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| Author | Catherine Vassallo |
| Abstract | Introduction: Over the years, the mental health sector has seen vast changes in the underlying concepts of services provided to people with developmental disability. These changes were provoked by deep dissatisfaction with traditional approaches to the care of patients with chronic mental and physical disability. The ultimate challenge is to develop a new paradigm or concept of supporting and empowering people with disability to meet their own basic needs with the assistance necessary to live valuable lives. Objective: The purpose of this research was to describe the level of preparedness and commitment for the "paradigm shift" of Dar Tal-Providenza (hereafter referred to as DTP) from operating a facility-based residential service into an organisation providing community living in the Maltese context. Methodology: An exploratory, qualitative methodology was adopted. This design allows the exploration of issues in depth, thereby contributing to the development of an understanding of participants' perceptions. An in-depth, semi-structured interview with open and close-ended questions was developed for the study. The interview schedule was developed on the basis of the main issues identified in the literature review. It covered the organisation's present culture, the goals and objectives of DTP, the understanding of community living by participants, attitudes towards disability, the type of support DTP holds within the community, and ongoing staff training and other resource issues. Results: Several issues emerged from this study. There is a need to establish a clear vision of community living throughout DTP. There is also a level of dissatisfaction with the present state of DTP as well as a lack of a stable, well-trained professional work force. Staff development is seen to be of major importance but needs more resources and planning while cost analysis is still rudimentary. A 'let-it-happen' attitude towards community integration and participation prevails, whereas DTP does not have a strong voice at the level of statutory policy-making. There is a striking difference between the organisational structures, systems and styles of Villa Mgr. Gonzi (hereafter referred to as VMG) and `Zerniq', with the latter being perceived as more successful. The present position of VMG as a virtual annex of DTP, as well as its rurality are important obstacles to the further development of VMG's role in community living. D iscussion: The change which occurred when VMG was opened was only of a first order type. A consensus about DTP's mission amongst key managing members of DTP is required in order to avoid a mixed commitment to organisational goal priorities. Another management implication is that unless the organisation recruits and trains professional staff, the ability to successfully implement large-scale change will be severely impaired. A detailed cost analysis was not available, leading to divergent perceptions as to the actual and eventual costing of community living service models. For transition to community living to be effective, community health services, accessible housing, transportation, recreational options and work opportunities have to be in place. Recommendations: The Board of Managers must invest energy and resources in reaching consensus on priorities and establishing a clear core mission. DTP should strive to implement and integrate a total quality approach (such as Total Quality Management) into its management system. Given that the transition state is very different from the pre-change condition, a separate management structure congruent with the tasks and organisation of resources within this unique state will be needed. The adoption of financial self-management or unit budget holders (as in `Zerniq') should promote a cost-conscious culture. Managers have to be committed to develop a communication plan that parallels the implementation of the proposed change. Significantly more investment in the training and development of staff is necessary to further support staff members who are committed to the change. Conclusion: The main challenge in this field appears to be a management challenge. The focus of all change management should be the people involved. Their roles and their tasks would ultimately determine whether goals and objectives will be achieved. |
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| Key words | Thesis, Health Services Management, Transition, Community Living, Developmental Disability |