bit silly
(unrealistic).
The
problem
is not the institution, but the way in which it is used.
Think of any good examples
of
institutionalised care: living,
education,
health, recreation etc.
Think of any bad examples of institutionalised care: living, education,
health,
recreation etc.
Think of any activity you are involved with.
Think of the various institutions that may be involved with the
activity.
What
we
(Disability services) should be doing is
acknowledging the role of institutions in our society, focusing on
their
strengths, not weaknesses, and developing a different approach to
service
delivery within an institutional framework. In
other
services (Health care, Justice system, even the education
system)
the institutional model provides the foundation for service delivery.
There are some excellent examples of aged care, where nursing homes,
retirement villages etc
provide the
specialised care, recreation, community participation etc.
If
anything ….
what
we should
be doing is not to De-institutionalise, but
to Re-institutionalise !!!!
It
could be
argued that by
applying the principles of Social
Role Valorisation (SRV) to the
particular setting that is supporting people with disability, there is
a conscious process of changing our values, behaviours, the social
structure, and the environment in which we participate, and that
all participants
are
being
institutionalised, in behaving within a defined
set of goals, beliefs, values, roles and behaviours that promote valued
roles for devalued people. By
providing valued roles for each community that
they participate in, as
well as
using the
principles of Social Role Valorisation (SRV) in developing personal
relationships, within the
institutional
setting of the respective
community, people
with high
support needs have a better opportunity to
become a part of their community.
The
organisation
in the future: Top
The
role of organisations in raising community awareness into the plight of
people with disability has been significant, and they (people with
disability)
would
still be in the same situation if it were not for their (the
organisation’s)
intervention.
As
mentioned earlier, I see the current role of organisations as one of
providing
direct intervention in the care of people with disability.
Now
that people with disability have a valued role in society, I
believe that we (as
a
SERVICE
to HUMANITY) should now focus on providing a valued role for their
community (so
to speak). The time has come for the organisation to shift into another
gear
(so to speak).
I believe …
The
organisation should focus more on providing the
necessary skills to the community through a decentralised management
hierarchy (Local
community support group, LCG),
with a greater focus on local community management, rather than direct
intervention. By acting as a
peak body, the organisation (still retains
the specialised services unique to the organisation and still functions
as an
institution) supports the LCG in providing the necessary resources
needed to
support people with disability within the community setting.
The
other
advantage is that the LCG has a more ready access
to other peak organisations that specialise in other areas of care.
Rather than two or three organisations providing the same services, The
LCG can optimise (and provide a more holistic approach to) service
delivery by matching the needs of its members with the particular
organisation that specialises in a particular need.
People
that have a rare disability or disease that are supported by small
organisations are able to join a LCG and still receive the support from
that speciality.
Each
organisation would have a supportive role in providing for the needs of
people
with disability.
The LCG would be made up of a committee of local community members with
a social worker that supports people with high support needs and their
families in developing valued relationships within their community. The
community has the opportunity to become more actively engaged in
supporting people with high
support
needs and their families through the various activities of the LCG. Having a local
support network can be the first step
towards independence.
(Click on image below to
view detail)
Structure of
LCG shows
community
stakeholders that support direct intervention in the care of people
with high support needs.
Various
activities are
coordiated through the LCG with the
support of
the various organisations that provide specialist services.
The LCG is accountable to the various government policies
and
regulations in respect to performance and service delivery.
Single / shared
accommodation that
supports a person with a disability.
By
shifting the organisation to
a supportive role, the community has the
opportunity to become more actively engaged in their (people with
disability)
care.
There will
always be a need for highly structured (institutionalised) care for
people with high care needs, respite etc. By
providing
a
facility (group home, group of units, boarding house, hostel, nursing
home or village) that supports a
small group of people
with mixed or the same characteristics (max 10 to15), the residents
have an
opportunity to
develop
relationships, participate in recreational activities within the
facility and
engage in other activities in the wider community. Yes, they are in an
institutional setting, but:
... the facility
that
they
are a part of is a part of the community and not a part of an
organisation,
... the institutions
that they
are a part of, are are a normal part of the life of the wider community,
... they
are
provided with the most appropriate care for their needs,
... SRV is still an important part
of developing personal networks,
...
they have the
opportunity to
develop social networks within the wider community,
...
they have the
opportunity to participate in
the
activities of the wider community,
...
they are valued as a
part of
their own community as well as the wider community.
The facility
that looks after
people
with high support needs is run by the LCG, rather than the organisation.
The LCG
can match the needs of the people
with each organisation that specialise in an area of care.
The LCG can also support each community in providing for the needs of
its members.
The advantages
…
… shifts the focus
of the
service from the
organisation to the community,
…
the person with a
disability has more control over their own lifestyle,
…
the person with a
disability is a part of their community, rather than a part of a
service provider,
…
family and
significent
others have valued
roles in
supporting the person,
…
each community (accommodation,
recreation, education and employment) has a greater input
in providing for
people who have high
support needs,
… a more rationalised and
effective use of existing
community resources (available skills, professional staff etc),
…
community resources are
tapped into more effectively,
thereby reducing the strain on more conventional methods of raising
support
(Gov funding, donations, sponsorship, fundraising events etc),
…
direct care is more open and
transparent,
… by being a part of a LCG,
members are
less likely to slip through the system besause they are a part of the
systam. Where there are no rescources available to support their needs,
members still feel conected through established networks within their
own
communities.
etc.
The
disadvantages …
… the organisation
looses its
control over stakeholders as it
shifts from an active to supportive role.
…
issues of
funding, accountability, guardianship, direct
care providers (nursing etc)
…
locating
services in appropriate areas.
…
co-ordinating
services from different organisations.
… The LCG in more
dependant
on the resources of the community.
…
distributing
limited resources between the LCG’s
etc.
The
community
in the future: Top
By fulfilling
an active role above, the organisation also
takes on a certain amount of ownership (in providing for the needs of
people with disability), and as a consequence, the community sees its
role as
a
passive and supportive. The higher the
profile of the organisation, the higher the
expectations of the community in the organisation in fulfilling its
role. The community
has not had an opportunity to develop the
necessary skills for an active role, and as a result a co-dependent
relationship
is unintentionally created between the people with disability <> organisation
<> community.
So
far
the focus has been on providing the skills to people with disability,
families
and significant others. Often the people
with
disability, families and significant
others do not have the skills or resources, or incentive to develop the
social
networks within their own communities. It can be a daunting task to
develop the confidence to reach
out
(especially with a disability). By shifting
the focus from the organisation, to the
community (and providing the skills and the tools), the co-dependent
relationship is broken.
An example of this is where Mr "A" has son "B" who has a severe
intellectual and physical disability. Mr "A" currently has the choice
of:
… Keeping
his
son at home and support him himself, ie; learning new skills, hiring
appropriate services such as medical, recreation etc,
… Or
contacting the particular organisation or community support service
that specialises in the particular disability that son "B" has.
The organisation or
community
support service may have services available (depending on their own
situation) according to "B"'s needs.
"B" may be admited to community facility that supports three other
people with high support needs. "B" becomes a part of the
organisation, where he is looked after by staff that work for the
organisation, taken to activities that are provided by the organisation
(or within the service framework) by staff of the organisation, and
lives with and socialises with other clients of the organisation.
"B"'s home is now with the
organisation and he is now a part of that community. Mr "A"
no longer has any direct input into his son's care and becomes
dependent on the organisation in providing for "B"'s needs.
In the future, I see an
alternative
option for Mr "A" as contacting a LCG that can
develop the
social networks (living, medical, education, employment, recreation)
that are most appropriate for "B" within
each
community, The LCG would be comprised of a social worker and members
from the local school, boarding home, recreation club etc in the
community and have trained volunteers. Mr "A" would have the
opportunity to develop the support networks (valued friendships etc)
for his son within each community that his son is a part of.
Rather than building new communities around people with disability,
we
should be building existing communities that have the skills and
resources
and valued roles, where people with disability are a part
of
their respective community. Through the development of valued roles for
the
school, employment and
recreational communities, they would be a part of the process in
finding the most appropriate solution for "B"'s needs. For example, the
local school could have its own program where "B" is included in the
activities of the school that are most appropriate for "B" and the
other members of the school community. Transport
for example could be provided by the
school, or volunteers, or even other members of the school community,
or
a mix, depending on the rescources of the school. There is already a
transport service industry (Swan Taxis etc) that provides transport for
wheelchails etc. Solutions to medical issues could also be found using
existing sevices in the community (similar to Silver Chain, HACC etc).
Most schools have (or
should have) a first aid post where medical needs for "B"
could be coordinated through the Dep of Health etc.
By actively
participating in activities that support "B", the other members learn
valued roles (SRV), behaviours, and skills. These learned values,
roles, behaviours, and skills will be
reflected in the culture (goals, beliefs, values,
cultures, institutions etc) of the community. By becomming a valued
member of each
community (accommodation, recreation,
education or employment), "B" has the opportunity to participate and
share experiences
with the other members of each community.
<------->
Direct support provided by family, friends (volunteers, co-workers etc)
and community
networks within each community (home, recreation,
education and employment).
<------->
Staff or specialised service employed by the
person,
family or LCG to provide specialised
care that is not available within
the local community network, eg medical, skills development, transport.
The local community has access to special skills provided by
the
respective organisation.
The various activities of
each community (education,
living/recreational and
employment) would be coordinated through
the LCG,
which is supported by the organisations that specalise in a
particular area of care.
The stakeholders
in the future: Top
It
can be seen
that the focus shifts from the organisation
to the LCG.
Each
community (accommodation,
recreation, education and employment) is supported by the LCG in
providing for the needs of the community.
Needs
based models of service delivery: Top
While SRV and PASSING are designed to provide valued roles,
social image and compentancy enhancement respectively to devalued
people, the particular model of support depends on the needs of the
person as well as the needs of their community. People with low support
needs only need a small amount of support, and are able to fulfil their
needs, actively partake in the normal activities of their community.
People with high support needs will require a different model that is
more structured and specalised in providing for their needs.
Service delivery has five main finctions:
… To provide a service to
the users,
… To provide the rescources (staff, volunteers, facilities, equipment,
skills,
knowledge etc) necessary for the service,
… To maintain the service to a standard that can be used by all members.
… To balance the needs of the service users with the needs of the
service, and the needs of the community,
… To share and draw on skills / resources where needed.
Different models will reflect
a particular aspect of the service delivery, these include, but are not
limited
to:
… Social (holistic):
is concerned with who we are, and how we socialise with each other.
Human
interaction with each other and the environment play an important part.
Families, ethnic or social groups, hobby clubs are
all about how the members interact
with
each other and how the
environment affects the members as a group. Members also have the
opportunity to change their own environment to their own needs without
affecting the community as a whole. The purpose (objectivities, goals,
policies etc) of the community are less formal with less defined roles.
… Professional (specialised / holistic): is
concerned with providing an environment that accommodates the
particular profession or the activity of the profession (educational
/ medical / business). The members
have to fit in to structured environments that are less accommodating
to the needs of individual members and how they interact with each
other. Work places, schools, churches, hospitals,
boarding houses, nursing homes (even suburbs) are about groups of
people, and how the
person fits into
the
environment rather than how
the environment fits into the person. The purpose (objectivities,
goals, policies etc) of the community are formal with clearly defined
roles for its members. Community services are often built around the
professional model, where staff or volunteers are employed by the
service to support the service users within the goals, values etc of
the service provider. Resords are kept on budgets, expenses, care
plans, progress notes, medical histories etc.
… Scientific / economic (specialised): is
concerned
with research, facts and figures. Focus is on objective systematic
enquiry of
objects, patterns of behaviour, time and resources, balance sheets
and budgets, efficiencies of scale, opportunity cost etc. Human
interaction
with each other and the environment is seen as a system or numbers on a
page. The purpose (objectivities, goals, policies etc) and the roles of
the community and its members are studied and assessed according to a
set of criteria.
Communities are generally a mixture of the three types (Social,
Professional and Scientific). Social groups need to have the freedom to
socialise, but also need some order and structure to coordinate
activities and work within budgets
etc. Work places etc need formal structures and
environments to achieve the desired goals, but, there also needs to be
some
flexibility
to allow for individual needs. Scientific communities
study, measure and
analyse
the
behaviour, performance and the
environment of the individual and the group, but, they also need to
have
some
flexibility
to allow for individual needs.
The
service setting: Top
Refers to the environment that the support is provided in. Can be
accommodation, recreation,
education or employment. The setting is usually adapted or modifyed to
enhance social image and personal competence, eg, allows the person to
participate in the activity in the least restrictive way.
There will always be a need for professional staff that are qualified
to
provide specalised support (nursing etc). The advantage is that a LCG
has the scope to access the appropriate skills from the appropriate
organisation. Just as a person would go to a doctor for medical
problems and a physiotherapist for other problems etc, the LCG would be
able to contact an organisation that specaliases in a particular area
of care.
The
least restrictive environment often refers to adapting the environment
to suit all members, so that they have an opportunity to participate in
activities, share experiences and be a part of their community. How the
environment is adapted will depend on it's particular construct
(social, professional or scientific), the amount of adaptation that is
needed to suite all members and how the members are advantaged or
disadvantaged through the adaption.
Staff are provided by the service provider, or are
employed, to
provide specialist care, skills development etc. A person may live in a
home that is run by a service provider,
and community recreation,
education or employment are supported by another service provider. An
example of this is in a classroom environment, where a person has a
intellectual or physical disability. The adaption is the inclusion of
an aide to assist the person has a intellectual or physical disability.
How the adaption
advantages
or
disadvantages the others depends on the overall type and the quality of
the
activities, the
opportunity
to participate in
the activities, share experiences and be a part of their community.
Shows the
relationship
between the needs and the support required in
providing
for those needs.
When providing support for prople with an intellectual or physical
disability, the environment in which the support is provided is
directly related to the needs of the person. The higher the support
needs of the person, the higher the intervention, which means that the
environment will be more structured and insitiutionalised. This does
not mean that the support is dehumanising. It does mean that the
support provided is most appropriate to the needs of the person.
The
role of the service setting: (See
Disability
services
role
models)
Top
Each of the types of
settings
described above is designed to fulfill a particular need of a group at
a particular time. Participants have the opportunity to move from one
type of setting to another (isolated, separated, partial integration
and full
integration etc.) according to their particular need at the time as
well
as the needs of the group or community that they are a part of.
Shows the
relationship between the needs and the type of setting in which the
activity is
placed.
Participants
have
the opportunity to move from one setting to another
according to their own needs as well as the needs of the community.
At a school, for example, we see all the above settings for different
activities. We see different classes for different subjects, special
classes for students that need help in maths or writing a thesis, one
on one tutors that provide specialise support for a need etc. We see
various recreational groups designed around an activity that requires a
specific setting. Can you imagine trying to play squash on a footy
oval, or a game of footy in a squash court? The members of the school
community have the opportunity to move from one activity and setting to
another according to their own needs as well as the needs of the
school. Within the school we also have different communities, the
photographic community, the chess community, the pub community etc.
Members often participate in one or more communities, and have the
opportunity to move from one to another according to their own needs,
as well as the needs of others within the school community. Within the
school we look for something that interests us or we are good at, as a
way to meet others and share experiences and develop valued
relationships. People with high support needs may have some difficulty
in developing these relationships, but by finding the most appropriate
community for the person, and introducing the person to others in the
community is a start.
Valued
community roles: Top
Each community has a particular role that fulfils a particular need.
Valued community roles provide a common cause or focus for the
community, as well as other communities that are a part of it.
Valued communities provide valued roles for their members.
Social role valorisation provides valued roles for ALL members of the
community.
Communities that have valued roles in society …
... The spiritual community
... The family community
... The living community
... The recreational community
... The learning community
... The employment community
... The health community
... The internet community
... The blind community
... The disability community
etc
The values of community start in the home where children have valued
roles in supporting others at school, sport or any other community that
they participate in.
Communities that have de-valued roles in society …
... The AIDS community
... The drugs / rave communities
... The criminal community
... The gay / lesbian communities
... The Muslim community
... The bikie community
... The street community
... The unemployment / homeless communities
... The aged community
... The single parent community
etc
By providing valued roles to the respective communities (living,
recreation, education and employment), where they become more actively
engaged in the process of supporting people with disability, they feel
that they are a part of the process.
Whichever model is used to support people with disability, they all
need to meet the same criteria:
… The model should meet the needs of the
person in providing the most
appropriate support for the person,
… The community should have a valued role in supporting disadvantaged
people.
… The community should provide valued roles for it's members.
… All members should be respected and valued as a part of the community,
… The needs on the community should be balanced with the needs of it's
members, and with the needs of the
community that it is a part of.
… The model should be consistant with the goals, beliefs, values,
cultures, institutions etc of the community.
"Community
empowerment is the process of
enabling people to shape and
choose the services they use on a personal basis, so that they can
influence the way those services are delivered. It is often used in the
same context as community engagement, which refers to the practical
techniques of involving local people in local decisions and especially
reaching out to those who feel distanced from public decisions." (Community empowerment
- Communities and neighbourhoods)
"Community
development
is a structured intervention that
gives communities greater control over the conditions that affect their
lives. This does not solve all the problems faced by a local
community, but it does build up confidence to tackle such problems as
effectively as any local action can. Community development
works
at the level of local groups and organisations rather than with
individuals or families. The range of local groups and
organisations representing communities at local level constitutes the
community sector."
"Community
development is a skilled process and part of its approach is the belief
that communities cannot be helped unless they themselves agree to this
process. Community development has to look both ways: not
only at
how the community is working at the grass roots, but also at how
responsive key institutions are to the needs of local
communities"
(What is
Community
Development)
By actively
participating in activities that support "B", the other members learn
valued roles, behaviours, and skills. By engaging the respective
community in an
active role, the learned values, roles, behaviours, and skills will be
reflected in the culture (goals, beliefs, values,
cultures, institutions etc) of the community.
Rather
than building new communities around people with disability, maybe we
should
be
building existing communities
that
have the skills and resources and valued
roles, where people with disability are a part of their respective
community.
Valued
roles
or valued relationships: Top
The
value of a persons role
is purely subjective when applied to different settings and activities
in
different communities. We all have different roles
depending on what we are doing, where we are doing it and who we are
doing it
with, and therefore the person's role
takes on different meanings within each community that the person is
participating in. Roles
are like the clothes we wear. Each activity requires a different outfit
(both
literally and figuratively). The example of actors in a play also shows
us that roles
are learned behaviours. We all are conditioned to behave a certain way
(we
learn our lines from the moment of birth) according to the activity,
setting
and the expectations of others within the activity and setting i.e.: we
don't
wear our bathers to a formal dinner etc. It could also be argued that
communities have become conditioned in behaving a certain way when
looking
after devalued people (in the historical sense, as well as in society
today) (Removing
the barriers to community participation and inclusion).
All members are expected to behave according to their role
within the setting. If a person’s role
is to be submissive, then, when the person takes on a more active role,
the person may be punished.
When
we
change the perspective from Society to Community we have a
better idea of what we are trying to achieve. Community is all about
valued relationships, about careing and shareing, about being with
others we love (Understanding
communities). SRV is all about providing those valued
relationships
and support networks to disadvantaged people who have been
disenfranchised by society for various reasons. Valued relationships
transcend roles. Without others to share our feelings with, life
becomes meaningless. It does not matter how much money or possessions
we have, if we have no one to share it with, life becomes meaningless.
SRV is all about building values and
relationships
in
communities. These communities may be a part of an organisation or
service provider, a family or club, or work, or school. By providing
valued roles for ALL members of each community that the person wishes
to participate in and is most appropriate for the person (Disability
services role
models), the person is
more likely to have valued relationships within those communities.
Living
in the community: Top
We see a variety of
types of buildings and settings that are used for accommodation within
the community (cities, towns, suburbs etc) . We see
large highrises, appartment blocks, vilages, estates, units, single
dwellings etc that
are mini communities within the wider community. These are all designed
for specific purposes and fulfill specific needs within the wider
community. To a certain degree people choose the setting that most
suits their life style. Each style of living has its own advantages and
disadvantages.
A one size fits all approach will not work. Accommodation (single,
group, clusters, village, nursing home etc) would need to
be tailored to the needs of the person (social, medical, specalised
support etc) as well as the needs of the community (economic, location,
size etc).
The needs of people that have a physical or intellectual
disability are as varied as the people themselves. Some need only a
small amount of care, and others need full time support, and spend
their whole lives in highly structured (institutionalised) care. Lets
be
realistic in providing for the most appropriate care in supporting
people that have a physical or intellectual disability. Of course there
will always be facilities that support groups of people (units or
"Co-Housing" or “Small Cluster”, shared accommodation,
boarding
houses,
respite centres,
nursing homes etc), but that does not mean that
these facilities are not a part of the community.
Rather than build better individual housing, supported accommodation
etc, we need to build better communities that are more able to fulfill
the needs of its members. By promoting institutions as an important
part of the community, we
can develop a more appropriate (and holistic) approach to balancing the
needs of people that have a physical or intellectual disability with
the needs of the community that they live in, i.e. people are placed in
accodomation
that is most appropriate for their needs, as well as the needs of the
community in which they live.
Being a part of a community is also about sharing experiences and
participating in other community activities. Community living is
more than our accomodation. We also work, and play. We may be employed,
go to school or be involved in a local club or community group. There
are any number of communities that we may be involved in. People with
high support needs may live in accommodation that is supported by
an organisation or service provider that is structured to their needs,
and have a network of friends within the accommodation. By having the
opportinity to develop networks and relationships within other
communities, with the support of the respective community,
people
with high support needs become valued members of each community.
The LCG could work with existing recreation groups to develop social
networks, strategies for inclusion etc for people with disability. A
LCG also has the opportunity to build new recreational clubs or groups
(probally along the lines of YMCA, Rotary, or Lions, church groups etc)
through established community networks, where people with high support
needs have the opportunity to develop relationships, share experiences
and become valued as a part of that community. The particular type of
club would need to meet the needs of the community as well as the needs
of individual members.
Education or employment could also be
coordinated by the LCG. By involving the whole community (education or
employment) in the process, solutions can be found to issues
such as transport, participation, medical needs etc, that are most
appropriate to the community, by the stakeholders,
where people with high support needs can be a part of the respective
commuity. The members of the respective communities develop new
relationships and skills, and the most appropriate support is provided
for the person with high support needs.
A
community group or a community service: Top
A community group is where a number of people get together for a common
purpose of interest. The group may provide support for each other, or
support others that need some help in providing for their own needs.
They share skills and resources to achive the goals of the group. There
is a sense of purpose and achievement in the project, All members
benifit in participating in the activity. There is a value in being a
part of the group. While the group may provide a valued role, it is
limited by the skills and resources that can be shared within the
group. As a result the members may look to a business or service to
provide a skill or resource that is not available within the group. A
service is a business or organisation that provides specalised skills
and resources to a community that are are not available within that
community. The service is structured or organised around a need. This
need can be transportation, home maintenance or anything that is not
available to a person or a group of people. Services such as
electricty, water, gas, telephone etc were originally (and still are in
some areas) the responsibility of the person (they were not provided as
a community service). The trend today is to encourage individuals
(through subsidies or bonuses) to provide for their own needs as much
as possible rather that relying on the service. This strategy reduces
excessive demand on existing services that are unable, through various
reasons, to keep up with population growths.
Originally human services were the providence of a family or group.
They managed as best as they could. Over a period of time human
services became so specialised within each area of care that they have
become service industries within their own right. These services now
provide important roles within society. They have the specialised
skills and resources that are not available within the wider community.
These days the trend is to shift the support mechanisims from congreate
care to indivualised care. While the settings may have changed, these
mechanisams are still there, where the support is provided by a service
that is specialised within a particular area of care. As a result we
see a multitude of services that support people in a vartety of
settings that most suits the persons needs, as well as the needs of the
wider communities that these services are a part of. People with high
support needs that can not be supported within their community are
still supported by a service that specialises in a paticular area of
care.
I feel that a time where people with high support needs are are
supported within their own communities will never return. We can change
the settings and provide more appropriate supports where these groups
have more opportunity to be more involved in local community
activities, however, these groups will always have the support
structures and mechanisms as a part of their lives. The way the support
is provided is determined by the society in wich we live, as well as
government policy and practice. This does not mean that a community can
not be a part of the process. Who knows what will happen in the future.
Will societies be the same as they are now in 100 years time? Will
communities as we know them today still exist? Somehow I feel that the
answers to both questions will be NO.
Whatever the future is, the reality is that we are living in the
present and it is up to us to determine the future. Communities are
changing in the sense that they are no longer bound by geographical
locations. However, the idea of community is probally more important
than at any other time. Communities provide the way we socialise with
each other. They provide a way to share experiences, and relationships.
Having a local community support network can be the first step towards
independence.
Rather than building new communities around people with disability, we
should be building existing communities that have the skills, resources
and valued roles, where people with disability are a part of their
community.
A better description of a group of
stake holders that get together would probably be "local area group" or
"a community network of support".
Representatives of the local businesses, recreational groups, youth
groups, educational institutions and government departments get
together to find the best solutions to enable people with high support
needs to participate within each community that they wish to
participate in. The community may be a local community or a part of a
service provider who specialises in a particular area of care. The idea
is to involve other local community services as much as possible in the
support.
This has the advantages of ...
... all stake holders are
a part of the
process
... various issues can be discussed and solutions can be found within
each community
... communities have the opportunity to become more familiar with these
groups
... new patterns of behaviors are introduced into the community
... the community learns new skills
... existing community resources are used more effectively
... can create networks within each community
... is flexible in providing for the individual needs of each person,
as well as each community that is most appropriate for the person
... provides the tools that help each community help themselves:
policies, funding, training can be coordinated through a local group.
... services that specialise in a particular area of care can be
employed to suit the needs of the person and the community.
An
example of a community service
providing direct community care: Top
CLAN Mirrabooka (Community Link
and Network) (CLAN)
"CLAN
WA will strengthen family life by encouraging healthy relationships,
effective parenting, support networks and community participation."
(http://www.clanwa.com.au/)
CLAN is community focused, and
provides the skills and networks for families to become empowered.
CLAN
is about
helping people help themselves.
People
with high
support needs: Top
Where people with high support needs can not be supported within a
community (family, living, recreational etc), new communities are
created that can provide for their needs. We see nursing homes,
hostels, group homes and villages designed around groups that have
similar characteristics.
Rather than being separated from other communities, we need to involve
other communities within the community of the nursing home, hostel,
group home or village. I am not suggesting that these facilities become
hotels, however, there is a simularity between the role of the hotel
and the role of the nursing home, hostel, group home or village in
society. A hotel provides services to the wider community that it is a
part of. There are function rooms, restaurants, shops, post office,
gift shops as well as providing a venue for small community groups. In
essence, the hotel is a community that is a part of the wider
community, and in some places, the hotel is the community.
By making these communities (nursing homes, hostels, group homes and
villages) more accessable to other communities, people with high
support needs have the opportunity to become more actively engaged
within these other communities. Also, there is no reason why a hotel
can not have the ficilities, skills and resources to support maybe 1 or
2 people with high support needs within that community.
The facility provides
valued
community services, and is more
accessable to the wider community.
The
good life: Top
Today disabled people generally have more opportunities to access
social activities (shopping, movies, functions etc) that most of us
take fore granted. Various government policies are designed to allow
entrance to buildings, parks and other venues so that disabled people
could participate in and share the same experiences as others in
society.
The goal of the human services is to make a positive difference in a
person's life. There are things we can change (values, attitudes,
behaviours, cultures etc.) and things we can't change (available
resources etc.). By enabling people to fulfill their needs, develop
community networks, participate in activities and share experiences
within their community, they have the opportunity to become valued
members of their community. Conversely, by enabling each community to
fulfill the needs of its members, to foster and develop personal
networks within that community, to facilitate strategies, solutions and
activities so that all members have the opportunity to participate in
those activities, and connect with other members through shared
experiences and valued relationships, the community has the opportunity
to become valued by its members as well as other communities that it is
a part of. By providing each community with the skills and resources
and valued roles that include people with high support needs, these
people have an opportunity to participate in activities, share
experiences with others and become valued members of each community.
"The good life" means different things to different people. Only by
developing the necessary skills, networks and valued relationships
within his/her community (living, recreation, education or employment)
can a person participate in, and become a valued part of their
community. The needs of the person also needs to be balanced with the
needs of the community in providing the most appropriate outcome for
the person (people with high support needs will need a more structured
setting than people with low support needs).
"The good life" could be described as: having the opportunity to
participate in activities and share experiences etc (whatever the
setting, structured or unstructured), in a positive way, where all the
participants have valued roles. Although the settings are more
structured and therefore more restrictive, it is possible for people
with high support needs to have as good a life as possible that is most
appropriate to their needs. (See also
Disability
services
role
models).
In
conclusion: Top
I
believe that
as a human service, we (collectively)
(unconsciously) place more emphasis on our own role as a service provider
rather than as a service to humanity, and
under value the community’s role in a patronising way (that they are
not
capable, or that I know what is best). Of course they (the community)
won’t be
capable if they do not have an opportunity to actively participate. The focus, so far
in
service provision, has
been on empowering and enabling people with disability, as well as
community
education. Problem as far as I can see, is that the community has had a
passive
role, kind of like a student at school.
I believe that
there is a huge resource out there that is
not being fully utilised … the community. By using a mix
of
community valued roles and SRV, the community can take a more active
part in supporting people with
disability.
The above is
intended to provide a more holistic (and
realistic) approach to service delivery, where the needs of people with
disability are balanced with the needs of their community, rather than
the
current model, where the needs of people with disability are balanced
with the
needs of the organisation.
I
am
not saying that SRV is a bad thing, on the contrary, people with
disability would still be in the same situation as they were 100 years
ago if it was not for SRV. What I am saying is that SRV needs to be put
into the context of the
community
(rather than the community being put into the context of SRV), where
the community has the skills, resources and valued roles in providing
for the needs of its members (takes ownership).
There
are
no perfect
solutions, and communities will make
mistakes, but hopefully they can learn from those mistakes and work
towards building better communities for all their members.
Just
like the
fisherman who gave fish to someone in need.
After several days of the person asking for fish, the fisherman had had
enough
and showed him how to catch fish. The
person
became empowered through knowledge (gaining the skill and the tool to
catch
fish). So to, the
community can become empowered (and develop a
sense of ownership) in providing direct intervention in the care of
people with disability. Only then can we
say that
people with disability are valued
as a
part of their community.
Time
line
(approx only)
People with
disability
1800’s
Housed
in
large buildings etc
1900’s
Normalisation,
social integration, empowerment, de
institutionalisation etc.
Focus is on people with disability and families.
Organisations
take on the role of asylums in providing
institutional care.
Community
(living,
Health, Education, Recreation, Emploument etc) takes on a
supportive role.
2000
Engaging
the
community in a more pro-active role.
Focus
is on
people with disability and families.
(People with
disability <>
organisation <> community)
Beyond 2000
Providing
the
communities with the tools for direct
intervention.
Shifting
from
an active role to supporting the community in
direct intervention.
Focus
is on
people with disability <> community
<>
organisation.
Co-ordinating
the various human services (Disability,
Health, Education, Aged etc) in providing a more holistic approach to
service
delivery.
Co-ordinating
the various communities with
the
appropriate services in providing a
more
holistic approach to
service
delivery.
Peter
Anderson
(Bach
Of
Social Science - Human Services (Disability) –
Minor in Community Studies)
01
July 2008