IAS - Just enough support

Just enough support

IAS was formed in 1988 with a commitment to provide high quality support services for people with learning disabilities. Since then, over 200 people have moved into supported tenancies. More recently IAS has developed a wide range of community support services and alternatives to day services in Salford, Oldham and Wigan as well as a supported employment service in Salford.

IAS has an innovative and progressive approach to service provision and is constantly seeking not only to improve the quality of existing services but to find alternative, cost effective ways of meeting the needs of each individual. Implicit in this approach is a desire to identify and develop the 'next generation' of appropriate service models.

In March 2002, after a 15 month process involving in-depth consultation with people supported, their relatives and other significant allies, IAS were able to de-register all the small Residential Care Homes in Salford and Trafford. Since then this has enabled all the people they support to become tenants of their own homes and to receive personal budgets that allow them to exercise far greater choice in how they live their lives and how they are supported.

The ethos within IAS is of providing 'Just enough support.' While this has obvious benefits in terms of efficiency and productivity that are particularly important in the current financial environment, it has been driven by a genuine commitment to transforming and improving services so that people live better and fuller lives with less dependence on paid support and greater involvement in local communities.

This has involved a range of practical steps to reconsider people's support grounded in the promotion of independence, the embedding of new technology and enabling greater community involvement. These have included:

• Reviewing the use of "double ups" to ensure this is not applied across all support where it could be used more discriminately and varied depending on the activity supported.
• Working with staff to increase their confidence in working on a 1:1 basis with more of the people they support.
• Reviewing the use of "waking nights" in supported accommodation to see if these can be replaced by "sleeping nights" or in some cases removed altogether.
• Using assistive technology more extensively and ensuring staff across the whole organisation know what is available and how it can be applied to reduce dependence on paid staff.
• Running an annual course for staff called "Making a difference" to encourage people to consider people's gifts and think innovatively about how even those with very complex needs can be involved in and contribute to local community life in meaningful ways.

The work began by drawing together staff from across the organisation and asking each team to identify one person they supported who had not ever got onto the "moving on" list with whom they would work differently. This was about increasing people's independence, sometimes in small ways, sometimes more substantial and has involved adopting a more positive approach to risk while still keeping people safe. It has also involved working with families to change people's perception of the services IAS provides, from simply providing support, to providing an enabling service designed to increase independence.

IAS feel they are well on the way to embedding this ethos within their service. One manager commented "This is about building the right set of assumptions into the culture of the service where people's skills and attributes are never underestimated."

Some examples of how this has changed people's support include:

• Mr X, who had previously been labeled as dangerous following his resettlement from an institution, was being over supported. He would ask why it was necessary for people to be sat with him in the evening while he watched television and as staff got to know him they began to ask the same question. IAS worked with Mr X through informal review meetings using a person-centred approach to risk to come up with some actions that would enable him to start spending more time alone. Initially this meant three hour periods where he was left by himself, which worked very well and led to a noticeable improvement in his self-confidence. The next stage, prompted by Mr X, was to consider removal of over night support. At this point IAS involved social services and the assistive technology team so everyone was sure that decisions were made in partnership and were in his best interest. With installation of assistive technology, these arrangements are now working well and have led to improved outcomes for Mr X as well as significant reductions in the cost of the support package.
• Miss Y had moved out of her parent's home into shared accommodation with two other people but this arrangement wasn't working well which was resulting in low moods and some challenging behaviour towards her housemates. It became apparent to IAS through the review process that Miss Y didn't need 24 hour support so with her agreement they began to build up her confidence by leaving her for periods of time without support. Despite this, relationships with her housemates continued to deteriorate and a further move into a flat with just one other woman did not solve the problem. With IAS's support, Miss Y found a private flat to rent. This new move is working well for everyone. Miss Y is now happy and contented in her home and is no longer exhibiting challenging behaviour. Previously Miss Y had needed 2:1 staffing and her behaviour had resulted in an increase in management hours and high staff turnover. Now Miss Y has a range of assistive technology in her home, including self locking doors, a door camera and gas safety cut off switches and staff rota's have been developed to maximise her much reduced support hours.

These and other examples of IAS's work can be found in the recent publication 'All together now'
http://www.puttingpeoplefirst.org.uk/BCC/topics/Latest/resourceOverview/?cid=8489