caring for people with severe learning difficulties in ordinary houses : issues of staff stress and...

MENTAL HANDICAP VOL. 20 DECEMBER 1992

Caring for People with Severe Learning Difficulties in Ordinary

- -

Houses Issues of Staff Stress and Support

Sabrina Halliday Maggie Potts Andrea Howard Judith Wright

Evaluation of community care only rarely con- siders management issues and the stresses which arise from new work structures and situations. This study examined the changed role of community care staff and the support required to maintain an effective service. Group interview methods were employed. Factors identified as important stressors were working together in a smaller setting, being in the public gaze and the risk-taking involved in client training programmes. It was suggested that meeting staff needs should focus on emergency cover, communication and consultation, and providing adequate training. Implications for management practices are discussed.

Introduction Occupational stress in the caring professions is a

well recognised phenomenon (Edelwich & Brodsky, 1980; Bailey 1981; Cherniss, 1987). It often leads to burnout, comprising emotional exhaustion, deper- sonalisation and low productivity accompanied by feelings of low achievement (Cherniss, 1987; Mayon, 1987). Nurses are particularly at risk of stress and burnout (Hay & Oken, 1972; Parkes, 1980a; Parkes, 1980b; Bailey, 1981, 1985; Hingley, 1984). Cherniss (1980) examined the features of the caregiver and their situation which give rise to the propensity to become ‘burnt-out’ and noted that professionals generally have high expectations and low reward. Handy (1986) focused on the specific factors in the individual’s work environment which increase stress levels and proposed a broader examination of the individual’s way of working or conceptualising work (Van Harrison, 1978; Cox, 1978) to include the

organisational, management and support structures within the work environment (Bailey, 1985; Firth & Myers, 1985). Both the individual and the organis- ation are therefore potential avenues for change in alleviating stress.

The cumulative evidence of the levels of stress experienced by carers of people with mental handicaps (Moores & Grant, 1977; Bailey, 1982; Thompson, 1987; Power & Sharp, 1988), by community nurses (Llewelyn & Trent, 1987) and by families of children with a mental handicap (Carey, 1982; Davis, 1985; Quine & Pahl, 1985) suggests that the combination of caring for a person with mental handicap in the community will give rise to a high level of stress. Whilst support for professional care givers is viewed as important if staff burnout is to be minimised, Firth & Myers (1985) suggested that staff support in many places is rarely realised.

The present study arose as a consequence of the findings of in-depth interviews designed to identify individual sources of stress and satisfaction in care staff who had been working in community houses for one year with adolescents with severe mental handicaps (Cuthbertson, Halliday, Potts & Wright, in prep). The findings indicated similar stresses across the houses due to the similar nature of their work and differing levels of stress between the houses which was thought to relate to different organisational structures. Overall, stress levels were high.

The focus of this study, therefore, was to examine organisational structures in more depth. The aims were explicitly to examine both staff and management practices and their effects on stresses experienced, to illuminate problems and to provide practical methods whereby actual and potential stresses could be reduced. This was deemed a

~~ ~

SABRINA HALLIDAY was a Research Psychologist at Meanwood Park Hospital at the time of the study, and is now a Clinical Psychologist at Airedale General Hospital, Steeton, Keighley, West Yorkshire. MAGGIE POTTS and ANDREA HOWARD are both Clinical Psychologists while JUDITH WRIGHT is a Research Psychologist, all three working at Meanwood Park Hospital, Leeds.

0 1992 BlMH Publications I37


particularly important exercise as the move from institution to the community was a new venture, presenting staff and management alike with different organisational and support problems.

A qualitative approach was adopted based on group interview methods (Quinn-Patton, 1980; Raynes & Sumpton, 1987), also known as consultative methods (Caves, 1988). In order to avoid the discussions becoming merely negative recrimi- nations about the problems of working in the community a concrete and neutral focus was given to the discussions. This focus was the work, roles and needs of care staff in the community.

Method Three community group homes (two managed by

the NHS, one by Social Services) were involved in the study. Two workshops were arranged. Both workshops were facilitated by an independent clinical psychologist. All discussions were tape- recorded for analysis purposes. The tapes of the discussions were transcribed in full. In addition to being tape-recorded, summaries of the discussions were agreed and written up throughout the workshop. The first workshop was attended by care staff only: the homeleader, one full-time and one part- time worker. This was the first time staff from each group had met for discussion. The first workshop focused on two questions:

(1) The defining characteristics of professionalism and commitment within the community.

(2) The circumstances surrounding three recent critical incidents (a method used by Caves (1988) to examine staff competencies, here used to look at where staff felt their competencies to be overstretched).

Summaries of the points of consensus from the first workshop were then made and circulated to the participants, who were asked to check for inaccur- acy and misquoting. These main issues were taken as the basis for further discussions at the second workshop attended by the same care staff and also by immediate and higher management. Two main issues were discussed:

(1) Organisational and strategic issues for professionals in the community (based on answers to question 1 in workshop 1).

(2) The needs of staff and how these might be met, particularly in terms of support (based on answers to question 2 in workshop 1).

Results The results from both workshops taken together

relate to avoidable stresses, expectations and

responsibilities of staff and management and means of alleviating staff stress.

Being a professional in the community Staff identified three main features which differen-

tiated being a professional in the community from being a professional in an institution. These are reported below and summaries can be found in Table 1.

(a) Working together In the smaller setting all staff experienced some

difficulty in working with each other, at least at some time. Most problems related to differences in attitudes. In a larger institutional setting such interpersonal differences could be ignored or relieved, via, for example, changing the rota. In the community setting undercurrents of tension between staff cannot be ignored easily and may indeed cause problems for the client through inconsistent handling and a negative atmosphere. As staff get to know each other better personal problems can be discussed with more equanimity and good humour.

(b) Being in the public gaze One of the major sources of stress when working

in the community is being in the public gaze. Some staff reported that they felt anxious immediately they stepped out of the door with their client. Part of the problem was that the public often felt they could legitimately scrutinise and pass comments on the client’s behaviour and the care staffs handling of that behaviour. This factor was made worse by the unpredictability of public reaction.

A second component of staff anxiety was their own internal expectations of themselves as professionals: competent, effective, and a ‘shining example’. In this instance staff also felt an extra responsibility as the standard bearers for community care. Given staffs expectations, inevitably when problems arise, they are more likely to be perceived as individual personal failures.

(c) Changing roles Finally, being a professional in the community

involves a complete change in role. The main function is to enable the client with learning difficulties to increase their independence and interpersonal skills and to give them the emotional support needed to grow, develop and cope with the demands of living in the community. This entails individual programme plans which cover every aspect of the daily routine. In practice it means that every part of the day is devoted to training. This is a strenuous schedule.

Although programme plans also specify how staff should handle each aspect of training, individual staff members have differing tolerance levels and attitudes to the amount of struggling they should accept before ‘giving a hand’. Tiredness, time of day, availability of other staff and the behaviour

138 0 1992 BlMH Publications


1. Working in a smaller environment means that it is even more important that staff work well together, personally and professionally. Smaller numbers of staff mean a smaller pool to call upon in emergencies and their energy gets used up rapidly.

2. Being in the community nieans that staff are always under the surveillance of the public; this has many implications: (i) Feeling constantly monitored.

(ii) The behaviour of staff reflects on the young person. (iii) Staff have to understand the reactions of the public to the client and be able to deal with these

sympathetically. (iv) It is often difficult to reconcile how staff should deal with the client in terms of; what is best for

the client, the client’s view of what he wants and expects of staff, the attitudes, expectations and reactions of the public to the client, the client’s behaviour and the response of staff.

(v) The staff‘s way of dealing with aspects of public reaction may be at variance with what they feel they must do as a professional.

3. There is an expectation from everyone that staff should embody all the qualities of a professional, that they can maintain a high level of commitment and that they are a professional for residents, parents, colleagues and the public, all the time. Staff have to be supportive of and have empathy for residents, colleagues, parents, neighbours and community.

4. The role of staff is that of teacher and person who gives emotional support rather than provider of physical care and protection. Risky dangerous situations have to be continuously faced in order for young people to learn and develop but these are often negative and worrying for staff.

TABLE 1. Features which differentiated being a professional in the community from being a professional in an institution

of the client also affect staff tolerance levels. Furthermore, staff are at different levels in their own training, in their confidence in applying that training and in their understanding and awareness of their role within the staffed house.

Staff training, staff attitudes and the physical resources they have to hand are particularly perti- nent when risk-taking is considered. Risk-taking involves the taking of calculated risks with the pre- defined aim of teaching a skill to the level of independence where there is a clearly identified element of failure and danger for the client (PSSRU, 1987). Essentially risk-taking is an integral part of an individual’s programme plan. It was stressed by managers that they must be kept informed of these situations if they are expected to give backing to the risks taken. Three difficulties are immediately apparent with this conditional support. Firstly, it is not practical for managers to have an intimate knowledge of each individual’s programme plan. Secondly, staff are not assured that managers will support their work, especially if (post hoe) they are deemed to have deviated in some substantial way from the original goal plan or not to have taken adequate precautions to minimise the risk. Thirdly, some risks occur unexpectedly.

The needs of staff in the community During the discussions of situations which illus-

trated stressful events, staff identified three main areas of concern. These are reported below and summaries can be found in Table 2. Several issues are relevant across more than one area.

(a) Immediate access to help This issue was discussed with reference to

emergency cover but is also relevant to the following section. The emergencies which caused difficulties for staff were those which involved covering for absent staff or providing adequate staff cover when the behaviour of a client deteriorated and became dangerous.

Sta.ff absences were mainly due to taking annual leave. Little staff time was lost through sickness. The average of 0.6 days sick leave per person over the year studied compared favourably with the equivalent figure of six days for the base hospital.

In all houses the home leader was the first line of emergency cover. Problems arose when this person was not available or the emergency was prolonged. In most instances staff coped by providing cover from amongst themselves, via working marathon shifts, single-handed shifts and extra hours, and forgoing training days, time-in-lieu, ‘week- ends’ and postponing holidays. In one month, for example, three full-time staff in one house each worked on average 10 shifts of 27 hours in length (including ‘sleeping-in’) as a result of one full-time unfilled staff vacancy. Such a system relies on the goodwill of committed staff.

On the only occasion when the NHS emergency cover system was tested and help was requested from the parent hospital, the system failed. It failed because it relied on one community nursing officer providing emergency cover at all times for a total of two fully staffed houses, twelve minimally staffed houses (i.e. with no sleeping-in duties) and nurses

0 1992 BlMH Publications 139

MENTAL HANDICAP VOL 20 DECEMBER 1992

EMERGENCY COVER Need to know who to contact.

A contact person must be available at all times.

That person must be able to give advice or arrange help as necessary.

Help should be immediate.

ON-GOING SUPPORT Managers must know the individual residents and what they do in their home.

There should be a shared outlook and philosophy of care amongst staff and management.

Effectiveness and morale within the house are dependent on staff having time to ‘hand-over’ between shifts.

Staff need to meet regularly by themselves arid with management.

Staff require back-up for risks taken in the community and in dealing with the community. Acknowledgement that problems do not equal failure. Recognition that the positive discussion of problems is a necessary constructive and efficient way of working.

RECRUITMENT AND TRAINING When selecting new staff particular attention should be paid to their attitudes towards the training of mentally handicapped people: independence and risk-taking. There should be trial period for new staff to assess their integration into the house and their methods of working. All staff need training (in areas ranging from sign language to working in groups to dealing with difficult behaviour) depending on their roles and needs. Joint training - with management - across NHS/DSS - would allow experiences to be shared.

TABLE 2. Needs expressed by staff regarding support of their role as professional carers in the community

in the community mental handicap teams with no- one being specifically nominated to take over when the community nursing officer was unavailable.

(b) Good communication and support Discussions regarding on-going support focused

on the support which should be available from managers and that which should arise from the staff group themselves.

(i) Staff-Management. Care staff felt managers should have a working knowledge of each house and the residents living therc so that they could give advice. This was felt to be particularly important in the present circumstances where managers had no previous knowledge of working in the community themselves and the scheme of community care for people with severe learning difficulties was still very much in its infancy. Managers themselves acknowledged this. The managers, however, stressed the clinical responsibility of the care staff and the managerial responsibility of the home leader. Demarcation of the roles of manager and staff is clearly an issue, particularly where it meshes with formal support. If, for example, formal support for risk-taking is lacking two undesirable out- comes are likely; firstly, if a situation goes

wrong managers might restrict the future activities of the clients and staff and secondly, staff might decide risks carry too much danger and not use risk-taking as a positive means of learning for the people in their charge.

As a means of overcoming demarcation issues it was proposed that the direction and goals of the house should be jointly decided between staff and managers and further, that time should be set aside for regular joint communication and consultation as the pre- dominant means of management. It was agreed that having a written policy was useful but it could not replace the consultative process.

Staff were aware that they, as well as managers, had oversimplified the whole philosophy of care in the community as ‘get into the community and all your problems will be solved’ and had been initially shocked to be still facing problems. Many had come to view community care as the ideal solution with optimum staffing levels, a small number of residents and access to opportunities for development. Under these circumstances problems were seen as negative and blame was more likely to be attributed to staff. In fact, for different reasons, staff were now in the same vulnerable position parents had been in



(ii)

for years: that of being directly blamed when the young person’s behaviour was worse at home than anywhere else. All staff felt it was essential that both they and managers did not equate problems with failure. Coping with problems is seen as a major and integral part of the job for managers and staff alike.

Staff-Staffi All staff believed that handover times between shifts were the most important means of staff communication. Indeed, in one house where a handover system did not exist, staff had instituted their own, even though this resulted in staff working extra hours without pay or compensation. Daily handover time was deemed the main forum for the exchange of ideas and information and for informal support. More formal staff meetings were also seen as necessary but were more difficult to arrange. Staff felt that being given time to have a staff meeting once a month was reasonable, as long as it was combined with daily handover periods.

(c) Training and recruitment Staff were concerned that they did not have

adequate training to carry out their job as well as they would like. An additional and related problem was the training of new staff who did not receive any pre-training but were expected to train on-the- job. This resulted in an experienced member of staff attempting to train the new staff member in addition to training the client. It was recognised that one of the problems was simply the newness of such schemes and therefore the dearth of experienced personnel who could give training. However, staff themselves were aware of immediate areas in which they required training and for which some broadly appropriate courses were available; parent counselling, group work and providing emotional support.

A further problem of working in a new and untried system is that of recruiting the right people for the job; most staff felt that the attitudes of the new people were more important than their skills, as skills can be acquired later. It was felt important that at least one member of the house staff should be present at interview and that they should have at least a veto and preferably a major role in deciding who is appointed. Nursing officers or higher managers would have an important role as external assessors. Since interviews can still recruit the wrong person, there was a consensus that a formal trial period would be useful.

Discussion The workshop, arranged to discuss the work,

roles and needs of care staff working in small houses in the community, enabled staff to define the issues involved in avoidable and unavoidable

stress and to devise an agenda for constructive discussion with higher management. Although individual issues raised had been discussed with various members of staff and management on an ad hoe basis on previous occasions, the joint workshop format provided staff and management with the opportunity to re-appraise these issues within the broader perspective of ensuring successul community services. The consultation process led to beneficial changes in support systems and, for Health Service staff, to the development of a regular forum for consultation.

Working in a community home bears little resem- blance to working in a hospital or even in a hostel. Staff were excited by the challenge and the novelty although they were in danger of being overwhelmed by the responsibilty and isolation. Thomson (1987) found that the physical environment was more distressing for staff working in community settings than for those working in hospitals. Although the outcome of the discussions in the present study concentrated on stress, the care staffs continued commitment to work in the community and their belief that the people with learning difficulties in their care were benefiting from their new lifestyle was apparent throughout. The stresses in their job were more than matched by the gains they saw the young people making. Thomson (1987) also found that for half the staff studied the effects of stress were offset by positive feedback from clients. However, the discussions equally revealed the potential for exploitation of this same goodwill, enthusi- asm and commitment. This was most apparent in the running of the emergency cover system. Group pressure, staff commitment and the expectations of managers combined with little or no alternative, militated against an objective choice being possible. The low sickness, absenteeism and turnover rates testify to the staffs commitment. However, this is a long-term project in its early stages. Failure to address the issues which emerge during the consultation process may modify these statistics. Moreover, only two of the twenty-one staff had family commitments: this may well change in the future and affect the willingness and ability of staff to work long, extra shifts at short notice.

It was recognised that, as the community houses scheme develops and the number of houses increases, a proper channel of emergency cover, incorporating back-up procedures, must be devised. Any system which relies on goodwill and informal communication can easily collapse. Firth & Myers (1985) proposed that the provision of adequate staffing numbers, for example, to cover in cases of sickness, is the most basic level of staff support. The problems of providing reliable emergency cover for a scattered community service were acknowledged as complex and different from those of providing such cover in an institution. House



staff emphasised the importance of having an emergency system which does not result in the introduction of staff who are strangers to the young people working in the houses. Not only does this undermine attempts by staff to teach the young people basic security rules such as not allowing strangers into one’s house, but such staff may also increase problems because, for example, they are unaware of individual methods of communication. Health staff suggested having a permanent pool of emergency staff who could provide cover to a limited number of houses on a regular basis. In the course of discussions which followed the workshops, a compromise was reached for Health Service staff two group home coordinators were appointed and shared the on-call duty with the nursing officer. This improved the reliability of access to advice and support. In addition, the establishment of a Special Needs Service with out- reach staff increased the possibility of practical help in an emergency.

The changes in the role of care staff associated with the move from hospital to a group home included having to learn new skills, teaching the young people new skills and, at the same time, coping with the vagaries of public reaction, stresses for which staff felt least prepared. Ward (1989) also found that the change in role from institution to community living was a cause of concern for staff, particularly goal planning and helping people with a mental handicap to learn new skills. This new role raised a host of issues about risk-taking, training, integration and communication with and support from management. Many of these issues have their roots in inexperience of and naivety about the realities of providing care in the community. Risks are an integral part of providing care in ordinary housing and cannot be avoided. The need for staff training in risk-taking with clients has been identified by Raynes & Sumpton (1987). Although safeguards can be built into some aspects of risk-taking and staff can be trained in planning and implementing risk-taking, staff may not feel confident if managers do not guarantee support. The balancing of acceptable and unacceptable elements of risk-taking presents both staff and management with a dilemma (PSSRU, 1987). Man- agement and staff must share the same aims and philosophies with regard to the role of care staff in the community and management must respect the professional judgement of care staff in their performance of that role. Achieving this requires on- going consultation rather than post hoe discussions. During this study a system of regular staff-management consultations on a three monthly basis was established for Health Service staff so that higher management7 professional support staff and house staff could develop mutual understanding of the requirements of providing successful com-

munity care. Staff felt insufficiently prepared for working in

the community: some staff training issues only emerged as the result of the experience of providing community care. The need for in-service and post- qualification training for both care staff and managers in response to new problems encountered in the community has been identified in other studies (Raynes & Sumpton, 1987; Ward, 1989). Management in both Health and Social Services regarded the appointment of a Joint Training Officer as impera- tive: this person would organise training across the city for everyone involved in community care be they working in a hostel, group home, adult training centre or community mental handicap team. The in- service training would then augment the current on- the-job training. To date, the Joint Training Officer appointment has not been funded but both Health and Social Services co-operate in making courses available to staff from either service and the Health Authority has instituted a six month rolling programme of half-day workshops for all staff working in the community.

Given the small size of the staff group and the intensity of the working environment, staff compatability and staff communication were recognised as crucial. Raynes & Sumpton (1987) identified the need for training in team work, assertiveness and confidence. In addition, face-to-face interaction is preferable to written communication (Firth & Myers, 1985). Following the workshops it was agreed that an official hand-over period should be established for the Social Services house. The immediate line manager, concerned by the issues raised, spent a period of time working in the house so that he could experience some of the problems at first-hand. The need for an additional member of staff to ease the difficulties of providing cover was recognised by managers. It was agreed that this should be looked into but no further staff were appointed. The necessity of appointing staff whose attitudes and aspirations are compatible with those of the existing staff group was amply demonstrated by experience. Both Thornson (1987) and Ward (1989) found that differences in staff attitudes and approaches to work caused tension within the staff group. The advisability of including at least the house leader on the appointments panel was agreed. This is now routine practice in all the houses. In addition, in the Health Service houses, short-listed candidates are individually invited to visit the house and meet the young people so that their reactions may be taken into account.

Conclusion The stressors reported in this study resulted from

transferring from an institutional pattern of care to a different and untried pattern of community service

~~ ~~



provision. Research demonstrated that, although the statistical indicators may be good, there were significant actual and potential stresses which had important implications for the development and management of the service. The workshop process enabled staff to focus on the major issues and develop a coherent and consistent account which aided subsequent work with management and led to positive changes in staff-management communication, staff selection, staff training and provision of emergency cover.

Acknowledgements This research was conducted under Yorkshire Regional Health Authority Grant No LE 57 with the help of Leeds Eastern District Health Authority and Leeds Department of Social Services. The authors wish to thank Lyn Woolnough for her assistance with the literature review, and all the staff who participated in the workshops.

REFERENCES Bailey, R. D. (1981) Counselling services for

nurses - a forgotten responsibility. Journal of the British Institute of Mental Handicap 9,457.

Bailey, R. D. (1982) Counselling services for nurses. Journal of the British Association fo r Coun- selling 39, 25-39.

Bailey, R. D. (1985) Coping with Stress in Caring. Lcmdon: Blackwell Scientific Publications.

Carey, G. E. (1982) Community care by whom? Mentally handicapped children living at home. Public Heath 96(5), 269-78.

Caves, R. (1988) Consultative methods for extracting expert knowledge about professional competence. In R. Ellis (ed.) Professional Competence and Quality Assurance in the Caring Pro- fessions. London: Croom Helm.

Cherniss, C. (1980) Staff Burnout: Job Stress in the Human Sermices. London: Sage Publications.

Cherniss, C. (1987) Staff burnout: Too much stress or too little commitment? In S. Landesman and P. Vietze (eds) Living Environments and Mental Retardation. Washington: American Association on Mental Retardation.

Cox, T. (1978) Stress. London: Macmillan. Cuthbertson, A. R. S., Halliday, S., Potts, M. and

Wright, J. (in prep.). Levels of stress experienced by community based staff in three houses for adolescents with severe mental handicaps.

Davis, H. (1985) Developing the role of parent advisor in the Child Health Service. In E. De’Ath and G. Pugh (eds) Working Together with Chil- dren with Special Needs. Partnership Papers, 3, 17-22. National Childrens Bureau.

Edelwich, J. and Brodsky, A. (1980) Burn-out: Stages of Disillusionment in the Helping Pro- fessions. New York: The Human Science Press.

Firth, H. and Myers, M. (1985) Supporting staff in community services. Mental Handicap 13, 1003.

Handy, J. A. (1986) Considering organizations in organizational stress research: A rejoinder to Glowinkowski and Cooper and to Duckworth. Bulletin of the British Psychological Society 39, 205-10.

Hay, D. and Oken, D. (1972) The psychological stresses of intensive care unit nursing. Psycho- somatic Medicine 34, 109-18.

Hingley, P. (1984) The human face of nursing. Nursing Mirror 159, 19-22.

Llewelyn, S. P. and Trent, D. R. (1987) Nursing in the Community. Leicester: The British Psychological Society in Association with Methuen.

Mayon, R. (1987) Burnout. British Medical Journal 295, 284-5.

Moores, B. and Grant, G. W. B. (1977) Feelings of alienation among nursing staff in hospitals for the mentally handicapped. International Journal of Nursing Studies 14, 5-12.

Parkes, K. (1980a) Occupational stress among stud- ent nurses: 1. A comparison of medical and surgical wards. Occasional Papers. Nursing Times 76(25), 113-16.

Parkes, K. (1980b) Occupational stress among nurses: 2. A comparison of male and female wards. Occasional Papers, Nursing Times 76(26), 117-19.

Power, K. G. and Sharp, G. R. (1988) A comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff. Journal of Advanced Nursing 13, 726-32.

Personal Social Services Research Unit (PSSRU) (1987) Risk taking. Care in the Community Spring, 3-6.

Quinn-Patton, M. (1980) Qualitative Evaluation Methods. California: Sage.

Quine, L. and Pahl, J. (1985) Examining the causes of stress in families with severely mentally handicapped children. British Journal of Social Work 15, 501-17.

Raynes, N. V. and Sumpton, R. C. (1987) Training needs of community staff: What do they want? Mental Handicap 15, 95-7.

Thompson, S. (1987) Stress in staff working with mentally handicapped people. In R. Payne and J. Firth-Cozens (eds) Stress in Health Professionals. London: Wiley.

Van Harrison, V. (1978) Person - environment fit and job stress. In C. L. Cooper and R. Payne (eds) Stress at Work. Chichester: Wiley.

Ward, L. (1989) ‘An Ordinary Life’: The early views and experiences of residential staff in the Wells Road service. Mental Handicap 17, &9.

Correspondence to Sabrina Halliday, Meanwood Park Hospital, Tongue Lane, Leeds, LS6 4QD.

RESIDENTIAL HOME

The J.S. Autistic Society is a new registered charity and will be opening a

new registered home for adults with autism in Moseley, Birmingham. It is due

to open at the beginning of November.

For information or referrals, please contact the Care Manager on:

(021) 441 4417.


caring for people with severe learning difficulties in ordinary houses : issues of staff stress and...

Documents