Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services

Factors facilitating or hindering meaningful staff-client interactions in people with intellectual disabilities and challenging behaviour: A systematic mixed studies review using thematic synthesis

BACKGROUND

Interactions with professional caregivers affect the quality of support and life of people with intellectual disabilities and contribute to the occurrence of challenging behaviour. The present literature review provides an overview of factors facilitating or hindering meaningful staff-client interactions in people with borderline to profound intellectual disabilities and challenging behaviour.

METHOD

Database searches, reference list and citation screening, and expert consultations were undertaken. A thematic synthesis of 28 studies was performed.

RESULTS

Factors were identified at the client (i.e. behaviour, emotions and (dis)abilities), staff (i.e. interactive principles, knowledge, psychological resources, attributions, attitudes and (coping with) emotions) and context levels (i.e. group size, team and organization).

CONCLUSIONS

The present overview provides insights into factors that facilitate or hinder meaningful staff-client interactions with people with intellectual disabilities and challenging behaviour. The results support the need to combine client, staff and contextual factors when considering staff-client interactions in research and practice.

A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours

BACKGROUND

the present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents' support and subsequently their challenging behaviours.

METHOD

In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method.

RESULTS

Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members' ability to change; clear boundaries between formal and informal caregivers; and staff's feelings of being unheard.

CONCLUSIONS

Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.

[Intellectual disabitily, challenging behavior, and care: A systematic literature review]

Introduction and background : People with intellectual disabilities present difficult behaviors, also called problem behaviors or challenging behaviors.Objective : The objective of this study was to describe the state of knowledge in nursing about challenging behaviors in people with intellectual disabilities.Methodology : We performed a systematic literature review based on the use of the keywords "challenging behavior," "intellectual disability," "nurs*," and "problem behavior" on the PubMed and Web of Science websites between 2008 and 2018.Results : Individuals with intellectual disabilities frequently present challenging behaviors, which can give rise to the abuse of psychotropic medication. These behaviors are also stressful for staff. Solutions in terms of staff training exist, as well as assistance in the identification of associated diagnoses that may sometimes be responsible for challenging behaviors. No publications in French on this topic were found.Conclusion : Nurses who work with people with intellectual disabilities should be encouraged to become involved in research so that they can contribute to developing knowledge on challenging behaviors and improve the quality of their care. This will also enable them to further develop their collaboration within the multidisciplinary team in order to promote good practice in terms of the management of challenging behaviors and in particular in terms of promoting a move away from prescribing psychotropic drugs.

Information infrastructure and quality person-centred support in supported accommodation: An integrative review

OBJECTIVES

To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support.

METHODS

We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis.

RESULT

All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support; 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information.

CONCLUSIONS

Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs.

PRACTICE IMPLICATIONS

Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.

Differences between staff groups in perception of risk assessment and risk management of inappropriate sexual behaviour in patients with traumatic brain injury

This research explored staff perceptions of risk assessment and management of inappropriate sexual behaviour (ISB) displayed in patients following a Traumatic Brain Injury (TBI). The primary focus was to determine differences in perceptions between qualified (N = 40) and direct care staff (N = 47). Vignettes depicting ISB displayed by a male following a TBI were rated. The vignettes varied in behaviour (intimate versus non-contact) and age of the victim (child versus adult). Ratings for causal explanations (poor management, attention seeking, negative emotion and education), attributions (need for action and increase awareness) and emotions were analysed alongside risk assessment and management variables. Intimate contact ISB and ISB directed towards a child were perceived to be more serious and in need of intervention. Direct care staff perceived ISB to be due to sexual motivations, poor emotion control and to seek attention. They elicited greater negative emotions and based their judgements of risk on seriousness. On the other hand, qualified staff were more concerned about implementing interventions based on the risk of recurrence. Differences between staff groups could cause conflict regarding the assessment and management of ISB in TBI. Training to increase awareness of the behaviour could minimise differences and produce greater cohesion within clinical practise.

Practice Leadership at the Front Line in Supporting People with Intellectual Disabilities and Challenging Behaviour: A Qualitative Study of Registered Managers of Community-based, Staffed Group homes

BACKGROUND

The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour.

METHOD

Interviews, primarily focussed upon staff practice, were conducted with 19 managers of staffed group homes in SE England. Transcripts were analysed using interpretive phenomenological analysis.

RESULTS

Five groups of themes emerged: monitoring staff performance, supporting new ways of working, shaping staff performance, influence of external and employing agencies, and importance of participants' personal values and experiences.

CONCLUSION

The themes identified contribute to a conceptual framework for thinking about front-line management/practice leadership. The limitations, and potential implications, of the findings are discussed.

Role, implementation, and effectiveness of advanced allied health assistants: a systematic review

Background

The purpose of this systematic review was to determine the effectiveness and implementation of advanced allied health assistant roles.

Methods

A systematic search of seven databases and Google Scholar was conducted to identify studies published in English peer-reviewed journals from 2003 to 2013 and reporting on the effectiveness and implementation of advanced allied health assistant (A/AHA) roles. Reference lists were also screened to identify additional studies, and the authors’ personal collections of studies were searched. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, and appraisal of higher-level studies (III-1 and above) conducted using the Centre for Evidence Based Medicine Systematic Review Critical Appraisal Sheet for included systematic reviews or the PEDro scale for level II and III-1 studies. Data regarding country, A/AHA title, disciplines, competencies, tasks, level of autonomy, clients, training, and issues regarding the implementation of these roles were extracted, as were outcomes used and key findings for studies investigating their effectiveness.

Results

Fifty-three studies were included, and most because they reported background information rather than investigating A/AHA roles, this representing low-level information. A/AHAs work in a range of disciplines, with a variety of client groups, and in a number of different settings. Little was reported regarding the training available for A/AHAs. Four studies investigated the effectiveness of these roles, finding that they were generally well accepted by clients, and provided more therapy time. Issues in integrating these new roles into existing health systems were also reported.

Conclusion

A/AHA roles are being implemented in a range of settings, and appear to be effective in terms of process measures and stakeholder perceptions. Few studies have investigated these roles, indicating a need for research to be conducted in this area to enable policy-makers to consider the value of these positions and how they can best be utilized.

Staff's attitudes and reactions towards aggressive behaviour of clients with intellectual disabilities: a multi-level study

Data were collected from 121 staff members (20 direct support staff teams) on background characteristics of the individual staff members and their teams (gender, age, years of work experience, position and education), the frequency and form of aggression of clients with an intellectual disability (verbal or physical), staff members' attitudes towards aggression, and the types of behavioural interventions they executed (providing personal space and behavioural boundary-setting, restricting freedom and the use of coercive measures). Additionally, client group characteristics (age of clients, type of care and client's level of intellectual disability) were assessed. Multilevel analyses (individual and contextual level) were performed to examine the relations between all studied variables and the behavioural interventions. The results showed that for providing personal space and behavioural boundary-setting as well as for restricting freedom, the proportion of variance explained by the context (staff team and client group characteristics) was three times larger than the proportion of variance explained by individual staff member characteristics. For using coercive measures, the context even accounted for 66% of the variance, whereas only 8% was explained by individual staff member characteristics. A negative attitude towards aggression of the direct support team as a whole proved to be an especially strong predictor of using coercive measures. To diminish the use of coercive measures, interventions should therefore be directed towards influencing the attitude of direct support teams instead of individual staff members.