An Efficacy Study of Leadership for Empowerment and Abuse Prevention (LEAP): A Healthy Relationships' Program for Adults with Intellectual Disability

People with intellectual disability (ID) are at high risk for abuse (Curtiss & Kammes, 2020). This efficacy study assessed the LEAP intervention’s effectiveness in helping adults with ID gain knowledge and skills to avoid abuse and develop healthy relationships and to determine what to do if they were in an unhealthy relationship.

A video vignette-based measure assessed participants’ comprehension of the program’s core concepts. Participants (n = 109) with mild and moderate ID were recruited from 15 residential and community-based ID agencies.

Following consent, participants completed the pre-test before the program and the post-test after session four. Implementation fidelity checklists were completed by observers. For pre and post, participants watched vignettes and answered questions. Six dichotomous scenario identification questions asked participants to identify whether the vignette scenario was abusive/exploitative. Identification scores summed correctly identified items. Six explanation questions asked participants to describe why they made their response choice. Three reviewers rated the accuracy of participant explanations. The open-ended resolution questions asked participants “what would you do next?” Three reviewers’ independently evaluated these responses. Fleiss’ Kappa measured inter-rater reliability. Wilcoxon signed-rank tests examined differences in scores between pre- and post-test (Z scores were able to be obtained) and effect sizes were measured using r. It was expected that correct responses and strength of response explanations would increase significantly from pre to post.

The qualitative component explored people with ID’s understanding of healthy and unhealthy relationships and potential actions to prevent abusive/exploitative relationships by using conventional content analysis to analyze the semi-structured interview data from the pre and posttest. The methodological approach was inductive and followed patterns within the specific data (Graneheim et al., 2017).

Identification scores. Wilcoxon test showed that differences between pretest and posttest scores were not statistically significant (Z= -1.69, p<.05), although median scores did improve marginally. Thus, participants can steadily improve at identifying abusive/exploitative situations, even though changes in response to intervention were limited.

Explanation ratings. (Fleiss’ Kappa .99 pre, .98 post). Wilcoxon test showed that posttest scores were greater than pretests (Z= -5.04, p<.001) indicating that participants more accurately described why situations were abusive/exploitative after LEAP. The effect size was medium-to-large.

Resolution items. (Fleiss’ Kappa .97 pre, .98 post). Wilcoxon test indicated participants got better at detailing resolutions to abusive/exploitative situations from pre to post (Z= -2.19, p<.01). The effect size was small-to-medium.

Average implementation fidelity score was 97%.

Five themes emerged from the qualitative data: agency to solve a problem, identifying unhealthy relationships, identifying healthy relationships, staff are not always my friend, and blaming the victim. Participants demonstrated an understanding of nuances in abuse scenarios. Researchers explored the language used by participants and the depth of their responses.

LEAP participants distinguished between healthy and unhealthy relationships and developed positive help-seeking intentions. Future studies should assess LEAP’s long-term effects. Evaluation of abuse prevention programs for people with ID should include accessible designs and implementation fidelity protocols. People with disabilities should be involved in all aspects of the programs.