Dimensions of group home culture as predictors of quality of life outcomes Lincoln Humphreys Christine Bigby, Teresa Iacono & Emma Bould Living with Disability Research Centre La Trobe University latrobe.edu.au CRICOS Provider 00115M
Group Homes and Quality of Life Group homes: accommodate up to 6 or 7 people. Support provided in the home and the community. • The measurement of Quality of Life (QOL) has been used to evaluate the quality of group homes. • Research has shown there can be variability in QOL outcomes (Emerson & Hatton 1996; Kozma et al., 2009) . • Engagement in activities: how much time are people engaged in meaningful activities and interacting • with people? E.g., Engagement in activities: 8% to 74% ( M = 47.7%; Emerson & Hatton, 1996) , 0% to 100% ( M = 51%; N = 147; • Mansell et al., 2013). La Trobe University 2
The Problem There are people who experience poor QOL. • There can be considerable differences in the quality of group homes. • What accounts for this variability in QOL outcomes? • La Trobe University 3
Predictors of Quality of Life Outcomes in Group Homes Examining the predictors of variability in QOL outcomes: could reveal the factors that can enhance the • provision of group home services and the QOL of people with intellectual disabilities. Adaptive behaviour: a person’s level of independence in performing everyday activities. • - Positively associated with a range of QOL outcomes. Staff support practices • - Active Support: assisting residents to engage in activities. - Following staff training, there have been increases in residents’ engagement in activities. - Variability in the implementation and maintenance of active support (Bigby et al., 2017). La Trobe University 4
Predictors of Quality of Life Outcomes in Group Homes Other variables that have been examined: • - Size and location of group homes. - Resources (e.g., financial resources and staff ratios). - Staff characteristics (e.g., qualifications). - Frontline management (e.g., practice leadership). The predictors of QOL are incompletely understood. • Adequate levels of resources and settings of small size are necessary but not sufficient conditions for • good outcomes. How resources are used by organisations, the management of organisations, how staff support is • organised and provided may be critical. La Trobe University 5
Organisational Culture and Quality of Life Outcomes Bigby et al., (2016, 2015, 2012) • 2 Qualitative studies. Culture in 5 underperforming and 3 better performing group homes. • Identified 5 dimensions of group home culture. • Comparisons showed: more positive cultures, higher QOL outcomes. • Gillet & Stenfert-Kroese (2003) • Quantitative study. Comparisons between 2 residential units from the same organisation. • More positive culture also had higher QOL outcomes. • Research is needed to examine this relationship statistically, using data from numerous group homes. • La Trobe University 6
Research Question and Method Are dimensions of group home culture predictors of QOL outcomes for people with intellectual • disabilities? Quantitative methods are useful for examining the relationship between variables. • Organisational Culture: • Staff members’ shared values, beliefs, and norms that influence how they think, feel, and act. La Trobe University 7
Recruitment and Participants Participants were recruited from a larger longitudinal study. • - 5 organisations. - 98 adults with intellectual disabilities. - 86 disability support workers and 21 house supervisors (n = 107 staff) . - 23 group homes: accommodated 3 to 7 residents ( M = 4.7) . La Trobe University 8
Measurement of Organisational Culture The Group Home Culture Scale (GHCS) was used to measure organisational culture in group homes. • 46-items rated on a 5-point Likert scale. • Completed by disability support workers and house supervisors (51% response rate). • La Trobe University 9
Group Home Culture Scale (GHCS) Supporting Well • Description: The extent to which staff practices are directed towards enhancing the well being of each resident. Being • Example item: Staff find ways to involve each resident in their local community. (11 items) • Description: The extent to which there are divisions within the staff Factional team that have a detrimental influence on team dynamics. • Example item: There are distinct groups of staff, rather than one staff (7 items) team. Effective Team • Description: The extent to which the house supervisor engages in leadership practices that transmits and embeds the culture. Leadership • Example item: The house supervisor role models how to appropriately (6 items) support and interact with the residents. La Trobe University 10
Collaboration within the • Description: The extent to which staff have a positive perception of Organisation organisational support and organisational priorities. • Example item: Senior managers help us to find solutions to problems. (6 items) Social Distance From • Description: The extent to which there is social distance between staff and residents, where staff regard the residents to be fundamentally Residents different from themselves. (5 items) • Example item: Staff talk to residents like they are talking to children. Valuing Residents and • Description: The extent to which staff value the residents and the Relationships relationships they have with them. • Example item: Staff take an interest in the residents’ lives. (7 items) Alignment of Staff with • Description: The extent to which staff members’ values align with the espoused values of the organisation. Organisational Values • Example item: As a staff team, our values match the organisation’s core (5 items) values. La Trobe University 11
Measurement of QOL and Control Variables Data Collection Method Predictor/ Control Variables QOL Outcomes/ Dependent Variables Questionnaire Short Adaptive Behavior Scale • Index of Community Involvement (Staff/ Proxy Respondent) (SABS; Hatton et al., 2001 ). (Raynes et al., 1994) . • Index of Participation in Domestic Life (Raynes et al., 1994) . • Choice Making Scale (Conroy & Feinstein, 1986) . Observation Active Support Measure (ASM; Engagement in Meaningful Activity & (Researcher) Mansell et al., 2005 ) Relationships (EMAC-R; Mansell & Beadle- Brown, 2005 ) . La Trobe University 12
Analyses Multilevel Modelling: Do these variables predict QOL? • Group Level Individual Level GHCS Adaptive QOL Behaviour Outcome 7 Subscales La Trobe University 13
Analysis: Engagement in Activities (EMAC-R) What are the predictors of engagement in activities? • Group Level Individual Level Adaptive Behaviour GHCS Engagement + in Activities 7 Subscales ASM Scores La Trobe University 14
Results: Engagement in Activities (EMAC-R) Effective Team Leadership ( p = .007) and Alignment of Staff with Organisational Values ( p = .021) • were found to be significant predictors. After controlling for level of adaptive behaviour ( p = .009) and Active Support Measure ( p < .001) scores. Group Level Individual Level Adaptive Effective Behaviour Team Engagement + Leadership in Activities + A. of ASM Values Scores 44% 9% 53% La Trobe University 15
Results: Engagement in Activities (EMAC-R) Suppression effect: Effective Team Leadership and Alignment of Staff with Organisational Values need • to be interpreted in combination. House supervisors that effectively lead teams probably also contribute to establishing shared values • among staff members that align with the organisation’s values. More effective team leadership and greater alignment of staff with organisational values were • associated with greater engagement in activities. More research is needed to replicate findings. • La Trobe University 16
Analysis: Index of Community Involvement What are the predictors of community participation? • Group Level Individual Level GHCS Adaptive Community Participation Behaviour 7 Subscales La Trobe University 17
Results: Index of Community Involvement Supporting Well Being ( p = .005) was found to be a significant predictor. After controlling for level of • adaptive behaviour ( p = .015). Individual Level Group Level Adaptive Supporting Community Participation Behaviour Well Being 27% 10% 37% La Trobe University 18
Results: Index of Community Involvement When staff practices are directed towards enhancing well being, residents experience greater • participation in community activities. La Trobe University 19
Analysis: Index of Participation in Domestic Life and Choice Making Scale What are the predictors of participation in domestic tasks? • What are the predictors of choice making? • Group Level Individual Level GHCS Adaptive QOL Outcome Behaviour 7 Subscales La Trobe University 20
Results: Index of Participation in Domestic Life and Choice Making Scale None of the GHCS subscales were found to be significant ( p < .05) predictors. • Perhaps a larger sample was needed to detect significant effects. • Group Level Individual Level Adaptive QOL Outcome Behaviour La Trobe University 21
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