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May 1998 - Ref 528 Most people with learning difficulties have little choice of housing and support options; residential care continues to dominate. This is a particular problem for people seen as a relatively low priority for community care packages, with few effective 'low support' alternatives to residential care being developed. The 'living support networks' provided by KeyRing offer one possible model for such services. According to research by Ken Simons, this model provides reliable, affordable support in a way that is liked by those who use the service.
About KeyRing Services provided by KeyRing are based on the idea of 'living support networks'. Small networks of up to nine people with learning difficulties are established in a particular neighbourhood, using ordinary social housing. Each individual has his or her own flat, all within walking distance of each other. The process of starting a network begins with the appointment of a 'community living worker' whose role is to help people settle into the network, and to provide continuing support. In return for free accommodation (plus the payment of some household bills) the community living workers commit an average of ten to twelve hours a week to assisting members of the network. The community living worker lives as part of the network, in the same neighbourhood as the KeyRing tenants. Indeed everyone in the network will know where everyone else lives and will have their phone number. The community living workers are themselves supervised and supported by network managers, who also work directly with tenants. Mutual support by tenants is encouraged and facilitated through a tenants' group in each network. KeyRing currently has 15 networks up and running, most of which are scattered across the Greater London area.Who uses KeyRing services KeyRing is primarily targeted at people with learning difficulties who have basic self-care skills, but who still need either continuing or intermittent support. Just over a third of KeyRing tenants (36 per cent) had lived in some form of shared housing (staffed houses of group homes) prior to joining KeyRing. Forty-two per cent had previously lived with family. Most of the remaining tenants had formerly struggled without formal support, including some who had become homeless.Help to access and maintain tenancies Access to housing is typically provided by a three-way agreement between the purchasers of the service (usually the social services department), the local housing department and KeyRing. Once people are accepted as potential KeyRing tenants, they are then treated as a priority for suitable accommodation in the area where a network is being developed. A key aim of KeyRing is to ensure that people with learning difficulties get their own home. This was something that many tenants had long aspired to, and for many it represented a significant achievement in the face of scepticism from families and professionals:It's what I've always wanted. Now look at me, I'm all set up.Further, KeyRing appears to be an effective method of helping this group maintain their tenancies. For example, amongst the longer standing networks (those in existence for over five years) three-quarters of the original tenants are still living in the accommodation they acquired through KeyRing. Some tenants have left KeyRing, but this was rarely because they required greater support or supervision. Help 'around the corner' The community living worker undertakes a wide range of tasks, with a particular emphasis on assisting tenants in dealing with the official world, and helping them budget. KeyRing's assistance was critical for most tenants, with all but six of the 49 interviewed saying they would not be able to cope entirely on their own:No, I don't think I could manage without [names community living worker].Even looking to the future, most tenants expected to remain part of KeyRing: No, I wouldn't want to leave KeyRing.KeyRing is based on an acceptance that the service cannot control the lives of the tenants; that the tenants are living in their own homes and leading their own lives. Support can be offered and negotiated, but not imposed, although community living workers go to some lengths to make sure any choices are informed ones: I can only work with what people tell me ... I might not think it's the most brilliant thing in the world, but it is important they tell me. I try and reassure people that I will not be angry with them ... and that we will work out together what to do.Many of the tenants are suspicious of authority figures, and any attempts at greater control risk being counter-productive. Often tenants will only talk about sensitive matters when they have established a relationship of trust with the community living worker, making continuity important. Although most of the community living workers work part-time in other jobs, they are accessible to tenants to an extent that would be rare in equivalent services: The thing that distinguishes KeyRing from almost any other job is that the tenants know where you live and have got your telephone number.Tenants can get the support of community living workers in the evenings or at weekends if needed. At the most, tenants have to phone one number or walk 'around the corner'. Equally, many of the community living workers felt that living in the same neighbourhood as the tenants helped them see the wider picture: ... the value of being able to put things in context. What might seem to be something trivial might actually reflect wider issues.There is also considerable emphasis within KeyRing on helping the tenants to do as much as possible for themselves. The KeyRing style of working is largely in tune with the views of tenants. Many were anxious that professionals did not 'interfere' in their lives: You can't have someone moaning and saying you can't do that.Equally they were generally keen to do as much for themselves as possible: They try to give you experience, get you to help yourself.Finally, they found the easy access to the community living workers reassuring: She's always to hand, more or less.As a result, the support provided by KeyRing was generally approved of by the tenants, with only a small minority making any critical comments. Indeed, when asked to compare KeyRing with more traditional services (some form of group home) all the tenants interviewed expressed a clear preference for KeyRing style services. Mutual support The emphasis within KeyRing on mutual support by the tenants is one of its more unusual features. The aim is not necessarily to substitute assistance from the community living workers with informal help from tenants. Rather it is to try and increase the resilience of the networks by ensuring they are as cohesive as possible. As one community living worker commented:The intertwined relationships really do mean you know what is going on.Tenants' meetings play an important role in developing mutual support, being both a vehicle for getting tenants together, offering a focus for social activities within the networks, and providing opportunities to raise shared concerns and tackle some of the issues strategically. On the whole the tenants liked the meetings, although they did have their critics: I didn't know what I was letting myself in for. I thought it [KeyRing] was to be like ordinary people and have your own flat ... But there's all these meetings.When asked about mutual support, tenants variously pointed to the importance of friendships among KeyRing tenants, the range of social activities on offer, and the practical assistance they provided to each other. For example, one tenant had become adept at re-lighting central heating boilers, and was proud to have performed this service for a number of his fellow tenants. For some, the contact with other tenants was clearly very important: She's a friend, She takes an interest and she cares about me.However, this was an area that as a whole tenants tended to downplay: A bit ... [of help from other tenants] ... not muchIndeed there was a small number of tenants whose participation within KeyRing was minimal. Although generally not a problem, in one network the presence of no less than four such tenants had caused considerable disruption. Not least, other tenants in the network complained about their lack of involvement: ... they won't do their bit. ...This implies that, for mutual support to be successful within any network, there needs to be a balance between tenants who are able and willing to play a leadership role and those who may be more passive. Relationships with the local communities Around three-quarters of the tenants interviewed talked in positive terms about the local neighbourhood:Yeah, I like it around here.In some situations tenants had developed significant relationships with people outside the network. However, nearly half the tenants also reported having problems with local people, including tensions with neighbours, harassment by relative strangers, and some deliberate targeting of vulnerable tenants. There was some evidence to support earlier research which identified three critical factors in predicting vulnerability: being distinctive in appearance or behaviour, being younger, and living in hard to let housing. However, there were complicating factors. The network with the highest rate of problems on the street, actually appeared generally less threatening than some of the council estates where there had been fewer problems. In addition, some problems could be very local. How tenants use an area can have an impact on their vulnerability. All these factors point to the importance of local knowledge. KeyRing has responded to these difficulties in a range of ways, including:
Support from outside KeyRing KeyRing is not meant to be a 'global service'; part of the role of community living workers is to help people access other services as and when needed. As a result, liaising with other services is a critical role for both community living workers and network managers. In some areas KeyRing tenants had also been able to tap into a range of other services such as home care, or outreach services, along with active involvement of care managers. This in turn has enabled KeyRing to support tenants with a wider range of needs. However, in other areas the lack of such services was a significant frustration. Concern was variously expressed about the lack of care manager involvement, and the difficulties of accessing mental health services for someone with learning difficulties, along with the impact of increasingly stringent eligibility criteria for many services. On the whole, professionals from outside KeyRing had a very positive view of the service. The basic model was seen to work for the target group, offering a flexible but stable form of assistance. Purchasers were particularly likely to comment on both the affordability of KeyRing, and its role in pre-empting crises:If KeyRing had not been there, then I don't doubt some of the users would need crisis support. That would have cost a lot of money. The costs of KeyRing services Even allowing for the other services used by tenants, KeyRing remains a relatively inexpensive option. The average cost per KeyRing tenant in a well-established network is just under £50 a week. If, on average, just over three out of the nine tenants would otherwise have been using residential care, the net savings made by their move into a KeyRing network would as a minimum pay for the whole network. Historically, this is almost identical to the proportion of tenants who joined KeyRing from shared living arrangements. Given that some of those joining KeyRing from other sources would probably also have needed a more expensive alternative had KeyRing not existed, then there is considerable potential for using KeyRing-style services to under-pin a wider supported living strategy.About the study The evaluation of KeyRing was carried out by Ken Simons, a Research Fellow at the Norah Fry Research Centre, University of Bristol, during the summer and autumn of 1997. The findings are based on:
How to get further information The full report, Living Support Networks: the services provided by KeyRing by Ken Simons (ISBN 1 900600 22 6, price £11.95 plus £1.50 p&p), is published by Pavilion Publishing.This title is now out of print. |
