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Watson E, Raghavendra P, Lawn S, Watson J. Improving communication access in psychoeducational interventions for people with complex communication needs: a scoping review and stakeholder consultation. Disabil Rehabil 2023; 45:3388-3406. [PMID: 36172972 DOI: 10.1080/09638288.2022.2127932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Psychoeducational interventions are commonly used to improve mental health among the general population; however, their application among people with complex communication needs is under explored. This scoping review aims to identify the psychoeducational interventions utilised with people with complex communication needs, any adaptations to improve communication access, and outcomes for this population. MATERIALS AND METHODS The scoping review was conducted using the Arksey and O'Malley guidelines and included stakeholder consultations. A systematic search of the literature was conducted. Stakeholder consultations were conducted via semi-structured interviews with informants from three populations: people with complex communication needs, everyday communication partners and mental health workers. RESULTS The search yielded 2112 articles. Twenty-four articles were retained for data extraction. Numerical analysis provided an overview of the existing literature. Thematic analysis highlighted the range of communication access strategies applied within psychoeducational interventions. Common aims and outcomes of interventions occurred across three interrelated themes: education, symptom reduction, and improved coping and wellbeing. Stakeholder consultations enabled contextualisation of literature. CONCLUSIONS People with complex communication needs may benefit from psychoeducational interventions when effective, personalised communication access strategies are employed. Future research should include lived-experience perspectives to ensure the relevance of communication access strategies in mental health support.Implications for rehabilitationThis scoping review adds to the evidence base supporting equitable access to mental health support for people with complex communication needs.A range of specific strategies are presented for mental health workers to consider when working with people with complex communication needs.Positive behaviour support (PBS) practitioners must be equipped to address the psychoeducational and mental health support requirements of people with complex communication needs.
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Affiliation(s)
- Eleanor Watson
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Parimala Raghavendra
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
| | - Joanne Watson
- School of Health & Social Development, Deakin University, Melbourne, Australia
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Tapp K, Vereenooghe L, Hewitt O, Scripps E, Gray KM, Langdon PE. Psychological therapies for people with intellectual disabilities: An updated systematic review and meta-analysis. Compr Psychiatry 2023; 122:152372. [PMID: 36724728 DOI: 10.1016/j.comppsych.2023.152372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities. METHOD A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy. RESULTS Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [-0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [-0.10, 0.85], N = 216, after outliers were removed. CONCLUSIONS Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions.
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Affiliation(s)
- Katherine Tapp
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Leen Vereenooghe
- v. Bodelschwinghsche Stiftungen Bethel, Psychologischer Dienst, proWerk, Nazarethweg 4, 33617 Bielefeld, Germany
| | - Olivia Hewitt
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Berkshire Healthcare NHS Foundation Trust, Learning Disabilities Service, Erlegh House, Earley Gate, Whiteknights Road, Reading, Berkshire RG6 6BZ, United Kingdom
| | - Emma Scripps
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Department of Psychiatry, School of Clinical Health Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, Birmingham B37 5RY, United Kingdom; Herefordshire and Worcestershire Health and Care NHS Trust, 2 Kings Way, Charles Hastings Way, Worcester WE5 1JR, United Kingdom; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom.
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Ee J, Stenfert Kroese B, Rose J. Experiences of mental health professionals providing services to adults with intellectual disabilities and mental health problems: A systematic review and meta-synthesis of qualitative research studies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:758-781. [PMID: 34165022 PMCID: PMC9442780 DOI: 10.1177/17446295211016182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mental health professionals play an important role in providing care and treatment for adults with intellectual disabilities. A number of studies use qualitative methods to explore the experiences of these professionals and their perspectives regarding the mental health services for this population. A systematic review using meta-ethnographic approach was undertaken to summarise this research. METHOD A systematic search found 14 relevant studies which were critically appraised. Key themes from these studies were extracted and synthesised. RESULTS Three main themes were identified: 1) Understanding the person, 2) Relational interaction and 3) Organisational factors. CONCLUSIONS The findings of this review identified the issues mental health professionals raised in relation to their work. They described the complex presenting problems as intense yet fulfilling therapeutic relationships with their clients and their wish to improve their knowledge and skills. They identified organisational issues that need to be addressed to improve staff morale and efficiency.
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Affiliation(s)
| | | | - John Rose
- John Rose, Centre for Applied Psychology,
School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15
2TT, UK.
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Ee J, Lim JM, Stenfert Kroese B, Rose J. Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 67:371-380. [PMID: 34570836 PMCID: PMC8451686 DOI: 10.1080/20473869.2021.1932394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 06/13/2023]
Abstract
Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.
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Affiliation(s)
- Jonathan Ee
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Jan Mei Lim
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Biza Stenfert Kroese
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
| | - John Rose
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
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Hronis A, Roberts L, Kneebone I. Assessing the Confidence of Australian Mental Health Practitioners in Delivering Therapy to People With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 56:202-211. [PMID: 29782234 DOI: 10.1352/1934-9556-56.3.202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research supports the use of psychological therapies among people with mild to moderate intellectual disability (ID). One barrier to people with ID accessing psychological treatments is the confidence of mental health practitioners. This article explores the confidence of Australian clinicians in providing therapy to people with ID. One hundred and fifty-two psychologists and counselors in Australia completed a survey exploring self-reported confidence when working with clients who have ID and mental health difficulties. Clinicians were most confident with generic counseling skills, but less confident with elements of assessments and interventions. The use of treatment protocols was endorsed as helpful particularly among those with low confidence. This highlights the need for dissemination of treatment guides and training to help increase clinician confidence.
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Affiliation(s)
- Anastasia Hronis
- Anastasia Hronis, Lynette Roberts, and Ian Kneebone, University of Technology Sydney
| | - Lynette Roberts
- Anastasia Hronis, Lynette Roberts, and Ian Kneebone, University of Technology Sydney
| | - Ian Kneebone
- Anastasia Hronis, Lynette Roberts, and Ian Kneebone, University of Technology Sydney
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Dagnan D, Masson J, Thwaites R, James A, Hatton C. Training therapists to work with people with intellectual disability in Improving Access to Psychological Therapies (IAPT) services. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:760-767. [PMID: 29152833 DOI: 10.1111/jar.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current policy in the England suggests that people with intellectual disabilities should, where possible, access mainstream mental health services; this should include access to mainstream therapy services. It is likely that mainstream therapists will need training and support to work with people with intellectual disabilities. METHOD Sixty-eight therapists working in an English Improving Access to Psychological Therapies (IAPT) service received one- or 2-day training on working with people with intellectual disabilities. Measures of confidence, general therapeutic self-efficacy and attitudes to people with intellectual disabilities' use of mainstream mental health services were completed pre-training, post-training and at 3-month follow-up; at which time, 12 participants were interviewed about the impact of the training on their practice. RESULTS There was a significant positive change in all measures immediately post-training which was maintained at 3-month follow-up. CONCLUSIONS Training considerations for mainstream therapists who may work with people with intellectual disabilities are discussed.
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Affiliation(s)
- Dave Dagnan
- Community Learning Disability Services, Unit 1, Lakeland Business Centre, Cumbria Partnership NHS Foundation Trust, Workington, UK
| | - John Masson
- Community Learning Disability Services, Unit 1, Lakeland Business Centre, Cumbria Partnership NHS Foundation Trust, Workington, UK
| | | | - Amy James
- Community Learning Disability Services, Unit 1, Lakeland Business Centre, Cumbria Partnership NHS Foundation Trust, Workington, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Marwood H, Chinn D, Gannon K, Scior K. The experiences of high intensity therapists delivering cognitive behavioural therapy to people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:76-86. [DOI: 10.1111/jar.12328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hayley Marwood
- Charlie Waller Institute; School of Psychology; University of Reading; UK
| | - Deborah Chinn
- Florence Nightingale Faculty of Nursing and Midwifery and the Centre for Language; Discourse and Communication; Kings College London; UK
| | | | - Katrina Scior
- Clinical Educational & Health Psychology; University College London; UK
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Dagnan D, Masson J, Cavagin A, Thwaites R, Hatton C. The Development of a Measure of Confidence in Delivering Therapy to People with Intellectual Disabilities. Clin Psychol Psychother 2014; 22:392-8. [PMID: 24802005 DOI: 10.1002/cpp.1898] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/06/2022]
Abstract
UNLABELLED Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale-Intellectual Disabilities [TCS-ID]). One-hundred and eighty-one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test-retest reliability purposes. One-hundred and seven people also completed a scale of general therapy self-efficacy. The TCS-ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test-retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS-ID and the General Therapy Self-efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS-ID was used pre-training and post-training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. KEY PRACTITIONER MESSAGE There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services. There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services. The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services. The Therapy Confidence Scale-Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities.
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Affiliation(s)
- Dave Dagnan
- Community Learning Disability Services, Cumbria Partnership NHS Foundation Trust, Workington, Cumbria, UK
| | - John Masson
- Community Learning Disability Services, Cumbria Partnership NHS Foundation Trust, Workington, Cumbria, UK
| | - Amy Cavagin
- Community Learning Disability Services, Cumbria Partnership NHS Foundation Trust, Workington, Cumbria, UK
| | - Richard Thwaites
- First Step, Cumbria Partnership NHS Foundation Trust, Elmwood, Penrith, Cumbria, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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Stenfert Kroese B, Jahoda A, Pert C, Trower P, Dagnan D, Selkirk M. Staff Expectations and Views of Cognitive Behaviour Therapy (CBT) for Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 27:145-53. [DOI: 10.1111/jar.12059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew Jahoda
- Institute of Health andWellbeing; College of Veterinary Medical and Life Sciences; University of Glasgow; Glasgow UK
| | - Carol Pert
- Institute of Health andWellbeing; College of Veterinary Medical and Life Sciences; University of Glasgow; Glasgow UK
| | - Peter Trower
- School of Psychology; University of Birmingham; Birmingham UK
| | - Dave Dagnan
- Institute of Health Research; University of Lancaster; Lancaster UK
| | - Mhairi Selkirk
- Institute of Health andWellbeing; College of Veterinary Medical and Life Sciences; University of Glasgow; Glasgow UK
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Rose N, Kent S, Rose J. Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:854-864. [PMID: 21917050 DOI: 10.1111/j.1365-2788.2011.01476.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. DESIGN A cross-sectional design was used. METHODS A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. RESULTS Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. CONCLUSIONS The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.
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Affiliation(s)
- N Rose
- Psychological Heath Service, Black Country Partnership NHS Foundation Trust, Stourbridge, UK.
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How do staff psychological factors influence outcomes for people with developmental and intellectual disability in residential services? Curr Opin Psychiatry 2011; 24:403-7. [PMID: 21587078 DOI: 10.1097/yco.0b013e3283476b0b] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW A broad range of organizational issues can have an impact on client outcomes in residential services for people with intellectual disabilities, and staff psychological factors are increasingly being recognized as important. This review explores some of the recent literature on staff attitudes, attributions, well being and other factors that may impact on outcomes for residents. RECENT FINDINGS Staff beliefs are associated with the relationship between challenging behaviour and burnout experienced by staff; resident outcomes such as placement breakdown may also be influenced by staff attributions. There is also a body of evidence emerging that suggests staff psychological factors may influence the quality of physical healthcare received by people with intellectual disabilities. SUMMARY Sufficient evidence exists to suggest that clinicians should routinely consider assessing and evaluating staff psychological factors in clinical interventions in order to assess their potential impact on client care. Further research is required, particularly, to evaluate the specific impact of staff psychological factors on resident outcome.
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