A Systematic Review of the Qualitative Evidence for the Use of Lifestyle Planning in People with Learning Disabilities

Lifestyle planning (LP) for people with learning disabilities is largely supported by qualitative rather than quantitative research. LP is a time-consuming and potentially resource-intensive area of practice which is becoming more prevalent in the UK. We present the first systematic review of the qualitative evidence base for the use of LP in people with learning disabilities. Such evidence concerns the special characteristics of LP and its outcomes in descriptive rather than quantitative terms. Qualitative research is usually aimed at enhancing validity by grounding theory in data collected. Twenty-one studies passed eligibility criteria for inclusion in this review, but only ten provided any outcome data, the others being concerned with process only. A replicable search strategy was employed and the resulting original data sources were critically reviewed with respect to major concepts and categories in the areas of: planning process, choices and preferences, ethics and outcomes. Explicitly person-centred approaches such as essential lifestyle planning are contrasted with more service-led methods such as individual programme planning. There are major methodological limitations in much of the available literature and suggestions for future research to clarify matters are made. The current evidence base suggests that no form of LP has significantly better outcomes than any other form and that it is not clear if LP in general enhances outcomes. Ongoing use of person centred planning in particular is informed by ethical considerations and is evolving in its structure and function.

The effectiveness of person-centred planning for people with intellectual disabilities: A systematic review

OBJECTIVES

To evaluate the effectiveness of Person-Centred Planning (PCP) on outcomes for individuals with intellectual disabilities (ID) across the age range.

METHOD

The electronic databases PsycInfo, Embase, CINHAL, PubMed, Web of Science, Scopus and Medline were searched for studies evaluating the impact of PCP on people with ID, published between 1990 and 2014; these were supplemented by manual searches of reference lists. Studies were considered irrespective of methodology, sample size and publication source, if outcomes reflected the impact of PCP on individuals with ID.

RESULTS

Seven quantitative, five qualitative and four mixed methods studies were included in the review. The overall quality of the evidence was low but suggestive that PCP may have a positive, yet moderate, impact on some outcomes for individuals with ID, particularly community-participation, participation in activities and daily choice-making. For other outcomes such as employment the findings were inconsistent.

CONCLUSION

The evidence supporting the effectiveness of PCP is limited and does not demonstrate that PCP can achieve radical transformations in the lives of people with ID. Clearer descriptions of PCP and its components are needed. Small-scale successful demonstrations of effectiveness exist, but its clinical, cost-effectiveness and wider implementation must be investigated in large scale studies.

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.

Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.