Five or six years ago we had four individuals in supported living – today we support nearly 100. This new direction came from the personalisation agenda, promoted by the then government in its Putting People First guidance. It was a real sea change. Local authorities no longer wanted to place people in residential settings – they wanted them to live in the community with bespoke support packages. Then came the horrors of Winterbourne View and that message was redoubled.
Wirral Autistic Society was founded in 1968 by a group of parents and has grown to become a substantial regional organisation with over 800 staff caring for more than 300 people with autism and social communication difficulties. We offer specialist support services for families and children, extensive daytime services and respite care along with our residential offers.
Despite our focus on supported living, we’ve resisted following the path taken by many service providers of moving all our residential services into that model. Some of our service users don’t have the capacity to understand the legalities of a tenancy and have complex sensory needs that can’t be fulfilled living in a local community. Our answer has been to put substantial investment into residential care. We’re developing our original Raby Hall site in Bromborough, adding a modern, autism-specific residence alongside the original building.
Our society uses a “step-through” model of care. Service users leaving institutions can begin in a larger residential unit and then gradually move into smaller units with the ultimate aim of moving to a supported living tenancy, if that is right for them. We have 85 people in individual accommodation in communities and 15 tenants at Weatherstone’s Court in Cheshire, a block of flats in a tranquil rural setting.
Historically, the review process, where life-changing decisions about accommodation are made, tended to revolve around statutory requirements. We felt strongly that what was important and meaningful for the individual should be at the centre of every decision and so our new “action reviews” are entirely person-centred. We ask the service user all about themselves – what things they want to stay the same or change and what they’d like to do better. Service users can write down their answers, or draw pictures or symbols on a colourful document, which then becomes the focus of the review meeting. Service users can invite anyone they wish to their meeting and we encourage them to attend, if they are able to. One person delighted us by choosing to sing at their meeting.
We’ve had significant successes with our move to community living and our Weatherstone’s Court service has just been shortlisted for a Laing Buisson independent specialist care award in the supported living category. Our step-through process has helped a number of people who were in crisis to gradually develop valuable lives in the community. We’ve also become good at matching support workers to service users. There’s nothing worse than seeing an 18-year-old man being supported by a 59-year-old woman. A young adult should spend time with his peers.
The most significant challenge has been to maintain sufficient funding for the service. On one hand, social care practitioners tell us they are desperate for our specialist help, on the other hand, the council has been trying to reduce costs, making it difficult to deliver that service. Downward pressure on hourly rates puts pressure on the wages we can pay staff. Our support workers need to be highly trained in order to cope with some of the most complex people in our region – the induction process alone takes them through 25 autism-specific courses designed by our in-house autism practice department. We feel their skill should be rewarded.
Tips for service providers looking to move people into supported living
• Aim where possible to secure a small advance budget from social services to cover a bespoke transition package so that you can have support workers going to where the person is already placed, getting to know them before the move.
• Communicate, communicate, communicate. Upfront planning with families, carers and service users makes a world of difference.
• If the individual is coming to you with a difficult reputation, be prepared to wipe the slate clean and allow them to have a fresh start in a new setting. Put in careful risk management and develop a tailored programme of support allowing socially responsible behaviour to increase in the new environment.
• Expect that a honeymoon period will be followed by a time of tension when boundaries are tested. You’ve got to support the staff and service user through both these periods before the real work begins.
• If your services are run by small teams, be careful that your staff don’t become isolated and start making their own decisions, rather than following the autism practice you’ve put in place.
This piece was first published by The Guardian, on 05/02/2015 and can be found here.