Defining quality in disability services: integration, prevention, co-production

“When it comes to social services for people with disabilities, the definition of quality has evolved”, said Marie Dubost from the European Platform for Rehabilitation (EPR), who is also responsible for the EQUASS project on social services’ quality. While a residential, ‘one-stop-shop’ facility was the gold standard of quality in the past, “today, quality is increasingly linked to the integration of various services in the community, the prevention of risks and abuse, as well as services being ‘co-produced’ with users”, Ms Dubost claimed.

The last meeting of ESN’s disability working group was the opportunity to discuss these dimensions and develop recommendations to support workforce development in disability services. This was done against the background of the 2010 European Commission’s Social Protection Committee (SPC)’s European Quality Framework for social services – an initiative whose momentum faded in the follow up of the financial crisis and the setting of new priorities at EU level.

From quality to excellence: the importance of relationships

At the heart of quality assurance lies the social services workforce. ESN members have addressed this issue in various ways across Europe. In Ireland, the national Health Service Executive (HSE) has created a toolbox to drive quality up in its residential services. It introduced new ways of working, focussing on person-centred support and users’ outcomes rather than fixed procedures.

In Halmstad (Sweden), changing professional cultures have transformed disability services. There, ‘feedback informed practice’ was implemented within the so-called Session Rating Scale (SRS). SRS is available on tablets and helps to measure the quality of the interviews that social services hold with users. According to Erich Semb, Head of the Social Services Department, this has had a positive impact on the relationship between users and practitioners. Per research implemented by Scott D. Miller, such relationships account for 66% of the outcome and are crucial in moving from quality to excellence in social services.

Balancing user involvement and staff expertise

Service user involvement has changed the way care and support are provided and evaluated. Social workers and care professionals are no longer the sole possessors of knowledge when it comes to supporting a disabled user.

In Gloucestershire (UK), the ‘360 degrees’ approach has started by putting the user at the centre, then involving the user’s whole network of professionals, friends and families. Users participate in quality-checking visits, while targeted questionnaires are sent to each member of their social network, so that their answers help to get a comprehensive overview of the users’ experience of a given service.

Recommendations on a framework for a quality workforce

Key messages from participants on planning and supporting the workforce in disability services included:

  • Improving workforce flexibility so it can adapt to a wide range of disabilities, needs and living arrangements;
  • Embedding quality indicators and evaluation in all contracts with providers;
  • Carrying out external evaluations of social services;
  • Educating children and young people with disabilities to be ‘experts by experience’ and play an active role in their care and support;
  • Improving leadership and management, ensuring that frontline staff is supported, valued, and has access to continuous training;
  • Training staff in prevention to improve the detection of any worsening conditions or potential risks to a user’s safety.

Difficulties in adapting workers’ training to current needs were mentioned on numerous occasions. Indeed, as social work practice evolves to become more person-centred, older training models become obsolete, creating challenges and sometimes, tensions for public social services managers and commissioners. As cohorts of people with (learning) disabilities are growing older and deinstitutionalisation is gaining ground, it becomes necessary to give workforce the appropriate skills mix.

Next steps

ESN’s disability working group will conclude its 2-year work with the publication of a toolkit on person-centred services for people with disabilities, focussing on user involvement, inclusion in the labour market, and independent living. All practice examples gathered in the past two years have gradually been uploaded onto our Practice Library. ESN members can access all additional resources in the members’ area.