The occupational therapy contribution to good home-environment designing
Intellectually disabled people who are a vulnerable and marginalised group, often experience limited affordable, appropriate housing, which has led to inappropriate and unsafe housing choices (Casson, et al., 2021). They may also have complex needs such as over-sensitivity to environmental stimulus (visual, tactile, auditory), isolation, poorer health, poverty and abuse (Simplican, 2019). These can affect peoples’ wellbeing and lead to behaviours of concern (NHS, 2017). Consequently, many intellectually disabled people are also hospitalised or in long-term facilities away from their communities and homes with their discharge delayed due to a lack of suitable housing (MENCAP, 2023).
NHS England (2017) recognise that behaviours of concern are a complex interaction between biopsychosocial and environmental factors but that this can be changed by providing high-quality, person-centred care in homes, meaningful activities and relationships to prevent behaviours that might be considered challenging from developing and becoming entrenched. By managing this, individuals can focus on goals, which promote choice and participation. Occupational therapists can be strong proponents of upholding people’s human rights and occupational justice, which proposes that everyone, no matter their differences, has the right to benefit from equal privileges for diverse participation in occupations that support their health and social inclusion (Hammell and Iwama, 2012). A focus, thus, for occupational therapists is to enable, mediate and advocate for environments which provide opportunities for people to participate meaningfully at home (Hocking, 2017).
The aim of this study is to explore how occupational therapists contribute to ensuring that homes for intellectually disabled people are well-designed, asking: how do occupational therapists contribute, promote or ensure good home designing, that support participation and wellbeing intellectually disabled people in their homes?
Research design
This is a qualitative study using participant interviews. Participants must be qualified occupational therapists, working in the intellectual disability field of practice and registered with the Health and Care Professions Council (HCPC). There will be no restrictions on who they work for. A Participant Information Sheet and consent form will be sent to interested voluntary participants. The interviews will have questions, designed with support from Team Springwell*, who will also have a member present at the interview. Braun and Clarke’s (2022) reflexive thematic analysis will be used to analyse data.
It is anticipated that the outcomes from this study will inform occupational therapy practice on good home designing methods, which allow for the participation and wellbeing of intellectually disabled people. The findings could further inform the role of occupational therapists in the ‘Building the Right Support’ programme (DoH, 2022), which maintains that intellectually disabled people should have equal human rights to live satisfying, valued lives in homes, within their community. I intend to disseminate the findings of this study in a peer-reviewed journal and at conferences.
The study will be a collaboration with University of Brighton and Team Springwell, a group of experts-by-experience, developed by Sussex Partnership NHS Foundation Trust (SPfT) who support intellectually disabled people to have a voice. This study is also supported by the Royal College of Occupational Therapists Research Foundation.
References: Braun V, Clarke V (2022) Conceptual and design thinking for thematic analysis. Qualitative Psychology, 9(1), 3–26. https://doi.org/10.1037/qup0000196
Casson J, Hamdani Y, Dobranowski K, Lake J, McMorris C, Gonzales A, …Balogh R. (2021). Housing design strategies and modifications for individuals with intellectual and developmental disabilities and complex behavioural needs: A scoping review. Journal of Policy and Practice in Intellectual Disabilities, 18(3),217-228. https://doi.org/10.1111/jppi.12377
Department of Health (DoH) (2022) Policy Paper: Building the Right Support Action Plan. Available at: https://www.gov.uk/government/publications/building-the-right-support-fo... Accessed 09.10.23.
Hammell KRW and Iwama M (2012) Well-being and occupational rights: An imperative for critical occupational therapy. Scandinavian Journal of Occupational Therapy 19(5): 385–394. https://doi.org/10.3109/11038128.2011.611821
Hocking C (2017) Occupational justice as social justice: The moral claim for inclusion.
Journal of Occupational Science 24(1): 29–42. https://doi.org/10.1080/14427591.2017.1294016
MENCAP (2023) No Freedom, No Dignity, No Life: Available at: https://www.mencap.org.uk/get-involved/campaign-mencap/transforming-care... . Accessed 09.10.23.
National Health Service (NHS) England (2017). Transforming Care. Model Specifications: Supporting implementation of the service model. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/02/model-service-spec... Accessed 19.05.23.
Simplican SC (2019). Behaviors that challenge disability studies. Disability & Society, 34(9-10), 1379-1398. https://doi.org/10.1080/09687599.2018.1552119
Sussex Partnership NHS Trust (2022). The Safe Home Environment Assessment (SHEA) Tool. Available at: https://portal.spft.nhs.uk/shea/. Accessed 09.10.23.