People with learning disabilities engaging in meaningful activity

The general population spends over 90% of their time engaged in meaningful activity, whilst people with a learning disability spend only 33% (without active support).

A new study looks at ‘social’ or ‘non-social’ domestic activities. An activity is deemed to contain social engagement when it involves recognisable speech, signs or gestures to attract or retain the attention of another person.

The sample group of 78 people with learning disabilities are all from one area of Minnesota in the USA. All participants live in group homes of 2-8 people and receive support either through 1:1 or shared support from one or more support workers. There are 21 group homes in total with nine separate organisations responsible for providing the support.

The study seeks to address two questions:

How much time are people with a learning disability in group homes engaged in activities?
How do individual factors (age, adaptive and challenging behaviours, receipt of staff assistance) and organisational factors (turnover, supervisor years of experience, and Support Worker competence) impact on individual engagement with activities?

The research seeks to explore whether the extent an individual is involved in daily life is influenced by their individual characteristics and the environment they live in, including their support.

How can we support people with learning disabilities to engage more in meaningful social and non-social activities?

Methods

The study uses a range of measures that apply to the individual themselves, their support staff and the organisation.

The measure of engagement in social or non-social activities was collated via observation of four, 10-minute blocks per person. This observation also provided the data for the level of staff assistance with that activity. Training was provided and 25% of data was subject to inter-observer agreement testing.

In addition to demographic data, which was collected for supported people and support staff, the other measured factors were:

The level of disability: mild to profound
The level of challenging behaviour, measured using a recognised scale
Experience and turnover of support workers
Competence of support staff as rated by their supervisors
The level of person-centred approach in a particular home as identified by a management practice questionnaire.

Factors that related per house were calculated using averages.

Results

The 78 participants were, on average, engaged in social activities 12% of the time and non-social 35% of the time. Staff assistance was provided to the person at 4% of the observation intervals.

Levels of engagement were higher for people with a mild learning disability, 47% non-social, 26% social. These are shown roughly on a sliding scale down to those with more profound needs, who had 21% non-social and 3% social engagement in activities. The results also imply that a person with greater adaptive behaviour skills and less challenging behaviour is likely to engage more in activities.

Results for the potential influencing factors have been statistically analysed and tabulated to show the correlation of each one individually against levels of engagement and each of the other factors.

None of the organisational factors were significant in the studied group, however, there were discrepancies between individual homes which were unexplained.

It should be noted that although active support training was provided to the support staff and observations carried out pre- and post-training, only the baseline data was used in this report, with the effectiveness of intervention being reported on separately.

Good adaptive skills and competent support workers are important facilitators of social engagement.

Conclusions

The report concludes that the extent to which an individual is engaged in daily life is a result of interplay between the individual’s characteristics and the group home environment. It reinforces the work of previous studies that adaptive behaviours are correlated with engagement and expected results that people with severe and profound disabilities are less engaged in activities than their more able counterparts.

Social engagement is most common where the person has good adaptive skills and is supported by a competent support worker. The impact of the competent support worker was not seen in non-social activities.

Strengths and limitations

The work highlights the key role that engagement in social and non-social activities can have in overall quality of life. This is an area which has perhaps been under considered until now.

The report self identifies a number of limitations including: relatively small sample size, not all potential factors on engagement being considered, for example geography and reliance on judgements about the meaning of gesture and facial expression.

In addition, I feel that there were key omissions in terms of some of the variables considered. The ratio of support staff to supported people at the time of observance would have provided valuable data in terms of the organisational role. Additionally, the number of people living together would, again, have had an influential factor in a person’s opportunity to make social contact, but also their familiarity with such interactions day to day.

A further unconsidered impact on the portability of these findings is the limited geography which suggests that either one, or a small number of local authorities, would work with all the homes in this sample. The approach to funding and monitoring of an authority may well impact on measured outcomes, as would the role and effectiveness of any regulation and regulator.

Summary

It is unfortunate that the statistical analysis is not able to offer us any understanding of why there should be any discrepancy between in the group homes as was identified in the report. This would surely have provided a valuable insight for provider organisations that could have helped to inform practice. It may be that factors mentioned above such as staffing ratio and size of home may play a part, as will culture.

I think that if we are to consider engagement as an important factor in quality of life, then we need to extend this beyond the boundaries of the home and into activities that occur outside and at other locations. These may well have an even greater impact and further research in this area would certainly be of benefit.

Alarmingly, the research found that in only 4% of the observed periods were support staff assisting the supported person with a particular activity, despite the criteria for that assistance being broad. This is something that needs to be considered carefully by organisations who would doubtless have predicted more positive activity from the workforce. Given the poor levels of engagement for this group compared to the general populous, real effort needs to be made to support greater participation in day to day activity. We cannot, however, make a judgement about any positive impact of training in active support, until such a study is published.

A final noteworthy point is that the reported salaries of the people working in the sector in the United States are approximately 25% above the minimum wage. In the UK, we are about to enter a period where the vast majority of the workforce will be receiving minimum wage with implications for status and morale, as well as recruitment and retention. Are we at risk of a workforce delivering even less impact than reported here?

This study highlighted a disturbing lack of support from staff in relation to the social and non-social activities covered by the research.

This study highlighted a disturbing lack of support from staff in relation to the social and non-social activities of people with learning disabilities.

Links

Primary paper

Qian X, Tichá R, Larson SA, Stancliffe RJ, Wuorio A. The impact of individual and organisational factors on engagement of individuals with intellectual disability living in community group homes: a multilevel model. J Intellect Disabil Res. 2015 Jun;59(6):493-505. doi: 10.1111/jir.12152. Epub 2014 Jul 25. [Abstract]