Differences in staff attitudes toward people with intellectual disabilities in Japan and the United States

Support

People with learning disabilities often face social exclusion. Support staff are able to influence the number and variety of opportunities for social interaction that individual service users have and act as gate-keepers to community activities. Therefore, it is particularly important to understand the attitudes of the staff that support people with learning disabilities. It would seem logical that staff with a more positive attitude towards community inclusion will provide more opportunities for service users with learning disabilities to socialise and interact with others.

However staff attitudes may also be influenced by their own culture. Previous research has shown that people in Japan are more likely to hold attitudes that support the sheltering and exclusion of people with learning disabilities. On the other hand, the research has shown that people in the United States are more likely to hold attitudes that emphasises the similarity between people with and without a learning disability and their inclusion with mainstream society.

The study conducted by Horner-Johnson and colleagues (2015) aimed to examine the attitudes of support staff in both Japan and the United States regarding community inclusion of people with learning disabilities. In doing so the authors wanted to see if there were any differences between the attitudes of the staff in the two different countries.

Support staff can provide people with learning disabilities the opportunity to be socially included in the community

Support staff can provide people with learning disabilities the opportunity to be socially included in the community

Method

Support staff in both Japan and the United States were asked to complete the Community Living Attitudes Scale Disabilities Form (CLAS-ID) questionnaire. The questionnaire measures attitudes based on four main subscales, outlined below:

  • Empowerment – attitudes towards people with learning disabilities making decisions about their own lives
  • Exclusion – the tendency to exclude people with learning disabilities from community activities
  • Sheltering – attitudes towards people with learning disabilities needing help and protection
  • Similarity – attitudes towards the shared characteristics between people with and without learning disabilities.

In the United States, data were collected from 151 staff members from across 45 community residence agencies within one state. Homes ranged in size from 2 to 22 individuals.

In Japan, data were collected from 76 staff members that worked in a large state-funded residential service that houses roughly 380 adults with learning disabilities. Japanese researchers were employed to distribute questionnaires that had been translated into Japanese.

The research team then looked at all of the collected data and performed several statistical tests to see if there were any differences in attitudes for staff from each country.

Results

An initial statistical test showed that there was a significant difference between the attitudes of staff in Japan and staff in the United States. Japanese staffed scored more highy on the Sheltering and Exclusion sub-scales, whereas staff from the United States scored more highly on the subscales on Empowerment and Similarity.

However, the team then looked at the effect of several other factors. This included, age, and educational level of the staff, in addition to the amount of time the staff had spent working in learning disabilities and the service users’ level of functioning.

Results suggested that some factors were “potential confounders” meaning that these variables also influence the attitudes of staff.

This included age and educational level of staff. All other factors did not affect staff attitudes.

In particular, older staff were more likely to report attitudes of Sheltering and less likely to report attitudes of Similarity.

Educational level was also an important factor, with staff that were more educated demonstrating more Empowering and less Sheltering attitudes.

The research team statistically re-examined the difference between the attitudes of Japanese and United States staff, this time taking into consideration the effect of the other potential confounding factors. On doing so the research team found the effect of country was no longer significant.

Conclusion

Initially results showed significant difference between the attitudes of staff from Japan and the United States and suggested that staff in Japan are more likely to treat people with a learning disability in a protective manner.

It is important to note that although the staff in Japan demonstrated higher levels of Sheltering and Exclusion, that is not to say that staff purposely exclude people with learning disabilities from social opportunities. Instead, the higher level of Sheltering and Exclusion amongst Japanese staff simply reflects the wider societal beliefs about the best way to provide care for people with learning disabilities.

However, when taking into account the effect of age and educational level, the difference between the attitudes of staff in Japan and the United States was no longer significant. This suggests that attitudes can change as newer generations of staff enter the field of support work, and their attitudes will in turn be influences by the wider culture and societal attitudes in which they live.

Staff in Japan more likely to report attitudes of sheltering and exclusion - but this was related to age and educational level

Staff in Japan more likely to report attitudes of sheltering and exclusion – but this was related to age and educational level

Strengths and Limitations

This study conducted by Horner-Johnson and colleagues (2015) is a useful starting point for examining the effect of culture on staff attitudes and for thinking about the ways in which staff attitudes can affect the lives of people with learning disabilities.

The study had a number of strengths, including large sample sizes and the use of Japanese researchers and questionnaires translated into Japanese language

The authors acknowledge that the study has several limitations. For example the sample of staff from Japan and the United States were very different. Not only were there many more participants from the United States, but the actual services in which the staff members worked were also very different from one another.

However, the difference is largely due to the way that supported living services are organised in each of the countries.

Summary

The study highlights the need to consider the way in which staff attitudes can shape the experiences that individuals with learning disabilities are able to access; particularly the opportunity to be socially included in community activities.

The results could have practical application. For example they suggest that it may be possible to speed up the process of attitude change through providing support staff with training around social inclusion.

In addition, the results suggest it could be possible to use measures that assess staff attitudes during the selection of new staff members and in the annual reviews of existing staff. These measures would enable both the individual staff member and the wider recruitment team to examine the attitudes of each staff member, which could prompt discussions around community inclusion of people with learning disabilities.

Results could have important practical applications in recruiting and appraising support staff

Results could have important practical applications in recruiting and appraising support staff

Links

Primary paper

Horner-Johnson, W., Keys, C. B., Henry, D., Yamaki, K., Watanabe, K., Oi, F., Fujimura, I., Graham, B. C., and Shimada, H. (2015) Staff attitudes towards people with intellectual disabilities in Japan and the United States. J Intellect Disabil Res, 59: 942947 [abstract]

Other references

Henry, D., Keys, C., Jopp, D., & Balcazar, F., (1996), The Community Living Attitudes Scales, Mental Retardation Form: development and psychometric properties. Mental retardation, 34, 149-158

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Fawn Harrad

Fawn has a background in both healthcare research and front-line health and social care roles. After graduating with a BSc Psychology with Sociology degree, Fawn spent 3 years worked at the University of Leicester. Based in the Department of Health Sciences, Fawn provided support to a number of research studies and evaluation projects that sought to improve local healthcare services. During this time Fawn also worked part-time as a Support Worker for adults with learning disabilities and as a Mental Health Recovery Worker. More recently, between, Fawn spent 18 months working on an NHS male dementia assessment and treatment inpatient ward. Alongside this Fawn has joined the ENRICH (Enabling Research in Care Homes) project, a national project that aims to increase the amount of research delivered in care homes. In September 2017 Fawn started a PhD project, focusing on understanding admissions from care homes.

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