Quality Services
Governing for quality and safeguarding: what might disability service provider boards learn from others?
Why do this research?
People with intellectual disability should receive good quality services. They should also feel safe in their services. Services have boards of directors. The directors have different skills. Some directors are lawyers and accountants. In disability services, directors might include people with a lived experience of disability. Boards do governance. Governance is looking at rules that help an organisation work well and spend money carefully. Boards are responsible for providing safe workplaces and good services. Other people and organisations think safety and quality are important too. These are
- people who write laws about what is right,
- commissions of inquiry (such as the Disability Royal Commission) and
- regulators (people who check that laws are being followed).
Boards of disability services need help to check the quality and safety of their services. There is no research to help them know what to do.
What did they do?
The author looked at the research. He looked at what hospital boards do about quality and safe services. He looked at whether governance made a difference to quality and patient outcomes. He also looked at the research on board governance of work health and safety. He looked for links between what the board did and any health and safety outcomes.
What did they find?
There were some links between what the hospital boards did and how well the hospital did. The hospitals that worked well train board directors in quality. They spend time in board meetings, looking at quality of care. They have measures (benchmarking) to help them look at quality and safety. The research on work health and safety is only beginning. This research did not show any links between what the board did and outcomes.
There are some things to think about. We know that disability services are not the same as hospitals. Usually hospitals are big organisations, employ trained professionals and pay their board directors. They have measures that helps them compare their services. We need to think about what might be a good model for boards of disability services. We need to think about
- who is on the board and how they are trained
- who are the workers in their workplace, how they are trained and paid
- how to make quality and safety important and measurable.
We do not know enough to tell boards what to do. Boards are different for services that are large and services that are small. How the board members work together will also make a difference. We need more research, and research that looks at what happens in boards over time. This type of research will help us know how boards can help organisations with safety and quality services. We also need to know more about what happens when people with intellectual disabilities are made board directors. We don’t know if that will make services safer or better quality.
Hough, A. (2023). Governing for quality and safeguarding: what might disability service provider boards learn from others? Research and Practice in Intellectual and Developmental Disabilities, 10(1), 26-41. doi:10.1080/23297018.2022.2109193
The effectiveness of visual activity schedules for individuals with intellectual disabilities: A meta-analysis
Why do this research?
People with intellectual disabilities often need help to do things. We need to find ways to help them be independent and do things on their own. Research shows Visual Activity Schedules(VAS) are one way of doing this. These are picture and word based instructions in a set order from the beginning to the end. They can be used for a task or for moving from one task to another. They might be like a diary and act as reminders of what to do next. Sometimes these are on paper and sometimes digital, on a phone or ipad. The researchers wanted to know
- If the VAS helped people be more independent
- the parts of the VAS that were helpful, was it the
- The research design
- The characteristics of the person with a disability
- the parts of the study that helped people be more independent
What did they do?
They did a meta analysis of the research literature. They chose 10 single case studies. The studies were on both children and adults. They did complex statistics comparing parts of each study.
What did they find?
They found VAS was helpful to teach a person skills that made them independent. It was useful for children and adults. The skills could be taught in the everyday environment or the classroom. The use of systematic instruction (the way the skills were taught) was important. The researchers said there needs to be more research to find out if using digital VAS was better than paper VAS.
Van Dijk, W., & Gage, N. A. (2019). The effectiveness of visual activity schedules for individuals with intellectual disabilities: A meta-analysis. Journal of Intellectual & Developmental Disability, 44(4), 384-395. doi:10.3109/13668250.2018.1431761
Predicting good Active Support for people with intellectual disabilities in supported accommodation services: Key messages for providers, consumers, and regulators.
Why do this research?
Many people with intellectual disabilities need help to do things. We call this ‘engagement’. If someone is doing nothing it does not always mean they are choosing to do nothing. It may mean they do not have the help they need to do something or be engaged. Paid support workers help people be engaged. Some support workers have been trained in Active Support. Active Support is a way of helping people with intellectual disabilities. When support workers use Active Support they:
- help people to choose what they want to do
- help people to do tasks around their home
- help people to talk to others in the community
- provide the right amount and type of help to do a task successfully
- break tasks down into small steps
- help people to try doing new things.
Research shows that Active Support is a good way to help people with intellectual disabilities. When support workers use Active Support, people with intellectual disabilities are more engaged and have a better life. Some services have trained their staff in Active Support but staff do not do it all the time. The researchers wanted to know how to get staff to use Active Support all the time. They also wanted to know why some support workers trained in Active Support did not use it most of the time.
In an earlier study, this group of researchers had studied services in organisations where support workers used Active Support most of the time. They had found 4 things in all the organisations where support workers used Active Support most of the time. These were
- Shared prioritisation of practice and Active Support. This means the senior managers in the organisation such as the Chief Executive Officer and the executives understand and see Active Support as important. They see a need to make it happen and give staff the skills and knowledge to do it well. They do this by the way they manage services and the messages they give to support workers about what is important.
- Strongly supporting practice leadership. This means the senior managers make sure that the frontline managers have time and skills to do practice leadership. Frontline managers are also called team leaders or house supervisors or service managers. Practice leadership means making sure that all support workers do good Active Support; that they work together as a team; that they focus on helping people to have a good quality of life. Practice leadership means that staff are told if they are doing a good Active Support and how to do it better. It also means that staff know what to do on each shift they work, and that they get feedback on what they are doing.
- Closeness of practice leadership to everyday service delivery. This means that frontline managers spend time in services and work alongside support workers to help them know what to do.
- Concentration of practice leadership tasks. This means that the frontline managers do all the tasks of practice leadership.
The researchers wanted to know if having these 4 things present in an organisation would help workers using Active Support. If support workers use Active Support all the time it means the service is good quality. Knowing what predicts Active Support and a good quality service is important for the government and the National Disability Insurance Scheme (NDIS) that funds services. The things that predict quality services can be called ‘quality indicators’. If they are present in an organisation then it is a sign they will provide good services. Quality indicators can also be used to measure the quality of services. Quality indicators can also help an organisation to know how to provide good quality services. Quality indicators can also be useful in helping people with intellectual disabilities and their families know what to look for when they choose a service.
What did they do?
The researchers conducted a large study and collected information about a lot of difference things that were happening in services and the organisations that managed them. They looked at 14 organisations which managed 272 services and supported 1112 people with intellectual disabilities. The researchers used information from
- staff surveys
- watching the support provided to the people with intellectual disabilities who used the service
- watching the activities and engagement of the people with intellectual disabilities who used the service
- interviews with senior managers, frontline managers and staff
They put all of the information together into a complex statistical model to work out what things were most important to staff using Active Support all the time. This means what things were predictors of Active Support, and need to be in place to ensure staff use Active Support all the time. They statistics they used were called multi-level modelling.
What did they find?
They found the predictors of the staff using Active Support all the time were all of the 4 things they had identified being present in an organisation together. These are shared prioritisation of practice and active support; strongly supporting practice leadership; closeness of practice leadership to every-day service delivery and concentration of practice leadership tasks.
They also found 4 more predictors of good Active Support. Some of these had been found in other studies on Active Support. Three of these things can be changed by organisations that manage services. They were: that the service had 6 or less service users; the manager in the service was good at practice leadership and the staff felt good about the management of their service. The fourth predictor was that service users had lower support needs. Service user support needs cannot be changed by a service providers. So this means organisations have to train staff better to do Active Support with people who have higher support needs.
Other studies have found that staff having training in Active Support is also a predictor of staff using Active Support all the time. The researchers explained that as most of the staff in this study had been trained in Active Support training was not identified a predictor. However, they suggested it should be included as there was evidence from other studies.
The new evidence about predictors of staff using Active Support can help develop a set of quality indicators for good quality services. These indicators can be used to look at each service but also at organisations that manage services.
The findings are important as they set up ways to measure good quality services where staff are using Active Support all the time. With some findings from other studies of Active Support the researchers suggest the following things could be made into quality indicators. This means if these things are present are service is more likely to be good quality.
- Staff training in Active support includes both classroom learning and hands – on practice.
- Practice leadership support for other staff through
- Observing and giving feedback
- Showing staff how to do it right
- Talking about Active Support in meetings
- Planning work rosters
- Looking at how best to support a service user at all times.
- Having practice leaders close to everyday practice.
- Staff feeling good about the management of the service.
- The service is for 6 or less people.
- The people with intellectual disabilities having similar support needs and not all having challenging behaviour.
- Senior staff having a good understanding of what Active Support is. They also see it as important for the people they support to have a good life.
The researchers suggest the quality indicators could be used
- To help people decide which service they want to use
- To help the NDIS Quality and Safeguard Commission with service registration
- To help auditors or the Commission to look at the quality of a service.
Bigby, C., Bould, E., Iacono, T., & Beadle-Brown, J. (2020). Predicting good Active Support for people with intellectual disabilities in supported accommodation services: Key messages for providers, consumers, and regulators. Journal of Intellectual & Developmental Disability, 45(3), 279-289. doi:10.3109/13668250.2019.1685479