This research explored the nature of engagement in occupation (meaningful activity) and the different levels at which people with profound intellectual and multiple disabilities may engage. Research suggests that many are poorly supported to do this meaningfully at home. When through circumstances beyond their control, people do very little, occupational injustice arguably results, impacting on physical and mental wellbeing and quality of life.
Research evidence and theory from occupational therapy, occupational science and active support underpins support for people to engage in occupations at home. Occupational therapists claim to support people to do this in complex situations, but exactly how they do it and whether it differs from other methods evidenced in the literature remains unclear. Better understanding is needed of how to support people to engage in ways that are authentic and meaningful.
Using a qualitative case study methodology from an interpretivist and social constructionist stance and multiple ethnographic methods (participant observation, interviews and document analysis), a single purposively selected case was explored over the course of one year. In this Esther, an occupational therapist, worked with Matt, Steve, Becky, Jane and Harold (all names are pseudonyms), five people with severe and profound intellectual disabilities and their support workers to increase their engagement in Cavendish House (the residential home where they lived).
Data were analysed systematically using an emergent coding strategy, with NVivo qualitative data analysis software to manage the process. Various formal first and second cycle coding and categorising procedures were used, alongside more intuitive and affective analysis (e.g. concept mapping).