Communication Patterns in Services for People with Severe Intellectual Disabilities: Function, Form and Responsiveness

An exploration of communication within active support for adults with high and low support needs

BACKGROUND

The aim was to explore the relationship between quality of active support and communication support for people in group homes with high and low support needs.

METHODS

Data from 182 service users, 20-81 years (mean = 40), 89 with high support needs, were observed to have either good (n = 142) or poor (n = 40) communication support. Measures were of quality of active support, engagement and staff contact; field notes provided examples of good and poor communication supports.

RESULTS

We found a relationship between the quality of communication support and active support. Receiving good communication was associated with higher levels of engagement. Field notes included some examples of appropriate communication supports, but limited use of augmentative and alternative communication (AAC).

CONCLUSIONS

Staff show limited use of appropriate communication with people having high support needs who require AAC. Strategies to improve quality of practice are discussed.

The challenges and benefits of using participant observation to understand the social interaction of adults with intellectual disabilities

Observation methods have been used in both communication and interaction research. Qualitative interpretive approaches are rare where participants have complex communication needs. Issues for qualitative researchers utilizing participant observation research methods have been well documented, but a similar discussion is lacking where the participants are people with severe intellectual disability. Observational data collected from a study of adults with severe intellectual disabilities in interaction with their social network members were scrutinized to identify challenges and benefits of participant observation. Challenges identified include the consent process, changing roles, and researcher intrusion. The use of participant observation with adults with severe intellectual disabilities allows for unexpected insights and provides context and credence for other lines of inquiry. Participant observation may be useful with other groups of people.

Complexity of staff communication and reported level of understanding skills in adults with intellectual disability

Staff reports of the communication acts taking place with 22 adults with intellectual disability were compared with video observations of the communication acts used by staff with 12 of these service users. The interactions were coded in terms of the form of communication used, the function of the act and the level of complexity. The results show that staff tend to underestimate their own use of verbal communication and overestimate their use of non-verbal communication. The findings also indicate a mismatch between the reported level of understanding of the service user and the level of complexity of the language used. Staff appeared unable to adapt their communication to the skills of the service user and an average of 45% of communicative acts were outside the reported understanding skills of the individual. The implications of these findings are discussed and possible explanations for staff behaviour are suggested.