Factors associated with increases over time in the quality of Active Support in supported accommodation services for people with intellectual disabilities: A multi-level model.
Strong practice leaders plus trained staff drive steady gains in Active Support quality in group homes.
01Research in Context
What this study did
Bould et al. (2019) tracked what makes Active Support better over time in group homes for adults with intellectual disability. They used a multi-level model to test staff training, practice leadership, and service size.
The team looked at repeated quality scores from many homes. They wanted to know which levers actually move the needle.
What they found
Two factors stood out: strong practice leadership and staff trained in Active Support. Where both were present, support quality rose year after year.
Larger, more mixed services improved more slowly. Size and complexity worked against change.
How this fits with other research
McGonigle et al. (2014) saw the same link between practice leadership and Active Support, but only when overall management was already good. Emma’s team shows the effect holds even after controlling for service traits—an extension, not a clash.
Lemons et al. (2015) built the tool that measures practice leadership. Emma used that lens, so the two papers fit like hand and glove.
Friedman (2018) found that keeping the same DSP boosts client quality of life. Emma adds that trained staff plus strong front-line leaders lift the whole service. Different angles, same message: invest in people.
Why it matters
If you run or consult on residential services, focus on two things: grow practice leaders and train every DSP in Active Support. Push administration to keep caseloads small and teams stable. These moves cost less than new buildings yet yield steady gains in support quality.
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02At a glance
03Original abstract
BACKGROUND: Disability support organisations have embraced Active Support, but it has proved difficult to embed in services. AIMS: This study aimed to identify the factors associated with increases over time in the quality of Active Support. METHOD: Data were collected on the predicted variable of the quality of Active Support, and predictor variables of service user, staff and service characteristics, including practice leadership, and composition and size of services from 51 services in 8 organisations over 2-7 time points. Data were analysed using multi-level modelling. RESULTS: There was significant linear change in Active Support scores (group mean centered at the organisational level) over time. Individuals with lower support needs received better Active Support and those with higher support needs experienced greater increases over time. Stronger practice leadership and more staff with training in Active Support were significant predictors of the quality of Active Support. Larger services with seven or more individuals and where there was a very heterogeneous mix of individuals were associated with lower quality of support. CONCLUSIONS: Ensuring strong practice leadership, and staff training in Active Support that emphasises the principle of adapting support to each individual's level of ability and preferences are key to delivering high levels of Active Support.
Research in developmental disabilities, 2019 · doi:10.1016/j.ridd.2019.103477