Active Support Measure: a multilevel exploratory factor analysis.

BACKGROUND: Active Support is a person-centred practice that enables people with intellectual disabilities (IDs) to engage in meaningful activities and social interactions. The Active Support Measure (ASM) is an observational tool designed to measure the quality of support that people with IDs living in supported accommodation services receive from staff. The aim of the study was to explore the underlying constructs of the ASM. METHODS: Multilevel exploratory factor analysis was conducted on ASM data (n = 884 people with IDs across 236 accommodation services) collected during a longitudinal study of Active Support in Australian accommodation services. RESULTS: Multilevel exploratory factor analysis indicated that 12 of the ASM's 15 items loaded on two factors, named Supporting Engagement in Activities and Interacting with the Person. CONCLUSIONS: The 12-item ASM measures two dimensions of the quality of staff support. Both technical and interpersonal skills comprise good Active Support.

The strength of Frontline Practice Leadership in Australian supported accommodation services: Challenges confronting service providers.

BACKGROUND: The strength of practice leadership predicts the quality of Active Support but it can be compromised by other demands on frontline managers. The study aimed to identify and understand differences in practice leadership over time and between organisations. METHOD: Data collected in 2022 in 96 services from 11 organisations using the Observed Measure of Practice Leadership were compared to similar data from 2013 and 2018. Qualitative fieldnotes were analysed thematically. FINDINGS: Practice leadership scores increased significantly between 2013 and 2018 but declined significantly between 2018 and 2022. Scores were significantly higher in organisations that had implemented Active Support since 2013 compared to later adopters. Higher scoring organisations had structures that supported frontline managers with practice leadership and that countered increasing administrative demands. CONCLUSIONS: Establishment of support structures for practice leadership by organisations warrants further investigation together with the relative importance of each task of practice leadership.

A Scoping Review of Outcomes Measured and Involvement of People With Intellectual Disabilities in Active Support Research.

BACKGROUND: Active Support is a staff practice that aims to increase engagement of people with intellectual disabilities. This study seeks to: (1) identify the outcomes of staff using Active Support and how these are measured; (2) identify how the views of people with intellectual disabilities have been included in Active Support research. METHOD: A scoping review was conducted of peer-reviewed articles about Active Support published between 2009 and 2023. RESULTS: Sixteen articles were identified. Outcomes included engagement, the quality of staff support, choice and challenging behaviour. Structured observations were the most frequently used measurement method. Only two studies explored people with intellectual disabilities' perspectives about Active Support. CONCLUSIONS: Consistent use of similar measures is a strength of Active Support research. Including perspectives of people with intellectual disabilities may provide insight into dimensions of support not been measured and assist in further developing these measures and Active Support practice.

Factors that predict good Active Support in services for people with intellectual disabilities: A multilevel model.

BACKGROUND: Active Support, now widely adopted by disability support organizations, is difficult to implement. The study aim was to identify the factors associated with good Active Support. METHODS: Data on service user and staff characteristics, quality of Active Support and practice leadership were collected from a sample of services from 14 organizations annually for between 2 and 7 years, using questionnaires, structured observations and interviews. Data were analysed using multilevel modelling (MLM). RESULTS: Predictors of good Active Support were adaptive behaviour, practice leadership, Active Support training, and time since its implementation. Heterogeneity, having more than six people in a service and larger organizations were associated with lower quality of Active Support. CONCLUSIONS: In order to ensure that Active Support is consistently implemented, and thus, quality of life outcomes improved, organizations need to pay attention to both service design and support for staff through training and practice leadership.

Implementing Active Support in disability day services: A 6-month prospective study on engagement and behaviours of concern among adults with intellectual disability.

BACKGROUND: Adults with intellectual disability are often disengaged in disability services. While Active Support has found efficacy in residential settings, less is known in day services. This study examines the impact of Active Support in day services for adults with intellectual disability in Singapore, particularly on engagement and behaviours of concern. METHOD: An experimental design was used, with a group of 32 participants receiving an Active Support programme over 6 months, compared to a control group of 16 participants with treatment as usual. Time sampling of behaviours was conducted every 4 weeks. RESULTS: The Active Support group saw increases in activity engagement and social engagement with staff, and decreases in disengagement and stereotypical behaviours, compared to the control group over time. CONCLUSION: Results support the implementation of Active Support across other day services for adults with intellectual disability. Active Support principles should be considered in planning policies and service outcome measures.

An exploration of communication within active support for adults with high and low support needs.

BACKGROUND: The aim was to explore the relationship between quality of active support and communication support for people in group homes with high and low support needs. METHODS: Data from 182 service users, 20-81 years (mean = 40), 89 with high support needs, were observed to have either good (n = 142) or poor (n = 40) communication support. Measures were of quality of active support, engagement and staff contact; field notes provided examples of good and poor communication supports. RESULTS: We found a relationship between the quality of communication support and active support. Receiving good communication was associated with higher levels of engagement. Field notes included some examples of appropriate communication supports, but limited use of augmentative and alternative communication (AAC). CONCLUSIONS: Staff show limited use of appropriate communication with people having high support needs who require AAC. Strategies to improve quality of practice are discussed.

Effectiveness of Active Support for adults with intellectual disability in residential settings: Systematic review and meta-analysis.

BACKGROUND: The review examined the effectiveness of Active Support (RQ1) and stakeholders' experiences of the model (RQ2). METHOD: Data were meta-analysed (RQ1; studies = 14) and synthesized narratively (RQ2; studies = 10). RESULTS: By follow-up (6 months post-training), effect sizes (RQ1) for resident total activity engagement were significant and ranged from small (d = 0.33, 95% CIs: 0.10-0.50) to large (Tau-U = 0.95, 95% CIs: 0.64-1.25) depending on study design. Follow-up changes in staff assistance were moderate (d = 0.56, 95% CIs: 0.23-0.89; Tau-U 0.63, 95% CIs: 0.32-0.93) and large for quality of support (d = 1.03, 95% CIs: 0.61-1.44). Other outcomes did not change. CONCLUSIONS: Active Support was more effective following complete staff training, in larger settings, at lower staff-to-resident ratios and with less experienced staff. Active Support training and outcomes were valued by staff and residents (RQ2), and staff experienced increased job satisfaction. Lower staff turnover and organizational readiness appear crucial for maintaining implementation.

Managers' views of skilled support.

BACKGROUND: Quality of life of people with intellectual and developmental disabilities has been found to primarily depend on whether staff are providing facilitative and enabling support that helps to compensate for severity of disability. Managers have a key role in facilitating staff to provide such support. METHOD: Qualitative interviews were conducted with 35 managers of supported accommodation services to explore service aims and the nature of, and challenges in providing, skilled support. Key themes were identified using a Thematic Networks Analysis. RESULTS: Service aims were rarely formalised, were related to the individuals supported and not to the organisation. Managers found it difficult to define skilled support, other than by reference to individuals. Practice leadership roles were challenged as a result of austerity measures. CONCLUSIONS: Front-line managers need more information and training in skilled support, with stronger leadership from senior management to provide the motivation and resources needed.

Intergenerational mentoring at Men's Sheds: A feasibility study.

BACKGROUND: This study reports on the feasibility of an intergenerational mentoring programme for youth with intellectual disability (ID) aimed at developing skills and building networks. METHODS: Youth with ID were paired with older male mentors who were trained to support the mentees participate in activities and social interactions during weekly sessions. We interviewed the mentees and mentors, and assessed them on a range of outcomes using standardized measures. RESULTS: Interviews highlighted that the programme presented a great "opportunity" for the mentees and mentors. The participants described facilitators and challenges to the acquisition of practical skills by mentees and the development of relationships between mentors and mentees, including communication, transportation and mentor training. The youth with ID had difficulty completing the self-report measures. CONCLUSIONS: Mentoring programmes are viable to support youth with ID during the transition to adulthood; however, refinement is required in the rollout out of a pilot intervention.

Quality of Life and Quality of Support for People with Severe Intellectual Disability and Complex Needs.

BACKGROUND: People with severe and profound intellectual disabilities often spend substantial time isolated and disengaged. The nature and quality of the support appears to be important in determining quality of life. METHODS: Structured observations and staff questionnaires were used to explore the quality of life and quality of support for 110 people with severe and profound disabilities and complex needs. RESULTS: On average, people spent approximately 40% of their time engaged in meaningful activities, received contact from staff 25% of the time (6% in the form of assistance to be engaged). Just over one-third received consistently good active support, which was associated with other measures of quality of support and emerged as the strongest predictor of outcomes. CONCLUSIONS: Quality of life and quality of support were relatively poor, although with about one-third of people receiving skilled support. Consistently good active support was the best predictor of outcome and proposed as a good indicator of skilled support.

Transition to retirement and participation in mainstream community groups using active mentoring: a feasibility and outcomes evaluation with a matched comparison group.

BACKGROUND: This paper reports on the feasibility and outcomes of a transition to retirement programme for older adults with disability. Without activities and social inclusion, retirees with disability are likely to face inactivity, isolation and loneliness. METHODS: Matched intervention and comparison groups each consisted of 29 older individuals with disability. There were 42 men and 16 women with a mean age of 55.6 years While attending their individual mainstream community group 1 day per week, intervention group participants received support from community group members trained as mentors. We assessed participants' loneliness, social satisfaction, depression, life events, quality of life, community participation, social contacts, and work hours before and 6 months after joining a community group. RESULTS: Twenty-five (86%) of the intervention group attended their community group weekly for at least 6 months. They increased their community participation, made an average of four new social contacts and decreased their work hours. Intervention participants were more socially satisfied post-intervention than comparison group members. CONCLUSIONS: The results demonstrate that participation in mainstream community groups with support from trained mentors is a viable option for developing a retirement lifestyle for older individuals with disability.

Observing practice leadership in intellectual and developmental disability services.

BACKGROUND: Improving staff performance is an issue in services for people with intellectual disability. Practice leadership, where the front line leader of a staff team focuses on service user outcomes in everything they do and provides coaching, modeling, supervision and organisation to the team, has been identified as important in improving staff performance. To date this finding is based only on self-report measures. METHODS: This paper describes and tests an observational measure of practice leadership based on an interview with the front-line manager, a review of paperwork and observations in 58 disability services in Australia. RESULTS: The measure showed good internal consistency and acceptable inter-rater reliability. Practice leadership was associated with staff practice and outcomes for service users. The observed measure of practice leadership appears to be a useful tool for assessing whether leadership within a service promotes enabling and empowering support by staff. It was found to discriminate higher and lower performing services in terms of active support. CONCLUSIONS: The measure had good reliability and validity although some further testing is required to give a complete picture of the possible uses and reliability of the measure. The measure is potentially useful in contexts of both research and service development. The confirmation of previous findings from self-report measures that practice leadership is related to the quality of staff practice and outcomes for service users has implications for policy and practice in terms of the training of managers and structures for organisational management.

The impact of individual and organisational factors on engagement of individuals with intellectual disability living in community group homes: a multilevel model.

BACKGROUND: Being engaged in daily activities is a strong indicator of quality of life for individuals with intellectual disability (ID) who live in small community group homes. This study aimed to identify individual and organisational factors that predict high levels of engagement. METHOD: Individuals with ID (n = 78), direct support professionals (DSPs; n = 174) and supervisors (n = 21) from 21 US group homes participated in the study. For each individual with ID, we conducted 80 min of observation at the person's residence. Information was also gathered regarding demographic characteristics, DSP competence, supervisor years of experience and management practices. Data were analysed using multilevel modelling. RESULTS: On average, individuals were engaged in social activities 12% of observed time and non-social activities 35% of the time. Individuals with greater adaptive skills who were supported by more competent staff showed significantly higher levels of social engagement. Individuals with less severe deficits in adaptive behaviours and less challenging behaviour showed higher levels of non-social engagement. Although none of the factors related to group homes were significant, 24% of the variance in non-social engagement existed among group homes. CONCLUSION: These results suggested that engagement is a dynamic construct. The extent to which an individual with ID is engaged in daily life is a result of interplay between the individual's characteristics and the group home environment. Future research is needed to investigate the influence of variables specific to the group home on the engagement level of individuals with disabilities.

Practice leadership and active support in residential services for people with intellectual disabilities: an exploratory study.

BACKGROUND: We hypothesised that a key factor determining the quality of active support was 'practice leadership' - provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support. METHOD: Relevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons. RESULTS: There was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support. CONCLUSIONS: A number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities.

Engineering of the ferrite-based support for enhanced performance of supported Pt, Pd, Ru, and Rh catalysts in hydrogen generation from NaBH4 hydrolysis.

A series of M/NiCo-Ferrite (M: Pt, Pd, Ru, and Rh) nanoparticles were successfully synthesized, through a facile sol-gel auto-combustion followed by impregnation-reduction approach, as a catalyst for hydrogen generation from hydrolysis of NaBH4. All synthesized samples were characterized by XRD, N2 adsorption-desorption method, ICP-OES, FE-SEM, and EDX analysis. Compared to the other samples, it was observed that the Rh/NiCo-Ferrite sample exhibited higher particle distribution and surface area. To evaluate the hydrogen generation rate, the hydrolysis was carried out at a temperature of 35 °C, with an aqueous solution containing 5 wt.% NaBH4 and 3 wt.% NaOH. The experimental findings indicate that the Rh/NiCo-Ferrite sample exhibited a superior rate of hydrogen generation, with an average value of 11,667 mL/min.gcat, compared to the other samples studied. Enhanced catalytic properties may be responsible for its high activity. In addition, the activation energy of hydrolysis of sodium borohydride over the Rh/NiCo-Ferrite sample was 54.5 kJ/mol which is lower than the activation energy of many Ferrite-based catalysts. Moreover, the re-usability test of the Rh/NiCo-Ferrite sample denoted a decline in the catalytic activity after 4 recycling experiments due to the alterations in morphology and the reduction in the quantity of active phase.

Synergizing Fe2O3 Nanoparticles on Single Atom Fe-N-C for Nitrate Reduction to Ammonia at Industrial Current Densities.

The electrochemical reduction of nitrates (NO3 -) enables a pathway for the carbon neutral synthesis of ammonia (NH3), via the nitrate reduction reaction (NO3RR), which has been demonstrated at high selectivity. However, to make NH3 synthesis cost-competitive with current technologies, high NH3 partial current densities (jNH3) must be achieved to reduce the levelized cost of NH3. Here, the high NO3RR activity of Fe-based materials is leveraged to synthesize a novel active particle-active support system with Fe2O3 nanoparticles supported on atomically dispersed Fe-N-C. The optimized 3×Fe2O3/Fe-N-C catalyst demonstrates an ultrahigh NO3RR activity, reaching a maximum jNH3 of 1.95 A cm-2 at a Faradaic efficiency (FE) for NH3 of 100% and an NH3 yield rate over 9 mmol hr-1 cm-2. Operando XANES and post-mortem XPS reveal the importance of a pre-reduction activation step, reducing the surface Fe2O3 (Fe3+) to highly active Fe0 sites, which are maintained during electrolysis. Durability studies demonstrate the robustness of both the Fe2O3 particles and Fe-Nx sites at highly cathodic potentials, maintaining a current of -1.3 A cm-2 over 24 hours. This work exhibits an effective and durable active particle-active support system enhancing the performance of the NO3RR, enabling industrially relevant current densities and near 100% selectivity.

Inconsistent definitions of prolonged labor in international literature: a scoping review.

Objective: Prolonged labor is the commonest indication for intrapartum cesarean section, but definitions are inconsistent and some common definitions were recently found to overestimate the speed of physiological labor. The objective of this review is to establish an overview of synonyms and definitions used in the literature for prolonged labor, separated into first and second stages, and establish types of definitions used. Data sources: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier. Study eligibility criteria: All articles in English that (1) attempted to define prolonged labor, (2) included a definition of prolonged labor, or (3) included any synonym for prolonged labor, were included. Methods: Data on study design, year of publication, country or region of origin, synonyms used, definition of prolonged first and/or second stage, and origin of provided definition (if not primarily established by the study) were collected into a database. Results: In total, 3402 abstracts and 536 full-text papers were screened, and 232 papers were included. Our search established 53 synonyms for prolonged labor. Forty-three studies defined prolonged labor and 189 studies adopted a definition of prolonged labor. Definitions for prolonged first stage of labor were categorized into: time-based (n=14), progress-based (n=12), clinician-based (n=5), or outcome-based (n=4). For the 33 studies defining prolonged second stage, the majority of definitions (n=25) were time-based, either based on total duration or duration of no descent of the presenting part. Conclusions: Despite efforts to arrive at uniform labor curves, there is still little uniformity in definitions of prolonged labor. Consensus on which definition to use is called for, in order to safely and respectfully allow physiological labor progress, ensure timely management, and assess and compare incidence of prolonged labor between settings.

Engagement in retirement: an evaluation of the effect of Active Mentoring on engagement of older adults with intellectual disability in mainstream community groups.

BACKGROUND: As adults with intellectual disability age, retirement options need to be explored. One option is to attend a mainstream community group for retirees. Support within these groups could come from group members who are trained to act as mentors for the older adults with intellectual disability. This research evaluated a support training programme, Active Mentoring, which combines elements of Active Support and Co-worker Training. METHOD: Three older women with intellectual disability participated in a non-concurrent multiple baseline design. Effect size analyses (Percentage of Non-overlapping Data) were used to evaluate observational data. RESULTS: Active Mentoring was effective in increasing most types of engagement in activities, but there was no observed effect for social engagement. Mentor help also increased. CONCLUSION: Active Mentoring was effective in eliciting support from mentors, and in increasing activity engagement of older adults with intellectual disability in mainstream community groups.

A University-Based Social Services Parent-Training Model: A Telehealth Adaptation During the COVID-19 Pandemic.

With the COVID-19 pandemic resulting in social-distancing recommendations, many service providers find themselves altering the way they must provide medically necessary therapy. Even with the advent of more advanced telehealth technologies, the implementation of behavioral programming falls mainly on the caregivers of the clients that are served. This crisis brings to light ethical dilemmas and upends the current ways many programs may have been implemented across the world. As a result, a reevaluation of how these services are delivered is in order. This article reviews how a university-based, state-funded service delivery program (USSDP) provided essential and necessary services during the COVID-19 pandemic. Specifically, the purpose of this article is to describe how the USSDP quickly adopted a telehealth care model in a program that previously had not delivered services in this modality. Ethical, contextual, and competency-based factors are reviewed in the context of this organization, followed by a dialogue on broader generalization suggestions utilizing an active support model of care within telehealth restrictions.

Synergism of transition metal (Co, Ni, Fe, Mn) nanoparticles and "active support" Fe3O4@C for catalytic reduction of 4-nitrophenol.

Research reports, up to date, on supports for non-noble metal catalyst focus mainly on tuning their surface functionality and increasing surface area to maximize metal loading for high catalytic reduction of 4-nitrophenol. However, the "passive" role of these supports leads to inefficient hydride formation on the metal surface which limits catalytic activity. Herein, we present Fe3O4@porous-conductive carbon (Fe3O4@C-A) core-shell structure as an "active" support for non-noble metals (M = Co, Ni, Fe, and Mn) nanoparticles. Fe3O4@C-A was prepared by annealing Fe3O4@dense-carbon (Fe3O4@C) under N2. The resultant M-Fe3O4@C-A catalysts show high catalytic performance at very low metal loading, while non-noble metals supported on a "passive" support (Fe3O4@C) shows very low activity even at high metal loading. The significant difference in catalytic activity is ascribed to the synergistic effect amongst Fe3O4, conductive carbon and metal nanoparticles which leads to efficient hydride formation. Amongst the prepared catalysts, Ni-Fe3O4@C-A and Co-Fe3O4@C-A show the best catalytic activity, completing 4-nitrophenol reduction within 50 s and 80 s, respectively, in the presence of NaBH4. This result is comparable with previously reported noble-metal-based nanocomposites. In addition, Co-Fe3O4@C-A shows high recyclability in 5 consecutive catalytic reactions. In the broader context, our finding highlights how an "active support" together with non-noble metals can provide an efficient mechanism for hydride formation, subsequently accelerating the catalytic reduction of 4-nitrophenol.