A project researching user-views on the outcomes of social care and support services for disabled children and their families presented new challenges to a research team. While the team had experience of working with other groups of disabled children, this project was the first in which the team sought to work directly with children with autistic spectrum disorders. This paper reports the process by which the research design and methods used were developed and tailored to the needs and abilities of these children. The key lesson learnt was the value of crossing disciplines, research areas and professional boundaries when trying to identify ways of working with a 'hard to reach group'.
Home-care re-ablement or 'restorative' services are a cornerstone of preventive service initiatives in many countries. Many English local authorities are transforming their former in-house home-care services to provide intensive, short-term re-ablement instead. The focus of this paper is on the organisation and content of re-ablement services and the features of their organisation and delivery that have the potential to enhance or detract from their effectiveness. Qualitative data were collected from five sites with well-established re-ablement services. Data included semi-structured interviews with senior service managers in each site; observation of 26 re-ablement visits to service users across the five sites (four to six in each site) and a focus group discussion with front-line staff in each site (in total involving 37 front-line staff). The data generated from all three sources were analysed using the framework approach. All five services had developed from selective pilot projects to inclusive 'intake' service, accepting almost all referrals for home-care services. A number of features were identified as contributing to the effectiveness of re-ablement services. These included: service user characteristics and expectations; staff commitment, attitudes and skills; flexibility and prompt intervention; thorough and consistent recording systems; and rapid access to equipment and specialist skills in the team. Factors external to the re-ablement services themselves also had implications for their effectiveness; these included: a clear, widely understood vision of the service; access to a wide range of specialist skills; and capacity within long-term home-care services. The paper argues that re-ablement can be empowering for all service users in terms of raising their confidence. However, the move to a more inclusive 'intake' service suggests that outcomes are likely to be considerably lower for service users who have more limited potential to be independent. The paper discusses the implications for practice.
Despite emphasis in policy on participation of disabled children, 1 we still know relatively little about how to obtain the views of disabled children with significant communication impairment and their views are often overlooked in planning and service provision. This article describes how the views of children who do not use speech were accessed in research aiming to identify disabled children and young people's priorities regarding outcomes of social care and support services. The main challenge was to develop a method that was reliable, non-threatening, enjoyable and relevant to individual children, as well as enabling children to think beyond their everyday life and express what they aspire to. Copyright # 2004 John Wiley & Sons, Ltd. IntroductionResearch shows that disabled children have been largely excluded from consultations and involvement in decisions, which affect them (Morris, 1999b;Morris, 1999c; Cavet and Sloper, in press). Particular exclusion has been experienced by the children and young people who do not use speech as their first mode of communication and/or are perceived as having significant cognitive impairments (Morris, 1998a;Morris, 2003). Underpinned by medical discourses, children who do not communicate using speech have been and continue to be defined by what they cannot do, rather than what they can. However, there is a growing body of literature, which indicates a whole range of communication strengths and a great willingness and ability on the part of disabled young people to communicate their feelings and experiences and be involved in a process of change (Disabled People using Scope services, 2002; Rabiee and others, 2001;Morris, 1999a;Stalker and Connors, 2003; Watson and others, 1999; Cavet and Sloper, in press Despite this emphasis in policy objectives on participation of disabled children/young people, evidence suggests that while in general children are more involved in the process of decision making, disabled children's participation has been more through other agents than being direct (Council for Disabled Children, 2000;Sinclair and Franklin, 2000; Robbin, 2001). Therefore our knowledge of their experiences is still largely second hand knowledge given to us by adults whose views and experiences may differ from those of the children (Beresford, 1997;Mitchell and Sloper, 2001;Thomas and O'Kane, 1998).The key issue is that we still know very little about how to involve this diverse group of children in areas affecting their lives. Fundamental to achieving the overall aim of participation is therefore to develop communication methods, which can maximise children's communicative potential to express themselves and address the barriers they face. The other key component for effective participation is to recognise the fact that communication is a two way process requiring others to learn and understand how a child expresses herself/himself (Triangle/NSPCC, 2001). As a disabled child with communication impairment has put it:We are used to people saying we cannot communicate, bu...
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