Background
Method
Setting
Sampling and recruitment
Data collection and analysis
Results
Participants
Mean (s.d.)/n by service type | ||||
---|---|---|---|---|
Characteristics | Residential Care | Supported Housing | Floating Outreach | All Services |
Clients |
n = 10 |
n = 10 |
n = 10 |
n = 30 |
Mean age | 45.4 (16.3) | 33.8 (9.3) | 39.8 (13.3) | 39.7 (13.7) |
Male | 6 | 5 | 6 | 17 |
Female | 4 | 5 | 4 | 13 |
Mean years in current accommodation service | 3.7 (3.9) | 4.2 (4.5) | 2.1 (1.2) | 3.3 (3.5) |
Range | 3 months – 14 years | 8 months – 11.5 years | 7 months – 4 years | 3 months – 14 years |
Previous accommodation situation | ||||
Inpatient Rehabilitation Unit | 0 | 2 | 0 | 2 |
Community Rehabilitation Unit | 2 | 0 | 0 | 2 |
Residential Care Home | 1 | 1 | 0 | 2 |
Supported Housing (staffed 24 h) | 0 | 0 | 3 | 3 |
Supported Housing (staffed <24 h) | 3 | 1 | 2 | 6 |
Temporary Accommodation (e.g. bed and breakfast, night shelter/hostel) | 1 | 1 | 0 | 2 |
Rented Property | 0 | 1 | 3 | 4 |
Family Home | 3 | 4 | 2 | 9 |
Staff |
n = 10 |
n = 10 |
n = 10 |
n = 30 |
Mean age | 52 (11.2) | 39.5 (12.5) | 43.6 (10.3) | 45.0 (12.2) |
Male | 5 | 2 | 5 | 12 |
Female | 5 | 8 | 5 | 18 |
Manager/Deputy Manager | 5 | 3 | 4 | 12 |
Support Worker | 5 | 7 | 6 | 18 |
Mean years working in the service | 8.2 (8.1) | 6.3 (6.4) | 4.9 (4.7) | 6.5 (6.5) |
Range | 3 months – 22 years | 8 months – 20 years | 7 months – 14 years | 3 months – 22 years |
Service |
n = 10 |
n = 10 |
n = 10 |
n = 30 |
Mean number of clients in service | 14.4 (5.1) | 13.9 (6.9) | 29.8 (15.5) | 19.4 (12.4) |
Mean number of staff in service | 15.4 (9.5) | 9.6 (9.1) | 6.9 (6) | 10.6 (8.8) |
The goals and purposes of supported accommodation
Participants | |||
---|---|---|---|
Theme | Clients | Staff | Total |
Goals and purposes of support accommodation
| 30 | 30 | 60 |
Building independence | 24 | 30 | 54 |
Supporting people with their mental health | 15 | 18 | 33 |
Providing safety and stability | 6 | 15 | 22 |
Building Confidence | 9 | 12 | 21 |
Competing theme - Anxiety about the continuity of support | 23 | 18 | 41 |
Helps and aids effective practice in supported accommodation
| 30 | 30 | 60 |
The supportive presence of others | 25 | 30 | 55 |
Incremental steps | 26 | 29 | 55 |
Working together to avoid deskilling and dependency | 28 | 27 | 55 |
Feeling known and personally understood | 23 | 26 | 49 |
Tailored support for social and community engagement | 26 | 17 | 43 |
Building confidence through encouragement | 8 | 27 | 35 |
Participant’s Service Type | |||
---|---|---|---|
Theme | Residential Care | Supported Housing | Floating Outreach |
Goals and purposes of support accommodation
| 30 | 30 | 60 |
Building independence | 19 | 15 | 20 |
Supporting people with their mental health | 8 | 13 | 12 |
Providing safety and stability | 8 | 6 | 8 |
Building Confidence | 8 | 4 | 9 |
Competing theme - Anxiety about the continuity of support | 14 | 12 | 15 |
Helps and aids effective practice in supported accommodation
| 30 | 30 | 60 |
The supportive presence of others | 20 | 19 | 16 |
Incremental steps | 18 | 19 | 18 |
Working together to avoid deskilling and dependency | 19 | 17 | 19 |
Feeling known and personally understood | 19 | 13 | 17 |
Tailored support for social and community engagement | 16 | 15 | 12 |
Building confidence through encouragement | 10 | 12 | 13 |
Building independence
“We don’t treat people, but we are more like life coaches now. We have kind of….our main role is to help people to maintain their independence, maintain their tenancies, stay in their own home basically.” (manager floating outreach s.01).
“…a place where there’s support, somewhere where I could get back on my feet, which is actually what this place is, you know, based on. It’s like a kind of stepping stone, you know what I mean?” (client residential care s.03)
“…we’ve got some clients here that we would imagine maybe in two years’ time they’d be able to live either in a minimum support setting; with a view to their moving to independent. Whereas there’s other people here that they would…you know, that is probably not within their reach, for various reasons. So that is… you know, then our job is to work with them to find out what their likes or dislikes are, what they need to [do], to have a good quality of life and independence really.” (manager residential care s.67)
“I never thought about it, but it will be great if I became normal like everyone else – could manage everything I want to do, could go like find a job and do some work and feel like everyone else – you know? I wish to one day become like that so I could live independently; I’d really love that – you know? And then become like normal: have a car, have a house or girlfriend or anything you know? Be like everyone else. ” (client floating outreach s.40)
Building confidence
“Well I’m getting my confidence back, ‘cos I haven’t had my confidence for a long while, and I’m getting more respectful towards people and I’m starting to see life in a different way now….” (client residential care s.17)
“I think in the main what it does is it helps develop their feelings of confidence about being able to deal with situations that may not be terrifically familiar, or by which they feel quite threatened, so that they learn how to do it in a more measured way so the confidence comes up, and the next time a similar situation comes around I can say well look, do you remember what we did last time?” (support worker floating outreach s.92)
Supporting people with their mental health
“Now, if there are four things that are from a social perspective – if you like, that have an impact on someone’s mental health, if you take those away then you’re looking at…I suppose better mental health. So I would focus on that. The clinical stuff…there are nurses and people and doctors that will look after that element.” (manager floating outreach s.56)
“I still kind of wasn’t very well – mentally I mean – and they said oh, we decided that, you need to go into a Home. So I thought they meant elderly people. So I was sat there like: ‘Do you want me to go into an elderly person’s home?’ Then they said no, the mental health places. So I kind of…because I’d been independent – living with friends and stuff – at first I didn’t really get it, and then obviously I didn’t…wasn’t very happy but when I came here, obviously yeah, I realised that now it was the right decision, and that I did need the support.” (client supported housing s.98)
Providing safety and stability
“I kept like moving around all the time, or like I didn’t…I don’t really get on very well with shared accommodation – and that’s kind of a lot of the accommodation I was in. So it was basically I needed somewhere stable.” (client supported housing s.52)
“…purpose like of this service I think is for safety, security so it’s that basic…that’s what if you ask any of [th]em, that’s what they say straight away – is that they feel safe and secure. And somebody who cares. Basically, well it’s giving them reassurance that, when they do go out – I’m thinking of [client], when he does go out, that nobody’s trying to hurt him. Just that reassurance that he will be safe, and if he does have any problems all he’s got to do is come back to me and I will give him the reassurance…” (support worker residential care s.80)
Anxiety about the continuity of support
“The anxiety’s always been there, it’s not just anxiety it’s things that like I know I wouldn’t cope in a flat on me own…” (client supported housing s.95)
“Yeah that’s because, you know everyone wants to be safe and secure whether, you know whether you’re ill or not, so to have that in the back of your mind to know that you’ve got a place for life, you know is good, but then at the same time, you know you can get caught in a trap and then you think well you know something’s a bit too safe and you don’t wanna move on ‘cos you know you get scared of change.” (client floating outreach s.76)
“…we’ve tried it once with one person and it was a no-go. As I say I think it’s a safety blanket, and I think it’s a case of not so much us approaching them but them approaching us if they’re ready to move. Because I think if they start to worry and panic and think ‘I’m going to lose me home’…” (manager support housing s.97)
Helping and aiding effective practice in supported accommodation
The supportive presence of others
“Yeah, I’m not very good at living alone. So just having…if anything goes wrong for me I’ve got, I’ve got the support… yeah residents as well actually. But I’ve lived in supported accommodation because of the having other people around helps really.” (client residential care s.67)
“We might not have actually touched on anything…serious, but just that, just that chin-wag, just that interaction with somebody that’s going through the same thing as you is…it’s just, you can’t put a price on that.” (client supported housing s.69)
“And I think, like I say…just from taking these ladies to the coffee mornings they have…you know it’s not for everybody but, you know you can see that they’ve made friends, they’ve interacted with people, they’ve…you know they’ve shared stories and also I think…it’s empowering really because you can help each other and sort of give each other tips on how you cope with your mental health..” (support worker floating outreach s.71)
“..One person hadn’t been taking their medication, was on Clozapine, became quite poorly quite quickly and was quite intimidating to another one of the tenants, and staff intervened pretty quick and basically take them aside, diffuse them…calm the situation down, get in touch with the CPN, and unfortunately that person was admitted to hospital, but sometimes that does happen.” (manager supported housing s.97)
Incremental steps to progress
“We have a lady and she was really, really poorly when she came to us, very low self-esteem, very anxious, very depressed, very paranoid – wouldn’t eat or drink off the table [stayed in bed]. We’ve taken little steps with her – she is now at the stage where she’s going out on public transport, she’s now going out to activities, she’s now attending appointments on her own, she’s confident in making telephone calls and we think we’ve done really well with her.” (manager residential care s.61)
“It won’t be shared; it’ll be a one-bedroom flat and I will get some support when I move from here, like the safety and support workers that support you for a few months. So they don’t just chuck you out – like you have got something.” (client supported accommodation s.52)
“So it’s discussed at every support plan - they happen monthly, two-monthly, three-monthly, depending on what the client’s needs are, so we just discuss about moving on, if it’s moving on from accommodation-based, or whether it’s to another accommodation setting that they require, but we’ll also discuss about the steps towards independent living and what services or support needs to take place to achieve that.” (manager floating outreach s.94)
Working together to avoid deskilling and dependency
“….what we’re aware of as well is there’s always a chance you can deskill people, and that’s what we’re very aware of; that we don’t wanna bring somebody into support like this and then take away the skills they’ve already learnt by offering too much support if that makes sense – that all your meals are provided here: that’s deskilling somebody…We always try and keep those people, when they come in to us, if they’ve got those skills we don’t want them to lose it.” (support worker supported housing s.19)
“You…you’ve got two sides of the coin, because you’ve got help being offered right? Um, but also you’ve got to help yourself. They go hand-in-hand as it were – if you’re not prepared to help yourself then she’s wasting her time, and that sort of motivates me.” (client floating outreach s.87)
Feeling known and personally understood
“..she’s aware that I’m intelligent enough to kind of look after myself, but just a little bit sort of overwhelmed with a load of stuff that’s been going on so…and that’s what’s made me fall behind and kind of lose track and things. But from her part kind of using her skills to try and sort of ascertain like what do I need to be doing for this guy and what can he do for himself?....it’s kind of been almost tailor-made for me, which I suspect is sort of a credit to [support worker’s] kind of people skills.” (client floating outreach s.71)
“…a necessary part of relationship building – not just at the beginning, but at times throughout my relationship with clients, to be social. So, maybe suggesting that we go out into town and have coffee - particularly if there’s a level of anxiety about being around a lot of people. And I will do that purposely.” (support worker floating outreach s.92)
Tailored support and provision for social and community engagement
“He’s got me in touch with, I’m not sure – I think they’re a charity and they do all sorts of things, mainly for homeless people but, with mental illness and all sorts and he’s got me in touch with those and I done a course – it was a resilience course; that was for a mental health course and he’s also helped me get onto a bike maintenance course, and also Monday morning down to the canal for fishing…” (client floating outreach s.85)
“We’ve got one gentleman who, he was visiting his step-father every weekend, and he’d done it for the last 20 years, and he turned round to me and said ‘Well I don’t want to go every weekend’ and I’m: what would you rather do? So we sat down at the computer and checked the cinema listings and now every other weekend he goes to the cinema, has a meal with a friend and then comes back. So that we broke out of his routine and he’s really enjoying having a bit more independence.” (manager residential care s.25)
“I mean I’m not one to tell people what to do, but I think it would be good for some tenants to get out and do different things, and I think if we were able to do that with tenants, I think the tenants would be amenable to do that. Because a lot of people they don’t want to go out on their own and don’t have that many friends and family, so it’s just like… the social aspect of it and I think it would be beneficial for the tenant’s mental health if we could sort of do a social activity with them. But the supported people contract that we are under, it only allows us to provide housing-related support.” (support worker floating outreach s.76)
Building confidence through encouragement
“Well like I have one client and like he needed a lot of support with his shopping but we sort of go with him in the initial stages or, so we’ll go round with him and then he knows what to buy and then we suggested maybe writing a list out prior with him, he went with the choices that he would use, and then bit by bit we try to drop off our support, so that he can then go by himself and mainly give him lots of encouragement in saying that he’d be fine and he’d manage well on his own, and to try to control his anxiety levels while he was there, and then we only now support if he’s feeling really unwell…but if he’s feeling well enough then we try to encourage him to go by himself.” (manager supported housing s.70)
“Well it’s confidence-building, helping you to deal with things that you need to know about, like it’s how to pay rent and your bills and how to keep yourself clean and…and where you should go.” (client supported housing s.95)