Self-determination and co-operation in supported mealtimes involving people with severe intellectual disabilities

Purpose People with severe intellectual disabilities are often supported during mealtimes. However, little information exists about how they and care staff co-ordinate their mealtime behaviours. Method Four people with severe intellectual disabilities and 12 members of care staff participated in this research. Video data were collected from two services for people with intellectual disabilities. Approximately 30 eating or drinking interactions were filmed, totalling approximately 9.5 h of footage. This footage was analysed using conversation analysis (CA). Ethnographic notes were made. CA is a fine-grained systematic approach which allows examination of how mealtimes are achieved, looking closely at verbal and non-verbal behaviours. Results Results show how people with severe intellectual disabilities can demonstrate whether they are ready, or not, for a mouthful of food or drink despite their limited language abilities. Ways in which readiness and unreadiness were demonstrated are outlined and staff responses are also considered. Conclusions There are wider implications for self-determination among people with severe intellectual disabilities. Examples provided suggest that people with severe intellectual disabilities can, and do, make decisions about how fast they eat and when they prefer to complete other activities. Respecting these decisions, carers better support the autonomy of individuals with severe intellectual disabilities.Impacts for rehabilitation People with severe intellectual disabilities often need support in eating and drinking. People with severe intellectual disabilities use a variety of verbal and non-verbal resources to show when they are ready and when they are not. Decisions made by people with severe intellectual disabilities relating to mealtimes should be acknowledged and respected. Allowing people with severe intellectual disabilities to steer mealtime activities promotes agency and self-determination.