Royal Dutch Visio - de Brink, Groningerstraat 15, Vries, the Netherlands.
Faculty of Behavioural and Social Sciences, department of Pedagogy and Educational Sciences, unit of special needs education and youth care, University of Groningen, Grote Rozenstraat 38, Groningen, the Netherlands.
BMC Health Serv Res. 2020 Apr 16;20(1):319. doi: 10.1186/s12913-020-05161-1.
While the participation of adults with visual and severe or profound intellectual disabilities (VSPID) in society and community life is important, evidence-based interventions to improve their participation are lacking. We conducted a process evaluation of the implementation of 'Care for Participation+' (CFP+), a new intervention targeting the attitudes of direct support professionals (DSPs) toward the participation of adults with VSPID, within a residential facility in the Netherlands.
CFP+ was inspired by the Boston Psychiatric Rehabilitation Approach and adapted by adopting a new definition and operationalization of the concept of participation for adults with VSPID. Following systematic training, 16 DSPs of adults with VSPID were able to apply key elements of CFP+ to explore diverse roles and activities for this population, facilitating their self-management, teaching them necessary skills for participation, and organizing support. Our process evaluation entailed an investigation of the delivered dose, reach, fidelity, and adaptation of CFP+ during and after the CFP+ intervention. We also evaluated the mechanisms of impact and context using questionnaires, assignments, documentation, interviews, and a logbook.
The intended dose, reach, and fidelity relating to the implementation of CFP+ were not achieved. Despite this fact, an assessment of the mechanisms of impact indicated that assignments of CFP+ were well (75%) or reasonably well (17%) understood by DSPs. CFP+ was applied by DSPs to stimulate self-management (83% of DSPs), new activities (100%), enhanced involvement in existing activities (67%) and to explore new roles (50%) for adults with VSPID. A negative contextual factor mentioned by the trainer and manager was the DSPs' lack of commitment to the training program. Another negative contextual factor mentioned by DSPs was the lack of time for implementing CFP+.
CFP+ provides new opportunities to improve the participation of adults with VSPID. Despite the non-optimal conditions for implementing CFP+ and the DSPs' general reluctance to apply the new intervention, some have actively used CFP+ within the residential facility. Future studies should focus on the outcomes of CFP+ regarding attitudinal changes among DSPs relating to the participation of adults with VSPID and their quality of life.
虽然成年人的视力和严重或极重度智力残疾（VSPID）参与社会和社区生活很重要，但缺乏提高他们参与度的循证干预措施。我们对“参与关怀+”（CFP+）在荷兰一个住宿设施中实施的情况进行了过程评估，该干预措施针对的是直接支持专业人员（DSPs）对 VSPID 成年人参与度的态度。
CFP+的灵感来自波士顿心理康复方法，并通过采用新的 VSPID 成年人参与度的定义和操作化进行了调整。在系统培训后，16 名 VSPID 成年人的 DSP 能够应用 CFP+的关键要素，为该人群探索各种角色和活动，促进他们的自我管理，教授他们参与所需的技能，并组织支持。我们的过程评估涉及调查 CFP+在干预期间和之后的交付剂量、覆盖范围、保真度和适应性。我们还使用问卷、作业、文件、访谈和日志评估了影响和背景的机制。
CFP+的实施剂量、覆盖范围和保真度均未达到预期。尽管如此，对影响机制的评估表明，DSPs 对 CFP+的作业理解得很好（75%）或合理（17%）。DSPs 应用 CFP+来激发自我管理（83%的 DSPs）、新活动（100%）、增强对现有活动的参与度（67%）和探索 VSPID 成年人的新角色（50%）。培训师和经理提到的一个负面背景因素是 DSPs 对培训计划缺乏承诺。另一个 DSPs 提到的负面背景因素是缺乏实施 CFP+的时间。
CFP+为提高 VSPID 成年人的参与度提供了新的机会。尽管实施 CFP+的条件并不理想，而且 DSPs 普遍不愿意应用新的干预措施，但一些人在住宿设施中积极使用了 CFP+。未来的研究应侧重于 CFP+对 DSPs 与 VSPID 成年人参与度相关的态度变化及其生活质量的影响结果。
