Tim Clement

‘It's pretty hard with our ones, they can't talk, the more able bodied can participate’: staff attitudes about the applicability of disability policies to people with severe and profound intellectual disabilities

BACKGROUND The level of residents adaptive behaviour and staff facilitative practices are key sources of variation in outcomes for residents in community-based residential services. The higher the resident support needs the poorer their outcome. Although substantial investment has been made in values-based training for staff, their attitudes and the impact of these on practice is largely unexplored. METHOD AND FINDINGS The first study used ethnographic and action research methods to examine the daily lives of 25 residents with severe and profound intellectual disabilities (ID), who lived in five small group homes, and the attitudes of the staff supporting them. Thematic analysis of the data led to a proposition that although staff accept principles of inclusion, choice and participation for people with ID in general, they do not consider it feasible to apply these to the people with severe and profound ID to whom they provide support. The findings from a second study that used a group comparison design and administered a short questionnaire about staff attitudes to 144 direct-care staff and first-line managers working in disability services confirmed this hypothesis. CONCLUSIONS The study suggests more focused attention is needed to staff understanding the values embedded in current policies and their application to people with more severe disabilities.

Uncovering Dimensions of Culture in Underperforming Group Homes for People with Severe Intellectual Disability

Culture recurs as an important but under-investigated variable associated with resident outcomes in supported accommodation for people with intellectual disability. This study aimed to conceptualize the potential dimensions of culture in all group homes and describe the culture in underperforming group homes. A secondary analysis, using an inductive interpretative approach, was undertaken of a large qualitative data set from a study that had used ethnographic and action research methods to explore the quality of life outcomes for residents in 5 small group homes. Five categories were developed: misalignment of power-holder values with organizations espoused values, otherness, doing for not with, staff centered, and resistance. Differences from institutional culture are discussed, and the potential of the findings as a starting point to consider culture in high performing group homes and develop a quantitative measure of culture.

Competencies of front-line managers in supported accommodation: Issues for practice and future research

Abstract Background Front-line managers of supported accommodation for people with intellectual disability are assumed to have a key role in the realisation of outcomes for service users. Yet, their job has been little researched. A job analysis from Minnesota that identified 142 competencies required of effective front-line managers was used to examine what was expected of the equivalent position in Victoria, Australia. Methods These competencies formed the basis of semistructured interviews with an extreme sample of 16 high-performing house supervisors and 5 more senior managers. Results Ninety-two percent of the original competences were retained, with changes in language and terminology to reflect the local context. Emergent findings highlighted the importance of house supervisors’ “orientations.” Conclusions The findings support the proposition that the front-line managers job is underpinned by core competencies and that the role merits further study. Issues of wider significance for human service organisations and researchers are discussed.

Ethical challenges in researching in group homes for people with severe learning difficulties: shifting the balance of power

Our aim in this paper is to open up debate about informed consent. We do this by presenting stories from group homes where staff have frustrated our research efforts and marginalised the interests of people with severe learning difficulties. We problematise normative ethics and argue that in some circumstances the basic principle of informed consent should be waived for employees of human service organisations. We maintain that, in such circumstances, researchers and an organisation’s senior managers can still act in a manner that is consistent with the broad aims of ethical regulation. We consider the role of Research Ethics Committees and suggest that in order to fully consider the conflicting interests of multiple stakeholders, the application of different ethical theories is required. A requirement for making balanced ethical judgements is to see outside the extant dominant view of ethical research standards and behaviour.

Ad hoc supervision of general practice registrars as a ‘community of practice’: analysis, interpretation and re-presentation

Abstract General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger’s (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning (‘communities of practice’) guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger’s theory and highlights the researchers’ interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others’ experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

The supervisory encounter and the senior GP trainee: managing for, through and with

Help‐seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs.

“Underdiscussed, underused and underreported”: Pilot work in team-based qualitative research

Purpose The authors, with disparate organisational affiliations and in different geographic locations, worked together on a qualitative multiple-case study of ad hoc supervisory encounters between general practice (GP) supervisors and GP-registrars. The purpose of this paper is to share our experiences and learning to highlight how valuable pilot work can be when conducting team-based qualitative research. Design/methodology/approach This paper outlines the value of pilot work in consolidating whole team understanding of the research plan, using our experiences as an example. We first offer a synthesis of published literature relating to pilot work, especially in qualitative research approaches. Next, we outline and justify the pilot work undertaken for the ad hoc supervision study. Lastly, we use each researcher’s voice to describe our experiences and then share the lessons we learned undertaking pilot work in qualitative research. Findings We found that while pilot work can be useful in refining strategies, data collection processes and analytic instruments. There are further benefits in galvanising whole team understanding of the research plan, in encouraging reflexivity, in ensuring transparency of the research process, and for ethical considerations. Originality/value There are few published papers or books which offer researchers guidance regarding pilot work, especially within a qualitative paradigm. Our experience shows there is value in planning and conducting pilot work. We believe others may benefit from our experience as they embark on team-based research.

Bye-Bye Charlie: Stories From the Vanishing World of Kew Cottages

I feel compelled to declare upfront that I was not a dispassionate reader of Bye-Bye Charlie, Corrine Manning’s oral history of the first purpose-built institution for people with intellectual disabilities in Australia. Opened in 1887 as Kew Idiot Asylum, it closed in 2008 as Kew Residential Services. It was also Australia’s largest institution for people with intellectual disabilities, its population peaking at 948 residents in 1968. The book quotes Sherryl Garbutt, a former Victorian Minister for Community Services, as stating in 2003 that ‘‘Kew Cottages belongs to a bygone era where people with intellectual disability were hidden from the community like a shameful secret. That is why we are closing them’’ (p. 231). For the past 3 years my livelihood has been tied to Kew’s closure, as I have worked on Making Life Good in the Community, a research project concerned with the lives of Kew’s former residents, now living mainly in purpose-built group homes. In a sense, many of us need Kew’s past to be ‘‘shameful’’ in order to justify the services that have replaced it. It has always been easy to talk about institutions as if there are no shades of grey. Institutions are bad, the community is good. So goes the mantra. We can tarnish both a staff member and his practice by prefixing both with the adjective ‘‘institutionalised’’. Bye-Bye Charlie reminds us that Kew’s contribution to the ‘‘care’’ of people with intellectual disabilities is not so clear cut. We may not know that when the institution first opened it was regarded as a world-leading facility, based on high ideals, which emphasised residential care and educational opportunities. Manning also informs us that there have been key moments in Kew’s history, such as the very public fire that killed nine residents in 1996 that have not been secret, and the practice of a good number of staff and volunteers have been anything but shameful. Oral history is a means by which stories from bygone eras can be collected and preserved. Corrine Manning’s aim was to write a history of Kew based on the memories of people intimately associated with it. In this way, people’s accounts enter the public domain and help ensure that they will be remembered. As well as making sure that the voices of people with intellectual disabilities are heard, we also get to listen to a range of stakeholders, such as families, staff, volunteers, administrators, and advocates.