! Understanding communities
Dysfunctional communities !
disability service organisations ! An
alternative model ! Community
research ! Community survey
provides the link between people with disability (and families) and the
wider community through various
Three broad roles within the service provider ...
Characteristics of the service provider:
of the management, staff and volunteers ...
… supporting and
maintaining the needs of the clients.
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.
actively support, through direct
education or employment), people with disability
in the wider community.
employment within the
the growth of other support services, such as transport,
catering, laundry, specalised equipment etc.
awareness of the situation of the group that is supported by
to government policy/practice in service provision.
The roles of the clients ...
rights and responsibilities.
in activities through decision making/choices.
The roles of the families, significant
the activities of the service provider.
goals, beliefs, values, cultures, institutions etc.
... Is organised within a set of formal/informal beliefs, values,
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
... 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
agree. Service providers are communities that are organised around more
formalised structures that are accountable to a governing body (See
also Characteristics of
... Is accountable to a
body, committee or government agency.
... Operates within a professional capacity in providing a
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
coordinated by the service.
... The activities of the members are usually highly organised
around the service (set routines, set activities etc).
... The larger the service the more resources the service needs
its own needs.
... The wider community generally supports the activities of
... 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.
Models of service:
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:
(holistic): is concerned with who we are,
and how we socialise with each other. Human interaction with each other
environment play an important part. Settings are all about how the
members interact with each other and how
environment affects the members as a group. Members also have the
to change their own environment to their own needs without affecting
community as a whole. The purpose (objectives, goals, policies etc.)
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
profession (educational / medical / business). The members have to fit
structured environments that are less accommodating to the needs of
members and how they interact with each other. Settings are about
people, and how the person fits into the environment rather than how
environment fits into the person. The purpose (objectives, goals,
etc.) of the community is formal with clearly defined roles for its
Community services are often built around the professional model, where
or volunteers are employed by the service to support the service users
the goals, values etc. of the service provider. Records are kept on
expenses, care plans, progress notes, medical histories etc.
… Scientific (specialised): is concerned with research,
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
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
Service communities are generally a
the three types (Social, Professional
and Scientific). Social groups need to have the freedom to socialise,
need some order and structure to coordinate activities and work within
etc. Work places etc. need formal structures and environments to
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
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
professional or scientific), the amount of adaptation that is needed to
all members and how the members are advantaged or disadvantaged through
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
to assist the person has a intellectual or physical disability. How the
adaption advantages or disadvantages the others depends on the overall
the quality of the activities, the opportunity to participate in the
activities, share experiences and be a part of their community.
of the service provider:
the current social structure, service providers (organisations and
agencies) take on an
active role (provide direct
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
with the disability <> service provider, rather than the
with the disability <> community.
... the community supports the
activities of the service
through funding, donations, sponsorships, promotions etc.
... the community supports the
activities of the members
through volunteers etc.
... the community becomes dependent on
service provider in providing the service,
... the activities of the service provider become the social norm
The service provider may have a number of broad
… to provide for its own needs in
supporting a person or group of people in society.
… to suppor
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
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
employment within the industry. The
employes staff, equipment, facilities, and other services within the
... To act as an agent or broker in
appropriate community that fulfils the needs of
... To develop skills and resources (theory, technology, equipment
... To provide a safe and secure environment that supports all members.
... To communicate with other communities that the community is a part
... To provide other services that are not available in the community
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
... To provide direct intervention in a
person's life, where the person in not capable of making their own
... To protect it's members from society.
... To protect society from
... To provide a cost effective way to support a group with high
Service providers are generally designed (and funded) to target a
group (community role):
... a particular disability
... a particular age group
... a particular income group
... a particular
... a whole of life
This process can be described as 'Profiling', where, there
is a set of criteria that service users must fulfil in order to receive
service. Profiling disadvantages people that have a rare condition or
do not fit the funding criteria of the organisation or there is no
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
The amount of success is determined by:
... the policy, mission
statement, institutions (values, cultures, expectations etc) of the
... government policy and practice (the institutions of
these institutions determine the decision making process towards
in community practice).
... funding : through government funding, private and community
... available resources : staff,
... 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
In theory, applying the principles of SRV to people with high support
provide a more positive social role
and lead to valued relationships within a community. However, the
that the skills and resources needed to support the person may not be
within each community that the person wishes to be a part of, and there
risk that the person does not connect with any community in any
permanent or "participatory"
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
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
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
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
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
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
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
care in the community. While there is considerable debate about the
desirability (value) of these types of facilities, my response is that
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 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
... 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:
Least Restrictive Principle (LRP):
Person Centred Planning (PCP):
Normalisation and Social Role Valorisation provide the underlying
that each model is built on.
What is the service that we are
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
What internal support mechanisms does the service need to provide the
What support mechanisms are a part of the service?
What support mechanisms are a part of the wider community?
Valorisation, the Least Restrictive Principle and Person Centred
How are we going to provide the service ?
Any activity that we participate
in usually involves some rules or restrictions that define the activity
you imagine a game of footy where the players made up the rules as they
along ? Or a living facility was used as a night club ?). These define
activity and to a certain extent its members. There is also a code of
(culture) associated with the activity that defines the community that
part of the activity. At a Roman Catholic Church, for example, the
generally Roman Catholics and follow the traditions of the church. At a
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)
activity, 2) the community. A person in a social or recreational
example, may need a different model of care (LRP) to a person who is
in a home (PCP).
The model of service delivery (social, accommodation, medical,
employment etc) depends on the type of service provided. The person in
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
Social model (holistic) Service delivery is concerned with the
how the service fits into the person. Services are designed around the
in order to enable the person to fulfill his/her needs in the best
way. Any restrictions are due to the activity and the setting of the
rather than the person. Accommodation, recreation, social groups etc
activities that involve some sort restrictions as a normal part of the
Professional model (specialised): Service delivery is concerned with a
particular aspect of a persons life, eg: accommodation, medical,
employment, etc. The person has a particular characteristic that needs
supported. The service is designed around that characteristic rather
person as a whole. Professional intervention is required (nursing,
worker, carer, taxi, etc) that means that the person will be restricted
other areas. Through the development of new technology (medical,
it is possible for the person to be less restricted in other areas of
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
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
Services that support people
with high support needs may be separate from other community based
and recreation groups because:
… the needs of the members may
require specialised support that is not available within other
… 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
... the cultures, values,
policies and behaviours of the administration and staff of the service
When people that have a physical or intellectual disability are
individual housing, supported accommodation etc, the service provider
provides the support, or it is provided within the service setting.
... the goals, beliefs, values,
and behaviours of the service provider provide the framework for
... the facility generally
functions within (but not limited to) three broad models of service
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
... the service provider supports and maintains the
needs of the
the service provider supports and maintains the
needs of the
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
Other activities such as recreation education and employment are
provided in the service setting. Any community activity is usually
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
... the service provider
provides the direct intervention in the needs of the person.
Refers to the environment that the support is provided in. Can be
education or employment. The setting is usually adapted or modified
enhance social image and personal competence, e.g., allows the person
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
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:
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.).
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.
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,
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
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
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
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
role of the service setting:
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
integration etc.) according to their particular need at the time as
as the needs of the group or community that they are a part of.
relationship between the needs and the type of setting in which the
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?
Types of service models:
What is the role of the setting within
What is the role of the activity within
What is your role in the activity,
within the setting?
What are the roles of the other members
in the activity, within the
Four broad types of service models that support people
with high support
needs could be described as:
... Full integration
... Partial integration
... Segregated (isolated)
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
(Click on image to view detail)
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
depend on his/her associations (connectedness)
with the other
members of each community.
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
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,
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
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 communities of the service provider:
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
While they share the institutions (the "social construction"
) of the
provider, they have their own "social constructions"
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:
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.
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
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
Is this the future of services that support people with high support
(aged, severe disability etc.) ????
While asyulms were origionally a place of safety or retreat from
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.
has the same basic needs to live fulfilled lives.
organisation also has its own needs in fulfilling its
role in providing for the needs of people with disability.
service provider can not provide for its own needs or the needs
of its clients, the culture and institutions of the service provider
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
medical staff, transport, recreational, employment, direct support
staff, relief management, relief staff - just to name a few roles
may have - may mean that there are 200+ people supporting 100 clients.
The Community Living
(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 employs more than 900 people
(management, staff support and direct support).
Provides direct support:
homes to 250 people, assist another 82
their own homes and deliver respite care to 268.
jobs to 1045 people with disability
= 1645 who receive direct support (source:
= 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
was designed as a twentieth century service
provider that provided for the needs for 1200+ men and
Origionally a hospital
Was ahead of its time
Supported a large number of people with an intellectual disability
To provide for the needs of people with
an intellectual disability
Provide a secure setting.
To protect society from this group.
Strict rules and regulations
Division of groups ... staff/residents, male/female
Residents basic needs are looked after.
Residents have the opportunuty to socialise with each other.
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
The life of institutional living is described through the experiences
of a former resident (Howard Mitchell) as well as others that were
"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
In order to support 1200+ men and women today the facility would need:
Assuming a direct support staff/client
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
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
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
... 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
When providing the most appropriate
care for people with high support
1) The community is not where the
person is living, but where the
person participates, shares experiences and has valued relationships
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
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,
profession or service define the way the person is supported within
7) Facilities that support people with high support needs do not
need to be the nursing homes or prisons in the
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.