Background and methods

Under the National Disability Insurance Scheme (NDIS), Specialist Disability Accommodation (SDA) is for people who need specialist housing solutions. This includes housing that caters for extreme functional impairment or very high support needs.

The NDIS robust SDA design category aims to ‘incorporate a reasonable level of physical access provision and be very resilient, reducing the likelihood of reactive maintenance and reducing the risk’ to the resident, service providers and the community₁. The National Disability Insurance Agency has published general design standards for robust SDA. But the guiding principles that focus on leading-edge and person-centred good-practice design in the robust category are not available. Residents’ preferences for robust SDA design have not been well explored.

The Department of Families, Fairness and Housing is Victoria’s primary supplier of robust SDA. To guide development of future robust SDA builds, the department commissioned ORIMA Research to:

• pinpoint good practice approaches
• develop a set of design principles.

The research project involved three stages:

• literature scan – gathering relevant literature and a ‘deep dive’ review of 8 academic articles, reports and policy papers
• initial interviews – one-on-one in-depth interviews and a group in-depth interview with four experts₂
• core qualitative research – one-on-one in-depth interviews, group in-depth interviews and mini focus groups with 29 people. This included 23 stakeholders, 2 people with a disability and 4 family/carers of people entitled to robust SDA.

Throughout the research, we refined the design principles with:

• stakeholders
• family members/carers
• residents.

Insights from the literature review informed the principles.

Resident needs, experiences and perceptions of robust SDA

Stakeholders said that robust SDA gives homes to a diverse group of people. This group has a wide range of disability types and sensory and environmental needs (more so than NDIS participants living in other SDA design categories). This includes a distinct group of NDIS participants who showed behaviours of concern.

The robust SDA group includes residents with a range of the following:

• Disabilities. This includes intellectual disability, autism, acquired brain injury, pica and Prader-Willi syndrome. Some residents have co-occurring disabilities or conditions such as an intellectual disability and co-existing diagnosed mental illness.
• Sensory needs that need to be addressed in a robust SDA. This includes internal temperature or humidity, lighting, the use of certain colours and noise.
• Behaviours of concern. This includes self-harming behaviours; aggressive or violent behaviours that may cause harm to others; and destructive or obsessive behaviours that may result in property damage.
• Environmental needs. These are other factors that could trigger behaviours of concern in the home. These include a lack of personal space, behaviours of other residents’, past trauma-associated triggers (e.g. ‘institutionalised’ design features) and items of fixation.

The research found an important link between the built environment (building location, features and design) and resident outcomes. Well-designed robust SDA plays an important role in improving resident outcomes. It does this by having specific and unique environmental features that support independence and reduce behaviours of concern.

Research respondents raised other issues with robust SDA including:

• the nature and quality of current robust SDA offerings (which was not considered ‘ideal’ practice)
• NDIS SDA robust design funding constraints
• challenges in meeting residents’ choices in shared living spaces.

Stakeholders and family members felt there was a clear need for improvements to robust SDA. The research found a lack of guidance and standards in good-practice robust SDA design.

Design principles

To improve robust SDA design, we developed seven good-practice design principles. The need for a person-centred co-design approach underpins the principles. To tailor homes to individual residents’ needs, spaces should be co-designed with:

• residents
• families/carers
• broader support networks (including family members/carers and support staff).

The good-practice design principles are 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.

The research found specific design elements that support these principles (detailed in Part C of this report). In a person-centred approach, consider these design elements with specific residents in mind. Some, but not all, of these elements could be adopted.

1. National Disability Insurance Agency 2019, NDIS Specialist Disability Accommodation: Design Standard, Edition 1.1, National Disability Insurance Agency, Canberra.
2. Stakeholders included SDA providers, Supported Independent Living providers and other experts in the field of disability (academics, advocacy organisations, peak bodies) as well as representatives from the former Victorian Department of Health and Human Services and the NDIA.

Background

Specialist Disability Accommodation (SDA) is for people who need specialist housing solutions. This includes housing that caters for residents’ extreme functional impairment or very high support needs. Under the National Disability Insurance Scheme (NDIS), the ‘bricks and mortar’ of SDA and the supports offered in homes (Supported Independent Living or ‘SIL’) are separated. SDA includes 4 building design categories:

1. improved liveability
2. robust
3. fully accessible
4. high physical support.

Robust SDA is ‘housing that has been designed to incorporate a reasonable level of physical access provision and be very resilient, reducing the likelihood of reactive maintenance and reducing the risk’ to the resident, service providers and the community¹. The National Disability Insurance Agency (NDIA) has published general design standards for robust SDA. But guiding principles that focus on leading-edge and person-centred good-practice design in the robust category are not available. Residents’ preferences for robust SDA have not been well explored.

The Department of Families, Fairness and Housing is Victoria’s primary supplier of robust SDA. The department commissioned ORIMA Research to develop principles to guide future robust SDA design and construction.

Project aims

The primary aim of the research was to develop guiding good-practice principles. These principles would inform construction of leading-edge, robust SDA. The research also aimed to:

• understand the design features, preferences and experiences of people who need robust SDA
• pinpoint design trends, both here and overseas, that relate to robust SDA
• develop design principles for robust SDA informed by a range of experts with knowledge on the topic
• find experts in robust SDA
• document tested or trial design, environmental and construction features that build on the NDIS SDA Design Standard guidance.

Research method

The research project involved three stages:

• literature scan – a scan and cataloguing of the available literature on the topic and a ‘deep dive’ review of 8 key academic articles, organisational reports and policy papers
• initial interviews – one-on-one interviews and a group in-depth interview with 4 experts
• core qualitative research – one-on-one in-depth interviews, group in-depth interviews and mini focus groups with 29 people. This included 23 stakeholders, two people with a disability and four family/carers of people entitled to robust SDA.

Literature scan

A literature scan catalogued trends, approaches, guiding principles and good practice in robust SDA. The purpose of the scan was twofold:

• produce a list of resources to use when developing guidelines for good-practice robust SDA design
• decide the relevance and value of conducting a full literature review.

The scan looked to find:

• trends in disability housing design, universal design and accessibility
• guidelines, principles and factors in building robust housing for people with complex needs
• subject matter experts
• examples of good-practice disability housing design and construction.

The literature scan found 44 local and overseas research papers and journals. The researchers decided that a full literature review was not necessary. Still, they chose 8 studies for a ‘deep dive’ literature review. This deep dive:

• helped develop guiding design principles and features
• gave background to the qualitative research findings.

We have included relevant findings from the deep dive in this report. Refer to Appendix 1 for the reference list.

Initial interviews

Initial stakeholder² interviews:

• gave first insights into the key issues and considerations about robust SDA
• helped refine research instruments
• found key stakeholder participants for the rest of the qualitative research.

Four research participants took part in this stage of the research through two one-on-one in-depth interviews and one group in-depth interview.

Core qualitative research

The core qualitative research included 23 people via:

• three online mini focus groups
• 11 one-on-one in-depth interviews
• two group in-depth interviews.

Fieldwork took place between 22 October 2020 and 26 January 2021. Researchers conducted almost all interviews online to protect health and safety during the coronavirus (COVID-19) pandemic.

The target audiences for this research included the following:

• Stakeholders. This included SDA providers, SIL providers and other disability experts (academics, advocacy organisations, peak bodies). There were also staff from the then Victorian Department of Health and Human Services and the NDIA. This audience included 10 SDA providers, nine SIL providers and eight other experts.
• Residents entitled to robust SDA. This included people whose current robust SDA was not meeting their housing needs.
• Family members and carers of people entitled to robust SDA. This included people living in robust SDA and those fit for robust SDA looking for this type of housing.

Most participants were from Victoria given the department’s scope. We also spoke with experts from other states and territories.

Table 1 shows the qualitative research design.

Table 1: Qualitative research design

Online mini focus group (OMFG); group in-depth interview (GIDI); online in-depth interview (OIDI); face-to-face in-depth interview (FIDI)

The following methods helped find participants for the research:

• Homes Victoria, the Department of Families, Fairness and Housing and ORIMA Research’s Disability Research Services Division used their industry experience and desk research to find initial interview participants.
• ORIMA used snowball sampling in the first interviews. Participants recommended SIL providers, SDA providers and developers and other experts in the field. The department sent these participants a primary approach letter to invite them to take part in the research. ORIMA then contacted them to schedule an interview or to include them in a mini focus group.
• We found a disability design academic during the literature scan. ORIMA invited the academic to take part in the research.
• ORIMA asked VALID, a disability advocacy body, to recruit resident and family/carer participants.

Resident and family/carer participants received an $80 payment (or gift voucher). This was to recognise their contribution and cover the costs of taking part.

Appendix 2 lists the people and organisations that took part in the stakeholder part of the research. ORIMA and Homes Victoria thanks all participants for their time and valuable contribution.

Research challenges and limitations

At the start, we planned to include more people with robust housing needs in the research. Yet, the timing of the research (during a COVID-19 lockdown period) and the communication preferences of people with robust housing needs made recruitment hard. We took a flexible approach (offering face-to-face talks after lockdown) and extended the fieldwork period. Still, fewer residents took part in the research than would have been ideal. We acknowledge the importance of giving people with lived experience direct input into the research.

Findings from people with lived experience of robust housing (residents and family members/non-paid carers of residents) were consistent with other stakeholders. This confirmed the research findings. But take caution when generalising the research findings to the broader population of people entitled to robust SDA. This is due to the small sample size of lived experience participants and the diverse range of needs among this group.

Presentation of findings

The research was qualitative and so we have presented the results and findings in a qualitative way.

The following terms used in the report estimate the size of the target audience who held certain views:

• Most refers to findings that relate to more than three-quarters of the research participants.
• many refers to findings that relate to more than half of the research participants.
• Some refers to findings that relate to around a third of the research participants.
• A few refers to findings that relate to less than a quarter of research participants.

The most common findings are reported except in certain situations where only a minority has raised certain issues. Still, these are important and may have wide-ranging effects or uses.

How to read this report

This report is divided into three sections:

• Part A: Background details research findings to give a snapshot of robust SDA and how to consider the design principles and elements.
• Part B: Good-practice design principles explains the good-practice design principles developed through the research.
• Part C: Design elements and features to support good-practice design details specific design elements and features to support good-practice design and resident outcomes. It includes case studies of good practice.

Quotes from research participants feature throughout the report. These support the main results or findings discussed.

The following terms appear throughout this report:

• Stakeholders refers to people involved in the research – (SIL) providers, SDA providers, government representatives and other industry experts. Industry experts include peak bodies, advocacy bodies and academics.
• Residents refers to people with disability who need robust SDA. They may or may not live in SDA.
• Family members refers to family members and carers of people with disability who need robust SDA.
• Participant refers to research participants (the above three groups).
• Behaviours of concern refers to behaviours that place the person or others at risk of harm⁴.

Quality assurance

Researchers carried out the project in line with the international quality standard ISO 20252 and the Australian Privacy Principles contained in the Privacy Act 1988. ORIMA Research also adheres to the Privacy (Market and Social Research) Code 2014.

1. National Disability Insurance Agency 2019, NDIS Specialist Disability Accommodation: Design Standard, Edition 1.1, National Disability Insurance Agency, Canberra.
2. Stakeholders in this phase of the research included peak bodies, advocacy organisations and representatives from the former Victorian Department of Health and Human Services.
3. One resident preferred a face-to-face interview. This took place outside the Victorian COVID-19 lockdown period and followed government health and safety guidelines.
4. NDIS Quality and Safeguards Commission 2019, Positive behaviour support capability framework, Canberra.

Resident needs

This section gives background to help understand the needs of residents in robust SDA. It outlines the link between the built environment and resident outcomes. It then discusses the range of resident disability types, behaviours and environmental triggers that need to be considered in robust SDA.

Link between the built environment and resident outcomes

The research found a natural and important link between the built environment (building location, features and design) and resident outcomes. Outcomes include health, wellbeing, emotional control, behaviours of concern and forensic behaviours. Academic literature on the topic highlights the link between building design and residents’ physical, mental and psychosocial wellbeing (Mobley, Leigh & Malinin 2017; Wright, Zeeman & Whitty 2016; Zeeman, Wright & Hellyer 2016). Golembiewski (2015) noted that even minor changes or improvements to building design can create strong and long-lasting improvements in residents’ behaviours.

The impact of the design is massive … it can have a really positive effect on people and their behaviours, but if it’s inadequately designed it can have the reverse effect where people’s behaviours remain or get worse.

Stakeholders felt that robust SDA could improve resident outcomes by offering the unique environmental features needed for specific sensory needs and reduce environmental triggers. The literature found that good-practice design can reduce behaviours of concern. This reduces agitation, aggressive behaviours and the rate of self-injury (Bridge & Vasilakopoulou 2019; Sax Institute 2020).

Good design reduces the incidence of poor behaviour, behaviours of concern like self-harm, damage to property, injuring other people … as a result that improves the life of residents, their co-residents and the people that work with them.

Figure 1 shows the link between building design and resident outcomes.

Figure 1: Effects of robust SDA on resident outcomes

Stakeholders also said that effective robust SDA design could improve safety for SIL staff and other residents. It could deliver SIL support in line with residents’ support preferences. For example, it could offer:

• more ways for residents to increase their independence
• less obtrusive observation of residents by SIL staff
• reduced staff-to-resident ratios.

Range of people needing robust SDA

Stakeholders told us that robust SDA gave homes to a diverse group of people. These people have a broad range of sensory and environmental needs, disabilities and behaviours of concern (more so than other SDA categories). These included the following:

The people who are likely to be eligible for robust [housing] are also likely to have a sensory processing disorder … they might be over-sensitive or under-sensitive to particular sensory inputs.

• Disabilities. These included intellectual disability, autism, acquired brain injury, pica and Prader-Willi syndrome.
  • Some residents had co-occurring disabilities or impairments and co-morbidities (e.g. epilepsy, mental health disorders). These must be considered when designing homes.

You see a real mix of disabilities in this cohort … the people who are eligible for robust [SDA] often have a range of different diagnoses that are multiple and overlapping.

• Behaviours of concern. These included:
  • self-harming behaviours (e.g. banging one’s head against a wall)
  • aggressive or violent behaviours that may harm others (e.g. physical aggression or throwing furniture)
  • destructive behaviours that may cause property damage (e.g. throwing large pieces of furniture or breaking fixtures and fittings)
  • obsessive behaviours (e.g. ‘picking’ at loose carpet or floorboards)
  • improper sexualised behaviours
  • leaving the home without support (where residents need support to access the community)
  • constant hunger because of Prader-Willi syndrome.

To get into the robust category you generally have some pretty extreme behaviours of concern … the vast majority of those in robust will have these challenging behaviours.

The research found that residents had unique housing needs. These needs require tailored building design and fit-out solutions.

Environmental features that can trigger behaviours of concern

The research found a range of environmental features that could:

• trigger or increase behaviours of concern for residents
• lower quality of life and reduce resident outcomes.

These were specific to each resident. But stakeholders and the literature (Ahrentzen & Steele 2009; Bridge & Vasilakopoulou 2019; Tuckett, Marchant & Jones 2004) mentioned the following common environmental triggers:

• Sensory triggers. These are sensory features of the space that cause residents’ discomfort:
  • noise – loud sounds, noises made by non-verbal residents, high-frequency noises or noises given off by appliances such as refrigerators, lights and exhaust fans
  • light – glare, rooms that are too bright or too dim and flickering lights (e.g. dim lighting can have a negative effect on the mood of patients with dementia; glare and bright reflections can trigger visions; Bridge & Vasilakopoulou 2019)
  • strong smells – food smells, cleaning products or perfume/deodorant worn by staff.

When [my son] is escalated, the smell of food makes him sick and drives him nuts..

• Temperatures and humidity levels that do not suit residents’ personal preferences. The literature also suggests that poor airflow and lack of fresh air can agitate residents (Bridge & Vasilakopoulou 2019).
• Certain colours and textures trigger behaviours of concern for some residents.
• Under-stimulation. While too much in the environment (e.g. bright lights, loud noises) can trigger residents, stakeholders warned that under-stimulating spaces (those with limited sensory stimulation – e.g. without colour, artwork on walls or tactile stimulation) could also trigger residents’ behaviours of concern.

When you look at the cause of challenging behaviours, it often comes from a sensory need … for some people it’s touch, and you can’t use certain textures in the home. For other people it’s light or sound.

• Features triggering obsessive behaviours. Stakeholders said that certain features in the home could become items of fixation for some residents. This could lead to damage or pose risks to residents’ health and safety. These included:
  • easy access to electrical wire or circuit boards and exposed screws, which some residents would play with or unscrew
  • ‘pickable’ fixtures and products (e.g. floor coverings, plaster board and light switches). Stakeholders said that some residents would pick at these fixtures until they came loose. For example, they would pick until the carpet unravelled or large sections of paint/plaster came away from the wall.

There’s people with obsessive behaviours. They might obsessively eat, or pick at paint, or unscrew screws … if there’s something like light switches, they can flick or things they can get their fingers around to pick, they’ll go for it.

• Triggers related to other residents include:
  • behaviour that triggers unwanted responses – stakeholders said that behaviours of concern (e.g. screaming) could be a trigger for others in the home
  • SDA layout that offers little personal space – a lack of personal space or a sense of crowding by other residents can be triggering for some.

The triggers often come from the other people that someone is forced to share a space with. If you don’t have a place where you can get away from other people and the triggers to self-soothe, the behaviour will keep escalating.

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.

This section presents good-practice examples across a range of robust SDA design and development aspects that stakeholders shared in the research. We give examples to do with:

• building and design for an individual’s needs
• creating flexibility
• using outdoor spaces for productive activities
• catering to cultural needs
• balancing needs for privacy and social interaction
• reducing restrictive practices and supporting independence through technology.

Building and design for an individual’s needs

One SDA developer said that a holistic understanding of the individual needs of their future residents underpinned their approach to developing robust SDA. To enable this, they got direct input from residents, their key support networks (e.g. family members and carers) and their SIL provider. This included reviewing individual behaviour support plans and including design features that would complement the plan.

Designing robust SDA for an individual’s needs from the beginning is best practice. Yet, one stakeholder gave an example of adjusting existing housing to minimise a resident’s individual triggers and behaviours, and the importance of knowing these. This stakeholder worked with a resident who was in accessible public housing and met the needs for robust SDA.

This resident’s main behaviour of concern was property damage due to banging her head against the wall. (This also put the resident at risk of injury, as well as damaging the property.) Robust design standards suggest that this resident needed stronger walls to prevent property damage. But this stakeholder understood the resident’s behaviour and saw that reinforcing the walls would place her at risk of further brain damage. Instead, the stakeholder used other solutions to offer a safer space. This included reducing environmental triggers and working with the resident to choose some of her own artworks and wall coverings to display. Decorating the walls with imagery that the resident liked reduced behaviours that may damage the property (and injure the resident).

Creating flexibility

One SDA developer includes design features of several SDA categories (e.g. robust, fully accessible and improved liveability) as a standard practice in all their SDA developments. This achieves greater flexibility in the future use and repurposing of SDA developments. The developer incorporates robust materials in SDA builds, even when not needed under the particular category they are building for.

Using outdoor spaces for productive activities

One stakeholder explained the value of having spaces and facilities for exercise and creative activities of choice in robust SDA for young men with autism. The stakeholder saw this as an effective way to support self-regulation and the pursuit of productive activities and hobbies for residents. This is particularly important for residents with autism. Engaging in such activities in a community setting can often be stressful and uncomfortable for this group.

This stakeholder worked with a man with autism who enjoyed spray painting and woodwork. The stakeholder set up a shed into the resident’s backyard to use for these activities. Another example included converting garages into spaces for gym equipment to offer ways for the body to understand its ability to sense its location, movements, and actions. This stakeholder said that these measures increased residents’ ability to self-regulate and their quality of life.

This type of at-home hobby is mostly overlooked; however, it is a very normalised way of enabling someone to engage in their own self-regulation and productive pursuits.

Catering to cultural needs

One stakeholder shared the example of a robust SDA designed for First Nations residents. The design addressed cultural needs through a co-design process with the resident’s community. This reduced the need for restrictive practices and the use of PRN medications (medications administered as needed) among residents.

The home design was a collaboration between an Aboriginal and a non-Aboriginal architect. Talks with Elders and the community about traditional housing structures to lessen behaviours of concern influenced the design.

Key features included:

• a housing design that used traditional First Nations design but was built with modern materials
• acknowledgment and use of First Nations belief systems into the housing structure and design – for example, curved walls to avoid sharp corners because sharp corners are where ‘bad spirits’ are found, to increase psychological safety
• outdoor features that reminded residents of home country used in the landscape of the garden (e.g. gum trees).

Balancing needs for privacy and social interaction

One SDA developer felt it could be useful to have ‘cluster’ style properties with around five single-person homes on a larger block of land. The block would have shared indoor and outdoor spaces for residents. Although this stakeholder had not yet built such a property, they felt this layout could give residents an ideal balance between having a private space and greater independence. It would also offer ways for connecting with other residents on the property when chosen. They also felt that this would help to avoid residents triggering each other because a resident could easily choose to leave a social situation.

Using this model, less invasive staff supervision could also occur by giving a good line of sight between indoor and outdoor areas. This would allow residents to spend time alone in their home while staff watch the area as needed.

Reducing restrictive practices and supporting independence through technology

One stakeholder shared an example of an SDA build that uses leading-edge technology. In collaboration with telecommunications and technology corporations, using the technology reduced restrictive practices. Design-phase meetings with residents’ family members and support workers led to permission to use these new technologies in the home.

Key features of the home included the following:

• Facial recognition to unlock the fridge. Restrictive locking practices did not have to be in place for residents where this was not needed. The health and safety of other residents who needed it was still protected.
• RFID (radio frequency identification) tags in residents’ clothing to help people to access the front gate. This technology allowed one resident to safely unlock the door and check the mail without the risk of other residents leaving the property without support. For this resident, being able to check the post was important. Not knowing when the mail arrived caused anxiety. Including this feature reduced anxiety, behaviours of concern and the need for PRN medications.
• Light automation. Lights came on at 6.00 am and slowly brightened over time to help residents wake up naturally at the beginning of the day. A similar feature that allowed blinds to lower on their own at the end of the day was also used.
• Google system reminders (e.g. through Google Home). These were set up to remind residents of certain daily care tasks, enabling greater independence. For example, a resident may receive a reminder to ‘remember to brush your teeth’ when they enter the bathroom.

Conclusions

Robust SDA plays a vital role in offering suitable housing for a diverse group of people. This group has a wide range of sensory and environmental needs, disabilities and behaviours of concern. The research found that good-practice robust SDA tailored to each resident’s specific needs has potential to improve quality of life and resident outcomes while reducing behaviours of concern. This link between the suitability and quality of the built space and resident outcomes highlights the importance of effective robust SDA design. It also points to more effective design in other SDA categories more broadly.

Yet, the research found several issues currently facing robust SDA including:

• the nature and quality of current robust SDA offerings (not considered good or ‘ideal’ practice)
• funding limits
• challenges supporting resident choice and best outcomes in shared living arrangements.

Stakeholders and family members felt there was a clear need for changes and improvements to robust SDA offerings and the systems that support it. The research found a lack of guidance in good-practice robust SDA. This highlights the need for a clear set of good-practice design principles. These principles would guide development of more effective housing solutions and support improvements in available robust SDA.

We developed seven good-practice design principles through the research. The need for a person-centred co-design approach with residents, their families/carers and broader support networks would ensure each home is tailored to individual residents’ needs.

These design principles also apply across other SDA categories. Using or adapting these more broadly could be considered in the future.

The research found a set of design elements and features to support these principles. Part C of the report outlines these.

Adopting the design principles found through this research will contribute to better quality outcomes for residents of robust SDA. But it is important to note that they form only part of the solution. Broader policy changes would need to address some existing barriers to creating effective homes for this group such as funding constraints.