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Hermsen M, Simons R, van Veen H, Prudon A, Rooijackers L, Otten R, Koordeman R. Building high-quality interpersonal staff-client relationships with people with severe to profound intellectual disabilities and challenging behavior: Insights of professionals and relatives. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:17-34. [PMID: 36198498 DOI: 10.1177/17446295221131443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Staff-client relationships impact the quality of support and life of people with severe to profound intellectual disabilities and challenging behavior, but are challenging to build due to clients' intense, complex and varying support needs. The present study explores the perspectives of professionals and relatives on what affects these interpersonal relationships. Method: 17 professionals and 11 relatives participated in focus groups and interviews. Data collection and analysis was performed in collaboration with a co-researcher. Data were synthesized thematically. Results: Interpersonal relationships constituted equivalence, striving for mutual understanding, trust and exploring clients' potential. The combination of staff characteristics (enthusiasm/passion, patience, resilience, creativity/humor, flexibility) and expertise (knowledge, vulnerability/sincerity, self-reflection) enabled staff to build these relationships. The importance of involving relatives was addressed. Contextual influences included the team (cooperation, flexibility, culture), organization (cooperation, boundary conditions) and setting (predictability, interior/atmosphere). Conclusions: The findings make practical knowledge explicit and scientifically underpinned for this specific population.
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Affiliation(s)
| | - Rianne Simons
- Pluryn, Netherlands
- Radboud University Nijmegen, Netherlands
| | | | | | | | - Roy Otten
- Pluryn, Netherlands
- Radboud University Nijmegen, Netherlands
- Arizona State University, Tempe, AZ, USA
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2
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Fisher AC, Reschke K, Shah N, Cheung S, O’Connor C, Piguet O. "It's Opened My Eyes to a Whole New World": Positive Behaviour Support Training for Staff and Family Members Supporting Residents With Dementia in Aged Care Settings. Am J Alzheimers Dis Other Demen 2024; 39:15333175241241168. [PMID: 38536663 PMCID: PMC10976499 DOI: 10.1177/15333175241241168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study examined the acceptability and usefulness of Positive Behaviour Support (PBS) training in enhancing the capabilities of support staff and family members providing behaviour support to residents with dementia in residential aged care (RAC). METHODS A mixed-methods pilot study was conducted across 3 RAC organisations, involving pre- and post-training questionnaire assessments for clinical leaders (n = 8), support staff (n = 37) and family members (n = 18). RESULTS Findings indicated increased confidence among support staff and family members in providing behaviour support, with 96% indicating it would support their practices across settings. Key training benefits included identifying and addressing underlying causes of challenging behaviours. A majority (89%) expressed the need for further behaviour support training. CONCLUSION Recommendations focus on developing systems to enable effective and collaborative behaviour support practices. Further research is needed to examine application of PBS principles and planning for residents living with dementia.
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Affiliation(s)
- Alinka C. Fisher
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Katrina Reschke
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Nijashree Shah
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Sau Cheung
- FRONTIER, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | | | - Olivier Piguet
- FRONTIER, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
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3
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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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4
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Donnelly LJ, Cervantes PE, Guo F, Stein CR, Okparaeke E, Kuriakose S, Filton B, Havens J, Horwitz SM. Changes in Attitudes and Knowledge after Trainings in a Clinical Care Pathway for Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:606-614. [PMID: 33201422 DOI: 10.1007/s10803-020-04775-y] [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] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.
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Affiliation(s)
- Lauren J Donnelly
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA.
| | - Paige E Cervantes
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Fei Guo
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Division of Biostatistics, Department of Population Heath, NYU Langone, New York, NY, USA
| | - Cheryl R Stein
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Eugene Okparaeke
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah Kuriakose
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Beryl Filton
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Jennifer Havens
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Office of Behavioral Health, NYC Health and Hospitals, New York, NY, USA
| | - Sarah M Horwitz
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
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5
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Mahon D, Walsh E, Holloway J, Lydon H. A systematic review of training methods to increase staff's knowledge and implementation of positive behaviour support in residential and day settings for individuals with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:732-757. [PMID: 34219540 PMCID: PMC9442775 DOI: 10.1177/17446295211022124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 06/13/2023]
Abstract
Behaviour support plans (BSPs), if accurately implemented, have been found to increase skills and decrease challenging behaviour of individuals with intellectual and developmental disabilities. Training is essential for staff to acquire the skills necessary for accurate implementation. The aim of this systematic literature review was to evaluate procedures used to train staff in Positive Behaviour Support (PBS), on both knowledge of PBS and implementation of BSPs. Systematic searches of 4 databases identified 18 studies as meeting criteria. Findings indicate that description alone was not consistently effective in increasing knowledge and should be used in combination with other training strategies. Staff's implementation of BSPs were increased by different combinations of the following training components: description, feedback, modelling, role-play, monitory incentive, and escape contingency. To identify evidenced based practice when training staff on BSPs, it is necessary to evaluate active and feasible training components from current training models.
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Affiliation(s)
| | | | | | - Helena Lydon
- Helena Lydon, Applied Behaviour Research
Clinic, School of Psychology, National University of Ireland, Galway, Ireland.
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Martin A, Tyrrell S, Honey E, Rodgers J, Ingham B. What Promotes Transfer of Staff Training Related to Challenging Behavior Displayed by Adults With Intellectual Disabilities? JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Aisling Martin
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust Newcastle upon Tyne UK
- Newcastle University Newcastle upon Tyne UK
| | - Sophie Tyrrell
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust Newcastle upon Tyne UK
| | - Emma Honey
- Newcastle University Newcastle upon Tyne UK
| | | | - Barry Ingham
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust Newcastle upon Tyne UK
- Newcastle University Newcastle upon Tyne UK
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Umb Carlsson Õ. Health-promotion intervention in a group home: Perspectives of residents, staff and rehabilitation professionals. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:210-229. [PMID: 31566071 DOI: 10.1177/1744629519874970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Promoting healthier lifestyles in people with intellectual disabilities is important in order to improve health and reduce health inequalities. Few studies have explored how health-promotion interventions for people with intellectual disabilities in community-based settings are experienced. The aim of this study was to explore residents', staff members' and rehabilitation professionals' experiences of how a health-promotion intervention affected the habits of people living in a group home regarding eating habits and physical activities and staffs' ways of working. Semi-structured group interviews were conducted with five residents, six staff members and five rehabilitation professionals. The group discussions were analysed with content analysis separately for each group. Four different categories described residents', staff members' and rehabilitation professionals' views respectively. It is suggested that including people with intellectual disabilities as active parties throughout the process would facilitate implementation of a health-promotion profile in community residences.
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8
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Klaver M, van den Hoofdakker BJ, Wouters H, de Kuijper G, Hoekstra PJ, de Bildt A. Exposure to challenging behaviours and burnout symptoms among care staff: the role of psychological resources. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:173-185. [PMID: 33331049 PMCID: PMC7839462 DOI: 10.1111/jir.12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Staff supporting individuals with intellectual disabilities are at risk of burnout symptoms. Evidence suggests an association between exposure to challenging behaviours of individuals with intellectual disabilities and burnout symptoms of staff, but the protective role of staff psychological resources in this relation has been understudied. METHOD We investigated the association between exposure to challenging behaviours and burnout symptoms of staff and the direct and moderating effects of several psychological resources. Staff (N = 1271) completed an online survey concerning burnout symptoms (subscale Emotional Exhaustion of the Maslach Burnout Inventory), exposure to challenging behaviours and a range of potential psychological resources. We examined main and moderating effects with multilevel analyses. In order to control for the multiple comparisons, P values corrected for false discovery rate (PFDR ) were reported. RESULTS We found a direct relation between exposure to challenging behaviours and increased levels of burnout symptoms in staff (b = .15, t(670) = 4.466, PFDR < .0001). Perceived supervisor social support (b = -.97, t(627) = -7.562, PFDR < .0001), staff self-efficacy (b = -.23, t(673) = -3.583, PFDR < .0001), resilience (b = -.19, t(668) = -2.086, PFDR < .05) and extraversion (b = -.20, t(674) = -3.514, PFDR < .05) were associated with reduced burnout symptoms. None of the proposed psychological resources moderated the association between exposure to challenging behaviours and burnout symptoms of staff. CONCLUSIONS Of the psychological resources found to be associated with reduced risk of burnout symptoms, staff self-efficacy and access of staff to supervisor social support seem to be the factors that can be influenced best. These factors thus may be of importance in reducing the risk of developing burnout symptoms and improving staff well-being, even though the current study was not designed to demonstrate causal relations between psychological resources and burnout symptoms.
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Affiliation(s)
- M. Klaver
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - B. J. van den Hoofdakker
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - H. Wouters
- General Practitioners Research InstituteGroningenThe Netherlands
| | - G. de Kuijper
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - P. J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - A. de Bildt
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
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9
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Organisational interventions for decreasing the use of restrictive practices with children or adults who have an intellectual or developmental disability. Hippokratia 2021. [DOI: 10.1002/14651858.cd013840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Inoue M, Kaneko S. Survey of Japanese Welfare Facility Staff and Special School Teachers Facing Difficulties at Work with Persons with Challenging Behaviors. Yonago Acta Med 2020; 63:326-334. [PMID: 33253331 PMCID: PMC7683893 DOI: 10.33160/yam.2020.11.018] [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: 09/17/2020] [Accepted: 10/22/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective training programs for managing people with challenging behaviors should be established in both welfare and education settings, as it is important that the support system for challenging behaviors covers the entire life span. For consistent support, it is necessary to understand the difficulties and needs of support staff in caring for people with challenging behaviors from infancy through adulthood. The purpose of this study was to gather data from welfare facility staff and special school teachers regarding their difficulties and needs for managing challenging behaviors, and to determine the differences between teachers and staff members. METHODS We investigated Japanese special school teachers (n = 317) and the staff of welfare facilities for intellectual disabilities (n = 202) regarding their difficulties and needs. The questionnaire comprised 23 items related to the needs and difficulties in responding to challenging behaviors. RESULTS Three factors were extracted from the analysis of the survey items: "Difficulty in coordination and information sharing with other organizations," "Difficulty in the workplace," and "Difficulty in support and response." The overall trend was that welfare staff have more difficulties and needs than special school teachers. CONCLUSION It is necessary to emphasize not only how to respond to challenging behavior but also the importance of establishing a collaborative system within the workplace and with other organizations for staff training in light of their perceptions of working conditions.
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Affiliation(s)
- Masahiko Inoue
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan and
| | - Shuhei Kaneko
- Faculty of Human Environmental Studies, Kyushu University, Fukuoka 819-0395, Japan
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11
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Lines J, Combes H, Richards R. Exploring how support workers understand their role in supporting adults with intellectual disabilities to access the Internet for intimate relationships. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:556-566. [PMID: 33070410 DOI: 10.1111/jar.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some adults with intellectual disabilities need support to access the Internet. This study explores how support workers understand their role in facilitating Internet access for intimate relationships. METHOD Eight support workers in the West Midlands of the UK were interviewed face-to-face, using semi-structured interviews and a thematic analysis was used to interpret the data. RESULTS Three main themes emerged; social and organizational dilemmas (including sub-themes of; role and moral positioning, expectations of support, and protected and reflective space), power and position and policy dilemmas. CONCLUSION Support workers said that adults with intellectual disabilities should have access to the Internet for intimate relationships. There was a range of views on whether it was their job to support this. A lack of training in Internet use was highlighted.
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Affiliation(s)
- Jason Lines
- Staffordshire University, Stoke-on-Trent, UK
| | | | - Ruth Richards
- North Staffordshire Combined Health Care, Harplands Hospital, Stoke-on-Trent, UK
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Klaver M, Bildt A, Bruinsma E, Kuijper G, Hoekstra PJ, Hoofdakker B. First Steps Toward Positive Behavior Support in the Netherlands: A Pilot Study Exploring the Effectiveness of a Training for Staff. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marian Klaver
- Centre for Intellectual Disability and Mental Health Assen The Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
| | - Annelies Bildt
- Centre for Intellectual Disability and Mental Health Assen The Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
- Accare, University Centre for Child and Adolescent Psychiatry Groningen The Netherlands
| | - Eke Bruinsma
- Centre for Intellectual Disability and Mental Health Assen The Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
| | - Gerda Kuijper
- Centre for Intellectual Disability and Mental Health Assen The Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
| | - Barbara Hoofdakker
- Centre for Intellectual Disability and Mental Health Assen The Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre Groningen Groningen The Netherlands
- Accare, University Centre for Child and Adolescent Psychiatry Groningen The Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of Groningen Groningen The Netherlands
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall IS, Crabtree J, Omar RZ, King M, Hunter R, Biswas A, Cooper V, Howie W, Crawford MJ. Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial. Br J Psychiatry 2018; 212:161-168. [PMID: 29436314 DOI: 10.1192/bjp.2017.34] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability. Aims To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276). METHOD We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants. RESULTS No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = -2.14, 95% CI: -8.79, 4.51) or secondary outcomes. CONCLUSIONS Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour. Declaration of interest None.
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Affiliation(s)
- Angela Hassiotis
- University College London Division of Psychiatry,UK and Camden and Islington NHS Foundation Trust,UK
| | | | - Andre Strydom
- King's College London and South London and the Maudsley NHS Foundation Trust,UK
| | | | - Ian S Hall
- Tower Hamlets Community Learning Disability Service,Mile End Hospital,London,UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service,Mile End Hospital,London,UK
| | - Rumana Z Omar
- Department of Statistical Science,University College London,UK
| | - Michael King
- University College London Division of Psychiatry,UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit,UK
| | - Asit Biswas
- Leicestershire Partnership National Health Service Trust,Directorate of Learning Disabilities,Frith Hospital,Leicester,UK
| | | | - William Howie
- Wandsworth Community Mental Health Intellectual Disabilities Team,Springfield Hospital,UK
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14
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Poppes P, van der Putten A, Post W, Frans N, Ten Brug A, van Es A, Vlaskamp C. Relabelling behaviour. The effects of psycho-education on the perceived severity and causes of challenging behaviour in people with profound intellectual and multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1140-1152. [PMID: 27189898 DOI: 10.1111/jir.12299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 03/09/2016] [Accepted: 04/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Prevalence rates of challenging behaviour are high in children and adults with profound intellectual and multiple disabilities (PIMD). Moreover, many of these behaviours are observed daily. Direct support staff report that most challenging behaviour identified has little impact on the person with PIMD and attribute challenging behaviour in children and adults with PIMD mainly to a biomedical model. The purpose of this study was to evaluate whether an intervention (psycho-education) had any effect on direct support staff's assessment of challenging behaviour in terms of its severity and their biomedical causal explanations (attributions) for this behaviour. METHOD A stepped wedge study design was used to evaluate the effects of a psycho-education intervention on the perceived severity and the attributions offered for challenging behaviour of people with PIMD by 198 direct support staff. We used questionnaires assessing the perceived severity of challenging behaviour and staff views of its causes. Data on the dependent variables were collected at four 1-month intervals. RESULTS The intervention was found to have an effect on the perceived severity of challenging behaviour identified in people with PIMD in the sense that staff generally scored challenging behaviour as more severe in its consequences after the intervention. However, this effect was very small. No significant effects were found in terms of reduction in the biomedical scale scores. CONCLUSION No evidence for the effectiveness of a psycho-educational approach on the assessment of challenging behaviour in terms of severity and the biomedical attributions for behaviour was found. More research is required to explore further the effects of more elaborate training using methods to enable direct support staff to reflect on the behaviour of people with PIMD and on their own behaviour.
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Affiliation(s)
- P Poppes
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A van der Putten
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - W Post
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - N Frans
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A Ten Brug
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A van Es
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - C Vlaskamp
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
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15
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Poppes P, van der Putten AAJ, ten Brug A, Vlaskamp C. Staff attributions of the causes of challenging behaviour in children and adults with profound intellectual and multiple disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:95-102. [PMID: 26551595 DOI: 10.1016/j.ridd.2015.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/04/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
A study has shown that staff do not generally perceive challenging behaviour in people with profound intellectual and multiple disabilities (PIMD) as being of serious consequence. In this study we aimed to gain a better understanding of the causal explanations that direct care and support staff give for challenging behaviour in this group. The purpose of this study was twofold: (1) to determine the way staff attribute challenging behaviour in children and adults with PIMD; and (2) to analyse whether more experienced staff attribute challenging behaviour in children and adults with PIMD differently than less experienced staff. In total, 195 direct support staff and an equal number of children and adults with PIMD participated in the study. Direct support staff filled out the Challenging behaviour Attribution Scale (five causal explanatory models of challenging behaviour) to explain challenging behaviour in one individual that they supported. The results show that direct support staff as a whole report the biomedical model as the most plausible explanation for challenging behaviour in children and adults with PIMD. However, in the present study the mean scores on all models are low. This might indicate that a large number of staff found none of the models particularly useful as possible explanations of challenging behaviour in people with PIMD. This could mean that staff have difficulties stating the cause of challenging behaviour in this group. Another possible explanation could be that there is little scientific knowledge about causing and maintaining factors of challenging behaviour in people with PIMD. It could also mean that staff have additional explanations for challenging behaviour in this target group that are not mentioned in the instrument used. Future research should address these issues. No differences were found between more experienced and less experienced direct support staff.
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Affiliation(s)
- P Poppes
- 's Heerenloo Zorggroep, Amersfoort, The Netherlands; Department of Special Needs Education and Youth Care, University of Groningen, The Netherlands.
| | - A A J van der Putten
- 's Heerenloo Zorggroep, Amersfoort, The Netherlands; Department of Special Needs Education and Youth Care, University of Groningen, The Netherlands
| | - A ten Brug
- Department of Special Needs Education and Youth Care, University of Groningen, The Netherlands
| | - C Vlaskamp
- Department of Special Needs Education and Youth Care, University of Groningen, The Netherlands
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Seewooruttun L, Scior K. Interventions aimed at increasing knowledge and improving attitudes towards people with intellectual disabilities among lay people. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3482-3495. [PMID: 25213473 DOI: 10.1016/j.ridd.2014.07.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 06/03/2023]
Abstract
Despite policies aimed at ensuring equal rights and maximising respect and social inclusion for people with intellectual disabilities, in their daily lives many continue to face negative attitudes and discrimination within society. Misconceptions about what it means to have an intellectual disability and about the capabilities of people with intellectual disabilities appear widespread, and may contribute to prejudice and discrimination. This review provides a summary and evaluation of empirical interventions aimed at increasing knowledge and targeting negative attitudes towards this population among lay people of working age. An electronic search using PsycINFO, Web of Science and PubMed identified 22 English language studies published between 1990 and early 2014 that reported a specific intervention with a lay population sample. The majority of studies reported promising outcomes, particularly those aimed at increasing knowledge of intellectual disability through education. Support for the positive influence of contact with people with intellectual disabilities was demonstrated across several interventions. Interventions delivered at least partly by individuals with intellectual disabilities, and educational interventions appear to hold the most promise. The evidence is limited though by the weaknesses of measurement tools employed.
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Affiliation(s)
- Leila Seewooruttun
- Clinical, Educational and Health Psychology, University College London, United Kingdom.
| | - Katrina Scior
- Clinical, Educational and Health Psychology, University College London, United Kingdom
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Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial. BMC Psychiatry 2014; 14:219. [PMID: 25927187 PMCID: PMC4149205 DOI: 10.1186/s12888-014-0219-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services. METHOD The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS. DISCUSSION The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour. TRIAL REGISTRATION This trial is registered with Clinical Trials.gov (Ref NCT01680276 ). Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/ .
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Hutchinson LM, Hastings RP, Hunt PH, Bowler CL, Banks ME, Totsika V. Who's challenging who? Changing attitudes towards those whose behaviour challenges. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:99-109. [PMID: 23046106 DOI: 10.1111/j.1365-2788.2012.01630.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although staff attitudes towards individuals with intellectual disability (ID) whose behaviour challenges may be an important part of a positive support culture, very little research has focused on the development of training specifically designed to change staff attitudes. Positive contact is hypothesised to be an effective way to change attitudes towards stigmatised groups. METHODS We designed and developed a half day training package about the experiences of individuals whose behaviour challenges - Who's Challenging Who (WCW). The WCW package was delivered according to a manual by a trainer with ID and a professional without disability. Seventy-six staff from a variety of organisations participated in one of 10 WCW training sessions and provided data on their attitudes and empathy towards individuals whose behaviour challenges prior to the WCW training and immediately at the end of training. Staff also completed a post-training evaluation questionnaire. RESULTS A training package was successfully developed collaboratively with individuals whose behaviour challenges, and received very positive evaluations from staff participants. Short-term positive change was shown for empowerment and similarity attitudes, and staff empathy and self-efficacy. These outcomes were associated with small to moderate effect sizes. CONCLUSIONS Meaningful short-term positive staff attitude changes were found and the WCW training model was shown to be feasible. More robust research designs are needed for future evaluation. In addition, the function of an attitude change intervention such as WCW within organisations' training strategies requires further development.
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Kleinberg I, Scior K. The impact of staff and service user gender on staff responses towards adults with intellectual disabilities who display aggressive behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:110-124. [PMID: 23126336 DOI: 10.1111/j.1365-2788.2012.01640.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The impact of staff and service user gender on responses of staff in intellectual disability (ID) services is poorly understood. The present study set out to assess the role of gender in influencing staff emotions, attributions and behavioural intentions in response to aggression displayed by adults with ID. METHOD A new scale measuring staff behavioural intentions was developed. A two × two (staff gender × service user gender) between subjects design was used to compare the responses of day and residential support staff to physical aggression by a hypothetical service user. In response to a vignette depicting a service user with ID assaulting a member of staff, 160 respondents completed measures of affective responses, causal attributions and behavioural intentions while imagining themselves as the target of the service user's assault. RESULTS Female participants reported feeling more fear/anxiety, more depression/anger and less confident/relaxed than male participants. The longer staff had worked with people with ID, the more likely they were to favour safety-focused behaviours. More confident female participants were less likely to favour safety-focused behaviours, but confidence had no effect on male participants' endorsement of these behaviours. Increased confidence in both was associated with lower agreement of safety-focused behaviours in relation to the female vignette, regardless of participant gender. The more control women believed the service user had over their behaviour, the more likely they were to choose safety-focused behaviours. Punitive behaviours were favoured more in response to the male rather than the female service user. Punitive behaviours were also favoured more by more junior staff and by participants who expected feeling more depressed/angry in response to the vignettes. CONCLUSIONS Both staff and service user gender influenced staff responses to aggression, yet the latter played a smaller role than expected. The role of gender in staff-service user interactions should be the focus of further research and should be considered in service delivery.
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Affiliation(s)
- I Kleinberg
- Hammersmith & Fulham Learning Disability Service, Central London Community Healthcare Trust, London, UK
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Allen D, Langthorne P, Tonge B, Emerson E, McGill P, Fletcher R, Dosen A, Kennedy C. Towards the prevention of behavioural and psychiatric disorders in people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:501-14. [PMID: 23712642 DOI: 10.1111/jar.12050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/30/2022]
Abstract
Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.
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Affiliation(s)
- David Allen
- Special Projects Team, Abertawe Bro Morgannwg Univerity Health Board, Cardiff, UK
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Ling CYM, Mak WWS. Coping with challenging behaviours of children with autism: effectiveness of brief training workshop for frontline staff in special education settings. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:258-269. [PMID: 21955252 DOI: 10.1111/j.1365-2788.2011.01469.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The present study examined the effectiveness of three staff training elements: psychoeducation (PE) on autism, introduction of functional behavioural analysis (FBA) and emotional management (EM), on the reaction of challenging behaviours for frontline staff towards children with autism in Hong Kong special education settings. METHODS A sample of 311 frontline staff in educational settings was recruited to one of the three conditions: control, PE-FBA and PE-FBA-EM groups. A total of 175 participants completed all three sets of questionnaires during pre-training, immediate post-training and 1-month follow-up. RESULTS Findings showed that the one-session staff training workshop increased staff knowledge of autism and perceived efficacy but decrease helping behavioural intention. CONCLUSIONS In spite of the limited effectiveness of a one-session staff training workshop, continued staff training is still necessary for the improvement of service quality. Further exploration on how to change emotion response of staff is important.
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Affiliation(s)
- C Y M Ling
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
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Gore N, Umizawa H. Challenging Behavior Training for Teaching Staff and Family Carers of Children With Intellectual Disabilities: A Preliminary Evaluation. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00315.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Williams S, Dagnan D, Rodgers J, McDowell K. Changes in Attributions as a Consequence of Training for Challenging and Complex Behaviour for Carers of People with Learning Disabilities: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011; 25:203-16. [DOI: 10.1111/j.1468-3148.2011.00654.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nankervis KL, Rosewarne AC, Vassos MV. Respite and Parental Relinquishment of Care: A Comprehensive Review of the Available Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00305.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hylkema T, Petitiaux W, Vlaskamp C. Utility of Staff Training on Correcting Sleep Problems in People With Intellectual Disabilities Living in Residential Settings. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00294.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tejo Hylkema
- Rijksuniversiteit Groningen, Groningen
- Sleepcentre SEIN, Groningen
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Dilworth JA, Phillips N, Rose J. Factors Relating to Staff Attributions of Control Over Challenging Behaviour. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1468-3148.2010.00570.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Perry J, Felce D, Allen D, Meek A. Resettlement Outcomes for People with Severe Challenging Behaviour Moving from Institutional to Community Living. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1468-3148.2010.00567.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Campbell M. Workforce development and challenging behaviour: training staff to treat, to manage or to cope? JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2010; 14:185-196. [PMID: 21062856 DOI: 10.1177/1744629510385624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Staff working directly with adults' challenging behaviours in learning disability services need to be very good at what they do. They also need to want to do the job. A theory-practice gap exists, however, between what is known about effective, evidence-based approaches and whether and how these are used in person-centred community services. Many frontline staff working with people with the most serious challenging behaviours do not have the skills to implement programmes to change behaviour. This discussion article reviews workforce development in the context of clinical and service guidelines and asks whether the legitimate purview of frontline staff is treating challenging behaviour, managing it or simply coping with it on a daily basis, whilst maintaining the best quality of life possible for service users.
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Ling CYM, Mak WWS, Cheng JNS. Attribution Model of Stigma towards Children with Autism in Hong Kong. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1468-3148.2008.00456.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Totsika V, Toogood S, Hastings RP, Nash S. Interactive training for active support: perspectives from staff. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2008; 33:225-238. [PMID: 18752095 DOI: 10.1080/13668250802283348] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND In this study, we describe the experience of participating in interactive training (IT) for active support (AS). Staff (N = 58) working with adults with an intellectual disability (ID) received IT on providing effective assistance for participation in daily activities. METHOD Semi-structured interviews were conducted with staff (N = 37) on their experience of IT, the way it affected their work, and their views on the implementation of AS. RESULTS High levels of satisfaction with IT were reported. Most staff identified at least one skill learnt during IT that they were still using 8 months later. No clear and consistent picture of AS implementation emerged across the service; staff identified a number of barriers, with lack of managerial support as the most significant. CONCLUSIONS Interactive training can directly affect staff behaviour and has the advantage of being positively perceived by staff. However IT alone cannot ensure successful AS implementation, which is affected by a number of other factors, such as managerial support and input, residents' challenging behaviours, and staffing levels.
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Remaining Open to Quantitative, Qualitative, and Mixed‐Method Designs: An Unscientific Compromise, or Good Research Practice? ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0074-7750(07)35005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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