Being a valuable contributor on the frontline: The self‐perception of staff in group homes for people with intellectual disability

Exploring the experience of working relationships for support workers of adults with intellectual disabilities

BACKGROUND

Research suggests that a better awareness of how staff who directly support people with intellectual disabilities experience their working relationships, will contribute to understanding staff wellbeing and the quality of care they offer. This study aimed to gain insights into the lived experiences of support workers in supported living services in England.

METHOD

Six support workers participated in semi-structured interviews, about their working relationships with service-users and colleagues. Data was analysed using interpretative phenomenological analysis.

RESULTS

Six interconnected themes emerged: The essence of good relationships; a trusting relationship as the vehicle for meeting service-users' needs; belonging to the support team; the organisational context of relationships; the social context of relationships; 'a fine balancing act'.

CONCLUSIONS

The findings provide insights into staff wellbeing, indicating that developing supportive, trusting relationships with both service-users and colleagues, plays an important role in delivering effective care. Potential implications for service providers are discussed.

Understanding how organizational culture shapes the experiences of direct support professionals: A qualitative meta-synthesis from an organizational justice perspective

Direct support professionals (DSPs) are critical to the quality of life of people with intellectual and developmental disabilities, yet high turnover rates significantly affect the quality and consistency of their services. A qualitative meta-synthesis could help understand how organizational culture shapes the experiences of DSPs. A systematic search found six articles that met all inclusion criteria. The initial findings show that although DSPs perceived their work as worthy and rewarding, they did not feel valued or supported by management either monetarily or professionally. The analysis revealed an overarching theme with elements congruent with the organizational justice literature. Findings suggest that cultivating a culture of justice and fairness is vital to retaining quality DSPs, promoting organizational outcomes, and improving the quality of life of people with intellectual and developmental disabilities.

Proposal of a service delivery model for supported living community forensic services

PURPOSE

Following serious case review, the Transforming Care agenda (DH, 2015) highlights the need for adults with learning disabilities, autism, mental health issues or behaviors that challenge to be supported within communities rather than hospitals. Poor or absent leadership has been identified as contributing to serious cases of abuse in health-care settings [Department of Health (DH), 2012]. This paper aims to focus on identifying the elements required for good leadership and service delivery in community forensic services (CFS).

DESIGN/METHODOLOGY/APPROACH

The perspectives of 12 support workers working in CFS were obtained through semi-structured interviews.

FINDINGS

Thematic analysis identified two predominant themes, namely, authentic leadership and effective team practice. A culture of trust and learning occurs when teams are well led. This culture leads to consistent practice which benefits services users and reduces risk of poor practice. Analysis suggests a framework for service delivery which is complimented by aspects of the Total Attachment model.

RESEARCH LIMITATIONS/IMPLICATIONS

The data set was collected from the same organisation and views may have been aligned to existing organisational policy. However, the sample was taken across different teams and geographical locations to collate more generalised experiences of team dynamics. The lead researcher works for the organisation and this dual role may have affected the candour with which individuals shared information during interviews.

PRACTICAL IMPLICATIONS

Using a model to understand the functional dynamics of teams within CFS may support leaders and practitioners to improve service delivery.

SOCIAL IMPLICATIONS

Improving service delivery within CFS may increase opportunity to meet the Transforming Care Agenda.

ORIGINALITY/VALUE

This paper examines staff perspectives and the application of theoretical frameworks to propose a unique service delivery model for supported living within CFS.

Health Information and the Quality and Safety of Care for People With Disability: An Analysis of Australian Reports of Reviewable Deaths in Residential Care

OBJECTIVE

Many Australians with disability live in residential care and require assistance to manage their health information across hybrid care settings encompassing residential care, primary and tertiary care, and allied health. In this study, we examined case study reports on people with disability living in residential care in New South Wales, Australia to (a) identify threats to the quality of care and safety for this vulnerable patient group in relation to health documentation and information infrastructure and (b) evaluate the applicability of a conceptual health information infrastructure model.

METHODS

All 99 case studies were extracted from eight New South Wales Ombudsmen reports of reviewable deaths for a directed content analysis applying a conceptual model of health information infrastructure in residential care.

RESULTS

Ninety-one percent of case studies (n = 90) contained information relation to documentation. Forty-seven percent of case studies (n = 47) linked failures in documentation to risk of death, and 12% (n = 12) described best practice use of documentation. Threats to quality of care and safety related to poor "coordination" of information, including information not being implemented, poor "communication" across services, and discrepancies between "policy and practice" in health management.

CONCLUSIONS

The conceptual model demonstrated how "coordination" and "communication" of health information relate to tensions between "policy and practice," influencing the safety and quality of care for people with disability in residential care. The model was a good fit to investigate how health information infrastructure may affect the quality of residential care and could inform holistic digital solutions to deliver safer, integrated, and higher quality care for people with disability.

What is good service quality? Day service staff's perspectives about what it looks like and how it should be monitored

Background

Australian disability services must comply with quality standards defined by federal government. Standards are abstract, focus on paperwork and rarely describe what good service quality looks like in practice. This research explored frontline day service staff's perceptions of good service quality to identify ways that it may be better monitored.

Methods

Using a constructivist grounded theory methodology, semi‐structured interviews were conducted with 9 frontline staff from 3‐day services. Interviews were recorded, transcribed and analysed for themes using constant comparison and line‐by‐line coding.

Results

Five categories of good practice were identified: collaborative hands‐on leadership, well‐planned services, respect for people with intellectual disabilities and their carers, a culture of continuous improvement and professionalization of the support worker role.

Conclusions

Results align with research undertaken in accommodation services for people with intellectual disabilities, suggesting commonalities in frontline staff's perceptions of quality in both day and accommodation services.

Exploring how support workers understand their role in supporting adults with intellectual disabilities to access the Internet for intimate relationships

BACKGROUND

Some adults with intellectual disabilities need support to access the Internet. This study explores how support workers understand their role in facilitating Internet access for intimate relationships.

METHOD

Eight support workers in the West Midlands of the UK were interviewed face-to-face, using semi-structured interviews and a thematic analysis was used to interpret the data.

RESULTS

Three main themes emerged; social and organizational dilemmas (including sub-themes of; role and moral positioning, expectations of support, and protected and reflective space), power and position and policy dilemmas.

CONCLUSION

Support workers said that adults with intellectual disabilities should have access to the Internet for intimate relationships. There was a range of views on whether it was their job to support this. A lack of training in Internet use was highlighted.

"I don't want to take any risks even if it's gonna mean this service-user is gonna be happier": A thematic analysis of community support staff perspectives on delivering Transforming Care

BACKGROUND

Transforming Care is making mixed progress in supporting people with intellectual and developmental disabilities, and complex needs, move to more appropriate specialist accommodations closer to home. Community support staff often spend greatest amounts of time with service-users, yet are some of the least heard voices about why placements succeed and fail to varying extents.

METHOD

Managers and support staff (n = 13), working in ostensibly "specialist" community placements, were interviewed about perceived barriers and facilitators to implementing Transforming Care. Transcripts were subjected to thematic analysis.

RESULTS

Participants identified difficulties balancing people's rights, safety and quality of life needs, and felt the system's expectations of them are hard to deliver within the resources, legislation, values and support models provided them. Multidisciplinary expertise was highly valued for both emotional and practical support, but was least valued when perceived as overly blaming or inspectorial. Specialist health input was seen to withdraw prematurely for this particular client group.

CONCLUSION

Recommendations are provided for how staff perspectives should inform Transforming Care in interests of service-users.

How frontline staff manage paperwork in group homes for people with intellectual disability: Implications for practice

BACKGROUND

Paperwork is a key tool that transforms organizational intentions into actions in group homes, although prescriptive procedures may limit how frontline staff use it in practice. The aim of this study was to explore how frontline staff use paperwork in group homes for people with intellectual disability and identify practice implications.

METHOD

Constructivist grounded theory methodology guided the research. Data collection included semi-structured interviews and participant observations. Coding, comparison and sorting methods were adopted to analyse how staff used paperwork.

RESULTS

Staff followed organizational paperwork rules when they aligned with their resident-focused approach to work. When they perceived rules to misalign with this approach, they managed paperwork by adjusting the time and place of completion, managing content, creating alternative tools and refusing completion.

CONCLUSIONS

Staff purposefully managed paperwork rather than simply following procedures. Disability service organizations could develop flexible paperwork procedures and include frontline perspectives in paperwork development.