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

Abstract

Background: Organisational and service level factors are identified as influencing the implementation of Active Support. The aim was to explore differences in organisational leadership and structures to identify potential relationships between these factors and the quality of Active Support in supported accommodation services. Method: Fourteen organisations participated in this mixed methods study, which generated data from interviews with senior leaders, document reviews and observations of the quality of Active Support. Results: Qualitative analyses revealed three conceptual categories: senior leaders in organisations where at least 71% of services delivered good Active Support prioritised practice; understood Active Support; and strongly supported practice leadership. In these organisations practice leadership was structured close to everyday service delivery, and as part of frontline management. Conclusions: Patterns of coherent values, priorities and actions about practice demonstrated by senior leaders were associated with successful implementation of Active Support, rather than documented values in organisational policy or procedures. KEYWORDS

Predicting good Active Support for people with intellectual disabilities in supported accommodation services: Key messages for providers, consumers and regulators

“…Finally, the unique codes provided from organisations using the audit database were used to ascertain the total number of services and service users supported by the organisation. The annual turnover was grouped into greater (>) or less than (<) $50 million, and these data, along with the total score for presence of the four organisational management features taken from Bigby et al (2019b), and number of years implementing Active Support were aggregated at the organisational level. These scores were subsequently assigned to all individual service users within the same organisation.…”

“…These data were in the form of surveys completed by staff about their own characteristics and work experiences, surveys completed by staff about service user characteristics, observations of service users, staff practice and practice leadership and interviews with practice leaders. Also included were the data on the organisational management features of each of these organisations reported by Bigby et al (2019b).…”

“…Organisational management features. The data from findings reported by Bigby et al (2019b) on the presence or absence of four organisational management features which are reproduced in Table 5 were used. Based on the presence (score of 1) or absence (score of 0) of each feature in each organisation, an organisational total score was calculated to yield a maximum score of 4 across the four items: (1) shared prioritisation of practice and Active Support by senior leaders (2) senior leaders strongly supporting practice leadership, (3) organisation of practice leadership close to every-day service delivery, and (4) concentration of practice leadership and frontline management tasks.…”

“…A qualitative analysis of interviews with senior leaders from 14 Australian disability organisations, which had adopted Active Support, identified four features of organisational management and structures (management features) that were common to the six of these organisations that delivered good Active Support to the majority of service user in 71% or more of their services (Bigby, Bould, Iacono, & Beadle-Brown, 2019b). These features were senior leaders who shared prioritisation of practice and Active Support and strongly supported practice leadership, and practice leadership organised close to every-day service delivery and concentrated in one position with frontline management.…”

“…Table 1 provides definitions for each of these features. Bigby et al (2019b) suggested the potential to statistically test whether the presence of these four features, along with other variables, were predictive of good Active Support, singly or in combination. Accordingly, the aim of the present study was to further explore predictors of good Active Support by including, in a multi-level model (MLM), results reported by Bigby et al (2019b) about the presence or absence of the four organisational management features in 14 organisations, together with other individual and service level data for these organisations,…”