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Disability services - three models of service delivery

Social Role Valorisation (SRV)
Deinstitutionalisation
Disability services
Disability and community

Understanding disability service organisations
Disability services role models
The role of the service provider in the community
How does the community care?



Disability services - three models of service delivery
Models of service
Models of service delivery
The service provider
Characteristics of the service provider
Service role models



Models of service:
Service delivery has five main functions:
… To provide a service to the users,
… To provide the resources (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.

While a service provider operates within it's own model of care, each community that the service operates within is based on a model that loosely describes it's function or role within society.
Three broad (and simplistic) models could be described as, but 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 (objectives, goals, policies etc.) of the community are less formal with less defined roles.

… Professional (holistic/specialised): 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 (objectives, goals, policies etc.) of the community is 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. Records are kept on budgets, expenses, care plans, progress notes, medical histories etc.

… Scientific (specialised): is concerned with research, facts and figures. The community is highly structured around a set of standards, procedures and principles that do not allow for individuals. Focus is on objective systematic enquiry of objects, patterns of behavior and interactions, time and resources, balance sheets and budgets, efficiencies of scale, opportunity cost etc. Research communities need to have a consistent approach to inquiry so results can be analysed and compared. Sporting communities are about finding the best performance of the players to achieve a desired outcome - to win the game.
 

The three models and how they relate to the community of the service provider.

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 behavior, performance and the environment of the individual and the group, but they also need to have some flexibility to allow for individual needs.

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.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.

Models of service delivery:
Least Restrictive Principle (LRP):
Person Centred Planning (PCP):
Transitional (T):

Normalisation and Social Role Valorisation provide the underlying foundation that each model is built on.
What is the service that we are providing?
Are we providing medical care?
Are we supporting a person in the work place?
Are we helping the person with their daily home chores, finance or teaching them life skills?
Are we providing specialised equipment/drugs etc?
What skills and resources does the service need to provide the service?
What facilities does the service need?
What internal support mechanisms does the service need to provide the service?
What support mechanisms are a part of the service?
What support mechanisms are a part of the wider community?
(See Normalisation, Social Role Valorisation, the Least Restrictive Principle and Person Centred Planning)

The service provider:
Any service that is provided by an agency, service group or organisation that specialises in looking after the needs of people with disability. The service provider may specialise in a particular area of care (accommodation, recreation, education or employment), or provide services that include all aspects of a person's life. They are generally funded by the Disability Services Commission (DSC) and contracted to provide the service within the policies of the DSC.

How are we going to provide the service ?
Any activity that we participate in usually involves some rules or restrictions that define the activity (can you imagine a game of footy where the players made up the rules as they went along ? Or a living facility was used as a night club ?). These define the activity and to a certain extent its members. There is also a code of behaviour (culture) associated with the activity that defines the community that is a part of the activity. At a Roman Catholic Church, for example, the members are generally Roman Catholics and follow the traditions of the church. At a school there are the roles of the teacher and the students.

When planing a service model (PCP, LRP, T etc), the needs of the person need to be built around 1) the activity, 2) the community. A person in a social or recreational setting, for example, may need a different model of care (LRP) to a person who is supported in a home (PCP).
The model of service delivery (social, accommodation, medical, educational, employment etc) depends on the type of service provided. The person in a social or recreational setting may need a volunteer or an aid that is employed by an agency (Social model), while the person at home would need a carer or nurse (professional model).

Social model (holistic) Service delivery is concerned with the person and how the service fits into the person. Services are designed around the person in order to enable the person to fulfill his/her needs in the best possible way. Any restrictions are due to the activity and the setting of the activity rather than the person. Accommodation, recreation, social groups etc are activities that involve some sort restrictions as a normal part of the activity.

Professional model (specialised): Service delivery is concerned with a particular aspect of a persons life, eg: accommodation, medical, educational, employment, etc. The person has a particular characteristic that needs to be supported. The service is designed around that characteristic rather than the person as a whole. Professional intervention is required (nursing, social worker, carer, taxi, etc) that means that the person will be restricted in other areas. Through the development of new technology (medical, equipment etc)(scientific) it is possible for the person to be less restricted in other areas of his/her life, however the person may always need some sort of intervention in fulfilling his/her needs and be dependent on others.

The way the service is provided depends on the persons needs:
... people with low support needs will require only a small amount of support and the service will be less structured (behavioural, medical, specialised equipment etc)
... people with high support needs will need a high amount of support and the service will be more structured around those needs (behavioural, medical, specialised equipment etc).

Services that support people with high support needs may be separate from other community based employment and recreation groups because:
… the needs of the members may require specialised support that is not available within other employment or recreation groups,
… the networks for people with high support needs are generally within the service setting.

The service provider may actively support, through direct intervention, disadvantaged people in the community.
Any service that supports people with high needs will require:
... a facility that is structured to the needs of the person,
... a model of care that includes the social, medical etc needs of the person,
... the structure of activities are determined by the needs of the person as well as the needs of the staff and others,
... the cultures, values, policies and behaviours of the administration and staff of the service provider.

When people that have a physical or intellectual disability are relocated to individual housing, supported accommodation etc, the service provider usually provides the support, or it is provided within the service setting.
... the goals, beliefs, values, cultures, roles and behaviours of the service provider provide the framework for identity and purpose,
... the facility generally functions within (but not limited to) three broad models of service delivery; social, medical and business,
... the service provider may specialise in a particular disability, activity or area of care,
... the service provider provides the buildings, staff and other services (transport, volunteers etc),
... the service provider supports and maintains the needs of the clients,
... the service provider supports and maintains the needs of the service provider,
... the service provider takes on a certain amount of ownership in providing for their clients needs,
... people that have a physical or intellectual disability mostly socialise with staff and others who share the same characteristics.

Other activities such as recreation education and employment are generally provided in the service setting. Any community activity is usually co-ordinated by the service provider.
... the principles of SRV become a part of the activity,
... the environment and the activity may be structured in the the least restrictive way for the person,
... the service provider provides the direct intervention in the needs of the person.

Characteristics of the service provider:
... Has formal/informal shared goals, beliefs, values, cultures, institutions etc.
... Is organised within a set of formal/informal beliefs, values, roles, expectations and behaviours
... Hierarchical Structure
... Have ownership of their members
... Members have one or more roles
... There is some form of communication between members
... Have resources that are shared between the members
... Balance the needs of the service provider with the needs of its members
... Share and draw on skills/resources where needed
... Often have communities, clubs, teams, groups etc. within the community

You may say that these are the same characteristics as a community, and I agree. Service providers are communities that are organised around more formalised structures that are accountable to a governing body.

Other characteristics:
... Is accountable to a governing body, committee or government agency
... Operates within a professional capacity in providing a service that is not available in the wider community
... The service is structured around a particular model of care
... The activities of the service in supporting its clients is usually coordinated by the service
... The activities of the members are usually highly organised and structured around the service (set routines, set activities etc.)
... The larger the service the more resources the service needs in supporting its own needs
... The wider community generally supports the activities of the service
... Members are:
1) Staff employed and trained to fulfill the needs of the service provider
2) Clients that receive the service
3) Volunteers that support the staff in service delivery
etc.

Service role models: (See Disability services role models)
Service role models are services that:
... Are successful in providing for the needs of its members
... Have been tested in providing the best outcomes for the members
... Have a valued role within the community that it is a part of, and the wider community
... Act as a model for other similar services

Services that look after people with high support needs are often modelled around service models that are successful in providing for the needs of its members.

Four broad types of service role models that support people with high support needs could be described as:
... Full integration
... Partial integration
... Enclaves
... Segregated (isolated)


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.






When providing the most appropriate care for people with high support needs ...
1) The community is not where the person is living, but where the person participates, shares experiences and has valued relationships with others.
2) People with high support needs (severe disability, aged etc.) will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education, employment or recreation) is directly related to the skills and resources of the person, and, the skills and resources of the community that the person wishes to participate in.
4) Institutions are going to be around in one form or another whether we like it or not, It is the way that they are used that is the problem.
5) The institutions of a society towards a particular group determine the way the group participates in society.
6) The institutions of a particular government department, organisation, profession or service define the way the person is supported within that society.
7) Facilities that support people with high support needs do not need to be the nursing homes or prisons in the sense that they are today, but can become warm inviting community places that offer a range of services to the community, as well as be a part of the wider community within that society.
8) People with high support needs are a minority group in our society, and will have the same problems as other minority groups in being a part of society.


01/10/2010
Peter Anderson
http://www.psawa.com