Empowering support workers to enable people with profound intellectual and multiple disabilities to engage in activity at home

Background: People with profound intellectual and multiple disabilitiesmay not always be well-supported to engage meaningfully in activity at home (Mansell 2010), arguably an occupational injustice (Townsend & Wilcock 2004). Research aimed to understand how occupational therapists seek to improve such support and encourage support workers and managers to adopt professionals’recommendations.Method: A single, purposively-selected case of supporting engagement in activity at home was investigated using a critical ethnographic case study method. An occupational therapist worked with five people with profound intellectual disabilities and their support workers over 1 year. Data were collected using ethnographic methods (participant observation, interviews and document analysis).Results: The case’s story highlights challenges encouraging others to follow recommendations as intended (Cross & West 2011). Its two overarching themes are how shifting support and leadership cultures impact on engagement in activity; and how occupational therapy seeks to create and sustain cultural change by working with support workers in a collaborative and empowering way.Conclusions: Staff occupational risks, in particular of burnout where roles are conflicting or ambiguous (Vassos & Nankervis 2012) may need to be addressed whilst promoting occupational justice for residents. The complexity of achieving implementation fidelity may be under-estimated.