final dimensions of culture in supported accommodation services for people with severe and profound...

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Title

NameLiving with Disability Research Centre La Trobe University

Dimensions of culture in group homes for people with severe intellectual disabilities.

Christine Bigby Julie Beadle-Brown, La Trobe University, Tizard University of Kent

2La Trobe University

Background – importance of group homes

Group homes have been a major strategy in implementing disability policy

Support high numbers of people with more severe intellectual disability (17,000 in Australia)

Despite calls for innovative models – still being built

Good quality of life outcomes are possible (Kozma et al., 2009).


Background – importance of group homes

High level of variability in outcomes – consistently worse for people with more severe intellectual disability.

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2 factors (adaptive behaviour and staff practice) reliably predict good quality of life outcomes.


Organisational characteristics, policies and processes

What makes a

difference

Necessary but not sufficient

conditions

Frontline staff and managerial

working practices

Organisational characteristics,

policies and processes

Culture

External environment

Adequate resources

Small size, dispersed, homelike

Practice reflects active support Compensates for difference Front line practice leadership

Strong HR Processes assist staff

focus on practice Staff training in active

support and hands on


Culture – important but very little evidence

Consistently identified as influencing staff practices (Felce et al., 2002; Hastings,

Remington, & Hatton, 1995; Mansell, McGill, & Emerson, 1994; Felce & Perry, 2007; Stancliffe, Emerson &

Lakin, 2004; Walsh et al., 2010).

Consistently identified as contributing to abuse (Hutchinson & Stenford Kroese, 2015)

Slippery concept - conceptualised and investigated in quite different ways

only handful of studies

‘The way we do things around here’

Schein's definition

“A pattern of shared basic assumptions…that has worked well enough to be considered valid and, therefore, to be taught to new members as

the correct way to perceive, think, and feel in relation to those problems” (Schein, 1992, p.12).


Culture in group homes - Aims

Describe the culture – put value to the variable

Identify relationship between nature of culture and QoL outcomes

Identify generative factors

Inform the development of strategies to foster this type of culture

Thus supporting good staff practice and good outcomes for people in group homes

Draws from evaluation of closure of Kew - 2004- 2007 (Making Life Good) (Clement &

Bigby, 2010)

Underperforming - low levels of engagement, respect, social participation

Discovery grant 2009-2012 (Ordinary Life)

Better’ group homes - rather than ‘good’ could be better re personal development and social relationships (Bigby et al, 2015 a, Bigby et al., 2015b)


Approach and Methods Interpretive paradigm – qualitative ethnographic methods to collect in depth

qualitative data

Prolonged participant observation and detailed field notes on shift

Staff interviews, observation of staff meetings, document review

Different times of day – days of week

Making Life Good – 5 underperforming group homes

Re analysis of field notes from Kew study

26 residents with severe intellectual disability

45 days – total 209 hours

14 interviews

Ordinary Life – 3 better group homes

Recruited by reputation and advertisement

17 residents severe or profound intellectual disability and other complex physical, health or communication needs

Participant observation 9-12 months, 60 visits average 3 hrs

35 staff interviews


Analysis

Inductive – coding, category development, constant comparison (Miles & Huberman, 1994)

Analytical lens of culture - staff practices, resident behaviour, interactions between staff and residents, expressed and inferred values or assumptions concrete artefacts

Artefacts

Espoused values

Basic underlying

assumptions

Aspects of organisation that can be seen, heard or felt, physical environment, layout, technology, behavioural norms, observed rituals, clothes worn by staff, the myths and stories about the organisation (easy to see, hard to interpret)

Ideas, goals, values and aspirations that are explicitly articulated (consciously known, accessed through observation and interviews)

Unconscious or taken for granted beliefs and values that determine behaviour – staff consistently act in accordance with basic assumptions and to behave otherwise is practically inconceivable (hard to identify long term observation and interviews)


Findings - 5 Dimensions

1. Alignment of power-holders vales

Misalignment of power holder values with organisation’s

espoused values

Alignment of power holder and staff values.

“The organisation’s vision and mission is exactly what we live to, ordinary people living

ordinary lives . . . that’s what we aim for”

“We’re not going to do it that way”

Power not aligned with formal positions

Values of those who exercise power does not reflect those of the organisation.

And

Strong leadership

Shared responsibility and teamwork

Negative end Hypothesised positive end



2. Regard for residents

Otherness

Positive regard as part of the same diverse humanity

Residents seen as fundamentally different from staff, e.g. as childlike, able to watch activities but too disabled to participate, having no skills, or worries.

Residents referred to in derogatory terms, e.g. ‘grabbers or shitters’.

Humanness

Acknowledging and attending to difference


‘Not like us’‘Like us’



3. Perceived purpose

Doing for Doing with

“So it’s being able to speak on their behalf, and understand them, what they like and what they

don’t like. If I’m making their life what they want it to be, as best as I can, from what I know of them”

Staff see their purpose to look after residents, attend to personal care and get them out into the community.

Disconnection of staff work from resident engagement, sequential and hierarchical view of purpose - completing domestic chores takes priority and is seen as separate from involving residents in these activities.

Recognising and respecting preferences

Including and engaging

Ensuring care, dignity and comfort


‘We look after them’

Making the life each person wanted it to be



4. Working practices

Staff-centred Person-centred

“I know I have staff on shift and they have lots of stuff they have to do and be there for the

people we support, but it’s not about making it easy for the shift, so that so-and-so needs to go

to bed because I’ve got to leave and then someone else might have to do it. It’s not about

that. The guys come first no matter what”

Task focussed

High and low intensity to allow breaks.

Staff needs, fair work allocation, staff preferences prioritised in rosters and choice of activities.

Regular routines tend to support residents as a group rather than individuals.

Attentive

Relationships

Flexible

Momentary fun interactions


‘Get it done so we can sit

down’



5. Orientation to change and ideas

Resistance Openness to ideas and outsiders

“I think we all need to be looked at about what we’re doing. . . . I want to know that we’re doing a

good thing, and you will tell us, maybe? . . . It would be nice to hear, where we can improve, because let’s face it, everyone can improve”

Sense of distance from the wider organisation and senior managerial staff

Strategies to preserve the status quo and resist external influences seeking change to practice.

Permeable boundaries, part of bigger organisation, part of community

Families and outsiders welcome


‘Yes but’


Findings - Overarching Culture in Better Group Homes

Coherent

Respectful

Motivating

Enabling


Generative factors

Frontline staff and managerial working practices

Bringing together knowledge - about communication, attachment, intensive interactions, processes to support

relationships, supporting inclusion in community places and active support.

Front-line practice leadership - modelling, coaching, monitoring, supervision and communication among team,

Team work


Generative factors

Organisational characteristics, policies and processes

HR policies regulating entry and exit to organisation

Recruitment – staff values, job descriptions reflect expectations

Close scrutiny of casual and prospective staff

Performance management and support to front line leaders

Organisation of work

Regulating entry to specific group homes - groups of service users - buddy shifts

Induction separated from orientation - practice same weight as procedures

Coherent messages

Explicit translation of organisational values – into grounded expectations - no doubt what’s expected


Implications

Not quite at hypothesised positive polar end – long way down the dimension

What’s missing ?

Does care and warmth temper pushing of boundaries of engagement and choice in activities at home?

Do the strong relationships and commitment reduce drive or necessity for external relationships?

Overstepping the boundaries of professionalism?

Does culture look different in houses that have stronger outcomes on personal development and specifically active support and interpersonal relationships, specifically external social networks?

These findings supports the importance of strong practice leadership to outcomes and preliminary findings from study of organisational factors that influence high levels of active support (Beadle-Brown, Bigby, Bould, in press)

Supports strong culture thesis

Gives value and meaning to culture in group homes


ReferencesBeadle Brown, J., Bigby, C., Bould, E. (2015). Development of an observational measure of practice

leadership. Journal of Intellectual Disability Research . DOI: 10.1111/jir.12208

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

Bigby, C., Knox, M., Beadle Brown, J., & Bould, E. (2014). Identifying good group homes for people with severe intellectual disability: Qualitative indicators using a quality of life framework. Intellectual and Developmental Disability, 52(5), 348-366. doi: 10.1352/1934-9556-.5.348

Bigby, C., Knox, M., Beadle-Brown, J., & Clement. T., (2015). ‘We just call them people’: Positive regard for people with severe intellectual disability who live in of group homes. Journal of Applied Research in Intellectual Disability. 28, 283–295

Bigby, C., & Beadle-Brown, J. (in press). Culture in better group homes for people with severe and profound intellectual disability Intellectual and Developmental Disability

Clement, T. & Bigby, C. (2010). Group homes for people with intellectual disabilities: Encouraging inclusion and participation. London, Jessica Kingsley

Felce, D., Lowe, K., & Jones, E. (2002). Staff activity in supported housing services. Journal of Applied Research in Intellectual Disabilities, 15(4), 388–403.

Felce, D., & Perry, A. (2007). Living with support in the community: Factors associated with quality-of-life outcome. In S. Odom, R. H. Horner, M. E. Snell & J. Blacher (Eds.), Handbook of developmental disabilities (pp. 410–428). New York, NY: Guildford Press.


References

Kozma, A., Mansell, J., & Beadle-Brown, J. (2009).Outcomes in different residential settings for people with intellectual disability: a systematic review. American Journal on Intellectual and Developmental Disabilities, 114, 193–222. http://dx.doi.org/10.1352/1944-7558-114.3.193

Hastings, R. P., Remington, B., & Hatton, C. (1995). Future directions for research on staff performance in services for people with learning disabilities. Mental Handicap Research, 8(4), 333–339.

Hutchison, A., & Stenfert Kroese, B. (2015). A review of literature exploring the possible causes of abuse and neglect in adult residential care. The Journal of Adult Protection, 17 (4) 216 - 233

Mansell, J., McGill, P., & Emerson, E. (1994). Conceptualizing service provision. In E. Emerson, P. McGill, & J. Mansell (Eds.), Severe learning disabilities and challenging behaviour (pp. 69–93).London, England:

Schein, E. H. (1992). Organizational culture and leadership (2nd ed.). San Francisco, CA: Jossey-Bass

Stancliffe, R. J., Emerson, E., & Lakin, K. C. (2004). Residential supports. In E. Emerson, C. Hatton, T. Thompson, & T. R. Parmenter (Eds.), The international handbook of applied research in intellectual disabilities (pp. 459–478). Chichester, England: John Wiley & Sons.

Walsh, P. N., Emerson, E., Lobb, C., Hatton, C., Bradley, H., Schalock, R., … Mosely, C. (2010). Supported accommodation for people with intellectual disabilities and quality of life: An overview. Journal of Policy and Practice in Intellectual Disabilities, 7(2), 137–142.

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latrobe.edu.au CRICOS Provider 00115M

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