The experience of mothers supporting self-determination of adult sons and daughters with intellectual disability

"They must get to know the individual very well": relationship-building of family and volunteer supporters in supported decision-making schemes

PURPOSE

Supported decision-making (SDM) is an emerging and innovative alternative to substitute decision-making practices. While relationships are pivotal in establishing proper and effective SDM, scant research has examined these relationships in-depth. This study explores how decision-making supporters perceive relationships embedded in SDM for adults with disabilities. Furthermore, it compares the points of view of family and volunteer supporters on these relationships.

MATERIALS AND METHODS

Using a semi-structured interview guide, in-depth interviews were held with 16 family and 16 volunteer supporters of Israeli decision-makers with disabilities.

RESULTS

Both family and volunteer supporters addressed the centrality of the support relationship. However, they differed in their perspectives on the ways such relationships should be formed and on their boundaries. We distinguish between families' continuing relationships vs. volunteers' emerging relationships to emphasize the identified differences.

CONCLUSIONS

The findings highlighted the importance of relationships to SDM processes, highlighting the need to examine in greater depth whether and how "typical" family relationships differ from SDM relationships. Based on these findings, we recommend training and guidance for both family and volunteer supporters in developing and strengthening these relationships.

Irish social policy to family carers of adults with an intellectual disability: A critical analysis

This paper explores contemporary Irish social policy for family caregivers with specific focus on the dynamic between the individual, the family and the state in terms of the social contract for care provision for people with intellectual disability. Drawing from Bacchi's analytical framework (Bacchi, 2009), the Irish National Carers' Strategy is interrogated specifically with regards to how it frames and assumes the social contract for family care provision for adults with an intellectual disability. We suggest that Irish social policy constructs family caregiving as the assumed natural and neutral point of departure for providing care within society, and this constructed identify is subsequently reinforced through the provisions contained with the policies themselves that seek to support such caregivers. A fundamental reconsideration of the social contract for such care provision and support with society would appear warranted.

Perspectives of adolescents with disabilities and their parents regarding autonomous decision-making and self-determination

BACKGROUND

Parents' promotion of autonomous decision-making (PADM) is essential for adolescents with disabilities and constitutes the basis for maturation of self-determination (SD). SD develops based on adolescents' capacities and the opportunities offered to them at home and at school, to make personal decisions regarding their life.

AIM

Examine the associations between the PADM and SD of adolescents with disabilities from their own perspective and that of their parents.

METHOD

Sixty-nine adolescents with disabilities and one of their parents completed a self-report questionnaire including PADM and SD scales.

OUTCOMES

The findings showed associations between parents' and adolescents' reports of PADM, and opportunities for SD at home. PADM was associated with capacities for SD among adolescents. Gender differences were also apparent, with both adolescent girls and their parents reporting higher ratings of SD than adolescent boys.

CONCLUSIONS

Parents who promote autonomous decision-making among their adolescent children with disabilities start a virtuous circle by offering greater opportunities for SD within the home. In turn, these adolescents rate their SD as higher, and communicate this perspective to their parents. Consequently, their parents offer them more opportunities for autonomous decision-making at home, thus enhancing their SD.

Homeward bound: Exploring the motives of mothers who brought their offspring with intellectual disabilities home from residential settings during the COVID-19 pandemic

BACKGROUND

At the start of the COVID-19 pandemic, some parents in the Netherlands decided to bring their offspring with intellectual disabilities, who normally live in residential care, home. The present study explored why the mothers decided to bring their offspring home.

METHOD

Interviews were carried out with seven mothers of adults with intellectual disabilities. An interpretative phenomenological approach was used to establish in-depth accounts of the mothers' experiences.

RESULTS

The analysis yielded three overarching themes: (a) Families are indispensable; (b) the complex role of being a mother of a child with intellectual disabilities; and (c) Who is looking out for our offspring during COVID-19?

CONCLUSIONS

The mothers experienced a strong sense of wanting to do what was best for their offspring with intellectual disabilities during COVID-19. The study provides insight into why mothers remain involved in the care for their offspring and the complexity of navigating lifelong care responsibilities.

"I used to call him a non-decision-maker - I never do that anymore": parental reflections about training to support decision-making of their adult offspring with intellectual disabilities

PURPOSE

A rights perspective proposes supported decision-making as an alternative to substitute decision-making. However, evidence about supported decision-making practice is limited. Our aim was to build evidence about building the capacity of decision supporters.

METHODS

Eighteen parents of people with intellectual disabilities were trained in decision support using the La Trobe Support for Decision-making Practice Framework. Data from repeated semi-structured interviews and mentoring sessions were used to capture parental reflections on the value of training.

RESULTS

The training acted as a catalyst for parent self-reflection and the Framework prompted them to adopt a more deliberative approach to supporting decision-making. Some parents perceived increased confidence of their adult offspring in expressing preferences resulting from their own changed approach.

CONCLUSIONS

This study demonstrates the efficacy of this Framework and evidence-based training in building the capacity of parental decision supporters to be consistent with the rights paradigm. IMPLICATIONS FOR REHABILITATIONThe La Trobe Support for Decision-making Practice Framework is an evidence-based approach to decision support practice with an accompanying set of free online resources which can be used by individual practitioners or programs to inform their practice and build the capacity of supporters.Parents of adults with intellectual disabilities value training in the La Trobe Support for Decision-making Practice Framework, which they consider helps to develop their decision support skills and self-reflection.Parents also value individual mentoring following training to assist them to apply the principles of the practice framework to the everyday support for decision-making they provide to their adult son or daughter.Training in support practice should be accompanied by individual mentoring or other strategies to assist parents of adults with intellectual disabilities to discuss and solve the difficult issues they confront in providing decision support more aligned to the rights paradigm.