12 Lessons from the Development and Operation of an Australian accommodation support system for Deafblind Adults.
These 12 Lessons were written jointly by

Trish Wetton OAM MSpEd(SensDisab), GrDipAdmin.
Forsight Australia, and

Dr Mike Steer
Royal Institute for Deaf & Blind Children, and
The University of Newcastle, NSW

An Australian with sensory and multiple disabilities is a full citizen with the rights and responsibilities accorded all adult Australians, and is entitled to dignity and respect. Forsight Australia located at North Rocks in suburban Sydney was founded 30 years ago by parents of children who were deafblind to provide quality accommodation support services and facilitate training and employment for adults who were both deaf and blind with additional disabilities; and to enhance and enrich their lives. In 2008, Forsight manages eight independent group homes, with 49 full-time, part-time and casual staff providing support to 32 adults with sensory and additional disabilities…
see photos in panel on right.

Forsight Australia staff firmly believes that each resident is a unique and important individual. The agency’s Board, staff, the residents, their families and advocates do all in their power to foster a service model that is based on mutual respect. Staff are trained by the agency to adopt a person-centred approach to all aspects of its Accommodation Support Program. The agency’s objectives are as follows:

• To promote, encourage, foster and develop the care, accommodation, communication and training of adults who are deafblind with additional disabilities.
• To assist residents to interact with others in the community, to protect their rights and treat them with dignity and respect as valued members of the community.
• To assist residents to lead satisfying lives and as far as possible become self-determining.
• To consolidate world knowledge and encourage sponsorship for research.
• To become a model of best practice in the provision of services for adults who are deafblind with additional disabilities.

In its 30 years successful experience at developing and managing a reasonably large accommodation and support system for deafblind adults, Forsight Australia's management, staff and residents have learned that the following areas are highly important to the success of the agency:

> Sound principles - Lesson 1

Sound principles
Lesson 1 Services need to be based on sound human service policy principles

Forsight Australia has developed and implemented policies and procedures including Code of Conduct, Code of Ethics, Meeting Individual Needs and Mutual Respect for Others. The ecology of each group is a high priority for Forsight Australia. Nurturing relationships between residents and also between staff, families and Advocates and residents is very important by Forsight Australia management.

Attempts are constantly made to have each Forsight Australia group home is a welcoming, safe and happy home and workplace. All staff focus on each resident’s needs to provide a person-centred service. The goal is to provide a person-centred service. Communication training in Augmentative and alternative methods of communication include finger-spelling, Makaton and Compic. These are provided to meet individual communication needs.

> Assessment - Lesson 2

Lesson 2 Residents with sensory and multiple disabilities need to be correctly needs-assessed.

Assessments at Forsight Australia take into account the centrality of the sensory and multiple disabilities, and include consideration of the whole person. Assessments require input from the resident with a disability or an advocate, and from family members and carers. The importance of identifying the range of impairments, the way they combine and the resultant effect cannot be over-emphasised. Early identification and complete assessment leads to effective program development and enhances the probability of providing positive outcomes.

Practical Assessments are conducted in each resident’s own group home to enable abilities to be identified more accurately. Residents are more confident in surroundings and with people they are familiar with. A range of medical and other Assessments are conducted for the Lifestyle & Environment Review, the Developmental Disability Health Unit Care Plan and the Forsight Australia Care Plans.

> Community presence - Lesson 3

Community presence
Lesson 3 Australians with sensory and multiple disabilities have a right to live and spend their time in the community, and not in facilities that deny their access to fellow citizens.

Towards this goal, Forsight Australia constantly seeks alternatives to such long-stay programs as nursing homes and institutions. The location of a support service is highly important as this can affect opportunities for involvement in ordinary, everyday community life. Residential support services need to be located within easy reach of such community facilities as shopping centres, post offices, community health centres, recreational facilities etc. Proximity to public transport is also highly important. In planning and delivering accommodation support services, equal weight should be given to day activity provision and access to community services.

Residents are able to access their local shopping centre with one-to-one support for personal shopping and personal care appointments. Additional one-to-one support is available through the Group Home Support Centre at North Rocks.

Forsight Australia obtains donations each year to provide support and transport for residents to attend Blind Bowls, Blind Cricket, Riding for the Disabled, RAPS and Hand Over Hand recreational activities in the community. The Agency believes that when group homes including gardens are well maintained, residents are accepted by their neighbours and welcomed into the local community. Forsight Australia welcomes local Service Clubs to participate in special events with residents.

> Relationships - Lesson 4

Lesson 4 Living in the community is not enough. Relationships in daily life with non-disabled people need as much as possible to be fostered.

Forsight Australia seeks Advocates to provide support to residents who do not have family members or friends to assist them to make informed decisions and choices about their lives. Links with Corporate partners allow relationships to be formed between volunteers and residents. Working bees, including group home garden and room makeovers involve community donors-in-kind and residents working side by side on a project.

Professional photographers have become mentors to blind residents, training them to take digital photographs to expand their perception of the world using their senses of touch, sound and smell. New opportunities for building new relationships are continually being sought.

> Choices - Lesson 5

Lesson 5 A person with a sensory and multiple disabilities has rights of citizenship in the service development process to make views known and have account taken of those views.

Residents attend regular meetings where they receive assistance to communicate their views about their group home. They have a representative on the Forsight Australia Homes’ Committee which gives them access to the Board. Under guidance from the CEO a unique communication link with each resident has been developed to enable all residents to make their views known and be listened to at any time.

> Communication - Lesson 6

Lesson 6 Opportunities for communication with other people is of primary importance in the development of relationships, since this enables choice and decision-making as well as participation in community life.

Individual Plans include goals for increasing communication skills.
Vision Australia, Deafblind Services NSW, Guide Dogs Association of NSW/ACT and the Deaf Society assist Forsight Australia to provide opportunities for residents to communicate with other people in their group home and in the community.

Staff receive training in offering choices to residents, knowing when to hold back to encourage independence is important to ensure that each resident is given the time he or she requires to make choices about being independent and doing things for him or herself. The Agency provides weekly Dance Therapy sessions to residents. Positive outcomes from this project include enhanced communication between residents, enjoyment and documented changes in challenging behaviour.

Families, friends and Advocates play an important role in the lives of deafblind residents. Home visits are anticipated eagerly. These highly important links are nurtured by staff.

> Home - Lesson 7

Lesson 7 Wherever possible, remaining in the family home with support from the agency should be considered a viable option for a person with a sensory and multiple disabilities.

New enquiries for accommodation support programs are referred to the Department of Ageing, Disability and Home Care Vacancy Management Committee. The Department provides Case Management and Assessment options to identify level of support needs to ensure that all viable options are considered. In-home support services are discussed with stakeholders at Individual Planning meetings.

Forsight Australia believes that all residents where possible go home to their families during Christmas and Easter breaks. Regular home visits are encouraged throughout the year.

> Educational/Developmental programs - Lesson 8

Educational / Developmental programs
Lesson 8 There must be a consistent and coherent approach to educational and developmental programming across residential, educational, recreational and vocational or occupational services.

Forsight Australia requires a comprehensive Transition Plan, Funding Agreement and Health Care Plan that clearly identify the unique current and future needs of the resident seeking to access the service. Adult learning programs and supported employment services are facilitated by Forsight Australia and transport to services is provided.

Forsight Australia staff training includes Certificate IV in Disability Studies and in house training. Competent staff can provide learning opportunities to residents across all programs.

> Specialist supports - Lesson 9

Specialist supports
Lesson 9 These are essential as part of the agency’s comprehensive service provision.

An experienced member of the Forsight Australia management team attends all appointments at the Developmental Disability Health Unit (DDHU) at Royal Rehabilitation Hospital or attends appointments with any treating Specialist with each resident. This practice ensures continuity and accurate information is provided confidentially. A comprehensive Care Plan is developed by the DDHU and regularly reviewed. A team of specialists is involved in the implementation each Care Plan. In addition, Forsight Australia Care Plans are developed for all hospital stays and Specialist treatments to record all information.

Clinics are conducted regularly by Westmead Dental Hospital, Dysphagia Clinic, Clinicall and Macquarie University Audiology Clinic for all residents at Forsight Australia Group Home Support Centre at North Rocks. Clinicians are always pleased to examine residents who are relaxed in their familiar surroundings.

Staff are kept informed of all specialist support arrangements through the Trans-disciplinary team confidential approach using group home computers.

> Comprehensive services - Lesson 10

Comprehensive services
Lesson 10 Providing comprehensive supports on an individual resident basis requires a planned approach with emphasis on periods of transition between phases, for example, that which occurs on leaving school for adulthood.

All new admissions require an individual planning approach. The Department of Ageing, Disability and Home Care (DADHC) Vacancy Management Committee oversees all placements. The comprehensive DADHC proposal for funding is based on Assessment outcomes and budgetary guidelines. Residents entering Forsight Australia from School would access the same process as the adults who transfer from another adult service such as an Aged Care Nursing Home, DADHC large residential or group home.

The location of family and friends of deafblind residents is taken into account to ensure relationships can be easily maintained. Day programs and supported employment services, including transport needs are identified.

> Changing needs - Lesson 11

Changing needs
Lesson 11 Program development must take into account the changing needs that arise from; improvements or deterioration of an individual’s condition; on-going developmental opportunities, different life stages; and choices made by the individual resident.

The changing needs of deafblind residents are monitored by Forsight Australia management and staff in collaboration with other services, families, Advocates and Guardians. A pro-active approach is used to ensure that early symptoms or deterioration of a resident are picked up. The ‘Preventive activities over the Life Cycle’ system provides a guide for screening for age related illnesses. Screening is firstly identified in the Individual Plan and then included in the DDHU Care Plan.

An accommodation retirement program operates at some group homes for residents who do not attend day programs or supported employment services full-time.

> Staffing - Lesson 12

Lesson 12 Individuals with sensory and multiple disabilities must have support services provided by staff who are well trained, experienced and who are provided with in-service training and supervision.

Forsight Australia is aware that due to the scattered nature of the eight group homes all staff do not work under ‘direct’ supervision but ‘general’ supervision only. To address this isolation and the solo shifts worked at most group homes, Forsight Australia implements a strict recruitment and induction process to ensure all staff have the skills required to work with 4 or 5 residents alone before being rostered to work at a Forsight Australia group home.

Deafblind residents rely heavily on their support worker to understand them so that they can convey their needs for day to day living to management on their behalf. A high level of trust exists between the different levels of staffing. Each staff member receives in-house training in the Life Cycle Model to equip them to become skilled managers at work and in their own life situations. This management training provides staff with the ability to manage critical incidents as they arise and to report them. An Action Planning approach identifies each situation and records actions needed to complete various tasks with a regular evaluation. Every critical incident reported to management is monitored closely until resolved. A Code Red critical incident must be reported to the CEO so that follow up can occur.

Forsight Australia's Trans-disciplinary confidential approach to group home care, using computers and cloud technology in each group home so that all staff can receive the same information to work as one team. In-house training in documentation and legal responsibility, medication management, epilepsy management, deafblind communication skills, fire evacuation and use of equipment and complaints reporting and handling are continually offered to all staff. Attendance at Quarterly General Staff meeting/training sessions is compulsory for all Forsight Australia employees.

Forsight Australia provides VitalCall direct telephone support at each group home. Individual VitalCall medallions are provided to residents as required.
24/7 telephone support is provided to residents and all employees at each group home by the Executive Leadership team and the CEO. The team is made up of Regional Managers, House Managers and Team Leaders. This unique system at Forsight Australia ensures that each group home has its own circle of support 24/7.

A CEO Payroll Memorandum containing valuable information about resident care, group home management, dates for your diary, IR and staffing matters is sent out regularly with pay slips to all group homes including the relief agencies. A new system incorporating ADP Payline and RosterLive ensures that all staff sign on using their thumb print to verify their shift attendance.

The authors acknowledge the assistance of SENSE residential service guidelines in the development of this article.