The project was to improve and increase the level of participation and engagement of people with disabilities (clients) living in the community. The Active Support Model incorporates systematic planning of activities and staff training, enabling clients to actively participate in everyday activities by focusing on provision of direct support. Effectiveness and facilitation were assessed using written assessments of clients' outcomes and direct observation of clients' engagement in activity and of staff help. Results indicated staff help and client engagement increased in 4 out of 5 group homes. There was significantly greater participation in a wider variety of activities with more frequent and varied community participation.

Changes in client engagement positively related to changes in staff help. Findings were consistent with earlier UK studies. The Active Support Model can be successfully applied in an Australian context and is an effective system to improve client engagement and participation in daily activities.

To implement and evaluate the Active Support Model in community houses of people with disabilities which aims to improve and increase clients' engagement and participation in daily activities.

In Australia, the Disability Services Act 1993 (DSA) provided the impetus for transition to community living of individuals with disabilities who had been residents of institutions. The group home model of service provision aimed at providing the support necessary for these individuals to take an active role in all aspects of their daily lives.

Studies in the UK and Australia found that the level of staff support did not necessarily ensure increased client outcomes – clients had long periods with little staff interaction and no engagement in activities.

The Active Support Model, developed in the UK, focuses ways that staff work with clients and the organization of group home procedures ensuring the primary focus is on direct support of the clients.

The University of Sydney's Human Research Ethics Committee and the Royal Rehabilitation Centre Sydney's Ethics Committee approved the project. Written informed consent was obtained from parents, persons responsible or guardians of participants. Written informed consent was also obtained from staff members in each group home.

Active Support training was staggered across the five group homes using a multiple-baseline-across-group-homes design. There was no control group. Six pre-test observational assessments (except for one house), six post-test observations, and two follow-up observations were conducted in each house and included a series of reliability observations. Analysis of written assessment data utilised a pretest-posttest design without a control group.

Participants included 22 Clients, 31 direct-support staff and 5 managers from five group homes in Sydney. All clients were adults with intellectual disability except for 2 with acquired brain injury. All clients live in group homes.

ICAP Assessments (Adaptive Behaviour, Challenging Behaviour, Service Score) were administered. ICAP service scores indicate the need for service support and can range from 0 to 100. Higher scores reflect increased independence and a lesser need for support. Service scores varied substantially from 1 (total personal care and intense supervision) to 82 (limited personal care and/or regular supervision).

Data on client engagement and staff help for client engagement were gathered by direct observation. The duration of each behaviour was recorded in seconds from onset using a Psion Workabout palmtop computer programmed for real-time multiple-category data entry. A total of 67 observations of 1.5 to 2 hours were completed with 14 sessions in four of five houses.

Observations took place on weekday afternoons for up to two hours prior to and during the evening meal, a period of substantial activity when all clients are normally at home. This approach enabled comparisons with observational data from the UK Active Support research.

Observations took place in public areas of the house and in community settings. Reliability observations were conducted pre-test, post-test and follow-up for 12 (18%) of 67 observation sessions.

Written assessment instruments were used before implementation at pre-test and at follow-up to assess: (1) group home environment, including staffing and staff working practices; (2) clients' personal characteristics; and (3) client outcomes. The written assessment instruments included the Staffing information Interview (Centre for Developmental Disability Studies, 2001), the Inventory for Client and Agency Planning (ICAP) and the Index of Participation in Domestic Life (Raynes, Wright, Shiell, & Pettipher, 1994).

Training materials and curriculum were obtained from the Welsh Centre for Learning Disabilities.

Active Support Training was delivered to each group home separately and involved two main components:

1. Classroom training – the entire group home staff and manager participated in a 2-day training workshop off-site.
2. Interactive training consisted of an individual 100-minute session at the group home where staff member was observed, coached and was given feedback in techniques for supporting clients to participate in activities.

The Active Support Model was implemented in each group home as quickly as practicable after training was completed. There was a strong emphasis on producing practical products; tangible resources for staff to use during implementation in their group homes. This was achieved through client-focussed group exercises for staff, and by investing time supporting staff to plan for each client's needs. Staff were encouraged to (a) attempt one new activity not previously tried with the client, and (b) try supporting two clients simultaneously, participating in a single activity together or each undertaking a separate activity in the same room.

1. 16 of out 20 clients (80%) had higher levels of observed engagement at post-test. At follow-up 12 (60%) had higher engagement.
2. In some houses, the person with the lowest adaptive behaviour score experienced the largest change in engagement, whereas the opposite was true in other houses.
3. Data on staff interaction with clients showed significant increases in staff help relative to baseline: from pre-test to post-test, and from pre-test to follow-up.
4. Increases in amount of staff help were significantly associated with increases in client engagement.
5. 76% (n = 16) of the 21 clients showed an increase in overall Index of Participation in Domestic Life scores.
6. There was a significant increase in both the frequency and variety of reported participation in community activities from pretest to follow-up. 80% (n = 16) of the 20 clients showed an increase in overall frequency of community participation. 60% (n = 12) experienced an increased variety of community activities.
7. Overall, a strong majority of clients increased their participation in community activities as a result of (a) more frequent participation and (b) involvement in a wider variety of activities.

1. Potential application of the Active Support Model in houses of people with disabilities across Australia.
2. Application of the Model for services to people with brain injury, dementia and physical disability, particularly individuals who require support in activities of daily living.