Service organisation, staff performance and client outcomes in services for people with learning disabilities

Research into direct-care staff performance in residential services for persons with a learning disability has led to a number of explanatory findings. Variables such as client ability, maladaptive behaviour, the employment status of staff, staff stress, facility size, staffing ratios, training and management strategies have all been found, by different authors, to variously affect levels of staff/client interaction. The influence of an informal social system within a residential service on staff behaviour has not, however, been fully examined. The aim of the study presented in this thesis was to uncover which features of a residential service, its organisation and delivery are responsible for levels of support offered by staff and also for the extent to which clients are engaged in activities. A wide range of variables including those previously found to be significant and others that represented the informal aspects of a service, such as the expectations of others, were included in the study. The main findings were that quality of care in the facilities studied was generally poor. Few significant differences were found between the provision of care offered by the two organisations included in the study although many were expected. Although staff responses revealed that the expectations of others in the workplace might have an influence over the ways in which they work with clients, multiple regression analysis did not find these informal variables to be significant. Only the adaptive behaviour of clients was found to be predictive of the levels of staff support offered. None of the variables included in the analysis was found to be predictive of the levels of client engagement found. The reasons for this are discussed and the proposition that staff behaviour in this study was perhaps contingent on arbitrary, haphazard and unpredictable circumstances was introduced.