published_or_final_version / Community Medicine / Master / Master of Public Health

The main focus of this thesis is to investigate the mental worlds of intellectually disabled people. It is intended to provide information about how members of this population construe their environments and how recent changes in the philosophy of care have affected their construct systems. Personal construct theory is used as the model that underpins the studies in the thesis and a modified version of repertory grid technique is developed and used to explore physical and social aspects of each subject's environment. After a pilot study was conducted to establish the viability of using modified rep grid techniques with this population, a longitudinal study over a four year period investigated the social constructs of 15 intellectually disabled residents. Eight were still in an institution at the end of the study and seven had moved into the community during that period. A comparison group of eight staff were sampled at the beginning of the longitudinal study. Information is made available concerning the size and complexity of each subject's construct system. It was found that the size and content of the construct systems of intellectually disabled people is limited relative to the comparison group and does not change significantly over four years. construct systems were analysed using two computerbased programs that solved the patterns of interrelationships and a graphic presentation of the network of significant correlations between constructs was completed. It was found that the graphic presentation was adequate for the intellectually disabled respondents but not for the comparison group. No difference was found between the community-based group of intellectually disabled people and those still resident in the hospital after four years. A further study with 17 intellectually disabled people, parents and non-parents, found no difference in their construct systems of children. These results are discussed in the context of the present philosophy and practice of normalisation and social role valorisation.

During the summer of 1987 a study was conducted to determine the effects of a summer employment training program. Forty-eight mildly handicapped (learning disabled, emotionally handicapped, educable mentally handicapped) students participated. There were two types of treatment conditions: work experience plus employability and social skills training (WE + ESST); and work experience only (WE). Fifteen students served as a control group. All students had participated in a work experience program during the preceding Spring and again in the following Fall. Students in the WE + ESST group received direct instruction on employability and social skills in a classroom setting for on hour a day, twice a week for six weeks. Work experience for both treatment groups consisted of working for a minimum of fifteen hours a week. They were monitored by job developers on at least a weekly basis.

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This study investigated the effects of modeling behaviors and verbal cues on retardate learning. Subjects were required to complete nine performance items after receiving one of four treatments: observing a model and receiving verbal cues, receiving only verbal cues, observing the model only, or neither observing the model nor receiving cues (control group). The methods employed were essentially identical with the methods employed by Forehand and Yoder (1972) with the exception of an additional treatment group (verbal cue only). Subjects' ages and I.Q.s also differed in that the subjects for this study were adults who possessed I.Q.s ranging from 35 to 67, whereas Forehand and Yoder's subjects were children with I.Q.s ranging from 50 to 80. The results yielded no significant differences in the number of errors in performance or in the time required to complete the items.The correlation between errors in performance and task completion time did not reach significance. The results were discussed in conjunction with the work of Forehand and Yoder and a hypothesis relating I.Q. level to information utilization was proposed.

This study aimed to build an understanding of the internal and external factors that affect the bereavement process in people with intellectual disabilities (PWID). This was achieved by drawing on my previously published works, by analysing the research of others and by applying a critical clinical reflection to examples from my practice as a dramatherapist with PWID, through the use of vignettes. The study is uniquely concerned with what can be learned by exploring the significance of the attachment relationship, the complexity of dependency and the effect of living with the primary trauma of disability on bereavement and grieving. A comprehensive analysis of the existing research revealed that there is little understanding of the normal bereavement process in PWID and that there is a high incidence of complicated grief. The critical reflection on practice enabled me to enlarge upon the emergent theory of complex grief and to identify important components. By applying the lens of attachment theory a greater awareness of how grief can become complicated has been reached that can inform the design of more responsive services for PWID. This study has highlighted that there are both internal and external reasons which may explain some of the emerging evidence that points to an abnormally high incidence of complicated grief in PWID (Brickel and Munir 2008 and Dodd and Guerin 2009), A new model of psychodynamic disability psychotherapy has emerged from this study, which proposes to include the supportive network as a component of the therapeutic treatment for PWID. The model and findings from this study can be used to inform the development of appropriate bereavement support for PWID. The findings can be further used in order to promote more supportive and effective practice from Health and Social Care Professionals towards families when a baby with intellectual disabilities is born.

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Previous research has explored the applicability of Weiner’s (1986) attributional model of helping behaviour to support workers of people with learning disabilities regarding challenging behaviour using optimism as a measure of the expectancy of success. No research has investigated the applicability of Weiner’s (1993) attributional model of helping behaviour to this group which gives a role to attributions of responsibility. Other research has found that self efficacy affects emotional response to challenging behaviour. The aim of the current research was to examine the relative applicability of these two theories to support workers regarding challenging behaviour using self efficacy as a measure of the expectancy of success. Method A total of 88 support workers completed measures addressing causal attributional dimensions, emotional reactions, attribution of responsibility, self efficacy and willingness to help in response to each of three vignettes regarding the challenging behaviours of aggression, self injury and destruction of property. Data was analysed using Spearman’s r correlations. Results None of the hypothesised significant correlations were found between measures of causal attributional dimensions and measures of responsibility or self efficacy. Attributing responsibility for the development of a challenging behaviour to the person engaging in it was significantly positively correlated with negative emotion. Self efficacy was significantly negatively correlated with negative emotion and significantly positively correlated with willingness to help. Emotional reaction was not significantly correlated with willingness to help. Conclusions The results provided little support for Weiner’s (1993) attributional theory of helping behaviour but provided more support for the expectancy of success aspect of Weiner’s (1986) theory and indicated that self efficacy is a useful measure of the expectancy of success. No firm conclusion could be drawn as to whether the failure to find significant correlations between causal attributions and other aspects of the theories was a genuine finding or due to the modified use of the Challenging Behaviour Attributions scale. It is concluded that a measure specifically designed for measuring causal attributional dimensions in this area is required. It is also concluded that low self efficacy may contribute to the development and maintenance of challenging behaviour via its impact on support workers’ intent to help. Efforts should therefore be made to raise support workers’ self efficacy by altering the perceived cause of challenging behaviour and highlighting to support workers the role of their level of effort, adherence to support plans and the role of any temporary external factors in the development and maintenance of challenging behaviour.

This thesis documents, develops and demonstrates a novel form of praxis in relation to disability in Scottish Higher Education. 'Praxis', as I use the term in this thesis, refers to an ongoing, irreducible, collective process through which is enacted, in one and the same process: 'knowledgementing' (the construction and legitimation of knowledge claims); 'radical reflexivity' (the bringing to awareness and critical problematisation of interests served by what is thought, said and done by all relevant parties); and 'ideologically progressive social action' (the pursuit of emancipatory process and just outcomes and the contesting of'external and internal' institutional oppression). The meaning of praxis is explicated in this thesis and demonstrated in action with reference to disability in Scottish Higher Education. Particular attention is paid to explicating and demonstrating the conceptual unity of praxis and the interconnectivity in actuality of the practices, procedures and policies which disable in assemblages or apparatuses, as Foucault uses the terms. The interconnectivity of the praxis is, it is claimed, the key to unlocking the interconnectivity of the assemblages which produce and maintain disability in Scottish Higher Education. The thesis traces the connections between the various elements of the assemblage producing a novel account (and new knowledges) which, it is claimed, could only have been derived as a result of the praxis and which can also account for the knowledges presented in previous research into disability in British Higher Education, locating these studies as part of the disabling assemblage. The thesis concludes by drawing out wider implications of praxis for conventional research, for psychology and social science.