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Armstrong H, McDowell C, Leavey G, Denne LD. 'Key skills' building in schools as a possible approach to reducing and preventing challenging behaviour. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13268. [PMID: 38937069 DOI: 10.1111/jar.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/18/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Building 'key skills' may help prevent the development of challenging behaviour in children with an intellectual disability. The aim of this paper was to extend the current limited evidence in this area. METHOD We undertook two studies with children with an intellectual disability in school settings: (1) a cross-sectional replication study exploring the relationship between 'key skills' and challenging behaviour. (2) a longitudinal study follow-up exploring change in 'key skill' levels and challenging behaviour. RESULTS The replication study recruited 74 participants, those scoring lowest in 'key skill' had a 94% chance of having challenging behaviour; those with the highest scores had a 6% chance. The follow-up study recruited 39 participants, we found a significant increase in children's 'key skill' level (p < .001) and a decrease in their challenging behaviour (p = .046). CONCLUSION Building 'key skills' in children with an intellectual disability may help reduce or prevent challenging behaviour.
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Affiliation(s)
- Heather Armstrong
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Claire McDowell
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Gerard Leavey
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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2
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Durand M, Nathan R, Holt S, Nall-Evans S, Woodrow C. Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13210. [PMID: 38382461 DOI: 10.1111/jar.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. METHOD A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. RESULTS We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. CONCLUSION By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.
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Affiliation(s)
- Marianne Durand
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Specialist Mental Health, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Chester Medical School, University of Chester, Chester, UK
| | - Sophie Holt
- Children, Young People and Families, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Sharleen Nall-Evans
- Information Management and Business Intelligence, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ceri Woodrow
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Centre for Autism, Neurodevelopmental Disorders and Intellectual Disabilities, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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3
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McDonnell AA, Page A, Bews-Pugh S, Morgalla KA, Kaur-Johal T, Maher M. Families' experiences of the Low Arousal Approach: a qualitative study. Front Psychol 2024; 15:1328825. [PMID: 38596338 PMCID: PMC11002904 DOI: 10.3389/fpsyg.2024.1328825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Parents and carers supporting a family member presenting with behaviors of concern experience heightened stress. The Low Arousal Approach is a crisis management strategy which recognizes that stress, or physiological arousal, can be expressed through behaviors of concern. This approach aims to equip parents and carers to manage behaviors in a person-centered and non-confrontational way. There is a paucity of published research exploring the experiences of families applying this approach. Methods Seventeen parents who had received training in the Low Arousal Approach were interviewed to gain their perspectives on supporting their family members using this approach. Results Thematic analysis revealed themes relating to parental stress, which was related to external pressures, isolation, family stress, and challenges in their caring role. They described encountering negative narratives relating to self-criticism and negative judgments from others. Training in the Low Arousal Approach was related to being empowered through access to evidence, increased confidence, and increased ability to advocate for their family member's needs. Low Arousal was described as a "lifestyle" that enabled increased coping for the family unit as a whole. Discussion/conclusion Findings indicate that it is vitally important to recognize the views of parents and carers, and these are equally as important as the views of professionals. We must understand parents' and carers' needs in order to provide adequate support.
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Affiliation(s)
| | - Andrea Page
- School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom
| | | | | | | | - Mary Maher
- Studio 3 Clinical Services Limited, Alcester, United Kingdom
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4
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Yoshida K, Lunsky Y, Müller DJ, Desarkar P. Prevalence of Psychotropic Medication Use and Psychotropic Polypharmacy in Autistic Adults With or Without Intellectual Disability. J Autism Dev Disord 2024:10.1007/s10803-023-06208-y. [PMID: 38219270 DOI: 10.1007/s10803-023-06208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 01/16/2024]
Abstract
The aim of this study was to compare the rates of psychotropic medication use and psychotropic polypharmacy between autistic adults with and without intellectual disability (ID) and to examine factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults, stratified by the presence of ID. We conducted a retrospective medical chart review of outpatients with an autism diagnosis aged 18 years and older. The rates of psychotropic medication use and psychotropic polypharmacy were compared between autistic adults with and without ID. Subsequently, logistic regression analyses were performed to identify factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults with ID and those without ID, respectively. The rates of prevalence of psychotropic medication use and polypharmacy were significantly higher in participants with ID than those without ID (78.6% vs. 58.8% and 49.3% vs. 31.2%; p-values < 0.05). Age, gender, race, residence, presence of mood disorders, presence of schizophrenia, absence of anxiety disorder, number of psychiatric comorbidities, and presence of behaviors that challenge were significantly associated with these outcomes, depending on the presence/absence of ID. The need to optimize pharmacotherapy in autistic adults, stratifying by the presence of ID, is highlighted.
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Affiliation(s)
- Kazunari Yoshida
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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5
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Korb L, Tromans S, Perera B, Khan N, Burrows L, Laugharne R, Hassiotis A, Allgar V, Efron D, Maidment I, Shankar R. The potential for medicinal cannabis to help manage challenging behaviour in people with intellectual disability: A perspective review. J Psychopharmacol 2023; 37:1201-1208. [PMID: 37937428 PMCID: PMC10714688 DOI: 10.1177/02698811231209192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Around 2% of the population have intellectual disabilities. Over one-third people with intellectual disabilities (PwID) present with 'challenging behaviour', which nosologically and diagnostically is an abstract concept. Challenging behaviour is influenced by a range of bio-psycho-social factors in a population, which is unable to suitably comprehend and/or communicate concerns. This predisposes to poor health and social outcomes. There is no evidence-based treatments for managing challenging behaviour. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are being trialled for a range of disorders, which are over-represented in PwID and provoke challenging behaviours, such as severe epilepsy, spasticity, post-traumatic stress disorder, social phobia, pain, etc. METHODS This perspective review explores the different conditions, which benefit from medicinal CBD/THC preparations, by analysing recent literature from neurobiological, pre-clinical and clinical studies related to the topic. The evidence is synthesised to build an argument of the therapeutic benefits and challenges of medicinal cannabis to manage severe challenging behaviour in PwID. RESULTS There is developing evidence of medicinal CBD/THC improving psychiatric and behavioural presentations in general. In particular, there is emergent proof in certain key areas of influence of medicinal CBD/THC positively supporting challenging behaviour, for example in children with neurodevelopmental disorders. However, there are significant challenges in employing such treatments in vulnerable populations such as PwID. CONCLUSION Further clinical research for the considered use of medicinal CBD/THC for challenging behaviour management in PwID is needed. Strong co-production with experts with lived experience is needed for further testing to be done in this exciting new area.
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Affiliation(s)
- Laura Korb
- Haringey Learning Disability Partnership, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Samuel Tromans
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Bhathika Perera
- North East London NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Nagina Khan
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | - Victoria Allgar
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Truro, UK
| | - Daryl Efron
- Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ian Maidment
- College of Life and Health Sciences, Aston School of Pharmacy, Aston University, Birmingham, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Truro, UK
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Kim D. Latent Class Analysis on Types of Challenging Behavior in Persons with Developmental Disabilities: Focusing on Factors Affecting the Types of Challenging Behavior. Behav Sci (Basel) 2023; 13:879. [PMID: 37998626 PMCID: PMC10669221 DOI: 10.3390/bs13110879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
This study sought to analyze the latent classes of challenging behaviors among persons with developmental disabilities and examine the effects of related variables. To this end, the Korea Employment Agency for Persons with Disabilities collected data from the Survey on the Work and Life of Persons with Developmental Disabilities from 3000 households that included at least one family member with a developmental disability aged ≥15 years, surveying the persons themselves as well as their caregivers. As a result of the analysis, four latent classes were derived based on the types of challenging behavior and named as follows: overall challenging behavior, aggressive behavior, socially inappropriate behavior, and no challenging behavior. The main disability, disability grade, presence of multiple disabilities, disability status, activities of daily living, reading skills, writing skills, and situational awareness were significant factors affecting each latent class in the type of challenging behavior. Significant factors differed among the groups. This study identified the types of challenging behaviors and their influencing factors in a large sample of individuals with developmental disabilities and analyzed the correlation between their challenging behaviors and activities of daily living.
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Affiliation(s)
- Daeyong Kim
- Department of Behavior Analysis and Intervention, Konyang Cyber University, 158, Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea
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Kouroupa A, Hassiotis A, Hamza L, Courtenay K, Hall I, Langdon PE, Taggart L, Crossey V, Lloyd-Evans B, Morant N. Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1101-1112. [PMID: 37271584 DOI: 10.1111/jar.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/06/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. METHOD Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). RESULTS Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. CONCLUSIONS ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community.
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Affiliation(s)
| | | | - Leila Hamza
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health, NHS Trust, London, UK
| | - Ken Courtenay
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health, NHS Trust, London, UK
| | - Ian Hall
- East London NHS Foundation Trust, Hackney Integrated Learning Disability Service, London, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, University of Ulster, Antrim, UK
| | - Vicky Crossey
- South West Community Learning Disability Team & Mental Health Intensive Support and Treatment Team, NHS Lothian, Edinburgh, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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8
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Sturgeon M. The impact of mindfulness interventions for staff on the care, treatment, and experiences of people with intellectual disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:978-999. [PMID: 37475692 DOI: 10.1111/jar.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Mindfulness interventions have been shown to ameliorate stress in support staff working with people with intellectual disabilities. This review aimed to explore what impact mindfulness interventions for staff have on their care and support behaviours, and on the experiences of people with intellectual disabilities receiving support. METHOD A systematic search of PsycINFO, Web of Science, ASSIA, and PubMed identified nine studies meeting the inclusion criteria. Outcomes were collated and a quality assessment tool was used to inform the critical analysis of the studies. RESULTS Despite identified methodological issues, positive results were consistently reported. These included reduced use of restrictive practices by staff, increased positive interactions between staff and people with intellectual disabilities, and reduced aggression displayed by people with intellectual disabilities. CONCLUSIONS Further research in this area is required; however, this review supports the benefits of mindfulness on staff behaviour and the quality of life of people with intellectual disabilities.
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Affiliation(s)
- Michaela Sturgeon
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
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9
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Busch L, Saini V, Budin R, Jones RM. PRN usage before and after discharge from a forensic inpatient unit: A series example of patients with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:405-410. [PMID: 36419217 DOI: 10.1111/jar.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
Adults living with intellectual and developmental disabilities are often prescribed psychotropic medication on an "as needed" basis (PRN) in response to behavioural challenges. In the present study we conducted a retrospective analysis of medication administration records in the 6-months preceding and following discharge of 11 adults with intellectual and developmental disabilities to community settings from forensic inpatient units within a mental health hospital. We found a significant reduction in the frequency of PRN usage after discharge. We propose potential reasons for the difference in PRN administration across settings and make suggestions for future research.
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Affiliation(s)
- Louis Busch
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Valdeep Saini
- Department of Applied Disability Studies, Brock University, St. Catharines, Ontario, Canada
| | - Radek Budin
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Roland M Jones
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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10
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Tilley E, Jordan J, Larkin M, Vseteckova J, Ryan S, Wallace L. Transitions for older people with intellectual disabilities and behaviours that challenge others: A rapid scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:207-229. [PMID: 36433739 PMCID: PMC10098666 DOI: 10.1111/jar.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 09/09/2022] [Accepted: 10/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities and behaviours that challenge others are living longer. This review aimed to explore what is known about the health and social care needs, experiences, service interventions and resources of and for this population as they transition to different care contexts in the UK. METHOD A rapid scoping review of published and unpublished literature was conducted based on collaborative working with key stakeholders and using systematic methods of data searching, extraction and analysis. RESULTS Consistent social work support, skilled staff, suitable accommodation, creative engagement with individuals and families to plan ahead, and timely access to quality healthcare are all required to promote successful transitions as people age, and to avoid unwanted/inappropriate transitions at points of crisis. CONCLUSIONS More research is needed to assess the types of services that this population can and do access as they age, the quality of those services, and the extent to which local commissioners are planning ahead for people with intellectual disabilities and behaviours that challenge others.
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Affiliation(s)
- Elizabeth Tilley
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Joanne Jordan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Mary Larkin
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Jitka Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Sara Ryan
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Louise Wallace
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
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11
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Windsor C, Zhang T, Wilson NJ, Blyth K, Ballentine N, Speyer R. Psychosocial-behavioural interventions for school-aged children with intellectual disabilities: A systematic review of randomised control trials. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:458-485. [PMID: 36814060 DOI: 10.1111/jar.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/09/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Evidence-based interventions are essential for school-aged children with intellectual disabilities to facilitate development and promote future independence. METHODS Using a PRISMA approach, systematic screening of five databases was undertaken. Original randomised controlled studies with psychosocial-behavioural interventions were included where participants were school aged (5-18 yrs) with documented intellectual disability. Study methodology was assessed using the Cochrane RoB 2 tool. RESULTS Two thousand three hundred and three records were screened with 27 studies included. Studies mainly included primary school participants with mild intellectual disabilities. Most interventions focused on intellectual skills (e.g., memory, attention, literacy and mathematics) followed by adaptive skills (e.g., daily living, communication, social and education/vocation) and some focused on a combination of these. CONCLUSION This review highlights the gap in evidence-base for social, communication and education/vocation interventions with school-aged children with moderate and severe intellectual disability. Future RCTs that bridge this knowledge gap across ages and ability are required for best practice.
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Affiliation(s)
- Catriona Windsor
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Tingwei Zhang
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Katrina Blyth
- Faculty of Medicine and Health, Discipline of Speech Pathology, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Ballentine
- Rehabilitation and Physical Medicine (Medicina Física y Rehabilitación), Clinica Alemana Santiago, Vitacura, Chile
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Leif ES, Fox RA, Subban P, Sharma U. 'Stakeholders are almost always resistant': Australian behaviour support practitioners' perceptions of the barriers and enablers to reducing restrictive practices. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:66-82. [PMID: 36743316 PMCID: PMC9897749 DOI: 10.1080/20473869.2022.2116908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/18/2023]
Abstract
A restrictive practice (RP) is defined as a practice or intervention that has the effect of restricting the rights or freedom of movement of a person, and includes physical, mechanical, and chemical restraint, and seclusion. If misused or overused, RPs may present serious human rights infringements. In Australia, behaviour support practitioners who deliver behaviour support funded by the National Disability Insurance Scheme are responsible for developing positive behaviour support plans that aim to reduce and eliminate the use of RPs. At present, little is known about the barriers that behaviour support practitioners experience when attempting to reduce and eliminate the use of RPs and, conversely, what helps (or enables) them to reduce and eliminate RPs. To learn more, we conducted an online survey consisting of two open-ended questions with 109 Australian behaviour support practitioners to identify barriers and enablers. We found that fear and reluctance on the part of stakeholders were often barriers to reducing the use of RPs. However, we found that having time, funding, and resources for training, supervision, other implementation activities, care team collaboration, and data-based decision-making helped overcome barriers. We provide specific recommendations for addressing identified barriers for individual behaviour support practitioners, service provider organisations, and government and regulatory agencies.
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Affiliation(s)
- Erin S. Leif
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Russell A. Fox
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Pearl Subban
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Umesh Sharma
- Faculty of Education, Monash University, Clayton, VIC, Australia
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13
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Gast DAA, Didden R, Westera JJ, van de Rest O, van Hemert AM, Giltay EJ. Dietary supplements for aggressive behaviour in people with intellectual disabilities: A randomised controlled crossover trial. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:122-131. [PMID: 36224110 PMCID: PMC10092216 DOI: 10.1111/jar.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Aggressive incidents are common in people with intellectual disabilities. Therefore, we aimed to assess whether supplementation of multivitamins, minerals, and omega-3 fatty acids (FA) reduces aggressive incidents. METHODS We conducted a randomised, triple blind, placebo controlled, single crossover intervention trial. People with intellectual disabilities or borderline intellectual functioning, between 12 and 40 years of age, and showing aggressive behaviour were included. Participants received either a daily dose of dietary supplements, or placebo. Primary outcome was the number of aggressive incidents, measured using the Modified Overt Aggression Scale (MOAS). RESULTS there were 113 participants (placebo, n = 56), of whom 24 (placebo, n = 10) participated in the crossover phase of the trial. All 137 trajectories were included in the analyses. There was no significant difference in mean number of aggressive incidents per day between those assigned to supplements and those who received placebo (rate ratio = 0.93: 95% Confidence Interval [CI] = 0.59-1.45). CONCLUSION In this pragmatic trial, we did not find significant differences in the outcomes between the supplement and placebo arms. The COVID-19 pandemic started midway through our trial, this may have affected the results.
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Affiliation(s)
- David A A Gast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Gemiva-SVG Group, Gouda, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | | | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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14
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Fellinger J, Dall M, Weber C, Holzinger D. Communicative deficits associated with maladaptive behavior in individuals with deafness and special needs. Front Psychiatry 2022; 13:944719. [PMID: 35966495 PMCID: PMC9372491 DOI: 10.3389/fpsyt.2022.944719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND At least one in three individuals who are prelingually deaf has special needs, most commonly due to intellectual disabilities. The scant literature on challenging behavior in this population, however, suggests high rates of prevalence and an important need to better understand the contributing factors. AIM We sought to analyze the prevalence of maladaptive behavior and its association with intellectual functioning, adaptive skills, language skills, and social communication in a population of adults with deafness and special needs. METHODS Participants were 61 individuals from three therapeutic living communities established for people with deafness and special needs. The participants had a mean age of 54.7 years, 64% were male. Intellectual functioning was measured with two versions of the Snijders-Oomen Non-verbal Intelligence Scale. The Vineland-II Scales were used to assess adaptive and maladaptive behavior. Language skills were measured with instruments specifically adapted for this population, including the Reynell Developmental Language Comprehension Scale, the comprehension scale of the Child Development Inventory, and the Profile of Multiple Language Proficiencies. Due to high correlations between instruments, a composite language score was used. A specific questionnaire to measure social communication in adults with intellectual disabilities was also utilized. RESULTS The mean nonverbal developmental reference age was 6.5 years, whereas the equivalent for the language measures was about 3.5 years. The prevalence rate of elevated maladaptive behavior was 41% (v-scale score ≥18) and 18% of the participants had a clinically significant score (v-scale score ≥21). Regression analyses showed that only language and social communication skills were significantly associated with maladaptive behavior, while intellectual functioning and adaptive skills were not. CONCLUSION These findings emphasize the importance of the constant promotion of communicative skills, as those people with better language and social communication skills demonstrate lower levels of maladaptive behavior.
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Affiliation(s)
- Johannes Fellinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria.,Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria.,Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Magdalena Dall
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Christoph Weber
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria.,Department for Inclusive Education, University of Education Upper Austria, Linz, Austria
| | - Daniel Holzinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria.,Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria.,Institute of Linguistics, Faculty of Humanities, University of Graz, Graz, Austria
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15
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Razali NA, Mohd Daud TI, Woon LSC, Mohamed Saini S, Muhammad NA, Sharip S. Case report: Bipolar disorder in 48,XXYY syndrome. Front Psychiatry 2022; 13:1080698. [PMID: 36713919 PMCID: PMC9874087 DOI: 10.3389/fpsyt.2022.1080698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
48,XXYY syndrome is a rare condition. The presentations of impulsive and aggressive behavior have been reported in several case reports among patients with 48,XXYY syndrome. The management of the psychological impact and neuropsychiatric sequela of this condition is a significant issue faced by families, carers, and healthcare professionals. We report a patient, 21-year-old Malay male, with underlying 48,XXYY syndrome with attention deficit hyperactivity disorder (ADHD) and intellectual disability, diagnosed later in adulthood with a bipolar mood disorder and benefited after being started on lithium. We describe the key clinical features and diagnostic workouts that allowed the arrival of the correct psychiatric diagnosis. Challenges in psychopharmacotherapy, including the risks of metabolic syndrome and deep vein thrombosis associated with 48,XXYY syndrome, are also considered. We suggest that for patients with 48,XXYY syndrome, routine psychological screening for mood symptoms such as mania and depression should be done by healthcare professionals with early involvement of psychiatrist in the multidisciplinary team due to the challenges in the management of these patients.
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Affiliation(s)
- Nur Atikah Razali
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Tuti Iryani Mohd Daud
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Suriati Mohamed Saini
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Noor Azimah Muhammad
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shalisah Sharip
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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16
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Naqvi D, Perera B, Mitchell S, Sheehan R, Shankar R. COVID-19 pandemic impact on psychotropic prescribing for adults with intellectual disability: an observational study in English specialist community services. BJPsych Open 2021; 8:e7. [PMID: 34865678 PMCID: PMC8649353 DOI: 10.1192/bjo.2021.1064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has had a disproportionate impact on people with intellectual disability (PwID). PwID are at higher risk of mental illness and receive psychotropic prescribing 'off licence' also, to manage distress behaviour. The lockdown and reduction of multidisciplinary face-to-face appointments had an impact on care delivery, the recourse possibly being psychotropic prescribing. It is imperative to comprehend the influence the pandemic had on psychotropic prescribing patterns to enable future planning. AIMS The aim was to understand the impact of the pandemic by comparing psychotropic prescribing patterns during the England lockdown with the prescribing patterns before lockdown in specialist urban and rural psychiatric services for PwID. METHOD Data was collected from Cornwall (rural) and London (urban) intellectual disability services in England as a service evaluation project to rationalise psychotropic prescribing. PwID in both services open across January 2020 to January 2021 were included. Baseline patient demographics including age, gender, ethnicity, intellectual disability level and neurodevelopmental and psychological comorbidities were collected. Baseline psychotropic prescribing and subsequent % change for each psychotropic group for the two services was compared using Pearson's chi-square and z-statistic (two tailed) with significance taken at P < 0.05. RESULTS The two centres London (n = 113) and Cornwall (n = 97) were largely comparable but for baseline differences in terms of presence of severe mental illness (37 v. 86, P < 0.001), challenging behaviour (44 v. 57, P < 0.05) and attention-deficit hyperactivity disorder (37 v. 3, P < 0.001). There was an overall increase in psychotropic prescribing during lockdown in urban as compared with rural settings (11% v. 2%). CONCLUSIONS The pandemic caused an increase in psychotropic prescribing associated with lockdown severity and urban settings. Team structures could have played a role.
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Affiliation(s)
- Danial Naqvi
- Barnet Enfield and Haringey Mental Health Trust, UK
| | | | | | - Rory Sheehan
- Institute of Psychiatry, Psychology and Neuroscience, King's College, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, UK; and Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula School of Medicine, UK
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17
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Oudshoorn CEM, Frielink N, Nijs SLP, Embregts PJCM. Psychological eHealth interventions for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:950-972. [PMID: 33704872 PMCID: PMC8359285 DOI: 10.1111/jar.12877] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of eHealth, which has accelerated in the wake of the COVID-19 pandemic, could contribute to the access to tailor-made psychological interventions for people with intellectual disabilities. METHOD A scoping review was conducted on peer-reviewed studies between 1996-2019. RESULTS Thirty-three studies reported on the use of psychological eHealth interventions focused on mental health problems and/or challenging behaviour. The vast majority of these studies reported on interventions that were delivered at the individual level. The context in which these interventions were delivered varied, primarily ranging from the home setting to residential settings, as well as day or activity centres and schools. The studies described various types of interventions: telehealth interventions, computerized cognitive behavioural therapy, and interventions focused on (social) learning principles targeting challenging behaviour. CONCLUSIONS eHealth provides new opportunities for both therapists and lay-therapists to deliver psychological interventions. Future studies should focus on the effectiveness of psychological eHealth interventions.
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Affiliation(s)
- Cathelijn E. M. Oudshoorn
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - Noud Frielink
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Sara L. P. Nijs
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Petri J. C. M. Embregts
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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18
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Inoue M, Inada N, Gomi Y, Aita C, Shiga T. Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form. Brain Dev 2021; 43:673-679. [PMID: 33589317 DOI: 10.1016/j.braindev.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/01/2021] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Behavior Problems Inventory-Short Form (BPI-S), which assesses behavior problems in individuals with intellectual disabilities (ID), is a shorter version of the BPI-01. This study investigated the reliability and validity of the BPI-S Japanese version (BPI-S-J) for adolescents/adults with ID and behavior problems. METHODS The test-retest reliability included participants with ID and behavioral problems who were enrolled in welfare services. For test-retest reliability, 42 caregivers independently responded to the BPI-S-J every two weeks. Inter-rater reliability was independently assessed using the BPI-S-J by two caregivers who were familiar with the 42 participants. The participants of the validity assessment were 227 students from special needs schools or patients with ID admitted to medical institutions. The total frequency total score was compared based on the degree of ID. To examine the criterion-related validity, we analyzed the total frequency score, the total score of the Criteria for Determining Severe Problem Behavior (CDSPB) and the total score of the Aberrant Behavior Checklist-Japanese version (ABC-J). RESULTS The BPI-S-J of test-retest reliability was satisfactory (intra-class correlation; ICC) = 0.954), and the total score significantly (ICC = 0.721) represented good inter-rater reliability. For the validity, the BPI-S-J score of participants who had severe and profound ID was significantly higher than those who had mild and moderate ID. Significant correlations were observed between the BPI-S-J score and CDSPB score (r = 0.499), and the ABC-J score (r = 0.699), indicating adequate criterion-related validity. CONCLUSION This study showed the utility of the BPI-S-J to assess behavior problems in the Japanese ID population.
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Affiliation(s)
- Masahiko Inoue
- Tottori University Graduate School of Medical Sciences, Japan.
| | - Naoko Inada
- Teikyo University Department of Psychology, Faculty of Liberal Arts, Japan
| | - Yoichi Gomi
- Gunma University Student Service Center, Japan
| | - Chie Aita
- National Hospital Organization Hizen Psychiatric Center, Japan
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19
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Murray GC, McKenzie K, Martin R, Murray A. The impact of COVID-19 restrictions in the United Kingdom on the positive behavioural support of people with an intellectual disability. BRITISH JOURNAL OF LEARNING DISABILITIES 2021; 49:138-144. [PMID: 33821134 PMCID: PMC8014888 DOI: 10.1111/bld.12379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED The way that people with an intellectual disability are supported is very important.The COVID-19 virus has changed the way that staff help people with an intellectual disability.We wanted to know about those changes and whether learning about positive behavioural support (PBS) helped staff to cope with them.The main changes were that people with an intellectual disability could not go out or see family and friends as often.Staff came up with new things to do for the people they supported, and PBS learning seemed to help staff to cope. BACKGROUND It has been suggested that COVID-19 and the associated restrictions are likely to have a negative impact on the provision of positive behavioural support (PBS) to people with an intellectual disability. METHODS Fifty-eight staff, who had recently completed an accredited positive behavioural support (PBS) programme, responded to an online questionnaire, which asked them to rate the impact of COVID-19 on factors related to PBS. RESULTS Participants reported a neutral or somewhat positive impact on all the areas measured, with the exception of the activities and quality of life of those they supported, which were somewhat negatively affected. The participants rated the learning from their PBS programme as helping them cope with COVID-19 to some extent. Examples of positive and negative effects and ways in which PBS helped staff to cope are presented. CONCLUSIONS Many staff developed creative solutions that allowed them to provide PBS despite the COVID-19 restrictions. PBS learning appeared to help staff cope with the negative impact of the restrictions.
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Affiliation(s)
- George C. Murray
- Northumbria UniversityNewcastle upon TyneUK
- NHS LothianEdinburghUK
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20
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McKenzie K, Murray GC, Martin R. 'It's been adapted rather than impacted': A qualitative evaluation of the impact of Covid-19 restrictions on the positive behavioural support of people with an intellectual disability and/or autism. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1089-1097. [PMID: 33484052 PMCID: PMC8014744 DOI: 10.1111/jar.12859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND We used a qualitative approach to explore the experiences of social care staff regarding the provision of positive behavioural support (PBS) to people with an intellectual disability at the height of the Covid-19 restrictions. METHOD We conducted semi-structured interviews with 19 staff who had recently completed a PBS workforce development programme. Data were analysed using thematic analysis. RESULTS Three themes were identified in the context of the restrictions: The challenges to maintaining quality of life and PBS of the people being supported and staff attempts to overcome these; the ways in which PBS and behaviour support plans were implemented and the impact on behaviours that challenge; the ways in which PBS principles were applied at organisational levels to help to understand and address staff stress and distress. CONCLUSIONS Overall, the staff identified many unexpected benefits of the restrictions. The results are discussed in the context of the study limitations.
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Affiliation(s)
- Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - George C Murray
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK.,NHS Lothian, Edinburgh, UK
| | - Rachel Martin
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
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21
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Bogenschutz M, Broda M, Lineberry S, Dinora P, Prohn S. Testing a Wellness Indicators Measure for People with Intellectual and Developmental Disabilities a. DEVELOPMENTAL DISABILITIES NETWORK JOURNAL 2021; 2:85-103. [PMID: 35721389 PMCID: PMC9201682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE People with intellectual and developmental disabilities (IDD) often have health and wellness issues that are not as good as people without disabilities. States are required to monitor health and wellness for people with IDD who use many disability services. However, there are few ways to monitor wellness between states or at different points in time. In this study, we share a new model that states may use to monitor wellness of people with IDD. METHODS We used data from a survey called the National Core Indicators (NCI) to develop this model. First, we developed the model using our state's data. Then, after we found a model that worked well, we tested that model using the National Core Indicators from the entire U.S. RESULTS Our final model worked well in both our state NCI data and the national NCI data. This is important because policies at both levels can affect the services that people with disabilities can use. Our model had three parts: heart health, mental health, and behavioral wellness. These are described more in the paper. We also used statistics to test some factors that might predict outcomes related to heart health, mental health, and behavioral wellness. Age, sex, where someone lives, and level of intellectual disability were all good predictors of all three categories of wellness that we studied. IMPLICATIONS The model of wellness that we developed worked well but should be tested using data from other individual states. It is very important to know about health and wellness right now since the services people with disabilities can use are changing in many states. We think our model can help planners and advocates understand how services affect wellness in a way that is easy to compare from state to state and at different points in time.
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Affiliation(s)
| | | | | | | | - Seb Prohn
- Virginia Commonwealth University, Richmond, VA
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22
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Womack KN, Alvord TW, Trullinger-Dwyer CF, Rice SPM, Olson R. Challenging Aggressive Behaviors Experienced by Personal Support Workers in Comparison to Home Care Workers: Relationships between Caregiver Experiences and Psychological Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5486. [PMID: 32751378 PMCID: PMC7432386 DOI: 10.3390/ijerph17155486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Personal support workers (PSW) are caregivers for children and adults with intellectual and developmental disabilities (IDDs) or adults experiencing mental illness or other behavioral health conditions. The work can be very meaningful, but many PSWs must prepare for, monitor, and manage challenging behaviors, including aggression. This study was designed to estimate the prevalence of aggression experienced by PSWs in Oregon, and compare it to a previous sample of Oregon home care workers (HCWs). This comparison included an analysis of relationships between exposures to aggression and psychological health factors. PSWs in Oregon (N = 240) were surveyed electronically at a single time point. PSWs generally reported higher rates of exposure to aggression compared to HCWs. Experiences with aggression were positively associated with fatigue and weakly associated with depression, but not stress. PSWs' self-reported lost work time injury rate was elevated compared to the US average, but it was comparable to previous self-reported injury rates from HCWs. Physical demands of work were the most prevalent reported primary safety concern, followed by challenging behaviors (including aggression). Developing tailored training to help PSWs understand, plan for, minimize, and manage challenging behaviors is a social priority.
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Affiliation(s)
- Kelsey N. Womack
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Teala W. Alvord
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
| | - Caitlyn F. Trullinger-Dwyer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Sean P. M. Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
- Department of Psychology, OHSU-Portland State University (PSU), Portland, OR 97201, USA
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