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Bigby C, Humphreys L. The strength of Frontline Practice Leadership in Australian supported accommodation services: Challenges confronting service providers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13227. [PMID: 38520280 DOI: 10.1111/jar.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The strength of practice leadership predicts the quality of Active Support but it can be compromised by other demands on frontline managers. The study aimed to identify and understand differences in practice leadership over time and between organisations. METHOD Data collected in 2022 in 96 services from 11 organisations using the Observed Measure of Practice Leadership were compared to similar data from 2013 and 2018. Qualitative fieldnotes were analysed thematically. FINDINGS Practice leadership scores increased significantly between 2013 and 2018 but declined significantly between 2018 and 2022. Scores were significantly higher in organisations that had implemented Active Support since 2013 compared to later adopters. Higher scoring organisations had structures that supported frontline managers with practice leadership and that countered increasing administrative demands. CONCLUSIONS Establishment of support structures for practice leadership by organisations warrants further investigation together with the relative importance of each task of practice leadership.
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Affiliation(s)
- Christine Bigby
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Lincoln Humphreys
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
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2
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Lindström M, Lindholm L, Liv P. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities. Trials 2022; 23:657. [PMID: 35971130 PMCID: PMC9377097 DOI: 10.1186/s13063-022-06622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness. Methods The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff. Discussion This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness. Trial registration ClinicalTrials.gov NCT05056415. Registered on 24 September 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06622-0.
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per Liv
- Department of Public Health and Clinical Medicine, Umeå university, 901 87, Umeå, Sweden
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3
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Lindström M. Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities. Front Psychiatry 2022; 13:954068. [PMID: 36051549 PMCID: PMC9424656 DOI: 10.3389/fpsyt.2022.954068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Umb Carlsson Õ. Health-promotion intervention in a group home: Perspectives of residents, staff and rehabilitation professionals. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:210-229. [PMID: 31566071 DOI: 10.1177/1744629519874970] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Promoting healthier lifestyles in people with intellectual disabilities is important in order to improve health and reduce health inequalities. Few studies have explored how health-promotion interventions for people with intellectual disabilities in community-based settings are experienced. The aim of this study was to explore residents', staff members' and rehabilitation professionals' experiences of how a health-promotion intervention affected the habits of people living in a group home regarding eating habits and physical activities and staffs' ways of working. Semi-structured group interviews were conducted with five residents, six staff members and five rehabilitation professionals. The group discussions were analysed with content analysis separately for each group. Four different categories described residents', staff members' and rehabilitation professionals' views respectively. It is suggested that including people with intellectual disabilities as active parties throughout the process would facilitate implementation of a health-promotion profile in community residences.
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Beadle-Brown J, Beecham J, Leigh J, Whelton R, Richardson L. Outcomes and costs of skilled support for people with severe or profound intellectual disability and complex needs. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:42-54. [PMID: 32755061 DOI: 10.1111/jar.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/14/2019] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND With increasing reductions in funding for social care across many countries, the need to ensure that resources are used to best effect is becoming increasingly important, in particular for those with severe and complex needs. METHODS In order to explore the outcomes and costs of skilled support for this group of people, quality of life was assessed for 110 people in 35 services in England. Information on costs was also collected. RESULTS People who received consistently good active support experienced better outcomes in terms of several quality of life domains. Good support did not require significantly more staff time, and there was no evidence of higher total costs for those receiving good support. CONCLUSIONS The inclusion of active support in government guidance and local commissioning practices related to people with severe intellectual disabilities is likely to improve user outcomes. Observation should be an important element in measuring service quality.
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Affiliation(s)
- Julie Beadle-Brown
- Tizard Centre, University of Kent, Canterbury, UK.,Living with Disability Research Centre, La Trobe University, Melbourne, Vic., Australia
| | - Jennifer Beecham
- PSSRU, University of Kent, Canterbury, UK.,London School of Economics and Political Science, London, UK
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Bigby C, Bould E, Iacono T, Kavanagh S, Beadle‐Brown J. Factors that predict good Active Support in services for people with intellectual disabilities: A multilevel model. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:334-344. [PMID: 31612579 PMCID: PMC7187299 DOI: 10.1111/jar.12675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/01/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Active Support, now widely adopted by disability support organizations, is difficult to implement. The study aim was to identify the factors associated with good Active Support. METHODS Data on service user and staff characteristics, quality of Active Support and practice leadership were collected from a sample of services from 14 organizations annually for between 2 and 7 years, using questionnaires, structured observations and interviews. Data were analysed using multilevel modelling (MLM). RESULTS Predictors of good Active Support were adaptive behaviour, practice leadership, Active Support training, and time since its implementation. Heterogeneity, having more than six people in a service and larger organizations were associated with lower quality of Active Support. CONCLUSIONS In order to ensure that Active Support is consistently implemented, and thus, quality of life outcomes improved, organizations need to pay attention to both service design and support for staff through training and practice leadership.
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Affiliation(s)
- Christine Bigby
- Living with Disability Research CentreLa Trobe UniversityMelbourneVicAustralia
| | - Emma Bould
- Living with Disability Research CentreLa Trobe UniversityMelbourneVicAustralia
- Department of Occupational TherapyMonash UniversityMelbourneVicAustralia
| | - Teresa Iacono
- Living with Disability Research CentreLa Trobe UniversityMelbourneVicAustralia
| | - Shane Kavanagh
- Department of Public HealthSchool of Psychology and Public HealthLa Trobe UniversityBundooraVictoriaAustralia
| | - Julie Beadle‐Brown
- Living with Disability Research CentreLa Trobe UniversityMelbourneVicAustralia
- Tizard CentreUniversity of KentCanterburyUK
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7
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Deveau R, Gore N, McGill P. Senior manager decision-making and interactions with frontline staff in intellectual disability organisations: A Delphi study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:81-90. [PMID: 31482622 DOI: 10.1111/hsc.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face-to-face and non-face-to-face contacts with staff and decision-making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short-term reactive and long-term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra-organisational focused upon meeting legal and regulatory demands and intra-organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations.
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Affiliation(s)
- Roy Deveau
- Tizard Centre, University of Kent, Canterbury, UK
| | - Nick Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | - Peter McGill
- Tizard Centre, University of Kent, Canterbury, UK
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Gomes MF, McVilly KR. The Characteristics of Effective Staff Teams in Disability Services. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2019. [DOI: 10.1111/jppi.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Keith R. McVilly
- University of Melbourne, School of Social & Political Sciences VIC Australia
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9
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Berlin Hallrup L, Kumlien C, Carlson E. Service managers' experiences of how the participation of people with intellectual disabilities can be promoted in Swedish group homes. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:427-434. [PMID: 30453384 DOI: 10.1111/jar.12540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/16/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities in staffed group homes often need lifelong support and dependency on others. Thereby, special demands are placed on staff and service managers to ensure opportunities for participation in everyday life. This study aims to explore how service managers promote participation in Swedish group homes for adults with intellectual disabilities. METHOD A qualitative research design involving individual interviews with 14 service managers was used to gain an understanding of how the participation of adults with intellectual disabilities can be promoted in Swedish group homes. RESULTS The results comprise two main themes; Creating preconditions for participation and Barriers for promotion of participation. CONCLUSIONS Service managers experienced that promoting service user participation in group homes was an important part of their responsibility. The findings indicate that structural strategies such as coaching, supervision and reflection are important and should be further developed.
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Affiliation(s)
- Leena Berlin Hallrup
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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10
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Olivier-Pijpers VC, Cramm JM, Buntinx WH, Nieboer AP. Organisational environment and challenging behaviour in services for people with intellectual disabilities: A review of the literature. ALTER 2018. [DOI: 10.1016/j.alter.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Haines D, Wright J, Comerasamy H. Occupational Therapy Empowering Support Workers to Change How They Support People with Profound Intellectual and Multiple Disabilities to Engage in Activity. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- David Haines
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Wright
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
| | - Huguette Comerasamy
- University of Brighton, Eastbourne; United Kingdom of Great Britain and Northern Ireland
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12
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Holst G, Johansson M, Ahlström G. Signs in People with Intellectual Disabilities: Interviews with Managers and Staff on the Identification Process of Dementia. Healthcare (Basel) 2018; 6:healthcare6030103. [PMID: 30149606 PMCID: PMC6164955 DOI: 10.3390/healthcare6030103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The aim of the present study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with an ID within intellectual disability services (ID-services). Twenty managers and 24 staff within an ID-service were interviewed and qualitative latent content analysis was applied. A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identify deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed a need for early and continuous guidance and education from specialists in dementia and primary healthcare. This finding indicates an urgent need for intervention research and digital support for staff in dementia care.
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Affiliation(s)
- Göran Holst
- The Swedish Red Cross University College, Box 1059, SE-141 21 Stockholm, Sweden.
| | - Maria Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
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13
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Kersten MCO, Taminiau EF, Schuurman MIM, Weggeman MCDP, Embregts PJCM. How to improve sharing and application of knowledge in care and support for people with intellectual disabilities? A systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:496-520. [PMID: 29696724 DOI: 10.1111/jir.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND To optimise care and support for people with intellectual disabilities (ID), sharing and application of knowledge is a precondition. In healthcare in general, there is a body of knowledge on bridging the 'know-do-gap'. However, it is not known to what extent the identified barriers and facilitators to knowledge sharing and application also hold for the care and support of people with ID, due to its specific characteristics including long-term care. Therefore, we conducted a systematic review to identify which organisational factors are enabling and/or disabling in stimulating the sharing and application of knowledge in the care and support of people with ID. METHOD A systematic review was conducted using five electronic databases of relevant articles published in English between January 2000 and December 2015. During each phase of selection and analysis a minimum of two independent reviewers assessed all articles according to PRISMA guidelines. RESULTS In total 2,256 articles were retrieved, of which 19 articles met our inclusion criteria. All organisational factors retrieved from these articles were categorised into three main clusters: (1) characteristics of the intervention (factors related to the tools and processes by which the method was implemented); (2) factors related to people (both at an individual and group level); and, (3) factors related to the organisational context (both material factors (office arrangements and ICT system, resources, time and organisation) and immaterial factors (training, staff, size of team)). CONCLUSION Overall analyses of the retrieved factors suggest that they are related to each other through the preconditional role of management (i.e., practice leadership) and the key role of professionals (i.e. (in)ability to fulfill new roles).
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Affiliation(s)
- M C O Kersten
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
- Dutch Association of Healthcare Providers for People with Disabilities (VGN), Utrecht, The Netherlands
| | - E F Taminiau
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
| | | | - M C D P Weggeman
- Industrial Engineering and Innovation Sciences, Technical University Eindhoven, The Netherlands
| | - P J C M Embregts
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
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MacDonald A, McGill P, Murphy G. An evaluation of staff training in positive behavioural support. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1046-1061. [DOI: 10.1111/jar.12460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anne MacDonald
- The Richmond Fellowship Scotland Glasgow & Tizard Centre; University of Kent; Canterbury UK
| | - Peter McGill
- Tizard Centre; University of Kent; Canterbury UK
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15
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Bradshaw J, Beadle-Brown J, Richardson L, Whelton B, Leigh J. Managers' views of skilled support. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:873-884. [PMID: 29479790 DOI: 10.1111/jar.12444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quality of life of people with intellectual and developmental disabilities has been found to primarily depend on whether staff are providing facilitative and enabling support that helps to compensate for severity of disability. Managers have a key role in facilitating staff to provide such support. METHOD Qualitative interviews were conducted with 35 managers of supported accommodation services to explore service aims and the nature of, and challenges in providing, skilled support. Key themes were identified using a Thematic Networks Analysis. RESULTS Service aims were rarely formalised, were related to the individuals supported and not to the organisation. Managers found it difficult to define skilled support, other than by reference to individuals. Practice leadership roles were challenged as a result of austerity measures. CONCLUSIONS Front-line managers need more information and training in skilled support, with stronger leadership from senior management to provide the motivation and resources needed.
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Affiliation(s)
- Jill Bradshaw
- Tizard Centre, University of Kent, Canterbury, Kent, UK
| | | | | | | | - Jennifer Leigh
- Unit for the Enhancement of Learning and Teaching, University of Kent, Canterbury, Kent, UK
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16
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Bigby C, Beadle-Brown J. Improving Quality of Life Outcomes in Supported Accommodation for People with Intellectual Disability: What Makes a Difference? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31:e182-e200. [PMID: 27778426 DOI: 10.1111/jar.12291] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The quality of life (QOL) of people with intellectual disability living in supported accommodation services is variable, influenced by many possible factors. Various frameworks have attempted to identify these factors without assigning value, direction of influence or relative impact on outcomes. METHODS A realist review of the literature aimed to expose different propositions about variables influencing QOL outcomes and review the strength of supporting evidence for these, to identify their relative influence. Evidence was reviewed for and against each of five clusters. RESULTS Evidence was strongest for the presence of staff practices (use of Active Support), front-line management practice (use of practice leadership), culture (enabling and motivating), human resources policies and practice (that support front-line leaders and recruitment of staff with the right values), adequate resources, and small, dispersed and homelike settings. CONCLUSIONS The evidence informs policy and practice but in some clusters remains limited, warranting further research which measures outcomes on all QOL domains.
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Affiliation(s)
- Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Vic., Australia
| | - Julie Beadle-Brown
- Living with Disability Research Centre, La Trobe University, Bundoora, Vic., Australia.,Tizard Centre, Kent University, Kent, UK
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17
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Bigby C, Beadle-Brown J. Culture in Better Group Homes for People With Intellectual Disability at Severe Levels. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:316-331. [PMID: 27673733 DOI: 10.1352/1934-9556-54.5.316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Building on cultural dimensions of underperforming group homes this study analyses culture in better performing services. In depth qualitative case studies were conducted in 3 better group homes using participant observation and interviews. The culture in these homes, reflected in patterns of staff practice and talk, as well as artefacts differed from that found in underperforming services. Formal power holders were undisputed leaders, their values aligned with those of other staff and the organization, responsibility for practice quality was shared enabling teamwork, staff perceived their purpose as "making the life each person wants it to be," working practices were person centered, and new ideas and outsiders were embraced. The culture was characterized as coherent, respectful, "enabling" for residents, and "motivating" for staff. Though it is unclear whether good group homes have a similar culture to better ones the insights from this study provide knowledge to guide service development and evaluation.
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Affiliation(s)
- Christine Bigby
- Christine Bigby, Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia; and Julie Beadle-Brown, Living with Disability Research Centre, La Trobe University, and Tizard Centre, University of Kent, Canterbury, England
| | - Julie Beadle-Brown
- Christine Bigby, Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia; and Julie Beadle-Brown, Living with Disability Research Centre, La Trobe University, and Tizard Centre, University of Kent, Canterbury, England
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18
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Deveau R, McGill P. Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour: A further examination and partial replication. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 56:160-164. [PMID: 27317875 DOI: 10.1016/j.ridd.2016.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Practice leadership (PL) style of frontline management has been shown to be associated with better experiences for staff working with people who may exhibit challenging behaviours (Deveau & McGill, 2014). This study aimed to examine additional staff experience factors with a different, larger sample and to partially replicate the findings of (Deveau & McGill, 2014). METHODS This study was a survey of staff self-reported data collected as part of a larger study. Information was collected on PL and staff experiences of: stress, turnover, job satisfaction and positive work experiences. RESULTS AND CONCLUSIONS The results broadly supported Deveau and McGill (2014) and demonstrated an association between PL and greater job satisfaction and positive experiences for staff. Results on staff turnover were inconsistent. The positive impact of PL on staff experience was further supported by this study. Suggestions are made for further research. IMPLICATIONS These findings suggest further research is needed to examine the potential of interventions in frontline management/leadership practice to improve staff experience of working in challenging environments.
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Affiliation(s)
- Roy Deveau
- Tizard Centre, University of Kent, Canterbury, Kent, England, United Kingdom.
| | - Peter McGill
- Tizard Centre, University of Kent, Canterbury, Kent, England, United Kingdom.
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Beadle-Brown J, Bigby C, Bould E. Observing practice leadership in intellectual and developmental disability services. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1081-1093. [PMID: 26058314 DOI: 10.1111/jir.12208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 04/07/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Improving staff performance is an issue in services for people with intellectual disability. Practice leadership, where the front line leader of a staff team focuses on service user outcomes in everything they do and provides coaching, modeling, supervision and organisation to the team, has been identified as important in improving staff performance. To date this finding is based only on self-report measures. METHODS This paper describes and tests an observational measure of practice leadership based on an interview with the front-line manager, a review of paperwork and observations in 58 disability services in Australia. RESULTS The measure showed good internal consistency and acceptable inter-rater reliability. Practice leadership was associated with staff practice and outcomes for service users. The observed measure of practice leadership appears to be a useful tool for assessing whether leadership within a service promotes enabling and empowering support by staff. It was found to discriminate higher and lower performing services in terms of active support. CONCLUSIONS The measure had good reliability and validity although some further testing is required to give a complete picture of the possible uses and reliability of the measure. The measure is potentially useful in contexts of both research and service development. The confirmation of previous findings from self-report measures that practice leadership is related to the quality of staff practice and outcomes for service users has implications for policy and practice in terms of the training of managers and structures for organisational management.
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Affiliation(s)
- J Beadle-Brown
- Living with Disability Research Centre, Latrobe University, Melbourne, Victoria, Australia
- The Tizard Centre, University of Kent, Canterbury, Kent, UK
| | - C Bigby
- Living with Disability Research Centre, Latrobe University, Melbourne, Victoria, Australia
| | - E Bould
- Living with Disability Research Centre, Latrobe University, Melbourne, Victoria, Australia
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