nds forum acheiving quality outcomes 20 10 2013
DESCRIPTION
Achieving Quality Outcomes in Group Homes. Presentation at the Vic NDS forum on Housing and Support for People with Disabilitie, 21 October 2013. Professor Christine Bigby, Living with Disability Research Group, La Trobe University.TRANSCRIPT
Achieving quality outcomes in supported
accommodation:
NDS forum October 2013
Professor Christine Bigby
Living with Disability Research Group
La Trobe University
What makes a difference
Good quality of life outcomes when...... Complex interactions 6 main elements
Necessary but not
sufficient conditions
• Adequate resources
•Design - Size & Type
Coherence of organisational values
and policies & a mission that puts quality of life
of service-users at the core of all its actions
• Organisational leadership policies and procedures
• Service characteristics
• Staff training
• Staff characteristics
An informal culture that is
congruent with and supports
the formal mission of the
organisation
Service user characteristics
Organisational and staff
practices that compensate
as far as possible for
inherently disadvantageous
characteristics of residents
An external environment that is
congruent and reinforces the
mission and values of the
organisation
Staff and managerial
working practices that
reflect organisational
values and policies and
the principles of active support
3
Outcomes and Staff Practice High and Lower Performing
Organisations Sample average and people with higher support needs
Whole Sample Org 1 Org 2
UK study
Good active
support
(Ashman, Beadle-
brown, 2006)
Engagement in
meaningful activity
and relationships
47% (31) 64% (54) 25% (16) 60% (54)
Percentage of time
spent in Social
Activity
15% (24) 23% (19) 9% (5)
Percentage of time
spent in Non-social
Activity
35% (31) 45% (38) 16% (11)
Active support 49 (38) 67 (64) 28 (12) 79 (79)
Time spent receiving
assistance and
contact from staff
12 mins (11) 18 mins (15.5) 7.5 mins (6) 23 (25)
0
20
40
60
80
100
Org1<151
Org 1151 +
Org2<151
Org 2151 +
Org3<151
Org3151 +
Org4<151
Org4151 +
Org5<151
Org5151 +
Org6<151
Org6151 +
Org7<151
Org7151 +
Org8<151
Org8151 +
Org9<151
Org9151 +
Whole<151
Whole151 +
Pe
rce
nta
ge s
core
on
ASM
Active Support: People with More Severe Disabilities vs.
People with Less Severe Disabilities
Target 66%
• More able people experience better active support - exception Org 6 (& Org 7)
• Only 3 orgs provide consistent good active support for more able people
Sig difference
Relationship between ability, active support, engagement, &
assistance
Higher engagement related to higher active support & more assistance
More able people get more assistance, better Active Support and are
engaged more.
With good implementation of active support should see:
lower, non-significant relationship between active support and level of
ability
weaker relationship between level of ability and engagement.
a slight negative relationship between Assistance and level of ability –
those who are more severely disabled should be getting the most help.
Engagement Active Support Assistance
Level of ability .689** .624** .199**
Engagement .614** .247**
Active Support .423**
Support for communication
• Only 6% of non verbal residents received any adaptive communication that
appeared to be effective.
• Increase for 3 of the 4 Vic orgs since 2012
All O1 O2 O3 O4 O5 O6 O7 O8 09
N/n 63 2 12 3 0 8 6 23 3 6
Number receiving good adapted communication
4 1 0 2 N/A 0 0 0 1 0
What affects practice - Practice Leadership * Relationship between Practice Leadership Scores, Engagement & ASM Score
• Evidence of relationship between Practice Leadership and Active Support and
Engagement
• Significant relationship between Active Support and overall PL score on three
domains
• Allocating staff - Team meetings - Manager focus
• Practice leadership generally poor – only one organisation had higher scores
• Big discrepancy between observational measures and staff ratings of PL (and practice)
• Staff clearly felt that managers prioritised more admin related tasks than user enabling
tasks *note all figures are from work in progress – see reference list for published studies
Allocating Staff
Coaching Supervision Team
Meeting Manager
Focus Average PL
Score
Any Engagement .245** -.116 .029 .180* .088 .094
ASM Score .257** .143 .105 .265** .225** .234**
Practice Leadership Components
Allocating and organising staff to deliver support when and how service
users need and want it
Coaching staff to deliver better support by watching how staff support
people, telling them what they are doing well and what needs to be
improved and showing people how to provide better support.
Reviewing the quality of support provided by individual staff in regular
one-to-one supervision and finding ways to help staff improve their
support
Reviewing how well the staff team is enabling people to engage in
meaningful activity and relationships in regular team meetings and
finding ways to improve it.
Focusing, in all aspects of their work as manager, on the quality of life
of service users and how well staff support this
9
Producing and Reproducing Positive regard (and Active
Support practice
Supportive organisational processes
HR policies
Core of long term staff – more than 10 years – deep knowledge and strong bonds
Rosters and Recruitment
• new staff rostered along side more experienced ones
• good practice modelled and new staff exposed to knowledge
• close scrutiny of casual and prospective staff
• only employment via casual pool
Even if they [casual] are a bit messy, we think, 'Ooh, we can work on that
person' because they’re fantastic with relating to everyone who lives
here, they’re great. We think, 'Alright, you’re a little bit messy, we’ll fix you
up, (laugh), we’ll neaten you up’.... you can, just follow instructions ‘til you
know what to do yourself. (I/LC/102811)
• induction separated from orientation - practice same weight as
procedures
10
Translation of values – no doubt what’s expected
‘What we expect of you: We expect you to treat ALL individuals with respect, dignity,
empathy, sensitivity, and to listen, learn and act on individuals needs, wants and desires,
which encourages participation in THEIR life. We expect that you value all individuals for
their individuality regardless of YOUR own opinions, morals and values’. (D109
PowerPoint slide)
‘each person is inherently valuable; people can grow and develop; people have dignity
and respect’ (D71, Quality measures/Shared values around people/indicators)
Reinforced through language and communication policies
Expectation that staff will, ‘use language that reinforces the individuality and humanity of
those people [who access our services] and emphasizes the fact that they are, like the
rest of us, a valued, member of the community in which we live’. (D/MSS/180507), D11)
First person language plans, communication books
Artefacts – pictures with family - on holiday
Above the sideboard with the fish-tank are photographs of the residents, some
taken at a fun-park, others are family pictures. In the pile of CDs, the top one is
Funhouse by Pink and the top DVD is I Robot starring Will Smith. On the
coffee table are some flowers and more photographs. (F/A/051411)
11
Reinforced by other dimensions of culture
Alignment of power holder values
• strong practice leadership in line with organisational values
• no sub culture counter to expectations
If I had to discipline somebody or talk to them about something, my approach to each
person would be different. I feel that a good manager, a really good manager is a leader
and leads by example I like to build trust and respect between all staff and with myself,
but also know that a manager has to wear the manager’s hat when it’s needed.
There was some real issues…..They felt that that it was a babysitting service, basically,
and I knew that when I left, things weren’t done the way we needed to do things for
people…... And they did everything to try and undermine me. There was a couple of
investigations going on. ….the organisation assisted me to have some sessions with a
personal development trainer type person. I was ready to ask for a demotion, because I
felt that I couldn’t manage that place the way I needed to manage and lead. And after
having sessions with this man.......I decided that I had a lot of good qualities. I knew that I
could manage a team of staff in a way that they would have respect for me, but also give
the best of themselves, but I knew that there was a couple of people that had to go.
12
Conclusions – Achieving quality outcomes
Attention to practice - Upward trend in 5 Vic organisations
Whole organisation commitment to a practice framework that includes Active
Support
Create and support conditions for good staff practices
Strong practice leadership
Organisational processes staff recruitment -gaining entry – screen for
values
Explicit translation of values to expectations / action avoids front line
interpretation
Space for reflection on practice avoid imposing own values
Depth of knowledge of people supported – prolonged engagement or
passed on - mechanisms to do this
Creation and re-creation of cultural norms of regard for people by staff
assumptions/values/thinking, seen in talk and action
Staff over estimate outcomes and quality of their own practice
Observation not paperwork a better way to make judgments - reinforce good
practice
13
References
Mansell., J., Beadle-Brown, J., & Bigby, C. (2013) Implementation of active
support in Victoria, Australia: an exploratory study. Journal of Intellectual and
Developmental Disabilities 38(1), 48–58 (download from
http://hdl.handle.net/1959.9/206149 )
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 (download from http://hdl.handle.net/1959.9/206141 )
Bigby, C., Cooper, B., & Reid, K. (2012). Making life good in the community:
Measures of resident outcomes and staff perceptions of the move from an
institution. Melbourne: Department of Human Services:
(http://hdl.handle.net/1959.9/200242 other Making life good reports also)
Bigby, C. (2013). Tackling the crisis in disability group homes. Opinion on line,
http://apo.org.au/commentary/tackling-crisis-group-homes-people-intellectual-
disability
Clement, T. & Bigby, C. (2010). Group homes for people with intellectual
disabilities:Encouraging inclusion and participation. London, Jessica Kingsley.