Dimensions of group home culture as predictors of quality of life - - PowerPoint PPT Presentation

latrobe.edu.au

CRICOS Provider 00115M

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

2 La Trobe University

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).

3 La Trobe University

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?

4 La Trobe University

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).

5 La Trobe University

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
• rganised and provided may be critical.

6 La Trobe University

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.

7 La Trobe University

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.

8 La Trobe University

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).

9 La Trobe University

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).

10 La Trobe University

Group Home Culture Scale (GHCS)

• Description: The extent to which staff practices are directed towards

enhancing the well being of each resident.

• Example item: Staff find ways to involve each resident in their local

community.

Supporting Well Being (11 items)

• Description: The extent to which there are divisions within the staff

team that have a detrimental influence on team dynamics.

• Example item: There are distinct groups of staff, rather than one staff

team.

Factional (7 items)

• Description: The extent to which the house supervisor engages in

leadership practices that transmits and embeds the culture.

• Example item: The house supervisor role models how to appropriately

support and interact with the residents.

Effective Team Leadership (6 items)

11 La Trobe University

• Description: The extent to which staff have a positive perception of
• rganisational support and organisational priorities.
• Example item: Senior managers help us to find solutions to problems.

Collaboration within the Organisation (6 items)

• Description: The extent to which there is social distance between staff

and residents, where staff regard the residents to be fundamentally different from themselves.

• Example item: Staff talk to residents like they are talking to children.

Social Distance From Residents (5 items)

• Description: The extent to which staff value the residents and the

relationships they have with them.

• Example item: Staff take an interest in the residents’ lives.

Valuing Residents and Relationships (7 items)

• Description: The extent to which staff members’ values align with the

espoused values of the organisation.

• Example item: As a staff team, our values match the organisation’s core

values.

Alignment of Staff with Organisational Values (5 items)

12 La Trobe University

Measurement of QOL and Control Variables

Data Collection Method Predictor/ Control Variables QOL Outcomes/ Dependent Variables Questionnaire (Staff/ Proxy Respondent) Short Adaptive Behavior Scale (SABS; Hatton et al., 2001).

• Index of Community Involvement

(Raynes et al., 1994).

• Index of Participation in Domestic Life

(Raynes et al., 1994).

• Choice Making Scale (Conroy & Feinstein,

1986).

Observation (Researcher) Active Support Measure (ASM;

Mansell et al., 2005)

Engagement in Meaningful Activity & Relationships (EMAC-R; Mansell & Beadle-

Brown, 2005).

13 La Trobe University

Analyses

• Multilevel Modelling: Do these variables predict QOL?

Adaptive Behaviour GHCS 7 Subscales QOL Outcome

Individual Level Group Level

14 La Trobe University

Analysis: Engagement in Activities (EMAC-R)

• What are the predictors of engagement in activities?

Adaptive Behaviour + ASM Scores GHCS 7 Subscales

Engagement in Activities

Individual Level Group Level

15 La Trobe University

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.

Adaptive Behaviour + ASM Scores Effective Team Leadership + A. of Values

Engagement in Activities

Individual Level Group Level 53% 9% 44%

16 La Trobe University

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.

17 La Trobe University

Analysis: Index of Community Involvement

• What are the predictors of community participation?

Adaptive Behaviour GHCS 7 Subscales

Community Participation

Individual Level Group Level

18 La Trobe University

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).

Adaptive Behaviour Supporting Well Being

Community Participation

Individual Level Group Level 37% 27% 10%

19 La Trobe University

Results: Index of Community Involvement

• When staff practices are directed towards enhancing well being, residents experience greater

participation in community activities.

20 La Trobe University

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?

Adaptive Behaviour GHCS 7 Subscales

QOL Outcome

Individual Level Group Level

21 La Trobe University

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.

Adaptive Behaviour

QOL Outcome

Individual Level Group Level

22 La Trobe University

Research Implications

• Contributes to the evidence base of predictors of QOL outcomes for residents of group homes.
• Provides support that dimensions of group home culture predict certain QOL outcomes.
• Adds to the evidence base that house supervisors influence service quality.

23 La Trobe University

Practice Implications

• Identified dimensions of group home culture that organisations and staff can develop to enhance

certain QOL outcomes.

• Effective Team Leadership
• The house supervisor engages in leadership practices that transmits and embeds the culture.
• Setting a clear direction for the team, role modelling, teaching, and providing feedback to

develop staff members’ knowledge and skills.

24 La Trobe University

Practice Implications

• Alignment of Staff with the Organisation’s Values
• Values: what is important, right and desirable. Guiding principles that influence decisions and

behaviour.

• Staff members’ values match the organisation’s core values.
• Supporting Well Being
• Staff members’ practices are directed towards enhancing the well being of each resident.
• Person centred support, active support, provide choice, and facilitate social inclusion.
• Norms, patterns of behaviour and the way things are done.
• Norms: provide guidelines of how staff ought to behave in certain situations.

25 La Trobe University

Further Research

1) Continue to address the question: Are dimensions of group home culture predictors of QOL outcomes for people with intellectual disabilities? 2) Are dimensions of group home culture predictors of the quality of staff support?

Th Thank you

latrobe.edu.au

CRICOS Provider 00115M

Contact L.Humphreys@latrobe.edu.au