Carnaby, Steven
(1997)
Designs for living: A comparative study of learning disability services in London and Milan.
PhD thesis, London School of Economics and Political Science.
Abstract
Normalisation as defined by Wolfensberger informs British services for people with learning disabilities, probably without exception. It is an approach which instructs services to help service users acquire behaviours and characteristics which are as 'culturally normative as possible' (1972:28). The later interpretation by O'Brien (e.g. 1980), where he summarises and translates normalisation into the Five Service Accomplishments, has attempted to aid support staff in the task of translating operational policies built upon normalisation principles into practice. While many studies have attempted to assess the efficacy of this approach, it is difficult to establish their success, as their measurement criteria are usually based upon levels of competence and participation - values themselves derived from the normalisation approach. This study attempts to step outside this dilemma by using a comparative research method. Services in London are compared with services in Milan, Northern Italy, as while the latter also undertake to support people with learning disabilities using individual planning processes and on rare occasions residential services, the operational policies, training and overall framework for doing so are underpinned by a holistic, legislative model which views the family or its substitution as the key to service provision. Milanese services also advocate a framework which values interdependence between service users, and indeed considers the group living perspective of living in the community as essential for the development of self esteem. This is felt to be a pre-requisite for effective integration with the local community. British services, conversely, aim to encourage relationships between people with learning disabilities and non-disabled others as the most appropriate pathway to integration. This then acts as a valuable contrast with normalisation and enables the impact of Wolfensberger's approach to be considered in a unique way. The comparison is on three levels. Residential services - one in London and one in Milan - are studied using in-depth interviews with a total of 12 service users and 11 staff, as well as participant observation of daily life in each project. Individual planning processes, seen as the most direct way by which service ideology is implemented, is compared by interviewing 21 service users and their key-workers and 5 relatives, and sitting in on individual planning meetings. Staff training structures are also compared. In addition, operational policies for the residential services and the planning services, as well as relevant legislation from each country, is analysed in depth. The findings are discussed at each stage and comparisons made. Recommendations related to interpreting service principles are made for increasing good practice in certain aspects of the British services. The main suggestion is that consistent, legislated training for support staff in British services might contribute towards ameliorating current difficulties described by much of the contemporary research. The observation that the implementation of normalisation is by way of an approach rather than a model of service provision is highlighted.
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