Article

Communication Quality Indicators: A Survey of Connecticut Group Home Managers

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Abstract

Thirty-one Connecticut group home managers responded to a 23-statement survey adapted from the Communications Supports Checklist for Programs Serving Individuals with Severe Disabilities (CSC; McCarthy et al., 1998, Paul H. Brookes, Baltimore, MD.). Results indicated that group home managers had very favorable opinions about the implementation of communication quality indicators in their group homes, and the degree of a residents intellectual disability was not a factor in communication supports implementation. Three communication quality indicators were rated especially high: program philosophy, protection of communication rights, and assessment. Environmental support for communication was rated less favorably. Follow-up interviews with seven group home managers found that they especially valued direct care staff who understood a residents idiosyncratic communication (e.g., response sensitivity). Managers also relied on team process for referral for ongoing speech-language consultation. Results from the surveys and interviews indicated that augmentative communication applications occurred less often than other quality communication indicators.

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... They reported, however, lower rates of actual practice using the quality indicators in their work with residents with severe disabilities. DeSimone and Cascella (2005) examined the opinions of 31 group home managers using a modified survey from the CSC. Results suggested there was high agreement, with 90% of all quality indicator statements. ...
... The research using the CSC quality indicators by DeSimone and Cascella (2005) and Ogletree et al. (2000) indicates that speech-language pathologists in residential settings and group home staff value the best-practice quality indicators. These studies, however, indicate that they may not be utilizing these indicators in their service delivery with individuals who have severe disabilities. ...
... Unfortunately, this practice seems to broaden each year while professional preparation struggles to keep pace. It is not known whether speech-language pathologists in schools who serve diverse individuals with communication impairments would respond similarly to their residential counterparts surveyed by Ogletree et al. (2000) and DeSimone and Cascella (2005). ...
Article
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Unlabelled: Speech-language pathologists in school settings were surveyed with an instrument created from the National Joint Committee for the Communication Needs of Persons with Severe Disabilities' quality indicators self-assessment tool. Participants valued practice indicators of quality communication assessment and intervention to a higher degree than their actual practice. These findings appear to suggest that SLPs may not provide best practice services to individuals with severe disabilities. Suggestions for enhancing inservice training and intervention practices of SLPs and team members who work with individuals with severe disabilities are provided. Learning outcomes: The reader will be able to; (1) understand the value of using the NJC quality indicators to guide SLP practices with individuals with severe disabilities in schools; (2) recognize that research indicates that SLPs working with individuals with severe disabilities in schools may not provide best practice services to the extent that they value these practices; (3) discuss possible strategies to increase the quality of services provided to individuals with severe disabilities in schools.
... This time scale of 6 months was used as a sampling criterion in other studies (DeSimone & Cascella 2005). Following receipt of ethical approval by the ethics committee of the organisation, access was granted to thirteen residential services comprising of large residential settings, group homes, community hostels and semi-independent living services. ...
... A quantitative self-report questionnaire developed by DeSimone & Cascella (2005) based on the theoretical constructs of the Communication Supports Checklist for Programs Serving Individuals with Severe Disabilities (CSC) (McCarthy et al. 1998) and adapted by the principal investigator was used with permission for data collection. ...
... Communication supports exist in environments where staff have appropriate skills allowing them to communicate effectively with service users (Bradshaw 2001;Healy & Noonan Walsh 2007;Lund & Light 2007;McConkey et al. 1999;Ogletree et al. 2000). While front-line staff recognise the importance of communication supports, it is evident from the findings of this study that supports are not consistently available for those who require them suggesting a gap exists between best practice guidelines and clinical practice, a finding reflected in other studies (Carnine 1997;DeSimone & Cascella 2005;Ogletree et al. 2000). This disparity must be addressed to ensure effective communication supports are available in residential services. ...
Article
Accessible summary • Support staff were asked what were the important things they did to support people with an intellectual disability and communication difficulties. • Support staff said that they understood that facilitating people to communicate effectively could improve the quality of life of these people. • However, support staff said they did not always have the training or resources to provide this support. • Support staff need to learn more about how to support people with an intellectual disability and ensure their right to communicate is upheld. Summary This study explores front-line staff knowledge and perceptions of how people with intellectual disability residing in residential services are supported to communicate effectively. Participants (n = 138) completed a self-report questionnaire adapted from an instrument developed by DeSimone & Cascella (2005) Journal of Developmental and Physical Disabilities, 17(1): 1. Support staff recognise that facilitating people with an intellectual disability to communicate is an important part of their role. Support staff indicate that when the importance of supporting communication is recognised and prioritised, it has a marked impact on the quality of life of people availing of residential services. However, front-line staff indicate that they do not always have the knowledge or resources to provide such supports. Lack of specialist support services such as speech and language therapists is identified as a constraint. It is suggested that an organization-wide commitment is required across front-line services to ensure that the right of people with an intellectual disability to communicate is upheld.
... This article set out to explore the successes and challenges of implementing a range of AAC methods within one school. The findings of this study correspond with those of other studies (Dalton & Sweeney, 2011;DeSimone & Cascella, 2005;Hetzroni & Roth, 2003) in that the use of AAC is widely understood by supportive adults to facilitate communication, but is hindered in its consistent use by the lack of staff confidence and the priority placed on it within schools. The reported lack of training and inadequacy of understanding of AAC is supported in the literature by other studies that have surveyed AAC (Baxter et al., 2012;Light & Drager, 2007;Martin & Alborz, 2014;Siu et al., 2010;Tam et al., 2003;Weiss et al., 2005). ...
... This article set out to explore the successes and challenges of implementing a range of AAC methods within one school. The findings of this study correspond with those of other studies (Dalton & Sweeney, 2011;DeSimone & Cascella, 2005;Hetzroni & Roth, 2003) in that the use of AAC is widely understood by supportive adults to facilitate communication, but is hindered in its consistent use by the lack of staff confidence and the priority placed on it within schools. The reported lack of training and inadequacy of understanding of AAC is supported in the literature by other studies that have surveyed AAC (Baxter et al., 2012;Light & Drager, 2007;Martin & Alborz, 2014;Siu et al., 2010;Tam et al., 2003;Weiss et al., 2005). ...
Article
This study surveyed staff use of augmentative and alternative communication (AAC) within a large inner city special school for children with complex needs and learning disabilities. A questionnaire asked 72 staff members about the range of AAC strategies they typically used during the working day and how often they used it; training they had received about AAC; and which AAC approaches they found easy to use and those they found difficult. A range of AAC approaches were identified by staff. Participant confidence and understanding of the reasons for using identified AAC strategies was reported to be one of the key barriers to implementing AAC effectively. The implications in relation to how children with complex needs receive support for their receptive and expressive communication within an education environment are discussed.
... Because multiple staff-related factors may influence AAC use, the self-developed questions comprised several aspects surrounding AAC implementation and were inspired by earlier studies (see Appendix A, for interview items). The items pertained to staff-client interaction (Dalton & Sweeney, 2013;DeSimone & Cascella, 2005), AAC purpose and value (Johnson et al., 2006;McCall et al., 1997;Stans et al., 2013), AAC use (Smith & Connolly, 2008;Stans et al., 2013;Torrison et al., 2007), staff training and skills (Bradshaw & Goldbart, 2013;Murphy et al., 1996), and team support (Batorowicz & Shepherd, 2011). ...
Article
Background Research findings suggest that direct support staff use augmentative and alternative communication (AAC) inconsistently. Various staff-related factors have been identified, and researchers agree that these factors somehow interrelate. Therefore, we approached AAC use as a behavioural process and examined the synergy between staff-related factors. Method Fifteen direct support staff and 10 speech-language/occupational therapists who work with adults who have an intellectual disability and use AAC were individually interviewed. Transcripts were studied using thematic analysis. Results Three main themes were discerned: consistent versus inconsistent AAC usage in direct support staff; time as a real and virtual barrier; friction in the peer–expert relationship. Conclusions Direct support staff primarily used AAC when there was an acute need for communication support. In contrast, both direct support staff and speech-language therapists felt that direct support staff should consistently provide augmented input. This discrepancy was driven by team dynamics as well as actual and perceived lack of time.
... (DeSimone & Cascella, 2005), they know fewer key word signing than their clients according to a survey . Staff who are untrained in key word signing may fail to recognize and interpret the communicative signals of clients who use this AAC strategy (Chadwick & Jolliffe, 2009). ...
Article
Purpose: Research has demonstrated that formal training is essential for professionals to learn key word signing. Yet, the particular didactic strategies have not been studied. Therefore, this study compared the effectiveness of verbal and video feedback in a key word signing training for future direct support staff. Method: Forty-nine future direct support staff were randomly assigned to 1 of 3 key word signing training programs: modeling and verbal feedback (classical method [CM]), additional video feedback (+ViF), and additional video feedback and photo reminder (+ViF/R). Signing accuracy and training acceptability were measured 1 week after and 7 months after training. Results: Participants from the +ViF/R program achieved significantly higher signing accuracy compared with the CM group. Acceptability ratings did not differ between any of the groups. Conclusion: Results suggest that at an equal time investment, the programs containing more training components were more effective. Research on the effect of rehearsal on signing maintenance is warranted.
... Why should this be so? Although evaluating the many potential explanations are beyond the scope of the current study, it is notable that recent surveys of communication supports available to users of intellectual and developmental disabilities residential services in Connecticut (DeSimone & Cascella, 2005) and Ohio (Mitchell, 2009) both showed that the lowest quality ratings were evident for responses to the item, ''staff know how to use AAC systems and devices used by individuals.'' This suggests that a lack of staff knowledge about AAC may contribute to the low levels of usage that we found. ...
... Why should this be so? Although evaluating the many potential explanations are beyond the scope of the current study, it is notable that recent surveys of communication supports available to users of intellectual and developmental disabilities residential services in Connecticut (DeSimone & Cascella, 2005) and Ohio (Mitchell, 2009) both showed that the lowest quality ratings were evident for responses to the item, ''staff know how to use AAC systems and devices used by individuals.'' This suggests that a lack of staff knowledge about AAC may contribute to the low levels of usage that we found. ...
... Why should this be so? Although evaluating the many potential explanations are beyond the scope of the current study, it is notable that recent surveys of communication supports available to users of intellectual and developmental disabilities residential services in Connecticut (DeSimone & Cascella, 2005) and Ohio (Mitchell, 2009) both showed that the lowest quality ratings were evident for responses to the item, ''staff know how to use AAC systems and devices used by individuals.'' This suggests that a lack of staff knowledge about AAC may contribute to the low levels of usage that we found. ...
Article
This study describes uptake of augmentative and alternative communication systems by adults with intellectual disabilities; their ability to self-report at interview; differences in self-reported loneliness experiences by communication mode; and predictors of loneliness. We analyzed National Core Indicators data from 26 US states involving over 13,000 service users grouped by primary means of expression: natural speech, gestures/body language, manual signs, or communication aid/device (aided AAC). Uptake of aided AAC was low; only 0.8% of participants used aided AAC as their primary means of expression. Valid interview responding was higher in turn for participants communicating with natural speech, aided AAC, and other modes. Almost half the participants were lonely, but loneliness did not differ by communication mode used; social contact and social climate variables predicted loneliness. Individuals who used aided AAC communicated more effectively than users of other non-speech modes, supporting more widespread use of aided AAC. Loneliness was prevalent but aided AAC users were not lonelier. Interventions to reduce loneliness are discussed.
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Objectives: To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support. Methods: We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis. Result: All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support; 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information. Conclusions: Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs. Practice implications: Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.
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Background: This study examined whether Motivational Interviewing (MI) follow-up calls improved the extent to which a specific therapeutic technique (Key Word Sign) presented in training was retained and implemented by staff supporting people with an intellectual disability. Method: Thirty-eight residential support workers who attended Key Word Sign (KWS) training were divided into three groups. One group received post training MI follow-up calls, the second received non-MI “check-in control” (CIC) follow-up calls and the third received no follow-up calls. Results: Both follow-up conditions outperformed the no follow-up condition on KWS knowledge retention and use. No significant differences were noted between the MI and CIC condition in this study. Conclusion: The results highlight the value of post-training follow-up in promoting knowledge retention and implementation of skills. Methodological challenges (including treatment fidelity issues across groups) prevented firm conclusions about the impact of MI from being drawn.
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This study documents the communication strengths of 14 adults who resided in community group-home settings through the use of staff informant reports. These participants had as many as 12 different communication forms (e.g., reaching gestures, body orientation, facial expression, leading gestures, eye gaze, vocalizations) and 11 different communication functions (e.g., conveying emotional state, making a choice when one was presented, requesting desired objects and people, conveying protest). The author compares his results to an earlier report (McLean, Brady, McLean, & Behrens, 1999) to demonstrate that caregiver report was as clinically useful as structured sampling in identifying the communication repertoires of these individuals. The author also discusses clinical implications with regard to the role of the speech— language pathologist and communication assessment in the adult community group-home setting.
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Background Communication skills are important to the pursuit of increased self-determination in individuals with disabilities. The aim of this investigation was to gather information about communication supports in state-run residential care facilities in Ohio, and to compare findings with a previous investigation on this topic examining such perceptions in group home environments. Methods An online survey was adapted from DeSimone & Cascella [Journal of Developmental and Physical Disabilities, 17, 2005, 1] to examine perceptions of habilitation managers regarding the quality of communication supports in their settings. Perceptions of communication supports by program manager-level staff in larger group residential facilities had not been previously investigated. Results Respondents reported a generally high quality of communication supports provided in their settings. Despite this general level of perceived quality, certain quality indicators related to supports for communication were relatively lower across respondents and were consistent with DeSimone & Cascella.
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Accessible summary• Support staff were asked what were the important things they did to support people with an intellectual disability and communication difficulties. • Support staff said that they understood that facilitating people to communicate effectively could improve the quality of life of these people. • However, support staff said they did not always have the training or resources to provide this support. • Support staff need to learn more about how to support people with an intellectual disability and ensure their right to communicate is upheld. SummaryThis study explores front‐line staff knowledge and perceptions of how people with intellectual disability residing in residential services are supported to communicate effectively. Participants (n = 138) completed a self‐report questionnaire adapted from an instrument developed by DeSimone & Cascella (2005) Journal of Developmental and Physical Disabilities, 17(1): 1. Support staff recognise that facilitating people with an intellectual disability to communicate is an important part of their role. Support staff indicate that when the importance of supporting communication is recognised and prioritised, it has a marked impact on the quality of life of people availing of residential services. However, front‐line staff indicate that they do not always have the knowledge or resources to provide such supports. Lack of specialist support services such as speech and language therapists is identified as a constraint. It is suggested that an organization‐wide commitment is required across front‐line services to ensure that the right of people with an intellectual disability to communicate is upheld.
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Speech-language pathologists were surveyed with an instrument created from The National Joint Committee for the Communicative Needs of Persons with Severe Disabilities' quality indicators self-assessment tool. Participants reported to value highly and, to a lesser degree, practice indicators of quality communication-based service delivery for persons with severe disabilities. Infrequent negative ratings for individual survey items and significant differences between opinion and practice ratings overall were unexpected and somewhat troubling. These findings would appear to suggest that in some areas of clinical practice even the most qualified speech-language pathologists fail to value and provide best practice services. Suggestions for promoting best practice are provided.
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Within both the pragmatics orientation and the revised definition of MR, the discussion of communication disorders for children with MR has begun to de-emphasize a developmental content-form protocol for assessment and intervention. Instead, the current model suggests the importance of communication stimulation and support in daily routines, the nature of which includes the perceptions and expectations of communication partners, and the characteristics of the social interaction that affect communication style.
How often and consistently do these get carried out? Changed? What would determine their needing a change? Communication instruction in the 1990's: An overview of future directions Communication Strategies for People With Developmental Disabilities: Issues From Theory and Practice
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Describe the communication goals that your residents currently have in place. How often and consistently do these get carried out? Changed? What would determine their needing a change? REFERENCES Arthur, M. (1994). Communication instruction in the 1990's: An overview of future directions. In Lightfoot, K. (ed.), Communication Strategies for People With Developmental Disabilities: Issues From Theory and Practice, Paul H. Brookes, Baltimore, MD, pp. 177–197.
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