Reconciling communication repertoires: navigating interactions involving persons with severe/profound intellectual disability, a classic grounded theory study

BACKGROUND

A rights-based agenda, informed by the UNCRPD, that advocates person-centredness, inclusion, empowerment and self-determination is shaping service provision to people with intellectual disability (ID). Listening to their perspectives is fundamental to meeting these goals. However, communication with people with severe/profound ID is challenging and difficult. Therefore, this study aims to generate a theory that explains how people communicate with and understand each other in these interactions.

METHODS

Classic grounded theory (CGT) methodology was used as it recognises that knowledge can be captured rather than interpreted. According to CGT, capturing rather than interpreting experiences strengthens findings, particularly in relation to participants with severe/profound ID. Concurrent theoretical sampling, data collection and analysis were undertaken. Twenty-two individuals participated in the study: 3 people with severe/profound ID and 19 people with whom they interact. Data were collected over a 9-month period and involved video recordings, field notes, individual and group interviews. Data were analysed using CGT methods of coding, constant comparison and memoing.

RESULTS

The Theory of Reconciling Communication Repertoires was generated. Nurturing a sense of belonging emerged as the main concern and core category that is resolved by reconciling communication repertoires. A communication repertoire refers to the cache of communication skills a person has available to them. To reconcile repertoires is to harmonise or make them compatible with each other in order to communicate. Interactions are navigated through five stages: motivation to interact, connection establishment, reciprocally engaging, navigating understanding and confusion resolution.

CONCLUSIONS

The Theory of Reconciling Communication Repertoires explains how interactions involving people with severe/profound ID are navigated. While this is a substantive rather than formal theory, it has the potential to inform practice, policy, management, education and research as it outlines how communication with people with severe/profound ID can take place to design, inform and plan person-centred care.

Measuring the Activity Patterns of Adults with Severe Disabilities Using the Resident Lifestyle Inventory

Outcome measures that document activity patterns provide an empirical basis for improving the lifestyles of adults with severe disabilities. This report provides a psychometric assessment of an instrument, the Resident Lifestyle Inventory (RLI), that can be used to measure the activities performed by such persons. In a series of three assessments the congruent validity (Assessment 1), test-retest reliability (Assessment 2), and social validity (Assessment 3) of the RLI were analyzed to determine its acceptability as a measurement instrument for documenting activity patterns. Results from the three assessments demonstrated that the RLI is a psychometrically acceptable measure that is used accurately by residential programs. It is perceived by support staff to be a useful strategy for improving lifestyle quality. Implications of this report are provided for the role of outcome measures in community-based residential support, the individualized plan development process, and future research.

Some Effects of Regular Class Participation on the Social Contacts and Social Networks of High School Students with Severe Disabilities

We studied the effects of participating in regular education classes on the social life of three high school students with severe disabilities. Using a multiple baseline design across students (with an embedded ABAB withdrawal design), participants' social contacts and social networks were analyzed. Data were collected throughout the school day across 1 school year. Regular class participation, the independent variable, was introduced within a baseline focusing upon a community-based curriculum including access to peers without disabilities via peer tutoring and “friendship” programs. Our results indicate that regular class participation: (a) increased the frequency of social contacts students had with peers without disabilities, (b) was the locus for meeting half of the peers without disabilities contacted across the school year, and (c) was an important source for meeting peers without disabilities who subsequently became members of students' social networks. In addition, our results showed that: (a) durable and frequent social contacts also occurred with peers without disabilities met outside of regular education classes, (b) the amount of contact with peers extending outside of regular classes varied across students, and (c) the perceived quality of social contacts did not vary systematically with the locus of initial contact. The results are discussed in relation to possible outcomes relating to regular class participation at the secondary level and areas for future research.

Building an Ecology of Support: A Case Study of One Young Woman with Severe Problem Behaviors Living in the Community

This case study describes 30 months in the life of a young woman with a history of life-threatening self-injurious behaviors (SIB) who moved from a large public institution to her community. Quantitative and qualitative research methods were employed to provide a nonexperimental description of her behavior and lifestyle in the community. Quantitative measurements included: (a) activity patterns, (b) social network, (c) self-injurious behaviors, (d) aggression against others, and (e) staff changes. Qualitative results emerged from semistructured interviews and participant observations conducted over a 6-month period. Together, these data revealed a young woman actively involved in a lifestyle characterized by an increase in the frequency and diversity of activities performed in the community. Problem behaviors occurred at low levels for extended periods, yet there continued to be times with major regression. Qualitative results also indicate a general reduction in the intensity of self-injurious behaviors. Results are discussed in terms of the importance of multicomponent positive interventions, the need to design environments that promote lifestyle changes, and the value of collaboratively employing quantitative and qualitative research methods.

Using a Social Guide to Improve Social Relationships of People with Severe Disabilities

Staff members of community-based residential programs serving individuals with intellectual disabilities often have difficulty helping participants develop social relationships with community members. A “social guide model” taught staff of an apartment-based residential program to use a set of “community network strategies” to improve the social relationships of three women with disabilities. Results demonstrated a functional relationship between staff members' use of the strategies under the supervision of the social guide model and increases in the size of participants' social networks and the frequency with which they experienced social integration. The intervention also was associated with a higher weekly rate of introduction of new network members and a higher rate of socially integrated activities per network member per week. Gains generally were maintained during a follow-up period, with a regular staff member assuming the role of social guide.

Practical Application of Functional Behavioral Assessment in Schools

Individualized Educational Program (IEP) teams working with students who have disabilities and a history of problem behavior that impedes their learning or that of others have the responsibility to develop their capacity to conduct functional behavioral assessments that lead to the delivery of effective behavior intervention plans. This article provides guidance to school-based teams that should prove useful to practitioners and families. In particular, this article highlights (a) the necessary components of a functional behavioral assessment, (b) a decision making framework concerning the selection of assessment and intervention procedures to be used at school, and (c) a description of one practical functional behavioral assessment tool—the Initial Line of Inquiry—that has been employed by school-based teams.

Application of a Lifestyle Development Process for Persons with Severe Intellectual Disabilities: A Case Study Report

This report summarizes the results of four data-based case studies that examined the efficacy of the Lifestyle Development Process (LDP) for persons with severe disabilities. The process involves five steps, described in detail in the paper. The planning process was implemented by means of a consultant model, and involved planning meetings, on-site visits, in-service training, problem solving, written program planning, and demonstrations of instructional techniques. The consulting teams were composed of educational and behavioral consultants. Four persons with severe disabilities and challenging behaviors were participants. These individuals resided in four communities in the Province of British Columbia, and received consultative services from 1989 through 1991. All four individuals engaged in a greater number of preferred, integrated activities during the mid- and posttests than at baseline. Their social networks and program quality scores also showed various degrees of improvement. The behavior problems that were reported at the referral stage were substantially reduced at the posttest for all individuals. These results are discussed in relation to previous research in the areas of lifestyle planning and behavior management. Problems in implementing the process by means of a consultant model are also discussed, and areas for future research are identified.

Placement along the Continuum of Services and its Impact on Students' Social Relationships

To better understand the conditions facilitating social relationships, we studied the impact of educational placement on the social life of students with severe disabilities. Several indicator variables were used to assess students' social relationships, including measures of social contacts, social support behaviors, and friendship networks. Placement at two points along the continuum of services—general education and self-contained classrooms—constituted the independent variables under study. Two matched groups of students with severe disabilities, one from each placement type, served as participants. The results from direct observation and interviews indicated that: (a) students placed in general education had higher levels of social contact with peers without disabilities; (b) students in general education received higher levels of social support from others, as well as provided higher levels of social support; and (c) those students had substantially larger friendship networks composed primarily of peers without disabilities. Implications regarding the impact of the continuum of services on students' social lives are discussed, along with general issues relating to the development and maintenance of social relationships.

A model of processes that underpin positive relationships for adults with severe intellectual disability

BACKGROUND

Relationships develop through social interaction and assist with participation and inclusion. Little is known about how relationships develop between people with severe intellectual disability who have limited communication and others.

METHOD

Interactions were observed between 6 adults with severe intellectual disability and paid workers or family members with whom those adults had positive relationships. Workers and family members were interviewed. The data were analysed through a grounded theory approach.

RESULTS

Data analysis led to the identification of 5 processes that underpin positive relationships: recognising individuality, sharing the moment, connecting, feeling good, and sharing the message.

CONCLUSIONS

A relationship model with clearly identified processes and sub-elements provides a framework for teaching others how to have positive relationships with people with severe intellectual disability. The model could be applied in training to support relationships between workers and people with a disability and more widely with other community members.

Social interaction with adults with severe intellectual disability: having fun and hanging out

BACKGROUND

Social interaction is integral to social inclusion. Little is known about the nature of social interaction between adults with severe intellectual disability and those with whom they engage.

METHOD

Participants were six adults with intellectual disability and people identified as those with whom they shared demonstrable pleasurable interactions. Data were collected through observation and interviews, and data were analysed using a constructivist grounded theory approach.

RESULTS

An overarching category of sharing time together with two main sub-categories of Having fun and Hanging out emerged. Having fun was composed of routines and comedic interaction; hanging out was comprised of contact and presence.

CONCLUSIONS

Legitimizing mirth and sharing time in social interactions may supplement paid worker job satisfaction and increase opportunities for social inclusion by people with severe intellectual disability.

The pearl in the middle: a case study of social interactions in an individual with a severe intellectual disability

BACKGROUND

People with severe intellectual disability have limited communication skills, small social networks, and may experience isolation. Little is known about how interactions occur with social network members and the role of social support.

METHOD

An adult with a severe intellectual disability was observed in her daily environments. Her social network members were identified and interviewed. Data were analysed using a grounded theory approach.

RESULTS

Fourteen social network members were identified. People with severe intellectual disability interact in different ways, which may not be understood by network members or conform to normative expectations. Still, network members experienced enjoyment, personal satisfaction, and love in their interactions.

CONCLUSIONS

Social interactions with people with severe intellectual disability are challenging. The results point to the benefits of a focus on learning that makes interactions meaningful for each individual, sharing that information with network members, and considering ways to increase interactions and extend the social network.

Mothers with learning difficulties and their support networks

Mothers with learning difficulties are thought to be among the most socially isolated parents in the community. A great deal of attention has been directed to assessing their parenting abilities and teaching parenting skills, but less has been given to the support that mothers may (or may not) receive from family, friends and the service system. The present paper investigates mothers' views about the types of support which they receive and from whom they receive it. Data were derived from 70 mothers who participated in interviews using a support interview guide designed to accommodate the mothers' cognitive difficulties. The primary purpose of the interview was to explore the quantity and composition of the mothers' support networks, the frequency of contact and geographical proximity of support people, and the type of support provided. Key findings include: the central place that family members have in these mothers' lives; the importance of service providers as sources of information and advice; and the relative absence of friends and neighbours. Briefly, mothers living alone have service-centred networks, mothers living with a partner have family-centred networks with relatively dispersed family ties, and mothers living in a parent/parent-figure household have local, family-centred networks. The overall conclusion to be drawn from the present results is that these mothers do not live in a social vacuum, but many are socially isolated. The finding that so few mothers could identify supportive ties with friends and neighbours suggests that these mothers are isolated from their local communities and are potentially vulnerable if a breakdown occurs in the support provided by their families. The need for service providers to be more actively involved in linking mothers to their communities is discussed.

Feedback to staff on resident lifestyle. A descriptive analysis

Providing feedback has been found to affect the behavior of staff of school and community programs. The present article presents a descriptive analysis of feedback provided to staff members concerning the lifestyle of 33 participants in 18 community residential programs in Oregon. Staff from four cohorts of programs were trained to monitor the physically and socially integrated activities experienced by program participants, and to review those data at weekly meetings. Examination of the results before and after programs had used the monitoring system indicated increases in the average number of community activities experienced by participants, the average number of activities they did with community people, the size of their social networks, and the number of individuals they identified as friends. Results were discussed in terms of the role of feedback in improving community support, the need for further research for understanding staff behaviors responsible for observed gains, and the need to better understand the relationship between observed patterns of activities and individual quality of life.