Part B: Good-practice design principles

Principles to support good-practice robust SDA

This section presents the seven design principles to support good-practice robust SDA found in the research. We give an overview of how we developed the principles and the intended outcomes and effects of each.

Developing the design principles

We developed the design principles with stakeholders and family members over the course of the research. Insights from the ‘deep dive’ literature review informed this process. The research found that literature and resident interviews supported the suggested design principles.

Overview of design principles and their intention

The research found seven overarching principles to guide good-practice robust SDA design. Their overarching aim is to maximise the quality of life for residents living in robust SDA.

The seven principles found in the research were to:

• enable a person-centred co-design approach
• create a homelike space that is not institutional in design
• maximise independence and freedom, minimising restrictive practices
• maximise safety and comfort of residents, staff, visitors and neighbours
• support resident choice and options for interaction with others when desired, as well as privacy and personal space
• enable (but not replace) effective supports
• maximise the adaptability and flexibility of the building design.

Stakeholders felt that well-designed robust SDA based on the above principles would have a positive impact on resident outcomes and housing sustainability. This was based on their experience in the disability sector and knowledge of relevant research studies. Specifically, this could be achieved in the following ways:

• Increase residents’ independence and participation in daily activities. They would be living in an environment specifically tailored to support their everyday activities.
• Reduce environmental triggers. Tailor the space to meet residents’ specific sensory needs and choices.
• Reduce behaviours of concern. Environments were less likely to trigger residents. Stakeholders suggested that good-practice robust SDA may reduce:
  • property damage
  • the risk to residents, staff and others
  • the need for restrictive practices.
• Improve the quality and adaptability of homes. Stakeholders felt this would increase the resale value of properties and allow them to be adapted to residents’ changing needs. They could also be remodelled for future residents.

These principles guide development of good-practice robust SDA housing solutions for individuals. Discussed below are the rationale and key considerations for each principle. Part C of this report gives more specific findings about design features to support these principles.

Enable a person-centred co-design approach

Stakeholders and the literature both said it was important to involve residents in decisions about the design of their home (Mobley et al. 2017; Zeeman et al. 2016). This would ensure the design is best tailored to their needs and choices. This would mean taking a person-centred co-design approach and including:

• expertise given by family members, carers or support staff
• information from residents’ behaviour support plans in relation to their environmental and sensory needs.

As well as asking those who know the resident, the literature calls for a multidisciplinary co-design approach to robust SDA. This would involve the expertise of:

• architects
• interior designers
• access consultants
• environmental psychologists
• constriction engineers
• staff from non-government organisations as needed (Wright et al. 2016; Zeeman et al. 2016).

The person and their supports and their families should be involved in the design from the start … involved in identifying triggers and identifying what their enjoyable places are, working with the architects to form the design and materials brief. You’ve got to start with that kind of co-design.

The research found that a person-centred co-design approach was important to achieve the following:

• Allow residents to self-regulate and reduce behaviours of concern. Stakeholders and the literature both said that homes tailored to each resident would help to minimise triggers and maximise positive resident outcomes (Ahrentzen & Steele 2009).

Part of it is about meeting people’s needs so that they don’t behave in unsafe ways. They need to be able to do what they need to do in their home to calm themselves down so that they don’t get into a full steam in the first place.

• Give residents choice. Stakeholders said it was important to give residents the chance to state their needs and preferences and have meaningful input into the design of their home. Stakeholder and family participants said this approach would give residents a sense of ‘ownership’ of their space. This would encourage positive emotions and minimise behaviours of concern.

We try to fully involve our daughter if we’re changing something in the house so that she gets to design it … it’s painted in the colours she wants and she has a garden with plants she’s picked that she looks after.

• Ensure homes are tailored to people of different cultural backgrounds (e.g. Aboriginal residents). A few stakeholders said this (refer to Part C for a case study showing how robust SDA can cater to residents’ cultural needs).

A homelike space

The research found it is important to recognise that robust SDA is a person’s home, rather than a care facility. Stakeholders said residents have a right to live in a place that looks and feels like a home. It is important for residents to feel their home is a meaningful and safe space. The literature also noted the importance of a homelike space (Bridge & Vasilakopoulou 2019; Scalzo in Sax Institute 2020; Wright et al. 2016; Zeeman et al. 2016).

It’s our daughter’s home, and it’s important to us that it’s treated as such. We need it to look and feel like a home to her, and that’s what it should be built around.

Stakeholders and family members said that this principle was important to achieve the following:

• Discourage using ‘institutional’ fixtures and products (e.g. fluorescent lighting, barred windows, ‘hospital-style’ linoleum flooring). These are not homelike and could trigger residents who had negative or traumatic experiences in institutions. Golembiewski (2015) said that homes without institutional features could reduce violence, rowdy behaviours and negative interactions with staff.
• Reduce behaviours of concern and destructive behaviours. Stakeholders said some residents are more motivated to respect and care for somewhere they see as a ‘home’. They are therefore less likely to cause property damage. The academic literature also said that a homelike space was likely to reduce violent and aggressive behaviour (Bridge & Vasilakopoulou 2019; Golembiewski 2015).

My son loves ripping things off the walls, but when we put up his own paintings, he never rips them down … we got him to choose his own furniture and he’s never smashed or broken it because they’re things that he chose himself.

• Support positive emotions. Spaces that are meaningful for residents are more likely to support positive emotions and improve wellbeing.
• Increase the flexibility of the property for future use. Homelike robust SDA would produce more attractive homes. This would increase opportunities for new residents to move in (including ‘non-robust’ residents) and resale value.

The literature also said that homelike spaces increase residents’ independence, participation in daily activities and sleep quality. The studies did not outline the reasons for these improvements (Bridge & Vasilakopoulou 2019; Mobley et al. 2017).

Maximise independence and freedom

Stakeholders said that effective robust SDA should maximise residents’ independence. This would offer freedom and independence while reducing the need for restrictive practices. The research found it was important for the following reasons:

• Give greater independence. Stakeholders and the literature both noted that giving residents the ability to self-regulate and have choice and control over their space (e.g. lighting, temperature) and the activities they do within the home is helpful. It gives them greater independence and freedom and could reduce behaviours of concern (Bridge & Vasilakopoulou 2019).

You want to create an environment that best supports them to be independent, that lets them move about their own home as they wish and do the things that they enjoy.

• Address environmental features that trigger of behaviours of concern. Stakeholders and the literature both said that good-practice design that minimises known environmental triggers could offer more prospects for self-regulation. It could also reduce aggressive and violent or self-harming behaviours of concern, which reduces the need for restrictive practices (Bridge & Vasilakopoulou 2019; Mobley et al. 2017; Sax Institute 2020; Tuckett et al. 2004). The literature explained that, by reducing environmental triggers, good-practice design can make the sensory space easier for residents to get around. This reduces overwhelming feelings and confusion that can present as behaviours of concern (Bridge & Vasilakopoulou 2019).

Our goal is ultimately to reduce restrictive practices … behaviours of concern come from environments of concern, and if you have someone in the right environment you can see those behaviours and the need for restrictive practices reduce massively.

• Encourage less intrusive monitoring and restrictive practices. These include indirect supervision and technologies that allow restrictive practices to only be used for residents who need them. Also, a high level of supervision is a trigger for some residents who do not want to feel they are under constant watch.

Maximise safety and comfort

A well-designed space can reduce the incidence of behaviours of concern. Yet, stakeholders said it was still essential to have safety principles and precautions in place in case of emergencies and events that may trigger behaviours of concern. Ahrentzen and Steele (2009) also said that some residents, particularly people with autism, may be less aware of dangers in the home. As such, the research found it was important to maximise the safety and comfort of residents, staff, visitors and neighbours.

Stakeholders and family members said this was important in achieving the following outcomes:

• Ensure all parties feel safe and comfortable in the home. This protects their health and wellbeing.
• Encourage visitors to visit the home. This would help residents’ relationships with their family, friends and support networks (including both family members/carers and support staff).

It used to be when I visited my son, I was always fixing things, patching things up, cleaning things up … he can escalate quickly so you had to be watchful. Now I can sit down in the lounge room with him and have a cup of coffee. We can enjoy the simple things with him now.

• Enable staff to give good-quality care. Reducing the time and effort spent protecting themselves and residents from dangers in the home could help achieve this.

If staff safety is a priority, then they can better support tenants and their needs … if you can’t look after staff, then they can’t look after residents.

• Reduce staff turnover. Staff feel safer and more comfortable at work.
• Give comfort and peace of mind to residents. One family member said that for her child, knowing there were measures in place to protect staff from their behaviours of concern was comforting. Their child did not want anyone hurt.

Support choice and options for interaction

The research found it was important to support residents’ choice and options in interaction with others when wanted, as well as privacy and personal space. The choice in where and how people interact also needs to allow residents to avoid or exit situations where others may trigger their behaviours of concern.

Good design requires the capacity for both people being together some of the time and people being separate some of the time ... so people have the ability to withdraw or the ability to engage with others.

Enable effective support delivery

With the important role played by SIL staff and other therapeutic services in improving resident outcomes in mind, stakeholders said it was important for robust SDA buildings to enable, but not replace, effective supports. Stakeholders said this was important for the following reasons:

• Enable the long-term provision and adaptation of supports. Consider how design features could best allow support services to remain efficient and effective as residents’ needs change over time.

There needs to be a lot more done in terms of what can be incorporated into the home design to facilitate the support that’s given… the right building can enhance the provision of effective support.

• Meet residents’ needs in the most effective way. Stakeholders felt it was important to actively assess whether residents’ needs could be best addressed through design or support services in the design phase. This was to ensure design solutions were not replacing the need for more effective behavioural or other supports. To this end, it is critical that all residents have a suitable behaviour support plan.

Adaptable and flexible design

Stakeholders felt that good-practice robust SDA should maximise the flexibility of the building design to support the changing needs and abilities of residents and broaden the appeal of properties for future use/sale. This is important for the following reasons:

• Support residents well throughout their life. Stakeholders said that adaptable robust SDA would better support people throughout their lifetime. This would allow for ‘ageing in place’ if desired and cater to supports that scale up or down based on resident needs.

We need to be able to adapt a home to people’s needs … people’s lives change, their needs change and their home should change with them.

• Increase the economic viability of the home for investors/developers. Flexible designs are easier to adapt to the needs of future residents only if we consider these costs at the start.

A few stakeholders also stressed ensuring residents have the option to move house at a later stage if they want, despite these long-term investments.

You also don’t want to be packing people into a house for life. They should have the option to move if they want to, just like any other adult.