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Beyond the Frame: A Photo-Elicitation Study of Sibling Experiences on the Stay of Their Sibling with a Moderate to Profound Intellectual Disability in Group Homes

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Title: Beyond the Frame: A Photo-Elicitation Study of Sibling Experiences on the Stay of Their Sibling with a Moderate to Profound Intellectual Disability in Group Homes
Language: English
Authors: Sien Vandesande (ORCID 0000-0003-4896-4370), Evy Meys (ORCID 0000-0001-7318-6799), Bea Maes (ORCID 0000-0002-5011-1134)
Source: Journal of Applied Research in Intellectual Disabilities. 2025 38(2).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 13
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Siblings, Children, Adolescents, Emotional Response, Family Environment, Group Homes, Family Structure, Photography, Moderate Intellectual Disability, Severe Intellectual Disability
DOI: 10.1111/jar.70028
ISSN: 1360-2322
1468-3148
Abstract: Background: Parents' decisions to use out-of-home support for children with intellectual disabilities significantly impact all family members, including siblings. However, siblings' perspectives on this transition to group homes remain underexplored. This study examines siblings' emotional experiences and changes in their personal and family lives due to their brother or sister's move to a group home. Methods: Using photo-elicitation and in-depth interviews, we engaged eight children (aged 7-17) with siblings in group homes. Participants captured changes or consistencies in daily life through photographs, which served as conversation triggers. Results: Participants highlighted objects and spaces reminding them of their sibling and documented missed or regained activities and interactions. Five themes emerged, reflecting their emotional experiences and perspectives. Conclusions and Implications: Siblings provided a nuanced view of their sibling's stay, noting benefits and feelings of incompleteness. Professionals should consider siblings' emotions and beliefs in caregiving decisions, recognising the significant impact on their lives.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1468979
Database: ERIC
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  Value: <anid>AN0184768022;e0301mar.25;2025Apr29.07:57;v2.2.500</anid> <title id="AN0184768022-1">Beyond the Frame: A Photo‐Elicitation Study of Sibling Experiences on the Stay of Their Sibling With a Moderate to Profound Intellectual Disability in Group Homes </title> <p>Background: Parents' decisions to use out‐of‐home support for children with intellectual disabilities significantly impact all family members, including siblings. However, siblings' perspectives on this transition to group homes remain underexplored. This study examines siblings' emotional experiences and changes in their personal and family lives due to their brother or sister's move to a group home. Methods: Using photo‐elicitation and in‐depth interviews, we engaged eight children (aged 7–17) with siblings in group homes. Participants captured changes or consistencies in daily life through photographs, which served as conversation triggers. Results: Participants highlighted objects and spaces reminding them of their sibling and documented missed or regained activities and interactions. Five themes emerged, reflecting their emotional experiences and perspectives. Conclusions and Implications: Siblings provided a nuanced view of their sibling's stay, noting benefits and feelings of incompleteness. Professionals should consider siblings' emotions and beliefs in caregiving decisions, recognising the significant impact on their lives.</p> <p>Keywords: children; group homes; intellectual disabilities; out‐of‐home support; photo‐elicitation; siblings</p> <hd id="AN0184768022-2">Summary</hd> <p></p> <ulist> <item> The stay of children with intellectual disabilities in group homes impacts the lives of siblings. Photo‐elicitation is a valuable, creative method to grasp emotional experiences of siblings on this transition.</item> <p></p> <item> Siblings photograph objects, spaces or activities reminding them of their brother or sister with intellectual disabilities, while he/she is out‐of‐home.</item> <p></p> <item> Siblings highlight both opportunities of the group homes on their personal and family lives, alongside a feeling of incompleteness.</item> <p></p> <item> The emotional experience of siblings regarding important care decisions should be taken into account by clinical practitioners.</item> </ulist> <hd id="AN0184768022-3">Introduction</hd> <p>Living with a child who has an intellectual disability can significantly influence the entire family, including siblings (Hastings [<reflink idref="bib9" id="ref1">9</reflink>]; Kruithof et al. [<reflink idref="bib13" id="ref2">13</reflink>]; Reichman et al. [<reflink idref="bib27" id="ref3">27</reflink>]). While siblings often cherish their relationship as a positive and central part of their lives, they may also go through a process of acceptance, experience various types of family stress, and adapt to taking on caregiving roles within the family (Correia and Seabra‐Santos [<reflink idref="bib6" id="ref4">6</reflink>]; Opperman and Alant [<reflink idref="bib24" id="ref5">24</reflink>]; Mulroy et al. [<reflink idref="bib21" id="ref6">21</reflink>]). The sibling relationship is typically the longest‐lasting family bond, and there is a possibility that siblings may become primary caregivers in the future (Correia and Seabra‐Santos [<reflink idref="bib6" id="ref7">6</reflink>]).</p> <p>Researchers have increasingly focused on understanding the perspectives of siblings of children with intellectual disabilities regarding family quality of life, often retrospectively. The systematic review by Múries‐Cantán et al. ([<reflink idref="bib22" id="ref8">22</reflink>]), in which 31 studies were included on minor siblings, highlighted how the disability influences various aspects of the siblings' lives, but also emphasised that the disability alone does not account for all their quality of life perceptions. Siblings experienced a range of emotions, including positive feelings (e.g., pride, gratitude, admiration) and negative feelings (e.g., worry, embarrassment, guilt). This ambivalence was also noted in young adults by Jacobs and MacMahon ([<reflink idref="bib12" id="ref9">12</reflink>]), who appreciated the unique opportunities to learn from having a sibling with a disability (e.g., becoming more patient, mature, and understanding) while also acknowledging the challenges (e.g., difficulties in mutual understanding). Additionally, the review by Múries‐Cantán et al. ([<reflink idref="bib22" id="ref10">22</reflink>]) underscored the significant impact of context on siblings' perceptions. For instance, stigma related to disability and social responses influenced siblings' willingness to take on certain roles. Sibling advocacy is crucial because individuals with intellectual disabilities often outlive their parents, leading to siblings assuming more significant support roles (Burke et al. [<reflink idref="bib3" id="ref11">3</reflink>]; Lee et al. [<reflink idref="bib14" id="ref12">14</reflink>]). In the studies by Correia and Seabra‐Santos ([<reflink idref="bib6" id="ref13">6</reflink>]), Jacobs and MacMahon ([<reflink idref="bib12" id="ref14">12</reflink>]), and Rawson ([<reflink idref="bib26" id="ref15">26</reflink>]), siblings expressed a need to be involved in the preparation and planning for their brother or sister with an intellectual disability and their potential future caregiving roles. However, decisions about future care, such as considering out‐of‐home support care facilities (group homes, residential care), often remain the responsibility of the parents with low levels of sibling involvement in service planning (Lee et al. [<reflink idref="bib14" id="ref16">14</reflink>]).</p> <p>In Flanders (Belgium), 6102 children and young people up to the age of 21 with disabilities out of the total number of 10,500 children with disabilities who received support from a specialised care facility for minors in 2023 utilised residential support in group homes (retrieved from the annual report of Vlaams Agentschap voor Personen met een Handicap, 2023). Some children attend (a special education) school during the daytime and transition to the group homes (associated to the school or separate from it) for the evening and night. Others are 'home schooled' in the care facility by special educational teachers. The intensity of this residential support varied, ranging from occasional support during holidays to regular support for one or more days a week (no separate numbers available). Regardless of the frequency, the stay of a child with disabilities in group homes can profoundly affect both parents and siblings, evoking strong emotions. Research indicates that this decision is one of the most challenging for parents, stirring complex emotions (Crettenden et al. [<reflink idref="bib8" id="ref17">8</reflink>]; Jackson and Olsen Roper [<reflink idref="bib11" id="ref18">11</reflink>]; Vandesande et al. [<reflink idref="bib32" id="ref19">32</reflink>]). Moreover, Jackson, and Olsen Roper ([<reflink idref="bib11" id="ref20">11</reflink>]) noted that out‐of‐home placement is an emotional rollercoaster for <emph>all</emph> family members. Similarly, Vandesande et al. ([<reflink idref="bib32" id="ref21">32</reflink>]) highlighted that the support needs of the entire family, including other children, influence this decision. In that study, some parents provided examples of how their other children's needs prompted the consideration of out‐of‐home support. Jacobs and MacMahon ([<reflink idref="bib12" id="ref22">12</reflink>]) reported ambivalent feelings in young adults about the residential placement of their sibling with an intellectual disability. For instance, they mentioned identifying as 'one family' but struggling to reconcile this with living apart, being supportive of the decision while also experiencing complex emotions such as guilt and isolation. Focusing solely on parents' perspectives concerning this significant care decision is thus insufficient and sibling's perspectives should be heard as well. However, until now, siblings' voices in these care decisions have often been underexplored.</p> <p>Given the ambivalent and complex emotions involved, it is challenging to discuss this care decision with children, especially at young ages. Even research on siblings' perspectives often uses parents' questionnaires (e.g., Mulroy et al. [<reflink idref="bib21" id="ref23">21</reflink>]). Creative methods can help engage children's imaginative processes and assist them in describing their emotional experiences (Veale [<reflink idref="bib33" id="ref24">33</reflink>]). Photography is particularly useful for involving children in research when their language skills are underdeveloped (Holm [<reflink idref="bib10" id="ref25">10</reflink>]). Participant‐driven photo‐elicitation, where participants take or collect pictures in response to prompts and reflect on them during interviews, stimulates for instance children's memory by providing visual cues from daily life and provides structure, reducing power imbalances between the interviewer and child (Clark‐Ibáñez [<reflink idref="bib4" id="ref26">4</reflink>]; Mandleco [<reflink idref="bib17" id="ref27">17</reflink>]; Pyle [<reflink idref="bib25" id="ref28">25</reflink>]; Richard and Lahman [<reflink idref="bib28" id="ref29">28</reflink>]; Van Auken et al. [<reflink idref="bib31" id="ref30">31</reflink>]). Luijkx et al. ([<reflink idref="bib15" id="ref31">15</reflink>]) successfully used photo‐elicitation to explore the perspectives on quality of life of children aged 6–13 with siblings who have profound intellectual and multiple disabilities. By using photographs as conversation‐starters, children showed the positive experiences (e.g., joy in sharing activities) and negative experiences (e.g., difficulties in accepting the disability) of having a sibling with severe disabilities.</p> <p>This study used participant‐driven photo‐elicitation with in‐depth interviews to explore siblings' emotional experiences regarding their sibling's transition to or stay in out‐of‐home group homes. By reflecting on these photos, the study aimed to capture the siblings' lived experiences and explore their emotions. The research questions were:</p> <p></p> <ulist> <item> How do siblings of children with intellectual disabilities experience the overnight stays of their brothers and sisters in group homes?</item> <p></p> <item> Are there changes in the siblings' personal or family lives due to the transition to or stay in group homes, and how are these changes emotionally perceived by the siblings?</item> </ulist> <p>Inductive thematic analyses were done on the interview transcripts and photographs to answer both research questions. This approach ensured alignment with the siblings' daily lives and allowed exploration of their tacit representations and emotions that were elicited by and went beyond the frame.</p> <hd id="AN0184768022-4">Method</hd> <p></p> <hd id="AN0184768022-5">Participants</hd> <p>A sample of eight children was included in this study. Eligible participants were aged 6–18 and had a sibling with an intellectual disability living in an out‐of‐home group home for at least four nights per week, except for special occasions. The participating children must live at home with their parent(s). Researchers contacted gatekeepers (clinical psychologists/orthopedagogues, support workers or directors) within various support facilities and organisations in Flanders (Belgium) to identify and reach out to eligible families. These organisations were versatile, but all provided mobile, ambulatory, (semi‐)residential support and/or leisure time to (families of) children with disabilities. The gatekeepers acted as contact persons and spread the information folder of this research to a large group of potential participants. They were also consulted after experiencing recruitment problems to gain insight into the reasons for non‐response. Parents and/or siblings who expressed an interest in the study were introduced to the researchers by the (care) organisation or contacted the researchers themselves, and eventually, all participated in this study. The final sample included three boys and five girls, aged 7–17 years (<emph>M</emph> = 10.25; SD = 3.33), with their siblings with disabilities aged 7–15 years (<emph>M</emph> = 12.13; SD = 2.90). Five participants also had another sibling without a disability. For a detailed overview, refer to Table 1.</p> <p>1 TABLE Description of the sample.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Participant</th><th align="center">Brother or sister with an intellectual disability</th><th align="center" /></tr><tr><th align="left">Number</th><th align="center">Sex assigned at birth</th><th align="center">Age (in years)</th><th align="center">Sex assigned at birth</th><th align="center">Age (in years)</th><th align="center">Diagnosis/type of disability</th><th align="center">Residence</th><th align="center">Moment of transition<xref ref-type="fn" rid="tfn1" /></th><th align="center">Family</th></tr></thead><tbody valign="top"><tr><td align="left">1</td><td align="center">Male</td><td align="center">10</td><td align="center">Male</td><td align="center">13</td><td align="center">Profound intellectual and multiple disability<xref ref-type="fn" rid="tfn2" /></td><td align="center">Full‐time in a group home, with exception of 2 weekends per month</td><td align="center">10 years ago</td><td align="center">Nuclear family with three children</td></tr><tr><td align="left">2</td><td align="center">Female</td><td align="center">17</td><td align="center">Male</td><td align="center">15</td><td align="center">Profound intellectual disability</td><td align="center">In a group home for 4 nights per week</td><td align="center">11 years ago</td><td align="center">Nuclear family with two children</td></tr><tr><td align="left">3</td><td align="center">Female</td><td align="center">9</td><td align="center">Male</td><td align="center">7</td><td align="center">Profound intellectual disability</td><td align="center">In a group home for 4–5 nights per week</td><td align="center">7 years ago</td><td align="center">Nuclear family with two children</td></tr><tr><td align="left">4</td><td align="center">Female</td><td align="center">7</td><td align="center">Female</td><td align="center">11</td><td align="center">Profound intellectual disability, autism, epilepsy</td><td align="center">Full‐time in a group home</td><td align="center">4 years ago</td><td align="center">Nuclear family with three children</td></tr><tr><td align="left">5</td><td align="center">Male</td><td align="center">7</td><td align="center">Female</td><td align="center">9</td><td align="center">Profound intellectual and multiple disability</td><td align="center">In a group home for 5 nights per week</td><td align="center">6 years ago</td><td align="center">Nuclear family with two children</td></tr><tr><td align="left">6</td><td align="center">Male</td><td align="center">13</td><td align="center">Male</td><td align="center">14</td><td align="center">Moderate intellectual disability, motor impairment, autism</td><td align="center">In a group home for 4 nights per week</td><td align="center">4 years ago</td><td align="center">Nuclear family with three children</td></tr><tr><td align="left">7</td><td align="center">Female</td><td align="center">9</td><td align="center">Female</td><td align="center">13</td><td align="center">Moderate intellectual disability, motor impairment, autism</td><td align="center">In a group home for 5–6 nights per week</td><td align="center">7 years ago</td><td align="center">Nuclear family with three children</td></tr><tr><td align="left">8</td><td align="center">Female</td><td align="center">10</td><td align="center">Female</td><td align="center">15</td><td align="center">Profound intellectual and multiple disability</td><td align="center">In a group home for 4 nights per week</td><td align="center">15 years ago</td><td align="center">Nuclear family with three children</td></tr></tbody></table> </ephtml> </p> <p>1 a The exact moment of transition to the (out‐of‐home) group home is often not clearly defined because it was a gradual process.</p> <p>2 b Profound intellectual and multiple disability, according to the definition of Nakken and Vlaskamp ([<reflink idref="bib23" id="ref32">23</reflink>]).</p> <hd id="AN0184768022-6">Data Collection and Procedures</hd> <p>The current study employed a participant‐driven photo‐elicitation methodology (Richard and Lahman [<reflink idref="bib28" id="ref33">28</reflink>]; Van Auken et al. [<reflink idref="bib31" id="ref34">31</reflink>]), prompting participants to take or collect pictures related to their sibling's stay in the group home. The specific prompting question was: <emph>'What is different during (and – if you can recall – what has changed or remained the same since) the stay of your brother/sister in the group home?'</emph> In‐depth semi‐structured interviews were conducted, guided by the participants' photographs and focused on their (tacit) emotions regarding the stay. The interviews were carried out by two graduate students in Educational Sciences and Clinical Psychology (both present in each interview), under the close supervision of the first author. Both students received training on conversational techniques in their curricula and were coached by the first author after both the pilot interview and the first interview of data collection. Before and during data collection, the supervision consisted of multiple consultations.</p> <p>Before commencing the study, the methodology was tested with a 6‐year‐old child. The primary objective of the pilot study was to assess whether a child of this young age (the lower end of our inclusion criteria) could take clear pictures and elaborate on them. Due to recruitment challenges and in alignment with the pilot study's goals, we worked with a child who did not have a sibling with disabilities. The prompt for this child was: <emph>'What is different in your life during the holidays compared to the school period? What remains the same in your life during the holidays?'</emph> Based on insights from the pilot study, minor adjustments were made to the interview guide to enhance clarity for young children (including adding visual aids, not imposing picture quota and creating an instruction folder for parents on their role).</p> <p>The data collection comprised four phases: (<reflink idref="bib1" id="ref35">1</reflink>) <bold>Preparation</bold>: Explaining the study to parents and children (via email or telephone), initial consent (orally), scheduling two meetings with the interviewers. (<reflink idref="bib2" id="ref36">2</reflink>) <bold>First encounter</bold> between the master's students and the participants: the study was explained comprehensively, and informed consent was obtained from both parties. For the children, the consent process was visually aided with pictograms. Collaboratively with the parents, a suitable medium for photography was determined for the child, utilising either their personal devices (tablet, phone, or camera) or an available device belonging to the parent(s). Parents were provided with an instruction folder, encouraging them to support and remind their child about the study without directing the content of the pictures. Children were also given instructions, including obtaining permission before capturing someone else's picture, along with a small notebook for noting details about the photographs if they found it helpful as a memory aid. The first encounter concluded with a brief brainstorming session to provide the child with ideas or inspiration for their photographs. The master students facilitated the brainstorm by asking open, non‐suggestive questions, always following the children's lead. (<reflink idref="bib3" id="ref37">3</reflink>) <bold>One‐month photography period</bold>: children were given 1 month to capture photographs based on the prompting question and, if desired, to make accompanying notes. A typical month was chosen, during which the siblings with disabilities resided both in the care facility and at home, maintaining their regular schedule. After 2 weeks, the master's students contacted the participants or their parents (depending on the child's age) to ensure the process was proceeding smoothly. Participants were encouraged to take as many pictures as they wished and were required to select and submit a minimum of 10 and a maximum of 25 pictures at the end of the month. All but one participant had at least 10 pictures, ranging from 6 to 17 (<emph>M</emph> = 11.63, SD = 3.25). (<reflink idref="bib4" id="ref38">4</reflink>) <bold>Second encounter</bold>: the in‐depth semi‐structured interview was conducted, guided by the participants' photographs. This interview was in absence of the parent, unless requested otherwise by the participant. One child (Participant 5) choose to have his mother present during the interview, but her participation was limited to clarifying or providing context to some of her son's examples. The interview consisted of standard questions for each photograph, such as <emph>'What can we see in the picture? Has this changed or remained the same? Why did you choose this picture? What emotions does it evoke?'</emph>. To capture and elaborate on the participants' emotions, a laminated sheet of emoticons was used as visual aid. General questions concluded the interview, including <emph>'What is your favorite photo and why? Did you consider any other photographs that you were unable to capture?'</emph> All interviews were recorded on video and ranged between 45 and 100 min. Ethical approval for the study was obtained from the Social and Societal Ethics Committee (KU Leuven) under number G‐2022‐5983.</p> <hd id="AN0184768022-7">Data Analysis</hd> <p>In this study, an inductive, semantic thematic analysis was conducted on the verbatim interview transcripts and the accompanying photographs (which were embedded in the transcripts on the appropriate place). The analysis process involved both the first author (referred to as the coder) and the second author, who acted as a peer auditor. Both authors hold doctoral degrees in Educational Sciences and have extensive experience in qualitative analysis.</p> <p>A six‐step procedure was followed based on the methodology outlined by Braun and Clarke ([<reflink idref="bib1" id="ref39">1</reflink>]). First, the coder and peer auditor immersed themselves in the data by thoroughly reading the interview transcripts. Next, inductive open codes were generated (on paper) for each transcript (within‐case). During this phase, each photograph was coded descriptively (e.g., '<emph>X with brother in the swimming pool in the garden</emph>', '<emph>Cuddle toy of brother</emph>'), and the interview transcripts were openly coded (e.g., '<emph>Like to swim together in the garden</emph>', '<emph>Not all swimming pools are suited for brother</emph>', '<emph>Favorite cuddle toy of brother</emph>', '<emph>Seeing the toy reminds me of brother</emph>'). The open codes on the interview transcripts were as much as possible categorised under the descriptive code of the photograph to maintain the connection between those two sources of data. Some open codes were, however, not specifically linked to one photograph (e.g., '<emph>Brother likes to be in the care facility</emph>', '<emph>Being used to the stay of sister in care facility</emph>'). Broader main and sub‐themes were then drafted across cases. In this step, themes were drafted to describe the clusters in the photographs (e.g., '<emph>Pictures of objects that remind of brother/sister</emph>') and the content of the interviews (e.g., '<emph>Missing the brother/sister when he/she is in the group home</emph>') separately. Of course, there remains a connection between both. These connections were mentioned in the description of the themes. In the fourth step, we reviewed and organised the inductively generated themes. The fifth step involved defining and naming the themes (e.g., '<emph>Missing and habituation</emph>'). Finally, we provided rich descriptions of the themes, supported by citations and photographs, to maximise the confirmability of the findings (Creswell [<reflink idref="bib7" id="ref40">7</reflink>]). Notably, the clustering of themes was based on visual images, creating clusters of photographs across children to recognise their central role in the interviews. Throughout the entire analysis process, the peer auditor validated the findings, and extensive discussion sessions were held to reach consensus, ensuring the study's trustworthiness (Cope [<reflink idref="bib5" id="ref41">5</reflink>]; Creswell [<reflink idref="bib7" id="ref42">7</reflink>]; Thomas and Magilvy [<reflink idref="bib29" id="ref43">29</reflink>]).</p> <hd id="AN0184768022-8">Findings</hd> <p>Five clusters of photographs will be described first with reference to the numbers of the participants who have provided photographs for this cluster. To illustrate, photographs from each photo cluster will be displayed. To ensure privacy, no images including people will be shown. The photo clusters together illustrate five different themes, which will be described second. Because there is no complete one‐to‐one association between the photo clusters and the themes and because both the photographs and the interview transcripts served as data for this study, we decided to describe the photo clusters and the themes separately. Nevertheless, some themes were mainly informed by the interview sections related to a specific photo cluster. These links will be clearly stated in the description of the themes.</p> <hd id="AN0184768022-9">Photo Clusters</hd> <p> <bold>Photo cluster 1: Objects or spaces in the home that belong to the sibling with a disability (or are reminiscent of him/her) – P1,2,3,4,5,6,7,8</bold>.</p> <p>The first cluster of photographs consists of specific objects or spaces within the family home that belong to the sibling with a disability. Some of these items or areas are purposefully designed for the sibling with a disability (such as a standing device, or a large play box), while others are not disability‐specific (such as a favourite cuddle toy or a photo collage on the wall). Participants mentioned these objects or spaces specifically because they evoke memories of their siblings while they are staying in the group homes. Participant 1 described, for example, what he feels when he sees the favourite cuddle toy of his brother: '<emph>I like to remind myself of [name brother] and sometimes I then think that he is here, but he actually isn't. Then I notice the cuddle toys more than I usually do</emph>'. Notably, the act of setting aside objects or closing off specific spaces triggers these reminiscences, resulting in varying levels of emotions among the participants. For instance, Participant 2 said when describing that it's unfortunate that her brother cannot be at the dinner table with them: '<emph>Because the wheel chair is in the hallway. (...) And then, you really have the realization: 'He is not here now, because his chair is there</emph>' (Figure 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01mar25/jar70028-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70028-fig-0001.jpg" title="1 Exemplary photographs of photo cluster 1." /> </p> <p></p> <p> <bold>Photo cluster 2: Objects or spaces in the home that symbolise the adjustment of 'a life with' a sibling with disabilities or that symbolise aspects of daily life on which his/her presence has an impact—Participant 1,2,4,5,6,7,8</bold>.</p> <p>The second cluster of photos comprises objects or spaces within the family home that symbolise the adaptations required from the participants to align their lives with their siblings' needs or that symbolise aspects of daily living together on which their sibling's presence has an impact. These photos predominantly capture negatively perceived adaptations, including care tasks actively performed by the participants (such as tidying up booklets that the sibling likes to tear), adjustments needed in daily life (such as waiting longer or feeling rushed during family departures), negative interactions with their sibling (such as tolerating difficult car rides or enduring hair‐pulling incidents), and differences in the execution of daily life activities when their sibling with a disability was present versus absent. On one hand, the latter activities involved tasks that demanded concentration or tranquillity, such as doing homework, reading, or watching TV shows. On the other hand, they also included activities that the participants enjoyed but weren't compatible with their sibling's needs. For instance, Participant 6 described how he had to turn off the radio in the car because his brother couldn't tolerate it. Related to negatively perceived interactions, the same participant explained his photo of a police car: '<emph>The police interferes with things; they try to fix things, and [name brother] does this as well. However, with him, he chooses one side and then starts stamping at me. He meddles quickly with everything, and that's annoying. (...) I end up fighting even more</emph>.' Usually, participants took these photos to highlight differences before and after the transition to the out‐of‐home care facility, as well as during weekdays versus weekends (Figure 2).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01mar25/jar70028-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70028-fig-0002.jpg" title="2 Exemplary photographs of photo cluster 2." /> </p> <p></p> <p> <bold>Photo cluster 3: Activities of the participant or the whole family, without the sibling with</bold> <bold>a</bold> <bold>disability—Participant 1,3,4,5</bold>.</p> <p>The third photo cluster featured photographs capturing various activities—either involving the individual participants (such as a running contest or a dance recital) or the entire family (such as a family celebration or vacation). In these images, the brother or sister with a disability was notably absent. No exemplary photos could be included in the manuscript for this photo cluster due to the presence of people in all the images. For instance, the photographs depicted a dance recital from the audience's perspective (Participant 1) or a group picture of the entire family on bikes during a vacation (Participant 5), providing a context for discussing the sibling's absence in those activities. Interestingly, this absence was not universally perceived negatively by the participants. Most could discuss it in a nuanced and realistic manner, even highlighting potential advantages. Participant 5, reflecting on his sister's absence during a family bike vacation, remarked: '<emph>It was fun [that she wasn't with us on vacation], because otherwise, we would be woken up by my sister. (...) She makes noise and wakes up at six already</emph>'. However, he later added: '<emph>It makes me sad because I wished she could have come with us</emph>'. Some participants also rationalised why their brother or sister couldn't join them (such as, '<emph>he would make too much noise</emph>'), although some of these reasons didn't seem entirely logical. Participant 5 explained to the researcher: '<emph>Because we traveled by car, and the car was full. She also can't bike with us</emph>'.</p> <p> <bold>Photo cluster 4: Activities or rituals of the participant or the whole family, with the sibling with</bold> <bold>a</bold> <bold>disability (or with him/her as the hub of being together)—Participant 1,3,4,5,6,8</bold>.</p> <p>The fourth photo cluster consisted of photographs capturing activities or rituals, involving either the participants or the entire family and the sibling with a disability. Sometimes the activities even revolved around the child with the disability. Examples of such activities included reading books together, playing in the garden, going horseback riding, or enjoying playtime with stuffed animals in bed. These interactions were positively valued by all participants and were also missed during the stay of the sibling with a disability in the group home. Participant 6, for instance, expressed longing for a ritual involving hand puppets that he shared with his brother and father before bedtime: '<emph>If he is not at home, then I feel like expending my last energy, which I can do with the hand puppets. But during the week, I don't have a similar thing. It's stupid—I wish I could do it during the week, but I can't</emph>' (Figure 3).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01mar25/jar70028-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70028-fig-0003.jpg" title="3 Exemplary photographs of photo cluster 4." /> </p> <p></p> <p> <bold>Photo cluster 5: Images that symbolise activities or aspects of daily life in which the sibling with a disability cannot participate, or which cannot take place when he/she is at home—Participant 2,3,5,6,7,8</bold>.</p> <p>The fifth photo cluster featured photographs that symbolise activities or aspects of daily living that are hindered when the sibling with a disability is at home (or the reverse: that become possible (once again) when the child is in the group home). Pictures within this cluster symbolised adjustments in habits, such as not being able to go out with the whole family. Participant 8, for instance, depicted this by showing her mother's shoe closet: '<emph>If [name of sister] is at home, mommy and daddy cannot go out simultaneously. (...) Because at least someone should always stay with [name sister] to give her medicines</emph>'. The presence of her sister also hindered going out spontaneously, as depicted by the front door: '<emph>If she is at home, we cannot go out last‐minute. For instance, if someone asks 'can you come by with your family?', we cannot say: 'yes, quickly, let's go'. That's not possible</emph>'. Some participants explained this by the care tasks that have to be done, others by the behavioural problems shown by their sibling during family outings. Some of the described activities, such as dining out at a restaurant or visiting a museum, were feasible before but had become unattainable over the years. This shift was, for instance, attributed by the participants to the emergence of behavioural problems or the increased difficulty of transporting the child. Another example of a change in habits was reflected upon by Participant 6 by showing a microphone, to symbolise things that couldn't be said at home when his brother was at home: '<emph>[If you say that something is going to happen] he will continuously whine about it. Sometimes I want to ask a question to my parents, but then I need to make sure that he is away and that's frustrating. I need to ask them: 'Is [name of brother] away? Can we now talk about it?'</emph>'. Additionally, he explained a photo featuring Playmobil puppets, symbolising the limitation that his friends couldn't visit: '<emph>If they come over, [name of brother] greets them repeatedly with 'hi, hi, hi, hi, who are you?'—which I think my friends don't really appreciate</emph>' (Figure 4).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01mar25/jar70028-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70028-fig-0004.jpg" title="4 Exemplary photographs of photo cluster 5." /> </p> <p></p> <hd id="AN0184768022-14">Themes</hd> <p></p> <hd id="AN0184768022-15">Missing and Habitation</hd> <p>A recurring theme, especially emerging within the first photo cluster, was '<emph>missing and habituation</emph>'. Several participants expressed longing for their brother or sister during their stay in the group home. For some of them, this absence translated into an incomplete sense of family. The feeling of missing was intricately tied to specific objects or spaces—some evoking memories, while others remained neutral. For instance, Participant 2 experienced this sentiment upon seeing her brother's wheelchair (as mentioned earlier), but the closed door of his room did not elicit the same response: '<emph>It's merely different because during the week, the door is closed, and on weekends, it's open. It's more neutral, as the closed door isn't inherently negative. However, seeing the chair stirs stronger emotions, perhaps because other doors are also closed. It's not special</emph>'. Some participants longed for the warm, enjoyable interactions they shared with their siblings (represented in photo cluster 4)—moments like cuddling in bed or playing with stuffed animals before bedtime. For others, their brother or sister with a disability played a crucial role in regulating their negative emotions. During their stay in the group home, they might feel lonely or sad. Participant 8, when asked why she crawls into bed with her sister after a bad night, explained: '<emph>Then I become peaceful again. Throughout the week, I'm grumpier than on weekends</emph>'. In contrast to the feeling of missing, other children emphasised their adaptation to their sibling's stay in the group home. For most, the transition occurred long ago, leading to a sense of familiarity with the situation. Overall, there were thus different levels of emotionality during the interviews across participants. While some experienced intense emotions when saying goodbye to their sibling each week and ascribed deeper emotional significance to the described differences, others maintained a more neutral stance. Participant 3, for instance, vividly expressed this emotional perspective: '<emph>I think it's sad that he leaves. Most children don't tend to cry when their brother departs because they consider it normal. But I don't view it as normal</emph>'.</p> <hd id="AN0184768022-16">Differences in Family Life</hd> <p>This theme represents the adjustments that participants (are required to) make—whether passively endured (e.g., eating without parents) or actively contributed to (e.g., tidying up toys from the sibling). One aspect of the differences in family life, mentioned by some participants, is the difference in tranquillity in the family home when the sibling is in the group home. Participants described a significant difference in the peace and quietness at home depending on whether their brother or sister with a disability was absent or present. They often conveyed this through depictions of empty spaces within their homes. Tranquillity manifested, for example, in the ability to converse peacefully with parents at the dinner table, watch TV shows with their mother, or experience better sleep quality. The latter aspect was evident across various interviews, emphasising the impact of cohabiting with a sibling with a disability on sleep quantity and quality. Participant 2 shared how she is awakened by the sound of her brother's cuddle bear in the morning. Although she used to be irritated by it, she has grown accustomed to it: '<emph>Before, I used to wake up from his banging on the walls, so this [the sound of the bear] is better. (...) [When asked if she prefers being awakened by her alarm clock] Yes, because then I can wake up at the hour I need to, rather than an hour earlier</emph>'. Another aspect of tranquillity is the difference of being at ease at home with regard to the safety of one's own toys or stuff. Participant 6, for instance, explained that he is afraid that his personal stuff will be broken by his brother: '<emph>During the week, I am much more at ease. Then, I know, 'everything is here and it doesn't matter where I put my stuff'. If [name brother] is at home, he can get angry and break stuff. That feeling is gone during the week</emph>'.</p> <p>Another aspect of the differences in family life is the difference in receiving exclusive attention of parent(s) when the sibling is in the group home. Participants often explained this phenomenon by highlighting their parents' temporary loss of caregiving responsibilities, freeing up more time to spent with the participant. For instance, Participant 8 described how her sister takes priority at times: '<emph>If [name of sister] is at home, she gets priority. If I want to go to sleep and she's also going to bed, they [parents] will put her to bed first</emph>'. Participant 5 illustrated the lack of exclusive attention by recounting an experience while building a Lego castle with his father: <emph>'If my sister is at home, Daddy cannot help me build [the Lego castle]. I don't like that'</emph>. When asked why his father couldn't assist, he responded '<emph>Because he is busy with my sister</emph>'.</p> <hd id="AN0184768022-17">Loving Brother/Sister While Not Liking the (Consequences of the) Disability</hd> <p>Another theme, mostly emerging within the second photo cluster, was '<emph>loving brother/sister while not liking the (consequences of the) disability</emph>'. While most interviews revealed participants' love for and acceptance of their sibling with a disability, along with pride in them, some of them also expressed a longing for a typically developing sibling who can engage in regular daily activities like attending school together or doing homework. Participant 3, for instance, emotionally reacted when a friend expressed a desire for a brother with a disability: '<emph>She says that she would like her brother to be disabled, but she wouldn't. I am sure. (...) You don't want that, because you cannot play with your brother. (...) It is difficult to play alone, you know</emph>'. Participant 4 endorsed this idea: '<emph>I want her to be normal like us, like my brother and me, that she could go with us and that my mother didn't have to stay at home. [quiet]</emph>'. Participant 1 even more strongly expressed the idea of not knowing what it is to have a real brother: '<emph>Normally, I would get a brother, but now I don't have that. Actually, I don't know what it's like to have a brother</emph>', although he immediately puts this in perspective for himself: '<emph>But other people also don't know what it's like to have a brother with a disability</emph>'.</p> <hd id="AN0184768022-18">Feeling the Absence and Cherishing the Presence</hd> <p>In the photographs of photo cluster 4 the presence of their sibling played a crucial role in activities, contrasting with their absence during other moments, represented by the photographs in photo cluster 3. This contrast is encapsulated in the theme of '<emph>feeling the absence and cherishing the presence</emph>'. Some participants described feeling whole again as a family when their brother or sister returned home during the weekends. For example, Participant 6 stressed the ambiguity regarding her brother's absence during family moments: '<emph>The family is not really complete then, and that is a bit annoying. However, it is also nice that he is not there sometimes. It is an ambiguous feeling</emph>'. Participant 6 further explained how he appreciates the joy his brother brings in home: '<emph>Sometimes it's nicer when he's not at home, but there are also moments with less joy. He shines with happiness, and that's the difference. When he's not at home, it's less fun because there's less joy. Yet, he can be sweet</emph>'.</p> <hd id="AN0184768022-19">The Stay in Out‐Of‐Home Care as an Opener of Opportunities</hd> <p>The transition to an out‐of‐home care facility created opportunities to reintegrate these activities into family life (mostly captured in photo cluster 5). Participant 2, for instance, described the activity of going to a restaurant, which can only occur during her brother's stay in the group home: '<emph>If [name of brother] is not home, we occasionally dine out, because we don't take him with us. He makes a lot of noise and it is of no use to him. However, when he is gone, we do go out. [comparing to before] (...) Previously, he could join us. It's unfortunate that he cannot longer participate. (...) He used to be much quieter, but now, we feel that he will start to shout with all the noise [in the restaurant]</emph>'. Participant 6 highlights the contrast between days when her brother is absent or present at home: '<emph>[Talking about a day without her brother] If we have a day off then, it is nice to do something. Then we go to [name of city] to go to a museum. I do like that, then we can do something instead of staying at home (...). Because with [name brother] at home, it is not easy to do something. (...) During weekends, we often find ourselves confined to our house, even though we sometimes want to do something</emph>'. Notably, during the interviews, some children adopted different perspectives to look at these opportunities. For example, Participant 3 shared the perspective of her brother with a disability and pointed to the opportunities or advantages of the group home for her brother: '<emph>I am sure that he makes fun in the care facility as well</emph>.' Participant 7 considered her parents' viewpoint: '<emph>If she were at home during the week, it would be much more difficult for us because we have to go to school, and mommy and daddy have to go to work</emph>. <emph>It is not possible</emph>'. Lastly, and important to nuance the theme, is that it became evident throughout the interviews that participants also noticed a sense of stability despite all the changes or differences. For instance, Participant 5 playfully responded to the researcher's inquiry about things remaining the same since the transition to the group home: '<emph>Eating croquettes with apple sauce</emph>.'</p> <hd id="AN0184768022-20">Discussion</hd> <p>This photo‐elicitation study aimed to explore the emotional experiences of children aged 7–17 years regarding the stay of their sibling with an intellectual disability in an out‐of‐home care facility (group homes). Overall, the participants presented a realistic, nuanced, and mainly positive perspective on their sibling's stay in a group home, although ambiguous emotions and feelings of sadness were also mentioned and an adjustment period might have been necessary. Despite their young ages, some children demonstrated the ability to consider their own perspective alongside those of their parents or siblings, highlighting their high level of empathy. This finding aligns with the research of Mulroy et al. ([<reflink idref="bib21" id="ref44">21</reflink>]), where parents reported their children to be compassionate, caring, and emotionally mature due to their sibling's disability.</p> <p>Most participants in this study expressed a mainly positive viewpoint regarding their sibling's stay in a group home. They stressed the advantages in terms of receiving exclusive attention, experiencing tranquillity at home or being able to undertake specific activities. This finding corroborates with findings in other studies, such as Luijkx et al. ([<reflink idref="bib15" id="ref45">15</reflink>]) and Correia and Seabra‐Santos ([<reflink idref="bib6" id="ref46">6</reflink>]). In both studies, siblings stressed enjoying shared activities, but also longing for private time. However, from these findings it should and could not be concluded that out‐of‐home support is the preferred, necessary or best way of support for children with intellectual disabilities, and no value judgement is included pro or contra this type of support. From a social model view of disability, one could also argue that it is mainly because of the lack of support to these families that the decision to appeal to residential care, which is invasive for the whole family, becomes a necessity in order to ensure positive interactions and family dynamics. In addition, many children in this study also nuanced their positive viewpoint by expressing mixed and ambiguous feelings. On one hand, they perceived the care facility as an opportunity for personal and familial freedom (from care burden), such as being able to go out to restaurants or invite friends over. On the other hand, participants conveyed feelings of missing their sibling, expressing deep love irrespective of their sibling's disability, and sensing an incompleteness within the family at times. This is in line with the study of Jacobs and MacMahon ([<reflink idref="bib12" id="ref47">12</reflink>]) in which young adults described identifying as 'one family' and struggling to reconcile this with living apart. The latter study with young adults showed that siblings were overall supportive of the residential stay but also described feelings of guilt and feeling different and isolated from peers. These feelings were not prominent in the current research and might be related to the younger ages of the participants in the current study.</p> <p>The perspectives of the siblings were well captured through the photographs provided by the participants, depicting objects or spaces in their homes (e.g., their sibling's cuddle toy), family activities (e.g., vacations), or abstract concepts symbolising traits of their sibling. Consistent with the findings of Clark‐Ibáñez ([<reflink idref="bib4" id="ref48">4</reflink>]), Mandleco ([<reflink idref="bib17" id="ref49">17</reflink>]), and Pyle ([<reflink idref="bib25" id="ref50">25</reflink>]), utilising participants' own photographs structured the interviews, elicited specific memories or stories, and empowered the children to guide the research process. This approach enabled emotional experiences, even those concerning difficult topics, to be described in a rich and nuanced manner, even by young children.</p> <p>Across participants, the emotional intensity associated with their sibling's stay in a group home varied. This discrepancy could be attributed to individual personality traits or, alternatively, to their adaptation and adjustment to the situation over time. In the study of Jacobs and MacMahon ([<reflink idref="bib12" id="ref51">12</reflink>]) and Luijkx et al. ([<reflink idref="bib15" id="ref52">15</reflink>]), siblings described a sense of normality with some even not being fully aware that there family situation might be seen as a special situation. In this study, for most children, the moment of transition of their sibling to an out‐of‐home care facility was a long time ago. Notably, due to recruitment challenges, the original study design's inclusion criteria regarding the maximum time elapsed since the transition had to be loosened. Nonetheless, participants clearly differentiated between weekends (when most siblings with intellectual disabilities were at home) and weekdays (when most siblings with intellectual disabilities were at the group home). A notable observation in this regard was the marked difference in family tranquillity between weekends and weekdays. Findings in research with parents reported that parents of children with severe disabilities typically devote a significant portion of their time to caregiving tasks (Luijkx et al. [<reflink idref="bib16" id="ref53">16</reflink>]). This responsibility seems to also impact siblings, who may feel obligated to fulfil certain care duties or experience pressure and haste due to the presence of their sibling with a disability. Some participants even mentioned variations in their sleep quality depending on their sibling's presence at home.</p> <p>It is interesting to examine Moyson and Roeyers' ([<reflink idref="bib19" id="ref54">19</reflink>], [<reflink idref="bib20" id="ref55">20</reflink>]) concept of 'Siblings Quality of Life' (SibQOL) in light of the research findings. This is a parallel framework to the Family Quality of Life framework (Brown et al. [<reflink idref="bib2" id="ref56">2</reflink>]) but applied to the subjective and objective quality of life of siblings. Many of the domains related to the quality of life of siblings of children with ID, as outlined in the studies by Moyson and Roeyers, were also evident in the current study. For example, 'Forbearance' (Domain 1), which refers to the sibling's ability to tolerate the behaviour of their brother or sister, was clearly demonstrated in the examples provided by the children. Numerous participants exhibited a certain level of tolerance towards the challenging behaviours of their siblings (such as destroying a cherished cuddle toy or pulling hair). However, what predominated was their 'Love and acceptance' of their sibling (Domain 6 of Moyson and Roeyers' SibQOL), although some still expressed a desire for a 'normal' sibling. It remains uncertain to what extent their levels of empathy and tolerance were influenced by social desirability bias. Despite this love and acceptance, some participants openly discussed difficulties in 'Dealing with the outside world' (Domain 9). Some mentioned friends' lack of understanding regarding having a sibling with a disability or their friends' discomfort with the presence of their disabled sibling, which could impact their quality of life. Consistent with the domains of 'Mutual understanding' (Domain 2) and 'Joint activities' (Domain 3), participants in this study emphasised the significance of warm interactions and family activities in which their sibling could still participate. Nonetheless, they also emphasised the importance of maintaining their 'Private time' (Domain 4), whether for their own activities or for activities with their parents where they receive exclusive attention. Lastly, aligning with Moyson and Roeyers' fifth domain, 'Trust in well‐being', participants in this study emphasised their trust in the happiness and well‐being of their sibling in the out‐of‐home care facility, which significantly influenced their positive perceptions of the facility.</p> <hd id="AN0184768022-21">Limitations and Future Research</hd> <p>There were some recruitment issues during this research. As a result of conversations with various care organisations about the reasons for non‐response, the inclusion criteria were loosened. First, originally we aimed to include only children between 7 and 14 years old, as it was reported by Moyson and Roeyers ([<reflink idref="bib20" id="ref57">20</reflink>]) that research in this young sibling group was especially lacking. Loosening this criterium and allowing participants up until the age of 18 years old resulted in a considerable age gap between the youngest and oldest participants in this study. However, no differences in themes or the quality of photographs were seen, suggesting that the methodology used for participant‐driven photo‐elicitation is suited to grasp personal perspectives in both age groups. Second, originally we aimed to include children only if their brother or sister transitioned to a group home recently to avoid memory or recalling biases (transition between 6 months and 2 years before their participation). Due to the specificity of this criterium and the difficulties in pinpointing the exact moment of transition, this was not feasible. As a result, most siblings transitioned to a group home several years before the study, often when the participants were still very young.</p> <p>A semantic thematic analysis was done in this study. This implies identifying themes at the explicit or surface meanings of data (Braun and Clarke [<reflink idref="bib1" id="ref58">1</reflink>]). Although this was a deliberate choice given the young age of the participants, this might have led to missing certain deeper meanings or interpretations on a latent level. For instance, some participants mentioned they would rather have a sibling without a disability. Thematic analyses on a latent meaning level could reveal the links between this expression and other factors, such as lack of support, societal views on disability, family dynamics, and so on. Another focus on a more latent level could be on the siblings' awareness and resolution of nuanced and sometimes conflicting emotions that they experience regarding outsourcing care for their brother or sister to a residential group home.</p> <p>Some of the themes were not focused on the transition to or the stay in the group home, but highlighted differences that illustrate a natural evolution over time (irrespective of the transition or the stay in group homes). Most of these changes were linked to the child growing older, having more specific medical needs, or exhibiting behavioural problems. For some, this appears to be one of the concrete reasons for transitioning to out‐of‐home care facilities. Some other themes were related to living with a sibling with an intellectual disability in general. Research should delve deeper into these themes. This study demonstrates that photo‐elicitation could be an interesting research method to explore these aspects further. Additionally, future research should investigate individual differences in children's perceptions or emotional responses regarding out‐of‐home care. Based on the research findings, it is hypothesised that factors such as the frequency of challenging behaviours displayed by the child with an intellectual disability, the gender and personality traits of the sibling without an intellectual disability, or the severity of the disability may be interesting factors to explore.</p> <hd id="AN0184768022-22">Implications for Practice</hd> <p>Clinical practitioners working with families of children with intellectual disabilities (such as staff from home support services, specialised day care centres, special needs schools or residential group homes) particularly those navigating the decision‐making process or transition to out‐of‐home care, should pay attention not only to parents' viewpoints but also to the perspectives of siblings. The present study indeed demonstrates the significant impact of such decisions on the personal lives and family dynamics of these siblings, as well as the complex emotions associated with them. It is important that clinical practitioners acknowledge and normalise these emotions and work with siblings to allow ambiguous and conflicting feelings to coexist. One way to facilitate the latter is to bring siblings together to talk about their experiences and coping strategies (McCullough and Simon [<reflink idref="bib18" id="ref59">18</reflink>]). In academic research, more efforts should go to the study of sibling interventions and support group research (Tudor and Lerner [<reflink idref="bib30" id="ref60">30</reflink>]). The findings of this research also show the urge to think carefully about how to optimally attune and reconcile both caregiving contexts and how to sufficiently and structurally support these families in their natural home environment. For instance, some participants expressed a sense of incompleteness and missed their sibling during their stay in the group home, especially during certain family activities. This finding shows the necessity of looking for creative and flexible ways to organise our support as professionals working in residential care, in order for siblings to keep in touch sufficiently during the stay in group homes and to facilitate the presence of the sibling in important family activities.</p> <p>In conclusion, this study sheds light on the multifaceted and complex emotional experiences of children with siblings in out‐of‐home care facilities. While many children expressed positive aspects of their sibling's stay, such as increased tranquillity at home or new opportunities, they also conveyed mixed emotions, including sadness and a sense of incompleteness. This study emphasises the importance of considering siblings' perspectives in both research and practice, advocating for more comprehensive support systems that address the needs of the entire family, especially in important care decisions that might impact the whole family system.</p> <hd id="AN0184768022-23">Author Contributions</hd> <p>All authors have contributed to, seen, and approved of the manuscript and agree to the order of authors as listed on the title page.</p> <hd id="AN0184768022-24">Acknowledgements</hd> <p>The authors wish to thank all participating children for their engagement in this study and Jolien Schepers and Jonine Capiot for their involvement in data collection.</p> <hd id="AN0184768022-25">Ethics Statement</hd> <p>This study met the ethical procedures and standards of the KU Leuven, Belgium and was approved by the Social and Societal Ethics Committee (G‐2022‐5983).</p> <hd id="AN0184768022-26">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0184768022-27">Data Availability Statement</hd> <p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p> <hd id="AN0184768022-28">Declaration of Generative AI and AI‐Assisted Technologies in the Writing Process</hd> <p>During the preparation of this work, the authors used Chat GPT and Microsoft CoPilot in order to give suggestions to improve English structure and language, but not to generate content. After using this tool/service, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.</p> <ref id="AN0184768022-29"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref35" type="bt">1</bibl> <bibtext> Funding: The authors received no specific funding for this work.</bibtext> </blist> </ref> <ref id="AN0184768022-30"> <title> References </title> <blist> <bibtext> Braun, V., and V. Clarke. 2006. " Using Thematic Analysis in Psychology." 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Beyond the Frame: A Photo-Elicitation Study of Sibling Experiences on the Stay of Their Sibling with a Moderate to Profound Intellectual Disability in Group Homes
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Sien+Vandesande%22">Sien Vandesande</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4896-4370">0000-0003-4896-4370</externalLink>)<br /><searchLink fieldCode="AR" term="%22Evy+Meys%22">Evy Meys</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7318-6799">0000-0001-7318-6799</externalLink>)<br /><searchLink fieldCode="AR" term="%22Bea+Maes%22">Bea Maes</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5011-1134">0000-0002-5011-1134</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2025 38(2).
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Siblings%22">Siblings</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Group+Homes%22">Group Homes</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Structure%22">Family Structure</searchLink><br /><searchLink fieldCode="DE" term="%22Photography%22">Photography</searchLink><br /><searchLink fieldCode="DE" term="%22Moderate+Intellectual+Disability%22">Moderate Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Severe+Intellectual+Disability%22">Severe Intellectual Disability</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jar.70028
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322<br />1468-3148
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Parents' decisions to use out-of-home support for children with intellectual disabilities significantly impact all family members, including siblings. However, siblings' perspectives on this transition to group homes remain underexplored. This study examines siblings' emotional experiences and changes in their personal and family lives due to their brother or sister's move to a group home. Methods: Using photo-elicitation and in-depth interviews, we engaged eight children (aged 7-17) with siblings in group homes. Participants captured changes or consistencies in daily life through photographs, which served as conversation triggers. Results: Participants highlighted objects and spaces reminding them of their sibling and documented missed or regained activities and interactions. Five themes emerged, reflecting their emotional experiences and perspectives. Conclusions and Implications: Siblings provided a nuanced view of their sibling's stay, noting benefits and feelings of incompleteness. Professionals should consider siblings' emotions and beliefs in caregiving decisions, recognising the significant impact on their lives.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1468979
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1468979
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jar.70028
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
    Subjects:
      – SubjectFull: Siblings
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Emotional Response
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Group Homes
        Type: general
      – SubjectFull: Family Structure
        Type: general
      – SubjectFull: Photography
        Type: general
      – SubjectFull: Moderate Intellectual Disability
        Type: general
      – SubjectFull: Severe Intellectual Disability
        Type: general
    Titles:
      – TitleFull: Beyond the Frame: A Photo-Elicitation Study of Sibling Experiences on the Stay of Their Sibling with a Moderate to Profound Intellectual Disability in Group Homes
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Sien Vandesande
      – PersonEntity:
          Name:
            NameFull: Evy Meys
      – PersonEntity:
          Name:
            NameFull: Bea Maes
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      – BibEntity:
          Dates:
            – D: 01
              M: 03
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1360-2322
            – Type: issn-electronic
              Value: 1468-3148
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            – Type: volume
              Value: 38
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
              Type: main
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