High-quality interactions. Pathways towards enhancing the quality of the interactions between direct support workers and clients with severe or profound intellectual disabilities visiting day-care or residential group homes

The importance of social interactions cannot be underestimated. This is equally so for individuals with severe or profound intellectual disabilities visiting day-care or residential group homes. The direct support workers supporting them in daily life are a significant source of their social encounters. However, with the individuals’ often idiosyncratic communication style and the direct support workers’ heavy workload, to name two, several challenges can be recognised that pose a risk of lower-quality interactions. This may render quality interaction both valuable and vulnerable.

This doctoral project is built around the central research question ‘What are possible pathways towards enhancing the quality of the interactions between direct support workers and their clients with severe or profound intellectual disability visiting day-care or residential support services?’ This question is operationalized in two parts (1) ‘Quality interaction, what is it about?’ and (2) ‘Quality interaction, how to improve it?’. With regard to part one, for Study 1a, a diary study was conducted to better understand what quality interaction means in practice, through the perspective of the direct support workers and close to their daily reality. Themes for the categories of behaviour, thought, and emotion emerged. Moreover, interaction quality indicators were distilled. The results of Study 1a lie at the basis of Study 1b. In this mixed method study, theme occurrence will be statistically analysed on a within- and between-subject level. The emerging patterns will be further examined by a narrative synthesis of illustrative diary entries, thus showing in-depth the experiences of direct support workers. Study 2 describes the development of a self-report screener questionnaire, the Screener Questionnaire for Interaction Quality (SQuIQ). The questionnaire asks about aspects that are indicative of the quality of the interaction (e.g., the direct support worker’s possibilities to be sensitive to the client’s signals). The questionnaire was constructed on the basis of the results from Study 1a and the relevant literature. This questionnaire could fill a gap for direct support workers wanting to take stock on how their interactions unfold, providing chances for critical reflection and improvement, and serve as an outcome questionnaire in further studies. Study 3 intends to build a model predicting interaction quality. To this end, the developed screener questionnaire is used and questionnaires assessing determinants of staff-client interactions on an intrapersonal and environmental level are included. Lastly, building on the knowledge gathered from studies 1 to 3, Study 4 will report on the development, implementation, and evaluation of an intervention aiming to increase the quality of the interactions between direct support workers and their clients.

Altogether, following these objectives, the doctoral project intends to contribute to the knowledge on what constitutes high-quality interactions in practice, incorporating and valuing the input of experiences of direct support workers, and to build an intervention program aimed at improving the quality of the interactions. Ultimately, by orienting on the valuable, but vulnerable concept of quality interaction, the project intends to contribute to the direct support workers’ job satisfaction, the services’ quality of care, and the clients’ quality of life.