Social public services: Local quality systems project, Halikko
This is a quality systems project run by the Finnish Association on Mental Retardation and a number of municipalities to develop quality and self-evaluation tools. Services were examined from first, a user viewpoint through quality groups and other tools, second, from the standpoint of quality work and activity, and from the standpoint of organisations. In Halikko the objective is to integrate disabled users of services with users of regular services. Services are monitored by a variety of quality control mechanisms.
- Adults with learning disabilities
- Public sector
- Locally based quality improvement measures
The local quality systems project ran between 1996-1998 and self?evaluation tools were developed. Kotka municipality, Turku municipality, Halikko municipality, the specialist care circuit of the federation of municipalities of south-western Finland (Varsinais?Suomi) and the social welfare services of the Espoo federation of municipalities took part in the project. In addition, Koivula, a central Sofianlehto department in Helsinki, acted as the pilot unit building the quality system. Quality was assessed in Valga province, Estonia, where a training programme for social workers involved in the project was arranged through collaboration between the Valga provincial administration and the Estonian Ministry of Social Affairs.
The services were examined i) from the standpoint of the user (by means of client interviews, parental quality groups, mentally retarded quality groups, working in a futuristic workshop, evaluating quality by means of a quality of life counter, description of service chains, experimenting with networks, etc.) ii) from the standpoint of quality work and activity (job descriptions by employees, discussions occurring in training groups and units, development methods, quality system modelling, entering quality objectives, development of self-evaluations) and iii) from the standpoint of organisations (development challenges of service structures and how to respond, cost comparisons, drawing up support and service plans, dialogue about modelling of transfers and increased client participation).
In 1993 services for people with learning disabilities were integrated into the town's social welfare services and an 8 bed residential care house began operating in 1993. It is a principle in Halikko, as in the rest of Finland, to integrate the users of services for the disabled with the users of regular services. The range of services includes guidance in home care matters at home or at day-care; regular health clinic specialist consultation once a year; training tuition or integration into a normal school; regular health and dental care services or specialist care services; home services; subsidy for care by a relative; temporary care; daytime activities for the seriously disabled; residential care home and activity center; dwellings for the disabled; assisted work and sheltered community work; and Disabled Persons Act services: transport, interpreter, preparation for adapting, alterations to housing.
A number of services are available for the adults with learning disabilities, in particular relating to residential living, such as preparing them to live independently and support services (cleaning and food delivery). For the seriously disabled there is support in the form of medical appliances for home use and provision of temporary care or day care in a residential care home. The families of people with learning disabilities supported by arranging leisure time recreation facilities, such as hikes, summer camps and concerts. All are able to be part of daytime activities, such as baking, food preparation, cleaning, laundry and engaging in various kinds of hobbies and handicrafts.
A social director with the help of three carers is in charge of residential care home activities. When the commune undertook the provision of services, three and a half employees were transferred from the children's day-care facility to look after people with learning disabilities. Two of these took advantage of training contract work to become rental health nurses. In 1995, a work and activities office for people with learning disabilities was opened. Two people are in charge and there are 12 clients on the books, of whom 4-10 engage in daytime activities. Care was developed by means of four training groups. The training groups were: a children's services group, an adult services group, a development group and a service users group. Members of the groups included social welfare professionals (from various sectors, such as elderly care, home service and social welfare work), a parents representative and a person acting as trustee. The personnel in the adult services group described their work. The descriptions indicated how personnel felt about routine tasks. The fact of having work of one's own was experienced as a positive, while the routine and loneliness of the work was experienced as a negative.
The quality of services in the residential home was measured using the quality of life counter prepared by the Finnish Association on Mental Retardation. The subjective well?being of clients was examined by interviewing them using the SWBS counter. Their living conditions and the services they received were assessed by personnel using the ELPA gradation scale. The personnel went over the principles and practices of the work community using a separate KELPO gradation scale. On the basis of this examination, practices in the residential care home were changed so as to respond better to the needs of occupants. When evaluating the quality of services, consideration was given to how quality can be monitored and evaluated for different kinds of services. The client orientation principle came to be the key concept: services must correspond to the client's needs. This concept made possible not only the variety and worth of services to be offered but especially the well-being and professionalism of the working community. The following principles underlie quality services: operations should be client-oriented, personnel should be expert, there should be a good framework, management should have an interest in and keep abreast of practical operations, and operations should be economical. At a practical level, the services are monitored through the use of quality counters, interviews, support and service plans, inspection lists, reviews and reports, and discussion forums.
In Halikko, attention was given to the potential problem areas arising from transitional phases in our life cycle, e.g. moving from home and leaving school to start work. The aim was to create operational models which took into account the needs and expectations of the client, the family and the immediate community with respect to services. An "assisted life model" was developed in Halikko to improve the ease of such transitions. Experiments in the development of services are encouraging. Operations development has made it possible to make changes and introduce entirely new forms of service, for example regarding public awareness of the mentally retarded. There is more attention given to what users of the services have to say and client-orientation is now one of the key criteria in developing new forms of service. Through operations development, personnel have gained a better grasp of the objectives underlying what they do and what the expectations of others are regarding these operations. Personnel have learned to ask for and listen to clients' opinions. Dialogue and collaboration between the authorities has increased. Attitudes towards people with learning disabilities at a general level have become more favourable.