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“The  power  of  pyjamas”:  Everything  effects  everything  else:  power,  perception  and  hidden  forms  of  restrictive  practice  in  shared  supported  accommodation    

Abstract  Since  the  introduction  of  the  Disability  Act  2006,  there  has  been  concerted  focus  on  identifying,   addressing   and   reducing   restrictive   interventions   and   compulsory  treatment   in   disability   accommodation   services   (DAS).   This   paper   reflects   on   a  participatory   action   research   (PAR)   project,   funded   by   the   Office   of   the   Senior  Practitioner  and  conducted  in  partnership  with  the  Department  of  Human  Services,  in  a  rural  region  of  Victoria,  Australia.  The  overall  goal  was  to  improve  the  quality  of  life   and   dignity   of   people   living   in   shared   supported   accommodation.   A   key   focus  was   to   explore   less   obvious   forms   of   restrictive   practice,   for   example   household  rules,   dietary   regimes   and   administrative   requirements.   The   project   adopted   a  partnership   approach   to   engage  with   support  workers   in   developing   strategies   for  challenging  restrictive  practices  at  interpersonal  and  systemic  levels.    Throughout   the  PAR  meetings  participant   reflections   revealed  how  a   concern  with  duty   of   care,   as   expressed   through   domestic   and   personal   support   requirements,  meant  staff  were  engaged  in  struggles  with,  and  between  household  members  over  everyday  life  choices.  In  some  houses,  ‘putting  on  pyjamas’  marked  a  significant  site  of  power,  where  care,  control  and  resistance  were  enacted  daily.  This  paper  explores  the  research  process  and  the  guiding  themes  of  the  project:  power,  perception  and  subtle  forms  of  restrictive  practice.      Key  Words:  Participatory  Action  Research,  Disability  Services,  Restrictive  Interventions  and  Practices.    

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Introduction  

The  research  project  described  in  this  paper  was  developed  in  response  to  requests  

from  direct   support  workers   in   disability   accommodation   services   (DAS).   This   staff  

group  approached  managers,  and  the  wider  Disability  Services  in  the  Department  of  

Human   Services,   Victoria,   seeking   opportunities   to   explore   their   practice   and  

increase  understanding  about  the  definition  of  restrictive   intervention  according  to  

the  Disability  Services  Act  2006.   Support   in   identifying  and  addressing   less  obvious  

forms  of  restrictive  practice  and  restrictive  intervention  was  also  requested.    

 

The   resultant   research   was   guided   by   the   goal   of   practice   improvement   through  

exploring  the  micro  operations  of  power  that  occur  within  Disability  Accommodation  

Services  (DAS),  and  which  take  form  as  subtle,  ‘invisible’  forms  of  restrictive  practice.  

For   example,   household   rules,   dietary   regimes,   choice-­‐making   and   administrative  

requirements.   Because   of   the   focus   on   practice   change,   Participatory   Action  

Research  (PAR)  was  identified  as  the  most  appropriate  approach.  An  overriding  goal  

of  PAR  is  to  empower  participants  to  become  active  agents  in  the  research  process,  

rather   than   objects   of   the   research   (Carr   and   Kemmis   1986;   Stringer   and   Dwyer  

2005).   This   also   fitted   with   the   aim   to   engage   DAS   support   staff   in   sharing   their  

experiences   and   perceptions,   and   to   support   them   in   developing   their   own  

strategies   for   challenging   restrictive   practices.   The   project  was   guided   by   two   key  

questions.   Firstly,   what   forms   of   subtle   restrictive   practices   operate   within   DAS  

houses  that  are  home  to  adults,  some  of  whom  display  ‘behaviours  of  concern’,  and  

secondly,  how  might  these  subtle  restrictive  practices  be  defined,  identified,  named  

and  addressed  by  the  staff  employed  in  these  houses?  

 

In  summary,  the  project  aims  were  to:  

• Improve   the  quality  of   life   and  dignity  of  people   living   in   shared   supported  accommodation   who   are   currently   subject   to   restrictive   practices   due   to  disability.    

• Define,  identify  and  name  subtle,  less  obvious  forms  of  restrictive  practice.  • Engage  shared  supported  accommodation  staff  in  a  partnership  approach  to  

address  all   forms  of  restrictive  practice  with  adult  residents,  some  of  whom  display  behaviours  of  concern.  

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• Develop   strategies   for   preventing   restrictive   practices   in   supported  accommodation  at  primary,  secondary  and  tertiary  levels.  

 

Background    

In  2006,  the  Victorian  government  introduced  the  Disability  Act  2006,  to  replace  the  

previous   legislation   governing   people   with   a   disability:   The   Intellectually   Disabled  

Person’s  Service  Act  1986  and  the  Disability  Service  Act  1991  (Department  of  Human  

Services   2006a).   The   new  Act  was   prompted   by   concerns   about   the   quality   of   life  

people  with  a  disability  were  able  to  achieve,  as  well  as  the  quality  of  care  received.  

Prior  to  the  introduction  of  this  Act,  the  Victorian  State  Government  acknowledged  

these  concerns  in  the  Victorian  State  Disability  Plan  2002–2012.    

 

The   Victorian   State   Disability   Plan   2002–2012   highlights,   as   one   of   its   guiding  

principles:  

 

The  Principle  of  Dignity  and  Self-­‐Determination  [choice]  grounded  in  respecting  and   valuing   the   knowledge,   abilities   and   experiences   that   people   with   a  disability   possess,   supporting   them   to   make   choices   about   their   lives,   and  enabling  each  person  to  live  the  life  they  want  to  live.    

    (Victorian  Department  of  Human  Services  2002)    

The   Victorian   Government   acknowledges   that   one   of   the   key   challenges   facing  

people  with  disabilities  (as  well  as  their  families  and  carers)  is  ensuring  that  supports  

are  enabling,  empowering,  and  that  they  promote  community  participation  and  the  

pursuit   of   a   lifestyle   of   choice   (Victorian  Department   of   Human   Services   2002).   In  

light  of  this,  the  Disability  Act  2006  creates  a  framework  for  people  with  a  disability  

to  become  more  active  participants  within  the  community.    

 

Guided  also  by  foundational  principles  of  human  rights  and  citizenship,  the  Act  seeks  

to   improve   the   quality   of   life   for   people   in   Victoria   who   have   a   disability   and,   in  

doing   so,   aims   ‘to   deliver  more   flexible   support   based   on  maximum   choice   and   a  

person’s   individual   requirements’   (Department   of   Human   Services   2006a).   Thus,   a  

key  objective  of  the  Disability  Act  2006   is   to  eliminate  restrictive  practices  that  are  

enacted  by  those  responsible  for  supporting  persons  with  a  disability.  The  Disability  

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Act   2006   also   established   the   role   of   Senior   Practitioner   to   protect   the   rights   of  

people   who   are   subject   to   restrictive   interventions   and   compulsory   treatment  

orders.    

Restrictive  practices    

Restrictive  interventions  are  defined  by  the  Act  as:    ‘Any  intervention  that  is  used  to  

restrict  the  rights  and  freedoms  of  movement  of  a  person  with  a  disability  including  

(involving  the  use  of,  but  not  restricted  to)  chemical  restraint,  mechanical  restraint  

or  seclusion’  (DHS  2006b).  The  Australian  Psychological  Society  (APS)  (2009)  notes:    

 

The  use  of  restraint  and  seclusion  can  constitute  a  breach  of  people’s  legal  and  human   rights.   The   latter   is   a  matter   of   increasing   concern   given   Australia   is  now   a   signatory   to   the   UN   Convention   on   the   Rights   of   Persons   with   a  Disability.                                  (APS  2009:  5)    

 

While  the  Act  highlights  the  obvious  forms  of  restrictive   intervention;  restraint  and  

seclusion,   it   does   not   address   interventions   that   are   less   obvious,   but   can  

nonetheless   limit   the   quality   of   life   and   choices   of   people   with   disabilities.   These  

more  subtle  restrictions  can  also  be  damaging  and  in  breach  of  human  rights.    

 

Weiss  and  Knoster  (2008)  argue  that  workers  who  do  not  engage  in  overt  restrictive  

interventions   are   not   necessarily   practicing   humanely   and   respectfully,   they  

maintain:    

 

It   is  tempting  to  believe  that   if  we  are  not  doing  work  that   is  disrespectful  or  inhumane  we  are  acting  in  a  person–centered  manner.  It  is  important  to  note  that   there   can   be   a   vast   and   dangerous   gray   [sic]   space   between   those  practices  we  know  to  be  unethical  and  those  that  would  be  truly  life–affirming.    

           (Weiss  and  Knoster  2008:  72)      

Unfortunately,  there  is  very  little  empirical  research  that  has  been  conducted  on  this  

important  issue.  While  researchers  have  sought  to  address  restrictive  interventions1,  

what   is   less   understood   is   how   clients’   rights   to   choice   may   be   violated   by   less  

obvious  forms  of  restrictive  practice.    

                                                                                                               1  see  McVilly  2008  for  a  more  in–depth  exploration  on  this  topic  

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In  preparation   for   the   research,  a   review  was  conducted  of   local  and   international  

academic   and   practice–based   literature,   focusing   on   overt   and   covert   forms   of  

restrictive   practice,   interpersonal,   institutional   and   systemic   power   abuse,   and  

strategies  for  addressing  restrictive  practices  in  disability  accommodation  services.    

 

Contributing  factors    

Understanding  the  factors  contributing  to  restrictive  practices  has  been  the  focus  of  

a  number  of  studies  (see  Chung  and  Thacker  1997;  Crosland  2008;  and  Clarkson  et  al  

2009).  Key  themes  emerging  from  interview  data  with  staff  responsible  for  caring  for  

people  with  a  disability  were   the   frequent  use  of   restrictive   interventions,  and   the  

effects  of  staff  well–being.  Chung  and  Thacker  (1997)  acknowledge  that  high   levels  

of   stress   can   contribute   to   poor   judgment   by   staff   in   addressing   behaviours   of  

concern,   while   Rose   (1993)   highlights   that   a   number   of   studies   conclude   that   the  

psychological   characteristics   of   workers   can   influence   their   response   to   clients   (in  

Clarkson  et  al  2009).  For  example,  Rose  et  al  (1998)  maintain  'poor  job  satisfaction,  

increased   perceived   stress   and   lack   of   support   has   been   associated   with   reduced  

positive  interactions  between  service  users  and  direct  support  staff,  and  lower  levels  

of  staff  assistance'  (in  Clarkson  et  al  2009:  283).    

 

Another  group  of   researchers   looked  at   the   level  of   training  and   skills  held  among  

carers  as  a  possible  explanation  for  restrictive  practices.  Lack  of  proper  training,  as  

well   as   high   stress   levels,   may   well   be   two   of   the   key   contributors   to   the   use   of  

restrictive   interventions   (Chung   and   Thacker   1997;   Mohr   et   al   1998),   with   the  

consequences   impacting   on   the   relationship   between   the   staff   and   clients.   Chung  

and  Thacker  (1997)  argue  that  being  under  stress  can  lead  to  (poor)  interactions  and  

communication  between  staff  and  clients:   ‘If   staff  are  highly  stressed   their   level  of  

engagement  would  be  lower.  For  instance  they  may  be  too  emotionally  exhausted  to  

have  a  meaningful  interaction  with  clients  and,  instead,  de-­‐personalise  them'  (Chung  

and   Thacker   1997:166).     Weiss   and   Knoster   (2008)   lend   further   support   to   this,  

observing   that   workers   who   do   engage   in   restrictive   interventions   have   to   be  

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somewhat   emotionally   disconnected   in   order   to   implement   such   strategies.   They  

note:   'It   is   almost   impossible   to  have  both   a   connected  and  nurturing   relationship  

while  increasingly  asserting  control'  (Weiss  and  Knoster  2008:  76).    

 

Other   studies   focus   on   attitudes   toward   restrictive   practices.   Despite   general  

recognition   about   the   negative   effects   of   using   restrictive   practices,   a   level   of  

support   for   their   use   has   also   been   identified   among   direct   support   staff.   Allen  

(2000)   reviewed   literature   on   attitudes   toward   the   use   of   restrictive   interventions  

and  found  that  many  direct  support  staff  had  a  positive  attitude  toward  the  use  of  

seclusion  and  restraint,  believing  they  were  'necessary  for  the  control  of  dangerous  

behaviour   when   other   less   restrictive   procedures   did   not   work   or   were   not   even  

attempted'  (in  Crosland  2008:  402).  This  raises  questions  about  whether  there  is  an  

acceptable  level  of  restrictive  intervention.    

 

Management   oversight   of   direct   care   and   support   practice   is   also   identified   as   a  

significant  contributing  factor.  It  is  difficult  to  ascertain  and  monitor  the  frequency  of  

restrictive  interventions  and  whether  their  use  is  within  justifiable  reasoning.  Within  

a   group   setting,   such  as   community   residential   units   (CRUs),  monitoring   restrictive  

intervention   is   difficult.   Clement   and  Bigby   (2008)  note:   'Observing  whether  direct  

support   staff   “do  what   they  are   supposed   to  do”   is  hard   in  group  homes,  because  

direct   support   staff   have   a   significant   amount  of   autonomy   to   interpret   and  apply  

rules  and  procedures'  (Clement  and  Bigby  2008:12).    

 

The   idea   of   restraint,   or   restriction   implies   the   use   of   power   or   force,   and  many  

people  understand  power  as  a  necessarily  oppressive  action.  However,  the  ideas  of  

Foucault  give  rise  to  different  conceptualisations  of  power  and  its  effects.  From  this  

perspective,  power  is  defined  as  primarily  productive;  exercised  through  actions  that  

are   expansive,   rather   than   a   thing   that   is   fundamentally   negative   and   oppressive  

(Foucault   1992).   In   conducting   this   research,  we   elected   to  work  with   this   idea   of  

power.    

 

 

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Power    

Perceptions   of   power   effect   how   we   understand   capacities,   relationships   and  

opportunities  for  change.  The  concept  of  power  adopted  here  is  as  an  active  force,  

rather   than   as   a   commodity   –   a   verb   rather   than   a   noun,   in   other  words.   Power,  

from   a   Foucauldian   perspective,   is   understood   as   being   most   effective   when  

engaged   in  productive  activity   (Foucault  1992).   It   ‘is  not  exchanged,  given  or  taken  

back  but  is,  rather  exercised  and  exists  only  in  action’  (Tremain  2005:  4).  

 

This  does  not  deny  its  oppressive  effects.  Rather,  this  perspective  highlights  hidden  

or   ‘subtle’   operations.   This   is   because,   while   power   is   ultimately   exercised   to  

prescribe   and   produce   desirable   human   behaviours   according   to   normalising  

standards,   it  also  constrains  and  limits  possible  identities  and  subject  positions.  For  

example,   our   society   first   and   foremost   defines   a   person  with   a   disability   by   their  

disability,   subsequently;   the   possible   actions   or   behaviours   that   they   are   able   to  

enact   are   circumscribed   by   this   identity.   Accommodation   settings,   or   living  

arrangements,   where   the   main   criterion   for   residency   is   having   an   intellectual  

disability,   and   where   behavioural   programs   are   organised   around   each   person’s  

capacities,  based  on  types  and  degrees  of  disability,  represent  a  stark  example  of  this  

‘hidden’  exercise  of  power.    

 

It  is  important  to  be  mindful  that  using  power  as  a  positive  force,  such  as  enabling  or  

encouraging   people   to   exercise   choice,   also   creates   opportunities   to   constrain,   or  

limit   their  behaviour.   In  other  words,   ‘free’  people  are  more   likely   to  be  compliant  

and  manageable  citizens:    

 

Power   is   exercised   only   over   free   subjects,   and   only   in   so   far   as   they   are  free.  By  this  we  mean  individual  or  collective  subjects  who  are  faced  with  a  field  of  possibilities  in  which  several  ways  of  behaving,  several  reactions  and  diverse  comportments  may  be  realised  …  Consequently  there  is  no  face  to  face   confrontation   of   power   and   freedom,   but   a  much  more   complicated  interplay.   In   this   game   freedom  may  well   appear   as   the   condition   for   the  exercise  of  power.                                                                                                                                    (Foucault  1992:  221)  

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Foucault  identified  a  specific  form  of  power  that  emerged  in  the  eighteenth  century,  

which   he   termed   ‘bio–power’,   or   bio–politics.   Driven   by   a   need   to   manage   large  

populations,  the  modern  state  engaged  a  technology  of  power  that  was  exercised  on  

‘life  itself’:  ‘the  life  of  the  human  in  so  far  as  it  is  a  living  being’  (Tremain  2005:4).  The  

actions  of  this  new  form  of  power  are  seen  in  the  emergence  of  the  human  sciences;  

medicine   and   psychology,   and   in   the   measurement   of   populations,   such   as  

reproduction   rates,   birth   and   death   statistics,   disease   and   illness   rates,   etc.   Social  

work  also  emerges  at  this  time,  as  a  mechanism  for  caring  for  those  who  are  not  able  

to   independently   function   within   the requirements   of   being   a   ‘normal’,   able,  

productive,  and  importantly,  predictable  citizen.  In  these  ways,  power  is  enacted  as  

knowledge.   For   example,   knowledge   about   a   human   subject,   about   what   they  

‘should’  be  expected  to  do  and  achieve,  determines  how  that  subject  will  be  treated  

and   how   they   will   be   encouraged   to   behave.   Thus,   the   limits   of   possibility   for  

individual  human  behaviour  are  prescribed  by  ‘scientific’  measurements  based  on  a  

normalised  population.    

 

A  further  key  element  of  bio–power  pertinent  to  this  study,  is  that  it  operates  at  all  

levels.  Power  does  not  have  a  singular  directional  flow,  ie.  top  down,  from  the  ‘most  

powerful’  to  the  ‘least  powerful’,  but  is  omnipresent,  diffuse  and  diverse.  It  operates  

in   a   ‘netlike   way’,   simultaneously   through   actions   between   people,   institutional  

regimes,   social   structures,   the   organisation   of   space   and   even   in   the   design   of  

architecture.    

 Thus,   evidence   of   the   actions   and   relations   of   power   can   be   found   in   an   array   of  

locations,  including  the  surface  of  the  human  body;  the  technologies  that  assist  it  to  

function   ‘normally’,   and   the   environments   in  which  we   live.   To   better   understand  

and   expose   actions   of   power,   Foucault   suggests   reading   outside   or   beyond   the  

borders  of  central  organising  principles,  proposing  that  it  might  be  more  productive  

to   analyse   the   strategies   of   power   in   the   struggle   between   resistance   and  

domination:  

 To   find  out  what  our  society  means  by  sanity,  perhaps  we  should   investigate  what   is  happening   in  the  field  of   insanity  …  and   in  order  to  understand  what  

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power   relations   are   about,   perhaps   we   should   investigate   the   forms   of  resistance  and  attempts  made  to  dissociate  these  relations.                       (Foucault  1992:  211)  

 Chris   Drinkwater   (2005:   234)   proposes   that   the   ‘actual   operations   of   support,   the  

techniques   of   normative   induction,   the   persistent   “actions   upon   actions”   that  

constitute  the  reality  of  power  in  the  everyday’  require  critical  reflection.  Drinkwater  

further  argues  that:  

 The   esteemed   values   of   rights,   independence,   choice,   and   inclusion   obscure  the  actual  lived  relations  of  support/power.  These  ideals  provide  no  hint  of  the  conflict   between   power   and   freedom,   responsibilities   and   rights,   choice   and  what  are  called  ‘developing  capacities’.       (Drinkwater  2005:  234)    

 These   ideas   are   challenging,   and   provoke   us   to   think   quite   differently   about  

restrictive   interventions;   the   forms   they   take,   their  prevention  and   the  way  clients  

resist  them.  Through  this  lens,  power  is  revealed  as  endless  actions  and  resistances  

operating  between  clients  and  clients,  and  clients  and  staff,  and  between  individual  

staff   members.   And   it   does   not   stop   at   people,   power   is   exercised   between   the  

people  within   the   house   and   the   ‘house’   itself,   through   the   ‘normalising’   routines  

and  objects  within   it,   and   through   the   institutional   frameworks,  governmental  and  

policy  regimes  that  enable  this  incessant,  multi–directional  flow  of  power.    

 

Rather  than  focusing  on  who  ‘has’  the  power,  in  this  study  we  adopted  the  position  

that   a   more   fruitful   investigation   of   subtle   restrictive   practices   is   to   look   at   the  

multiple   effects   of   power.   How   it   operates   to   define   possibilities   for   people   with  

disabilities,   how   this   is   resisted   and   how   it   is   used   by   and   between   clients.   For  

example,   limiting   access   to   food,   or   living  within   a   structured,   regimented   routine  

are   often   instigated   and   justified   as   in   the   best   interests   of   a   client.   Dietary  

restrictions  are  imposed  in  the  interests  of  maintaining  a  ‘normal’,  ‘healthy’  weight;  

household   routines   produce   predictability,   order   and   cleanliness.   These   are   not  

defined   by   the   Disability   Act   2006   as   being   restrictive   and   yet   they   do   limit   the  

choices  and  freedoms  of  individuals.  In  order  to  assist  understanding  of  the  flows  of  

power  within   a   DAS   house,   and   how   these  might   be   implicated   in   bringing   about  

change,  we  identified  eco-­‐mapping  as  a  helpful  application.    

  10  

 

 

 

Ecological  systems  theory  and  eco–maps  

The   project’s   title   “Everything   effects   everything   else”   perfectly   describes   the  

essence   of   ecological   systems   theory,  which   provides   a   conceptual   framework   for  

understanding   the   person   as   a   part   of   their   total   life   situation   (Compton   and  

Galaway   1999:28).   It   focuses   on   the   multiple   factors   involved   in   interactions  

between  individuals,  groups  of  people,  organisations  or  communities.    

 

An  eco–map  is  a  diagrammatic  illustration  of  how  a  person  locates  themself  in  their  

environment  and  the  nature  of  the  interconnections  and  relationships  between  the  

different   systems   of   which   they   are   a   part   (O’Donaghue   and  Maidment   2005:41).  

The  map  creates  opportunities  to  see  where  strengths  and  tensions  exist  within  or  

between   the   sub–systems   that   impact   on   a   person’s   well–being,   and   assists   in  

identifying   points   in   the   system   where   an   intervention   might   create   change  

throughout  the  entire  system.    

 

This   was   introduced   to   participants   as   a   framework   to   explore   how   their   work  

practices  are  effected  by  personal,  employment  and  other  factors  and  how  these  in  

turn   influence   how   they   work   with   residents   in   the   houses.   In   other   words,   how  

everything   effects   everything   else.   Ecosystems   theory   and   eco–maps   provided  not  

only   a   conceptual   and   visual   tool   to   explore   the   interconnections   between   the  

different  systems  which   impact  on  the  participants’  work–life   from  the  perspective  

of  their  role  as  DAS  workers.  They  also  focussed  on  points  of  intervention,  where  a  

change  in  the  participant’s  practice  might  positively  influence  the  lives  of  clients  and  

other  systems  with  which  they  interact.  For  example,  at  a  macro  level,  the  Disability  

Act   2006   and   the   establishment   of   the   Senior   Practitioner   role,   which   requires  

monitoring   the  use  of   restrictive   interventions   and   reporting   annually   through   the  

Senior  Practitioner  Annual  reports,  has  resulted  in  significant  change  for  workers  and  

clients  at  the  practice,  or  micro,  level.    

 

  11  

These  concepts  of  power  and  approaches  to  understanding  how  we  are  situated  and  

situate   ourselves   within   institutional   regimes   were   incorporated   into   the   action  

research  meetings.  

 

Participatory  Action  Research  (PAR)  Meetings  

Disability  Accommodation  Services  support  workers  from  seven  houses  were  invited  

to   participate   in   a   series   of   meetings   held   at   the   campus   of   Monash   University,  

Gippsland.  Nine  staff  responded,  and  a  total  of  eight  individual  staff  participated.  Six  

meetings,  each  of  three  hours  duration,  were  held  over  a  six  month  period.  The  time  

allowed  between  sessions  was  considered  important  by  participants  to  enable  them  

to   trial   new   and   different   practice   strategies   discussed   during   the   sessions.   Client  

activities  and  holidays,  as  well  as  staff  holidays  and  roster  arrangements  also  needed  

to  be  accommodated.  All  but  one  of  the  participants  were  women  with  between  11  

and   19   years   experience  working  with   people   living   in   supported   accommodation  

houses,   in   the   non-­‐government   (CSO)   and   government   sector   (DAS).   Three  

facilitators   were   in   attendance   at   the   majority   of   the   meetings.   Their   roles   were  

flexible   and   included   note   taking,   presenting   information   or   resource   materials  

requested   by   participants,   following   up   issues   that   arose   during   the   free   flowing  

discussions,  and  ensuring   that  housekeeping   issues,   such  as   session  end   times  and  

the  next  meeting  date,  were  not  forgotten.    

 

Using   the  model   of   the   action   cycle:   plan;   act;   observe;   reflect;   plan;   act,   and   so  

forth,   each   meeting   took   the   form   of   an   engaged   and   guided   discussion.   During  

these   sessions,   participants   defined,   identified   and   explored   the   concept   of   subtle  

forms   of   restrictive   practice,   and   reflected   on   how   these   occurred   and   how   they  

might   be   addressed.   The   initial   meeting   centered   around   the   plan   cycle   of   the  

model,   while   subsequent   sessions   addressed   action,   observation,   reflection   and  

further   planning.   Discussions   with   participants   encouraged   sharing   and   reflecting  

upon   any   changes   that   may   have   occurred   in   the   intervals   between.   This   time  

between   sessions   also   provided   opportunities   for   participants   to   act   (implement  

various  strategies)  and  observe  (How  is  it  affecting  others?)  and  reflect  (Did  it  work?  

Did  it  improve  my  practice  interactions  with  house  members?).    

  12  

 

 

 

Recording  and  analysis  

Discussion  at  the  PAR  meetings  was  recorded  using  written  notes  and  audio–taping.  

Between  meetings,  audiotapes  were  transcribed  and  summary  notes  were  prepared  

by   the   research   team  and  circulated   to   the  participants.  These  notes   recorded   the  

main   topics   of   discussion,   offered   some   links   between   the   different   issues   and  

reflected   on   the   importance   participants   accorded   them.   They   also   included   a  

reminder  of   the   ideas  and   tasks  participants  wanted   to  explore  and   try  out  before  

the   next   meeting.   Participants   were   encouraged   to   keep   research   journals   for  

recording   reflections   and   insights   between   meetings.   Excerpts   from   these   were  

voluntarily  shared  and  discussed.  These  included  changed  perceptions  of  a  situation  

or   relationship,   reports   of   the   outcomes   of   new   ways   of   doing   things   as   well   as  

frustrations   and   factors   that   thwarted   efforts   to   introduce   change.     A   productive,  

shared   learning  space  was  created  through  discussing  participants  experiences  and  

the  researchers’  reflections  at  each  session.  

 

Recorded  notes,  transcripts  and  participants’  written  contributions  were  analysed  by  

the   research   team  and   then   shared   in   discussion.  We  were   specifically   looking   for  

experiences  and   ideas   in   the  discussions  that  engaged  and  challenged  participants.  

These   were   reflected   in   the   insights   gained,   intensity   evoked   by   an   issue   or   the  

recurrence   of   particular   issues   in   different   meetings.   The   dominant   themes   were  

power,   perception,   subtle   and  hidden   forms  of   restrictive   practice,   choice,   change  

and   ‘doing   things   differently’.   These   themes   within   the   transcripts   were   also  

analysed  using  poetic  interpretation  to  capture  moments  of  insight  and  movements  

towards  change.    

 

The   use   of   poetic   forms   in   research   has   grown   substantially   over   the   last   twenty  

years.  Richardson  (1997:143)  explains  that  poetry  ‘can  evoke  embodied  responses  in  

listeners   and   readers   by   recreating   speech   in  ways   that   traditional   research   prose  

can   not’.   Poetry   in   its   various   forms   has   become   a   valuable   research   tool   for  

  13  

qualitative  researchers.    A  recent  annotated  bibliography  of  poetry  as  a  qualitative  

research   method   found   twenty-­‐nine   different   ways   researchers   utilised   poetic  

inquiry  in  research  (Prendergast  2009  cited  in  Faulkner  2009).    

 

Research   poetry   is   used   to   celebrate   lived   experiences   as  well   as   to   connect  with  

wider   political,   cultural   and   historical   conditions   that   give   the   experiences   deeper  

meaning  (Faulkner  2009).  One  form  of  research  poetry  is  poetic  transcription,  used  

to  preserve  the  speaking  style  and,  in  particular,  to  give  ownership  of  the  words  to  

the   speakers   rather   than   the   researchers   (Richardson   2002).   Poetic   transcription  

uses  ‘the  participants’  exact  words  and  language  from  interview  transcripts,  cutting  

and   pasting   the   essential   elements   in   an   effort   to   reveal   the   essence   of   a  

participant’s   lived   experience   (Faulkner   2009).   The  method   applied   in   this   project  

follows  Glesne’s  (1997)  approach,  in  which  phrases  are  drawn  from  anywhere  in  the  

transcript,  as  long  as  they  are  the  original  words  and  retain  the  participant’s  rhythm  

and  way  of  speaking.  The  poetic  representations  which  appear  here  are  intended  to  

bring  to  the  fore  the  participants’  voices  and  perspectives.    An  example  of  a  site  of  

power,  and  the  struggles  and  resistances  enacted  within  this  space,   is   illustrated  in  

the  following  research  transcript  poem.  

  14  

 

 

The  Power  of  Pyjamas:  a  conversation2  

 Kim,  likes  to  get  in  her  pyjamas  early.  But  …  how  do  you  say  this?    We  don’t  like  our  ladies  changing  into  their  pyjamas  too  early,    You  know,  we  like  them  to  do  tea,  clean  up  or  whatever,  watch  a  bit  of  telly  and  then,  about  8  o’clockish  go  and  change  into  their  pyjamas.    Ours  like  to  have  their  showers,  4-­‐4.30pm  and  get  into  their  pyjamas.  We  don’t  have  a  problem.  See,  I’m  a  jarmie  person  myself,  If  I’m  at  home,  I’ve  got  my  pyjamas  on.  I  think  we  all  bring  in  our    own  little  family  routines.    I  have  to  try  and  get  them    into  their  routine  as  well.    If  you  came  and  worked  with  us    and  said  ‘Let  her  get  in  pyjamas  early’,  we  would  probably  turn  around  and  say  ‘No,  in  here  we  work  like  this  and  this,    because  our  ladies  are  in  their  routine,      and  sometimes,  if  you  throw    something  in  that’s  not  there,  it  can  upset  their  whole  night.’    Our  ladies  just  don’t    get  into  their  pyjamas  too  early.  The  Supie  would  say,    ‘No,  our  ladies  are  to  wait.’  Because  once  they’ve  had  showers  our  ladies  think    ‘Well,  that’s  it,  I’ve  done  my  jobs  for  the  night,  I’m  in  my  jarmies.    I  don’t  have  to  do  any  more  now.’    She’s  seen  in  other  houses,  That  they  come  home  from  placement  -­‐  showers,  pyjamas,  sitting  there    waiting  to  have  tea.  The  staff  have  done  the  jobs  that  they  have  to  do  for  the  night.    

 You’re  not  going  to  take  them  for  a  walk  up  the  street  and  do  active  support  with  them  or  take  them  to  a  park  or  whatever.    That’s  the  way  the  Supie  looks  at  it.  While  they’re  dressed  you’re  still  going  to  do  active  support    or  do  things  with  them  at  night.  Once  they’re  in  their  pyjamas,  that’s  it.  They  don’t  want  to  do  anything.  You  say  ‘Kim,  I’m  going  down  the  street.  Do  you  want  to  come?’  ‘No,  I’m  in  my  pyjamas’    You  see,  ours  know  that  if  they’ve  got  something  on,  they  leave  their  shower  or  bath  until  later.    If  they  choose  to  bath  before  tea  That’s  what  they’ve  chosen,  that’s  what  they  want  to  do.  But  they  also  know  if  they’ve  got  something  on,    We’ll  say,  off  we  go.      You’ll  say,  ‘Kay  go  and  get  changed.’  ‘No,  I  don’t  want  to.’    But  that’s  their  choice  to  do  it.    If  she’s  not  in  her  pyjamas  she  will  come,    But  once  they’re  in  their  pyjamas,    they  don’t  want  to  do  anything.      (Conversation   between   two   staff   from  different  houses  –  Session  4:  58-­‐63)  

                                                                                                               2  This  poetic  transcript,  represents  a  conversation  between  two  participants  who  worked  at  different  houses,  which  clearly  had  different  approaches  to  client  (resident)  autonomy.  The  words  of  participant  2  are  italicised  to  distinguish  the  two  voices.  

  15  

 

Methodological  Challenges  

There   were   some   significant   challenges   in   undertaking   research   utilising   a   PAR  

approach  that  had  implications  for  this  project,  and  also  more  broadly.  Firstly,  while  

the   research  was   developed   as   a   result   of  DAS  workers   approaching  management  

and   seeking   opportunities   to   explore   restrictive   practices   in   the   context   of   their  

roles,  these  workers  did  not  contribute  to  the  project  design.  As  with  most  funding  

requirements,   timelines   and   the   necessity   of   providing   a   fully   formed   plan   when  

seeking   financial   support   meant   that   the   methodology   was   determined   prior   to  

engaging  participants.    

 

Researchers  wishing  to  utilise  a  PAR  approach  immediately  confront  this  incongruity  

between   funding   guidelines   and   methodological   requirements.   In   this   project   the  

participants’   lack   of   involvement   in   the   design  may   have   impacted   on   the   group’s  

ownership  of  the  project,  leading  to  a  small  number  of  participants  staying  for  the  six  

month  duration.  This  small  group,  however,  was  committed  and  enthusiastic  about  

the  value  of  the  PAR  process  and  outcomes  for  their  work.    

 

Secondly,   the   length   of   the   project   itself,   six   meetings   over   six   months,   had  

advantages  and  disadvantages.  The  project  was  designed  over  that  period  of  time  to  

create  a  living  engagement  with  the  work-­‐life  of  participants.  Inevitably  it  covered  a  

period  when  participants   experienced   significant   life   issues   in   tandem  with   critical  

work  place  events  that  led  to  staff  and  role  changes.  To  ensure  the  project  remained  

both   connected   and   relevant   to   its   practice   focus   a   project   reference   group   was  

established   to   guide   implementation.   The   members   included   a   supported  

accommodation  resident,  a  Department  of  Human  Services  DAS  manager  and  a  CSO  

Disability  program  manager.  The  reference  group  decided  that  no  house  supervisors  

were   to   be   included   in   the   participant   group,   as   it   could   stifle   open   and   frank  

discussion.   Participants   supported   this   decision   and   when   staff   changes   occurred  

during   the   project   that   moved   workers   into   house   supervisor   roles,   they   left   the  

project.  

 

  16  

Thirdly,  from  a  PAR  perspective  the  meaning  of  participation  includes  engaging  with  

the   participants   as   partner   researchers,   and   sharing   responsibility   for   the   content  

and   process   of   the   reflections.   This   raised   issues   for   researchers   and   participants  

around   their   identities  and   roles   in   the  group.  Throughout   the  project  participants  

and   researchers   engaged   in   overt   and   subtle   negotiations   around   the   different  

expectations  each  had  of  the  other.    

 

Traditional   hierarchical   relations   between   participants   and   researchers   are  

eschewed  with  a  PAR  approach,  but  they  are  so  entrenched  in  our  experience  that  it  

can  at  times  be  a  source  of  tension.  This   is  because  expectations  by  participants  of  

direction,  control  and  responsibility  are  not  met  by  researchers,  and  concomitantly,  

self-­‐direction   and   responsibility   are   not   necessarily   embraced   by   participants,  

despite   the   best   intentions.   Equally,   it   can   be   as   difficult   for   researchers   to   resist  

taking  control  of   the  research  process  when  participants  seek  direction  or  defer   to  

the   researchers’  presumed  expertise,  as   it   is   for  participants   to   take  control  of   the  

research  process.  Somewhat   ironically,   in  this  project  focussed  on   investigating  the  

multiple   effects   of   power   relating   to   the   use   of   subtle   restrictive   practices,   the  

researchers  found  themselves,  as  part  of  the  PAR  partnership  process,  exploring  and  

negotiating  relationships  of  power  with  the  participants.    

 

This   leads  back  to  the  funding  agreement,  entered  into  by  the  researchers  in  order  

to  secure  financial  support  for  the  project,  whereby  research  outcomes  are  explicitly  

outlined  and  anticipated.  The  research  agenda,  however  understated  by  researchers  

engaging   in   a   PAR   approach,   is   likely   to   come   into   tension   with   the   participants’  

agenda  as  a  direct   result  of  successfully  engaging  them  as  partner   researchers  and  

encouraging  them  to  take  responsibility  for  the  project’s  direction  and  outcomes.  

Furthermore,   researchers   must   carefully   consider   how   they   report   back   to   their  

participants  and  their  funding  bodies.  

 

Importantly,   the  outcomes  of  a  PAR  approach  are  as  equally   in   the  process  as   the  

results.   In   this   research   project   there   was   no   capacity   to   measure   or   observe  

changes   in   the   participants’   practice   over   the   six-­‐month   timeframe.   We   were  

  17  

dependent  on  participants’  perceptions  as   they  reported  back   to   the  group.   It  also  

unclear   whether   this   project   engendered   long   term   changes   in   the   participants’  

practice   as   there   was   no   follow   up   process.   Although,   drawing   on   their   long  

experience  of  working  with  people  with  disabilities,  the  participants’  discussions  did  

move  away   from  their  own  direct  practices   to   the   impacts  of  organisational   issues  

and   stress   levels   on   their   ability   to   offer   clients   greater   choice.     Similar   issues   are  

discussed  by  Chung  and  Thacker  (1997).      

 

Finally,  this  project  drew  on  the  initiatives  of  staff  seeking  to  understand  restrictive  

practices  in  relation  to  their  practice  with  clients  and  their  wish  to  develop  ways  of  

increasing   client   choices.   While   one   of   the   people   who   live   in   a   supported  

accommodation  house  was  a  member  of  the  project  reference  group,  our  research  

did   not   extend   to   seeking   the   perspectives   of   other   clients   about   restrictive  

practices.    

 

Reflections  on  power,  perceptions  and  hidden  forms  of  subtle  restrictive  practices:  key  project  outcomes.      

Themes   of   interconnectedness   and   interdependency   were   woven   throughout   the  

project.  While  reflections  by  the  authors  of  this  paper  on  methodological  dilemmas  

revealed  issues  of  power,  resistance  and  perception  that  confronted  and  challenged  

their   role   as   the   primary   research   team,   participants   who   worked   in   DAS   houses  

were   encouraged   to   explore   how   this   operated   through   a   framework   provided   by  

ecological  systems  theory.    

 

Participants   embraced   ecosystems   theory   and   the   task   of   drawing   personal   eco-­‐

maps  to  depict  the  nature  and  quality  of  the  different  relationships  within  their  work  

environment.   They   readily   recognised   the   interconnectedness   of   their   experiences  

with  residents  in  the  household  environment  (micro)  with  DHS  management  and  the  

broader   community   (mezzo),   and   the   influence   of   the  Disability   Act   2006   and   the  

Senior  Practitioner  at  the  policy  level  (macro).  Discussion  of  their  personal  eco-­‐maps  

revealed  that  participants  experienced  a  balance  between  the  energy  flowing  out  to  

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their   work   and   that   coming   in   through   work   enjoyment.   These   participants  

expressed  satisfaction  with  their  work-­‐life  balance.  Others  felt  that  the  demands  of  

the  mezzo  and  macros  levels  increasingly  dominated  their  work–lives,  draining  them  

of  energy  they  would  otherwise  give  to  their  work  with  clients.  Eco-­‐systems  theory  

and   eco-­‐maps   extended   their   initial   understanding   of   restrictive   practices.  

Participants   moved   from   being   focussed   on   the   worker-­‐client   level,   to   consider  

directives  or  resource  limitations  at  an  organisational  level,  requirements  of  external  

professionals  and  community  expectations  as  also  restricting  their  ability  to  provide  

clients  with  greater   choice.  A  growing   realisation  of   the  different  ways   ‘everything  

effects  everything  else’  offered  a  new  perspective  and  focussed  discussion  on  ways  

to  initiate  change  individually  and  collectively  at  these  other  levels.  

 

At  the  mid–point  of  the  project  one  participant  used  the  eco–map  as  an  ongoing  way  

of   assessing   and   then   making   changes   in   her   professional   practice   in   order   to  

maintain  a  balance  between  energy  flowing  in  an  out  of  her  work  environment.  She  

reported  that  she  found   it  so  useful  she  shared  the  principles  of   the  eco-­‐map  with  

others   in  her  workplace.   She  assisted   them   to  draw   their  own  eco-­‐maps  and   then  

urged   them  to   recognise  and  make  changes   to   their  work  practices   in   response   to  

the  stresses  they  experienced  and  to  address  perceived  imbalances  in  energy  flow  to  

minimise   inadvertent   and  hitherto   invisible   forms  of   restrictive  practices.   The  eco-­‐

maps  made  visible  the  sources  of  stress  and  frustration  that  otherwise  flowed  from  

workers  into  their  relationships  and  practices  with  clients  living  in  the  houses.  

 

Participants’  discussion  also  increasingly  explored  the  depth  and  complexity  of  their  

workplace  interrelationships  across  all  levels.  They  began  to  recognise  different  ways  

they   actively   participated   in   these   interactions   and   how   this   affected   outcomes.  

Focussing   on   their   practice   at   a  micro   level,   they   openly   explored  how   they   could  

change   their   interactions  with   residents   to  give  clients  greater  choice   in   their  daily  

lives.    

 

Interrelationships   at   the  mezzo   and  macro   levels   were  more   complex.   Supporting  

participants   to   identify   changes   they   might   make   that   would   influence   their  

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relationships  at  the  management  level  proved  the  greatest  challenge.  There  seemed  

to  be   few,   if  any,  possibilities   for  change  generated  by   the  workers   themselves,  as  

they   perceived   the   boundaries   between   the   two   subsystems,   management   and  

workers,   to   be   impenetrable.   And   yet,   reflecting   their   growing   awareness   that  

‘everything   effects   everything   else’,   this   mezzo   or   management   level   was  

increasingly   perceived   by   participants   as   producing   the   greatest   restrictions   on  

residents’   freedom  of   choice.   The   following   research  poem  offers   insight   into  how  

one  participant  used  the  eco-­‐map  to  reflect  on  increasing  work  demands  across  the  

duration  of  the  PAR  project.  

 

Eco–mapping    All  I  know  is  that    I  had  more  energy  coming  in    on  my  first  eco-­‐map,  than  what  I  do  now.    I  was  getting  the  enjoyment,  but  I  don’t  feel  that    I  am  getting  that.    

   There  is  more  stress.  There  is  more  of  my  energy  going  out  to  it.    And  it’s  not  recharging  me,    coming  back.  That  is  where  I  feel    at  the  moment,  with  work.  (Session  6:79/80)  

 

 

Participants   in   the  PAR  meetings   initially   conceptualised  power  as   something  used  

over  clients  as  the  primary  indicator  of  subtle  restrictive  practices.  In  later  meetings  

they   began   focusing   on   how   power   operated   in   many   directions,   how   it   was  

activated  in  various  ways  by  everyone  in  the  house,  and  importantly,  the  effects  of  

power  on  behaviour;  their  own,  the  clients,  and  management.    

 

While   staff   reflected   on   their   own   use   of   power   with   clients,   they   also   described  

their   constant   struggle   managing   and   negotiating   the   culture   of   blame   and   risk  

aversion   perpetuated   by   institutional   and   professional   actions   of   power.   Duty   of  

care,  as  expressed  through  domestic  and  active  support   requirements,  meant  staff  

engaged   in   struggles   with   and   between   household   members   over   everyday   life  

choices,   such   as   the   correct   time   of   day   to   put   on   pyjamas,   as   illustrated   by   the  

research   transcript  poem,   ‘The  Power  of  Pyjamas’.   This   conversation  between   two  

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support  workers,  exposes  the  interplay  of  power  and  resistance  by  revealing  the  way  

workers   are   compelled   to   ‘manage’   client   behaviour   according   to   institutional  

regimes  and  the  associated  requirements  of  conformity,  such  as  household  routines,  

and   expectations   of   participation   in   ‘active   support’.   At   the   same   time,   the  

household   residents   (clients)   found  ways   to   resist   these   subtle   forms  of   restrictive  

practice  by  putting  on  their  pyjamas,  which  signified  relaxation  time,  and  that  they  

had  finished  work  for  the  day.    

 

Summary  and  Conclusions    

Overall,   and   most   significantly,   the   DAS   staff   that   participated   in   this   research  

project  revealed  a  strong,  often   impassioned,  desire  to  ensure  their  work  practices  

resulted  in  the  ‘best’,  or  most  desirable  outcomes  for  clients.  They  were  enthusiastic  

about  developing  positive,  creative  solutions  and  strategies  for  improving  quality  of  

life  for  the  client  group.    

 

At   the   same   time,   high   levels   of   frustration  were   expressed,   and  much   discussion  

circulated  around  perceived  barriers   to  achieving   the  most  desirable  outcomes   for  

clients.   Identified  obstacles   included  differing  perceptions  of  what  constituted  best  

practice,   and   the   best   interests   of   clients.   For   example,   as   the   research   transcript  

poem,   ‘The   Power   of   Pyjamas’   shows,   some   staff   clearly   prioritised   duty   of   care,  

ensuring  adherence  to  household  routines,  the  provision  of  nutritious  meals  on  time,  

client  cleanliness,  equity  between  household  members  and  an  overall  atmosphere  of  

contentment  and  harmony  within  the  house.  On  the  other  hand,  as  revealed  by  the  

voice   of   the   second   participant   in   the   poem,   there   were   staff   who   professionally  

identified  with  fulfilling  a  support  role,  prioritising  activities  and  decisions  that  aimed  

to   develop   clients’   capacity   for   independence,   self-­‐determination   and   exercise   of  

choice.  The  evident  tension  amongst  staff  and  between  staff  and  management  over  

the  definition  of  ‘best’  and  least  restrictive  practice  with  clients  was  also  revealed  as  

a   barrier   to   maximizing   freedom   of   choice   for   clients.   Despite   these   tensions   a  

number   of   positive   outcomes   for   the   participants   in   their   approaches   to   practice  

were  identified.  In  summary,  these  can  be  described  as:  

   

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§ Subtle  restrictive  interventions  were  defined  and  made  visible  § Recognition  was  given   to   the   idea   that   ‘how’   is  often  more   important   than  

‘what’  is  said  or  achieved  § Reawakening  of  respect  for  clients  and  each  other  § Increased   confidence   in   addressing   management   issues   and   liaising   with  

people  outside  the  DAS  house,  e.g.  Disability  Client  Services  staff  at  DHS    

In   conclusion,   for   the   Monash   University   based   researchers,   who   have   long  

experience  as  welfare  practitioners,  using  a  PAR  approach  was  an  effective  way   to  

explore   and   address   restrictive   practices  with   participants.   It  was   also   challenging,  

particularly  maintaining  a  balance  that  kept  faith  with  the  goals  of  the  granting  body  

and  responding  to  the  expertise  of  the  participants,  who  took  the  research  to  places  

that   they   believed   to   be  most   productive.     PAR   offered  ways   of  working  with   the  

participants   in  a  respectful  partnership  that  encouraged  and  valued  different  skills,  

knowledge  and  ways  of  practicing.  At  the  same  time,  the  interactions  and  reflections  

during  the  meetings  which  centred  on  the  complexity  of  the  DAS  house  as  a  working  

and   living   environment   hopefully   contributed   to   creating   conditions   which   might  

increase  opportunities  for  greater  autonomy  and  choice.    

 

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