Reid, D., Everson, J., & Green, C.,

1999,

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

Methodology

This study looked at the accuracy of a person-centered mapping process to identify specific preferences for people with profound multiple disabilities. Accuracy of reported preferences was evaluated by systematically observing the frequency of approach responses to items and events identified by person-centered mapping. Participants were four adults with multiple physical disabilities and profound learning disabilities. All lacked the communication skills sufficient to describe their preferences.

Person-centered planning meetings were held for each participant. During the meeting a leisure preference map was developed using a three step procedure: asking what works and what does not work for (focus person); presentation of leisure preference information graphically; and asking eleven questions about perceived preferences of the focus person. Identified leisure preferences were entered into the person's plan.

Accuracy of identified preferences was assessed using a single item presentation format and measurement of approach and avoidance behaviour within 5 seconds of the presentation of the item or activity. Six assessment sessions with five trials per session were conducted for each item or activity. Only identified preferences that were sufficiently specific and lent themselves to this form of assessment were included. A total of 24 items and activities were assessed, representing 35% of all preferences identified in plans. Each activity was categorised as: highly preferred (approached on at least 80% of trials); moderately preferred (approached on at least 50% of trials); and non-preferred (approached on less than 50% of trials).

Critical appraisal

The study is based on a small sample size. Information regarding the systematic preference assessments does not give a clear picture of how the assessments were carried out. For example, it is not clear whether all sessions took place on the same day, or at the same time. Repeated presentation of the same stimulus in a short space of time may well lead to avoidance. It is also not clear whether the same person presented the stimuli and whether they were all presented in the same context. It may be that some stimuli are preferred only in certain contexts, or when presented by certain people. In such cases the method used in this study may not be appropriate for evaluating preferences. Finally, as the authors note the results should be qualified by the fact that only 35% of all items in plans were sampled for preference assessment.

Key findings

Of the 24 sampled items, 33% were identified as highly preferred, 42% as moderately preferred, and 25% as non-preferred. For two participants, several preferences (25% and 40% of sampled items and activities) identified in the plan were non-preferred. For one participant, 20% of reported preferences were avoided frequently and 10% were avoided on the majority of assessment trials.

Social work practice/policy implications