This presentation summaries research about the culture in group homes in Australia - it contrasts the positive culture in better group homes which is respectful, coherent, enabling and empowering with culture in underperforming group homes. the difference is not accounted for by resources but organisational factors such as leadership, strong HR policies and translation of values into expectations for staff.

1. latrobe.edu.au CRICOS Provider 00115M
Dimensions of culture in group homes for
people with severe intellectual disabilities.
Professor Christine Bigby & Dr Julie Beadle-Brown
Living with Disability Research Centre
La Trobe University

2. Background – importance of group homes
 Group homes have been a major strategy in implementing disability policy
 Support high numbers of people with more severe intellectual disability (17,000 in
Australia)
 Despite calls for innovative models – still being built
 Good quality of life outcomes are possible (Kozma et al., 2009)
 But high level of variability in outcomes – consistently worse for people with more
severe intellectual disability (graph)
 2 factors reliably predict good quality of life outcomes :
 Adaptive behaviour
 Staff practice

3. 0
20
40
60
80
100
Org 1
<151
Org 1
151 +
Org 2
<151
Org 2
151 +
Org 3
<151
Org 3
151 +
Org 4
<151
Org 4
151 +
Org 5
<151
Org 5
151 +
Org 6
<151
Org 6
151 +
Org 7
<151
Org 7
151 +
Org 8
<151
Org 8
151 +
Whole
<151
Whole
151 +
Percentagetimespentengaged
Engagement for people with less severe
disabilities compared to people with more
severe disabilities
151+ Good
Level
Engagement:
Mean = 75
(45 min per
hour)
minutes per hour
<151 = 19.76
151+ = 38.90
<151 Good
Level
Engagement:
Mean = 54
(32.4 min per
hour)
• Mean engagement much less for people with more severe ID
• Most fall below what is possible to achieve
Sig difference

4. What makes a difference
Complex interactions 5 main elements
Necessary but not
sufficient conditions
• Adequate resources
• Small size, dispersed, homelike
Organisational characteristics focusses on QoL outcomes
Vision – coherent, consistent translation
Policy & Processes, coherent, congruent
• HR processes, job descriptions, recruitment
• Clearly defined procedures to guide work of staff
• Staff training – type, availability and organisation
• Staff characteristics
Culture
• Coherence – formal & informal External environment
• Supportive of QoL outcomes
Frontline staff and managerial working practices
•Staff practice reflect active support
•Staff practice responsive to individuals, compensating for
disadvantageous characteristics
•Front line practice leadership

5. Culture – important but very little evidence
 Consistently identified as influencing staff practices (Felce et al., 2002; Hastings, Remington, & Hatton,
1995; Mansell, McGill, & Emerson, 1994; Felce & Perry, 2007; Stancliffe, Emerson & Lakin, 2004; Walsh et al., 2010).
 Consistently identified as contributing to abuse (Hutchinson & Stenford Kroese, 2015)
 Slippery concept - conceptualised and investigated in quite different ways only
handful of studies
‘The way we do things around here’
 Schein's definition
‘A pattern of shared basic assumptions…that has worked well enough to be considered
valid and, therefore, to be taught to new members as the correct way to perceive, think,
and feel in relation to those problems” (Schein, 1992, p.12).

6. 6
Culture in group homes - Aims
La Trobe University
 Describe the culture – put value to the variable
 Identify relationship between nature of culture and quality of life outcomes
• Identify generative factors
• And by capturing picture of culture associated with good outcomes to inform
development of strategies to foster this type of culture – thus supporting good staff
practice and good outcomes for people in group homes
Draws from evaluation of closure of Kew - 2004- 2007 - Discovery grant 2009-2012
UK School of Social Care Research – 2015- 2017
 Underperforming group homes (Making Life Good)
̶ low levels of engagement, respect, social participation
 ‘Better’ group homes (Ordinary Life)
‒ rather than ‘good’ could be better re personal development and social
relationships (see Bigby et al., 2015)

7. Approach & Methods
 Interpretive paradigm – qualitative ethnographic methods to collect in depth
qualitative data
 Prolonged participant observation & detailed field notes on shift
 Staff interviews, observation of staff meetings, document review
 Different times of day – days of week
 Making life good – 5 group homes
 Re analysis of field notes from Kew study
 26 residents with severe intellectual disability
 45 days – total 209 hours
 14 interviews
 Ordinary life – 3 group homes
 Recruited by reputation and advertisement
 17 residents severe or profound intellectual disability and other complex
physical, health or communication needs
 Participant observation 9-12 months, 60 visits average 3 hrs
 35 staff interviews

8. Analysis
Inductive – coding, category development, constant comparison (Miles & Huberman, 1994)
Analytical lens of culture - staff practices, resident behaviour, interactions between
staff and residents, expressed and inferred values or assumptions concrete
artefacts

9. Findings 5 Dimensions
Dimension Negative end Descriptor
1. Alignment of
power-holders
vales
Misalignment of power holder values with organisation’s
espoused values
• Power not aligned with formal positions, e.g. power
dispersed among staff or held by a small cliques rather
than resting with the house supervisor.
• Values of those who exercise power does not reflect
those of the organisation, e.g. staff disregard goal of
building inclusive communities and focus on
community presence but not participation.
‘We’re not going
to do it that way’
Alignment of power holder and staff values.
• strong leadership
• shared responsibility and teamwork
‘Vision and
mission is exactly
what we live to’
Hypothesised positive end - Alignment
More Positive end
Descriptor

10. 2. Regard for
residents
Otherness
• Residents seen as fundamentally different from staff,
e.g. as childlike, able to watch activities but too
disabled to participate, having no skills, or worries.
• Residents referred to in derogatory terms, e.g.
‘grabbers or shitters’.
‘Not like us’
Dimension Negative end Descriptor
Hypothesised positive end – the same as other citizens
More Positive end
Descriptor
Positive regard as part of the same diverse humanity.
 humanness
 acknowledging and attending to difference
‘Like us’

11. 3. Perceived
purpose
Doing for
• Staff see their purpose to look after residents, attend
to personal care and get them out into the
community.
• Disconnection of staff work from resident
engagement, sequential and hierarchical view of
purpose, completing domestic chores takes priority
over and is separate from involving residents in these
activities.
‘We look after
them’
Dimension Negative end Descriptor
Hypothesised positive end – doing with
More positive end
Making the life each person wanted it to be.
 recognising and respecting preferences
 including and engaging
 ensuring care, dignity and comfort
‘It’s her choice’

12. 4. Working
practices
Staff-centred
• Task focussed and structured into high and low
intensity periods to allow breaks.
• Staff needs, fair allocation of work and staff
preferences prioritised in things such as composition
of rosters and choice of activities.
• Regular routines tend to support residents as a group
rather than individuals.
‘Get it done so
we can sit
down’
Dimension Negative end Descriptor
Hypothesised positive end – client centred
More positive end
Descriptor
Person-centred.
• attentive
• relationships
• flexible
• momentary fun interactions
‘The guys come
first no matter
what’

13. 5. Orientation to
change and
ideas
Resistance
• Sense of distance from the wider organisation and
senior managerial staff
• Strategies to preserve the status quo and resist
external influences seeking change to practice.
‘Yes but’
Dimension Negative end Descriptor
Dimension Hypothesised positive end – openness
More positive end
Descriptor
Openness to ideas and outsiders.
• Permeable boundaries, part of bigger organisation,
part of community
• Families and outsiders welcome
‘Let’s face it
everyone can
improve’
Overarching Culture in Better Group Homes
Coherent – Respectful- Motivating – Enabling

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Generative factors
Frontline staff and managerial working practices
•Staff practice reflect active support
•Staff practice responsive to individuals, compensating for
disadvantageous characteristics
•Front line practice leadership
Organisational characteristics focusses on QoL outcomes
Vision – coherent, consistent translation
Policy & Processes, coherent, congruent
• HR processes, job descriptions, recruitment
• Clearly defined procedures to guide work of staff
• Staff training – type, availability and organisation
• Staff characteristics

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Organisational characteristics
Organisational commitment and HR support to front line leaders – staff management
HR policies regulating entry to organisation
• Recruitment – job descriptions reflect expectations
• Close scrutiny of casual and prospective staff
Organisation of work
• Regulating entry to specific group homes - groups of service users - buddy shifts
• Induction separated from orientation - practice same weight as procedures
• Explicit translation of organisational values – no doubt what’s expected
• Language and communication policies
• First person language plans, communication books
• Artefacts – pictures with family – holidays
• Roster planning –new staff rostered along side more experienced ones
• Skilled staff and supervisors who walk the talk

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Implications
Not quite at hypothesised positive polar end – long way down the dimension
What’s missing ?
 Does care and warmth temper pushing of boundaries of engagement and choice in
activities at home?
 Do the strong relationships and commitment reduce drive or necessity for external
relationships?
 Overstepping the boundaries of professionalism?
 Does culture look different in houses that have stronger outcomes on personal
development and specifically active support and interpersonal relationships,
specifically external social networks?
 These findings supports the importance of strong practice leadership to outcomes and
preliminary findings from study of organisational factors that influence high levels of
active active support (Beadle-Brown, Bigby, Bould, in press)
Supports strong culture thesis
Gives value and meaning to culture in group homes

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References
Beadle Brown, J., Bigby, C., Bould, E. (2015). Development of an observational measure of practice
leadership. Journal of Intellectual Disability Research . DOI: 10.1111/jir.12208
Bigby, C., Knox, M., Beadle-Brown, J., Clement, T., Mansell., J (2012). Uncovering dimensions of informal
culture in underperforming group homes for people with severe intellectual disabilities. Intellectual and
Developmental Disabilities 50, 6, 452–467
Bigby, C., Knox, M., Beadle Brown, J., & Bould, E. (2014). Identifying good group homes for people with
severe intellectual disability: Qualitative indicators using a quality of life framework. Intellectual and
Developmental Disability, 52(5), 348-366. doi: 10.1352/1934-9556-.5.348
Bigby, C., Knox, M., Beadle-Brown, J., & Clement. T., (2015). ‘We just call them people’: Positive regard
for people with severe intellectual disability who live in of group homes. Journal of Applied Research
in Intellectual Disability. 28, 283–295
Bigby, C., & Beadle-Brown, J. (in press). Culture in better group homes for people with severe and
profound intellectual disability Intellectual and Developmental Disability
Clement, T. & Bigby, C. (2010). Group homes for people with intellectual disabilities: Encouraging inclusion
and participation. London, Jessica Kingsley
Kozma, A., Mansell, J., & Beadle-Brown, J. (2009).Outcomes in different residential settings for people
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