Improving Quality of Life Outcomes in Supported Accommodation for People with Intellectual Disability: What Makes a Difference?

Abstract

Background The quality of life (QOL) of people with intellectual disability living in supported accommodation services is variable, influenced by many possible factors. Various frameworks have attempted to identify these factors without assigning value, direction of influence or relative impact on outcomes. Methods A realist review of the literature aimed to expose different propositions about variables influencing QOL outcomes and review the strength of supporting evidence for these, to identify their relative influence. Evidence was reviewed for and against each of five clusters. Results Evidence was strongest for the presence of staff practices (use of Active Support), front-line management practice (use of practice leadership), culture (enabling and motivating), human resources policies and practice (that support front-line leaders and recruitment of staff with the right values), adequate resources, and small, dispersed and homelike settings. Conclusions The evidence informs policy and practice but in some clusters remains limited, warranting further research which measures outcomes on all QOL domains.

Managers’ views of skilled support

“…As already noted, research has generally found that active support is key to both achieving better outcomes for those receiving support and in making it easier to implement other elements of person‐centred support such as effective communication, positive behaviour support and the provision of autism friendly environments (Beadle‐Brown et al., ; Bigby & Beadle‐Brown, ; Bradshaw et al., ; Mansell & Beadle‐Brown, ; Stancliffe et al., ).…”

“…Although living in ordinary housing dispersed in the community is a necessary condition for improved quality of life (such as inclusion, independence, self‐determination, well‐being), it is not sufficient (Mansell, ). Apart from the severity of disability and the presence of complex needs, only one factor has emerged from the research as predicting quality of life of those with intellectual and developmental disabilities—whether those services are providing a facilitative style of support that focuses on enabling and empowering people with disabilities (See Bigby & Beadle‐Brown, for a recent review). One approach for providing such support, and the one with the most research, is usually referred to as [person‐centred] active support (Mansell & Beadle‐Brown, ; Stancliffe, Jones, Mansell, & Lowe, ).…”

“…, ) and one‐third of people with intellectual disabilities in small group homes (supporting six people or fewer) and supported living arrangements (Beadle‐Brown et al., ; Mansell, Beadle‐Brown, & Bigby, ) . The factors that predict whether or not staff work in this way are less well researched (Bigby & Beadle‐Brown, ).…”

Implementation of active support over time in Australia

“…However, despite many other hypotheses about what supports implementation and maintains good active support, most notably the role of culture, there is very little research exploring these (Bigby & Beadle-Brown, 2016). The ongoing project from which the data in this paper are drawn is attempting to fill that gap by exploring the organisational factors that impact on implementation and maintenance of active support.…”

“…The evidence base spans four decades, involves at least 1400 people, uses different methodologies, in different countries, in different settings and involves different research teams and training approaches. Studies of effectiveness have ranged from small-scale pre-post training comparisons through to larger scale observational studies (see Bigby & Beadle-Brown, 2016;Jones, Felce, Lowe, Bowley, Pagler, Gallagher, et al, 2001;Jones, Felce, Lowe, Bowley, Pagler, Strong, et al, 2001;.…”