Between self-determination and coercion - insistent practices in services to people with intellectual disabilities

Project summary

To a large extent, the political, academic and professional debate about services to people with intellectual disabilities has revolved around the categories “self-determination” and “coercion”. We find this dichotomy insufficiently nuanced to adequately describe the interaction between care staff engaged in service provision and many service users  with intellectual disabilities. In our textbook “Vernepleiefaglig teori og praksis” (University Press 2011), we presented a model that offers a more nuanced categorization.

One of the categories, "insistent practices", frames forms of interaction that do not represent self-determination for the service user, but at the same time can not be termed coercion. These forms of interaction, which we call "insistent practices", are characterized by care staff

 

• taking physical or verbal initiatives that go beyond service users’ expressed wishes, needs or preferences,

and persevering even though they understand that these initiatives are unwanted on the part of the service user, desisting only on the verge of coercion.

 

Goals

 

• Acquire more knowledge about when, how and why care staff employ insistent practices.
 
• In collaboration with them, explore what differences the analytical nuancing that our model offers can do for service quality.
 
• In collaboration with them, develop an appropriate mapping tool that can support care staffs’  own analyses of their interaction with service users.
 
• Develop the concept of insistent practice theoretically.
 
• Present and discuss the resulting knowledge in a textbook, that also outlines the mapping tool.


 

Method

Method

The overall methodological framework of the research process is action research and action learning. Action research requires a partnership between scientists and concerned individuals or groups in the field of research (Nielsen and Nielsen 2010, p. 110). Action learning takes place in a process in which participants question their own practices, come up with other ideas for alternative practices, trying them out, reflect on the process and perhaps change their daily practices in line with the new ideas (Engeström 2001, Postholm 2007).
 

In the data collection phase, we will use a combination of
1. Focus group discussions spring from participants' descriptions and stories of interactions with service users that may be termed insistent practices,
2. Stimulating the participants to explore these practices through log writing and reflection,

3. new rounds of focus group discussions, based on their logs and our qualitative analyses of data from the previous round.

Our data set will consist of notes from the participants and sound recordings from the focus group discussion and email exchanges with participants between sessions. We will visit each group three times within a twelve month period - autumn 2014, spring 2015 and fall 2015. We have four such groups, in the west, southwest, east and north of Norway.

 

Our focus is care staff’s descriptions and reflections, but these will inevitably also entail some information about the specific service users their examples involve. We will ask participants to present all examples in anonymous form, and not give more detail about service users than is needed to understand the priorities and actions of the staff. As researchers, we take responsibility for not including information in our data material that makes individual service users recognizable. The project has been approved by the Data Protection Official for research at the Norwegian Social Science Data Services.