Supporting people to live self-directed lives in the community: Learning from 54 Irish projects

Background In line with Government policy, 54 projects have been supporting people with disabilities and people with mental health difficulties to move from institutional settings to live self-directed lives in their... [ view full abstract ]

Background
In line with Government policy, 54 projects have been supporting people with disabilities and people with mental health difficulties to move from institutional settings to live self-directed lives in their communities. These projects received innovation funding, training and mentoring to support the successful implementation of personalised accommodation and supports.
Aims and objectives
The aim of this paper is to synthesise the implementation learning across sites, to identify common practices in effectively providing personalised accommodation and supports, in order to inform future work in this area.
Method
This opportunistic group of 54 projects comprised the sample. Informants included project leads, managers and front-line staff. Quantitative and qualitative data were collected over the lifetime of each project on at least three time points through interviews with informants and completion of an anonymous descriptive dataset for beneficiaries. A brief questionnaire was used to guide interviews, addressing progress against the aims and objectives for each project, identifying challenges and enablers. Ethical approval was not required for this analysis of anonymous organisational data. In addition, a detailed dataset on outcomes and costs for a subset of projects and beneficiaries collected as part of an independent study was available McConkey et al. 2013).
Findings
Since 2010, 359 people have successfully moved to the community and a further 291 are being supported. The current biggest barrier to people moving is the availability of housing. The factors which have supported effective implementation include; multi-level leadership, the person leading the process, involving families and allies, engaging and consulting with stakeholders, staff skills and training, understanding readiness, addressing housing and relationship building simultaneously, intentional building of community networks, starting small and modelling change, addressing the challenge of reconfiguration, allowing sufficient time, a focus on outcomes and monitoring progress.
Conclusions and implications
The factors supporting implementation match very closely those identified in the Common European Guidelines on the Transition from Institutional to Community Care (2012). The synthesis of learning from practice is essential to guide effective policy implementation. In order to develop further understanding, an analysis of this dataset against an implementation framework is underway and will be reported.