Contextual Factors Associated with Implementing Active Support in Community Group Homes in the United States: A Qualitative Investigation

Abstract

Although numerous studies in the U.K. and Australia have shown that Active Support (AS) is an effective intervention in increasing staff assistance and engagement for people with intellectual and developmental disabilities (IDD) who live in small community residential settings, studies in Taiwan and the U.S. did not replicate these results. The mixed findings may be due to the unique challenges faced by small community group homes serving people with disabilities from different countries. The purpose of this qualitative study was to describe the views of participants in a AS implementation study about contextual factors that affected their efforts at implementing AS in a U.S. context. Interviews were conducted with Direct Support Professionals (DSPs) and AS trainers. A focus group was conducted with directors from organizations that implemented AS in the U.S. This study revealed several reported challenges to AS implementation, including the lack of leadership support, lack of buy‐in, and high staff turnover rate. Despite these difficulties, study participants identified positive impacts of AS on both DSPs and people with disabilities. Implications of these findings are discussed.

Quality of practice in supported accommodation services for people with intellectual disabilities: What matters at the organisational level

“…Reflecting the influence of implementation science, the study focused on senior leaders and the organisational context in which Active Support is implemented. Its findings include conceptualisation of some features of leadership and contextual factors in disability service organisations, furthering the opportunity to assess or measure these in the future as proposed by Qian et al (2017). Overall these findings reflect some of the features associated with coherence within organisations, proposed as significant to good service user quality of life, for which there is scant evidence (Bigby & Beadle-Brown, 2018).…”

“…The senior leadership in nine organisations shared practice as an organisational priority, reflecting the type of commitment by senior leaders necessary for implementation of evidence-based practice found in studies of other health and human services sectors (Bertram et al, 2015). In contrast, in the other five organisations, senior leaders regarded practice as only one of many competing priorities, resembling to some extent, the absence of support by organisations for the implementation of Active Support identified by Qian et al (2017). These qualitive data, which also suggest a change in commitment to practice by senior leaders in some organisations since the study begun, are indicative of the fragility of prioritising practice over time by senior leaders.…”

“…Bigby and Beadle-Brown (2018) noted the limited research about these features and Flynn et al (2018), in their review, found only weak evidence for the influence of organisational leadership in disability services on Active Support. In a small study, on the basis of qualitative interviews with staff, Qian, Tichá, and Stancliffe (2017) identified a lack of support from the higher levels of the organisation, and absence of policies and structures for implementing Active Support together with an overall lack of organisational readiness as barriers. These findings support the argument of Mansell and Beadle-Brown (2012), drawing on practice wisdom about the significance of commitment from senior managers to successful implementation of Active Support.…”

“…As Qian et al (2017) suggested, there is a need to develop consistent conceptualisations of organisational features and management practices relevant to services in the disability sector in order to operationalise and measure the influence of these contextual factors on implementation of Active Support. Importantly, Qian et al identified the influence of factors external to organisations that have been studied rarely, such as sector pay conditions, as barriers to the implementation of Active Support in the United States (US) context.…”

Our Homes: An inclusive study about what moving house is like for people with intellectual disabilities in Ireland

“…Providing ongoing training for facilitating personalised, active supports was advised in well-structured narrative reviews (Amado, Stancliffe, McCarron, & McCallion, 2013), in position statements by influential scholars (Mansell & Beadle-Brown, 2010), and in comparative analyses across groups living in different accommodation models (McConkey et al, 2016). Equally, Qian, Ticha, and Stancliffe (2017) emphasised the importance of strong leadership, buy-in from stakeholders and staff retention to successful implementation of active supports. Thus, the relationship between people with intellectual disabilities and supporters, guided by active support principles (Felce, Jones, & Lowe, 2000;Mansell, Elliott, & Beadle-Brown, 2002), coupled with strong, person-centred leadership within organisations form a stable framework for positive transitions from family homes, group homes and congregated settings to community accommodations.…”