Initial Investigation of Organisational Factors Relevant to Implementing Active Support

1. Initial Investigation of Organisational Factors Relevant to Implementing Active Support ASSID Canberra, 2006 Risk and Resilience: Hope for the Future Project Funded by Department of Human Services, Disability Services Division, Victoria mcfyffe@ozemail.com.au

2. Project rationale • The relationship between increased resident engagement and Active Support staff practice is well established in the international research literature • Beyond consideration of the training programs for staff, how Active Support staff practice is established and maintained within an organisation has been less well investigated. • This project aimed to identify organisational factors contributing to the changed staff practices consistent with implementing Active Support. mcfyffe@ozemail.com.au

3. Questions • Is there a relationship between the staff reports of the occurrence of specific organisational activities and: • The staff reports of changed staff practice consistent with Active Support implementation, and • Minimisation of problems associated with Active Support implementation? • Are there differences between the reports from house staff, house supervisors and Active Support regional managers, and • How might this affect Active Support implementation? mcfyffe@ozemail.com.au

4. Diagram 1: STRUCTURE OF THE IMPLEMENTATION FRAMEWORK FOR THE ACTIVE SUPPORT PILOT Training House meetings Teamwork Role of management Recording/ paperwork Unexpected/exceptional Knowledge of engagement Ultimate goal: Increased residents’ engagement Intended direct result of pilot: Changed staff practices Few implementation problems Identified components of successful implementation mcfyffe@ozemail.com.au

5. Development of questionnaires • Questions developed from research literature and staff and manager interviews • For direct care staff, house staff and regional management staff involved the same questions about the occurrence of: • Training for Active Support • Teamwork • House-based meetings • The role of regional managers • Paper work for Active Support • Changed staff practice consistent with Active Support • Common implementation problems with Active Support. • Additional categories of questions considered: • Respondents’ understanding of resident engagement • For house supervisors and managers the occurrence of: • *Training relevant to staff supervision and performance feedback • *Region-wide planning processes to support Active Support • *Note: Not reported today mcfyffe@ozemail.com.au

6. Examples of questionnaire items • Training for Active Support • Were you part of a one or two day training course with other house staff about Active Support? • Do you know how you’re going with Active Support because of regular feedback from the house supervisor? • Team work • There is stable team membership with few changes of staff • There are ways to work out problems and disagreements in this team if they arise • Staff work as a team to coordinate residents’ routines and choices • House meetings • Are there regular house staff meetings (eg 4-6 weekly) with Active Support as a fixed agenda item? • Does the agenda include how to support residents in daily activities? • Are the participation summaries discussed at each staff meeting? • Active Support paperwork • Are Activity and Support Plans worked out every day? • Is each resident’s participation recorded at the end of each shift? • Are there written protocols describing for staff how best to engage with each resident and how to provide ‘just enough’ support? mcfyffe@ozemail.com.au

7. Examples of questionnaire items • Changes since implementing Active Support • There have been increases in what staff think residents can do and how residents can participate in daily activities. • Staff spend more time interacting with residents than before Active Support • Active Support and engagement is: • Talking or listening to another person • Just walking around holding something • The role of regional managers (not the house supervisor) • Regional managers are regularly involved in various ways to support staff, and monitor Active Support implementation • Regional managers visit the house even when things are going well • Common problems with Active Support • Staff don’t try to fill in forms accurately and get frustrated, confused or annoyed • Staff have too many other things to do to do Active Support mcfyffe@ozemail.com.au

8. Information gathering • How to complete the questionnaireEach question has four options for your answer. On the basis of your experiences and knowledge in this house: • Answer ‘yes’ if this statement is definitely or generally true. • Answer ‘no’ if this statement is rarely or never true. • Answer ‘sometimes’ if the statement is sometimes true and sometimes not true, that is if the statement is only true some or part of the time. • Answer ‘don’t know’ if you don’t know anything about this statement or it’s not your role • Questionnaires were completedindividually and confidentially as part of a staff meeting, or completed independently by managers mcfyffe@ozemail.com.au

9. Responses analysed • ‘Yes’ responses • Training for Active Support • Teamwork • House-based meetings • The role of regional managers • Paper work for Active Support • Changed staff practice consistent with Active Support • ‘No’ responses • Common implementation problems with Active Support. • ‘Yes’ or No’ responses • Respondents’ understanding of resident engagement • Training relevant to staff supervision and performance feedback • Region-wide planning processes to support Active Support mcfyffe@ozemail.com.au

10. Analysis • Relationship between the frequency of responses to six input measures and two output measures. • Mean percentage of responses overall and by house. • Spearman correlations between inputs and outputs • Multivariate analyses using multiple linear regressions to explore the relationships between inputs and outputs in more depth. • Exploratory analysis that categorises individuals according to the responses on the inputs and assesses whether these groups differ in the mean percentage of responses on the outputs. mcfyffe@ozemail.com.au

11. Respondents • 64 respondents from 11 houses (comprising 11 house supervisors and 53 direct support house staff). • 16 regional managers – various • Trends in house supervisor responses overall did not differ significantly from the responses of other staff • Trends in regional managers’ responses overall did not differ significantly from the responses of other staff exceptregional managers reported significantly more of their activities were occurring consistent with supporting Active Support implementation than house staff and house supervisors. • Regional managers are not included in subsequent figures due to low numbers, role across several houses etc mcfyffe@ozemail.com.au

12. Percentage scores • The lowest mean (and median) percentage responses was recorded for the management input (mean=24.6%, median=12.5%). • The highest mean (and median) percentage of responses was recorded for the knowledge of AS input (mean=64.8%, median=72.7%) and teamwork (mean=63.1%, median 68.8%) • The percentage responses for each organisational input category ranged from around one quarter to just under two thirds, well below 100 percent performance. • The percentage responses for the reports of changed staff practice averaged below fifty percent, suggesting some progress with changed staff practices. mcfyffe@ozemail.com.au

13. Spearman correlations for the relationship between inputs and outputs** Correlation is significant at the .01 level (2-tailed).* Correlation is significant at the .05 level (2-tailed). mcfyffe@ozemail.com.au

14. Relationships between items • More (or less) reports of the activities related to training, teamwork, meetings and paperwork were associated with higher (or lower) reports of staff practice consistent with Active Support. • This relationship also exists, but less strongly, between the knowledge of Active Support input and changed staff practice output. • Significantly, but to a lesser extent, more reports of the activities related to training, teamwork, meetings and paperwork are associated with reports of fewer of the common Active Support implementation problems. These relationships are lower than those observed for the changed staff practice output. • The changed staff practice output is associated with fewer implementation problems. • Management category and knowledge of Active Support category do not vary with the other inputs. mcfyffe@ozemail.com.au

15. Predicting outputs from inputsfrom multiple linear regressions • Predicting changed staff practice from inputs: R2 = .63, ie 63% of variation accounted for. The overall regression model was significant, F (6, 57) = 18.5, p<0.05. • Predicting fewer implementation problems for inputs: The regression was only a fair fit as indicated by the adjusted R2 = .28 The overall regression model was significant, F (6, 57) = 5.0, p<0.05 • Changed staff practice scores were predicted better from the organisational inputs, than the reports of fewer implementation problems. • Teamwork, meetings and paperwork made a significant contribution to the prediction of changed staff practice scores. • Only teamwork made a significant contribution to the prediction of fewer implementation problem scores. Strong teamwork is a very important aspect of Active Support implementation. • Management and knowledge of Active Support did not predict the changed staff practice or fewer implementation problems. mcfyffe@ozemail.com.au

16. Regional managers responses- a guide only • The pattern of correlations between the inputs and outputs is similar for regional managers and house staff. • There is a strong correlation between training, teamwork, meetings, paperwork and changed staff practice. • The management input was not associated with other measures. mcfyffe@ozemail.com.au

17. Training • About two thirds of house staff and of regional managers reported they would recommend the Active Support training. Given the association between training and changed staff practice in this study, there is a need to ensure that most participants in training find it useful and report this to others. This may suggest there were some finer grain variations in training quality beyond what this study could detect. • House supervisors reported a greater occurrence of training relevant to Active Support than regional managers, except in relation to performance feedback. This may explain part of the difference between the perceptions of what regional managers are doing to support Active Support. Regional Managers may simply know less about Active Support. mcfyffe@ozemail.com.au

18. Most common implementation problems • ‘Staff don’t try to fill informs accurately and get frustrated, confused or annoyed.’ The problems with the paperwork requirements have been identified throughout the project. • ‘There are things which really interfere with doing Active Support, which are nothing to do with Active Support eg industrial relations, staff changes, illness or leave, computer problems.’ The identification of the exceptional and extraneous issues which can overwhelm Active Support implementation supports the Implementation framework. mcfyffe@ozemail.com.au

19. Conclusions - Using the implementation framework • Is there a relationship between the staff reports of the occurrence of the organisational inputs and changed staff practice? • There is support for the proposed Implementation framework developed in this project. However, in the future it is important not rely on staff report alone and to introduce independent monitoring of staff practice and resident engagement. • Increasing the activities associated with staff training, house level team work and meetings and Active Support recording and paperwork were associated with increases in reports of changed staff practice in particular and fewer reports of Active Support implementation problems. • This relationship between the inputs was stronger with changed staff practice than for reducing implementation problems. Other factors may be contributing to implementation problems and such problems could be concurrent with Active Support practice being solidly implemented. The occurrence of problems and changed staff practice are not mutually exclusive and the strongest relationships were between organisational processes and reports of changed staff practice. • Strong teamwork emerges as a very significant variable. mcfyffe@ozemail.com.au

20. The role of regional management and knowledge alone of Active Support emerge as weak in their effect on current Active Support implementation regarding changed staff practice or fewer implementation problems. • The low levels reported of management activity may be relevant here. Perhaps regional managers’ activities are at a sufficiently low level so as not to influence staff practice or the minimisation of implementation problems. mcfyffe@ozemail.com.au

21. Are there differences between the reports from house staff, house supervisors and Active Support regional managers? • Regional managers report a higher level of their activities than house based staff. • These overall results may reflect the extent to which house teams can achieve changed staff practice and minimise implementation problems, with little regional management input. mcfyffe@ozemail.com.au

22. Final reflections • This study does identify implementation strategies for Active Support implementation. The items identified could be used to assist organisations plan and implement AS practice. • The effect on Active Support implementation with strong regional manager involvement is yet to be tested, but is predicted to be an important input. mcfyffe@ozemail.com.au