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).

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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

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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

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Bigby, C., & Beadle-Brown, J. (in press). Culture in better group homes for people with severe and

profound intellectual disability Intellectual and Developmental Disability

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