Observing practice leadership in intellectual and developmental disability services

Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice

BACKGROUND

Intellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided.

AIM

To design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland.

DESIGN

An accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis.

SETTING

Intellectual disability services.

PARTICIPANTS

102 participants completed the programme and survey.

METHODS

Pre-post survey and reported using the CROSS guidelines.

RESULTS

Participants' expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects.

CONCLUSIONS

Overall, the programme was positively evaluated and through engaging with the programme participants' perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership.

The strength of Frontline Practice Leadership in Australian supported accommodation services: Challenges confronting service providers

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.

Pilot of a dog-walking program to foster and support community inclusion for people with cognitive disabilities

PURPOSE

To evaluate a dog-walking program (called "Dog Buddies") designed to address the need for evidence-based programs that create opportunities for people with cognitive disabilities to be more socially included in mainstream society. The research question was: Does community dog walking foster social interaction for people with cognitive disabilities?

MATERIALS AND METHODS

Single-case experimental design was used with four individuals (three with intellectual disability; one with Acquired Brain Injury (ABI)) recruited via two disability service providers in Victoria. Target behaviours included frequency and nature of encounters between the person with disability and community members. Change was measured from baseline (five community meetings with a handler but no dog) to intervention period (five meetings minimum, with a handler and a dog). Semi-structured interviews, audio-recorded and transcribed verbatim, provided three participants' subjective experiences of the program.

RESULTS

Dog Buddies increased the frequency of encounters for all participants. The presence of the dog helped to foster convivial encounters, community members were found to be more welcoming, and some participants were recognised or acknowledged by name over time in the intervention phase.

CONCLUSIONS

The dog-walking program offered a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.IMPLICATIONS FOR REHABILITATIONThe co-presence of people with disabilities in the community with the general population does not ensure social interaction occurs.Both disability policy, and the programs or support that is provided to people with disabilities, needs to have a strong commitment to the inclusion of people with disabilities in mainstream communities.Dog Buddies is a promising example of a program where the presence of a pet dog has been demonstrated to support convivial, bi-directional encounters of people with cognitive disabilities and other community members.Dog-walking offers a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.

What is good service quality? Day service staff's perspectives about what it looks like and how it should be monitored

Background

Australian disability services must comply with quality standards defined by federal government. Standards are abstract, focus on paperwork and rarely describe what good service quality looks like in practice. This research explored frontline day service staff's perceptions of good service quality to identify ways that it may be better monitored.

Methods

Using a constructivist grounded theory methodology, semi‐structured interviews were conducted with 9 frontline staff from 3‐day services. Interviews were recorded, transcribed and analysed for themes using constant comparison and line‐by‐line coding.

Results

Five categories of good practice were identified: collaborative hands‐on leadership, well‐planned services, respect for people with intellectual disabilities and their carers, a culture of continuous improvement and professionalization of the support worker role.

Conclusions

Results align with research undertaken in accommodation services for people with intellectual disabilities, suggesting commonalities in frontline staff's perceptions of quality in both day and accommodation services.

A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours

BACKGROUND

the present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents' support and subsequently their challenging behaviours.

METHOD

In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method.

RESULTS

Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members' ability to change; clear boundaries between formal and informal caregivers; and staff's feelings of being unheard.

CONCLUSIONS

Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.

Intellectual disability and independent living: Professionals' views via a Delphi study

BACKGROUND

The Convention on the Rights of Persons with Disabilities (2006) states that people have the right to decide where to live and with whom. Professionals play a key role in supporting processes for independent living (IL). This research aimed to identify which ideas generated more or less consensus among professionals regarding the role of different agents involved in the processes of IL in Spain.

METHOD

The Delphi method was applied to an expert panel of 25 professionals.

RESULTS

A high consensus was reached regarding the role that people with intellectual disabilities, their families and their natural support networks play in supporting IL processes, but there was less consensus on the role played by organizations and professionals.

CONCLUSIONS

The study highlights the need to promote practices that favour the decision-making capacity of individuals to move towards models of support based on community and the human rights model.

Outcomes and costs of skilled support for people with severe or profound intellectual disability and complex needs

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.

Factors that predict good Active Support in services for people with intellectual disabilities: A multilevel model

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.

Development and psychometric evaluation of the Group Home Culture Scale

BACKGROUND

Organizational culture in group homes for people with intellectual disabilities has been identified as influencing staff behaviour and residents' quality of life (QOL). Despite this influence, culture has been under-researched, with no published and validated instrument to measure its dimensions in group homes. The aim was to develop such a measure.

METHOD

The Group Home Culture Scale (GHCS) was developed using a theory-driven approach. Items were generated from the research literature, which were reviewed by experts and tested in cognitive interviews. Data from 343 front-line staff were used for exploratory factor analysis.

RESULTS

The content and face validity of the GHCS were found to be acceptable. Exploratory factor analysis indicated that the GHCS measured seven dimensions of group home culture. Cronbach's alpha for the dimensions ranged from 0.81 to 0.92.

CONCLUSIONS

The GHCS has potential use in research to determine whether dimensions of group home culture predict the quality of staff support and residents' QOL.

Factors associated with increases over time in the quality of Active Support in supported accommodation services for people with intellectual disabilities: A multi-level model

BACKGROUND

Disability support organisations have embraced Active Support, but it has proved difficult to embed in services.

AIMS

This study aimed to identify the factors associated with increases over time in the quality of Active Support.

METHOD

Data were collected on the predicted variable of the quality of Active Support, and predictor variables of service user, staff and service characteristics, including practice leadership, and composition and size of services from 51 services in 8 organisations over 2-7 time points. Data were analysed using multi-level modelling.

RESULTS

There was significant linear change in Active Support scores (group mean centered at the organisational level) over time. Individuals with lower support needs received better Active Support and those with higher support needs experienced greater increases over time. Stronger practice leadership and more staff with training in Active Support were significant predictors of the quality of Active Support. Larger services with seven or more individuals and where there was a very heterogeneous mix of individuals were associated with lower quality of support.

CONCLUSIONS

Ensuring strong practice leadership, and staff training in Active Support that emphasises the principle of adapting support to each individual's level of ability and preferences are key to delivering high levels of Active Support.

Managers' views of skilled support

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.

Training staff to promote self-management in people with intellectual disabilities

BACKGROUND

People with intellectual disabilities have increasing difficulties managing their daily affairs. This study examined the effectiveness of a staff training, which teaches staff to promote self-management in people with intellectual disabilities.

METHOD

Effectiveness was assessed with questionnaires addressing clients' (n = 26) independence and self-reliance, support needs and challenging behaviour, using a pre-posttest control group design. Additionally, focus groups were conducted with trained staff members 6 months after the training.

RESULTS

In the long term, the intervention group showed a significant increase in independence and self-reliance, in contrast to the comparison group. No effect was found on support needs and challenging behaviour. Trained staff members reported limited benefits of the training, but had noticed changes in their attitude and method of working afterwards.

CONCLUSIONS

Further self-management research is required to investigate how independence and self-reliance can be promoted more effectively in this population. Future trainings should carefully consider their content, format, and implementation.

Healthy Ageing in People with Intellectual Disabilities from Managers' Perspective: A Qualitative Study

An increasing number of people with intellectual disability (ID) are reaching older ages today although they experience more health problems than the older population without ID. Leaders in intellectual disability services can greatly influence the conditions for a healthy ageing, and the aim of the present study was to explore healthy ageing in this group from the perspective of the leaders. Interviews with 20 leaders were subjected to qualitative content analysis. The findings gave rise to the overall theme ageing in dependence, which emerged from the following six categories: Supporting self-determination; Inaccessible activities after retirement; Signs of decline; Increased and specific needs for support and care; A non-question of gender; Aspects concerning the end of life and death. A prerequisite for healthy ageing in the case of people with ID is, according to the leaders, that they can live the life according to their preferences and make independent choices whilst at the same time receiving adequate support. With the shrinking of their social network after retirement, they become increasingly dependent on staff and leaders in the group home, who need to know what healthy ageing implies.

Identifying conceptualizations and theories of change embedded in interventions to facilitate community participation for people with intellectual disability: A scoping review

BACKGROUND

Little progress has been made towards community participation of people with intellectual disability despite it being a policy aim since the 1980s. We aimed to identify the features of programmes designed to support community participation.

METHOD

A scoping review was conducted of peer-reviewed literature between 2000 and 2015, about interventions to support community participation for adults with intellectual disability.

RESULTS

A small body of evidence relates to the design and effectiveness of interventions to enhance community participation. Seventeen studies reported programmes reflecting three conceptualizations of community participation (as social relationships, as convivial encounter and as belonging) that used strategies such as active mentoring, facilitative support worker practice and arts-based programmes.

CONCLUSIONS

Studies showed the diverse and person-centred nature of community participation and demonstrated the need for larger-scale studies of promising interventions that include details of costs, and strategies to guide implementation of policies to support community participation.

Evidence and Evidence-Based Practices: Are We There Yet?

The purpose of this article is to move the field of intellectual and closely related developmental disabilities (IDD) towards a better understanding of evidence and evidence-based practices. To that end, we discuss (a) different perspectives on and levels of evidence, (b) commonly used evidence-gathering strategies, (c) standards to evaluate evidence, (d) the distinction between internal and external validity, and (e) guidelines for establishing evidence-based practices. We also describe how the conceptualization and use of evidence and evidence-based practices are changing to accommodate recent trends in the field.

People with intellectual disability who are ageing: Perceived needs assessment

Background/Objective: Ageing and progressive increase in life expectancy in people with intellectual disability present significant challenges. The present study is to examine the needs that arise in the aging process of this population. To detect these needs is fundamental to ensure personal wellbeing; almost no psychometrically sound instruments have been developed. Method: A structured interview was developed and evaluated by a panel of 20 experts to obtain evidence of content validity. The interview was then applied to 1,173 people with intellectual disability. The ages ranged from 35 to 80 (M = 52.27; SD = 7.5). Results: The interview consisted of 93 items evaluating four areas: perceived needs, personal problems, future perspectives, and solutions required. The results demonstrated the proximity and relationship of the various needs evaluated. In addition it was observed that those with intellectual disability who were older, male and users of residential services tended to indicate more needs, problems, and required more solutions. Conclusions: The instrument has adequate evidence of validity, allowing the evaluation of specific needs of people with intellectual disability. The results advocate the design of transversal intervention policies in order to effectively meet the needs and requirements of this population.

Culture in Better Group Homes for People With Intellectual Disability at Severe Levels

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.

The role of practice leadership in active support: impact of practice leaders' presence in supported accommodation services

Objectives: Research shows practice leadership to be a factor in the successful implementation of active support. The aim of the study was to explore differences in staff practice, associated with the presence of a practice leader in a shared supported accommodation service. Methods: Quality of support and engagement for 189 service users with intellectual disability from 58 services were collected during a 2 h observation using the EMAC-R and ASM. The practice leader was present in 19 services (n = 59) and absent in 39 (n = 111). An Observed Measure of Practice Leadership was administered during a second visit to each service. Results: When the practice leader was present, levels of engagement and active support were statistically higher (p < 0.01). Although measured at a different time, observed practice leadership was also higher in services where the practice leader was present during the first observation. Conclusion: The level of observed practice leadership and presence of the practice leader appear to be associated with better quality of support. This finding provides further evidence of the importance of systems for supporting, monitoring, modeling, and improving staff practice for effective implementation of active support.

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

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.