Services for people with learning difficulties are currently
moving from predominantly institutional facilities to community based
services. The two studies addressed this major change by assessing the
views of the users and using a number of quality of service measures.
Study I investigated twenty-one people who had left hospitals in
Leicestershire. An assessment of each person was completed which
included the views of users and carers and quality of service measures.
The majority of users expressed a preference for their community
placement. In addition, it was found that their measured views were
not statistically associated with any quality of service measure. It
was decided to investigate this finding further in Study II by using a
different methodological approach.
Study II used an innovative methodology emphasising outcome
measures and involving six detailed case studies of people living in
community residential services. These all addressed the same set of
questions by the systematic collection and analysis of in-depth,
objective information. An important advantage of this methodology was
that it enabled a number of processes to be identified, which were not
detectable using large sample techniques.
It was found that certain features of service style, such as
systematic allocation of domestic tasks, were powerful influences over
the amount of time that people participated in these activities. Time
spent in integrated settings used by the general public was influenced
by factors such as having an active link in the community, e.g., a
person to visit. Users in Study II expressed greater dissatisfaction
than those in Study I, and some people wanted to move to places
offering greater independence. Factors were identified which
influenced this viewpoint, including knowledge of alternative
Guidelines for practice are offered. Recommendations are made
for case study designs which will enable processes to be identified.
Suggestions are given for implementation and feedback within services,
and for targets to be achieved.
A Doctoral Thesis. Submitted in partial fulfillment of the requirements for the award of Doctor of Philosophy of Loughborough University.