Housing and Support Program (HASP): Final Evaluation Report

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66 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
available when and where needed by clients. It is clear that the provision of support services should be based on some ongoing assessment of client need, and services should be provided to match this need. In relation to HASP, there needs to be greater clarity on how decisions are made regarding the level of support provided to individuals within the model. While support agencies have greater freedom to meet client support needs within the ‘block’ funding model, there appears to be less fl exibility for clients to move between service providers. Clients wishing to transfer to another agency have to fi nd an agency with suffi cient funding capacity to cater for their support needs (since the transferring agency retains the funding). This can be especially diffi cult for consumers with large support packages. Thus, there needs to be a review of the block funding model to ensure that there is suffi cient fl exibility to enable clients to move between agencies if they so desire. Accommodation Services The provision of appropriate and affordable accommodation was considered by the clients and staff interviewed to be one of the most important components in the success of HASP. While it is clear that housing has a physical component (i.e. an identifi ed building), it also provides people with a sense of identity and ‘asylum’ from the outside world. The quality of housing has been found in previous studies to impact on the rehabilitation, functioning, and quality of life of people with mental illness. Individuals living in appropriate housing that met their needs had better outcomes at follow-up (Nelson et al., 1995; Baker & Douglas, 1990; Rosenfi eld, 1990). Having enough space was an important factor in overall satisfaction with accommodation. Clients valued having a spare bedroom for visiting family members. Others, with a fl air for art and other hobbies valued having a second bedroom which they used as a studio. However, some clients experienced diffi culties when friends of family members moved in to a spare room. Having people staying became a source of stress when these people refused to leave or began to demand food and money from the client. Thus, careful assessment of the client and their need for additional bedrooms needs to be carried out as part of the process of allocating accommodation. The majority of HASP clients (76%) lived on their own. However, 22% felt that they would like to live with a roommate or friend in the future. The evaluation team notes that while HASP clients are not prevented from sharing accommodation, they are unable to share the support services they receive. It may be worth exploring how the program can better facilitate share housing for a small sub-group of clients who may prefer this option. Fourteen of the 80 clients in our sample had moved accommodation since joining HASP. Eleven of these had moved once, one had moved twice and two had moved thrice. There were three main reasons cited for moving — noise from neighbours and or unable to get along with neighbours (n=8), dislike of the area in which they lived (n=3), and to be closer to family (n=3). While client requests to move accommodation could be viewed as a negative for the program, it is reassuring that clients can ask to be relocated to a new neighbourhood and this appears to be feasible within HASP. It is clear that having one’s own home in the community provides a connectedness to that community. Themes that emerged from the interviews with clients suggest that stable housing plays an important role in one’s recovery. Clients viewed their housing as being important in providing stability in their lives and a platform from which to participate in the recovery process. Two other themes to emerge included a ‘sense of freedom’ and a ‘sense of home’. Housing and Support Program (HASP) 67
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Department of Psychiatry (UQ) and S
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Final Evaluation Report of the Quee
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• Community integration While eig
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List of contents Executive summary
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Section 1 Introduction Since the 19
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1.1.1 HASP — Management Structure
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1.2 Housing and supports - previous
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Table 1.2.2 Outcomes for clients mo
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activities, while others tried to c
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1.2.6 Section summary It is clear f
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Section 2 Method 2.1 Design The stu
Page 23 and 24: 2.2.1.2 Clients unavailable to part
Page 25 and 26: 2.2.1.5 Clinical staff — sample F
Page 27 and 28: 4) Data collected from mental healt
Page 29 and 30: 2.4 Procedure 2.4.1 Clients - proce
Page 31 and 32: All focus group discussions and ind
Page 33 and 34: However, it was clear that the deve
Page 35 and 36: Importance of the Supports Facilita
Page 37 and 38: Accountability There was a percepti
Page 39 and 40: Support workers highlighted issues
Page 41 and 42: 4.1.2 Client perceptions of support
Page 43 and 44: In general, Case Managers expressed
Page 45 and 46: 4.2.2 Client perceptions of the amo
Page 47 and 48: Support workers felt, as a result o
Page 49 and 50: 4.2.8 Amount of support required in
Page 51 and 52: 4.3.2 Living arrangements The major
Page 53 and 54: 4.3.7 Housing in HASP — compariso
Page 55 and 56: The majority of HASP clients (76%)
Page 57 and 58: 5.2 Satisfaction with key life doma
Page 59 and 60: 5.7 Depth of friendships We explore
Page 61 and 62: 5.11 Community involvement Clients
Page 63 and 64: 5.13 Section summary During our int
Page 65 and 66: etter functioning). However, while
Page 67 and 68: 6.7 Physical and mental health Link
Page 69 and 70: 6.10 Section summary The average ti
Page 71 and 72: 7.2 Comparing HASP with inpatient/r
Page 73: of applications, increase Case Mana
Page 77 and 78: 8.4 The ability of the program to m
Page 79 and 80: Section 9 Recommendations 1. More i
Page 81 and 82: Section 10 Reference list Anthony,
Page 83 and 84: Shepherd, G., Murray, A. & Muijen,
Page 85 and 86: Housing and Support Program (HASP)
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Housing and Support Program (HASP): Final Evaluation Report

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