The support model is developed as a new model to provide community care and community support. It is based on a number of different models: supported living (O’Brien, 1993), psychosocial rehabilitation (Anthony et al. 2002; Wilken & Den Hollander, 1999, 2005), community support (Carling, 1995), the presence approach (Baart, 2001) and the empowerment model (Van Regenmortel, 2002).
Living in the community
A person with disability gets the support they need to live in their own home. If the person’s needs change the support they get can also be changed. The most important thing is that the support matches the person’s needs. This means the supports are designed for the person… they fit the person, the person does not have to fit the supports. This helps the person to live in their community.
Supported living is an approach to housing and support for people with disability based on the fundamental belief that every person has a right to lead their own life, to determine where, how, with whom they live and who provides them with support.
Common elements of supported living include:
- Separation of housing and support
- Support is provided by a combination of informal (non-paid) and paid support with intentional strategies used to develop informal support
- Paid support is individualised, flexible and under the control of the person with disability
Where a service provider is involved, it stands beside the person with disability and their family to develop and implement the lifestyle the person wants.
The support model combines different angles.
* Focus is never exclusively on either an individual or a community; the interaction between person(s) and environment is always in sight.
* There is a distinction between ‘natural’ social support and professional support. The emphasis is on the natural resources. Professional support is only given when natural resources fail or are still insufficient.
* Focus is on empowering individuals and communities, in order to increase and use the own strengths. Focus is on strengths and not on limitations. Support is aimed at empowerment, options, growth and development.
* Focus is also on inclusion and participation: working together on ‘social capital’.
The support model focuses on the person as well as on the community. As far as the person is concerned we favour a holistic humanistic approach, in which the individual, even in the role of a receiver of a professional service, is not reduced to the illness or disability part, but is looked upon as a whole person. Person orientation also includes equality in the sense that the professional, although in the role of a professional service provider, is also a whole person. Seeing each other as individuals, both with strengths and weaknesses, both with valuable experiences, is an important starting point for creating a helping relationship. The professional has to recognize and acknowledge the client’s social environment and experiences, especially with regard to the suffering connected to psychological, social and financial problems. Focus is on the individual’s strengths rather than on his deficiencies.
The support model is characterised by a contextual approach. It is environment-specific. The interaction between the individual and his environment is essential. We distinguish between the immediate environment and the larger societal environment. The immediate environments we discern are the life domains of living, working, learning and recreation. We talk about neighbourhoods, enterprises, schools, community centres and sports clubs. Interventions can be aimed at improving the quality of these environments, both physically and socially. Support can be offered to reinforce networks connected to these settings, and to encourage employing the strengths and talents of the network members. A special endeavour is to create hospitality for persons who are ‘different’, to create room for them so that they feel welcome and can be included as well. Support workers have an important function as bridge builders, creating bridges between someone who is isolated, and the community. We help a person with a disability to fit in specific environments, and to fulfil ordinary social roles.
A person with an illness or a disability is not only, or mainly, a patient or a consumer of services, but is first and foremost a citizen. This connotation, which can be regarded as a delayed consequence of the movement for citizen rights, is connected to the human rights movement. A person with disabilities has the same rights as every other citizen, and consequently also the same obligations, which coincides with the emphasis which, in the practice of psychosocial rehabilitation, is put on the ‘normal’ or healthy sides of the person (Wilken & Den Hollander, 2005). Citizenship also refers to community participation, and to the social skills necessary to be a good fellow-citizen. Community participation is only possible if the community allows or enables participation. In the process of deinstitutionalization much effort is made to create sufficient professional support in the community. Far fewer efforts have been made to use natural resources in the community (Rapp, 1998; Wehman & Bricout, 2002). In other words, citizens are assisted to support a disabled fellow citizen. This is an important new challenge in social work.
Empowerment and self-help
In the support approach, emphasis is on self-help and empowerment. Basically every person is responsible for his own life and self-care, although at the same time interdependency is a given fact. Support is connected to the self-management and self-efficacy abilities, and is focused on compensation for disabilities and strengthening the available competences.
Empowerment can be regarded as a process whereby people, organizations, and communities gain control over their lives (Rappaport, 1984). On an individual level Solomon (1976) defines empowerment as “a process whereby persons who belong to a stigmatized social category throughout their lives can be assisted to develop and increase skills in the exercise of interpersonal influence and the performance of valued social roles”. Zimmerman and Rappaport (1988) formulate three core elements: control, critical awareness, and participation. Control refers to perceived or actual capacity to make or influence decisions. Critical awareness refers not only to understanding yourself, but also to how the world turns, for example how power structures operate, decisions are made, causal agents are influenced, and resources are mobilized. Participation refers to taking action to make things happen so as to get the desired outcomes. Participation is closely connected to emancipation, influencing policy-makers, taking part in decision-making, but also to self-help and consumer-run initiatives. Finally, participation is an important notion for citizenship: participating as a citizen in the community, but also participation in local policy-making and the organization of services.
A specific aspect of empowerment is to have the freedom and ability to make choices. People with disabilities have the same rights and freedom to make choices as other people. Usually citizenship includes having the right to choose how to live your life, and where to live, where to work or where to go to school. But also to choose how and by whom you want to be supported. The other side of the coin is that there is a limited range of choices, as goes for every citizen. An important part of a support worker’s task will be to provide the person with the skills, supports and information, necessary to create as much “choice ability” as possible. This is also an empowering way of increasing freedom and self-determination. The better a person is able to make his own choices, the more motivated he is to set goals and to work actively towards achieving these goals. Choice increases involvement.
Different methods are based on the principles described above:
- CARe model (Wilken & Den Hollander, 2005; 2012)
- Supported Living (O'Brien, 1993) and Person-Centered Direct Support (O'Brien & Mount, 2005)
- Supported Employment (Rinaldi et al., 2008).
This text is taken from Wilken J.P. (2005). Working on Social Inclusion: the development of a Support Model. In: Van Eijken J. & H. van Ewijk (eds), Reinventing Social Work. Utrecht: Hogeschool Utrecht.
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O'Brien, J. (1993). "Supported Living: What's the Difference?" Lithonia, GA: Responsive Systems Associates.
O'Brien, J. & Mount, B. (2005). "Making a Difference: A Guidebook for Person-Centered Direct Support." Toronto, Canada: Inclusion Press.
Rinaldi M., Perkins R, Glynn E., Montibeller T., Clenaghan M. and J. Rutherford (2008). Individual placement and support: from research to practice. Advances in Psychiatric Treatment (2008) 14: 50-60.
last edited by Jean Pierre Wilken March 2013