Research: Support workers and sports

Attitudes, approaches and barriers to helping people with complex disabilities engage in sport and physical activity.

Contents

• Executive summary
• 1. Perceptions of participation in sport and physical activity
• 2. Current approaches to sport and physical activity
• 3. Barriers to supporting people
• 4. Improvements in support
• 5. Conclusions and recommendations
• Appendices

Executive summary

Sense launched Sense, Active Together with funding from Sport England to help reduce the number of inactive disabled people in England. The three-year programme aims to build on Sense’s existing sport and physical activity offer for people with complex disabilities and help over 2,500 people to become active. 

Sense has identified that support workers will play a key role in achieving this outcome – they are ‘key messengers’ who play a critical role in encouraging, informing and helping adults with complex disabilities to access sport and physical activity. 

Research

Sense commissioned Traverse – an independent, social research organisation – to understand how to help support workers engage people with complex disabilities in physical activity and sport. The main research questions in this report include: 

• How do support workers feel about helping adults with complex disabilities to access sport and physical activity?
• What do support workers do to help adults with complex disabilities access sport and physical activity?
• What help do support workers currently access to help with this?
• What challenges and barriers do support workers face in this work? 
• How can the Sense sport and physical activity team assist support workers in this work?

• The conclusions and recommendations in this report will inform the Sense sport and physical activity team’s strategy and activities to help support workers in their work.
• Broader findings may also be of use to other organisations where support workers are key messengers of physical activity.

Methodology

Traverse completed 14 in-depth telephone interviews with Sense staff. 

Staff interviewed included support workers, as well as team leaders and coordinators and service senior management – many of whom also acted as support workers or had previous experience in the role. Interviewees were selected by Sense and Traverse using a purposive sample to capture a wide range of views and experiences across interviewees – including variation by service type, location and staff work experience. .

 Interviewees worked across different types of service: residential services; day centres; Sense centres and community services. Services were also based in different regions of England and included both urban and rural locations. Some interviewees had no previous contact with the Sense sports and physical activity teams. Interviews were completed between January 2020 – April 2020. The research was curtailed due to the outbreak of Coronavirus in January 2020. See Appendix A for a breakdown of interviewees. We have changed the names of interviewees to protect their identities. 

Key findings

The main findings from this report are: 

1. Most support workers and staff had observed people with complex disabilities experience a wide range of benefits from taking part in sport and physical activity, including increased confidence, independence and improved wellbeing. 

The likelihood of people experiencing these benefits was linked to support workers applying positive, inclusive approaches and practices in their work.

2. However, some reported that enthusiasm for sport and physical activities varied among staff. Delivery was often driven by passionate advocates or experienced staff, but was still subject to other priorities in services that required one-to-one support such as food shopping. 
3. Most support workers and staff interviewed had promoted sport and physical activity in some form, but methods varied across services. Different approaches ranged from active listening (to pick up on potential interests) through to open suggestions (sometimes supported by activities coordinators) or role modelling of activities in front of people. 
4. Support workers have to provide a wide range of direct and indirect support to actually help people with complex physical disabilities take part in physical activity. This support requires a broad skillset, including creativity, collaboration and use of person-centred approaches. 
5. Coordinator roles bring vital expertise regarding inclusive activities, accessible, local provision, as well as additional logistical support. 
6. Where support workers draw on external support, inconsistencies in external facilitators’ knowledge, awareness and understanding of inclusive sport and physical activity can be a barrier to participation.
7. Support workers and staff with a personal interest in sport felt more confident communicating its benefits to people with complex disabilities. Staff were less confident when they had concerns about encountering and overcoming complex communication challenges.
8. Travel and transport to, from and between activities was the main reported barrier to participation. This challenge cut across types of service and was an issue in both rural and urban locations. 
9. Support workers and services face a wide range of other logistical challenges that inhibit the delivery of sport and physical activity at their services. This includes a lack of well-trained, experienced staff in physical activity provision, lack of accessible equipment or facilities and lack of funding available within people’s personal budgets to support activities. 
10. Most support workers and staff want more training on how to support people with complex disabilities to take part in physical activity. However, opinions are mixed on the merits and feasibility of face-to-face training versus other methods. Staff also want more equipment and/or practical resources to help identify activities in their local areas.

Background 

Research carried out by Sport England found that almost half (42%) of disabled people are classed as inactive (i.e. less than thirty minutes of exercise per week). This rises to over half (51%) among people with complex disabilities. 

Sense launched Sense, Active Together with funding from Sport England to respond to this need. It aims to build Sense’s existing sport and physical activity offer for people with complex disabilities. 

This three-year programme will engage and support over 2,500 people with complex disabilities to become active between August 2019 – July 2022. 

As part of this initiative, Sense has identified that support workers and other frontline staff are ‘key messengers’ of physical activity. Support workers play a critical role in encouraging, informing and helping adults with complex disabilities to access sport and physical activity and need to be supported in this role. This builds on recent approaches undertaken by other organisations – including Disability Rights UK and University of Birmingham – who have identified and supported social workers as key messengers of physical activity for disabled people.

Conclusions

The research has found that there is strong acknowledgement of the benefits of sport and physical activity among Sense staff – and the role that support workers play in helping people to realise these benefits. 

However, staff face challenges in putting or keeping sport and physical activity high on the agenda among other priorities and service delivery pressures. 

Enthusiasm for helping people to take part in sport and physical activity can also vary among staff based on personal interest, previous experience and – critically – confidence in delivering activities and overcoming communication barriers or challenges. This often places the responsibility to drive the sport and physical activity agenda into the hands of just a few staff rather than as a shared endeavour. 

Systemic challenges that sit outside of services’ control – such as transport, accessible facilities in the local area (and their staffing), or sufficient personal budget sizes to support activity – are also a major barrier to support workers helping people to take part in physical activity. 

While current forms of support such as coordinator roles are highly valued and have started to mitigate some of these challenges, services and support workers could benefit from being helped to deliver their own, simple, on-site, adaptive sport activities to expand and diversify their sport and physical activity offers for all the people that they support. 

Recommendations

Based on these findings, it is clear that any activities to encourage and help support workers to promote the benefits of sport and physical activity to people with complex disabilities need to take into account the personal, organisational and local delivery challenges that support workers face. Key recommendations are outlined below and accompanied by potential routes to action in the conclusions and recommendations chapter: 

1. Build a cultural shift towards placing physical activity support at the heart of the support worker role. 
2. Embed sport and physical activity within processes to build on the acknowledgement of benefits and improve confidence. 
3. Help support workers integrate conversations about sport and physical activity into their everyday communication and support planning sessions with people with complex disabilities. 
4. Support services to promote and deliver more adaptive activities onsite to help overcome logistical challenges. 
5. Undertake activities in communities around services to address broader infrastructure and system-based challenges.

1. Perceptions of participation in sport and physical activity

This section provides an overview of attitudes in services towards supporting service users to engage in sport and physical activity.

Most interviewees had observed people with complex disabilities to experience a wide range of benefits from taking part in sport and physical activity, including increased confidence, independence and improved wellbeing.

Interviewees were asked about the benefits of sport and physical activity for people with complex disabilities and its relative importance compared to other support needs. 

Most had observed that people with complex disabilities experience multiple benefits from taking part in sport and physical activity. 

The most common benefits cited include:

• Increased confidence and sense of independence.
• Improved mental and/or physical wellbeing.
• Increased opportunities to socialise.
• Exposure to new sensory experiences.
• A sense of competition and achievement. 
• Improved behaviours that challenge. 
• Increased staff engagement with the people they support. 

A few participants reported that sport and physical activity also helped people with complex disabilities engage with and feel that they are part of the local community in which the service is located. Most interviewees felt that the likelihood of people experiencing these benefits was related to the attitudes and approaches of support workers.

  In particular, they highlighted the importance of: 

• A positive attitude when promoting physical activity supports them to take part in activities, as people with complex disabilities can pick up on hesitant or negative (body) language. 
• A healthy appetite for risk – and supporting people to feel optimistic about trying new activities. 
• Activities that are inclusive of all abilities, but also adapted and tailored activities to meet and challenge individuals’ needs. 

Exposure to new experiences and sensations is hugely beneficial for deafblind [people]. You can see how happy they are on their face.

Support Worker, Residential Service

Some interviewees reported that enthusiasm for sport and physical activities varied among staff. Delivery was often driven by passionate advocates or experienced staff, but was still subject to other priorities.

While most interviewees reported that participation in sport and physical activity had multiple benefits for people with complex disabilities, some also reported that enthusiasm for it among other staff varied. 

Enthusiasm among staff was felt to depend on: 

• Self-belief in their ability to engage in activities .
• Confidence in the activity, its safety and outcomes.
• Personal interest in sports and physical activity. 
• Level of experience in supporting people to access sport and physical activities.
• The accessibility of the location where activities would take place. 
• Personal healthcare issues of staff.

In practice, this meant that the delivery of sport and physical activity was often linked to the presence of passionate advocates or more experienced staff. Interviewees reported that fewer people with complex disabilities took part in sport and physical activity when more enthusiastic members of staff were on leave.

Some interviewees also reported that it was difficult to prioritise sport and physical activity over other forms of support. This challenge manifested itself in different types of services for different reasons.

In Residential Services, limited one-to-one time between support workers and residents makes it harder for staff to support people with sport and physical activity: 

Time constraints… with people with mobility issues it takes two hours to support them out of bed, [get them into their] morning routine and time to relax before we go out… then the staff are trying to catch up, they have a deadline… they’re rushing to get everything done.

In Day Services and Community Services, holistic care models require staff to balance sport and physical activity against other priorities that require one-to-one support, such as food shopping and social outings.

2. Current approaches to sport and physical activity 

This section provides an overview of approaches to supporting people with complex disabilities to take part in sport and physical activity.

Most interviewees promoted sport and physical activity in some form, but methods varied across services, from active listening to open suggestions and role modelling.

Interviewees were asked how they promote and encourage people with complex disabilities to engage in sport and physical activities. 

Most promoted sport and physical activity in some form, but methods varied between services. Common forms of promotion and encouragement included: 

• Actively listening during support planning sessions to pick up on potential interests, followed by encouragement to try those interests or related activities dependent on local provision and financial resource.
• Asking people simple questions about aspirations to identify any physical activity interests (for example, “If you could do anything what would it be?”). 
• Suggesting light activities or ‘taster’ sessions to generate interest, supported with basic information or success stories of others. 
• Approaching people with proactive suggestions researched by activities coordinators or other staff who have in-depth knowledge of people’s individual abilities and needs 
• Role modelling activities to build confidence through taking people to observe sessions, or demonstrating activities.

 A few interviewees highlighted that for people who required higher levels of support, sometimes participation itself was part and parcel of promotion and encouragement. 

It’s not telling them about the benefits, they’ll know when they get there whether it’s fun or interesting…we look for feedback to see if someone enjoyed a session and that would be them telling us.

Activities Coordinator, Day Service 

One noted that talking about a specific sport or physical activity was a different challenge compared to talking about general physical wellbeing and fitness. 

Support workers provide a wide range of direct and indirect support to help people take part in physical activity. This requires a combination of creativity, collaboration and person-centred approaches.

Most interviewees said that support to access sport and physical activities entailed many different activities to support people’s individual needs. A few examples of everyday support that directly or indirectly linked to sport and physical activity included: 

• Personal development such as improving communication skills, socialising or increasing independence (in the context of sport and physical activity). 
• Personal care such as helping with eating and getting dressed, or attending appointments. 
• Direct support in taking part in sport and physical activity, such as using hoists or pushing wheelchairs. 
• Indirect support such as verbal encouragement.
• Hands off support such as doing risk, medical and accessibility assessments, to check activities were safe. 
• Logistical support such as transporting service users to and from activities.

 In practice, this means that support workers have to be adaptable and think creatively in order to help people take part in sport and physical activity.

A few interviewees described taking a person-centred or user-led approach to coming up with and organising activities (including sport and physical activity) to help ensure that the support they are providing is appropriate. 

This included working with people’s families to consider different factors such as communication levels or personal interests and activities attended in the past. For example, asking someone’s family what activities they enjoyed in school. 

Some also mentioned the importance of collaborating with colleagues to identify or create physical activities that were inclusive and engaging for all service users. 

For example, one described completing monthly reviews with colleagues to check on how activities had been received and to come up with activities in response for the following month.

A few interviewees reported that inconsistencies in external facilitators’ knowledge, awareness and understanding of inclusive sport and physical activity can be a barrier to participation.

A few interviewees reported that the quality of external facilitators present at activities was inconsistent. 

External facilitators are individuals who provide additional support with activities, usually when they are held externally. Facilitators work alongside support workers to support people with complex disabilities. 

Poor facilitation due to a lack of training was one of the main challenges highlighted. It can be impossible for service users to be included if the external facilitator is not aware of the requirements for disabled people to take part in an activity. 

One example given was waiting times at a trampolining centre. Despite calling ahead and speaking with the facilitator to announce their arrival, when the service user and support worker arrived they had to wait before getting onto the trampolines because they were still in use. This disrupted the session. This means that whilst external activity centres may well be technically accessible, the lack of trained staff who can provide appropriate support results in a different kind of inaccessibility.

A few interviewees also mentioned that the number of external facilitators available at activity centres to assist support workers was an issue. 

A few had attempted to overcome these challenges by proactively identifying and drawing on local organisations to find suitable activities for people. Examples include building relationships with the local football team to organise visits, creating sports groups with other charities, and sourcing equipment to be used in services. 

Nine times out of 10 staff have to go in the boat with service users, and some staff aren’t capable or are frightened of the water, they only have one or two facilitators at the centre.

Deputy Manager, Residential Service

3. Barriers to supporting people

This section provides an overview of the barriers that support workers and other staff face when supporting people to participate in sport and physical activity.

Interviewees with a personal interest in sport felt more confident communicating its benefits. Interviewees were less confident when they had concerns about overcoming complex communication challenges.

Interviewees who had a personal interest in sport tended to feel more confident communicating with people about sport and physical activity. These people had experienced the benefits first hand and felt less intimidated or apprehensive about supporting people to take part.

However, some interviewees felt less confident in promoting and supporting people to access sport and physical activity. This was often due to concerns that they or other support workers would find it hard to know if the person was enjoying the activity due to that complex communication challenges. This was felt to be especially true when working with children who may have less well developed language.

A few also highlighted concerns about whether they or others could fully communicate and explain activities to people, which, in turn, could cause distress and trigger behaviours that challenge.

These issues were felt to be exacerbated if support workers were less experienced, had no relationship with the service user and/or were an agency worker and not necessarily as committed. 

In some cases, lack of confidence in sport and physical activity also stemmed from concerns that people might injure themselves while taking part in an activity. Less experienced staff were far more cautious in this regard, which hindered delivery in services where higher staff turnover was an issue. 

All of these concerns had the potential to limit the range of sport and physical activity opportunities at services. Combined with instances of a lack of buy-in from parents and carers, it was considered easier for support workers to opt for less risky, tried-and-tested activities, though these had less sensory stimulation or health benefits. 

I’ve been offered work to take someone swimming and I’ve never done it – I turned it down because I didn’t feel confident to do it, a shame because I’d like to, but I’d want training first before I attempt it.

Intervenor, Day Service

Travel and transport to, from and between activities was the main reported barrier to participation. This challenge cut across types of service and both rural and urban locations.

Interviewees were asked about barriers to supporting people with complex disabilities to take part in sport and physical activity. Most interviewees focused on a wide range of practical challenges that inhibited its actual delivery.

Most reported that transporting people to and from places was the main barrier.

This was especially the case for Day Services which lacked on-site facilities. Here, support workers faced a combination of challenges: 

• A lack of drivers available on shift limits how many people can attend activities at the same time. 
• A lack of appropriate transport means that some people and their support workers have to rely on public transport, which can be challenging and expensive.

A few interviewees that worked in Residential Services and services located in rural areas also identified a lack of suitable activities in the local area as a barrier. The geographically spread nature of Residential Services meant that there is no centralised location where activities take place. This meant travel to activities required additional time and money. 

This was especially the case if a service user had to pay for the time spent travelling to and from an activity with their personal budgets, which limited the amount of time they could spend participating in the activity itself. However, city-based services also reported transport challenges. 

Even where services had access to good taxi services or public transport links in towns and cities, interviewees highlighted that journeys to activities could still be expensive and were also high risk for people who are vulnerable or have mobility issues. 

<Blockquote> “The location, because we personally haven’t got enough vehicles for the people we support because we’re an expanding day service.” Activities Coordinator, Day Service

Lack of capacity

Some interviewees highlighted staffing pressures and a lack of spare capacity as a barrier to supporting people to take part in sport and physical activity. 

This was especially the case where services lacked well-trained and experienced staff who had developed a rapport with service users ,and therefore lacked the confidence to support service users. 

One interviewee who worked in Community Services reported that some colleagues cared for up to eight service users and, if there was demand, it would not be feasible to support all of them to take part in sport and physical activity in the same week. 

Limited staff capacity, combined with longer travel periods to and from activities, meant there was simply not enough time in the week. This was exacerbated by the additional logistical issues that staff face in supporting people to take part in sport and physical activity.

Lack of equipment

Some interviewees described a lack of resources to support people with complex disabilities to take part in sport and physical activity. A lack of accessible facilities (e.g. swimming pools) and/or equipment such as hoists or adequate was highlighted across all service types and locations.

We struggle to find swimming pools with hoists to hoist people, and shallow water where staff can feel confident they’re not in deep water.

Deputy Manager, Residential Service 

Lack of funding

Approaches to providing sport and physical activity support were also dependent on whether the person was required to fund the activity and, if so, the source of funding. For example, a few interviewees reported that people with complex disabilities often had limited amounts of funding available within their personal budgets to support sport and physical activity, which restricted the type or range of activities available (e.g. reduced options due to reduced travel time). 

Logistical issues

A few interviewees reported that they faced additional logistical issues when supporting people with complex needs to access sport and physical activity. These included: 

• Routine tasks such as getting ready to attend an activity took longer where the activity was delivered at an external venue. One or two hour time slots of support were therefore not enough to fully participate in activities. 
• Unforeseen waiting times for activities caused distress and disruption, which booked venues often didn’t factor into their delivery/support. 
• A lack of available information about the venue and activities, such as accessibility levels and what the activity will entail.

4. Improvements in support

This section provides an overview of the support that support workers and other staff feel would help them to enable people to participate in sport and physical activity.

Most interviewees wanted more training on how to support people, but opinions were mixed on the merits and feasibility of face-to-face training versus other methods. Interviewees also requested more equipment and practical resources to help identify activities in local areas.

Interviewees were asked what forms of support would help them enable service users to take part in sport and physical activity. Responses broadly fell into three categories: training; resources, capacity and equipment; and engagement from the Sense sports and physical activity team.

Training

Most interviewees reported that training on how to support people with complex disabilities to engage in sport and physical activity would be beneficial. 

Face-to-face training was the most popular suggestion because learning practical skills via demonstrations was felt to be most appropriate to this work. This was especially true for training around how to make adaptations to sport and physical activity to ensure it is inclusive and tailored to individual needs. 

However, opinions were mixed as to whether face-to-face training was feasible if support workers are required to travel due to capacity constraints.

One interviewee suggested that a better form of support might be a ‘train the trainer’ approach that would support in-service training and shadowing: 

I know this isn’t available, but training for staff is good and then they can pass on the training, even if it’s just one person trained then they can pass it down to other staff members.

Support Worker, Residential Service

Online training and accompanying toolkits were also suggested as an alternative. However, some interviewees still felt that watching a video or using a toolkit would not be as effective as it would not sufficiently help staff understand whether they were putting skills into practice properly, correcting mistakes and receiving additional feedback. 

Equipment, capacity and resources

Some interviewees requested specific support to resolve equipment and capacity issues. This included access to equipment such as hoists. Without equipment such as this in services or local facilities, it was felt that solutions to other capacity, logistical or resource challenges would be redundant.

Practical guidance and information at a national or regional level was also requested by some interviewees. This included resources on accessible facilities around services that could be used or signposted to and toolkits on how to deliver different adaptive activities within services (including what is required to run it, how it could be delivered etc.) 

Toolkits for sensory and music have been good, so sports one could work.

Support Worker, Sense Centre 

One interviewee suggested that any resource of regional or local activities should include ratings of their inclusivity and accessibility. This would allow for quicker assessment of whether an activity is suitable for various accessibility requirements.

Increased engagement from Sense

A few interviewees wanted to see more engagement from the Sense sports team, such as having staff coming out to meet residents. This could help build relationships and motivate both residents and staff to take part in more sport and physical activity. It was also suggested that the Sense sports and physical activity team could organise ‘taster sessions’ of different activities for support workers to get inspired about activities that they could easily run in their own services. 

Sometimes the Sports team could just come and have a cup of tea, get to know them – then the residents will get to know them and feel more confident.

Support Worker, Residential Service

5. Conclusions & recommendations

This section presents recommendations for Sense and other organisations working with support workers to support participation in sport and physical activity.

How do support workers feel about helping adults with complex disabilities access sport and physical activity?

What do support workers do to help adults with complex disabilities to access sport and physical activity?

What support do support workers currently access to help them support people with complex disabilities?

What challenges and barriers do support workers face in this work?

How can the Sense sport and physical activity team assist support workers in this work?

Key recommendations

1. Build a cultural shift towards placing physical activity support at the heart of the support worker role 
   • Build partnerships with key healthcare training providers to include physical activity awareness in support worker training programmes. 
   • Incorporate interest in, or experience of, physical activity within support worker job descriptions and application processes. 
   • Include training on how to encourage and support people with complex disabilities to take part in physical activity within staff induction processes.

2. Embed sport and physical activity within processes to build on acknowledgement of benefits and improve confidence. 
   • Train service-based ‘Physical Activity’ Champions to inspire staff, overcome concerns and train them in how to support people. 
   • Include promotion of physical activity as regular items within formal development management processes or team meetings. 
   • Integrate physical activity outcomes within the Sense person-centred outcomes framework to create stronger links between physical activity and other outcome domains (e.g. social connectedness). 
   • Place an increased emphasis on physical activity over sport – including more non-sports based examples. 
   • Produce person-centred planning session templates to support collaboration between staff in the promotion or support of physical activity ideas.

3. Help support workers integrate conversations about sport and physical activity into their everyday communication and support planning sessions with people with complex disabilities.
   • Deliver service-specific, face-to-face training to support workers via regional coordinators or ‘Physical Activity Champions’. 
   • Create accompanying resources or toolkits that help support workers explain different sports and physical activities and how they can be adapted. 
   • Develop a shadowing programme or resources to help slowly build confidence. 

4. Support services to promote and deliver more adaptive activities onsite to help overcome local lack of provision and logistical challenges. 
   • Support the delivery of local taster sessions and service-specific, face-to-face adaptive sport training via a ‘train the trainer’ approach with Physical Activity Champions.
   • Create an online peer support network where support workers can contribute and seek ideas on how to promote and support participation in physical activity where access to equipment is limited.

5. Undertake activities in communities around services to address broader infrastructure and system-based challenges 
   • Create regional (and regularly updated) lists of external facilities rated for inclusivity and accessibility or potential partner organisations. 
   • Create a Sense “kitemark” or work with existing accreditation providers, to denote that physical activity providers and facilities are inclusive of people with complex disabilities. 
   • Create a list of funds or grants that services and facilities can apply to for adaptive equipment. 
   • Engage social workers to support the inclusion of physical activity in personal health budgets.