bigby culture in group homes better and underperforming june 2016
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latrobe.edu.au CRICOS Provider 00115M
Dimensions of culture in group homes for people with severe intellectual disabilities.
Professor Christine Bigby & Dr Julie Beadle-Brown
Living with Disability Research Centre La Trobe University
Background – importance of group homes
Group homes have been a major strategy in implementing disability policy
Support high numbers of people with more severe intellectual disability (17,000 in Australia)
Despite calls for innovative models – still being built
Good quality of life outcomes are possible (Kozma et al., 2009)
But high level of variability in outcomes – consistently worse for people with more severe intellectual disability (graph)
2 factors reliably predict good quality of life outcomes :
Adaptive behaviour
Staff practice
0
20
40
60
80
100
Org 1<151
Org 1151 +
Org 2<151
Org 2151 +
Org 3<151
Org 3151 +
Org 4<151
Org 4151 +
Org 5<151
Org 5151 +
Org 6<151
Org 6151 +
Org 7<151
Org 7151 +
Org 8<151
Org 8151 +
Whole<151
Whole151 +
Pe
rce
nta
ge t
ime
sp
en
t e
nga
ged
Engagement for people with less severe disabilities compared to people with more severe disabilities
151+ Good Level Engagement:Mean = 75(45 min per hour)
minutes per hour <151 = 19.76151+ = 38.90
<151 Good Level Engagement:Mean = 54(32.4 min per hour)
• Mean engagement much less for people with more severe ID • Most fall below what is possible to achieve
Sig difference
What makes a differenceComplex interactions 5 main elements
Necessary but notsufficient conditions• Adequate resources• Small size, dispersed, homelike
Organisational characteristics focusses on QoL outcomesVision – coherent, consistent translationPolicy & Processes, coherent, congruent • HR processes, job descriptions, recruitment• Clearly defined procedures to guide work of staff • Staff training – type, availability and organisation• Staff characteristics
Culture• Coherence – formal & informal External environment
• Supportive of QoL outcomes
Frontline staff and managerial working practices•Staff practice reflect active support•Staff practice responsive to individuals, compensating for disadvantageous characteristics•Front line practice leadership
Culture – important but very little evidence Consistently identified as influencing staff practices (Felce et al., 2002; Hastings, Remington, & Hatton,
1995; Mansell, McGill, & Emerson, 1994; Felce & Perry, 2007; Stancliffe, Emerson & Lakin, 2004; Walsh et al., 2010).
Consistently identified as contributing to abuse (Hutchinson & Stenford Kroese, 2015)
Slippery concept - conceptualised and investigated in quite different ways only
handful of studies
‘The way we do things around here’
Schein's definition
‘A pattern of shared basic assumptions…that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think,
and feel in relation to those problems” (Schein, 1992, p.12).
6
Culture in group homes - Aims
La Trobe University
Describe the culture – put value to the variable
Identify relationship between nature of culture and quality of life outcomes
• Identify generative factors
• And by capturing picture of culture associated with good outcomes to inform development of strategies to foster this type of culture – thus supporting good staff practice and good outcomes for people in group homes
Draws from evaluation of closure of Kew - 2004- 2007 - Discovery grant 2009-2012
UK School of Social Care Research – 2015- 2017
Underperforming group homes (Making Life Good)
low levels of engagement, respect, social participation
‘Better’ group homes (Ordinary Life)
‒ rather than ‘good’ could be better re personal development and social relationships (see Bigby et al., 2015)
Approach & Methods
Interpretive paradigm – qualitative ethnographic methods to collect in depth qualitative data
Prolonged participant observation & detailed field notes on shift
Staff interviews, observation of staff meetings, document review
Different times of day – days of week
Making life good – 5 group homes
Re analysis of field notes from Kew study
26 residents with severe intellectual disability
45 days – total 209 hours
14 interviews
Ordinary life – 3 group homes
Recruited by reputation and advertisement
17 residents severe or profound intellectual disability and other complex physical, health or communication needs
Participant observation 9-12 months, 60 visits average 3 hrs
35 staff interviews
Analysis
Inductive – coding, category development, constant comparison (Miles & Huberman, 1994)
Analytical lens of culture - staff practices, resident behaviour, interactions between
staff and residents, expressed and inferred values or assumptions concrete
artefacts
Findings 5 DimensionsDimension Negative end Descriptor
1. Alignment of
power-holders
vales
Misalignment of power holder values with organisation’s espoused values
• Power not aligned with formal positions, e.g. power
dispersed among staff or held by a small cliques rather
than resting with the house supervisor.
• Values of those who exercise power does not reflect
those of the organisation, e.g. staff disregard goal of
building inclusive communities and focus on
community presence but not participation.
‘We’re not going
to do it that way’
Alignment of power holder and staff values.
• strong leadership
• shared responsibility and teamwork
‘Vision and
mission is exactly
what we live to’
Hypothesised positive end - Alignment More Positive end
Descriptor
2. Regard for
residents
Otherness
• Residents seen as fundamentally different from staff,
e.g. as childlike, able to watch activities but too
disabled to participate, having no skills, or worries.
• Residents referred to in derogatory terms, e.g.
‘grabbers or shitters’.
‘Not like us’
Dimension Negative end Descriptor
Hypothesised positive end – the same as other citizens
More Positive end Descriptor
Positive regard as part of the same diverse humanity.
humanness
acknowledging and attending to difference
‘Like us’
3. Perceived
purpose
Doing for
• Staff see their purpose to look after residents, attend
to personal care and get them out into the
community.
• Disconnection of staff work from resident
engagement, sequential and hierarchical view of
purpose, completing domestic chores takes priority
over and is separate from involving residents in these
activities.
‘We look after
them’
Dimension Negative end Descriptor
Hypothesised positive end – doing with
More positive end
Making the life each person wanted it to be.
recognising and respecting preferences
including and engaging
ensuring care, dignity and comfort
‘It’s her choice’
4. Working
practices
Staff-centred
• Task focussed and structured into high and low
intensity periods to allow breaks.
• Staff needs, fair allocation of work and staff
preferences prioritised in things such as composition
of rosters and choice of activities.
• Regular routines tend to support residents as a group
rather than individuals.
‘Get it done so
we can sit
down’
Dimension Negative end Descriptor
Hypothesised positive end – client centred
More positive end
Descriptor
Person-centred.
• attentive
• relationships
• flexible
• momentary fun interactions
‘The guys come
first no matter
what’
5. Orientation to
change and
ideas
Resistance
• Sense of distance from the wider organisation and
senior managerial staff
• Strategies to preserve the status quo and resist
external influences seeking change to practice.
‘Yes but’
Dimension Negative end Descriptor
Dimension Hypothesised positive end – openness
More positive end
Descriptor
Openness to ideas and outsiders.
• Permeable boundaries, part of bigger organisation, part of community
• Families and outsiders welcome
‘Let’s face it
everyone can
improve’
Overarching Culture in Better Group Homes
Coherent – Respectful- Motivating – Enabling
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Generative factors
Frontline staff and managerial working practices
•Staff practice reflect active support
•Staff practice responsive to individuals, compensating for
disadvantageous characteristics
•Front line practice leadership
Organisational characteristics focusses on QoL outcomes
Vision – coherent, consistent translation
Policy & Processes, coherent, congruent
• HR processes, job descriptions, recruitment
• Clearly defined procedures to guide work of staff
• Staff training – type, availability and organisation
• Staff characteristics
15
Organisational characteristics Organisational commitment and HR support to front line leaders – staff management
HR policies regulating entry to organisation
• Recruitment – job descriptions reflect expectations
• Close scrutiny of casual and prospective staff
Organisation of work
• Regulating entry to specific group homes - groups of service users - buddy shifts
• Induction separated from orientation - practice same weight as procedures
• Explicit translation of organisational values – no doubt what’s expected
• Language and communication policies
• First person language plans, communication books
• Artefacts – pictures with family – holidays
• Roster planning –new staff rostered along side more experienced ones
• Skilled staff and supervisors who walk the talk
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ImplicationsNot quite at hypothesised positive polar end – long way down the dimension
What’s missing ?
Does care and warmth temper pushing of boundaries of engagement and choice in activities at home?
Do the strong relationships and commitment reduce drive or necessity for external relationships?
Overstepping the boundaries of professionalism?
Does culture look different in houses that have stronger outcomes on personal development and specifically active support and interpersonal relationships, specifically external social networks?
These findings supports the importance of strong practice leadership to outcomes and preliminary findings from study of organisational factors that influence high levels of active active support (Beadle-Brown, Bigby, Bould, in press)
Supports strong culture thesis
Gives value and meaning to culture in group homes
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ReferencesBeadle Brown, J., Bigby, C., Bould, E. (2015). Development of an observational measure of practice
leadership. Journal of Intellectual Disability Research . DOI: 10.1111/jir.12208
Bigby, C., Knox, M., Beadle-Brown, J., Clement, T., Mansell., J (2012). Uncovering dimensions of informal
culture in underperforming group homes for people with severe intellectual disabilities. Intellectual and
Developmental Disabilities 50, 6, 452–467
Bigby, C., Knox, M., Beadle Brown, J., & Bould, E. (2014). Identifying good group homes for people with
severe intellectual disability: Qualitative indicators using a quality of life framework. Intellectual and
Developmental Disability, 52(5), 348-366. doi: 10.1352/1934-9556-.5.348
Bigby, C., Knox, M., Beadle-Brown, J., & Clement. T., (2015). ‘We just call them people’: Positive regard
for people with severe intellectual disability who live in of group homes. Journal of Applied Research
in Intellectual Disability. 28, 283–295
Bigby, C., & Beadle-Brown, J. (in press). Culture in better group homes for people with severe and
profound intellectual disability Intellectual and Developmental Disability
Clement, T. & Bigby, C. (2010). Group homes for people with intellectual disabilities: Encouraging inclusion
and participation. London, Jessica Kingsley
Kozma, A., Mansell, J., & Beadle-Brown, J. (2009).Outcomes in different residential settings for people
with intellectual disability: a systematic review. American Journal on Intellectual and Developmental
Disabilities, 114, 193–222. http://dx.doi.org/10.1352/1944-7558-114.3.193
Felce, D., Lowe, K., & Jones, E. (2002). Staff activity in supported housing services. Journal of Applied Research in Intellectual Disabilities, 15(4), 388–403.
Felce, D., & Perry, A. (2007). Living with support in the community: Factors associated with quality-of-life
outcome. In S. Odom, R. H. Horner, M. E. Snell & J. Blacher (Eds.), Handbook of developmental
disabilities (pp. 410–428). New York, NY: Guildford Press.
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Hastings, R. P., Remington, B., & Hatton, C. (1995). Future directions for research on staff performance in services for people with learning disabilities. Mental Handicap Research, 8(4), 333–339.
Hutchison, A., & Stenfert Kroese, B. (2015). A review of literature exploring the possible causes of abuse
and neglect in adult residential care. The Journal of Adult Protection, 17 (4) 216 - 233
Mansell, J., McGill, P., & Emerson, E. (1994). Conceptualizing service provision. In E. Emerson, P. McGill,
& J. Mansell (Eds.), Severe learning disabilities and challenging behaviour (pp. 69–93).London, England:
Schein, E. H. (1992). Organizational culture and leadership (2nd ed.). San Francisco, CA: Jossey-Bass
Stancliffe, R. J., Emerson, E., & Lakin, K. C. (2004). Residential supports. In E. Emerson, C. Hatton, T.
Thompson, & T. R. Parmenter (Eds.), The international handbook of applied research in intellectual
disabilities (pp. 459–478). Chichester, England: John Wiley & Sons.
Walsh, P. N., Emerson, E., Lobb, C., Hatton, C., Bradley, H., Schalock, R., … Mosely, C. (2010).
Supported accommodation for people with intellectual disabilities and quality of life: An overview. Journal of Policy and Practice in Intellectual Disabilities, 7(2), 137–142.
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