the staff support questionnaire: a means of measuring support among staff working with people with...

MENTAL HANDICAP VOL. 21 DECEMBER 1993

The Staff Support Questionnaire A Means of Measuring Support Among Staff Working with People with Challenging Behaviour

Philip Harris Graham Thomson

Staff are the most important resource of a service for people with learning difficulties and challenging behaviour. Good staff support helps to prevent stress, maintain high staff morale and aid staff erformance. This article describes the Staff Support Questionnaire which was developed as a means of evaluating staff support. The evidence, to date, suggests that it is a reliable and valid measure which can be used to identify the particular strengths and needs of support systems.

Much attention has been given to the harmful effects of stress in occupations which provide health and social services. The term ‘burnout’ was coined to refer to a syndrome of emotional exhaustion among individuals who do ‘people-work’ of some kind. As their emotional resources are depleted, service providers feel they are no longer able to give of themselves. Another aspect of burnout is the development of negative, cynical attitudes and feelings towards clients (Maslach & Jackson, 1981; Cherniss, 1980).

The importance of providing social support to help combat the harmful effect of stress is well established in the field of occupational stress (Payne, 1980). Firth & Myers (1985) made a useful distinction between organisational and personal support systems. The absence of organisational factors, such as consultation, participation in decision making and feedback about one’s own performance, have been identified as potentially stressful (Browner et al., 1987; Harris, 1989). Supportive relationships between colleagues are important in maintaining staff morale and appear to have a moderating influence on the effects of stress (Crawford, 1990; Browner et al., 1987). A good support system appears

to be an effective synthesis of organisational and personal support.

Porterfield (1987) has suggested a number of positive steps that managers can take to bring out the best from their staff. This includes defining the aims of the service, helping staff to achieve these aims, giving specific feed-back to staff on their work, listening to staff comments and suggestions and reviewing individual staff performance. There are surprisingly few accounts of personal support systems for service providers working with people with learning difficulties. Crawford (1990) described one such network which appeared to be successful but was terminated due to a lack of organisational support.

Providing services for people with challenging behaviour is arguably one of the more stressful situations for service workers. George & Baumeister (1981) found that coping with behaviour difficulties presented by residents in community facilities was a major contributor to staff turnover. Causby & York (1991) suggested that the planning of community services for people with challenging behaviour should include the provision of high levels of support for service providers. However, the means of evaluating staff support systems are poorly developed.

The Staff Support Questionnaire (SSQ) was developed by the authors in the absence of an existing means of evaluating staff support. It has been tested and used in a study (funded by the Department of Health) concerning an evaluation of services received by people with learning difficulties and challenging behaviour. This article will describe the SSQ, examine its reliability and validity as a measure of staff support and discuss its use in practice.

PHILIP HARRIS is currently a Lecturer in Psychology at the Cardiff Institute of Higher Education. GRAHAM THOMSON is a Research Assistant at the Norah Fry Research Centre at the University of Bristol.

122 0 1993 BlLD Publications


Description of the SSQ The SSQ is a self-report measure of support

which takes between 10-20 minutes to complete. It consists of 24 questions, 20 of which are closed questions. Eight of the questions are rated on a five-point scale, four on a three-point scale and eight are Yes-No (or Don’t Know) answers.

The questionnaire (see Appendix 1) is organised into four main sections. The first section is concerned with role ambiguity resulting from a lack of clarity about the job. Firth & Myers (1985) suggested four questions which may reveal the extent of role ambiguity and these were incorporated in the SSQ. The second section includes questions about practical support in crisis situations, the availability of emotional support in the form of someone to talk to when experiencing difficulty and the opportunity for regular supervision or performance reviews. The identification of risk-situations and the availability of clear guidelines if something goes wrong is the focus of the third section. The fourth section includes four questions about job satisfaction.

Respondents are requested not to put their names on the questionnaire. An assurance is given that the information provided will be treated confiden- tially and that the results will be compiled to give a general view of staff support needs in the particular setting.

Reliability of the SSQ The test-retest reliability of the SSQ was examined

with the help of 18 service providers from three different settings for people with challenging behaviour. Between March and July 1991 the participants completed the SSQ twice, with a two-week interval between filling in the first and second questionnaire. Ten of the staff worked in a private residential setting and were involved in a group test-retest. Five staff who were attending a training course and three staff, from a social services day centre, assisted with individual test-retests.

The group test-retest reliability was determined by comparing the two sets of summed responses to each of the 23 scaled questions on the SSQ. The percentage agreement for each question varied from a low of 70% to a high of 100% with a mean of 87.4%. The two sets of responses for each question were also ranked and a Spearman’s rank-order correlation co-efficient (rs) was calculated. The results indicated a highly significant level of agreement (rs = 0.66, p < 0.001) between the two ranks.

The reliability of the individual test-retest scores was calculated using the percentage agreement statistic. The overall agreement between test and retest varied from a low of 56.5% to a high of 87% with a mean of 74% over the eight staff. The highest agreement was evident on the risk-situations and

job satisfaction sections of the SSQ (75%). The role ambiguity section showed the lowest agreement (56%). The agreement for the personal support section was 62.5%. Each individual was also ranked by SSQ score and using Spearman’s r, a significant result was obtained between the two sets of data (r, = 0.89, p < 0.01). It appears that these results may underestimate the reliability of the SSQ given that seven of the eight people involved indicated that something significant had happened between test and retest which had affected their response to the questionnaire.

Validity Concurrent validity was examined by correlating

the scores on the SSQ with scores from the General Health Questionnaire (GHQ) which was completed at the same time. The GHQ is a validated self- administered screening test which focuses on the psychological components of ill-health. It has been widely used as an outcome measure in studies of occupational stress. In this study, the shortened version (GHQ-28) was used and scored using the Likert method (Goldberg & Williams, 1988).

Between November 1990 and April 1991, 41 staff were given an SSQ and a GHQ to complete. All staff worked with people who presented challenging behaviour. The majority worked in residential settings in the community although staff from a community day centre and a hospital setting were also included. Thlrty staff completed and returned both questionnaires, a response rate of 73%.

The SSQ scores were calculated using a three- point scale and varied from 24-58, lower scores indicating higher levels of support. The GHQ scores varied from 5-54, higher scores indicating higher levels of stress. The GHQ scores were compared to the subscores for the four sections of the SSQ and to the total SSQ scores using Spearman’s rank- order correlation co-efficient (rJ. The results are shown in Table 1. There was a highly significant correlation between the GHQ score and the total SSQ score. The strongest correlation was with the job satisfaction section and the weakest with the risk situations section.

Using the SSQ A number of staff support surveys have now been

conducted using the SSQ. Initial and follow-up surveys have been carried out in two settings: a private home in the community for three people with challenging behaviour and a day centre for 15 people jointly funded by health and social services. Single surveys have also been completed in a hospital ward and two community homes. All the questionnaires were completed anonymously and returned directly to the authors in sealed envelopes.

0 1993 BlLD Publications 123


SSQ section Role Personal Risk Job Total ambiguity support situations satisfaction

Spearmans (rs) 0.42 0.46 0.33 0.70 0.60 1 Significance (p) 0.05 0.01 0.05 0.001 0.001

TABLE 1 SSQ correlations with the GHQ

The response rate varied from 73-100%. A group profile of staff support and stress was prepared in the form of a report for each setting. The average SSQ and GHQ scores are shown in Table 2.

The most positive picture emerged from the private residential home where five full-time staff and five part-time staff worked with three people with chaknging behaviour. The follow-up survey was conducted five months after the initial one and the findings were broadly consistent. Generally, the staff in this setting were satisfied with their work situation and the support they received. Crisis support and guidelines about risk situations were well organised and levels of stress were low. Most of the staff were clear about their main objectives at work and about the limits of their authority and responsibility. The majority of staff already received regular supervision and the main recommendation in this setting was to extend supervision to all staff.

Staff support was lower in the other settings and levels of stress were generally higher. The highest levels were reported in the day centre where five staff worked with 15 people with challenging behaviour. Satisfaction had clearly diminished since the initial survey was conducted shortly after the centre first opened. Six months later the staff were less clear about the goals of the service and their roles at work and more dissatisfied with the support they received and their level of involvement in decision making. As the number of clients in the centre had increased there had been a corresponding increase in the number of risk-situations reported. The staff were less clear about what to do if something went wrong than they were six months previously. The main recommendations in this

setting included a review of the aims and objectives of the service, a re-evaluation of the swcl ien t ratios and the provision of on-going staff training.

Conclusion The evidence so far suggests that the SSQ has

acceptable levels of test-retest reliability and the validity data suggest that the SSQ is a meaningful indicator of stress: support as measured by the SSQ was found to be inversely related to stress as measured by the GHQ. Although it was devised specifically for staff working with people with challenging behaviour, we believe that the SSQ can be easily adapted for use with staff working with a wider range of client groups.

Reliability and validity are not the only criteria for judging the appropriateness of a questionnaire. We believe that a tool such as the SSQ must also be demonstrably useful and acceptable to potential users. Our experience in a number of settings has suggested that the SSQ can be useful in identifying the strengths and needs of the staff support system. In some of the places where we conducted the surveys, feeding-back the results has had direct positive effects, for example, supervision systems were set up in two of the settings. Much depends upon the response of the organisation to the results of the survey.

Not all of the surveys we conducted were successful. In three instances, the response rates were too low to be meaningful. It appeared that the staff concerned lacked the motivation to complete the questionnaires either because they were concerned about how their managers would react

Setting SSQl

Private (residential) 25.7 Voluntary Trust 51.1 (residential) Hospital Ward 40.9 Day Centre 34.2 Social Services 45.8 (residential)

GHQl Response SSQ2 GHQ2 Response rate (%) rate (%)

14.0 100 28.4 15.6 100 - 73

24.5 80 - 100 44.4 36.2 100

35.0 100 -

- -

- -

-

TABLE 2 Average SSQ and GHQ scores over five different settings



or they thought that nothing useful would come of it. Staff in some of the settings, where the survey was successful, indicated that peer support was good but they did not feel supported by their managers within the organisation. Many respondents felt that communication at work only flowed in one direction, i.e. down the hierarchy, and that they only received feed-back about their work when something had gone wrong.

To conclude, the staff support surveys were more likely to be successful in settings where the managers were perceived as being responsive. Unfortunately, the staff in unresponsive settings were more likely to feel unsupported in their work situation and less likely to respond to the SSQ. The inclusion of a measure such as the SSQ as part of a quality assurance package may help to demonstrate that managers do care and want to know whether or not their staff feel supported at work. This may help to increase the response rate in settings where staff morale is low and simultaneously encourage an atmosphere more conducive to staff development.

Acknowledgements We wish to acknowledge the financial support from

the Department of Health and to thank all the staff who took part in this study.

Correspondence should be directed to Philip Harris, Cardiff Institute of Higher Education, Llandaff Centre, Western Avenue, Cardiff CF5 2YJ3.

APPENDIX 1

STAFF SUPPORT QUESTIONNAIRE

All workers need support whatever their work situation. The purpose of this questionnaire is to find out what support you receive, how satisfied you are with this and what support you would like to receive in the future.

Please read these instructions carefully before com- pleting.

1. Please answer the questions on your o m before you talk to other staff about it.

2. Do not put your name on the questionnaire as the results will be compiled to give a group view of staff support needs.

3. The answers you give will be treated as strictly confidential and only the group view of staff support will be shown to others.

4. Remember there are no right or wrong answers - give your opinion about your support needs.

Please describe in detail the present sources of staff support at your place of work.

REFERENCES Browner, C. H., Ellis, K. A., Ford, T., Tampoya, J.

and Yee, C. (1987) Stress, social support and health of psychiatric technicians in a state facility. Mental Retardation 25, 31-8.

Causby, V. D. and York, R. 0. (1991) Predictors of success in community placement of persons with mental retardation. The British Journal of Mental Subnormality 37, 25-34.

Cherniss, C. (1980) Staff Burnout: Job Stress in the Human Services. Beverley Hills: Sage.

Crawford, J. V. (1990) Maintaining staff morale: The value of a staff training and support network. Mental Handicap 18, 48-51.

Firth, H. and Myers, M. (1985) Supporting staff in community services. Mental Handicap 13, 100-3.

George, M. J. and Baumeister, A. A (1981) Employee withdrawal and job satisfaction in community residential facilities for mentally retarded persons. American Journal of Mental Defiiency Research 85, 639-47.

Goldberg, D. and Williams, P. (1988) A User's Guide to the General Health Questionnaire. Windsor: NFER-Nelson.

Harris, P. E. (1989) The Nurse Stress Index. Work and Stress 3, 335-46.

Maslach, C. and Jackson, S. E. (1981) The measure- ment of experienced burnout. Journal of Occu- pational Behaviour 2, 99-1 13.

Payne, R. (1980) Organisational stress and social support. In C . L. Cooper and R. Payne (eds) Current Concerns in Occupational Stress. Chi- Chester: Wiley.

Porterfield, J. (1987) Positive monitoring: A Method of Supporting Staff and Improving Services fo r People with Learning Disability. Kidderminster: BIMH Publications.

How satisfied are you with this? (circle the appropriate number)

Very satisfied 1 Satisfied 2 Undecided 3 Dissatisfied 4 Very dissatisfied 5

Please describe the sort of support you would like to receive at work.

Please describe a way of alleviating stress in your job.



The following questions are about how you see your job.

1. How clear are you about the main objectives you should be working towards in your job?

Very clear 1 Clear 2 Undecided 3 Unclear 4 Very unclear 5

2 . How clear are you about what your superior expects from you?


3. How clear are you about the limits of your authority and responsibility in your present position?


4. How clear are you about how satisfied your superior is with what you do?


Is there somebody you can talk to at work if you are experiencing difficulty in your job?

Yes 1 No 2

How satisfied are you with this?


If you were unable to cope with a situation at work is there anybody you can call on for practical help?

Yes 1 No 2

Is there always somebody available?

Yes 1 No 2

How long does it usually take for help to arrive (in minutes)?



Do you receive regular supervision sessions or performance reviews as part of a structured pro- gramme of staff development?

Yes 1 No 2



Risk-taking

Have risk situations been clearly identified at your place of work?

Yes 1 No 2 Don’t Know 3

If yes, were you involved in identlfylng the risks?

Yes 1 No 2

Have clear guide-lines been established about what to do if something goes wrong?

Yes 1 No 2 Don’t Know 3

If yes, do you agree with the guide-lines?

Yes 1 No 2

Please indicate how much you agree or disagree with the following statements by circling the appropriate number.

I am satisfied with my present situation at work.

Agree 1 Disagree 2 Undecided 3

I am satisfied with my present level of involvement in decision making at work.


I am satisfied with the degree of support I receive in my job.




I often think about finding another job.


Please write any other comments below:

Please mention Mental Handicap

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