Local area co-ordination ( LAC) originated in Australia and was introduced to Scotland in the form of a recommendation in The same as you? report, following a national review of services to people with learning disabilities. With a strong, person centred value base, LAC is an innovative way to support individuals and families to build a 'good life' and to strengthen the capacity of communities to welcome and include disabled people. As part of its core funded programme for the Scottish Executive, the Social Work Research Centre at the University of Stirling was asked to conduct an evaluation of the implementation of local area co-ordination in Scotland. This 11 month study ran from October 2005 to August 2006.
The aims of the study were:
- To examine the lessons from implementation of LAC across Scotland
- To explore (in broad terms) the outcomes of LAC work
- To assess the future scope for LAC.
An initial literature and policy review was conducted. Data was collected through:
- 44 information sheets completed by local area co-ordinators in 24 authorities
- Interviews with 35 local area co-ordinators in 24 authorities
- Interviews with 14 managers in 13 authorities
- Interviews with a manager in seven authorities without LAC
- Four case studies of LAC practice which involved talking to individuals and families, LACs, managers, and staff in other agencies.
The policy context in which LAC has been introduced to Scotland is a complex one, with an array of legislation and guidance from social work, education, children's services, health and community planning and development potentially impacting on, and in turn being influenced by, local area co-ordination. Common themes emerging from these various policy arenas include: partnership and joint working; service user, carer and community participation and empowerment; easier access to services and support; promoting social inclusion; choice and control for service users; and early intervention and preventive work. Also important is the emphasis given to challenging discriminatory attitudes. There are also some more recent additions such as 'personalisation' and 'co-production of wellbeing'. LAC would appear to fit well with current policy agendas and offers some insights into potential directions for implementation of principles into practice.
The literature review highlights that little research has been carried out on LAC to date. Existing studies suggest the main benefits which can be identified for individuals and families include: empowerment; trusting relationships with LACs or other key workers; accessibility; choice; flexibility; reliability and the provision of emotional and practical support. Communities are said to become more inclusive and accepting. Concerns raised in the literature include the market-driven nature of individual funding schemes which may increase privatisation and a low wage sector; insecure and inconsistent support; inappropriate expansion of the role, resulting in high workloads, dilution of the values and role conflict; a blurring of professional/personal boundaries, raising questions about the sustainability of the relationships involved, and a need for more robust support mechanisms.
Differences in LAC practice across local authorities and the broad remit of LAC generally meant that clearly identified, measurable outcomes were difficult to extract from the LAC process. However, LACs identified three main areas of achievement: a better overall quality of life for people; specific differences in individuals' lives; and particular areas of work, such as transitions to adulthood, where they believed they had made a wider impact.
Four case-studies were conducted to provide a closer examination of LAC and to highlight the views of individuals and families, LACs, managers and staff in other agencies. The local authorities were selected to illustrate the operation of LAC in four distinct contexts: rural settings; urban settings; across traditional service user groups; and managed within the voluntary sector. In addition to highlighting pertinent issues in each setting, the case-studies provide evidence of a range of relevant outcomes. These include the following:
- Having time to build relationships with individuals and families, help them to identify their own needs and accordingly, to work toward change in their lives
- Supporting individuals to actively engage in their local community
- Assisting individuals and families, through networks established by the LAC, to mutually support each other
- Helping individuals and families to engage effectively with other agencies
- Enabling individuals and families to believe they have someone working in a professional capacity who is 'on their side'
- Bringing together individuals and families from diverse backgrounds and with different life experiences to work together to reach solutions within their local communities
- Ensuring people have access to support and services, are better informed, have more choice of activities and some increase in availability of flexible supports such as holidays and day and leisure opportunities.
The findings from the four case studies suggest that LACs were highly valued by all respondents, including individuals, their families and other agencies; individuals and families in particular reported that LAC had made an important contribution to their lives. Generally, it was found that individuals gained improved access to services, support and information as a result of their contact with LACs. In some cases, inter-agency cooperation was enhanced. Community capacity building was also seen as an important aspect of the overall work of LACs, although at different stages of development within different local authorities. Additional outcomes included supporting individuals and families to build networks with each other, with appropriate services and with the local community, and increasing choice and flexibility in services for individuals and families.
There is wide variation in almost every aspect of the organisational arrangements for LAC in Scotland. Some of this diversity indicates a departure from the principles and ethos underlying the Australian model of LAC and was experienced as problematic by many LACs.
By March 2006, there were 59 LACs in post, or about to take up work, occupying 43 full-time and 16 part-time posts across 25 local authorities. Most LACs were employed by local authorities but three authorities had commissioned voluntary agencies to provide LAC. One LAC was employed by an FE college while in another area an NHS Trust and local authority were joint employers. Those employed by local authority social work departments voiced a number of reservations about this but recognised a number of advantages too. Over half the LACs were physically based in social work teams or resource centres and, again, most had concerns about their location.
Overall, LACs were well qualified, with 82% having a first degree or equivalent and 11% having qualifications up to N/SVQIII level, although 7% had no formal qualifications. Their previous work experience was predominantly within the social and health care sectors, but overall they had a wide and diverse range of experience. Our findings show variations in the salaries paid to LACs although this range did include LACs in managerial positions, and may reflect the range of qualifications held. Nevertheless this constituted an issue which caused strong feelings among most.
All the authorities with LAC serve adults with learning disabilities and most also work with children with learning disabilities. A few LACs work with people with other conditions, notably physical impairment and/or mental health issues. LACs in 12 authorities worked with people from 'cradle to grave'. There is considerable variation in the size of area LACs have to cover and in the total and target populations within those areas. Some reported having too large an area to cover while those working in smaller communities sometimes had to turn away requests for support from further afield. In only 11 authorities do LACs have access to dedicated budgets, nearly all amounting to less than £5,000. There were reports of delays, reductions and withdrawal of budgets.
About two thirds of the LACs had been given protected time for community mapping and/or networking when first in post. Thirty percent had little or no induction. However, as a group, they had received training on a range of diverse topics. There was general enthusiasm for the national training and Action Learning Sets run by the Scottish Consortium for Learning Disability ( SCLD). LACs indicated that they would appreciate additional training on community capacity building: the creation of neighbourhood, local and community resources to provide natural supports for individuals and families.
LAC IN PRACTICE
Most individuals and families were introduced to LACs by service providers. Word of mouth and self-referrals also played a part. In a minority of authorities, people had to go through the social work allocation system or a similar 'vetting' procedure to access local area co-ordination. This would appear to be at odds with the LAC ethos of easy, informal access. There was considerable variation in the numbers of people LACs were in contact with or supporting. Figures ranged from 2 to 47 families and from one to 42 individuals.
Relatively little time was spent on community capacity building, although it was deemed important within the overall ethos of LAC. In only six of the 24 authorities did LACs claim to have made significant progress in that area. Apart from lack of time and the fact that community capacity building is a long term process, disinterest and sometimes resistance was reported among some local communities. Where progress had been made, this may be linked to more welcoming communities, the LACs having a strategic base in the area, their previous knowledge of the locality and/or their community development background.
LACs were enthusiastic about the role of local area co-ordination and the potential impact they believed they could make in the lives of individuals and local communities. However, their satisfaction varied in accordance with the structural location of their post and managerial support.
THE ROLE OF LACs
LACs identified several distinctive features of their role, not least its person centred value base (although many other workers in human services would also lay claim to that). The non-bureaucratic and preventive aspects of LAC and its remit to challenge where appropriate were also highlighted. All the LACs were agreed on the importance of promoting inclusion, but there were different understandings of what that meant and how it should be achieved. While most fully embraced the LAC ethos, a small minority thought there was an idealistic, even an unrealistic, strain within this. Some LACs struggled at times with the emphasis on promoting family support which, for a range of reasons, was not always feasible or appropriate.
In only five authorities did LACs consider their job was clearly defined and understood, while those in nine authorities reported it was ill defined and not fully grasped by managers. About two thirds were aware of ongoing confusion and/or tension between the LAC role and that of social work/care management, although the relationship could work well where activities were accepted as complementary. In some areas, LACs have been drawn into care management procedures and it appears that in at least three authorities, LACs acted as care managers for part, or all, of their role. Collaboration with other agencies was unevenly developed. Partnership with the voluntary sector was generally better advanced than with statutory organisations.
Steering groups appeared to have limited success. Half the authorities had never had one and among those that had, experiences were evenly divided between positive and negative. Groups made up of individuals and/or family carers were seen as most useful while those composed of professionals were more likely to be experienced as unsupportive. Six steering groups were either inactive or had been disbanded.
Overall, about half the LACs felt well supported, although those in nine authorities reported experiences of isolation and a sense of being devalued with five LACs reporting that they felt undermined in their role. It was suggested by a small number of LACs and managers, for example, that LAC may have been introduced only to 'satisfy' the Scottish Executive and not on the basis of real understanding of the role or commitment to the work of LACs.
Overall, line and operational managers had mixed views about the efficacy of local area co-ordination, although generally welcoming it. Those who were enthusiastic, were extremely so, largely attributing this to the skills and experience of the workers they had recruited into the posts. Where others were more sceptical, this was often due to the shortage of other resources within the local authority and the requirement that they managed this shortfall. It was in such contexts that LAC was viewed as a 'luxury' rather than a necessary resource.
NON- LAC AUTHORITIES
All of the seven authorities without LAC were positive about the ethos and principles of LAC, although many had concerns about adopting the model in practice, not least in transplanting it from Australia to Scotland where different social, cultural and governmental structures were in place. However, whilst the majority of these authorities either had specific plans or hopes to implement LAC in their authorities in the foreseeable future, others felt that they could take on board the recommendations of The same as you? in relation to LAC without necessarily creating posts with that title, and cited the expansion or development of existing services to illustrate how they were working to achieve these recommendations.
Barriers to implementation within these non- LAC authorities have tended to be practical rather than ideological, with budgetary constraints and embedded bureaucratic structures being the two particular concerns for respondents. Perceived pressure from the Scottish Executive, coupled with a seeming lack of forward planning regarding introducing LAC into existing local authority social work settings, have resulted in some animosity amongst the non- LAC authorities with regard to the implementation of LAC.
Suggestions from LACs and their managers for future development at local and national level were broadly similar although the emphasis at local level was on greater security and support for workers while, at national level, for more consistency and clarification of the LAC role. Many respondents highlighted a need for debate at national level about how certain aspects of the LAC ethos relate to the structural and political context of Scotland, as distinct from that of Australia, notably in relation to: the development of LAC without a reduction in the provision of social work and health services to those who need them; appropriate provision of family support; and a realistic approach to the development of community capacity building.
Although the evaluation highlighted some difficulties in implementation and a measure of confusion surrounding key aspects of the role, nevertheless, LAC was highly valued by individuals, families and staff from other agencies. There was evidence of positive outcomes in terms of increased independence, choice and inclusion, and huge commitment to the role among LACs. At present geographical coverage is uneven as is the availability of support to people of different ages and with a range of impairments and needs. Therefore, the authors conclude that in order to provide a more equitable support system across Scotland, the number of LAC posts should be increased. This could be achieved by the creation of a ring fenced fund to finance new LAC posts and to support and/or fund the training of LACs. To assist in this process, the evaluation has highlighted the need for updated guidance on the implementation of LAC in Scotland, setting out the ethos and values of LAC, and providing practical guidelines on its implementation and operation in a Scottish context. This could be supported by the creation of a National Development Worker post, funded by the Scottish Executive, which could assist local authorities in implementing formal guidance and promoting the development of LAC across Scotland.