Servicios públicos específicos

This study took place at an ICF/IID, hereafter referred to as the Community Center for Developmental Disabilities (CCDD), in the southeastern United States. The CCDD provides state-funded programming, day and respite care, and educational services to 400 children and adults with mild to profound ID. Hope House, the primary residence for the staff participants of this study, is one of the oldest residences at the CCDD. Hope House is home to five men and five women with profound ID. Hope House employs 22 staff members including a house

manager, three shift supervisors, and 17 habilitation technicians who provide 24-hour direct care to the residents. Specifically, staff participants included one administrator (Cynthia), one house manager (Mary Ann), one shift supervisor (Elijah), and five habilitation technicians (Heather,

Margaret, Kena, Niecey, and Ann). Six of the staff participants are African-American, one is Caucasian, and one is Indian-American. Their mean age is 43 years, with the oldest participant being 65 years old and the youngest 22 years old. They have worked at the facility for an average of 6 years and 8 months. Cynthia has the most experience having worked at the CCDD for 25 years; Ann has least amount of experience having worked only six months.

Administrators and upper level managers (e.g., Therapy Manager, Director of Education, and Director of Nursing) at CCDD were typically college educated, middle-aged, and Caucasian. Upper level managers supervised house managers, shift supervisors, and habilitation technicians. House managers, shift supervisors, and habilitation technicians typically had some college

education (an Associate of Arts or Associate of Science degree or less), were female, under 40 years of age, and primarily African-American. These positions were also comparatively low- paying (less than 30,000 US dollars for annual income per year), and considered relatively unskilled by administrators and upper level managers.

Cynthia served as the direct supervisor to Mary Ann and coordinated the habilitation training programs for all residents. Mary Ann managed the daily operations of Hope House including the implementation of habilitation, behavioral, and educational programming, and medical care. Elijah, as a shift supervisor, ensured the execution of quality care, as well as housekeeping and maintenance by the habilitation technicians. The habilitation technicians were responsible for providing daily personal care (e.g. bathing, dressing, toileting), creating

opportunities for residents to complete habilitative and behavioral goals, planning community outings, and accompanying residents on medical appointments. Although the habilitation technicians spent the most time with and were the most knowledgeable about the residents’ particular needs and wants, they were often left out of the care planning process. Overall, there

was little interaction between administrators and upper level managers, and house managers and habilitation technicians.

All staff participants provided verbal and written consent for participation and consented to having informal conversations and formal interviews audio recorded. The remaining staff members did not formally provide consent, but participated in informal conversations and were observed as they worked throughout data collection. This study was approved by the Office of Human Research Ethics Institutional Review Board at the University of North Carolina at Chapel Hill and the human rights committee at the CCDD.

6.3.1 Methods

Data were collected over a 14-week period. Participant observation, formal semi-

structured interviews and informal conversations, and text work were the methods utilized in this study to demonstrate how staff’s self-governance and moral obligation to the residents were reorganized and aligned to the institution through a circuit of accountability.

Participant observation. Observations occurred for six to 10 hours per day, four days per week. Staff were observed in congregate areas of Hope House (e.g., multipurpose room, dining room, patio, garden), as well as in residents’ bedrooms, staff-specific spaces (e.g., staff lounge), CCDD-wide events, and community outings. I also observed Mary Ann and Cynthia during staff meetings, administrative meetings, and Individualized Program Plan (IPP) review conferences. I recorded key words and phrases, descriptions of people and the physical

environment, interactions of the participants, traffic of people entering and exiting Hope House, location and times of day activities occurred, objects and documents used, and my sensory experiences. Jottings also included which staff organized activities and which staff participated. I functioned primarily as an observer while I built rapport with the participants. As staff became

ask to me to assist with activities, invite me join them during lunch, and include me in group conversations concerning their work in Hope House.

Interviews. Informal conversations occurred throughout each observation visit, whereas formal interviews convened during a time and location chosen by each participant. Formal interviews occurred with Cynthia, Mary Ann, Elijah, Ann, and Margaret. Informal group conversations transpired, and well as one formal group interview with eight habilitation technicians. Interviews were conversational and aimed at eliciting narratives about the participants’ work responsibilities and daily activities, relations with residents and other staff, and about the texts important to their work. Informal conversations were either included in the field notes or recorded and transcribed. All formal interviews were recorded and transcribed verbatim.

Text work. Text work refers to the identifying, reading, and linking of everyday action to material and nonmaterial texts (Campbell & Gregor, 2004; Smith, 2005). I reviewed the texts staff identified as important to their work. Texts included the electronic medical record, the residents’ (IPP), the Individualized Habilitative Plans (IHP), the socialization and leisure checklists, the behavioral management checklists, the staff Communication and Shift Change logs, and the policies and procedures of Hope House and the CCDD. These documents outlined the roles and responsibilities of the staff, as well as provided the necessary documentation to hold staff accountable to their institutional responsibilities.

6.3.2 Analysis

Excerpts from field notes and interview transcripts were analyzed using first and second cycle coding (Miles, Huberman, & Saldaña, 2014) in order create smaller analytic units. For this paper, data segments related to staff work and staff relationships were extracted, constructed into

2009). I discussed each narrative with my dissertation advisor, revisited the data, and developed more focused connections between staff responsibilities and self-governance, and their

immediate alignment to institutional objectives. Themes within the narratives included

obligation to residents and coworkers, inter-professional and trans-professional power, positional politics (e.g. leveraging political power in the institution based on position), and textual

work/alignment. Analyses revealed a paradox in which self-governance through accountability circuits shifted responsibility from the organization level to habilitation technicians while simultaneously negating professional judgment and moral obligation at the front-line.

6.4 Negotiating Moral Obligation, Self-governance, and Accountability