Support Needs of Residential Units

MENTAL HANDICAP VOL. 20 MARCH 1992

Support Needs of Residential Units

Alan Blair Graham J. Collins

With increasing dispersion of residences for people with learning difficulties into smaller units in the community, the issue of support systems become more important. This paper describes a survey of 15 residential managers in Mansfield and Ashfield to discover their perceptions of need for support and shortfalls in provision. The areas considered most important by the managers were staff support and staff development. The areas where the biggest shortfalls were perceived were support for residents needs, staff support and staff development. There was considerable variation between units. On the whole, managers of units run by statutory agencies felt that the needs for support for their services were met more adequately than managers of units run by non- statutory agencies. Some of the implications of these findings are discussed.

Introduction Residential services for people with learning

difficulties are becoming smaller and more dispersed within the community. Such a change has long been recognised as presenting potential problems for the staff; for example Tyne (1981) commented, ‘Management structures then need to ensure that small residential units do not somehow become “isolated” and cut off from larger systems’. Despite such warnings, C,rawford (1990) reported that ‘Mov- ing into smaller, ordinary houses led some staff to feel isolated, to lose touch with the service as a whole, and to feel they were the only ones to experience any difficulties as a result of the change.’

In addition to the general dispersal of people with learning difficulties into community settings, there has been a move to a more mixed economy of care in which voluntary agencies are taking over large

parts of provision which might previously been the province of statutory health or social service agencies. Voluntary agencies, however, may not have local organisational structures established to the same extent as the statutory agencies, and their staff may be even more at risk to isolation and lack

The study reported here arose when the Central Nottinghamshire Community Mental Handicap Team examined its role in providing support and direct services to the local residential services for people with learning difficulties. A brief survey of team members was carried out to discover which types of input each person was giving to the residential units. Following this, the question arose as to whether such input matched up to the needs perceived by such units. It was therefore agreed that the residential units themselves should be surveyed to find out what types of support that they felt were most important, and where they thought the biggest shortfalls were. It was hoped that this would help to inform the team of the appropriateness of our current input, and identify unmet needs so that a process of meeting them could be set up in conjunction with other bodies.

of support.

The sample While ideally it would be useful to know percep-

tions of need from staff at all levels within services, time and resources did not permit this. Therefore, the study focused on the perceptions of the residential managers or those occupying similar positions. Managers of all the residential units in Mansfield and AsMeld were interviewed, with the exception of a few very small privately run homes. This gave a sample of 15 units which ranged in size from a dispersed housing project supporting people in one to four place homes, to a hostel of 25 places. Nine of the units were run by statutory agencies (social

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ALAN BLAIR is a Trainee Clinical Psychologist at the Department of Clinical Psychology of Leicester University. GRAHAM J. COLLINS is a Clinical Psychologist with the District Clinical Psychology Service, Mansfield, Notts.

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services, health or a healthhousing association partnership) and six by non-statutory agencies (housing associations, charitable trusts). Overall t,he units provided homes for over 200 people with learning difficulties, and cmployeti approximately 250 members of staff.

The method A structured interview was used to elicit the

views of each residential manager. The interview

lasted approximately two hours and covered six general areas in which people might need support. There were 49 individual questions which covered six general areas. The items are listed in Table 1.

For each item, the managers were asked for their views, and also for a quantitative reply. They were asked to rate how much the home needed such input from 0 = ‘not needed at all’ to 10 = ‘completely essential’. They were then asked to rate how much of this figure the home was actually receiving, and from whom they received the input. This enabled a

1. External Support for Service users (13 items) Physical needs Practical skills Emotional needs Transport Vocational needs IPPS Leisure needs Keyworker outside home Communication Keyworker inside home Relating to relatives Self Advocacy Relating to other residents

Individual personal support Supervision of work Meeting staff from other homes Meeting staff from same home

Understanding aims and goals of the home IJnderstanding wider sewice issues Liaising with relatives Identifying residents’ strengths and needs Teaching residents new skills counselling Challenging behaviour Basic care skills Keyworking Preparing IPPs Understanding roles of CMHT members Knowledge of resources outside home

Individual personal support Supervision of work Meetings with other managers

Home’s aims and goals Understanding wider service issues Liaising with relatives Managing staff Identifying residents’ strengths and needs Counselling IPPS Performance feedback Understanding roles of CMHT members Knowledge of resources outside home Chairing meetings

Input to management committees Quality assurance Staff recruitment Preparation of new residents Support after introduction of new resident Relationship with local community

2. Staff Support (4 items)

3. Staff development (12 items)

4. Support for manager (3 items)

5 . Manager’s development (1 1 items)

6. Administrative support (6 items)

TABLE 1. Interview structure

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‘percentage need met’ score to be calculated for each item and for the general areas. Some of the main results are presented below.

What were the perceived support needs and where were the shortfalls?

Figure 1 shows the mean of the 15 managers’ ratings on the need for input averaged for each of the six general areas of need. It can be seen that the areas of staff support, staff development, and manager’s support were rated as most important. The least important area was considered to be administration. Figure 2 shows the input received as a percentage of input needed for the six general areas, averaged across the 15 managers.

It can be seen that the areas in which the biggest shortfalls in provision were perceived were with individual residents’ needs, staff support, and staff development. Managers’ own need for support was the area where needs were perceived to be most effectively met.

Ertrnt of Nwd

Needs opment Dew1 Staff Manager opment Admin Support support istration

Matn Areas of N r ~ d

FIGURE 1. Average of managers’ ratings of extent of input needed for the six main areas

’ Percent of Perceived 901%, Nred Met

84 n

” Needs Developments Develop-

Staff Manager ment Admin- support support istration

Main Areas of Nerd

FIGURE 2. Average of managers’ ratings of input received as a percent of input needed for the six

main areas

What specific needs were identified? The above general results, while important, con-

ceal many variations between individual items within the general areas, and between units. In the area of Individual Resident’s Needs, the biggest shortfalls were identified in the areas of Self Advocacy and Having an Outside Keyworker. Both of these seemed related to helping the residents’ views to be heard. Comments from the managers included: ‘They don’t seem to do self advocacy at the day centres or anything like that’. ‘A link worker wouldn’t be useful but a befriender or advocate might be. The trouble is that we tend to be subjective. Somebody from the outside would be more objective and look at things from a different point of view’.

The two needs where input was perceived to be particularly poor in the area of Staff Support were: Meeting Staff f rom Other Homes and Personal Support. One manager commented on the desir- ability of meeting staff from other homes: ‘We haven’t been able to arrange this at all. They need to know what other people are doing’. The issue of personal support varied a lot from home to home, but one manager commented ‘People usually have to go outside our service’.

In the area of Staff Development the greatest unmet need was for Counselling Skills. For example one manager commented ‘We need that a hell of a lot. It’s one of the problems here. Some think that they’re experienced counsellors’. Some managers were less sure that such development was a good thing. ‘I don’t think that any of the staff can counsel apart from myself. That’s a skill where you’ve really got to know what you’re doing’. Other largely unmet needs in the staff development area were Liaising with Relatives, Keyworking, and Dealing with Challenging Behaviour.

For the area of Manager’s Own Support the greatest unmet need was Supervision of Their Own Work. One manager commented: ‘I’m hoping it’s going to be improved, but I’ve never really had any supervision.’ The greatest unmet need in the area of Manager’s Own Development Needs was Coun- selling Skills. Such skills were seen as important for work both with residents and staff. For example one manager said ‘It’s an area that I’d like to do work on because they always come to me when they’ve got a problem. I do my best to help but I’d like to know what I’m doing more’.

The main unmet need in the Administration area was Quality Assurance. For example one comment was ‘I think there’s a need for someone in an advisory capacity to help me improve the quality of care’.

What were the general differences between statutory and non statutory agencies?

Figure 3 shows the input received as a percentage of need for the six general areas, comparing the

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9o!x

8Wx

70‘%

60‘X Resident Staff Staff Manager Manager Adminls- Needs Support Develop- Support Develop- tration

ment ment Key: Statutory units (N ~ 9) McJirL arr?as c!f t cped

0 Non-statutory units ( N = 6) ~ I ~ ~~

FIGURE 3. Comparison of statutory and non statutory units: Average of managers’ ratings of input received as a percent of input needed for

the six main areas

means for the statutory and non-statutory managers. It can be seen that in the area of support for residents needs, the perceived percentage of needs met is lower for statutory than non statutory agencies. This is somewhat surprising in view of the results of the earlier survey of CMHT members involvement in residences. That survey found that on average 6.8 team members were involved with each statutory unit for residents’ needs compared with 4.3 for each non-statutory unit. The lower proportion of needs met for the statutory units may therefore reflect the actual need levels of the residents. The current survey results bear this out, as they show a slightly bigger perceived need for this type of input by the statutory managers compared to non-statutory managers (5.9 versus 5.3 out of a maximum 10). This result may reflect the type of person who lives in each type of scheme as much as any shortfall in provision.

In the other five areas, the managers of statutory services reported a higher percentage of needs met compared to non-statutory service managers. This was especially true of the support and development needs of the managers themselves.

What specific differences were there? There were several individual items in the survey

which showed a large variation between the statutory and non-statutory agencies. For ease of reporting, only those items which showed a difference of at least 20% in extent to which needs were met will be reported here.

Support for individual residents’ needs

following areas: Non-statutory units reported better support in the

0 Self advocacy.

Leisure.

0 Relationships with relatives.

Physical needs.

Some of the comments in this area reflected the differing abilities of the residents in the various units. For example one non-statutory manager said: ‘They all make their own way (to leisure activities). There’s only three of my residents who are not capable of going out on their own’. While a statutory service manager said: ‘We need volunteers to take them out, you know adopt somebody and take them out for the day’. Statutory services reported better support in the area of contributing to Individual Programme Plans.

Staff support Statutory services reported greater satisfaction

with support from team meetings. Generally, statutory services seemed to put more organisation and time into such meetings. For example, one non- statutory manager said: ‘We try to have them once a month. It used to be every fortnight’. While a manager of a statutory service commented: ‘We have staff meetings once a fortnight, which are called Team Building sessions. I find it even better than the support session. A lot of positive work has come out of it. They really look forward to it. It’s well attended. We sometimes invite outside speakers’.

Staff development Statutory agencies showed greater satisfaction

with the following areas:

0 Managing challenging behaviour.

0 Understanding the CMHT’s role.

0 Preparing Individual Plans.

Challenging behaviour and IPPs have received considerable staff training input locally in recent years, which has been more available to health and social services staff. This probably accounts for some of the greater satisfaction by respondents in those services. However, there were several comments that training is often biased towards the qualified staff, but that in these areas all staff need training. Staff in non-statutory units were more satisfied than the others with the area of teaching new skills. This was recognised by several units as a priority training need, but there was not a single clear solution, for example, ‘We will receive it but I don’t know from where’.

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Manager’s support Statutory managers expressed greater satisfaction

in the following areas:

Supervision of own work.

Meetings with other managers.

Health and social services have well organised meetings and supervision sessions. For the other units, meetings and supervision seems less formal and more patchy. One non-statutory manager said: ‘I did have one or two sessions, but it wasn’t structured enough. I’ve no idea where it (supervision) is going to come from’.

Manager’s development Statutory service managers expressed greater

satisfaction than others with the following areas of personal development:

0 Implementing IPPs.

0 Receiving performance feedback.

Feedback seems related to the previous comments about supervision arrangements. The other areas may reflect recent initiatives within the statutory services to improve and update the individual planning systems.

Identifying residents’ strengths and needs.

Administration Statutory units were more satisfied than the others

with outside input on administrative matters in the following areas:

Staff recruitment and selection.

This generally reflected a difference of opinion on how much the parent organisation needed input from outsiders to educate it in the needs of the client group. For example, the manager of a housing association project said: ‘It’s important because they (the housing association) don’t understand enough about the work that’s involved. They know about housing and housing needs. They don’t understand the different aspects of the job. We’ve educated them quite a lot. We need a social worker on that committee’.

Input to the management committee.

Discussion A survey such as this produces a wealth of

information. It has obvious limitations in tapping only the views of individuals at a certain level in the system. However, the residential managers are in a key position to assess the support needs of each residential unit, and are the usual means by which such needs are identified. For this reason,

their perceptions arc- particularly important. While there was great variation between units, it has been possible to pull out some common threads. It must be said that overall, managers expressed satisfaction with the outside support they received from the CMHT and other sources. There were clear differences in perceptions between the statutory and non- statutory agencies. Overall, there seemed to be more areas of shortfall for the non-statutory agencies. There may be two reasons for this. There do seem to be more established local systems of management, information and training for statutory services. Also, in our earlier survey of CMHT members’ input to homes, on average 8.0 team members had input to each statutory services unit, compared to only 6.3 on average for other units. This is not to imply that the local health and social services have ‘got it right’, or that local voluntary and independent provision is inadequate. However, the results do seem to indicate that a local support bureaucracy can alleviate some of the effects of isolation that small dispersed units in the community experience.

In planning what to do to meet the shortfalls, there is a need for local discussion to consider which are the priority areas for each unit, who should be meeting these (CMHTAine management etc.) and what needs to be done to enable this to happen? If we wish to encourage people to work in a caring and supportive way, we need to treat them with similar care. Support systems are not an optional extra but an integral part of a high quality service system.

Acknowledgements We would like to thank all the residential managers for their time and effort in taking part in this survey, and Ann Walter, Clinical Psychologist, and Helen Scott, Senior Social Worker, Central Notts. CMHT for their help and advice

REFERENCES Crawford, ,J. V. (1990) Maintaining staff morale: The

value of a staff training and support network. Mentwl H a n d i m p 18(2), 48-51.

Tyne, A. (1981) StuJfing and Supportiny a Residwi- t in/ Servicv. London: CMH Publications.

Correspondence should be sent to Graham J. Collins, District Clinical Psychology Service, Ransom Hospital, Rainworth, Mansfield, Notts NG21 OER.

Positive Monitoring Jan PORTERFIELD A method o f supporting staff and improving services. Writ- ten primarily for managers, Positive Monitoring suggests ways in which they can support the efforts and recognise the achievements of staff, and thereby encourage their enthusiasm and commitment. 1987 32 pages Pbk 0-906054-62-1 $3.95 Orders and sules enquiries to: BIMH Publications, Bank House, 8a Hill Road, Clevedon, Avon BS217HH. Tel. (0275) 876519

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Support Needs of Residential Units