Malette, P., Mirenda, P., Kandborg, T., Jones, P., Bunz, T. & Rogow, S.,

1992,

Reviewed by Janet Robertson,
Institute for Health Research,
Lancaster University

Methodology

This small scale study looks at the impact of the Lifestyle Development Process (LDP) for 2 adults and 2 children with severe learning disabilities. As well as incorporating the values of PCP, LDP incorporates outcome measures to evaluate changes in the focus person's social and activity patterns and to evaluate intervention effectiveness.

Once agreement was obtained from all relevant parties, LDP was implemented for the 4 individuals. Implementation time varied from 4 to 16 months. LDP implementation involved 5 steps: vision planning; assessing and remediating barriers to participation in integrated or community settings; assembling meaningful routines and schedules; developing specific intervention strategies; and evaluating effectiveness and developing a monitoring system.

Three validated measures were used to evaluate intervention effectiveness related to lifestyle changes. Firstly, the Resident Lifestyle Inventory (RLI) was used to measure: types of activity during a 1 month period; how often activities done; where activities occur; which activities are preferred by the focus person; and the level of support needed for participation in activities. This information was collected from the focus person and two other people who were in daily contact with them. Secondly, the Social Network Analysis Form (SNAF) was used to collect information on: people who were socially important in the life of the focus person; and the types and frequencies of activities during which persons in the network engage with the focus person. Thirdly, the Program Quality Indicators (PQI) checklist was used with support staff or teachers to see if "most promising practices" were being used. The RLI and SNAF were administered at steps 1, 3 and step 5 of the LDP process for 3 people (baseline, mid-intervention, and post-intervention), and steps 1 and 5 for one person. PQI was administered during step 1 and step 5.

Critical appraisal

This study stands out as one of the few studies looking at the effectiveness of a form of person centred planning that presents some form of quantitative data. This is presented alongside detailed qualitative information which gives a good insight into the process of LDP and resulting change. However, it is a small scale study. Importantly, as the authors note, the sample was to some extent self-selecting in that only people who completed all 5 LDP step could be included in the study. There is no information given as to the proportion of potential participants for whom the process was not completed and reasons why the process could not be completed. Identifying why the process fails for some people and ways of overcoming barriers to their Lifestyle Development Process would seem to be vital if such a process is to be used widely.

Key findings

The results are presented in the form of data-based case studies along with detailed descriptive information on the 4 focus people and the changes that took place in their lives. Quantitative data is presented for baseline, mid-intervention, and post intervention. To varying degrees, the Lifestyle Development Process had a positive impact on the activity patterns and social networks of the 4 focus people. All 4 took part in a greater number of integrated activities during mid and post-intervention than at baseline. Three out of the four participants experienced gains of 200% in the number of preferred, integrated activities they performed at the end of the intervention period. All four experienced at least slight increases in their unpaid social networks, and performed a greater number of integrated activities with people who were not paid to spend time with them. All four also showed evidence of improved behaviour and communication, although as noted by the authors it is not possible to causally link this to the LDP intervention. Finally, all four participants' programs reflected an increase in the number of "most promising practices" as measured by the PQI, with gains ranging from 13% to 43%.

Social work practice/policy implications

The study lends some support for the effectiveness of one form of Person Centred Planning for people with severe learning disabilities, the Lifestyle Development Process, in improving outcomes for focus people. An important aspect of LDP is the emphasis on evaluating the effectiveness of the process and developing a monitoring system. The collection of data prior to LDP being implemented, such as number of different types of activities done, allows some objective measure of how well the process is working. Services should consider ways in which they can monitor the effectiveness of Person Centred Planning for individuals.