CHAPTER FOUR CASE STUDIES: DUNDEE AND ARGYLL AND BUTE
Given the variations previously outlined in relation to LAC implementation and operation, four areas were selected as case studies to illustrate the process of LAC and identify outcomes in four distinct settings. An account of how the case studies were selected and conducted is given in Annex One. The case studies had three aims: to explore individuals' and families' views about LAC; to examine LAC practice in relation to the specific criterion on which each authority was selected; and to gather evidence about outcomes for individuals, families and communities. The two case studies presented here reflect examples of LAC as operated in an urban (Dundee) and rural (Argyll and Bute) setting.
Dundee was selected as an urban setting where LACs work with families from Black and minority ethnic communities. In addition, the two areas where the LACs work, Hilltown and Stobswell, fall into the 15% of data zones (small areas with a population of between 500 and 1000) ranked highest in Scotland for social deprivation in the Scottish Index of Multiple Deprivation (Scottish Executive, 2004d). Their joint population is just under 10,000 with almost 15% being from Black and minority ethnic communities, the majority of Pakistani origin (Census 2001 quoted in Dundee City Council, 2005). There is a high incidence of long term illness - 41.3% in Stobswell compared to an average of 36.6% across Scotland. In 2001, unemployment was 33.3% in Stobswell and 32.2% in Hilltown, compared to 22.4% nationally. Owner occupation is far lower than the Scottish average with many people living in local authority housing or renting from private landlords. The vast majority lives in flats, including tower blocks. Over half the residents have no car. Single parents make up 11.7% of households in Hilltown and 10.1% in Stobswell, compared to 6.9% nationally (Census 2001 quoted in Dundee City Council, 2005). In these areas, marked by poverty, crime, vandalism, drug addiction and ill health, individuals with learning disabilities and families with disabled children can be vulnerable to harassment and exploitation. Those from Black and minority ethnic communities may experience communication and cultural barriers as well as the risk of racism. However, as discussed below, there is goodwill among sections of the community and some successful capacity building projects under way.
There are two FTELAC posts in Dundee, one being a job share. During our visit, which was spread over 2.5 days, we met:
- two of the LACs (the third was absent from work at the time)
- the Resource Manager, Day Services, Dundee Social Work Department (line manager of the LACs)
- three service users, two of whom live independently and one living in a nursing home
- four family carers - three mothers and one grandmother
- three community development workers employed by Dundee's Department for Leisure and Communities - a Community Capacity Worker (part of the Central Development Team), the Communities Officer for the Central area (with responsibility for co-ordinating production of the Community Plan) and the Project Leader of a local community centre.
- One researcher shadowed LAC visits to two families, including one Pakistani household where an interpreter was present.
An interpreter also attended an interview with an Urdu-speaking mother while a support worker was present at an interview with one woman who has no speech. The case study also draws on the Information Sheet completed by the LACs and the initial interview with them.
Background to implementation of LAC
The decision to appoint LACs in Dundee was based primarily on the recommendation of The same as you? Its publication coincided with an internal review of services to people with learning disabilities which indicated the need to look at alternative ways of supporting families, reinforcing the recommendations of the national review. The internal review concluded that existing social work services did not have the capacity to increase inclusion significantly for people with learning disabilities. Thus there was a need to locate the LACs in an area where community capacity building activities were already underway. Dundee Central, which already had Social Inclusion Partnership funding, was initially identified as such an area but proved too large. After some initial work, the LACs' target area was reduced to two distinct geographical communities - Hilltown and Stobswell. These are both mixed communities, sitting side by side near the city centre, where many residents - not only those with learning disabilities - face high levels of poverty, social deprivation and exclusion. The first LACs were appointed in August 2003. They had no formal induction but were given time to establish community connections and meet service providers before starting work with individuals and families. The posts were originally financed through the Change Fund but are now core funded.
Overview of role and remit
The LACs are based in their own office in a day centre for people with learning disabilities at the edge of the area they serve. Their remit is to work with people with learning disabilities of all ages and their families, living in the designated communities. They work with people at the latter's invitation, do not accept formal referrals and do not carry out assessments. At the time they completed the Information Sheets, the three LACs were working with 9, 3 and 12 individuals and families respectively, some of whom had care managers. The LACs can draw on the Day Services budget to purchase resources such as educational materials and equipment but have no dedicated budget of their own. A steering group set up for the project has been disbanded.
Individuals' and families' views of LAC
The individuals and families whom we spoke to thought the purpose of the LAC role was to give support to people with learning disabilities and their families, help them access information and link them to other services and supports. One family carer commented that the LACs' job was to "look after people who cannot look after themselves" but, she added, she had not realised how much the LAC could do until work with her relative began. Most respondents reported that they saw the LACs frequently, at least once a fortnight and in at least one case, twice a week. When circumstances required it, people would be visited more frequently. In addition, the LACs kept in touch by phone between visits, to see how people were getting on and keep them informed of progress on various matters.
Without exception, these respondents spoke very highly of the LACs:
"Very helpful person and listens to your troubles"
"If I didn't have [the LAC] I don't know where I'd be… she's stuck with me through thick and thin."
As these comments imply, individuals and families particularly appreciated the relationship they had with the LACs. Indeed, a couple of people described their LAC as a friend or member of the family. The LACs were said to be readily accessible, including outside normal office hours, to go out of their way to help and to be persistent both in looking for the right kind of support for people and in challenging other agencies to meet their responsibilities. One person commented that even if the LAC "gets a knock back", she keeps going. Another said that the LACs were in a difficult position: not having a statutory role, it was not always clear how much 'clout' they had. This sense of professional and indeed personal tenacity and commitment was a recurring theme.
It was evident that both individuals and families trusted the LACs' judgement and thought they offered good advice. Families appreciated the LACs' holistic approach, with a couple of mothers commenting that they could raise any issues of their own with the LAC. One parent, exhausted after years of attending meetings with professionals and, in her view, "being labelled a trouble-maker" was supported to attend meetings with other agencies. She was able to continue to participate with the LACs support and, in some instances, the LACs would advocate on her behalf when they and she considered this appropriate.
None of the respondents, when asked, expressed any reservations about LAC involvement or suggested anything should have been done differently. Some thought local area co-ordination should be implemented across the city. Two people interviewed would have welcomed some involvement from a male LAC, to accompany one young man to sporting activities and support another living in an all-female household. The LACs themselves identified a third case where a male colleague would have been useful.
Compared with support from the social work and education departments, these respondents were unanimously in favour of LAC. One individual for example had been allocated a care manager from another authority who, in her support worker's view, had been indifferent to the point of 'negligence'. A mother described her frustration with lack of social work support over many years, being kept on waiting lists and falling outwith the remit of various services. Social work support was described as piecemeal and fragmentary, largely due to staff shortages which meant that support tended to be forthcoming in relation to specific one-off issues. The Education Department also came in for criticism from one parent for being insular, not engaging in sufficient partnership working and failing to understand the issues facing families with disabled children.
It should be noted that neither the social work nor the education department have had the opportunity to respond to these points. However, the LACs reported that several people they work with, including some we met, were ineligible for statutory services despite their perceived vulnerability. Social work had referred one young man for a psychological assessment, including an IQ test to determine whether he had a learning disability. It was discovered he had an IQ just above the learning disability threshold and there was discussion about his eligibility for care management. Despite identified vulnerability, his case was closed although he continues to receive support from LAC and a social care officer.
Local area co-ordination in an inner city setting
It is evident that the LACs spend a good deal of time supporting people with problems arising from the environment, such as poor housing, debt management and disputes with neighbours. For example, one family living in a privately rented flat had problems getting their landlord to deal with housing issues. When we visited, there was a strong smell of gas emanating from a kitchen cupboard but the mother was reluctant to phone either the landlord or the gas company for fear the former might evict them for being a nuisance or incurring expenditure. The father had chronic health problems and could not work: their 14 year old disabled son had challenging behaviour, as did at times their younger child. The LAC was currently arranging for the parents to have a short break in London for which she had raised funding.
Another tenet of local area co-ordination is the focus on strengthening family supports. In a couple of cases where people were living with their families, we were told that the LACs' involvement had helped improve relationships and communication. However, the LACs are also working with some people whose families may be abusive, separated or under severe stress. An example was given of a young man who was the victim of abuse and crime, had spent time in a homeless unit, had little contact with his family and did not receive any support from them. We met a middle aged woman living alone whose daughter had been removed from her care; a woman aged 45, living, unhappily and inappropriately, in a nursing home, whose parents were dead and who had limited contact with her siblings; a young man who lived alone, his main support being his grandmother, not his immediate family; a 60 year old woman who had lived with her parents until their death but was now on her own and, she said, lonely, and an Urdu speaking mother who, until recently, had been a single parent. The stereotype of supportive extended families within the Pakistani community did not apply to her. The LACs believed that the combination of poverty and absence of family support was particularly hard to tackle. They had raised this with Eddie Bartnik at a training course but did not feel they received a satisfactory response:
"So even with the poverty, if there is a close family network then that…but if you have a level of poverty where there is no family network, you kind of need all the elements to be there and Eddie Bartnik didn't give us any answer to the question 'what do you do if there is no family?' Because…families are all the way through [ LAC]."
Given the combination of social deprivation and absence of family support, it might be thought that the LACs would focus on community capacity building. However they had found that the level of need among individuals and families prevented them from working at the community level as much as they would have wished. One of the LACs commented:
"And it is a time [issue] and I think it's really important that we remember that it [community capacity building] is a big part of the job and try not to get sucked into the kind of social work side of things all the time."
The three community development staff to whom we spoke were keen to emphasise the capacity building aspect of the LAC role, where they perceived significant similarities with their own remit. They seemed to think the LACs had made more headway in capacity building than the LACs gave themselves credit for, although one added that developments could have moved 'at a quicker pace'. The community development workers described a number of joint initiatives. The LACs had supported a few individuals to attend group activities within the local community centre. There had been some adverse reaction from other group members including a couple who sat on the community centre's management committee. (Indeed we were told by one service user that she had been harassed by two people in the class she attended at the community centre). It was therefore agreed that the LACs would deliver learning disability awareness training to the management committee and a number of successful sessions were held. In addition, the centre was looking at ways of welcoming and including more people with learning disabilities in its various activities. Another project planned with the local community capacity building officer was an inclusive art group.
The need to consult people with learning disabilities about the Community Plan had been identified by a number of partners and steps were being taken to ensure their involvement. The LACs are not directly involved in this initiative although the community development staff reported a positive impact of the LACs' work in promoting inclusion generally, pointing out that capacity building initiatives often fail to include disabled people living in local communities. One of them commented:
"It's chicken and egg because part of why the LACs came to focus on this area was that it was more fertile ground because there was some local interest in moving the learning disability agenda forward, so there was a bit of both there. I think for me local interest has been one of the big positives in that there was a bit of local support around a number of workers to take it forward plus the LACs have come in and built on that and that has created a bit of momentum to move the whole agenda forward."
Outcomes for individuals and families
It was evident that the LACs had assisted people to access a range of supports and services. For example, individuals and families had been put in touch with occupational therapy, social work assistance, care management and housing services. The LACs had accompanied people to appointments with schools, GPs, solicitors, the police and other agencies with the intention of advocating on their behalf or supporting self-advocacy. Independent advocates had been found for two individuals. A fulltime college place had been secured for one young person. A number of people were being supported to find paid work, voluntary work and alternative housing. Others had received financial assistance, for example, to attend college, from the Independent Living Fund and for a holiday.
As a consequence of LAC involvement, the people we spoke to were better informed about the options available to them, in terms of formal and informal support. Some were also better informed about welfare benefits and sources of financial help. LACs also signposted individuals and families on to other sources. This was particularly appreciated by the Urdu speaking families: one mother explained that while Pakistani children learn to read and write English at school, this is not the case for mothers, making it difficult for them to access information about services and supports. The LACs have translated a leaflet about their services into relevant community languages. In addition, the community centre was now displaying more information than before about services and support for disabled people.
Good information provision enables people to make meaningful choices. The people we spoke to all reported being given various options by the LACs which they could choose to accept or reject. Since these often related to activities or support they were previously unaware of, it can be surmised that, in a general sense, they had more choices than before. In one case, the LAC had taken a mother and son to visit various clubs to help them decide on the most suitable. One manager thought it unlikely that LAC activity had resulted in more choice for people, in the sense that there had been no increase in available services or resources. On the other hand, he thought that the LACs' person centred approach meant that people were choosing activities that genuinely appealed to them rather than an activity perhaps chosen for them for the sake of having something to do. Planning was an important part of the LACs' role: people had been involved in Person Centred Plans and Essential Lifestyles Planning. For one individual with no speech, the final product, complete with photographs and illustrations, was a powerful way of communicating her preferences, wishes and aspirations to all who knew her, as well as making her feel valued and involved in the process.
Several respondents told us they - or their relative - were lonely and had few or no friends. A key aim here was to promote inclusion by identifying community based activities and encouraging people to try them out. This involved the LACs accompanying people to a range of community groups including art groups, youth groups, keep fit classes, over-50s lunch club, kickboxing and a red squirrel watch. Some people have continued to attend independently with the LAC withdrawing once the individual had gained confidence and/or developed relationships with other group members. One young person continues to attend kickboxing classes with the support of a volunteer arranged by her LAC. One professional respondent identified helping people develop friendships as a 'huge challenge'. While social networks had been widened, this was considered to be an area the LACs could helpfully focus on.
Sometimes having more choice had not led to more activity, or to sustained activity. The LACs told us about two men they had tried to support to join various groups but without lasting success. This was attributed partly to the men's desire for a romantic attachment, both losing interest in going out if not accompanied by the LAC.
Other outcomes included:
- Developing individual capacity
- Providing accurate and timely information to enable individuals and families to access other resources
- Access and support to take up and complete education
- Individual achievements as the result of links with other community groups (eg Discovery Award)
- Access to bereavement counselling
- Access to voluntary employment
Outcomes for Communities
There was evidence of LAC activity raising awareness of disability issues within the community through the community centre. This took the form, as mentioned above, of disability equality training, information provision and increased efforts to ensure the centre was welcoming to disabled people. Including disabled people in mainstream activities and setting up an inclusive art group were also ways of raising awareness among the non disabled population. However these developments were at an early stage. The community development workers reported that the LACs were "nurturing people with learning disabilities to take the disability agenda forward". There was plenty of evidence of the LACs developing links and networks across agencies and groups. Besides partnership working with key community groups and the Department of Leisure and Communities, they had good relationships with the social work and housing departments, voluntary agencies, particularly Barnardos, the community police and the translation and interpreting service. These links were mostly in relation to securing support for an individual rather than at strategic level. One manager commented that that the council initially thought the LACs' main challenge would be to foster interagency collaboration between different organisations and co-ordinate the delivery of the services to individuals and families. In practice however, he explained, the introduction of LACs had identified vulnerable individuals who had fallen through the social work net and the focus now was on supporting them.
DISCUSSION AND CONCLUSIONS
Without doubt, the LACs are highly valued by all the individuals and families we met. We were struck by the range and diversity of people with whom the LACs have evidently formed trusting relationships, irrespective of gender, age, ethnicity and level of impairment. This is a testament to their skills. Individuals and families appreciated the tenacity with which the LACs went about their job. Adopting a positive and holistic approach, bridging the transition years between adolescence and adulthood, and supporting families from Pakistani communities, particularly where there have been communication issues, are key strengths of the LAC approach in Dundee.
While the time and energy devoted to building relationships and the level of one to one, 'hands-on' work with individuals clearly reaps benefits, there are questions about the sustainability of such close relationships, a concern also raised in Chenowith and Stehlik's (2001) research on LAC in Queensland. In some cases it seems the LACs were perhaps expected to do more for individuals, rather than building their capacity to do things for themselves as well as building community capacity. Likewise, the intensity of the work undertaken means that only a small number of individuals and families - about 22 - are benefiting from LAC.
The findings suggest that in Dundee the process of LAC is at least as important as the outcomes. Indeed, one manager believed that, to date, progress was more evident in process rather than outcomes. However, there was evidence of some positive outcomes for individuals and families, in terms of people having access to support and services, being better informed, having more choice of activities and some increase in availability of flexible supports such as holidays and day and leisure opportunities. There was less evidence of people developing new friendships or relationships, other than with the LACs themselves. In relation to communities, we found some evidence of LACs raising awareness of disability issues in the community. More progress has been made in forging links and networks across agencies and groups.
There are three distinctive aspects of LAC within the Hilltown and Stobswell districts of Dundee which raise wider issues about social work/care management and about local area co-ordination. First, the introduction of the LACs has identified individuals and families who either fall short of the criteria for more formal support - because they have mild impairment and/or appear to be living independently - or for whom 'the box is ticked' because they have some form of support, albeit that support may be inappropriate or insufficient. These include lonely and/or vulnerable people who require a good deal of sustained support to secure a decent quality of life. Secondly, the absence of supportive family contact presents a significant challenge to the focus within LAC on strengthening family networks. Thirdly, working in a deprived inner city area raises questions about the emphasis on developing supportive informal community networks: the LACs suggested that many people were too preoccupied dealing with their own immediate issues to offer support to others. Similarly, some of the people the LACs were working with were focused on day to day survival rather than long term planning. These points are discussed further in the conclusions.
ARGYLL AND BUTE
Argyll and Bute was chosen as a case study due to the opportunity it presented to examine local area co-ordination in a rural setting. There are four full-time LACs in Argyll and Bute, currently located in Helensburgh, Dunoon, Oban and Lochgilphead 16. Although each LAC and representatives from the authority-wide People and Agencies Coming Together ( PACT) groups took part in the interviews for this case-study, logistical factors required us to focus mainly on the work of one LAC.
Argyll and Bute is spread over a wide geographical area. Oban, Lorn and the Isles covers 1040 square miles with a population of 19,164. Helensburgh and Lomond covers 141 square miles, with the population of Helensburgh alone accounting for 27, 809 people. Bute and Cowal spans 419 square miles with a population of 22,590 while Mid Argyll and Kintyre covers 1080 square miles with a population of 21, 743 17.
LACs in Argyll and Bute work with individuals with a learning disability and their families, across all age groups. Individuals with autistic spectrum disorders, mental health issues and physical impairment may also be referred and can be offered advice and support. This case study took place over two days and one evening and included the following interviews:
- Four Argyll and Bute LAC's
- Four members of the Oban PACT group (two agency representatives, two individuals)
- Mid Argyll, Bute and Cowal, Helensburgh and Lomond, and Oban PACT Groups joint interview (seven individuals, one LAC)
- Oban Community Sensory Garden meeting (eight individuals, two community members, one LAC, two Care Outreach workers) followed by an interview with representatives of the Management Committee (consisting of two individuals and one support worker)
- Individual interviews with the Project Co-ordinator Care Solutions, Leisure Centre Manager, Head Teacher of the local Learning Centre and a telephone interview with a Care Manager
- OPCA (Oban Parents whose Children have Autism) interview with three parents
- Individual interviews with one parent, and a joint interview with an individual and parent
- Individual interview with LAC line manager.
Background to implementation of LAC
Local area co-ordination was implemented in Argyll in 2002. Each area is expected to work to the same principles but the service can be developed to meet local needs. Local area co-ordination was not officially launched by Argyll and Bute Council, LACs themselves designed and issued leaflets advertising their role and promoting their activities. By presenting LAC in this way, they were able to signpost the service and principles to individuals and communities.
Overview of role and remit
Expectations of LAC were varied. Respondents indicated that the planning and preparation which had gone into informing agencies and families about the role meant that they had insight into the LAC role and valued all aspects of it, both in terms of supporting individuals and families, and developing community capacity.
The LAC role was seen as much broader than that of care management, although LACs could work closely with care managers in an advisory and supportive capacity. There is a current shortage of care managers in Argyll and at present, not all adults with learning disabilities have care managers. This has meant that the LAC role has included a degree of care management where there is no allocated care manager to enable individuals/families to obtain the services they need (for example completing Carenap assessments, care planning, arranging reviews and access to services such as direct payments, short breaks, ILF and support to maximise benefits). When LACs have intervened in this way it has been primarily to address the needs of the individual or family and, respondents suggested, has on occasion prevented services being predominantly resource led.
There were many examples of joint work between the Argyll LACs and other agencies. Monthly meetings had been established between one LAC, and workers from education and social work, to facilitate information sharing about individuals or families where there was joint involvement between the agencies. This was valued by those involved. Other agency representatives also commented on the benefits that accompanied the flexibility of the LAC role. While social workers were sometimes seen as "difficult to get hold of" by other workers, often due to demands on social work services, the LAC was seen to be more accessible, with a good knowledge of the individuals and families that she was working with, and the ability to interact between families and other agencies.
The Argyll LACs were viewed by respondents as able to network, liaise, support and provide information to all agencies (including health, education, community services, housing) alongside enabling/supporting families and individuals. Working with other agencies sometimes led to the identification of gaps in services and this could require LACs to take on an advocacy role or to support families in obtaining services. It was recognised, by a number of professional and family respondents, that given the diversity of the LAC role, effective working could be directly related to the individuals' personal skills and experience. However, as one Argyll LAC commented: "It's not fixing it for the family, it's about empowering the families".
Individuals and families views of LAC
While the Argyll LACs would work with families and individuals who invited their support, considerable emphasis was given to setting up groups which would empower individuals to support each other. Nevertheless, the LAC who was the focus for this case study was considered to be readily accessible to individuals and families who, along with workers in other agencies, commented on the ease with which they could contact her (mobile phone, email, at group meetings) and greatly appreciated the fact that she would always get back to them within a short space of time, and would direct them to any sources of information that she did not have herself. One individual commented of the LAC that: "She has her finger in every pie in the sky".
LACs were viewed as acting as a buffer from statutory services, empowering people to do things for themselves. The LAC's good local knowledge also helped with the identification of funding sources and development of links across services to help support people, illustrated by a number of identified outcomes. Communication was seen as the crux of the success of local area co-ordination enabling the LAC to listen to what families and service users were recommending. Importantly, the LAC was seen as 'neutral' by families in that she did not side with other agencies and could maintain an overall view of a situation. While individuals and families were clear that the LAC would advocate on their behalf, they appreciated the measured stance she was able to adopt, helping them to remain realistic in their goals. She was also viewed as active in making people come together, with the flexibility to organise services. The combination of flexibility of role and LACs knowledge was viewed positively by families and other workers, enabling them to challenge other services, where appropriate, and to encourage services to work together.
The LAC role was viewed by respondents as relatively unique in terms of developing community capacity. In particular the PACT groups (People and Agencies Coming Together) which had been developed throughout Argyll and Bute were seen as significant in this respect. This had enabled communication and co-ordination between agencies and service users. The LAC had supported the development of networking in communities to help families, carers, and adults with learning disabilities find out about community resources (sign-posting) including training opportunities, employment, voluntary work, transport issues, leisure and recreational opportunities. Other agency representatives noted the importance of being able to work jointly to pool resources and work with individuals and families to provide additional support, the LACs' ability to put across views of both agencies and service users, and to help both groups reach solutions together.
LAC work in a rural setting
Argyll and Bute covers a wide area and the LACs are located in four geographically disparate settings. This has meant that there can be discrepancies in the development of LAC. The areas that LACs covered and the time required to travel within each area necessarily meant that some parts were better serviced than others. For example, the Oban LAC has telephone contact with the islands and will visit families as required, but the service received in the islands is limited in comparison to that provided in Oban itself. This situation is replicated throughout Argyll and Bute.
Despite the geographical distance between the four LACs, they tried to maintain regular contact. However, as demands on their services increased, the time available for meeting had reduced. It was seen as important that they took the opportunities available to learn from each other, sharing ideas and supporting each other.
LACs believed that individual planning potentially worked well in a rural area where members of the communities and workers often knew of each other. However it could mean that there was not always the necessary concentration of services to meet the needs of individuals. Direct payments were considered crucial by LACs in meeting needs that local resources could not cover (e.g. short breaks) and it was viewed as important that they were used creatively to support people.
Outcomes for individuals and families
It was recognised that there were many difficulties in measuring outcomes in this area of work where there may not always be 'hard' outcomes which can be measured tangibly. However there were many areas where the LAC was seen as making a real difference to the lives of individuals and families. Of particular importance was the skill of listening to individuals, and allowing them to tell their story. The initial approach of the LAC and the fact that she would contact families to explain her role and then offer support, meant that she was viewed very differently to statutory services by individuals and families. Despite the sometimes ambiguous role associated with local area co-ordination, families seemed clear about what this entailed. As the Argyll LAC pointed out: "Families are very quick at understanding the LAC role and how it differs from care management".
Many agencies, individuals and families claimed, professed to want to increase independence for people but often did not help/allow for that to happen. LACs were seen as providing support for individuals to help build their confidence - so that people could do things for themselves. By supporting individuals on a personal basis, and through the development of group activities and social networks, this meant that people could "get out more", were able to voice their views, develop friendships and participate in social activities. They described "getting things done" through the LAC, who had helped individuals get jobs or find new ones, secure independent accommodation and take an active role in community forums.
Individuals gave examples of:
- getting involved in SCLD Training and becoming trainers themselves
- travelling independently outside their home area
- participating in seminars and presentations to the local community
- feeling included in the community
- having the resources, through the networks established by the LAC, to mutually support each other.
It was seen as important that LACs were able to support the whole family rather than being limited to work with individuals. This had also meant that the LAC could support other agencies who were attempting to work with individual family members due to their knowledge of the family as a whole. Both families and agencies commented on the importance of the LACs' separate identity from social work. As well as being seen as independent, the LAC was also seen as having considerably more time than statutory workers to spend with families and to find or clarify information for individuals and families. She was also able to work with people outside social work services, providing some form of support for families who had no other form of assistance. Similarly, it was acknowledged by individuals and family respondents that they may be more likely to contact the LAC in situations where they would hesitate to contact social work services.
The importance of the LAC role in the co-ordination of services and information was seen as very beneficial by other agency respondents, and it was suggested that the role of the LAC was likely to mean that individuals and families could, in some instances, be less reliant on statutory services.
Families indicated that they can struggle at times to get heard by overwhelmed statutory agencies, and greatly appreciated the support of the LAC. She had assisted families to set up meetings to get agencies to discuss things with each other and with families, and by doing so, attempted to overcome the inter-agency hierarchy that can exist.
It was seen as important for families that LAC is not linked to other services, but can provide a guide through these other services (e.g. health, education, social work). Several respondents stated that they wished LAC had been around for longer and believed that this would have been very beneficial for them, particularly in situations where families perceived other agencies to be slow in responding to their needs, or not responding to them. Some of the benefits of LAC identified by individuals and family members included the following:
- Can guide families through services
- Not the same boundaries as with other services
- Realistic about what can be achieved
- Informal contact
- Can respond to crisis (in a different way from social workers)
- Tells you your rights
- Can empower you
- Acted on what families thought was important
- Helps individuals and families have a voice
- Accompanies people to meetings
- Helps you look at your options/choices
- Giving families the confidence to do things for themselves - not by doing them for us
- Always gets back to you.
Outcomes for Communities
In Argyll, considerable emphasis has been given to developing forums aimed at co-ordinating services and providing opportunities for service users to participate in local planning. At the point where LAC was introduced, agencies had been providing services without much communication between them, resulting in duplication and lack of co-ordination. There was particular consternation among individuals that Christmas parties had frequently coincided in the past, but the difficulties resulting from this way of working could be considerably more problematic. Accordingly, the Argyll LACs had set up the PACT groups to bring agencies and service users together.
The groups which had been developed by the LACs were seen as important in supporting individuals to feel more positive about themselves, as well as creating greater public awareness of the needs of individuals. The PACT groups have received funding from Supporting People to provide a development worker and each group is currently working towards the development of a constitution as well as applying for grants to develop inclusive training, leisure and recreational activities to provide alternatives to daycare. The LACs commented that PACT groups have been useful in highlighting the need to identify outcomes from their work as these are needed when applying for grants where the outcomes of interventions need to be identified. Respondents indicated that the groups had resulted in a more co-ordinated approach to service delivery as well as providing a useful channel of communication. The groups also communicate through the use of email, although it was pointed out that this e-group is largely made up of agencies rather than individuals. Attempts to increase service user access to email facilities are ongoing.
In addition to co-ordinating services, guest speakers are sometimes invited to come along to the PACT groups (most recently from the Fire Brigade) and sub-committees have been established to discuss social and fundraising issues/events and report back to the wider group.
Respondents indicated that the groups were important in giving people the confidence to do things themselves (they are service user led), and have significantly raised the profile of people with learning disabilities within the community. Indeed it was suggested that the PACT groups have 'brought the community together', and helped to develop a sense of community which had perhaps been lacking previously. They gave examples of fund-raising the groups had carried out, enabling them to organise social activities which they determined. Activities were decided through consultation within the groups, for example, Helensburgh PACT had sent out a questionnaire to service users to find out what people wanted to do, and discovered that most wanted to go bowling. The groups opened up their activities to the whole community, and were satisfied with the response they received. Respondents commented that they were unhappy that some voluntary organisations would come along to their activities but did not reciprocate by opening up their activities in the same way. There was a lot of networking between the different area PACT groups, respondents gave examples of sharing ideas and formal resources (e.g. constitution) which prevented another group having to 'reinvent the wheel'.
Groups had set up information sharing days where agencies were invited to come along - but the group also told agencies what they wanted to happen. They could co-ordinate events, and let everyone know what was going on. Most of the groups kept a diary which listed all agency events in their local area to avoid duplication. The PACTMAKI group ( PACT Mid Argyll, Kintyre and Islay) have set up a website to publicise their work and keep people informed of forthcoming events.
Participation in these forums was seen by the individuals involved as making a significant contribution to changing the awareness of local communities - learning disability was seen by the service users as less stigmatised than it had been in the past. They also pointed out that people were now doing things more proactively than they had in the past. PACT members were also involved in developing strategies and informing people about their views - for example, going into schools to talk to children with the aim of changing attitudes. All of the respondents did, however, recognise that it could take a while to make a difference.
The PACT group in Oban had achieved a number of things including: increased uptake of Argyll College courses and Individual Learning Accounts as courses were increasingly designed to meet people's needs; Oban Community Sensory Garden project; fundraising events; inclusive training with service users and providers; annual public information days; promotion of health, well being and community safety (One Life Live it Well); Leisure Link; and future planning after The same as you? In addition, service users and providers have more information and knowledge; service users said they felt more empowered, less confused, have greater understanding of service provision and delivery, and there is improved information provision.
In Helensburgh the LAC was involved in bringing ARC (Achieving Real Change) to facilitate a meeting of all agencies including health, education and social work management to look at ways forward for The same as you? after five years. This was in October 2005. This continues to be ongoing and more meetings are being arranged to help implement and feed into the planning of the future resources within Helensburgh.
Other services had also been enhanced as a result of the LAC's contribution. For example there had been some negotiation with the manager of the local leisure centre to set up Leisure Link which resulted in carers being able to use the swimming pool free of charge when accompanying an individual who was in receipt of a concessional rate. This had led to an increase in the use of the leisure facilities. The Oban LAC is now based in the leisure centre and other agency respondents commented that ongoing collaboration has been viewed very positively, with people making increased use of the facilities, which in turn has led to services being developed (e.g. access, sport events) to meet their needs and ensure they are fully included in local events.
Another initiative which illustrates the importance of agencies working together with each other and service users to enhance the community was the development of Oban Community Sensory Garden. The management committee, in which service users are supported to hold key roles, has been involved in co-ordinating the design and creation of a sensory garden and are currently fundraising to meet the costs of this initiative. Respondents involved with this noted that they enjoyed being involved in the development of this important resource for the local community, and also gave examples of the ways in which this had led to the development of their self-confidence and involvement in the wider community at a personal level. As well as making friends and getting to know people, they gave examples of being able to do things that they had not previously felt they could do.
Three members of Oban Parents of Children with Autism ( OPCA) participated in the evaluation and respondents indicated that the establishment of this group, which the Oban LAC had been instrumental in setting up, had created greater awareness of the needs of children on the autistic spectrum. This had led to a corresponding influence on social inclusion through the group's participation in local community projects.
OPCA consists of a group of parents representing 15 families, who form a constituted group in order to identify needs of children on the autistic spectrum. The Oban LAC had supported parents to design a survey which was used to help identify future service delivery in the area, and led to the successful award of £80,000 from Child Care Partnerships, Better Neighbourhood Services and FUSIONS to develop local short breaks services. OPCA have commissioned the Scottish Society for Autism to provide a Saturday club and an after school care service to families whose children have autism. The group gave many examples of the support they had received from the LAC in attaining their goals, and considered it of prime importance that they were given the support and advice they needed to do things themselves, resulting in their personal confidence and competence being developed.
The future remit of LAC involved the continued development and enhancement of service provision and supports within the local community. It was noted that inclusive training involving both service users and agencies had taken place, but needed to continue, with a clear value base underpinning training to avoid tokenism. Respondents, by way of example, pointed out that staffing needs can create inflexible ways of working (e.g. entrenchment in rota systems), but that some of the difficulties this creates can potentially be rectified by socially inclusive training. LACs, it was highlighted, were useful at pointing out issues such as this because of the independence of their role.
DISCUSSION AND CONCLUSIONS
Local area co-ordination was viewed very positively by all respondents and the flexibility of the role, commitment and personal knowledge of the LAC was greatly appreciated by individuals, families and other agencies.
It appeared that service users were more likely to have contact with LACs than statutory services, both in the initial stages of a difficulty arising and given the shortage of care managers in some parts of Argyll. In addition, the ease with which families could maintain contact with the LAC could also result in greater access (via text, email, meetings, mobile phone).
Problems which were noted related largely to the current lack of funding for LACs in Argyll. The initial budget available to LACs has been frozen at present due to increased central control and this has created some tensions. Previously, it was suggested, the LAC budget was used carefully and only as a last resort, and accountability for money spent was very important. When money was used from the LAC budget, the LACs considered it likely that their interventions may have saved Argyll and Bute Council money in the longer term by preventing individuals and their families experiencing crises.
Potential problems could also arise due to line management which was located in adult services, while LACs also support children and their families. These issues were generally resolved due to good working relationships between individuals. Clearly the LAC role requires initiative and confidence to work in innovative ways, which respondents repeatedly acknowledged.
Workers in other agencies noted the importance of being able to work jointly with LAC and commented that the service they provided was invaluable. Key features included the time that LACs could give to individuals and families, their flexible ways of working and their ability to ensure services are co-ordinated and accessible to families who are not in contact with statutory social work. The key issues identified in this case-study are discussed further in the following chapters.