Written by two leading authorities on active support, this book provides an up‐to‐date account of the concepts, practices and research on supporting people with intellectual disabilities to take more control of how they live their lives. The authors’ declared aim is to bring together in one place a description of active support, how and why it developed, what the critical components are, and how it can be successfully implemented. The volume describes the origins and development of active support and the authors’ own work on developing a system of Person‐Centred Active Support (P‐CAS). The underlying principles and defining features of this approach are presented alongside a realistic appraisal of its reach, thus far, into human service environments. In my opinion, the authors fully meet their aims.
The writing throughout is crisp, clear, thoughtful and analytic. The chapters are logically sequenced and, as might be expected, most of the content is evidence based. Some room is made, however, for opinion and argument borne out of experience and the application of principle. These passages are clearly flagged and make for a more rounded account relevant to readers whose interest goes beyond empirical research. This is just as well, as many aspects of active support and its implementation have yet to be researched and active support research methodologies have not received universal acclaim or acceptance. The authors’ approach is nonetheless principled and authoritative. Their description and analyses are robust, objective and honest. The product is a conceptually coherent and succinct delineation of P‐CAS, its place in human service delivery, and the identification of a host of issues that have, so far, challenged successful and widespread implementation.
A number of themes run throughout the book. One of these themes emphasises principle over technology. For example, the authors repeatedly stress the importance of promoting active support as something that is real in people's lives, rather than a set of procedures or paper‐based exercises to be followed slavishly by staff working in human service environments. This argument demands flexibility in working practices and how they are defined, which raises interesting questions about how active support is itself defined and how a participant or observer would know when services were and were not implementing active support. While the principles of active support are likely to be safe in the hands of creative and highly motivated practitioners working in progressive and dynamic services, poorly defined procedures must leave the approach open to the risk of corruption and dishonest claims for its implementation. Overcoming this problem is partly what the book is about. A number of questions are raised, however, particularly in the final chapter, for which adequate answers are yet to be found. The authors are candid about the status of active support in the UK and its limited reach into human service environments. They point out that engagement levels reported in research undertaken over the past two decades do not match those of the original development sites in the early 1980s. This could, of course, be related to similarities and differences in the compilation and implementation of active support components between the original and all subsequent studies, but no comment is made. In any event, implementation in the UK remains patchy and overly dependent on personal interest and commitment from individuals or service organisations. A new and welcome addition to the discussion on active support is the authors’ treatment of strong vs weak implementation of active support as an alternative to the previously held binary position of all active support or no active support. This could turn out to be an important contribution to the debate as it raises again the possibility of assessing active support implementation as a series of dynamic iterations around process and outcome, rather than as a measure of outcome alone or the simple delineation of procedure and procedural compliance. A related theme is the status of the evidence regarding active support, its believability and acceptance by policy makers. Surprising then, that there is no call for a large‐scale randomised‐control trial of active support or to evaluate collateral effects of implementing active support on the occurrence or abatement of challenging behaviour. The authors present their own views on the relationship between P‐CAS and positive behaviour support (PBS), citing possible reductions in challenging behaviour as a side effect of enrichment. Although clearly not evidence, the discussion is welcome given the area is under‐researched and the two approaches are increasingly confused or even conflated. Pages 36‐37 summarise the principles of normalisation beautifully. Also included are perspectives on active support and quality of life, mindfulness, and the contribution of applied behaviour analysis. Finally, there is some secondary analysis of previously published data.
Although chapters can be read selectively, the book is organised to from a logical narrative. Chapter 1 provides an introduction and core rationale for active support. The relationship between a person providing support and a person receiving it is identified as pivotal in pursuing quality of life outcomes with and on behalf of people with intellectual disabilities. There follows an overview of a 40‐year history of the development of active support and its evolution into P‐CAS. Here readers are introduced to the concept of engagement and variables that influence how opportunities may be created or denied to people with severe or profound intellectual disabilities. Identified at this early stage are problems of uptake and implementation, independent of researcher involvement, another theme that runs throughout the book. Chapter 2 provides a more in depth definition and analysis of engagement and relationships as an expression of quality of life and of “operationalising service principles”. Chapter 3 deals with the quality of “enabling relationships” and introduces the four defining principles of person‐centred active support. Each is described briefly and all are placed together in the context of creating a virtuous circle of engagement. Research on staff support for client engagement is reviewed.
The following Chapter 4 deals with properties of the environment that are likely to support or inhibit enabling relationships. Routine, consistency and predictability in activity and communication are identified as necessary considerations along with the allocation of staff support. This chapter discusses monitoring active support implementation and assessing personal outcomes through paperwork and observation. Here readers discover that as many as 400,000 paid carers in the UK are likely to have literacy skills equivalent to those of children leaving primary school. Chapter 5 explores what is needed to support day‐to‐day implementation of active support and describes an approach known as practice leadership. The authors draw heavily on their own experience in this and the following chapter, which deals with active support at an organisational level. Organisational issues discussed include deciding what is important, managing the motivational context and giving appropriate feedback to staff. Here the role of senior managers is assessed as mission‐critical. Chapter 7 briefly reviews person‐centred planning (PCP), PBS, total communication, intensive interaction and SPELL. Each of these approaches is variously described as being connected with, a component of, similar to, or in symbiotic relationship with P‐CAS. This is an important chapter for two reasons. First, it differentiates active support from other person‐centred approaches, so the scope for confusion and the tendency towards what the authors call “menu‐driven” approaches should be lessened in future. Second, it highlights the potential for accruing additional benefit by integrating approaches. Here, as elsewhere, there are practical examples of successful approaches by provider organisations. The final chapter draws together much of the material in the book and discusses lessons to be learned and possible futures for active support. One of the most powerful sentences in the book asks “[…] why it is so easy to get things wrong and keep them that way, and so difficult to establish and sustain good practice over the longer period […]” (p. 181). The research and practice agendas suggested are complex and multi‐faceted and set in the context of stakeholder interests and contributions.
Overall, the book is optimistic and provides a fitting summary of the enormous contribution made to learning disability services by the late Jim Mansell and his many colleagues, but most especially his co‐author Dr Julie Beadle‐Brown. Chapters may be read sequentially or selectively, the subject and author indexing are good, and there are very useful tables summarizing research findings in the appendices. The book is essential reading for anyone interested in commissioning, providing, evaluating, researching or teaching students about high‐quality human service delivery.
