Person-Directed Staffing and Quality of Life: Links Between Staff Choice, Perceived Staff Stability and Community Participation for Individuals With IDD in the United States.
James Houseworth, Renáta Tichá, Roger J Stancliffe and 2 others
People with IDD who don't choose their own staff are about 45% less likely to report stable staffing.
Stable staffing is linked to community participation matching the person's preferences, but not to choice-making. Cross-sectional; sample skewed to milder disability.
Key findings
1Having a role in choosing your own staff was significantly associated with perceiving your staffing as stable. Those whose staff were chosen by someone else had an odds ratio of 0.54, and those whose staff were assigned but changeable had an odds ratio of 0.61, compared with those who chose their own staff.
2Perceiving your staff as stable was significantly associated with your community participation matching your own preferences (odds ratio 1.30). The authors note this was a modest effect size and that staff stability is only one of several factors.
3Perceived staff stability was not significantly associated with either everyday choice-making or support-related choice-making. The authors suggest a ceiling effect may explain the everyday choice null, but note no ceiling effect was evident for support-related choice.
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What it does not show
Cross-sectional design: no causal conclusions can be drawn. The direction of the relationship between staff stability and community participation is unknown. Participants had to be able to answer survey questions for themselves, which excluded those with more severe ID, non-verbal communication, and higher behavioural support needs. The sample is skewed toward mild ID (68.3%), verbal communication (96.5%), and fewer behavioural challenges. The authors note a modest effect size for the community participation finding, meaning staff stability is only one of several factors. The support-related choice scale was not fully applicable to people living with family (two of three items not asked), limiting that analysis. Other important factors affecting community participation (social capital, familial support, transportation access) were not captured by the survey. The 38% of eligible participants who did not respond to the staff stability item (staff present during interview, 'don't know', or other missing) were excluded, which may introduce bias.
Declared interests
Funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant 90DNCE0007-01-00). The authors declare no conflicts of interest.
The easy way to misread this
Do not read these associations as evidence that choosing staff or improving staffing stability will improve a client's community participation. The data come from a single time point, so it is equally possible that people with more stable lives are more able to choose their staff, or that a third factor (e.g., a well-resourced agency) drives both. The sample is also skewed toward adults with mild ID who can answer for themselves, so the findings may not apply to clients with higher support needs.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →