Housing and Support Program (HASP): Final Evaluation Report

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Section 8 Discussion
Non-clinical Service Provision
Support services are often essential in compensating
for the lack of a family network and/or reducing the
burden of care placed on carers (Oliver et al., 1996).
They assist people to navigate the fragmented maze
of mainstream social and disability services by
linking people to community-based recreational and
vocational services. Non-government organisations
have been able to develop models of care that allow
for the episodic and fl uctuating nature of chronic
illness. Moreover, the community focus of the disability
sector, which is not treatment or illness-orientated,
offers an alternative to existing medical models.
Many of the clients spoke about their relationship
with their support workers and described them
as friends, mates and companions. The issues of
friendship between support workers and clients can
be viewed in different ways. On one hand, support
workers who are too successful at becoming friends
for clients may defeat the long-term goal of reducing
contact with clients (i.e. as independence increases).
On the other hand, clients making friends with those
people with whom they have most contact is not only
a good survival strategy, but also exercises a capacity
for friendship which can be used outside the home
environment to widen support networks.
Support workers felt, as a result of their interactions
with Case Managers, that they had an important role
to play in the treatment process. However, just over
half (54%) agreed that Case Managers had provided
them with as much information as they needed. Six in
every 10 support workers expressed a desire to have
a greater say in the services provided to HASP clients.
Only one-third of support workers indicated that they
were involved in developing care plans for clients.
However, in most support agencies this task is left to
the Supports Coordinator who disseminates relevant
information to the support workers.
Training for support workers was raised by Case
Managers and support workers themselves. Both
groups felt that support workers require more training
in a range of areas to enable them to work with clients
who have complex needs. Indeed, almost half of the
support workers involved in the study (45%) felt they
required more training to be able to work effectively
with their HASP clients. Training in the use of recovery
principles was identifi ed as a key area for additional
Final Evaluation Report
training. While 85% outlined that they were familiar
with the principles of recovery, 37% felt that they
needed more training in the use of recovery
principles in practice.
Support workers highlighted issues with transport,
lack of money and lack of motivation in their clients
as key areas of concern. Lack of motivation in clients
was mentioned by most of the support workers who
participated in the study. Support workers found it
diffi cult to engage clients in exercise or activities
outside the home. One support worker described
her client as being a ‘bit lazy… it’s so diffi cult to get
him to do anything’. The issue here is unlikely to be
laziness, rather a lack of motivation that is frequently
found in conditions such as schizophrenia. Acquiring
a better understanding of this issue (through training)
may help support workers to appreciate consumer
behaviours and how best to work with these.
The disability support sector has demonstrated its
ability to manage people with severe and persistent
psychiatric disability in community settings. However,
there is a danger that the disability sector will expand
to meet needs that should be met by other services —
a problem that has plagued the mental health sector
for years. This could further marginalise and isolate
people with mental illness. Onyett & Smith (2001)
noted that the correct mix of clinical and non-clinical
staff on mental health teams continues to be widely
debated. Both groups of staff seem to be dependent
on each other. Non-clinical support staff depend
on clinical staff to ensure that adequate treatment
and symptom control is provided to maximise the
outcomes of support. Clinical staff, on the other
hand, depend on non-clinical staff to provide lifestyle
support to maximise the outcomes of treatment.
The fi ndings suggest that support agencies were able
to reduce the levels of support provided to clients over
the study period. Support hours provided each week
decreased by an average of 7.13 hours, from a mean
of 27.6 hours on entry into HASP to a mean of 20.4
hours at the follow-up time-point. However, fl exibility
of funding within the model needs to be continuously
monitored as there is potential for over-servicing.
Strauss (1996) notes that fl exibility in support should
form the cornerstone of any disability support program
and stresses that disability services should be on
tap, not on top. In other words, services should be