When Autistic Adults Living in a Residential Facility Compose Their Own Staff Teams

Introduction

Since March 2023, the Residential Facility ‘Banebyen’ – a part of Specialist Area Autism, Central Region Denmark – has introduced the so-called “Resident-composed Staff Teams”, meaning that residents themselves choose which employees should be part of their team. The initiative is followed and evaluated with support from the Social Department’s Research and Development Fund, Central Region Denmark. This learning note reflects on the experiences after the first 6 months of the initiative. The purpose of the learning note is to highlight preliminary results, areas for development, and points of attention that can strengthen the further implementation of citizen-formed teams. A final evaluation report will follow in the autumn of 2024.

The learning note is based on:

• Five individual interviews with residents
• One focus group interview with four employees
• An interview with the management of “Banebyen”
• Two questionnaires: a baseline questionnaire (completed by 12 out of 19 residents) and a follow-up questionnaire six months after initiation (completed by 14 out of 19 residents).

The development of questionnaires and interview guides, the interviews, and the preparation of the learning note were done in collaboration between autistic project employees Cecilie Borch-Andersen and Jesper Lau Guldager, and project leader Johanne Svane. The advice and reflections from Jesper and Cecilie, as mentioned in the learning note, are excerpts from their written reflections and thoughts based on the interviews.

Preliminary Implementation Experiences
From three to 19 teams

“It is evident that this project is idealistic, and the management are truly passionate about it. I believe their passion and belief in the project are crucial for employees and residents to see possibilities in the project. I also think that both the management’s and employees’ passion for the project will be challenged when new challenges arise, but it is their passion, along with the residents’ hope for the project, that will determine the project’s success.”

Reflection from autistic project employee Cecilie Borch-Andersen

In recent years, the management in “Banebyen” has been inspired by other initiatives working with various variations of Resident-Formed Staff Teams. This has been discussed with employees, but it is the management itself that has been primary in devising how “Resident-composed Staff Teams” could be implemented in “Banebyen”. In December 2022, employees were finally informed that citizen-formed teams would become a reality from the first quarter of 2023. Residents received written information and were individually invited to a meeting with the daily manager to learn more about the purpose of the new teams and to express their preferences for team members.

Employees were similarly invited to a discussion with the department head to discuss options and any concerns regarding the reorganization, as well as provide input on which residents they had a particular desire to collaborate with – although it was a known premise that the residents’ preferences were decisive. In the dialogue with both employees and residents, it has been important for the management to clearly communicate the vision of the “Resident-composed Staff Teams”, because support for this seemed crucial to creating commitment to such a significant organizational change.

Both interviewed residents and employees have experienced the process as positive. However, the management mentions that a few residents have felt uneasy about the idea of changes to their team or found it difficult to choose some over others. Especially employees express that individual employee interviews have been essential in gaining support for the new organization and addressing challenges and concerns, and they have felt seen and heard by the management throughout the entire process.

Based on conversations with residents and employees, the 19 new teams were formed. Before initiation, there was concern among management and employees that some employees might not be chosen for any teams.

However, this did not happen in practice, and everyone got a place in one or more teams. The management’s perception is that all teams were formed based on the residents’ wishes. However, in the conducted questionnaire survey, one resident indicated that they had not chosen their team, and furthermore, two residents answered that they did not know.

Regarding the choice of employees, the questionnaire shows that the majority of residents have wanted employees they feel comfortable with (9 out of 12). Many have also indicated that they have chosen employees they like (5 out of 12) or those who support their development (5 out of 12). The interviewed residents have focused on different aspects in forming their team: one resident chose employees they feel comfortable with, another chose based on the employees’ work schedules to receive support on specific days, while it was important for a third that the employees could complement each other with their specific skills.

The Initial Experiences with the New Teams

Most teams have had a good start. In the last couple of months, there have been a few replacements or requests for replacements. According to employees and management, one reason for this is that residents may initially choose employees with whom they are familiar and comfortable but find that the collaboration and relationship dynamics change when working together in a team with a more targeted focus on the citizen’s development. In this context, the management expresses a desire for the residents to consider not only the relationship but also the professional competencies of the employees in their choices.

One resident mentions that it would be desirable to have a broader basis for selection beyond merely the names and pictures of all employees. Instead, could profiles be developed for employees, describing their professional background, competencies, and personal interests, allowing choices to be made on a more informed basis?

“When new employees are hired, involve the principle of ‘teamless-ness’ in organizing some activities, so that the residents can get to know them. Ideally, tailor the activities to appeal to different residents’ interests (game nights, walks, outings, etc.). Perhaps create a list of the new employees with their photographs, a bit about them, and their interests, as well as the skills they bring to the table. This can serve as a ‘menu’ for residents looking to add new people to their teams.”

Advice from autistic project employee Jesper Lau-Guldager

A structure that can accommodate 19 teams

Management and employees findt that the primary challenge with “Resident-composed Staff Teams” has been to establish a new meeting structure that can cater to 19 teams assembled in various combinations. This has not only presented internal challenges within “Banebyen” but has also impacted external collaborations where finding common meeting times has proven difficult. Management emphasizes that success has largely relied on the support, flexibility, and goodwill of the employees.

The interviewed employees also think that the organizational change has been challenging and that they continue to invest a significant amount of energy in this new way of structuring their work. At the same time, it is an inherent premise in “Resident-composed Staff Teams”, that there are ongoing replacements based on the Residents’ desires and needs, and as a result, the meeting structure may continuously evolve.

One consideration is that, over time, relying too much on employees’ flexibility and willingness to make it work can become vulnerable. Employees express that being in the midst of a prolonged development process is energy-consuming and that there is a need for a certain level of security and stability. However, the project currently holds so much significance that the employees are willing to exert extra effort.

Upcoming focus areas in relation to further implementation

Following a successful initial implementation where the residents’ wishes have been fulfilled, and all employees have been selected for one or more teams, many of the concerns initially raised by “Banebyen” remain unexperienced. However, due to desired changes within the teams, relocations, and new employees, “Banebyen” will need to make adjustments to the existing teams in the months to come. They expect facing questions such as:

• How do we ensure a good balance for both citizens and employees between the familiar and the secure and a new, flexible, non-static way of working?
•  How do we create a good framework for dialogue when:
  o The residents want to make changes to their teams?
  o Wishes cannot be accommodated, or employees/managers encourage the resident to make changes in their team?
• How do we handle the emotions that may arise if an employee feels excluded?
• How and when do new employees join teams?
  
  

In the interviews with the managers, they mention that, in hindsight, they would have liked to involve both residents and employees in the design of the project to bring more perspectives into the work, and create the best solutions for “Banebyen”. A recommendation is therefore to involve a broad spectrum in finding possible answers to the above questions.

“The residents I interviewed showed great enthusiasm for the success of this project. I could imagine that they might find it interesting to be asked about solutions to problems, if nothing else, to feel heard.

Advice from autistic project employee Jesper Lau Guldager

My advice to Banebyen is a clear communication to the residents that teams are flexible, intended to change periodically based on the needs of the residents. Remember to provide clear examples of why a change could be beneficial and how it would happen. This might help prevent some uncertainty and unpredictability.

Advice from autistic project employee Cecilie Borch-Andersen

Preliminary Results

Results concerning the residents

The survey, answered by 14 out of 19 residents six months after initiation, shows that:

• 10 residents state that they completely agree that Resident-composed Staff Teams are a good idea. One partially agrees, while three responded ‘don’t know’ (of these, one indicated not having chosen their team).
• 11 residents state that they themselves have chosen their team. One stated not having chosen their team. Two responded ‘don’t know.’
• 12 residents completely or partially agree that choosing the team members themselves increases their desire for collaboration. Two residents responded ‘don’t know.’
• All residents experience having a good relationship with their team.
• 13 residents feel that all team members listen and take them seriously. One resident disagrees with this statement.
•  9 residents often have fun and enjoy the company of the team members. One neither agrees nor disagrees, while two responded ‘don’t know.’
•  The proportion responding positively to the above statements has increased from the baseline measurement in March 2023 to the measurement in September 2023.
  
  

The management’s expectations with Resident-composed Staff Teams have been to strengthen the three fundamental psychological needs according to self-determination theory: Autonomy, relatedness, and competence – thereby increasing opportunities for well-being and development among the residents. Despite only six months passing since the introduction of Resident-composed Staff Teams, there are indications that the introduction strengthens these three needs: Regarding autonomy and competence, the interviewed citizens use expressions such as ‘control over their own social circle’ and having ‘authority over the assistance they receive.’

One resident expresses it as follows: “I didn’t think I had anything to say because the others were professionals. But after this, I understood that I also have a voice. I know what’s best for me in some things.” Concerning the experience of relatedness, one interviewed resident describes feeling seen for who they are, while another mentions the importance of equality and feeling respected.

One resident did not have specific preferences for the composition of their team because they have a good collaboration with everyone. However, this resident expresses that it has become clearer and more manageable to identify who they collaborate with after the introduction of the new teams: “I am very interested in my own life, so I want to be [at the team meetings] as much as I can. (…) I would almost wish it was more often. (…) For the first time, I feel: this is something I have control over, I decide these things, it’s my life, and I am heard in this, and they come up with suggestions, and then I can choose from those suggestions. And that just makes me more willing to work with the things laid on the table.”

Interviewed Resident

Several of the interviewed residents express that Resident-composed Staff Teams enhance their development opportunities. One resident explains this by stating that they used to waste ‘energy’ communicating with their team, but a small self-selected team now releases energy to “eliminate other topics that waste energy. To get into a better situation day by day.” Another describes that feeling secure in their team provides a better foundation for development.

However, the management expresses concern that some residents isolate themselves due to the new collaboration, making themselves vulnerable to support from others outside the team. At the same time, few employees may be left alone with very significant and emotionally demanding tasks. The management explains this shift as the introduction of Resident-composed Staff Teams as more ‘legalizing’ the selection and deselection of employees. There is a consideration whether the organization should clarify to both residents and employees what the team’s tasks are and what are ‘everyday tasks’ that can be handled by those outside the team to counter vulnerability and isolation in citizens and fatigue in employees.

Does the creation of Resident-composed Staff Teams create a culture that focuses so much on the relationship and self-determination regarding whom to collaborate with that it risks having the effect that residents isolate themselves with very few employees and feel that they cannot get help from others, thus receiving less support? How can this tendency be counteracted to ensure that the residents can receive support, even during holidays and illness?

Reflection from autistic project employee Cecilie Borch-Andersen

Apart from the above concern from the management, both they and the employees experience that Resident-composed Staff Teams generally positively enhance the development of the Residents: Teams formed around one specific individual mean that there is now a concentrated focus on the individual. With the previous team organization, some residents could fade into the background because residents with particularly complex issues required special attention at meetings.

Employees and management find that especially the residents’ participation in team meetings has supported the positive results. The management believes that this, combined with the above, has strengthened the quality of the efforts and expresses that, “where we may have thought before that we were responsible for coming up with the solution, it is now a shared responsibility.” Today, 15 out of 19 residents participate in their own team meetings.

Therefore, an important focus area seems to be how to create frameworks that enable the remaining residents to also participate in their own team meetings. Similarly, a point of attention is whether, in planning team meetings in the future, the resident’s schedule should be considered to acknowledge their importance in the team and support the possibility of participation, as several citizens mention that planning primarily relies on the schedule of the employees.

“It makes sense that each resident is part [of their team meetings], so we’re not deciding everything without them, but they’re involved in the process and in the conversation. This way, we’re not just discussing things hypothetically; we’re getting a sense of what’s actually happening here. And it’s actually a strange way to work, as it’s what we did before.”

Interviewed Employee

Both employees and management point out that more residents than before participate in social events. Employees attribute this to the introduction of Resident-composed Staff Teams, creating a safer space and making it easier for the resident to express the frameworks that can support participation. At the same time, the increased focus on each individual means being aware of discussing with the resident their desires regarding participation in social events – where there used to be a tendency to assume a lack of desire for participation, especially among quieter residents. We have not been able to confirm the employees’ thesis that Resident-composed Staff Teams strengthen the overall social life in “Banebyen”, as this area has not been part of the questionnaires, and there has been no systematic inquiry in the interviews. This will be further explored in the final evaluation.

Results concerning the employees

Concerning the employees, Resident-composed Staff Teams also seem to have yielded positive results. Employees emphasize that being chosen by the residents increases motivation, meaning, and job satisfaction. At the same time, both employees and management experience that it has positively affected the working environment and collaboration among employees. Previously, there was a tendency for the three employee teams to close in on themselves, only exchanging ideas within the team and not across teams.

This closed-off approach is no longer possible: The small teams make everyone dependent on each other, fostering cross-team collaboration and inspiration. It also means that the politeness of not interfering with each other has been replaced by a higher degree of curiosity about why people do what they do. Employees feel that this shift has been supported by a general focus on strengthening psychological safety, as well as a focus on collaboration within each team, where individuals can express what they excel at, where they need an extra push, and their expectations of each other.

At the same time, management points out that all employees make more effort in collaboration, respecting that the resident has chosen everyone around the table. However, employees feel that they have not yet created a completely open culture of collaboration but are moving in the right direction.

“I experience a greater motivation. You also feel chosen by the residents. I have some skills that the resident has thought could be useful for them. And you really want to live up to that.”

Interviewed Employee

Both management and employees find that one of the significant gains from the introduction of Resident-composed Staff Teams is that meetings have become more effective due to the concentrated focus on the individual and the resident’s own participation. This also means that new initiatives can be initiated more quickly. However, it also leads to a sense of increased work pressure in combination with spending a lot of time coordinating the schedule of each team. Paradoxically, employees express that the new work format is both more efficient and more time-consuming in terms of coordination.

Employees also share that Resident-composed Staff Teams force them into new work processes and understandings: Where each team previously had a team coordinator with overall responsibility, it is now up to the team to distribute tasks and each to be responsible for carrying out the agreed-upon tasks. With so few meetings compared to before, it also means relying on trust that tasks are actually being carried out, and colleagues are individually living up to their responsibilities.

At the same time, the daily manager’s participation in team meetings are challenged by having now 19 teams. The resident may not necessarily consider administrative or coordination competencies when forming the team, so there should be an effort to ensure that all teams can handle this task. When asking employees how to organizationally address the above challenges, several look inward and suggest it’s something each person needs to work on individually. However, we would like to point out that if challenges are individualized rather than elevated to an organizational concern, it becomes vulnerable and challenges sustainability in the long run.

The employees seemed unable to fully acknowledge that the workload was too intense. They directed their focus on their own energy management, making themselves the problem.

Reflection from Jesper Lau Guldager based on the interviews.

Learning Note Conclusions

Summarily, this learning note indicates that:

• There is strong support for and satisfaction with the introduction of Resident-composed Staff Teams.
• Employees in particular feel that they have been well taken care of in the transition to a new team structure.
• There are indications that Resident-composed Staff Teams strengthen the residents’ sense of autonomy, cohesion, and competence, supporting development.
•  Resident-composed Staff Teams enhance job satisfaction and motivation among employees and collaboration across teams.
  
  
  

“Banebyen” can further benefit from:

• Supporting more residents in participating in team meetings.
• Involving the residents in planning the timings of team meetings.
• Striking a balance for both residents and employees between the familiar and secure and a new flexible team structure.
• Supporting a good balance between prioritizing the relationship but also being able to receive support from employees outside the team.
• Creating a conducive framework for dialogue when changes are desired in the team.
• Transforming the challenges experienced by employees into an organizational rather than an individual concern to support sustainability in the long run.
• Involving residents and employees in the ongoing development of the concept.