“Let the people you’re supporting be how you learn”: a grounded theory study on quality support from the perspective of disability support workers

Figures & data

Table 1. Participants characteristics.

Pseudonym	Support setting	Experience	Employment arrangements	State	Interview method
Jordan	Private home/community	1–3 years	Online platform	South Australia	Zoom videoconferencing
Danny	Private home/community	5–10 years	Service provider	Victoria	Telephone
Kerry	Private home/community	1–3 years	Online platform & service provider	New South Wales	Zoom videoconferencing
Frankie	Private home/community	3–5 years	Online platform & service provider	Victoria	Zoom videoconferencing
Stacey	SSA/community	3–5 years	Service provider	Victoria	Zoom videoconferencing
Joyce	Private home/community	5–10 years	Online platform & service provider	Western Australia	Zoom videoconferencing
Pat	SSA/community	6–12 months	Service provider	Victoria	Zoom videoconferencing
Morgan	SSA/community	6–12 months	Service provider	Victoria	Zoom videoconferencing
Courtney	SSA/community	3–5 years	Service provider	Victoria	Zoom videoconferencing
Sam	Varied	5–10 years	Online platform & service provider	New South Wales	Zoom videoconferencing
Rory	SSA/community	1–3 years	Online platform	Victoria	Telephone
Jamie	Private home/community	1–3 years	Online platform	New South Wales	Zoom videoconferencing

SSA: shared supported accommodation.

Table 2. Themes, subthemes and example participant quotes.

Theme	Subtheme	Example quotes
Being the right person for the role	Having the capacity to connect	“I think that being a people person helps very much so, and I know that I am someone who is very much like that. I love people and I love working with - just talking to different people” Frankie “If you don’t have empathy or compassion for this human being, you quite literally cannot provide therapeutic support to that person” Sam
	Wanting to do the role	“If they don’t enjoy the work they do, then they shouldn’t be doing it. It’s not just a job. It’s a very personal field, so yeah, just to take their time and enjoy what they do.” Danny “Everybody wants to have a job for the money but they don’t necessarily want to work for it and they definitely don’t want to go outside the box or take the initiative and do anything more than what they need to for that wage” Kerry
	Learning from experience	“A lived experience is the best. Go and volunteer somewhere and actually get some exposure to people with disabilities is a lot better” Joyce “I feel that no training thought in a classroom can trump the experience handed down from experienced staff.” Rory
Delivering quality support in practice	Recognising the person as an individual	“Keep an open mind. There is no rule book, there is no certain way. You have to always adapt to the resident and what they want.” Rory “I love that two people, actually 30 people can have the same disability and then none of them are the same… That is the number one foundation of good support. Know who your human is and what their needs are.” Joyce
	Centring the person with disability	“I’m like, ‘Have you ever been hoisted?’ And they’re like, ‘No.’ And I was like, ‘You don’t understand how uncomfortable being hoisted is, how vulnerable it makes you. And until you have that insight, you will never have a full appreciation of what it is like for somebody to put their trust in you to hoist’” Sam “The support worker was just sitting on her phone while the person was bowling… Not even looking or paying attention to what she was doing… Try to make the client feel good. And put your phone away. You don’t need your phone for three hours, like put it away.” Stacey
	Respecting the person’s autonomy	“Let the people you’re supporting be how you learn how to support them. Let [them] guide you and if they’re not at the capacity to do that explicitly, get to know people and their individual support needs and try when you offer your support to not make assumptions.” Courtney “I’m all about risk enablement. I think that everyone should have the opportunity to make stupid choices… I will tell you here’s all the problems with your choice or here’s all the good things with your choice, if you want to still do it, let’s find a safe way to do it.” Joyce
Working well together	Being the right fit	“We were just going out in the community, so I was taking him to like transport expos and train days. And I quite like trains as well myself, so it was kind of a match made in heaven. We were both having fun together.” Jamie “My clients want people that will click with them as well which they have the right to” Kerry
	Building trust	“…a good relationship would be one where they feel comfortable to talk with you. They feel comfortable to bring up maybe any issues or concerns, depending on their personality, but feel comfortable joking around and just making general conversation.” Pat “…feeling that you have that autonomy and space to be like, ‘Hey man, can we actually try it this way because…’ rather than just being like, ‘this is a person that comes into my house and I don’t wanna say the wrong thing or piss him off’” Sam
	Finding the balance	“I’m not saying be friends, but a working friendship in that you can communicate easily but be mindful that when you leave their home that there is that degree of separation.., that you don’t involve them in your personal life… you definitely need to have a line in the sand.” Danny “A lot of people view their support relationships as friendships and they absolutely can be, but there also needs to be a professional element… You wanna be able to have that dynamic with somebody where it isn’t uncomfortable… But you also need to be able to draw the line and be like, ‘No, mate. You can’t actually call me at 10:30 at night because your washing machine doesn’t work.’” Sam
Maintaining and improving the quality of support	Engaging in reflective practice	“…you should raise your hand, be accountable. Everyone makes mistakes, we’re human… Learn by it and hopefully not repeat it.” Kerry “We have an open conversation so I don’t need a specific time to do it but I always say to her like ‘if I need to correct something you can tell me’ and she has the same from me like ‘if I’m doing something wrong you can tell me’” Jordan
	Developing skills and competencies	“…always furthering your knowledge and your experience and your education and being willing to do that all the time” Frankie “I think there should be some sort of training with maybe like a doll… just see how you would react in that sort of situation because I think a lot of people go ‘yeah, yeah’ but then when it comes down to it, they won’t.” Kerry
	Looking after yourself	“…making sure you look after yourself as well, because the way you’re going to be able to perform best is to make sure like you’re getting everything you need to do your role to the best that you can” Courtney “You’ve also got to look after yourself a little bit. You can’t really take on everyone’s – you know, having such a severe injury like an ABI where it just happens out of nowhere is obviously really traumatic. So, yeah, it can be a lot” Morgan
Considering the broader context	Feeling valued	“…see the difference in level of support if you go to the mall and see the organisations there with their humans, and then the independent ones who actually go to work because they are being paid fairly, having a good time with their person, engaging with them.” Joyce “Take care of your worker because they take care of your business, or people. And if you were feeling undervalued as a human, you’re not going to provide the adequate care because you’re already just a little bit angsty.” Joyce
	Having a community of practice	“I think everybody that works under the umbrella of the NDIS needs to take part in educating each other” Joyce “People bounce ideas off each other, like if somebody’s having an issue they ask, and other people answer… ‘oh, you should do this, or maybe do this’. And you can get five different perspectives for one issue” Stacey
	Working within institutional constraints	“You see the level of the quality of support in an independent support worker over an organisation… there are limitations because there are so many rules and regulations that the organisation has implemented themselves, but also they have to adhere to NDIS regulations ” Joyce “My induction was like, ‘Don’t form relationships with these people…’ Quite an awful organisation in hindsight. And whereas my logic was always like these are human beings. Like if you don’t form a connection with these people, why are you here?” Sam
	Lack of institutional structure	“…if the disability is profound and they change from the service provider who does provide quite a bit of training, then by going to those other platforms perhaps that training wouldn’t be as consistent, which is of concern for the level of care” Danny “It’s hard too for the clients, it makes it hard too that our roles, even though we can work fulltime hours we’re still only casual. And they… as the client, they don’t feel it’s stable, they don’t think there’s stability in the casual role.” Kerry

Figure 1. Model of quality disability support from perspective of disability support workers.

Left to right process diagram. Left-hand input rectangle with bold-faced heading reading “being the right person for the role” with the subthemes listed below. Arrow from left-hand rectangle to large circle. Within large circle is the heading “delivering quality support…” with the subthemes listed below. To the right of the large circle are curved forward-back arrows leading to another rectangle. Right-hand rectangle has the heading “maintaining and improving quality” with the subthemes listed below. Line arching over the three shapes with the words “considering the broader context.” Upward curved line beneath the factors reading “working well together.”

Data availability statement

Qualitative data – for purposes of protecting participants identity, this cannot be made available publicly.