Case Study 03. A training program to empower residential program teams to improve the lives of people with dual diagnosis. 

The Performance Gap

The demographic in community homes for adults with developmental disabilities is changing. People are living longer with more complex mental health issues and the level of support required is increasing. Residential programming and human resources are challenged to meet this new demand.

The Ask

GC was approached by the Community Networks of Specialized Care to help them "draw a new line in the sand" in terms of problem solving skills required by the teams supporting adults in group homes with complex dual diagnoses - persons living with a developmental disability and mental illness.

The Performance Objectives

The overall aim of this endeavour was to improve the quality of life for individuals with developmental disabilities who have behaviours associated with complex and challenging mental health needs. In working with staff from community homes and Behaviour Therapists, we knew we needed to start by identifying what this "new line in the sand" could look like in practice. Six performance objectives were the result, and guided the subsequent program design. If fully engaged in the program, program teams would be able to:

  1. Observe, recognize, and respond to challenging behaviours
  2. Plan ongoing data collection and two-way information sharing with team members 
  3. Practice making evidence-informed, team-based decisions
  4. Communicate effectively with clinicians and other external supports
  5. Spread learning to enable program-level capacity building and sustain practice change
  6. Plan to implement evaluation strategies for continuous quality improvement
I was really fascinated to see the enthusiasm that developed with my staff because for some it’s not easy and they haven’t been too “into” training (though they needed it). It speaks to the great design of the program.
— Common Thread Participant (Executive Director)
Common Thread Program Manual

Common Thread Program Manual

The Program Design

With these performance targets in our sights, we began collaboratively designing an approach with a focus on learning from real-world, yes-this-really-happened, case studies. We worked intensely with subject matter experts to create a suite of cases and our team wrapped around them a learning strategy and methods to ensure the performance objectives would be achieved. The Common Thread Initiative emerged as a 10-month program that included a blend of online and in-person learning sessions as well as self-directed study and reflection, practical application work and coaching. All fully supported by a custom suite of tools and facilitation strategies aimed at revealing, collecting and organizing the practice-based knowledge of the team so they could put that knowledge to work for the individuals they support.

Before it was 10 people giving ‘personal’ thoughts. But now the data collection and tools allow us to look objectively at things. This has changed the conversations. With a single staff model it’s easy to feel disconnected from the program and the core team, it was nice to see the whole team engaged and connected to the process.
— Common Thread Participant (Residential Program Supervisor)

The Strategy

Residential program teams (versus individual program staff) were invited to participate in Common Thread. Each participating organization was to send a minimum of two to a maximum of five program staff and each session (cohort) would engage five to seven organizational teams enabling cross-organization peer to peer exchange and learning. This model of participation was to ensure that teams practiced together to best achieve the performance objectives. And the choice to invite teams from multiple organizations was also considered of high sector turnover (given staff burnout) and relationship building amongst peers that may work together in the future addressed this key contextual design parameter.

I have seen growth for me and for my team. I’ve seen the growth in the two staff in particular as well as bringing the director closer to the program team. The staff have grown in terms of our service delivery. There was a lot frustration before, now we follow due process [the CT process] and trust that there will be an answer at the end. Sometimes in this field we become immobilized with anxiety and frustration because the answer is not always apparent. We place blame. CT taught us that answers are emergent. It showed the team that we are the answer and how to use other resources more effectively.
— Common Thread Participant (Executive Director)

The Program Outcomes

During our time working with the program teams we had the privilege of hearing about lives being changed. We were told of new policies and practices being put in place that improved the quality of data used to inform support strategies, reduce risk and communicate with the Behaviour Therapist. We were told of strengthened relationships between full-time and part-time staff and of better ways to engage the person's family so they could more actively understanding and support their loved one. Across the board, programs told us they had better insight into the individual’s preferences, network of support, quality of relationships, integration in the community, areas of interest, potential new connections and were developing plans to expand the person's current support network. We were also told by staff that they were happier, more confident and felt more rewarded by their work.

All of these changes within the teams led to some exciting improvements in the lives of the people they support. Through greatly improved prevention and management strategies, challenging behaviours decreased for several program participants, including behaviours that up to that point had significant negative impact on the person's life. With changes such as improvements in self-toileting and reductions in self-harm the people supported by participating teams were able to, in some cases for the first time ever, meet their personal goals to go on weekend outings, get take-out foods or eat in restaurants without incident and overall get more enjoyment out of life in the community where they live.

After designing, implementing and evaluating the program for two cohorts of learners over two years, we were asked to prep an in-house team of facilitators to continue the legacy - which we happily did!

The person we support has had far fewer incidents since Common Thread – the new techniques helped to prevent behaviours. We have been able to decrease some medications. The number of incidents decreased, the person is getting out more, lost weight and overall has a better life.
— Common Thread Participant (Residential Program Staff)