Naturalist decision-making processes of multidisciplinary teams that facilitate community living options for adults with intellectual disabilities

Abstract

In Ireland, multidisciplinary teams (MDTs) such as those comprising healthcare and social care professionals, as well as senior managers, are tasked with the implementation of the national deinstitutionalisation programme for people with disabilities in Ireland. The main aim of this study was to explore the decision-making processes of MDTs who were involved in transferring adults with an intellectual disability (ID) to dispersed housing in the community. The objectives of the study were as follows: (1) to determine what decision-making processes were used by MDTs when transferring an adult with an ID from congregated settings to dispersed housing in the community; and (2) to determine the factors that MDTs considered in their discussions when transferring an adult with an ID to dispersed housing in the community. This study adopted an exploratory multiple-case study research design. Twenty-eight MDT members from five service providers participated in five different focus group discussions and five senior managers were interviewed from each of the service providers. Findings indicated that four of the five MDTs in focus groups used six decision-making task processes when considering transferring an adult with an ID to community housing. The sequential pattern of the decision-making task processes of describing, recommending and planning were the most frequently used, followed by predicting and explaining. The least used decision-making task process was constructing hypothesis. MDTs considered a myriad of factors when making decisions to move adults with an ID from campus-based to community-based settings. Five overarching themes emerged namely, client profile, deinstitutionalisation, resources, person-centredness and ethos. The present study has contributed to the body of knowledge by identifying the Naturalistic Decision-Making (NDM) framework as a suitable framework that could be used by MDTs for exploring the task decision-making processes. The present study also highlighted theoretical and practical implications applicable to MDTs’ decision-making process within the ID field, as well as implications for policy in the deinstitutionalisation process within the Irish context.