Journal of Intellectual Disability Research, 1992, 36, 489-503
Activities and engagement in day services for people with a mental handicap K. LOWE, S. BEYER, M. KILSBY & D. FELCE Mental Handicap in Wales: Applied Research Unit, University of Wales College of Medicine, Cardiff, Wales
ABSTRACT. Policy on the role and function of day services for adults with mental handicaps has changed considerably during the last 2 decades. What such settings offer their users has also changed as services have attempted to evolve in line with policy. However, the impaa of these changes has gone largely unevaluated. This paper describes a study of two day centres to categorize the activity programmes of these services, and to assess service user and staff behaviour prior to a larger scale study of such services in Wales. The two centres were found to differ significantly in their programmes but not in the extent to which activities were organized in the community. Service user participation in activities varied with activity type, group composition and activity location. Whether activities were organized for thefallduration of the timetabled sessions was critical to the interpretation of the extent of service user engagement. Staff showed a commendable orientation to clients and their activities in both services. Differences in the activity programmes of the two centres are discussed in terms of a continuing lack of clarity over the purposes of such day services in general. The relevance of some activities to objectives is questioned. Concem is also expressed about the resulting level of engagement achieved in planned activity.
INTRODUCTION The history of day service provision for people with mental handicap stretches back to the Mental Deficiency Act of 1913, which enabled 'occupation centres' to be established with the aim of training, occupying and supervising those people covered by the Act. After the Second World War, the number of such centres increased as a result of growing concem with care in the community, reflected in further legislation such as the Mental Health Act of 1959. These day centres had a predominantly industrial and commercial outlook, providing sheltered places of work, with clients involved in production assembly, simple manufacture and craft work. Central guidance on the role of such centres came in 1968 via a 'model of good practice' issued by the Department of Health and Social Security (DHSS, 1968). This placed emphasis on the training of people for outside employment, and marked the beginning of what has proved to be continuing change in the role of day services, by now commonly known as adult training centres (ATCs). The 1970s witnessed a broadening of the function of ATCs, through the Government White Paper Better Services for the Mentally Handicapped (DHSS, 1971),
Correspondence: Dr S. Beyer, Mental Handicap in Wales: Applied Research Unit, 55 Park Place, Cardiff CFl 5AT, South Glamorgan, Wales. 489
490
K. Lowe et al.
to include the assessment of people's needs, the provision of permanent daily occupation where no alternative form of sheltered employment was available and respite for families. Care policies in the 1970s were concerned increasingly with promoting independence and maintaining people in the community. However, the provision of small scale housing was in its infancy, domiciliary support services were yet to be developed, and large residential facilities, by their very nature, were unable to meet the challenge of providing adequate opportunities for independence and social skills training. ATCs represented the only major resource that could answer the growing demands to develop the potential for independence of adults with mental handicap. The National Development Group's Pamphlet 5 (NDG, 1977) emphasized the need for social training and promoted a model of systematic assessment of individuals' abilities in real life situations, followed by clear teaching programmes and continuing review. The DHSS ratified the NDG recommendations as official guidance, and this laid the foundations for a further shift of ATCs away from an industrial to a social education model with increased involvement in supporting people in a variety of activities, including those in community settings outside the central base. Subsequently, a number of ATCs have been redesignated 'Social Education Centres'. Therefore, ATCs have undergone several shifts in their aims and in the way they work over the last 20 years. However, there has generally been a lack of research to document and analyse their development over this extended period, and there has been particularly little attention focused on the experience of service users. A major national survey of ATCs carried out in the early 1970s (Whelan & Speake, 1977) revealed that, even then, centres had a wide variety of aims, with the greatest consensus being around the provision of work training, and social and further education. Whelan & Speake's (1977) recommendations, proposing a broadening of the scope of work preparation, a move to systematic analysis of training needs and a more programmed approach to teaching, supported those of the NDG published in the same year. More recently, two large scale surveys (Seed, 1988; SSI, 1989) both indicate that a wide range of models continues to exist, and that there is still considerable confusion over the primary role that day services should play. Seed, in his study of Scottish centres, generated seven models of ATC operation, representing the full range of policy on day occupation from sheltered work through work training to the more recent social education emphasis. Eurther, he found that, generally, individual ATCs operated a number of different models concurrently. The SSI found wide variation in the 150 ATCs they examined. However, the SSI inspectors failed to recommend a model approach which might lead to a consistently higher quality of service. In the Welsh context, the All-Wales Strategy (Welsh Office, 1983) has provided strong central policy guidance linked to a planning strategy and additional funding. However, advice on day services was only pitched at a general level, with a diversification of day time options apart from ATCs being sought. Within this climate for new development, ATCs have remained the major resource, but one which has been susceptible to the developing policy influences outlined above. This paper describes a study undertaken as a precursor to a broader evaluation of the ATCs throughout Wales. The overall aim of the present research is to evaluate the impact
Activities and engagement in day services 491
of changing policy on day services for adults with a mental handicap. Its purpose is to identify the dominant models of provision by examining the pattern of activities undertaken by ATCs, and to investigate the experience of service users across the range of activities typical of different kinds of centre. The aim of this study was to test the feasibility of collecting accurate descriptive data on the activities of day centres by questionnaire, and to test a variety of observational methods for assessing staff and client engagement in activities. In particular, the present authors wished to explpre a method for typifying the extent of engagement achieved by different activities and in the ATC overall, bearing in mind that it would not be feasible to observe all clients at all times because of the numbers attending ATCs and because activities are programmed to occur in many locations at the same time. While some minor methodological alterations will be incorporated into the broader evaluation, the study described here provides a useful insight into the current performance of two ATCs and highlights issues relevant to the provision of day services. METHOD Settings
The two centres were selected to represent what was considered in advance to be different models of operation: one a long-established traditional ATC, and the other a newer development along the more progressive 'social education' lines. The present authors' hypothesis was that the traditional centre would focus largely on centre-based activities, organized mainly on a group basis, with more emphasis on sheltered work, traditional personal development and segregated occupation, and that the progressive centre would focus on community-based activities, organized more on an individual basis, vidth greater emphasis on integrated occupation and the development of community living skills. Centre A, regarded as the more traditional ATC, was situated in a purpose-built unit within an industrial estate; centre B, the more recently established social education centre, operated in a residential area within a building which was previously a school. Centre A offered approximately 145 places, including 21 for people with special needs provided mainly in a separate unit attached to the centre. The managerial/instructor/care staff complement comprised a manager and deputy, four senior instructors, 12 instructors and four care assistant (19-5 whole time equivalents) giving an overall ratio of 1:7-4. Centre B provided places for around 59 people, including 15 considered to be of high dependency yvho were fully integrated into the mainstream centre activities. The staff establishnient of Centre B comprised a manager and deputy, two senior day officers, 10 day service officers and two support workers (15-5 whole time equivalents), giving an overall ratio of 1:3-9. Measurement, procedure and analysis
Two main methods of data collection were employed: (1) descriptive information Was collected by interview and analysis of service documentation; and (2) data on client and staff participation in activities was obtained by direct observation.
492
K. Lowe et al.
Descriptive information. Interviews were conducted with the manager of each centre to obtain information on centre organization, staffing levels, grades and deployment of staff, external management arrangements, budgetary control, numbers of people attending, their attendance patterns, and current weekly timetabled activities. The weekly timetabled activities were analysed by activity type (see Table 1) in order to determine the emphasis placed on each form of activity offered by the two centres. In doing so, the number of person sessions allocated to each activity and whether activities occurred within the centre building or elsewhere were taken into account. Direct observation of a sample of sessions established whether activities occurred as timetabled, and thereby, the validity of categorizing centres on the basis of their reported activities. Chi-square tests (two-tailed) were used to compare the distribution of activity types between and within the two centres (Siegel, 1956). Behavioural information. The aim of this part of the study was to assess the extent of client engagement in the activities provided by each centre, together with the role of staff. A sample of activity sessions was selected from the analysed timetables to represent the balance of weekly activities offered by each centre. This approach was followed because it was not feasible to deploy sufficient observers to observe all activities, clients and staff even over a limited period because of the size of the services, and the dispersed nature of some activities. The Planned Activity Check (Risley & Cataldo, 1973) was used to observe the level of service user engagement in the selected activities. This measure was developed to reflect the educational and developmental value of day centres for pre-school children Table 1. Examples of each activity type Example Music, drama, photography, gardening, woodcrafts, pottery, model making, cookery, needlecrafts, painting, macrame and upholstery Swimming, tennis, judo, keep fit, aerobics, snooker, horseriding, popmobility and relaxation exercises. Self advocacy, shopping skills, discussion groups, social skills, community living skills and personal care skills Playgroups, mother and toddler groups, charities and church organisations. Adult literacy, college attendance, computer work and current affairs Packing, box-making, assembly and manufacture of goods Organized placements in ordinary work settings, sheltered workshops and employment training Waged employment Speech therapy, physiotherapy and music/drama therapy Any activity that cannot be categorized above (e.g. mail collection and delivery and hairdressing)
Activity type
Arts and crafts Sports Personal development Volunteering Education Contract work Work experience Work Therapy Other
Activities and engagement in day services 493
although its use is not limited to such settings (e.g. Porterfield et al., 1980). It provides a method rather than a set of measurement definitions. The latter are developed for each planned activity in each setting in tum. Its focus is on evaluating the effectiveness of the setting by assessing the participation of the individual in the intended activity of the setting based on a rationale that there is a broad purpose to the activity in terms of therapeutic or developmental benefit which would be missed if the individual did not participate. Hence, an effective service will be one which achieves a level of organization that succeeds in a high proportion of service users being involved in the activities that have been timetabled to meet the therapeutic and developmental objectives of the service. This measure seemed highly appropriate to adult day services for people vvdth mental handicap because the policies underljong such services, referred to above, make very clear that such settings should be working towards a range of objectives on behalf of their users, and therefore, that they should be concerned whether their clients participate in timetabled activities or not. Engagement was defined after establishing the intended content of each selected session by prior interview with the responsible staff member. It was assessed by counting the number of clients in the group being observed at 2-min time intervals, then counting the number engaged in the specified behaviours, and representing the latter as a proportion of the former. In general, observation began at the beginning of the activity and continued until the activity group broke up. For each sampled activity, the following data were obtained: planned group size (taken fi-om the timetable and statements of staff); actual group size; percentage observed engagement during the activity; the actual duration of the activity (all gained via observation); its planned duration (taken from the timetable and statements of staff); and percentage engagement averaged across the planned activity session duration. This last datum was calculated by multiplying percentage observed engagement by the actual duration of the session and dividing by its planned duration. It is taken as an estimate of how much engagement in plarmed activity there is in the session based on the assumption that planned activity catinot occur outside of the organized activity. Averages across activities in each centre are weighted by actual group size. Mann- Whimey U tests (two-tailed) were used to compare levels of groUp engagement across the two centres, and across those which occurred within and outside of the centre buildings (Siegel, 1956). The Staff Behaviour Measure (Porterfield et al., 1981) was used to observe the staff involved in each session. Categories of staff behaviour were: direct client contact; handling client related materials; staff to staff interaction; administrative tasks; 'other' (such as interacting with a client from another group); and "no recording' (usually when staff leff the area). The category of direct client contact was further subdivided into: on-task talk; off-task talk; supervising task; physical guidance; giving materials to clients; doing something to clients (e.g. tying shoelaces); and demonstrating task Qones et al., 1984). Observations of staff behaviour were also conducted at 2-min time intervals, alternating with the observations of group engagement so that, overall, observations were made each minute throughout the sessions. Where more than one staff member was involved in a session, all (up to a maximum of three) were observed
494
K. Lowe et al.
in sequence within each time interval, allowing 20 s for the behaviour of each staff member to be noted. In addition, observers made notes during the observations. Reliability assessments were conducted on client engagement and the staff behaviour observations. Percentage agreement was calculated by dividing the number of items on which codings agreed by the number of agreements plus disagreements, and multiplying by 100. Agreement on group size was 99% (range 98-100%). Agreement on client engagement was 92% (range 86-97%), with a Cohen's Kappa of 0-74 (range 0-53-0-91). Agreement on staff behaviours was 81% (range 77-88%). RESULTS Range of activities
Table 2 shows the proportion of person sessions, normally of 2-3 h duration (i.e. all morning or all afternoon), timetabled within each centre presented according to activity type. It also shows the proportion of sessions within each activity type occurring vwthin and outside of the centre building. A series of analyses and Chi square tests were carried out: (1) the balance of activities offered by each centre was compared by examining the distribution of person sessions across activity tj^es; (2) the extent to which activities were offered within the centres or organized outside the building were compared for each centre separately and the proportions for each centre contrasted; (3) the types of activities organized in or out of the centres were compared in total and for each centre separately. The two centres were significantly different in the number of person sessions allocated to the various activities on offer (P
Activities and engagement in day services for people with a mental handicap K. LOWE, S. BEYER, M. KILSBY & D. FELCE Mental Handicap in Wales: Applied Research Unit, University of Wales College of Medicine, Cardiff, Wales
ABSTRACT. Policy on the role and function of day services for adults with mental handicaps has changed considerably during the last 2 decades. What such settings offer their users has also changed as services have attempted to evolve in line with policy. However, the impaa of these changes has gone largely unevaluated. This paper describes a study of two day centres to categorize the activity programmes of these services, and to assess service user and staff behaviour prior to a larger scale study of such services in Wales. The two centres were found to differ significantly in their programmes but not in the extent to which activities were organized in the community. Service user participation in activities varied with activity type, group composition and activity location. Whether activities were organized for thefallduration of the timetabled sessions was critical to the interpretation of the extent of service user engagement. Staff showed a commendable orientation to clients and their activities in both services. Differences in the activity programmes of the two centres are discussed in terms of a continuing lack of clarity over the purposes of such day services in general. The relevance of some activities to objectives is questioned. Concem is also expressed about the resulting level of engagement achieved in planned activity.
INTRODUCTION The history of day service provision for people with mental handicap stretches back to the Mental Deficiency Act of 1913, which enabled 'occupation centres' to be established with the aim of training, occupying and supervising those people covered by the Act. After the Second World War, the number of such centres increased as a result of growing concem with care in the community, reflected in further legislation such as the Mental Health Act of 1959. These day centres had a predominantly industrial and commercial outlook, providing sheltered places of work, with clients involved in production assembly, simple manufacture and craft work. Central guidance on the role of such centres came in 1968 via a 'model of good practice' issued by the Department of Health and Social Security (DHSS, 1968). This placed emphasis on the training of people for outside employment, and marked the beginning of what has proved to be continuing change in the role of day services, by now commonly known as adult training centres (ATCs). The 1970s witnessed a broadening of the function of ATCs, through the Government White Paper Better Services for the Mentally Handicapped (DHSS, 1971),
Correspondence: Dr S. Beyer, Mental Handicap in Wales: Applied Research Unit, 55 Park Place, Cardiff CFl 5AT, South Glamorgan, Wales. 489
490
K. Lowe et al.
to include the assessment of people's needs, the provision of permanent daily occupation where no alternative form of sheltered employment was available and respite for families. Care policies in the 1970s were concerned increasingly with promoting independence and maintaining people in the community. However, the provision of small scale housing was in its infancy, domiciliary support services were yet to be developed, and large residential facilities, by their very nature, were unable to meet the challenge of providing adequate opportunities for independence and social skills training. ATCs represented the only major resource that could answer the growing demands to develop the potential for independence of adults with mental handicap. The National Development Group's Pamphlet 5 (NDG, 1977) emphasized the need for social training and promoted a model of systematic assessment of individuals' abilities in real life situations, followed by clear teaching programmes and continuing review. The DHSS ratified the NDG recommendations as official guidance, and this laid the foundations for a further shift of ATCs away from an industrial to a social education model with increased involvement in supporting people in a variety of activities, including those in community settings outside the central base. Subsequently, a number of ATCs have been redesignated 'Social Education Centres'. Therefore, ATCs have undergone several shifts in their aims and in the way they work over the last 20 years. However, there has generally been a lack of research to document and analyse their development over this extended period, and there has been particularly little attention focused on the experience of service users. A major national survey of ATCs carried out in the early 1970s (Whelan & Speake, 1977) revealed that, even then, centres had a wide variety of aims, with the greatest consensus being around the provision of work training, and social and further education. Whelan & Speake's (1977) recommendations, proposing a broadening of the scope of work preparation, a move to systematic analysis of training needs and a more programmed approach to teaching, supported those of the NDG published in the same year. More recently, two large scale surveys (Seed, 1988; SSI, 1989) both indicate that a wide range of models continues to exist, and that there is still considerable confusion over the primary role that day services should play. Seed, in his study of Scottish centres, generated seven models of ATC operation, representing the full range of policy on day occupation from sheltered work through work training to the more recent social education emphasis. Eurther, he found that, generally, individual ATCs operated a number of different models concurrently. The SSI found wide variation in the 150 ATCs they examined. However, the SSI inspectors failed to recommend a model approach which might lead to a consistently higher quality of service. In the Welsh context, the All-Wales Strategy (Welsh Office, 1983) has provided strong central policy guidance linked to a planning strategy and additional funding. However, advice on day services was only pitched at a general level, with a diversification of day time options apart from ATCs being sought. Within this climate for new development, ATCs have remained the major resource, but one which has been susceptible to the developing policy influences outlined above. This paper describes a study undertaken as a precursor to a broader evaluation of the ATCs throughout Wales. The overall aim of the present research is to evaluate the impact
Activities and engagement in day services 491
of changing policy on day services for adults with a mental handicap. Its purpose is to identify the dominant models of provision by examining the pattern of activities undertaken by ATCs, and to investigate the experience of service users across the range of activities typical of different kinds of centre. The aim of this study was to test the feasibility of collecting accurate descriptive data on the activities of day centres by questionnaire, and to test a variety of observational methods for assessing staff and client engagement in activities. In particular, the present authors wished to explpre a method for typifying the extent of engagement achieved by different activities and in the ATC overall, bearing in mind that it would not be feasible to observe all clients at all times because of the numbers attending ATCs and because activities are programmed to occur in many locations at the same time. While some minor methodological alterations will be incorporated into the broader evaluation, the study described here provides a useful insight into the current performance of two ATCs and highlights issues relevant to the provision of day services. METHOD Settings
The two centres were selected to represent what was considered in advance to be different models of operation: one a long-established traditional ATC, and the other a newer development along the more progressive 'social education' lines. The present authors' hypothesis was that the traditional centre would focus largely on centre-based activities, organized mainly on a group basis, with more emphasis on sheltered work, traditional personal development and segregated occupation, and that the progressive centre would focus on community-based activities, organized more on an individual basis, vidth greater emphasis on integrated occupation and the development of community living skills. Centre A, regarded as the more traditional ATC, was situated in a purpose-built unit within an industrial estate; centre B, the more recently established social education centre, operated in a residential area within a building which was previously a school. Centre A offered approximately 145 places, including 21 for people with special needs provided mainly in a separate unit attached to the centre. The managerial/instructor/care staff complement comprised a manager and deputy, four senior instructors, 12 instructors and four care assistant (19-5 whole time equivalents) giving an overall ratio of 1:7-4. Centre B provided places for around 59 people, including 15 considered to be of high dependency yvho were fully integrated into the mainstream centre activities. The staff establishnient of Centre B comprised a manager and deputy, two senior day officers, 10 day service officers and two support workers (15-5 whole time equivalents), giving an overall ratio of 1:3-9. Measurement, procedure and analysis
Two main methods of data collection were employed: (1) descriptive information Was collected by interview and analysis of service documentation; and (2) data on client and staff participation in activities was obtained by direct observation.
492
K. Lowe et al.
Descriptive information. Interviews were conducted with the manager of each centre to obtain information on centre organization, staffing levels, grades and deployment of staff, external management arrangements, budgetary control, numbers of people attending, their attendance patterns, and current weekly timetabled activities. The weekly timetabled activities were analysed by activity type (see Table 1) in order to determine the emphasis placed on each form of activity offered by the two centres. In doing so, the number of person sessions allocated to each activity and whether activities occurred within the centre building or elsewhere were taken into account. Direct observation of a sample of sessions established whether activities occurred as timetabled, and thereby, the validity of categorizing centres on the basis of their reported activities. Chi-square tests (two-tailed) were used to compare the distribution of activity types between and within the two centres (Siegel, 1956). Behavioural information. The aim of this part of the study was to assess the extent of client engagement in the activities provided by each centre, together with the role of staff. A sample of activity sessions was selected from the analysed timetables to represent the balance of weekly activities offered by each centre. This approach was followed because it was not feasible to deploy sufficient observers to observe all activities, clients and staff even over a limited period because of the size of the services, and the dispersed nature of some activities. The Planned Activity Check (Risley & Cataldo, 1973) was used to observe the level of service user engagement in the selected activities. This measure was developed to reflect the educational and developmental value of day centres for pre-school children Table 1. Examples of each activity type Example Music, drama, photography, gardening, woodcrafts, pottery, model making, cookery, needlecrafts, painting, macrame and upholstery Swimming, tennis, judo, keep fit, aerobics, snooker, horseriding, popmobility and relaxation exercises. Self advocacy, shopping skills, discussion groups, social skills, community living skills and personal care skills Playgroups, mother and toddler groups, charities and church organisations. Adult literacy, college attendance, computer work and current affairs Packing, box-making, assembly and manufacture of goods Organized placements in ordinary work settings, sheltered workshops and employment training Waged employment Speech therapy, physiotherapy and music/drama therapy Any activity that cannot be categorized above (e.g. mail collection and delivery and hairdressing)
Activity type
Arts and crafts Sports Personal development Volunteering Education Contract work Work experience Work Therapy Other
Activities and engagement in day services 493
although its use is not limited to such settings (e.g. Porterfield et al., 1980). It provides a method rather than a set of measurement definitions. The latter are developed for each planned activity in each setting in tum. Its focus is on evaluating the effectiveness of the setting by assessing the participation of the individual in the intended activity of the setting based on a rationale that there is a broad purpose to the activity in terms of therapeutic or developmental benefit which would be missed if the individual did not participate. Hence, an effective service will be one which achieves a level of organization that succeeds in a high proportion of service users being involved in the activities that have been timetabled to meet the therapeutic and developmental objectives of the service. This measure seemed highly appropriate to adult day services for people vvdth mental handicap because the policies underljong such services, referred to above, make very clear that such settings should be working towards a range of objectives on behalf of their users, and therefore, that they should be concerned whether their clients participate in timetabled activities or not. Engagement was defined after establishing the intended content of each selected session by prior interview with the responsible staff member. It was assessed by counting the number of clients in the group being observed at 2-min time intervals, then counting the number engaged in the specified behaviours, and representing the latter as a proportion of the former. In general, observation began at the beginning of the activity and continued until the activity group broke up. For each sampled activity, the following data were obtained: planned group size (taken fi-om the timetable and statements of staff); actual group size; percentage observed engagement during the activity; the actual duration of the activity (all gained via observation); its planned duration (taken from the timetable and statements of staff); and percentage engagement averaged across the planned activity session duration. This last datum was calculated by multiplying percentage observed engagement by the actual duration of the session and dividing by its planned duration. It is taken as an estimate of how much engagement in plarmed activity there is in the session based on the assumption that planned activity catinot occur outside of the organized activity. Averages across activities in each centre are weighted by actual group size. Mann- Whimey U tests (two-tailed) were used to compare levels of groUp engagement across the two centres, and across those which occurred within and outside of the centre buildings (Siegel, 1956). The Staff Behaviour Measure (Porterfield et al., 1981) was used to observe the staff involved in each session. Categories of staff behaviour were: direct client contact; handling client related materials; staff to staff interaction; administrative tasks; 'other' (such as interacting with a client from another group); and "no recording' (usually when staff leff the area). The category of direct client contact was further subdivided into: on-task talk; off-task talk; supervising task; physical guidance; giving materials to clients; doing something to clients (e.g. tying shoelaces); and demonstrating task Qones et al., 1984). Observations of staff behaviour were also conducted at 2-min time intervals, alternating with the observations of group engagement so that, overall, observations were made each minute throughout the sessions. Where more than one staff member was involved in a session, all (up to a maximum of three) were observed
494
K. Lowe et al.
in sequence within each time interval, allowing 20 s for the behaviour of each staff member to be noted. In addition, observers made notes during the observations. Reliability assessments were conducted on client engagement and the staff behaviour observations. Percentage agreement was calculated by dividing the number of items on which codings agreed by the number of agreements plus disagreements, and multiplying by 100. Agreement on group size was 99% (range 98-100%). Agreement on client engagement was 92% (range 86-97%), with a Cohen's Kappa of 0-74 (range 0-53-0-91). Agreement on staff behaviours was 81% (range 77-88%). RESULTS Range of activities
Table 2 shows the proportion of person sessions, normally of 2-3 h duration (i.e. all morning or all afternoon), timetabled within each centre presented according to activity type. It also shows the proportion of sessions within each activity type occurring vwthin and outside of the centre building. A series of analyses and Chi square tests were carried out: (1) the balance of activities offered by each centre was compared by examining the distribution of person sessions across activity tj^es; (2) the extent to which activities were offered within the centres or organized outside the building were compared for each centre separately and the proportions for each centre contrasted; (3) the types of activities organized in or out of the centres were compared in total and for each centre separately. The two centres were significantly different in the number of person sessions allocated to the various activities on offer (P
