Effect of Service Structure and Organization on Staff Care Practices in Small Community Homes for People with Intellectual Disabilities

Abstract

Background An important question in community living is what factors influence the extent to which staff provide 'active support'. Methods Engagement, care practices and a range of staff and organizational characteristics were studied in 72 residential homes serving 359 adults with intellectual disabilities. Managers in 36 settings were trained in person-centred active support (PCAS). A group comparison design and multivariate analysis was used to investigate the relationship between variables. Results The PCAS group showed more active support, assistance, other contact from staff and engagement in meaningful activity but no difference in choice-making or assessment of participation in activities of daily living. The PCAS group had more staff with a professional qualification, were more likely to think that challenging behaviour was caused by lack of stimulation, had attitudes more in line with a policy of community care, rated most care tasks as less difficult, and were more organized to deliver active support. The comparison group were more likely to think that challenging behaviour was learned negative behaviour, showed more teamwork and were more satisfied. Multivariate analysis identified a range of staff and organizational variables associated with engagement and active support.Conclusions The results suggest that some variables which have not hitherto been studied in relation with active support are associated with it. Professional qualification, knowledge and experience appear to be important as do some staff attitudes, clear management guidance, more frequent supervision and team meetings, training and support for staff to help residents engage in meaningful activity.

From “what do you do?” to “a leap of faith”: developing more effective indirect intervention for adults with learning disabilities

“…This paper seeks to further understanding of these issues and to suggest a framework for a robust, indirect therapy model which maximises the likelihood of a successful outcome. Values Societal values and cultural beliefs have always impacted significantly on the lives of individuals with learning disabilities and the support they receive (Bridges, 2004;Colodny, 2008;Mansell et al, 2008) and can be a challenge to implement (Burton and Kagan, 2006). Hickman (2002) lists various sources of values and beliefs including the World Health Organisation, ''normalisation'' principle (Nirje, 1994), Wolfensberger's (1983) ''Social role valorisation'', valuing people and person-centred planning (Department of Health, 2001Health, , 2006Health, , 2007.…”

A conceptual model of quality service provision for people with intellectual disability and challenging behaviours: Enhancement and enrichment through service user and other stakeholder consultation

“…Mansell et al (2008) found that positive staff attitudes towards community care, rights of the service users, and treatment of ID service users was significant to staff's ability to engage service users in meaningful activity. Elgi, Feurer, Roper and Thompson (2002) determined that positive staff attitudes towards community inclusion of people with ID was significant to staff-initiated social interactions, which in turn was significant to community activities.…”

“…The Office of the Public Advocate (2009, p. 13) indicates quality of supported accommodation as dependent on the skills, experience and qualifications of staff. However, with specific regard to qualifications, studies in ID services have not equivocally supported qualifications as necessary for quality service provision (see Felce et al, 2002aFelce et al, , 2002bMansell et al, 2008;Robertson et al, 2000;Robertson et al, 2001b). Similarly, experience has been implicated in service user engagement in meaningful activity in some studies (see Felce et al, 2002a;Felce et al, 2002b;Mansell et al, 2008) but not in others (Mansell, Beadle-Brown, MacDonald, & Ashman, 2003).…”

“…It is considered one of the most important drivers in ensuring positive outcomes for service users (Children's Workforce Development Council (2007) and is well documented in the management literature (Burke & Krey, 2005;Mosley, Mosley, & Pietri, 2010;Wiener, Mizen, & Duckham, 2003). Supervision and feedback has been identified as a factor significant to quality provision in disability services by numerous authors in the Australian context (Bigby, Clement, Mansell, & Beadle-Brown, 2009;Clement & Bigby, 2008) and internationally (Berkery, Tiernan, & Armstrong, 2009;Bigby et al, 2009;Mansell, 2006;Mansell, Beadle-Brown, Whelton, Beckett, & Hutchinson, 2008;Skirrow & Hatton, 2007;West, Guthrie, Dawson, Borrill, & Carter, 2006).…”

“…This was upheld by supervisors, support workers, advocates and families/carers who identified service users' developing relationships with people in the community as a necessary requirement. Non-identification of this element by CEOs, managers, clinicians and senior practitioners highlights the need for reflective supervisory practice, which is identified as a significant requirement for delivering quality services (Berkery et al, 2009;Bigby et al, 2009;Clement & Bigby, 2008;Mansell, 2006;Mansell et al, 2008;Skirrow & Hatton, 2007;West et al, 2006).…”