Managing relational autonomy in interactions: People with intellectual disabilities

Abstract

BackgroundThis article is about interactions that occur when someone with intellectual disabilities is engaged in everyday activities with a personal assistant (PA) or a support worker.MethodWe examine the detail of nine hours of naturally occurring video‐recorded interactions, to explore how “relational autonomy” is done in practice. Nine people with ID and seven staff took part in the research, which took place in England from 2016–17.ResultsWe selected six extracts to illustrate different types of joint decision‐making. Informed by inclusive research with a drama group of people with intellectual disabilities, we focus on the ways in which (a) future plans are discussed; (b) choices are offered during an activity; (c) people reflect on their decisions.ConclusionThe article concludes with discussion about the teaching and learning content of choice‐making, on relational autonomy, and the practice learning for PAs, support workers and for people with intellectual disabilities.

Misfitting and social practice theory: incorporating disability into the performance and (re)enactment of social practices

“…However, finding 'teachable moments' in an interaction could be seen as part of the job of the support worker. As we highlighted in Dowling et al (2019) and Williams et al (2019), sensitivity to the precise positioning of a prompt, reference to a past conversation, or seizing an opportunity to expand on a reflection, were positive interactional accomplishments shown by support workers in our data. These data showed how communication matters, enabling both parties in an interaction to establish jointness, mulling over their choices, and respecting each other's spheres of knowledge.…”

“…The projects involving people with intellectual disability in the community, as well as those with people with dementia, were approved by a national ethical committee, the Social Care Research Ethics Committee, who continued to support the researchers as new perspectives in methodology arose during the project (Dowling et al 2019;Williams et al 2020;. In all cases, therefore, the data presented in this paper has been anonymised, with assumed names and details changed slightly where they might make participants recognisable.…”

“…Some of the practices in which we were particularly interested were those in which there is a potential underlying power asymmetry, as in hierarchical organisations such as universities (Merchant et al 2020), in hospitals (Read, Williams, et al 2018) or in relationships between non-disabled support staff and people with intellectual disability (Dowling et al 2019). Since Foucault (1982) the idea of everyday power has been central to social practice theory (Barnes 2001), offering tools to study the notion of oppression, which is critical in Disability Studies (Oliver and Barnes 2012).…”

“…It was often true that our extracts resembled teacher-pupil interactions (Dowling et al 2019), where the teacher asks a question to which they already know the answer. However, finding 'teachable moments' in an interaction could be seen as part of the job of the support worker.…”

View of relatives on quality of care: narratives on the care for people with visual and intellectual disabilities

“…The stories provided in our study may serve as concrete examples of aspects of such interactions. Other recommendations for care professionals with respect to interactions with clients can be found in literature on person-centred care (Santana et al 2018) and in articles focusing on interaction with people with intellectual disabilities (Dowling et al 2019;Williams et al 2016). Although health professionals are under pressure to provide good care despite financial cuts, we believe that it is possible to take up on most of the recommendations, as the focus is on the quality of care instead of on the quantity.…”