Exploring the relationships of people with an intellectual disability and their support staff: To what extent is rapport a useful and measurable concept?

Background Research interest in exploring the quality of relationships 'rapport' between people with an intellectual disability (ID) and those that support them is slowly expanding. People with ID, particularly those that present a challenge to others, are more likely to experience abuse; consequently they have been the subject of many service scandals. People with little or no verbal language are likely to struggle to tell others that relationships with staff or family carers have deteriorated to the point of becoming abusive.

The limited research available indicates that rapport with staff is associated with reductions in behaviour described as challenging, particularly when the behaviour serves a demand avoidance function.

Despite some suggestions of how people with ID and limited language, may show that the relationship with carers is of a good quality there was no observational method of obtaining this information.

Method A systematic review was conducted and literature used to design an observational method of rapport measurement, the IRM. Participants with ID were filmed in the presence of SP. Alongside the filmed observations staff completed the Staff Rating of Other Staff, Staff Self- Rating of Rapport and took part in Preference Testing Sessions (McLaughlin and Carr, 2005). Filmed material was analysed using the IRM. The IRM was subsequently developed into the easier to use Rapport Rating Scale (RRS). The RRS and measures used in the original IRM study were piloted by clinicians and reviewed in focus groups over an 8 month period.

Results Literature searches found that there is very little research that has directly examined rapport between people with intellectual disabilities and staff or unpaid carers. Consequently concepts similar to rapport were examined and identified some material useful to the development of the IRM. Most concepts asserted that it is possible to see observable changes in participants with ID when rapport with staff or unpaid carers is developed.

The IRM study showed, higher average IRM scores for the SP in the good rapport groups when compared to each of the McLaughlin and Carr (2005) measures. Analysis of the easier to use RRS indicated that professionals and trainees, were able to use the RRS to discriminate between good, neutral or poor rapport towards carers

Conclusions Using rapport measures in clinical practice, suggests that clinicians supporting people with ID were able to use rapport measurement tools successfully. For a number of clinicians the content of the Positive Behaviour Support plan was altered or enhanced through the rapport information collected during assessment. There are implications of understanding and the ability to measure rapport between people with ID and staff, on, clinical practice, staff training, service development and the wider policy agenda.