Background: Some persons with intellectual disability may express, e.g., distress, protest or pain in a manner that is perceived as challenging by staff and an entire organisation. Although these persons are few, their support requires knowledgeable staff who are supported by front-line managers within a capable organisation, as well as sufficient and adequate resources. The aim of this study was to explore organisational factors that enable or hinder good quality of support from the perspective of staff in group homes and day programmes.

Method: 96 staff in group homes and day programmes were interviewed in groups. Their experience with working in services for persons with intellectual disability ranged from 2 months to 35 years, with a median of 10 years. The interviews used the problem-centred interview method described by Witzel and Reiter, allowing interviewer and participants to explore and co-create topics of interest and importance.

Findings: According to staff, it was difficult to meet the needs of persons with intellectual disability when they experienced an organisational focus on budget and administrative procedures. Managers who lacked adequate knowledge or were seldom present in a service were of no help when difficulties arose. Participants described a lack of alignment and logical connection between decisions and procedures at the organisational level and the support provided by staff. They also maintained that preventing staff and manager turnover would enable continuity, stability and trustful relationships. Providing support of good quality would also require front-ine and senior managers who truly understood or recognised the needs of the service users.

Conclusion: Staff in group homes and day programmes report that staff satisfaction and good quality support require an organisation that can be trusted. This involves that managers have a clear focus on and knowledge about what is essential in supporting persons with intellectual disability.