Improving the participation of adults with visual and severe or profound intellectual disabilities: A process evaluation of a new intervention

Abstract

Background While the participation of adults with visual and severe or profound intellectual disabilities (VSPID) in society and community life is important, evidence-based interventions for improve their participation are lacking. We conducted a process evaluation of the implementation of ‘Care for Participation+’ (CFP+), a new intervention targeting the attitudes of direct support professionals (DSPs) toward the participation of adults with VSPID, within a residential facility in the Netherlands. Methods CFP+ was inspired by the Boston Psychiatric Rehabilitation Approach and adapted by adopting a new definition and operationalization of the concept of participation for adults with VSPID. Following systematic training, DSPs of adults with VSPID are able to apply key elements of CFP+ to explore diverse roles and activities for this population, facilitating their self-management, teaching them necessary skills for participation, and organizing support. Our process evaluation entailed an investigation of the delivered dose, reach, fidelity, and adaptation of CFP+ during and after the CFP+ intervention. We also evaluated the mechanisms of impact and context using questionnaires, assignments, documentation, interviews, and a logbook. Results An assessment of the mechanisms of impact indicated that assignments of CFP+ were well (75%) or reasonably well (17%) understood by DSPs. CFP+ was applied by DSPs to stimulate self-management (83% of DSPs), new activities (100%), enhanced involvement in existing activities (67%) and to explore new roles (50%) for adults with VSPID. These results were obtained despite the fact that the intended dose, reach, and fidelity relating to the implementation of CFP+ were not achieved. A negative contextual factor mentioned by the trainer and manager was the DSPs’ lack of commitment to the training program. Another negative contextual factor mentioned by DSPs was the lack of time for implementing CFP+.Conclusions CFP+ provides new opportunities to improve the participation of adults with VSPID. Despite the nonoptimal conditions for implementing CFP+ and the DSPs’ general reluctance to apply the new intervention, some have actively used CFP+ within the residential facility. Future studies should focus on the outcomes of CFP+ regarding attitudinal changes among DSPs relating to the participation of adults with VSPID and their quality of life.

Intervention effects on professionals’ attitudes towards the participation of adults with visual and severe or profound intellectual disabilities

“…First, it is possible that CFP+ simply does not induce changes in DSPs’ attitudes towards the participation of adults with VSPID. However, this finding would contradict the results of a previous study, which showed that after training, DSPs worked towards goals of improving self‐management, involvement in existing activities, and developing new roles and activities for the target group (Hanzen et al., 2020). Nevertheless, our finding that DSPs were less focused on the disabilities of adults with VSPID could be understood as the first indication of a changing attitude, which is in line with a previous study (Hanzen et al., 2016).…”

“…The demonstrably effective BPRA approach (Korevaar & Dröes, 2016; Swildens et al., 2011), adjusted for adults with VSPID (Hanzen et al., 2016), prompted the development of CFP+. Moreover, drawing on recent work on the definition and operationalization of the concept of participation of adults with VSPID (Hanzen et al., 2017, 2020), we tested CFP+ in a three‐arm trial in which the PMM control group was considered a “low‐dose” CFP+ intervention and the usual care control group served as a reference.…”

“…These perceptions could have hampered the implementation of CFP+, thus accounting for limited positive changes in the attitudes of the participating DSPs (Knoster, Villa, & Thousand, 2000). Another barrier in the implementation of CFP+ reported by the DSPs was the lack of available time for practicing CFP+ and of available volunteers for performing new activities with the target group (Hanzen et al., 2020). According to Maxwell et al (2012), affordability and availability of resources are important environmental factors influencing participation.…”

“…CFP+, which is aimed at improving the participation of adults with VSPID, is based on the demonstrably effective Boston Psychiatric Rehabilitation Approach (Anthony, Cohen, Farkas, & Gagne, 2002) and adjusted for adults with VSPID (Hanzen, Korevaar, Van der Putten, Zijlstra, & Waninge, 2016; Hanzen et al., 2020). Additionally, CFP+ includes the previously established definition and operationalization of the concept of participation for this target group (Hanzen et al, 2017) that has been included in the PMM brochure.…”

“…The content of CFP+ has been described elsewhere (Hanzen et al., 2020). Briefly, CFP+ includes a training for DSPs with exercises directed at enhancing the participation of individuals with VSPID whom the trainees routinely support.…”