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The role of the service provider in the community

Social Role Valorisation (SRV)
Deinstitutionalisation
Disability services
Disability and community
How does the community care?

How does the community care?
Explanation of terms




The role of the service provider in the community
The service provider
The roles of the stakeholders
Characteristics of the service provider
Service role models
Models of service
The role of the service provider
Models of service delivery
The service setting
The role of the service setting
Types of service models
Full integration
Partial integration
Enclaves (separated)
Segregated (isolated)

The communities of the service provider
The future of the service provider
Saturation point
Full circle
Lennox Castle Hospital





The service provider:  (Top)
Any service that is provided by an agency, service group or organisation that specialises in looking after the needs of people who can not be supported in a community. 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.

The roles of the stakeholders:  (Top)


The organisation provides the link between people with disability (and families) and the wider community through various activities.

Three broad roles within the service provider ...
The roles of the management, staff and volunteers ...
supporting and maintaining the needs of the clients.
supporting and maintaining the needs of the organisation.
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 wider community.
provides employment within the sector.
promotes the growth of other support services, such as transport, catering, laundry, specalised equipment etc.
raises awareness of the situation of the group that is supported by the service.
… accountable to government policy/practice in service provision.
The roles of the clients ...
consumer rights and responsibilities.
participation in activities through decision making/choices.
The roles of the families, significant others ...
supporting the activities of the service provider.

Characteristics of the service provider:  (Top)
... Have 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 service.

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 (See also Characteristics of a community, Understanding communities).

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

Models of service:  (Top)
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.

While a service provider operates within it's own model of care, each community of the service is based on a model that loosley 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. Settings 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. Settings 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 setting 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 behaviour 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.

Service 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 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.

The role of the service provider:  (Top)
Within the current social structure, service providers (organisations and service agencies) take on an active role (provide direct intervention) in providing for the needs of people with high support needs. These service providers often become communities in their own right by providing a service to a specific group, providing whole of life approach to service delivery (take ownership of their members). The wider community's role is to support the service provider, any community engagement and participation has generally been from the perspective of the person with the disability <> service provider, rather than the person with the disability <> community.
... the community supports the activities of the service provider through funding, donations, sponsorships, promotions etc.
... the community supports the activities of the members through volunteers etc.
... the community becomes dependent on the service provider in providing the service,
... the activities of the service provider become the social norm (institutionalised) in the community.

The service provider may have a number of broad roles:
… to provide for its own needs in supporting a person or group of people in society.
to suppor and maintain the needs of the clients in society.
… to actively promote the needs of disadvantaged people through the principles of normalisation, social integration, empowerment and social role valorisation in society.
… to actively support, through direct intervention (accommodation, recreation, education or employment), disadvantaged people in society.
… to provide support within each community that the person is a part of.
… to support other communities (family, living, employment, recreation etc) in providing for the needs of their members.

While the primary role of the service provider is to support disadvantaged people, there may be other secondary roles that are associated with that role.
... Provides a knowledge base of theory and practice that can be used within the service as well as other services that support people with the same characteristics.
... To provide a knowledge base and research into a specific area if interest.
... Provides employment within the industry. The service provider employes staff, equipment, facilities, and other services within the wider community.
... To act as an agent or broker in finding the most appropriate community that fulfils the needs of the person.
... To develop skills and resources (theory, technology, equipment etc.).
... To provide a safe and secure environment that supports all members.
... To communicate with other communities that the community is a part of.
... To provide other services that are not available in the community such as transport, health services and other specialise services designed for the needs of the target group.
... To comply with various Government, Local Government and Council funding agreements, policies, regulations, Bylaws etc.

Other less obvious or hidden roles may be:
... To provide direct intervention in a person's life, where the person in not capable of making their own decisions
... To protect it's members from society.
... To protect society from it's members.
... To provide a cost effective way to support a group with high support needs.

Service providers are generally designed (and funded) to target a particular group (community role):
... a particular disability
... a particular age group
... a particular income group
... a particular activity
... a whole of life approach
This process can be described as 'Profiling', where, there is a set of criteria that service users must fulfil in order to receive the service. Profiling disadvantages people that have a rare condition or disability do not fit the funding criteria of the organisation or there is no service in their area.

The value that is placed on the service provider by its members, as well as the community that is a part of, is determined by its success in fulfilling its role.
The amount of success is determined by:
... the policy, mission statement, institutions (values, cultures, expectations etc) of the service provider
... government policy and practice (the institutions of government, and how these institutions determine the decision making process towards interventions in community practice).
... funding : through government funding, private and community donations
... available resources : staff, facilities, equipment
... ability to provide for the needs of its members
... ability to balance the needs of the service provider with the needs of its members
... the expectations of the wider community in the service fulfilling its role.

In theory, applying the principles of SRV to people with high support needs may provide a more positive social role and lead to valued relationships within a community. However, the reality is that the skills and resources needed to support the person may not be available within each community that the person wishes to be a part of, and there is a risk that the person does not connect with any community in any permanent or "participatory" sense.

 
Figure 1. Shows the relationship between the needs and the support required in providing for those needs.

When providing support for disadvantaged people, 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 institutionalised. The service provider may have a valued role and is valued within the community that it is a part of. The problem is that while the goal of most service providers is to promote their members within each community that they participate in (community options, access and employment) through the principles of SRV, the result may be that these communities may become a part of the service provider because of the nature of the disability and a lack of skills and resources in the community.

This is not a bad thing in as much as the members of the community of the service provider still have the opportunity to develop shared experiences and valued relationships within that community, as well as the other communities that the service provider is a part of, as long as the principles (formal and informal beliefs, values, roles, expectations and behaviours) of the service provider are consistent with the principles of SRV (PASS, PASSING). It does not mean that the support is devaluing or dehumanising. It does mean that the support provided is most appropriate to the needs of the person as well as the needs of each community (living, recreational, educational or employment).

This is not to say that people with high support needs will always be in a more structured and institutionalised environment. With the development of medical knowledge, practice, treatments, drugs, technological innovations, as well as informed social policy and decision making, and community involvement at all levels, people with high support needs will have the opportunity to move from one community to another according to their own needs as well as the needs of their community.

Just as people sometimes need the specialised care of a nursing home or hospital (they get old or have a debilitating disease or condition), disadvantaged people should be accorded the same right as any other member in the community in being able to access the appropriate care if it is not available within their own community. The Royal Perth Rehabilitation Hospital and Graylands Hospital Mount Claremont are examples of institutions in the community that provide institutionalised care in the community. While there is considerable debate about the desirability (value) of these types of facilities, my response is that the problem is not because of the institution and the building, but rather to do with the design, location, culture and organisation of the institution and the building.

Service role models:  (Top)
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.

Models of service delivery:  (Top)
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?
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)

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) 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.

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 modified to enhance social image and personal competence, e.g., allows the person to participate in the activity in the least restrictive way (as normal as possible for the person). How the environment is adapted will depend on it's particular construct to suit the needs of the person (low support needs Vs high support needs), the amount of adaptation that is needed to suite all members and how the members are advantaged or disadvantaged through the adaptation.

Types of settings:
Full integration
These are activities that are held in the same venue at the same time by groups/teams that have mixed characteristics (age, gender, height, ability etc.). These are social activities where people of any ability can mix or form teams (Able/Disabled Vs Able/Disabled etc.).

Partial integration
These are activities that are held in the same venue at the same time by groups that participate in the same activity (compete against each other etc.), but the groups are separated because of a particular characteristic of each group (age, gender, height, ability etc.). Again, there are lots of examples of these types of activities in the community. Abled and disabled who compete in their own groups at the same time at the same venue would have the opportunity to socialise before during and after the event.

Enclaves (separated)
These are activities that are held in the community by a group, but are separated from other groups that participate in the same or similar activity because of a particular characteristic of the group (age, gender, height, ability etc.). There are lots of examples of these types of activities in the community. Competitions etc. are generally held separately from other social activities.

Segregated (isolated) :
The activities are removed from the society and have no interaction with other communities.
Very rare these day to find examples of these types of activities, however, they do exist. People in prisons, in high security or solitary confinement are isolated from the wider community. The armed forces often have activities that are isolated and restricted to service personnel only. Some activities that people with high support needs participate in are sometimes isolated (restricted to the particular group and have no interaction with other communities - debatable and open to conjecture). You may be able to think of some other examples.

And finally : Fund raising/supporting activities
These are activities that are held in the community as an event that is designed to raise community awareness/profile or promote a particular illness, condition or situation, or support a particular charity, organisation or research group. The primary goal is to include as many participants as possible that are not a part of the group, in the activity, although it is not uncommon for representatives of the group to participate. May also be sponsored by a company or organisation that has an interest in the particular group.

Just because the service setting may be in a school, the work place, recreation center, special needs center or nursing home, does not mean that the activity is not a part of a community. There are many examples of activities today that are separated into able and disabled communities. To a large extent these are accepted as the social norm. The most prominent example is the Olympic games, where able athletes compete in one competition and the disabled athletes compete in another.

Ten pin bowling is another activity where we see examples of separated (competitions etc.), partial integration (school activities, bowling classes, special needs groups etc.) and full integration (social etc.). Education communities (schools, universities etc.) are other examples where these types of activities occur.

The Riding for the Disabled Association of Australia is an example of a community activity that is specialised (separated) in providing for people with high support needs. The association is a part of a world wide community that is not a part of any service provider and includes both able (as volunteers) and disabled members (and may include people with high support needs that are supported by a service provider or organisation). Whether the person with a disability feels a part of the Riding community would depend on his/her associations (connectedness) with the other members of the community.

The Riding community:
... has a role that is valued by its members and the wider community that it is a part of.
... there is a sense of purpose and direction within the community
... has ownership of its members
... has the skills and resources to provide for the needs of its members

The role of the service setting:  (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.

Think of any activity, can be shopping, going to the pictures, riding a bicycle, a game of chess, attending a lecture in nuclear physics etc.
What is the setting of the activity - isolated, separated, partial integration, full integration or a mixture?
What is the role of the setting within the activity?
What is the role of the activity within the setting?
What is your role in the activity, within the setting?
What are the roles of the other members in the activity, within the setting?

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

Full integration:
The person is a part of and supported within each community that is most suitable for his/her needs. The service provider supports the community, where the community has the skills and resources in providing direct intervention (takes ownership).



(Click on image to view detail)


Partial integration:
People with high support needs may not be able to be a part of all communities because of the nature of the disability, or a lack of skills and resources within each community. Just because a person is a part of the community of a service provider does not mean that the person does not have the opportunity to participate in the activities of other communities.



It can be seen that while the person may have various interactions within other communities, the person is still a part of the service provider. This is not a bad thing, in as much as the person still has the opportunity to participate in other community activities. Whether the person feels a part of each community (Living, recreational, educational or employment) would depend on his/her associations (connectedness) with the other members of each community.

Enclaves (separated):
Where people that have a severe disability, or for some other reason may not be able to participate in any community activity, the service provider creates new communities (recreation, employment or education) within the wider community, or it is provided in another service setting that is a part of another service provider.



It can be seen that while the communities are separated from the service provider, they are still a part of the service provider or within the service setting.
The advantages over segregated services are:
... They are treated as individuals
... Have more variety in their life and daily living patterns
... More choices and decision making
... Able to socialise with others in different settings
... The opportunity to experience other experiences that are not available within the setting of the service provider

Segregated (isolated):
People that may have a condition or characteristic that needs full time intensive care, or may be a harm to themselves or others in the wider community are generally isolated from the rest of the community. Some hospitals (psychiatric, paraplegic etc.), nursing homes (aged care, dementia etc.), prisons etc. are examples of communities that are removed from society. While these communities are separated, there is still some interaction with the wider community by the staff, other professionals, family, friends, volunteers etc.





In all of the above, the person has the opportunity to develop relationships with family, friends, volunteers and others that are not a part of their community, and therefore has a greater opportunity to become accepted as valued members of each community that he/she participate in. People with high support needs may have more difficulty in being able to access the wider community, or a particular community that they wish to be a part of. Through the development of skills and resources within each community, as well as technological innovations, the person may have a greater opportunity in the future to become a part of each community.

Whether a person is in a integrated, partially integrated, an enclave or segregated community, he/she still has the opportunity to move from one to another according to their own needs as well as the needs of the wider community that he/she is a part of.

Services can also be a mixture of integrated, partially integrated, an enclave or segregated. A service may support people in their own community, as well as providing full time support in it's own facility (nursing home, respite or a group home etc.). The members also have the opportunity to move from one community to another within the service according to their own needs as well as the needs of the service.

The communities of the service provider:  (Top)
A service provider generally containes a number of communities (parts, teams or groups of people) that specialise in a particular skill or role. While these communities are a part of the service, they act independently of the other parts in providing a particular area of speciality that is not available within the other parts.

Just as communities have different power groups, a service provider may have different groups that jostle with each other in asserting their own agenda within the organisation. There may be "Turf wars" where one department may be seen to encroach on another's territory, or important information or a resource is not distributed to a department because of some internal dispute or power struggle. Personal conflicts can also contribute to a lack of coordination in service provision where there is more effort used in counterproductive behaviour than proving for the needs of the clients.

Where a service provider supports groups of people in different settings (nursing home, hostel, group home, recreation, employment or education), these groups are communities in their own right i.e., they share the same facilities, the members interact with each other etc.

While they share the institutions (the "social construction") of the service provider, they have their own "social constructions" that are particular to the group or facility and the activity. This is most noticeable in group homes that are supported by a service provider. Each home has its own unique characteristics that require different policies, routines etc., that are designed around the needs of the members of the group. Staff also play an important role in promoting or supporting particular institutions within the community that sometimes take precedence over the institutions of the service provider that the home is a part of.

The future of the service provicer:  (Top)
Services providers have become specalised in providing for a specific group within the disability arena. They provide the knowledge base, the skills and resources in supporting a particular group. As a result the wider community supports these activities.

Saturation point:  (Top)
Any service or organisation that grows above a certain size (saturation point : that the organisation can no longer function as an organisation, but rather as a collection of mini organisations) is dependent on it's departments in fulfilling their own roles within the organisation. These departments become specialised in providing a specific function within the organisation. Just as a person becomes specialised in a specific task, and the person looses the skills in other related tasks, the departments within the organisation may become so specialised within a role, that other skills that are important to the needs (overall health) of the organisation, become less important than the needs of the department. Each department may have budgets, performance criteria, targets, assessment programs etc. that determine the efficiency of the department, which means that the department becomes more concerned with it's own performance rather than the overall health of the organisation. Communication, cooperation etc. between departments becomes slow, uncoordinated and sometimes nonexistent (have you ever experienced the frustration of trying to deal with the government, a large bank, internet service provider or any large multi national organisation).

Full circle:  (Top)

Is this the future of services that support people with high support needs (aged, severe disability etc.) ????



While asyulms were origionally a place of safety or retreat from society, they became places of hardship, deprivation and depravation. What started as small hospital facilities soon became large buildings that supported hundreds of people. Built around a medical model of care, a culture evolved that enabled a small number of people to support a large number of people. Social policy was to hide these groups behind walls, where society was protected from the activities that happened within those walls. There has been a great deal written about the values, behaviours and attitudes of the system that supported the residents of these buildings within society. Because they were in long term institutional care, the term "Institution" referred to the building, the culture and the outcomes of the building and the culture. While the charasteristicts of this institutional care was similar to other institutions, the outcomes were different. Today, we see small services evolve into organisations that support different groups within society. Organisations are getting larger to cope with increased demand for services. As an organisation gets larger, more resources are needed to support the organisation. Things wear out and need replacing. New equipment and technology replaces old and outdated equipment and technology. Direct care staff need to be increased to meet the needs of its clients, which means more support staff are needed to meet the needs of the direct care staff.


Everyone has the same basic needs to live fulfilled lives.


The organisation also has its own needs in fulfilling its role in providing for the needs of people with disability.

If the service provider can not provide for its own needs or the needs of its clients, the culture and institutions of the service provider change,
so that the basic needs of its clients can be met, and other needs that are considered as not important are not met.


For example the normal staff ratio may be 1 staff to 4 clients. As the service grows, and the service can not get the extra staff because of a lack of funding, skills or available workforce, then the service has to prioritise needs as well as ration resources. Because the service provides direct intervention in supporting its clients there may be no other service that can provide support. The result is that the service may become the Asylum that Goffman, Wolfensberger and others wrote about in the past.

This is most noticeable in nursing homes where costs increase and suitable staff are scarce. The nursing home tries to cut costs and ration resources and as a result the clients are not getting all their needs met. Hospitals are also suffering from a lack of skills and resources. People are not getting the proper care, patients are left in corridors because of a lack of space, etc. etc. This also happens within disability service organisations where the needs of the organisation become more important than the needs of the clients. Administration, OHS, payroll, maintain, staff training, policy development, volunteer coordination, area coordination, medical staff, transport, recreational, employment, direct support staff, relief management, relief staff - just to name a few roles that the organisation may have - may mean that there are 200+ people supporting 100 clients.

The Community Living Project (CLP) - SA for example has approx 40 staff employed to support more than 20 and up to 30 clients, of which approx 20% need 24 hr support. Suppose this group was supporting 100 clients. It is not unreasonable to suppose that the group would need a minimum of 80 to 150 staff to provide the same quality of service. Imagine what the service would look like if it was supporting 200 or more clients. What would the service look like if it was supporting 600 clients, which could easily happen in the future.

Activ:
Activ employs more than 900 people (management, staff support and direct support).
Provides direct support:
homes to 250 people, assist another 82 in their own homes and deliver respite care to 268.
jobs to 1045 people with disability
= 1645 who receive direct support (source: http://www.activ.asn.au/)
= 1/1.83 staff/clients ratio

Would the service become the Asylum that Goffman, Wolfensberger and others wrote about in the past (both literally and figuratively) if the community did not have the skills and resources to look after their needs?

Lennox Castle Hospital  (Top)
Lennox Castle Hospital was designed as a twentieth century service provider that provided for the needs for 1200+ men and women.

Origionally a hospital
Was ahead of its time
Supported a large number of people with an intellectual disability

Roles:
To provide for the needs of people with an intellectual disability
Provide a secure setting.
To protect society from this group.

Characteristics:
Self contained
Strict rules and regulations
Division of groups ... staff/residents, male/female

Positive outcomes:
Residents basic needs are looked after.
Residents have the opportunuty to socialise with each other.

Negative outcomes:
Low expectations of the residents.
Large group of people seperated from the wider community.

Shift in public and Gov. oppinions, values and policy towards this group has ment that the residents of the hospital were moved to other places.
The life of institutional living is described through the experiences of a former resident (Howard Mitchell) as well as others that were living there.
"How do we make sense of what we saw? The video tells the story of the hospital in dramatic tones: we hear about a riot, escapes, punishment and drug treatment regimes. But we also hear about football matches, dances and friendships. Even so, they are only part of the story of 60 years and many hundreds of people's lives. We saw several volumes of detailed records. What can be learnt from so much information? How can Howard Mitchell begin to organise all these facts and accounts?" (Lennox Castle Hospital)

In order to support 1200+ men and women today the facility would need:
Assuming a direct support staff/client ratio of 1/4, there would need to be 300 primary support staff.
Management and other support staff would probably be 50-100.
Which means that the facility would need to support 1600-1800 people minimum, which is a lot of people.
Assuming a total staff/client ratio of 1/1.83, there would need to be app 660 total staff + 1200 residents = app 1860 staff & clients.

If you feel inclined to watch the videos that are at the site (highly recommended) some other interesting questions may come to mind:
... What are the values, attitudes and expectations of the community towards people with an intellectual disability as described in the video?
... What are the values, attitudes and expectations of your community towards people with an intellectual disability today?
... What are the characteristics of institutional life as described in the video?
... What are the similarities and differences between the characteristics of institutional life as described in the video and the characteristics of life in a service today?
... What are the outcomes of institutional life as described in the video?
... What are the similarities and differences between the outcomes of institutional life as described in the video and the outcomes of life in a service today?

The real tragedy in all this was a lack of skills and resources available within society, and of a set of activities, values, attitudes and expectations embedded into that society (institutionalised) meant that people with an intellectual disability were not fit to live a normal family live and share normal loving relationships that we all take for granted.



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