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Early support should help autistic children lead flourishing lives. We sought to understand parents' experiences of their children's involvement in early intervention and associated research, through focus groups with 23 parents (of 22 children) enrolled in a university-affiliated service. Reflexive thematic analysis revealed four themes. Parents conveyed a strong sense of gratitude (Theme 1) arising from their perceptions of the importance of early intervention and feelings of having 'hit the jackpot' to secure access to the service from which they perceived their children 'gained so much'. They valued the service and staff expertise which made them feel secure (Theme 2). University affiliation and the associated research also contributed to parents' sense of safety, from perceived 'accountability' and 'integrity'. Parents conveyed deep commitment to the service (Theme 3) but shared often-negative experiences as their child's enrolment came to an end (Theme 4) and they expressed feelings of abandonment and disempowerment, being confronted with the reality of needing to secure next-stage support for their children and of perceived critical need for 'conversion of research into practice'. These parents' accounts offer insights into the benefits and ongoing challenges of achieving truly effective supports for autistic preschoolers and their families.

Training key stakeholders in the design of reasonable adjustments for students with disabilities could promote collaboration and inclusion. We tested the feasibility of a randomized controlled trial to evaluate the effectiveness of online education (intervention) in designing reasonable adjustments by Victorian (Australian) parents and professionals (n = 31). Participants suggested reasonable adjustments for contrived students with varied needs to support their participation in described classroom activities. Data collected pre- and post-intervention, and, at follow-up, were rated across five dimensions: Authenticity, Agency, Real Learning, Strengths Based, and Inclusion. Analyses from 15 intervention and 14 control participants (10 parents, 10 teaching staff, and 9 allied health professionals) showed higher scores for Inclusion post-intervention for the intervention group. This difference was maintained at follow-up, generalized to a new contrived student scenario, and mostly attributable to parents. Online education may improve parents' contribution in the design of reasonable adjustments that promote inclusion. A larger study is warranted.

The study aim was to scope research into student outcomes of co-teaching models to promote inclusive school education for students with disability. A systematized search was conducted of studies addressing models of co-teaching involving two teachers and student outcomes published from January 2008 to June 2019. Each study was appraised for quality. Most of 21 studies that met inclusion criteria were conducted in the United States (n = 17). Fourteen studies followed quantitative approaches, six followed qualitative and one included both. Although the benefits of co-teaching for students were demonstrated, it was difficult to determine comparative effectiveness across models, with only one study providing a systematic comparison. There was some evidence of differential effects across factors such as disability type, grade level, and outcome types, but heterogeneity across study aims, participants characteristics, extent to which co-teaching models were described or implemented, and outcomes targeted precluded meaningful comparisons. Limitations were found in study designs, with appraisal scores ranging from 0.6% to 89%. Hence, the research into student outcomes for various models of co-teaching was found to be limited both in number and quality. Findings point to the need for greater attention to what occurs in classrooms to support positive student outcomes of inclusive education through co-teaching.

Background: Organisational culture in group homes for people with intellectual disabilities has been identified as an influence on service delivery and staff behaviour. The aim was to examine patterns of culture across group homes in disability organisations. Method: The Group Home Culture Scale (GHCS) was used to measure staff perceptions of culture. Data were available from 260 staff who worked across 58 group homes managed by eight organisations. Using scatterplots and measures of dispersion, the scores on the seven GHCS subscales were examined for patterns of integrated (i.e., similarities) and differentiated (i.e., variability) culture within the organisations. Results: Patterns of differentiated culture were found in six organisations for one or more GHCS subscales. Patterns of integrated culture were found in three organisations for one subscale. In two organisations, patterns of both integrated and differentiated culture were found. Conclusions: The findings contribute to the conceptualisation of and research into organisational culture in group homes, with implications for changing and maintaining culture.

Our aim was to explore insights from clinical practice that may inform efforts to understand and account for factors that predict spoken language outcomes for children with Autism Spectrum Disorder who use minimal verbal language. We used a qualitative design involving three focus groups with 14 speech pathologists to explore their views and experiences. Using the Framework Method of analysis, we identified 9 themes accounting for 183 different participant references to potential factors. Participants highlighted the relevance of clusters of fine-grained social, communication, and learning behaviours, including novel insights into prelinguistic vocal behaviours. The participants suggested the potential value of dynamic assessment in predicting spoken language outcomes. The findings can inform efforts to developing clinically relevant methods for predicting children's communication outcomes.

Background: Research has shown that there is variability in quality of life (QOL) outcomes for people with intellectual disabilities who live in group homes. The aim was to examine dimensions of group home culture as predictors of QOL outcomes. Method: The Group Home Culture Scale (GHCS) was used to measure staff perceptions of culture in 23 group homes. QOL data were available from 98 people with intellectual disabilities. Multilevel modelling was used to examine the associations between the GHCS subscales and four QOL-dependent variables. Results: Of the GHCS subscales, Effective Team Leadership and Alignment of Staff with Organizational Values significantly predicted residents' engagement in activities. Supporting Well-Being significantly predicted residents' community involvement. None of the GHCS subscales significantly predicted domestic participation and choice making. Conclusions: The findings suggest that strategies to improve Effective Team Leadership and Supporting Well-Being dimensions of culture may contribute to enhancing certain QOL outcomes.

AbstractThe Disability Royal Commission received evidence of educational exclusion of school students with disabilities, occurring in both overt and covert forms, and of students’ experiences of violence and abuse. According to this evidence and prior research and reports, exclusionary and abusive practices appear to be entrenched in school education in both mainstream and special settings. The relationship between the evidence presented to the Commission and prior inquiries and research is presented with the aim of providing a critique of its approach and recommendations. Highlighted are the contrasting recommendations to either abolish or retain special schools and other segregated school settings. Other recommendations are reviewed to demonstrate how the final recommendations were part of a comprehensive suite of strategies to address long-standing exclusionary practices. Particular attention is given to students with severe-profound intellectual disabilities, who are most likely to be enrolled in or diverted to special schools and segregated units located in mainstream schools. Although the recommendations were comprehensive in addressing key contributors to exclusion, they showed a failure to consider in greater depth prior research and current positive practices of authentic inclusive education. It is argued that the Commission missed the opportunity to draw on research based on models of supports, shared understanding of inclusion, and making use of professionals beyond educators to provide complementary expertise. [ABSTRACT FROM AUTHOR]

The Victorian Government, Australia, committed to deliver recommendations from a review of the Program for Students with Disabilities. We report on the implementation of Recommendation 7: to explore options for how special schools could become 'centres of expertise' to support inclusion in mainstream schools. Informed by evidence reviews of inclusive education practices and interviews of special and mainstream staff and parents, stakeholders were engaged in a forum to develop a range of options. A larger sample of stakeholders then completed a survey to evaluate them. Forum attendees were parents, education staff, and allied health professionals from special and mainstream schools. They worked in small groups to develop options, which were later grouped into 5 categories. These options were entered into an online survey for distribution to a wider group of stakeholders. Survey respondents were 142 stakeholders from special (71%) and mainstream primary and secondary schools (parents, education staff, and allied health professionals). They rated each option, such that 8 with high ratings for feasibility and acceptability were recommended to support inclusive mainstream education through utilisation of special school expertise. The final list of options focused on collaboration, development, and coordination of networks of special and mainstream schools, and building capacity and leadership to support mainstream schools to meet diverse student need.

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.

Background: Organizational culture in group homes for people with intellectual disabilities has been identified as influencing staff behaviour and residents' quality of life (QOL). Despite this influence, culture has been under-researched, with no published and validated instrument to measure its dimensions in group homes. The aim was to develop such a measure. Method: The Group Home Culture Scale (GHCS) was developed using a theory-driven approach. Items were generated from the research literature, which were reviewed by experts and tested in cognitive interviews. Data from 343 front-line staff were used for exploratory factor analysis. Results: The content and face validity of the GHCS were found to be acceptable. Exploratory factor analysis indicated that the GHCS measured seven dimensions of group home culture. Cronbach's alpha for the dimensions ranged from 0.81 to 0.92. Conclusions: The GHCS has potential use in research to determine whether dimensions of group home culture predict the quality of staff support and residents' QOL.

Background: There is strong evidence about the effectiveness of Active Support. Recent research has established predictors of good Active Support as staff training, practice leadership, and service setting size. This paper explores features of organisational leadership and structures predictive of Active Support. Methods: Multilevel modelling with data from surveys, observations and interviews was used to identify predictors of Active Support at the levels of service users (n = 253), services (n = 71) and organisations (n = 14). Results: Good Active Support was predicted by: (1) positive staff perceptions of management, (2) prioritisation of practice and Active Support by senior managers, (3) strong management support for practice leadership, (4) organisation of practice leadership close to everyday service delivery, and (5) concentration of practice leadership with frontline management. Conclusion: These findings extend understanding of predictors of Active Support and provide indicators of service quality, with important implications for service providers, service users and those monitoring the quality of services.

Background: Organisational and service level factors are identified as influencing the implementation of Active Support. The aim was to explore differences in organisational leadership and structures to identify potential relationships between these factors and the quality of Active Support in supported accommodation services. Method: Fourteen organisations participated in this mixed methods study, which generated data from interviews with senior leaders, document reviews and observations of the quality of Active Support. Results: Qualitative analyses revealed three conceptual categories: senior leaders in organisations where at least 71% of services delivered good Active Support prioritised practice; understood Active Support; and strongly supported practice leadership. In these organisations practice leadership was structured close to everyday service delivery, and as part of frontline management. Conclusions: Patterns of coherent values, priorities and actions about practice demonstrated by senior leaders were associated with successful implementation of Active Support, rather than documented values in organisational policy or procedures.

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.

Our aim was to explore insights from clinical practice that may inform efforts to understand and account for factors that predict spoken language outcomes for children with Autism Spectrum Disorder who use minimal verbal language. We used a qualitative design involving three focus groups with 14 speech pathologists to explore their views and experiences. Using the Framework Method of analysis, we identified 9 themes accounting for 183 different participant references to potential factors. Participants highlighted the relevance of clusters of fine-grained social, communication, and learning behaviours, including novel insights into prelinguistic vocal behaviours. The participants suggested the potential value of dynamic assessment in predicting spoken language outcomes. The findings can inform efforts to developing clinically relevant methods for predicting children's communication outcomes., Author(s): David Trembath [sup.1] [sup.13] , Rebecca Sutherland [sup.1] [sup.2] , Teena Caithness [sup.1] , Cheryl Dissanayake [sup.3] , Valsamma Eapen [sup.4] , Kathryn Fordyce [sup.5] , Grace Frost [sup.6] [...]

Children who lack functional spoken language are candidates for augmentative and alternative communication (AAC). Aided AAC and naturalistic interventions offer the potential to extend the communication functions demonstrated by children with autism spectrum disorder (ASD) who are nonspeaking. Related intervention research, however, has been limited, in that interventions have generally targeted a limited range of communication functions taught in highly structured, decontextualized environments. The aim of this study was to investigate the efficacy of an intervention that combined aided AAC with a naturalistic intervention – enhanced milieu teaching (AEMT) - to increase symbolic communication in children with autism spectrum disorder. Three children with autism spectrum disorder participated in a multiple probe design, in which a range of communication functions were targeted using the AEMT. Results showed increases in the use of symbolic communication from baseline to intervention phases, which were found to be statistically significant for two of the three children (phi 0.7–0.81; p <.001). Intervention outcomes were generalized to a communication partner not involved in the intervention and maintained over time for all children. The study provides preliminary evidence that communication functions beyond object requests could be taught using a systematic, multi-element approach implemented across activities. [ABSTRACT FROM AUTHOR]

Background: We investigated the context for translating evidence-based early intervention for autism spectrum disorders (ASD) into real world settings through a case study of a regional town characterised as disadvantaged. Methods: Data were from interview surveys of five managers reporting on 15 services, and surveys from 19 practitioners and 15 mothers of young children with ASD. Results: The 15 services were multidisciplinary, offering diagnostic assessments (n = 2) and interventions delivered in the home and centres. Children were diagnosed at a mean age of 3 years; access to intervention was delayed and mostly limited to one session every two weeks. Some families travelled substantial distances to services, driving on average 50 minutes each way. Practitioners described intervention strategies in broad terms, rather than name interventions. Conclusions: Services available to young children with ASD in this town were far removed from good practice in terms of early diagnosis, and intervention frequency and intensity.

Background: Studies incorporating staff-rated or observational measures of practice leadership have shown that where practice leadership is stronger, active support is better implemented. The study aim was to compare measures of practice leadership used in previous research to determine the extent of their correspondence. Method: A subset of data from a longitudinal study regarding 29 front-line managers working across 36 supported accommodation services in Australia was used. An observed measure of practice leadership, based on an interview and observation of a front-line manager, was compared with ratings of practice leadership completed by staff. The quality of active support was rated after a 2-hour structured observation. Results: Correlations between staff-rated and observed measures were nonsignificant. Only the observed measure was correlated with the quality of active support. Conclusions: This study provides evidence to support using an observational measure of practice leadership rather than reliance on staff ratings.

Objectives: Research shows practice leadership to be a factor in the successful implementation of active support. The aim of the study was to explore differences in staff practice, associated with the presence of a practice leader in a shared supported accommodation service. Methods: Quality of support and engagement for 189 service users with intellectual disability from 58 services were collected during a 2 h observation using the EMAC-R and ASM. The practice leader was present in 19 services (n = 59) and absent in 39 (n = 111). An Observed Measure of Practice Leadership was administered during a second visit to each service. Results: When the practice leader was present, levels of engagement and active support were statistically higher (p < 0.01). Although measured at a different time, observed practice leadership was also higher in services where the practice leader was present during the first observation. Conclusion: The level of observed practice leadership and presence of the practice leader appear to be associated with better quality of support. This finding provides further evidence of the importance of systems for supporting, monitoring, modeling, and improving staff practice for effective implementation of active support.

School inclusion of students with disabilities relies on reasonable adjustments to curriculum and class activities. The Reasonable Adjustments for Inclusive Education (RAIE) was designed to elicit reasonable adjustments from stakeholders in mainstream school inclusion for three contrived students with varied learning needs. We evaluated a scale for rating the quality of elicited reasonable adjustments across five dimensions: Agency, Authenticity, Real Learning, Strengths Based, and Inclusion. A trial (n = 5 participants) led to refinement of the scale, which was tested for inter-rater reliability with data from a randomized controlled trial (RCT) of an intervention to improve the quality of reasonable adjustments. RCT participants (10 parents, 10 educators, nine allied health professionals) provided 596 reasonable adjustments, rated for each dimension by two independent raters (n = 2980 ratings). Overall agreement was 75.3%; intraclass correlation (ICC) was.778. ICCs were moderate-good (.612–.816). Further refinement and testing with multiple raters are recommended. [ABSTRACT FROM AUTHOR]

Background: The social relationships model was developed to describe positive relationships between support staff and people with intellectual disability. We evaluated an educational intervention based on this model. Method: Eighteen staff supporting 5 adult service users with severe or profound intellectual disability from 3 day services received the intervention. Mixed methods were used. A multiple baseline design determined changes in relationship processes between staff and service users following intervention. Descriptive field notes and staff interviews provided qualitative data. Results: Positive changes in relationship processes were found, but the results were variable. Of note was a high effect for 1 service user, a minimal effect for 2, and no effect for 2 service users. Field notes revealed contributors to variable results, and interview data highlighted changes not captured by quantitative measures. Conclusions: An educational intervention based on the social relationship model shows promise as a means to enhance staff relationships with people with intellectual disability.

The study aim was to scope research into student outcomes of co-teaching models to promote inclusive school education for students with disability. A systematized search was conducted of studies addressing models of co-teaching involving two teachers and student outcomes published from January 2008 to June 2019. Each study was appraised for quality. Most of 21 studies that met inclusion criteria were conducted in the United States (n = 17). Fourteen studies followed quantitative approaches, six followed qualitative and one included both. Although the benefits of co-teaching for students were demonstrated, it was difficult to determine comparative effectiveness across models, with only one study providing a systematic comparison. There was some evidence of differential effects across factors such as disability type, grade level, and outcome types, but heterogeneity across study aims, participants characteristics, extent to which co-teaching models were described or implemented, and outcomes targeted precluded meaningful comparisons. Limitations were found in study designs, with appraisal scores ranging from 0.6% to 89%. Hence, the research into student outcomes for various models of co-teaching was found to be limited both in number and quality. Findings point to the need for greater attention to what occurs in classrooms to support positive student outcomes of inclusive education through co-teaching. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore the experiences of an individual navigating life in the first year after stroke, with attention to the influence of health professionals on adjustment. In-depth interviews were completed at regular intervals with an individual in rural Australia. This longitudinal approach supported the exploration of views over time. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory methods. Findings are presented as an instrumental case study. The experience of stroke was one of adjustment to a new reality and of an altered and evolving concept of self: captured within the themes of fragmentation, loss, and reconstruction. Self-efficacy emerged as a driver in the adjustment process. Interactions with health professionals influenced adjustment and impacted on conceptualisations of self and self-efficacy. Adjustment to stroke necessitated a reconceptualization of self. Relationships and interactions with others emerged as potential facilitators. For health professionals working with people after stroke, knowledge of the adjustment process and attention to practices that affirm personhood and enhance self-efficacy have the potential to facilitate long term outcomes. Processes linked to adjustment are represented visually to guide conceptual understandings and facilitative actions. All interactions with health professionals, including casual or ad hoc interactions, have the potential to influence adjustment after stroke. Health professionals who interact in ways that recognise personhood may have an especially positive influence on processes linked to adjustment. Giving time to listen to personal narratives and reflections may assist with sense-making and support the process of reconceptualising self after stroke. Through bidirectional sharing of experience and ideas, health professionals can facilitate the experience of self-efficacy. [ABSTRACT FROM AUTHOR]

Training key stakeholders in the design of reasonable adjustments for students with disabilities could promote collaboration and inclusion. We tested the feasibility of a randomized controlled trial to evaluate the effectiveness of online education (intervention) in designing reasonable adjustments by Victorian (Australian) parents and professionals (n = 31). Participants suggested reasonable adjustments for contrived students with varied needs to support their participation in described classroom activities. Data collected pre- and post-intervention, and, at follow-up, were rated across five dimensions: Authenticity, Agency, Real Learning, Strengths Based, and Inclusion. Analyses from 15 intervention and 14 control participants (10 parents, 10 teaching staff, and 9 allied health professionals) showed higher scores for Inclusion post-intervention for the intervention group. This difference was maintained at follow-up, generalized to a new contrived student scenario, and mostly attributable to parents. Online education may improve parents' contribution in the design of reasonable adjustments that promote inclusion. A larger study is warranted. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) are often described as visual learners. We tested this assumption in an experiment in which 25 children with ASD, 19 children with global developmental delay (GDD), and 17 typically developing (TD) children were presented a series of videos via an eye tracker in which an actor instructed them to manipulate objects in speech-only and speech + pictures conditions. We found no group differences in visual attention to the stimuli. The GDD and TD groups performed better when pictures were available, whereas the ASD group did not. Performance of children with ASD and GDD was positively correlated with visual attention and receptive language. We found no evidence of a prominent visual learning style in the ASD group.