Why dont they do what theyre supposed to?
Article Type: Editorial From: Tizard Learning Disability Review, Volume 18, Issue 2
It has sometimes been suggested that we do not need more research to improve the quality of services for people with learning disabilities. If only we applied what we already know, we could do so much better. So why do not we apply what we already know, why do not we do what we are “supposed” to? Alix Lewer’s and Celia Harding’s article provides an excellent illustration of this problem. Highly trained speech and language therapists “work out what might help” but “sometimes the things that the [speech and language therapist] asks people to do don’t happen”. As noted in Sharron Reynolds’ commentary, this problem is not specific to speech and language therapists. Sharron found similar issues in the implementation of behaviour support plans and both articles draw attention to a broader literature addressing the “implementation gap”. It turns out that this is a problem affecting practice in many areas of work, not just something specific to learning disability provision. Both these articles draw attention to some of the reasons for this state of affairs. In particular, they note the importance of“involving” frontline staff, of identifying “shared aims and goals”, of providing “ongoing support” to enable problems of implementation to be addressed and resolved. There is an obvious, but unfortunate, corollary to these findings. If this is what it takes to get better implementation then the frequent failure of implementation suggests that too many professionals, managers, policy makers, etc. are not involving staff, not identifying shared aims and not providing ongoing support. Changing practice is not just about following someone else’s new procedures, no matter how sensible and evidence-based they might be. Rather it requires an understanding of the practice context and only frontline staff can truly have this. The best family support services are “family-centred”,working collaboratively with the family not just because it is nice to do so but because it is the only way to achieve change in a context that only family members truly understand. Yet, in our work with frontline staff, we often are not sufficiently “staff-centred” and fail to take account of their understanding of the context in which our fine new procedures, plans,programmes, etc. are to be implemented.
The problems outlined by Hilary Brown and Liz Marchant also centre on implementation. Why are practitioners not applying the principles of the Mental Capacity Act to their most complex cases? The research they report provides rich detail on the problems faced by practitioners working with these cases. As Michael Dunn notes in his commentary, the Mental Capacity Act may sometimes result in practitioners being “constrained by procedure” with a consequent inability to “safeguard a person’s wider interests”. This too is a problem of procedure and context not fitting together well. But while practitioners can more easily disregard the therapist’s or psychologist’s programme it is less easy to disregard “the law”. So, in this scenario, procedure almost takes precedence over context. The lesson is the same. If we want to change the way in which people with learning disabilities are supported we need, most fundamentally, to involve the person with a learning disability. But we also need to collaborate with families and frontline staff. Otherwise we are whistling in the wind and the changes we want to achieve will either not happen or will have unforeseen (at least by us)consequences.
Regular contributors of high quality articles are a boon to a journal editor. I would like, here, to draw attention to and thank our current regular contributors to the Law and Trends sections of TLDR. Robin Mackenzie and John Watts have contributed articles to most issues of TLDR over the last three years. Their often highly topical takes on a wide range of legal issues relevant to learning disability arrive reliably, require very little editing and always both add to our understanding and contribute material of practical relevance. Similarly, Eric Emerson and Gyles Glover have, over the last year, contributed a series of fascinating Trends articles, all of which use data to tell an interesting story, sometimes one that is reassuring, sometimes less so. I am very grateful to both sets of authors.
Peter McGillTizard Centre, University of Kent, Kent, UK.
