The Role of Recognition: Using Q Methodology to Explore DSP Decision Making

Background and Purpose:  There has been very little research exploring the viewpoints that exist among direct support professionals (DSPs) who are employed in community-based settings with individuals with intellectual and developmental disabilities (ID/DD) on how they make decisions on-the-job.  Of particular interest is how DSPs facilitate autonomy and self-determination for the individuals they support, while simultaneously providing supervised care that ensures the safety of individuals with ID/DD within community-based group settings.  The tensions inherent in such decision making is explored, in part, through the theory of recognition developed by Axel Honneth. This research adds insight into previous works exploring the DSP/client relationship within the framework of person-centered services and how DSPs manage the complexity of their jobs.

Methods: 30 DSPs participated in a Q methodology study consisting of a card sorting task followed by in-depth, semi-structured interviews. All DSPs were over the age of 18 and had at last 3 months experience on the job with the sample being predominately female (60%), Black/African American (90%), and having over 3 years of experience as a DSP (60%). DSPs were recruited by flyers from two care providers. Participants were given 48 statements developed from previous qualitative research looking at DSP perspectives on their work. These statements were also representative of 6 different thematic areas found within the qualitative literature consisting of: Recognition, paternalism, self-referential thinking, agency policy, agency resources, and group home culture. Participants ranked each statement in to a forced distribution pattern according to statements that were most important to how they did their job to least important on a scale from -4 (most unimportant) to + 4 (most important). The Q sorts were analyzed using PQ method software in three steps: 1) correlation, 2) factor analysis (principal components analysis with varimax rotation) and 3) the computation of factor scores. Post-sort interviews focused on the selections at the +4 and -4 locations and an in-depth examination on their feeling of how to instill independence in clients that receive support due to their lack of independence. Interviews were transcribed verbatim and coded thematically using Atlas.ti Qualitative software and used in conjunction with the factors developed in the quantitative analysis to form indigenous typologies.

Findings: The quantitative analysis revealed a 5 factor solution each placing a different ranking of importance on the concept of recognition. Recognition and concepts of personhood for people with ID/DD differed among the factors as did the way DSPs described their level of recognition for the people they supported as being pre-developed (previous life experience) or growing over time on-the-job. Further, recognition was often intertwined with the seemingly contradictory themes of self-referential thinking and paternalism in some participants. Finally, participants spoke about care vs. independence tension as something requiring sound judgement while weighing policy vs. individual freedom concerns.

Conclusion and Implications: Findings detail the variety of viewpoints that likely exist on recognition among DSPs and how these may or may not be in line with the philosophy of person-centered services. Implications for enhancements to agency trainings are also discussed.