Goal Planning in Residential Care for the Severely Mentally Handicapped

Abstract

Effecting change in any organisation is a difficult process (Watson, 1972; Georgiades & Phillimore, 1975), but this is particularly so in hospitals for the mentally handicapped. These are under considerable public pressure to change the aims of the organisation away from simply a caring role, and towards a teaching role aimed at the maximum development of each individual's abilities. Translating these demands into tangible changes presents enormous problems. Very often projects which demonstrate what can be done for the handicapped remain isolated examples of excellence, and do not translate into general service provision effecting the lives of large numbers of handicapped people. The gap between current knowledge and actual practice remains enormous. The particular programmes to be described here arose out of just a small scale “demonstration” project with a group of children on one ward in a mental handicap hospital (Clements, 1976). This programme which was highly staffed aimed at encouraging the all round development of a group of young profoundly, and multiply handicapped children. These children were part of a 30 bedded-ward for multiply handicapped children and young adults. The ages ranged from 12–23 years, no child was fully ambulant, none had any speech, none were continent, and only a few were able to feed themselves. After the success of the demonstration programme, it became necessary to find ways of applying the findings to the ordinary ward situation, where staff ratios were far less favourable. And if a method of sustaining a whole-ward programme were found, this would be of relevance to other wards within the hospital complex.