Disability services
- three models of service delivery
Contents
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.
(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)
