Residential Care Services Research Articles

Respecting privacy in care services

Purpose In care homes concerns about abuse have established a culture where all information pertaining to a person must be shared, and little attention is paid to privacy in its broader sense. The purpose of this paper is to take a human rights perspective and consider how information governance may impact on the health, well-being and quality of life of residents. It proposes a proactive approach and presents a template for a privacy impact assessment which services could use to improve their approach to privacy, protecting the human rights of those in their care, contributing to their independence and improving outcomes. Design/methodology/approach A review of historical and current thinking about the value of privacy in human services and wider society leads to a series of challenges to the way in which privacy is upheld in residential care services. Findings Recent preoccupations with data privacy have led to a myopic neglect of broader considerations of privacy. Whilst it continues to be important to protect the confidentiality of personal data and to ensure that residents are protected from abuse, human services that provide 24 hour care in congregated settings must not neglect broader components of privacy. Research limitations/implications Privacy impact assessments have been widely used to check whether data privacy is being upheld. The broader concept that might be termed “Big Privacy” is introduced within which data privacy is but one section. It is suggested that big privacy is severely compromised in residential care settings, thus denying residents their human right to privacy. The extent of such violation of rights should be investigated. Practical implications Having set out the potential reach of the human right to privacy, important work needs to be done to find out how privacy might be upheld in the real world of congregate residential care. Some service providers may have solutions to the organisational challenges, have addressed staff training needs and revised risk assessment strategies so that privacy is upheld alongside other rights. Social implications Nearly half a million people live in congregate residential care settings in England, and deprivation of privacy is argued to be a significant deprivation of human rights. Occasional tragedies and scandals in congregate settings create pressure for increasing the level of surveillance, and the right to privacy is sacrificed. This paper offers a challenge to this process, arguing that competing rights need to be balanced and privacy is an essential component of a decent quality of life. Originality/value Personal growth and development depends to some extent on choice and control over access to privacy. Recent changes in the law regarding data protection have narrowed our thinking about privacy until it is a small concept, largely concerned with data handling. This paper invites consideration of big privacy, and invites congregate residential care settings to consider how a deep and broad definition of privacy could transform these services.

WHEN A LITTLE GOES A LONG WAY: EXPANDING HOME CARE SERVICES TO ADULTS WITH DISABILITIES

Policy makers are increasingly interested in reducing public spending while maintaining quality of life. Since 1975, Oregon Project Independence (OPI) has supported community-based adults aged 60 and older to avoid or delay the need for residential long-term care services by increasing access to personal and home care services. The program also aims to prevent the need for Medicaid by optimizing personal resources and natural supports. In 2014, the OPI Expansion (OPI-E) pilot project began to serve adults aged 18-59 with disabilities in seven of Oregon’s seventeen Area Agencies on Aging (AAAs). This poster describes the evaluation of the expansion using three data sources: administrative data about consumer characteristics compiled by the AAAs and State of Oregon from 2015-2017 (N=3,824 traditional consumers, N= 581 OPI-E consumers), qualitative interviews conducted with AAA directors and OPI-E case managers (N=23), and a survey of current OPI-E consumers (N=126). Compared to traditional OPI consumers, OPI-E consumers were somewhat more likely to be men and people of color. Interviews with AAA staff highlighted the need for outreach, lack of service provider capacity, unique characteristics of younger consumers, and issues related to data management and rural access. Staff reported valuing the program, noting how “even low levels of service go a long way.” Qualitative and quantitative consumer responses showed consumers found OPI-E services invaluable. The majority stressed their appreciation for the program, with several describing it as “lifesaving.” These three sources informed recommendations for expanding the OPI-E program statewide.

Trans Women’s Perceptions of Residential Aged Care in Australia

AbstractMany older people in trans communities in Australia and elsewhere have experienced long histories of violence and discrimination in the health and social care sectors, making some of them fearful of interacting with contemporary health and social care providers. This study explored older trans women’s perceptions of these services. It involved a qualitative, thematic analysis of semi-structured, one-on-one audio-recorded interviews with ten trans women aged sixty years and older in Australia. Participants expressed a number of concerns about using residential facilities for older people in Australia, including potential for abuse and discrimination as a result of being trans, and not having access to appropriate treatments. Participants indicated a range of alternatives in using services, such as renovating the home, relocating to areas with greater access to trans-inclusive services and potential euthanasia. Participants perceived that service providers were not adequately trained for trans and gender diverse needs, and highlighted a number of ways aged care services could better support the trans and gender diverse community. The findings provide important information to assist health and social care professionals, including social workers, as well as residential care service providers, in supporting the health and well-being of older trans women.

Key features of an innovative sub-acute residential service for young people experiencing mental ill health

BackgroundNumerous studies across international settings have highlighted a need to improve the appropriateness and continuity of services for young people experiencing mental ill health. This paper examines key features of a sub-acute youth mental health residential service model, Youth Prevention and Recovery Care (Y-PARC) service. Y-PARC provides up to 4 weeks care to 16 to 25 year-olds at risk of hospitalisation and to those transitioning out of hospital inpatient units. The research was conducted at one of three Y-PARCs located in Victoria, Australia.MethodsThis paper presents findings from analysis of two data sources collected during evaluation of a Y-PARC service in 2015–17. Routinely collected administrative data of Y-PARC residents (n = 288) were analysed and semi-structured interviews were conducted with 38 participants: a) former residents (n = 14); b) family members of group a) (n = 5); key stakeholders (n = 9); and, Y-PARC staff (n = 10 respondents in 3 group interviews). Analysis of the qualitative data was thematic and structured by the interview guide, which covered the key service aims.ResultsConsistent with the aims of the service, respondents described practice at Y-PARC that aligns with recovery-oriented care. Key features emphasised were: a safe and welcoming environment for residents and families; provision of person-centred care; promotion of autonomy and self-help; informal interactions with staff allowing for formation of naturalistic relationships; time spent with other young people with similar experiences; and, assurance upon exit that the ‘door is always open.’High levels of satisfaction were reported. Outcomes described included: improved resilience; better understanding of mental health; the importance of seeking help; and, stronger connections to therapeutic services. Longer and multiple stays were associated with progressive and sustained change. Family members and stakeholders widely reported that the service fills a gap between community services and acute inpatient mental health hospital wards.Some challenging areas of practice identified included: integration of evidence-based psychosocial interventions; provision of care within a model that blends clinical and psychosocial support services; and, negotiation of family-inclusive practice.ConclusionsThe Y-PARC service model shows promise with young people experiencing mental ill health, particularly in improving the range and availability of options across a spectrum of need.

Capital and Value in Late Adulthood

In the present neoliberal context, life is structured within management of capital. Late adulthood is a period of final decision making about human capital and financial capital. In past generations, older adults were supported by social capital systems of family and voluntary care, largely detached from large systems powered by financial capital. Now, late adulthood is about efficient movement of older adults from the workplace to retirement, from families to residential care, and on to death. Late adulthood is structured by efficient management of financial capital for and by systems that produce, manage, and/or deliver medical care, pharmaceuticals, residential care, insurance, investments, banking, death, and other services. In the present analysis, the focus is on financial capital, human capital, and social capital in late adulthood. The paper organizes some concepts and aspects of capital, value, aging, and late adulthood that are common knowledge and experience, for examination and analysis within systemic contexts.

182 Feasibility and Usability of a New National Transfer Document for Older Persons: A Pilot Study

Abstract Background There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document. Methods Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085). Results Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated. Conclusion In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer.

The Contribution of Religious to Irish Healthcare

The Contribution of Religious to Irish Healthcare Tim O’Sullivan A recent Studies special issue, ‘The Nuns’ Story: Writing the Record’, included a comment by Deirdre Raftery that ‘Irish women religious have left a vast, and largely undocumented, legacy to healthcare and education’.1 This comment could be extended to male religious as well in healthcare, in areas such as intellectual disability and mental health services. Growing appreciation of the neglect of the contribution of religious has led to significant work on religious congregations in recent years, such as that reported on in Studies by Raftery and others. In the field of social policy, there has been considerable analysis of the historical importance of Catholic health care providers in Irish social services, but relatively little coverage ‘from within’ of Catholic non-profit providers in Ireland – partly perhaps because of their own reticence or their pragmatic focus on progressing the job at hand rather than in theorising about it.2 Many analyses set out statecentred narratives that view the involvement in social provision of non-profit providers, and particularly those with a religious motivation, as anomalous and distracting from the responsibility of the State to provide basic social services.3 . Interest in the perspectives of religious has also clearly suffered because of their declining numbers and relative importance in Irish social services and because of grave concerns about the historical abuses in residential child care services run by religious orders.4 As a result, although Catholic providers have been a very significant stakeholder in Irish social services, their perspectives on these services have arguably received limited coverage in the social policy literature. Nevertheless, as the Studies authors suggested, there is a strong case today for a more balanced reflection on the contribution of the religious. This contribution is not just an historical one, even if the religious orders delivering healthcare are in significant decline in Ireland. An important recent report chaired by Catherine Day on the role of voluntary organisations in publicly funded health and personal social services made it clear that the Tim O’Sullivan Studies • volume 108 • number 431 288 Studies_layout_AUTUMN-2019.indd 56 21/08/2019 09:14 faith-based contribution to Irish healthcare remains substantial.5 This article seeks to reflect on the contribution of the religious in healthcare, while taking account of their own perspectives. It offers some thoughts on the Day report and draws on a 2013 study of my own, which incorporated interviews with representatives of significant Catholic healthcare providers.6 Substantial presence of religious in Irish healthcare The Day report listed seven Catholic hospitals that are still under religious ownership: the Mater Misericordiae University Hospital, St Vincent’s University Hospital and Temple Street Children’s University Hospital in Dublin; Mercy University Hospital, Cork; Cappagh National Orthopaedic Hospital, Dublin; St Michael’s Hospital, Dun Laoghaire and St John’s Hospital, Limerick. It also noted that there was a faith-based element in the governance arrangements of several additional hospitals. It referred to the planned withdrawal of the Sisters of Charity from St Vincent’s and added that the number of voluntary acute hospitals owned by religious orders may be reduced to four in the coming years: Cappagh, the Mater, the Mercy and St John’s (par. 3.3). In the same paragraph, the report stated that two thirds of all disability services are still provided directly by the voluntary sector, including eighty per cent of residential places. A number of large disability service providers are faith-based, for example: Brothers of Charity Services Ireland, Carriglea Cairde Services, Daughters of Charity Disability Support Services, Saint John of God Community Services. These organisations, the review group stated, account for approximately fifty-eight per cent of the funding allocated to disability service providers under the ‘Section 38’ funding system. A somewhat State-centred distinction is drawn at times in the Irish policy literature between large non-profit bodies that provide services ‘on behalf of’ a statutory body and community and voluntary organizations that provide other services and undertake developmental activities to meet social need without being delivery agencies on behalf of a statutory agency.7 . In legal terms, this distinction is reflected in the 2004 Health Act...

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential-care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential-care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.

‘I see a totally different picture now’: an evaluation of knowledge exchange in childcare practice

This article draws on a critical evaluation of a knowledge exchange (KE) project, Food for Thought, devised to promote and develop awareness of the use of food within children’s residential and foster care services. From the 22 qualitative interviews conducted, reflections on the differing forms of knowledge incorporated into the design of the project and its outputs are discussed and the limitations of current thinking on knowledge exchange are explored. Finally, links are made to show how this reflective approach to practice operationalised and enlivened local and national food and care policies.

Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges.

The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these individuals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using individual subjective assessment of personally relevant outcomes, often used to monitor care planning. Examples from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment.

THE FORDHAM LONG-DISTANCE CAREGIVING (LDC) STUDY: RECRUITMENT EXPERIENCES AND SAMPLE CHARACTERISTICS

This paper presents recruitment experiences and sample information from the Fordham LDC Study (N=286). We initially planned to recruit LDCs from primary contacts of elders receiving residential or home care services. However, low recruitment rates lead us to research matching services, list serves, and participant and personal referrals. As a result, 46% of the sample were recruited from service agencies and 54% from non-affiliated sources. However, among the latter group, 27% of the elders were in residential care, and of those living at home, 38% were receiving home care services. LDCs were typical in being 72% women; while we found our LDCs to be highly educated (74% with college or more) and somewhat younger (mean = 57 years). While 72% were caring for parents, 28% were caring for more distant relatives and friends, suggesting that for many, LDCs step in when proximate and/or closer relatives are not available.

PMU88 - HEALTH EXPECTANCIES FROM CLINICAL DATA: AN ALTERNATIVE TO THE SULLIVAN METHOD?

Healthy life expectancies are systematically calculated in the EU countries using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific % of prevalence of healthy life. The main limitation is that the progressive deterioration of health throughout life remains undisclosed. A second important limitation is that prevalence data depends on expensive national health surveys. The objective of this work is to obtain an equivalent estimation of healthy life expectancy, considering multiple health states, but using available morbidity and mortality data. Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Girona), N = 91,130. The set of individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states according to the 3M-Clinical Risk Groups. The information analysed included acute inpatient care, acute outpatient care, primary care, pharmacy prescriptions, diagnostic tests, emergencies and long-term residential care services. Based on the health transitions observed between 2016 and 2017, life expectancies by health state were obtained from a microsimulation model. Life expectancies at birth and 65 years were E0female=85.67, E0male=80.43, E65female=21.25, E65male=16.61. Healthy life expectancies at birth and 65 years were HE0female=39.95, HE0male=42.92, HE65female=2.46 , HE65male=1.90. Life expectancies were totally consistent with the official estimates for 2016. Healthy life expectancies substantially differed from the last official estimates based on self-reported health surveys and the calculation method of prevalence. The decomposition of life expectancies into morbidity profiles can be efficiently obtained from multistate models based on clinical information and can be very useful in monitoring the population according to their health status, in a health services management context. The figures obtained are not comparable with those calculated with the Sullivan method.

Continuing care in rural Alberta: A scoping review

AbstractAcross Canada the demand for continuing care services is increasing. However, little is known about the implications this has for rural communities. This scoping review identifies several key themes in the literature related to continuing care in Alberta. These include contextual factors, quality assurance and improvement, and workforce issues. We identify the ways in which rural dynamics are included in, or omitted from, this literature and recommend areas for future research on rural continuing care provision. Further research on residential care services in rural communities should work towards bridging the rural health, academic, and organizational literature on continuing care. This synthesis will help to position rurality as a determinant of health and to situate continuing care services in specific rural settings.

Türkiye’de Ruhsal Hastalığı Olan Bireylere Yönelik Kurum Bakım Hizmetleri ve Bu Hizmetlerde Sosyal Hizmet Uygulamaları

Ruhsal hastalığı olan bireylere yönelik toplum tarafından sağlanan hizmetler zamana ve toplumların bakış açısına göre değişikliğe uğramıştır. Ruhsal hastaları kurumlara kapatma geleneği 1950’li yıllardan sonra yerini toplum temelli hizmetlere bırakmıştır. Ancak toplumda tedavi edilemeyen, gidecek yeri olmayan kimsesiz ruhsal hastalığı olan bireylere yönelik kurum bakım hizmetleri 1990’lı yıllardan sonra tekrar önem kazanmaya başlamıştır. Türkiye’de kurum bakım hizmetlerine yönelik 2000’li yıllardan sonra çıkarılan yasalar çerçevesinde özel yatılı bakım merkezleri desteklenmiş ve yaygınlaştırılmıştır. Bu doğrultuda, özel yatılı bakım merkezlerinde sosyal hizmet uzmanları da istihdam edilmeye başlamıştır. Bu çalışma, Türkiye’de kurum bakım hizmetlerinin gelişimi ve yasal düzenlemeleri, kurumlarda verilen hizmetler ile merkezdeki sosyal hizmet mesleğinin uygulama alanlarına yönelik düzenlenen bilgilerin literatüre ve alanda çalışan sosyal hizmet meslek elamanlarına katkı sunması amacıyla hazırlanmıştır.

Mapificación de los centros de acogida de menores en la Comunidad Valenciana, España

Tras casi veinte años, se realizó recientemente en España una reforma normativa que afecta al sistema de protección a la infancia y a la adolescencia, a través de la Ley 26/2015, del 28 de julio, y de la Ley Orgánica, del 22 de julio, de modificación del sistema de protección. En ellas, vuelve a establecerse que el servicio de acogimiento residencial será una de las medidas de protección que se podrá decretar cuando nos encontremos ante un niño o niña en situación de desprotección. Al ser uno de sus principios normativos “mantener al/la menor lo más cerca posible de su entorno de origen”, nos propusimos conocer cuál era la mapificación de los centros de acogida existentes en la Comunidad Valenciana (España), además de la titularidad y gestión de los mismos, para comprobar la posibilidad de cumplir con tal principio normativo. Para tal fin, realizamos un estudio de carácter exploratorio, que nos permitió configurar la mapificación de los centros de acogida de menores de la Comunidad Valenciana, a través de la explotación de datos y de la observación directa. Como resultado, se observó una clara desigualdad de oportunidades debido a la ubicación física en la que se encuentran dichos centros.

Aggression in mental health residential facilities: A systematic review and meta-analysis

Abstract Objectives To estimate the prevalence of aggression exhibited by patients living in community residential facilities and to identify risk factors for such aggression. Methods A systematic review with meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) dataset (registration number: CRD42016042475). PubMed, Scopus and Web of Science were searched for studies published prior to February 21st 2017. Studies reporting the number of patients who perpetrated aggressive behavior in residential facilities were included. Methodological quality, publication bias, and the role of moderators were assessed. A pooled effect size was calculated for each outcome. Factors affecting between-study heterogeneity were analyzed using sub-groups and meta-regression analysis. Results Ten studies met the inclusion criteria, for a total sample of 3760 patients. The pooled prevalence of aggression in residential facilities was 29% (95% CI 0.17–0.42) with a high heterogeneity and variability among studies. History of violence, personality disorders, lifetime substance and alcohol misuse were found significantly associated with aggression. Conclusion Aggression in residential care services is common. Certain individual factors are associated to an increased risk for such aggression.

‘I’m not getting out of bed!’ The criminalisation of young people in residential care

Evidence from both Australian and international jurisdictions show that children in residential care are over-represented in the criminal justice system. In the current study, we interviewed 46 professionals who had contact with young people in residential care settings in New South Wales, Australia. Our sample included police officers, residential care service providers, legal aid lawyers and juvenile justice workers, about their perceptions of the link between residential care and contact with the criminal justice system. Factors identified by the participants included the care environment itself, use of police as a behavioural management tool, deficient staff training and inadequate policies and funding to address the over-representation. These factors, combined with the legacy of Australia’s colonial past, were a particularly potent source of criminalisation for Aboriginal children in care.

Securing the floor but not raising the ceiling? Operationalising care quality in the inspection of residential care for children in Sweden

ABSTRACTIn many countries, inspections are employed as a central instrument to promote good social work practice, but how inspections should operationally achieve this is not evident. By utilising data from guidelines, interviews and observations, the aim of the article is to analyse how the Swedish inspectorate operationalises care quality within the residential care services for children. Analytically, the inspectorate is regarded as an open system that is receptive to different ideas of how to operationalise care quality. The results show that: (a) the standards display a marked variation, change annually and are similar across all homes, (b) there is a limited link to good quality care as it is defined in empirical research, (c) there are several driving forces for care aspects to inspect and, in general, the distinct standards pertain to formal requirements, while how the care is provided is associated with more indistinct standards and (d) if there is no obvious malpractice in care provided, the inspections appear to have rather unclear formative effects. The results are inter alia discussed regarding whether inspections foster the idea that the ‘floor’ of the care is raised (i.e. securing a basic level of care) but not the ‘ceiling’ (i.e. maximising care).

Developing a positive living group climate in residential youth care: A single case study

AbstractIn residential youth care, a positive living group climate is one of the main pillars for having a child grow up and develop optimally. Despite its importance, the development of a positive living group climate seems to be “under pressure,” due to recent evolutions in residential youth care all over the world. This article describes what could be learned from a project focused on monitoring the living group climate in a residential youth care service in Flanders, Belgium. The objectives were (a) to investigate the implications of this project specifically aimed at improving the living group climate, and (b) to discuss the opportunities and challenges of this process, in relation to the particular service and staff, and residential youth care in general.The outcomes indicate that group workers perceive the monitoring process as a constructive tool for discussing outcomes in establishing a positive living climate. Furthermore, the findings show that the living group climate is perceived as a complex context, with many interactions that are difficult to measure or capture—therefore, discussion about the outcomes is an essential part of improvement processes. This study provides insight into the key factors and tensions in the development of a positive living group climate.

Evaluation of a Residential Mental Health Recovery Service in North Queensland.

Evidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas. This study describes (a) the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b) reports on the formative evaluation outcomes. Continuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2) service development tool, Individual Recovery Plans (IRPs), and the impact assessment of the service on psychiatric inpatient admissions (reported separately). Service strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers). The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.