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Ondrušková T, Oulton K, Royston R, Hassiotis A. Process evaluation of a parenting intervention for pre-schoolers with intellectual disabilities who display behaviours that challenge in the UK. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13263. [PMID: 39045819 DOI: 10.1111/jar.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/09/2023] [Accepted: 05/27/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Stepping Stones Triple P (SSTP) is a complex parent-mediated intervention aimed to reduce behaviours that challenge in children with moderate to severe intellectual disabilities, aged 30-59 months. METHODS To formulate a comprehensive understanding of SSTP implementation in the UK, we conducted a process evaluation collecting stakeholder views and considering intervention fidelity, dose, reach, delivery adaptations, and acceptability. RESULTS Fidelity and quality of delivery ratings were high. Parents perceived SSTP as valuable, reporting increased parental confidence and understanding of the child's behaviours. However, only 30% of families received an adequate dose of the intervention. Parents who only received treatment as usual described feeling abandoned by current services. Service managers emphasised the importance of availability of resources and therapist training for successful intervention delivery. CONCLUSIONS SSTP supports effective management of early-onset behaviours that challenge. Further work is needed to ensure equitable access to the intervention across health and social care services. TRIAL REGISTRATION NCT03086876 - https://www. CLINICALTRIALS gov/ct2/show/NCT03086876?term=Hassiotis+Angela&draw=1&rank=1.
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Affiliation(s)
| | - Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Royston Royston
- Division of Psychiatry, University College London, London, UK
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Täljedal T, Granlund M, Osman F, Norén Selinus E, Fängström K. Parenting children with disabilities in Sweden: a cluster-analysis of parenting stress and sufficiency of informal and formal support. Front Psychol 2024; 15:1389995. [PMID: 38882520 PMCID: PMC11177875 DOI: 10.3389/fpsyg.2024.1389995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To investigate patterns of parenting stress and access to sufficient informal and formal support among parents of children with disabilities. To explore whether child cognitive level, conduct problems and the need of language interpretation in contacts between parents and professionals are associated with patterns of parenting stress and support. Method Parents (N = 140) of children with disabilities in Sweden completed a questionnaire about parenting stress and support. Patterns of three variables-parenting stress and access to sufficient informal and formal support-were investigated using cluster analysis. The relationship of child cognitive level, level of conduct problems and of language interpretation needs between parents and professionals to cluster membership was explored using multinomial logistic regression. Results Five different clusters of parenting stress and support emerged. Parents in cluster 1 had lower than sample mean ratings on all three variables. Cluster 2 had elevated parenting stress, cluster 3 had elevated insufficient informal support and cluster 4 had elevated insufficient formal support. Cluster 5 had elevated ratings on all three variables. Greater child cognitive difficulties increased the likelihood of parent membership in cluster 2 (elevated stress), cluster 3 (elevated insufficient informal support), or cluster 5 (elevated ratings on all variables). Child conduct problems increased the likelihood of membership in cluster 2 (elevated stress) or cluster 5 (elevated ratings on all variables). No relationship between language interpretation needs and cluster membership was found. Conclusions Patterns of parenting stress and sufficiency of support, and their associations with child characteristics, vary substantially. However, families of children with conduct problems experiencing elevated parenting stress in combination with insufficient informal and formal support, may be particularly vulnerable. The results of the current study highlight the clinical importance of exploring and identifying individual parenting stressors and perceived levels of support, to be able to adapt services to better suit a variety of needs, and thus promote equitable care.
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Affiliation(s)
- Torun Täljedal
- Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
- CHAP, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mats Granlund
- CHILD Research Environment, Jönköping University, Jönköping, Sweden
- Department of Mental Health, Norway Technical and Natural Sciences University, Trondheim, Norway
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Eva Norén Selinus
- Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Karin Fängström
- CHAP, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Low LPL, Kwong ANL, Wang Y, Wong MYC, Tiu MMH, Wan KWS. Qualitative Protocol of Chinese Parents and Siblings Experiences of Managing Challenging Behaviours of Adult Persons with Intellectual Disability in Hong Kong and Northern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:673. [PMID: 38928920 PMCID: PMC11203297 DOI: 10.3390/ijerph21060673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND While the literature has highlighted the immense challenges in caring for family members, it is still unclear what the needs of family carers of persons with intellectual disability and challenging behaviours are and what has worked for them. This study aims to examine 60 parents' and siblings' experiences in managing the challenging behaviours of their adult family member with intellectual disability whilst living at home. METHODS A qualitative grounded theory approach using semi-structured interviews will be adopted. Purposive sampling will be used to recruit family carers who live with adult persons with intellectual disability and use one community service in Hong Kong. Three special schools for persons with intellectual disability from northern China will be approached. RESULTS This study will aim to provide an in-depth understanding of the experiences of family carers and compare the different circumstances they face when managing the challenging behaviours of their adult relatives with intellectual disability in their family home. CONCLUSIONS Although this study targets adults with intellectual disability, the findings will provide a point of reference for adolescents and younger persons who exhibit demanding and challenging behaviours and live with their families. Recommendations can guide the development of appropriate strategies to strengthen services for family carers.
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Affiliation(s)
- Lisa Pau-Le Low
- School of Health Sciences, Saint Francis University, Tseung Kwan O, Hong Kong 8732, China; (A.N.-L.K.); (M.Y.-C.W.); (K.W.-S.W.)
| | - Alice Nga-Lai Kwong
- School of Health Sciences, Saint Francis University, Tseung Kwan O, Hong Kong 8732, China; (A.N.-L.K.); (M.Y.-C.W.); (K.W.-S.W.)
| | - Yue Wang
- School of Nursing, Tianjin Medical University, Tianjin 301700, China;
| | - Maggie Yat-Cheung Wong
- School of Health Sciences, Saint Francis University, Tseung Kwan O, Hong Kong 8732, China; (A.N.-L.K.); (M.Y.-C.W.); (K.W.-S.W.)
| | - Mimi Mei-Ha Tiu
- School of Nursing, St. Teresa’s Hospital, Kowloon, Hong Kong 327, China;
| | - Karen Wing-See Wan
- School of Health Sciences, Saint Francis University, Tseung Kwan O, Hong Kong 8732, China; (A.N.-L.K.); (M.Y.-C.W.); (K.W.-S.W.)
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Hulsmans DHG, Otten R, Poelen EAP, van Vonderen A, Daalmans S, Hasselman F, Olthof M, Lichtwarck-Aschoff A. A complex systems perspective on chronic aggression and self-injury: case study of a woman with mild intellectual disability and borderline personality disorder. BMC Psychiatry 2024; 24:378. [PMID: 38773533 PMCID: PMC11110386 DOI: 10.1186/s12888-024-05836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as "complex". Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. CASE PRESENTATION A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. CONCLUSIONS A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.
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Affiliation(s)
- Daan H G Hulsmans
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands.
- Pluryn Research & Development, Nijmegen, The Netherlands.
| | - Roy Otten
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands
| | - Evelien A P Poelen
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands
- Pluryn Research & Development, Nijmegen, The Netherlands
| | | | - Serena Daalmans
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands
| | - Fred Hasselman
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands
| | - Merlijn Olthof
- Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, The Netherlands
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Anna Lichtwarck-Aschoff
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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Durand M, Nathan R, Holt S, Nall-Evans S, Woodrow C. Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13210. [PMID: 38382461 DOI: 10.1111/jar.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. METHOD A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. RESULTS We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. CONCLUSION By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.
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Affiliation(s)
- Marianne Durand
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Specialist Mental Health, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Chester Medical School, University of Chester, Chester, UK
| | - Sophie Holt
- Children, Young People and Families, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Sharleen Nall-Evans
- Information Management and Business Intelligence, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ceri Woodrow
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Centre for Autism, Neurodevelopmental Disorders and Intellectual Disabilities, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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Murthy S, Parker Harris S, Hsieh K. Formal support and service needs of family caregivers of adults with intellectual and/or developmental disabilities in India. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13235. [PMID: 38561937 DOI: 10.1111/jar.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 03/03/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed. METHOD A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews. RESULTS Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions. CONCLUSIONS Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.
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Affiliation(s)
- Sumithra Murthy
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sarah Parker Harris
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kelly Hsieh
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
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Shpigelman CN, Araten-Bergman T. Adults With IDD in Supported Accommodation During COVID-19 Lockdown: The Families' Perspective. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:215-230. [PMID: 38657961 DOI: 10.1352/1944-7558-129.3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/21/2023] [Indexed: 04/26/2024]
Abstract
The present study aims to understand and describe family caregivers' perceptions and experiences regarding contact and relationships with their adult relatives with intellectual and developmental disabilities (IDD) living in supported accommodation during the COVID-19 lockdown. A qualitative phenomenological approach was applied in which 19 Israeli family caregivers (parents and siblings) were interviewed. Inductive thematic analysis revealed themes at the microsystem level (the resident, the caregiver, and their relationship), and at the mesosystem level (the caregivers' interactions with service providers and other residents' families). The findings highlight the pivotal role of family caregivers in times of uncertainty and the need to develop explicit policies and mechanisms to facilitate family engagement in the residents' lives.
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Affiliation(s)
- Carmit-Noa Shpigelman
- Carmit-Noa Shpigelman, Department of Community Mental Health, University of Haifa, Israel
| | - Tal Araten-Bergman
- Tal Araten-Bergman, Social Work and Social Policy, School of Allied Health, Human Services and Sport, and Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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Clarke EB, McCauley JB, Lutz A, Gotelli M, Sheinkopf SJ, Lord C. Understanding profound autism: implications for stigma and supports. Front Psychiatry 2024; 15:1287096. [PMID: 38317766 PMCID: PMC10839016 DOI: 10.3389/fpsyt.2024.1287096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families. Methods The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults. Results The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma. Discussion Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.
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Affiliation(s)
- Elaine B. Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - James B. McCauley
- Department of Psychology, St. Mary’s College of California, Moraga, CA, United States
| | - Amy Lutz
- Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Marina Gotelli
- Fundación Brincar por un Autismo Feliz, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Ondruskova T, Royston R, Absoud M, Ambler G, Qu C, Barnes J, Hunter R, Panca M, Kyriakopoulos M, Oulton K, Paliokosta E, Sharma AN, Slonims V, Summerson U, Sutcliffe A, Thomas M, Dhandapani B, Leonard H, Hassiotis A. Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38329108 PMCID: PMC11017145 DOI: 10.3310/jkty6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. Objective To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. Design, setting, participants A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Intervention Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. Main outcome measure The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. Results We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. Limitations There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Conclusions Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Future work Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. Study registration This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Rachel Royston
- Division of Psychiatry, University College London, London, UK
| | - Michael Absoud
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University, University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- National and Kapodistrian University of Athens, Vyronas-Kessariani Community Mental Health Centre, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, UK
| | - Aditya Narain Sharma
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
| | - Vicky Slonims
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Helen Leonard
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Brennan D, D’eath M. Irish social policy to family carers of adults with an intellectual disability: A critical analysis. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:1013-1031. [PMID: 35835719 PMCID: PMC10647897 DOI: 10.1177/17446295221115296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper explores contemporary Irish social policy for family caregivers with specific focus on the dynamic between the individual, the family and the state in terms of the social contract for care provision for people with intellectual disability. Drawing from Bacchi's analytical framework (Bacchi, 2009), the Irish National Carers' Strategy is interrogated specifically with regards to how it frames and assumes the social contract for family care provision for adults with an intellectual disability. We suggest that Irish social policy constructs family caregiving as the assumed natural and neutral point of departure for providing care within society, and this constructed identify is subsequently reinforced through the provisions contained with the policies themselves that seek to support such caregivers. A fundamental reconsideration of the social contract for such care provision and support with society would appear warranted.
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Affiliation(s)
- Damien Brennan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maureen D’eath
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Slade K, Shaw RL, Larkin M, Heath G. Care-giving experiences of parents of young people with PMLD and complex healthcare needs in the transition to adulthood years: a qualitative poetic synthesis. Arts Health 2023:1-18. [PMID: 38018798 DOI: 10.1080/17533015.2023.2288058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To synthesise qualitative research exploring the care-giving experiences of parents of young people with profound and multiple learning disabilities (PMLD) and complex healthcare needs, in the transition to adulthood years. METHOD Four databases were systematically searched: Scopus, WoS Core Collection, Medline and SciELO. Included papers were assessed for quality and thematically synthesised. Findings are presented in the form of free-verse poems. RESULTS Nineteen papers from eight countries were included. Analysis generated three themes: interdependency of parent and child, where parents retained responsibility for their child's care; apprehension regarding sharing and shifting responsibility between parents and professionals; an uncertain future in terms of care provision. CONCLUSIONS Parents are concerned about the future care of their children. Training professionals in alternative and effective communication is fundamental to successful transition. Encouraging discussions about advanced care planning may also alleviate parental concerns and ensure good outcomes for young people with PMLD.
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Affiliation(s)
- Katharine Slade
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Rachel L Shaw
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Michael Larkin
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
| | - Gemma Heath
- Institute of Health & Neurodevelopment Aston University Birmingham United Kingdom of Great Britain and Northern Ireland
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Vitale SR, Schneider H, Gardner L, Alessandri M, Marker C. Challenging Behavior and Parental Depression: The Effects of Everyday Stressors and Benefit Finding for Parents of Children with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3356-3368. [PMID: 35749002 DOI: 10.1007/s10803-022-05627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Children with autism spectrum disorder present with challenging behaviors that can impact caregivers by increasing parental perceived stress and risk for depression. However, positive coping strategies have also been identified as protective factors for parents of children with ASD. The present study examined parental perceived daily stressors and positive coping strategies (i.e., benefit finding) as mediators to depression for parents of children with ASD. A latent profile analysis identified three classes of behavior severity for children with ASD. Across all classes, higher levels of perceived daily stressors predicted increased parental depression, while benefit finding predicted lower parental depression. Results support interventions that increase positive coping strategies to decrease levels of depression in parents of children with ASD.
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Affiliation(s)
- Sarah Rose Vitale
- Department of Psychology, College of Health Professions, Mercer University, Atlanta, GA, USA.
| | - Hoa Schneider
- Center for Neuropsychology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Gardner
- Autism Program, Department of Psychology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael Alessandri
- UM Center for Autism and Related Disabilities, University of Miami, Coral Gables, FL, USA
| | - Craig Marker
- Department of Psychology, College of Health Professions, Mercer University, Atlanta, GA, USA
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Chaudhry N, Sattar R, Kiran T, Wan MW, Husain M, Hidayatullah S, Ali B, Shafique N, Suhag Z, Saeed Q, Maqbool S, Husain N. Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting. CHILDREN (BASEL, SWITZERLAND) 2023; 10:913. [PMID: 37371145 DOI: 10.3390/children10060913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3-6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother-child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes.
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Affiliation(s)
- Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Rabia Sattar
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Ming Wai Wan
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Mina Husain
- Department of Psychiatry, University of Toronto, Toronto, ON M5S IR8, Canada
| | | | - Bushra Ali
- Pakistan Institute of Living and Learning, Karachi 75600, Pakistan
| | - Nadia Shafique
- Department of Psychology, Foundation University Islamabad, Rawalpindi 44000, Pakistan
| | - Zamir Suhag
- TVI-Trust for Vaccines and Immunization, Head Office, Suite No 301, Al-Sehat Centre, Rafiqui Shaheed Road, Karachi 74000, Pakistan
| | - Qamar Saeed
- School of Public Health, Dow University of Health Sciences DUHS, Karachi 74200, Pakistan
| | - Shazia Maqbool
- Department of Developmental-Behavioral Pediatrics, The Children's Hospital, (UC HS-CH), University of Child Health Sciences, Lahore 54600, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
- Mersey Care NHS Foundation Trust, Prescot L34 1PJ, UK
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Celik P, Kara Uzun A. Stressful experiences and coping strategies of parents of young children with Down syndrome: A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023. [PMID: 37100435 DOI: 10.1111/jar.13108] [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: 06/13/2022] [Revised: 02/26/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Previous studies have focused mostly on the negative experiences of parents of children with Down syndrome. We aimed to explore both the stressful experiences and coping strategies of parents from a non-Western country. METHODS Twenty-six parents of children aged 8-48 months with Down syndrome were included. Semi-structured interviews were conducted, and the data were analysed using thematic analysis. RESULTS The main themes of the stressful experiences were emotional burdens, caregiving burdens, struggle against stigma and discrimination, concerns about the future, challenges related to health, education, and financial issues. Parents used a variety of coping strategies to overcome the challenges by seeking support and help, searching for information, accepting and adapting, and adopting optimistic attitudes. CONCLUSION Although being a parent of a child with Down syndrome has many challenges, most parents effectively used coping strategies and adapted their lives to their new parental roles in their child's early years.
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Affiliation(s)
- Pelin Celik
- Department of Pediatrics, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Aysun Kara Uzun
- Division of Social Pediatrics, Department of Pediatrics, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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15
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Lokman S, van Oorsouw WMWJ, Didden R, Embregts PJCM. Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1348-1359. [PMID: 35789034 PMCID: PMC9795899 DOI: 10.1111/jar.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors). METHOD Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results. RESULTS Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home. CONCLUSIONS Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start.
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Affiliation(s)
- Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
| | | | - Robert Didden
- Radboud UniversityBehavioural Science InstituteNijmegenThe Netherlands,TrajectumZwolleThe Netherlands
| | - Petri J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
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16
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Family members' experience of well‐being as racial/ethnic minorities raising a child with a neurodevelopmental disorder: A qualitative meta‐synthesis. Res Nurs Health 2022; 45:314-326. [DOI: 10.1002/nur.22217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/07/2022]
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Gore N, Bradshaw J, Hastings R, Sweeney J, Austin D. Early positive approaches to support (E-PAtS): Qualitative experiences of a new support programme for family caregivers of young children with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:889-899. [PMID: 35289031 PMCID: PMC9311085 DOI: 10.1111/jar.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early Positive Approaches to Support (E-PAtS) is a co-produced and co-facilitated group programme that aims to provide early years support to family caregivers of children with Intellectual and Developmental Disabilities. METHOD Thirty-five caregivers who had attended E-PAtS groups took part in individual interviews or focus groups. Caregiver experiences concerning attendance of E-PAtS were explored, in relation to process variables and perceived outcomes. Interviews were thematically analysed. RESULTS Three major themes were identified: our group, evolving emotions, and positive approaches. Being with and being supported by other families was very important to caregivers. Families reported increased confidence and greater realisation of the need for self-care. Children were reported to show fewer behaviours that challenge and increases in adaptive skills. Findings corresponded to mechanisms and outcomes in the E-PAtS logic model. CONCLUSION E-PAtS shows promise as one way families and children with Intellectual and Developmental Disabilities can access early years support.
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Affiliation(s)
- Nick Gore
- Tizard Centre, Cornwallis North East, University of Kent, Canterbury, Kent, UK
| | - Jill Bradshaw
- Tizard Centre, Cornwallis North East, University of Kent, Canterbury, Kent, UK
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Coulman E, Gore N, Moody G, Wright M, Segrott J, Gillespie D, Petrou S, Lugg-Widger F, Kim S, Bradshaw J, McNamara R, Jahoda A, Lindsay G, Shurlock J, Totsika V, Stanford C, Flynn S, Carter A, Barlow C, Hastings R. Early positive approaches to support for families of young children with intellectual disability: the E-PAtS feasibility RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/heyy3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Parents of children with intellectual disability are 1.5–2 times more likely than other parents to report mental health difficulties. There is a lack of clinically effective and cost-effective group well-being interventions designed for family carers of young children with intellectual disability.
Aim
To examine the feasibility of a randomised controlled trial of the clinical effectiveness and cost-effectiveness of the Early Positive Approaches to Support (E-PAtS) intervention.
Design
A feasibility study (including randomisation of families into a two-arm trial), questionnaires to assess the feasibility of proposed outcome measures (including resource use and health-related quality of life) and practitioner/family carer interviews. An additional question was included in an online UK survey of families, conducted by the research team to assess usual practice, and a survey of provider organisations.
Setting
Families recruited from community contexts (i.e. third sector, local authority services, special schools) and self-referral. The E-PAtS intervention was delivered by trained community-based providers.
Participants
Families with at least one child aged 1.5–5 years with an intellectual disability. At least one parent had to have English-language ability (spoken) for E-PAtS programme participation and participants had to provide informed consent.
Interventions
E-PAtS intervention – two caregivers from each family invited to eight 2.5-hour group sessions with usual practice. Usual practice – other support provided to the family, including other parenting support.
Objectives
To assess randomisation willingness/feasibility, recruitment of providers/parents, retention, usual practice, adherence, fidelity and feasibility of proposed outcome measures (including the Warwick–Edinburgh Mental Well-Being Scale as the proposed primary outcome measure, and parent anxiety/depression, parenting, family functioning/relationships, child behavioural/emotional problems and adaptive skills, child and parent quality of life, and family services receipt as the proposed secondary outcome measures).
Results
Seventy-four families (95 carers) were recruited from three sites (with 37 families allocated to the intervention). From referrals, the recruitment rate was 65% (95% confidence interval 56% to 74%). Seventy-two per cent of families were retained at the 12-month follow-up (95% confidence interval 60% to 81%). Exploratory regression analysis showed that the mean Warwick–Edinburgh Mental Well-Being Scale well-being score was 3.96 points higher in the intervention group (95% confidence interval –1.39 to 9.32 points) at 12 months post randomisation. High levels of data completeness were achieved on returned questionnaires. Interviews (n = 25) confirmed that (1) recruitment, randomisation processes and the intervention were acceptable to family carers, E-PAtS facilitators and community staff; (2) E-PAtS delivery were consistent with the logic model; and (3) researchers requesting consent in future for routine data would be acceptable. Recorded E-PAtS sessions demonstrated good fidelity (96% of components present). Adherence (i.e. at least one carer from the family attending five out of eight E-PAtS sessions) was 76%. Health-related quality-of-life and services receipt data were gathered successfully. An online UK survey to assess usual practice (n = 673) showed that 10% of families of young children with intellectual disability received any intervention over 12 months. A provider survey (n = 15) indicated willingness to take part in future research.
Limitations
Obtaining session recordings for fidelity was difficult. Recruitment processes need to be reviewed to improve diversity and strategies are needed to improve primary outcome completion.
Conclusions
Study processes were feasible. The E-PAtS intervention was well received and outcomes for families were positive. A barrier to future organisation participation is funding for intervention costs. A definitive trial to test the clinical effectiveness and cost-effectiveness of E-PAtS would be feasible.
Trial registration
Current Controlled Trials ISRCTN70419473.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nick Gore
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jeremy Segrott
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Geoff Lindsay
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | - Vaso Totsika
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Catherine Stanford
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Samantha Flynn
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | | | | | - Richard Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
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19
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Deb S, Limbu B. Support staff liaising effectively with family caregivers: Findings from a co-design event and recommendation for a staff training resource. Front Psychiatry 2022; 13:977442. [PMID: 36245872 PMCID: PMC9555056 DOI: 10.3389/fpsyt.2022.977442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
A high proportion of people with intellectual disabilities (ID) and autism spectrum disorder (ASD) are prescribed psychotropic medications such as antipsychotics, antidepressants etc., outside their licensed indications, primarily for the management of behaviors that challenge (BtC) in the absence of a psychiatric disorder. Examples of BtC are aggression to people and property or self-injury. BtC could be challenging to manage and may cause the person with ID/ASD and their caregivers distress, breakdown of community placement leading to hospitalization, and restrictive practices such as restraint or inappropriate medication use. Caregivers play a pivotal role in the prescribing process. However, many family caregivers feel that they have not been fully involved in the shared decision-making process about the care planning of their relatives with ID/ASD. To address the public health concern regarding the overuse of off-license prescribing in people with ID/ASD, we have recently developed a training programme called SPECTROM (Short-term Psycho-Education for Carers To Reduce OverMedication of people with intellectual disabilities) for direct care staff who support people with ID/ASD within community settings. We used co-production and a modified Experience-Based Co-Design (EBCD) method to develop SPECTROM, which involved a literature review, four focus groups and a co-design event day involving 26 stakeholders. Recommendations from the co-design event day were analyzed by a Programme Development Group (PDG) consisting of 21 stakeholders who made the final recommendations to the project team regarding the contents and the format of SPECTROM, which was finalized after receiving feedback from further 59 stakeholders. SPECTROM has web-based resources introduced through two core modules in face-to-face workshops/training. A small field test found SPECTROM was effective in improving staff's knowledge of psychotropic medications and attitude toward BtC and people with ID (p < 0.05). One of the 14 STOMP modules is "Effective liaison with family carers and advocates". In this paper, we have presented data from the co-design event day recommendations for this particular module. The group recommended ways to improve collaborative working and effective shared decision-making with family caregivers and people with ID/ASD.
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Affiliation(s)
- Shoumitro Deb
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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Rogers G, Perez‐Olivas G, Stenfert Kroese B, Patel V, Murphy G, Rose J, Cooper V, Langdon PE, Hiles S, Clifford C, Willner P. The experiences of mothers of children and young people with intellectual disabilities during the first COVID-19 lockdown period. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1421-1430. [PMID: 33759291 PMCID: PMC8250127 DOI: 10.1111/jar.12884] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent COVID-19 lockdown restrictions resulted in reduced access to educational, professional and social support systems for children with intellectual disabilities and their carers. AIM The aim of this study was to gain insight into the ways mothers of children with intellectual disabilities coped during the first 2020 lockdown period. METHODS Eight mothers of children with intellectual disabilities were interviewed. The recordings of these interviews were subjected to a thematic analysis. RESULTS Three main themes were identified: carrying the burden; a time of stress; and embracing change and looking to the future. CONCLUSIONS All mothers experienced increased burden and stress. However, some also described some positive impact of lockdown conditions on them as well as on their child's well-being and behaviour. These findings are discussed in the light of the (Journal of Applied Research in Intellectual Disabilities, 33, 2020, 1523) survey results on parental coping and suggestions for future service provision during pandemic conditions are proposed.
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Affiliation(s)
- Gemma Rogers
- The Tarentfort CentreKent and Medway NHS and Social Care Partnership TrustDartfordUK
- Division of PsychiatryUniversity College LondonLondonUK
| | | | | | - Varsha Patel
- Birmingham Community Healthcare NHS Foundation TrustBirminghamUK
| | | | - John Rose
- School of PsychologyUniversity of BirminghamBirminghamUK
| | | | - Peter E. Langdon
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Mental Health and Wellbeing ResearchWarwick Medical SchoolUniversity of WarwickCoventryUK
- Coventry and Warwickshire Partnership NHS TrustCoventryUK
| | - Steve Hiles
- Swansea Trials UnitClinical Research FacilityInstitute of Life ScienceSwansea UniversitySwanseaUK
| | | | - Paul Willner
- Swansea Trials UnitClinical Research FacilityInstitute of Life ScienceSwansea UniversitySwanseaUK
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21
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Bailey T, Hastings RP, Totsika V. COVID-19 impact on psychological outcomes of parents, siblings and children with intellectual disability: longitudinal before and during lockdown design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:397-404. [PMID: 33634520 PMCID: PMC8013753 DOI: 10.1111/jir.12818] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Parents of children with intellectual disability (ID) report comparatively lower levels of well-being than parents of children without ID. Similarly, children with ID, and to a lesser extent their siblings, are reported to show comparatively higher levels of behaviour and emotional problems. Psychological problems may be accentuated by restrictions associated with the COVID-19 pandemic, due to increased social, caring and economic stressors and reduced social support. However, existing studies have not been able to examine the impact of COVID-19 restrictions accounting for pre-COVID levels of well-being in these families. In a naturalistic design, we examined outcomes for parents, siblings and children with ID in a two-wave longitudinal study where Wave 2 data were gathered for some families before and some during COVID-19 restrictions. METHODS Parents of children with ID who took part in a Wave 2 survey pre-lockdown (n = 294) and during/post-lockdown (n = 103) completed a number of measures about their well-being and the behaviour and emotional problems of both their child with ID and their nearest-in-age sibling. These same measures had also been completed for all families 2-3 years previously in Wave 1 of the study. RESULTS After accounting for covariates including family socio-economic circumstances, pre-lockdown and post-lockdown groups did not differ on Waves 1 to 2 change for measures of parental psychological distress, life satisfaction, the impact of caregiving on their lives or perceived positive gains; nor child or sibling internalising or externalising behaviour problems. CONCLUSIONS Findings of the current study indicate that during and shortly after the COVID-19 lockdown in the United Kingdom, well-being in families of children with an ID (as reported by parents) was at similar levels compared with prior to the lockdown period.
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Affiliation(s)
- T. Bailey
- CEDARUniversity of WarwickCoventryUK
| | - R. P. Hastings
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVicAustralia
| | - V. Totsika
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVicAustralia
- Department of PsychiatryUniversity College LondonLondonUK
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22
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Zambrino N, Hedderich I. Family Members of Adults with Intellectual Disability Living in Residential Settings: Roles and Collaboration with Professionals. A Review of the Literature. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:46958021991301. [PMID: 33631985 PMCID: PMC7919211 DOI: 10.1177/0046958021991301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to review the literature concerning the role of family members of adults with an intellectual disability living in diverse residential settings and their collaboration with residential staff. Whenever the scarce literature on the subject allowed, the focus was laid on family members of persons with additional challenging behavior. Electronic databases, reference screening, and hand search of selected journals was employed to collate literature using key terms such as family members, intellectual disability, and residential setting. By extracting relevant data of the eighteen articles that fulfilled all inclusion criteria, the following 3 main themes with each subthemes were identified inductively: roles of family members after the transition, the effects of the transition on family members, and the collaboration between the family members and professional care staff. This review presents the different roles family members partake and highlights the importance of regular open two-sided communication for collaboration with professional staff to be successful. Practical implementations are discussed and the need for further research in the field is indicated.
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Affiliation(s)
- Natalie Zambrino
- Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
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23
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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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24
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Broady TR. Carers’ Experiences of End‐of‐Life Care: A Scoping Review and Application of Personal Construct Psychology. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tromans S, Kinney M, Chester V, Alexander R, Roy A, Sander JW, Dudson H, Shankar R. Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic. BJPsych Open 2020; 6:e128. [PMID: 33118913 PMCID: PMC7609203 DOI: 10.1192/bjo.2020.122] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers. AIMS To provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic. METHOD Senior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: 'mental health and challenging behaviour', 'physical health and epilepsy' and 'social circumstances and support'. The feedback was developed into statements on frequently reported priorities. These statements were then rated independently by expert clinicians. A video-conference meeting to reconcile outliers and to generate a consensus statement list was held. RESULTS Thirty-two organisations were contacted, of which 26 (81%) replied. From the respondent's data, 30 draft consensus statements were generated. Following expert clinician review, there was initially strong consensus for seven statements (23%), increasing to 27 statements (90%) following video conferencing. CONCLUSIONS These recommendations highlight the expectations of people with intellectual disabilities and/or autism in the current pandemic. This could support policymakers and professionals' deliver and evidence person-centred care.
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Affiliation(s)
- Sam Tromans
- Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | | | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, UK; and Norwich Medical School, University of East Anglia, UK
| | - Regi Alexander
- Hertfordshire Partnership University NHS Foundation Trust, UK; and University of Hertfordshire, UK
| | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, UK; and University of Warwick, UK
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, UK; Chalfont Centre for Epilepsy, UK; and Stichting Epilepsie Instellingen Nederland (SEIN), the Netherlands
| | - Harry Dudson
- Department of Health Sciences, University of Leicester, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, UK; and University of Exeter Medical School, Truro, UK
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Dunn K, Jahoda A, Kinnear D. The experience of being a father of a son or daughter with an intellectual disability: Older fathers' perspectives. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:118-128. [PMID: 32794330 DOI: 10.1111/jar.12791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND As life expectancy for people with an intellectual disability increases, there is a growing cohort of older father carers. This study aimed to gain a more in-depth understanding of older father carers' experiences of parenting. METHODS Semi-structured interviews were conducted with 7 older fathers (M = 63.9 years) and analysed using constructivist grounded theory. RESULTS Three conceptual categories were identified. "Wearing different hats: how fathers' sense of identity had altered over the years. "Family comes first": importance placed on the family unit. "Getting on in years": the challenges faced by ageing fathers parenting their son/daughter. CONCLUSIONS Fathers re-evaluated their priorities and found a new identity in their parenting role, although they continued to see themselves as secondary carers. Fathers worried about the future as their health declined but drew strength from the benefits they had derived and the challenges that they had overcome to do their best for their son/daughter and their family.
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Affiliation(s)
- Kirsty Dunn
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
| | - Andrew Jahoda
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
| | - Deborah Kinnear
- Department of Mental Health and Wellbeing, Gartnavel Royal Hospital, Glasgow, UK
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Olivier-Pijpers VC, Cramm JM, Nieboer AP. Residents' and resident representatives' perspectives on the influence of the organisational environment on challenging behaviour. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103629. [PMID: 32142969 DOI: 10.1016/j.ridd.2020.103629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/28/2020] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study explored the perspectives of residents of residential disability service organisations and resident representatives on the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID). METHOD Sixteen residents and representatives from four specialised Dutch disability service organisations were interviewed. Data were analysed using a grounded theory approach, with a sensitising frame based on Bronfenbrenner's ecological theory. RESULTS Some organisational factors (e.g. staff turnover, insufficient finances) can have negative effects on interactions among residents and staff and family members, resulting in more challenging behaviour, but other organisational factors (e.g. shared vision, values and expectations, competent staff) can positively influence staffs' attitudes and actions, which in turn helps to manage challenging behaviour in people with ID. CONCLUSIONS Residents' and representatives' perspectives provide a better understanding of the positive and negative influences of the organisational environment on challenging behaviour in people with ID.
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Affiliation(s)
- V C Olivier-Pijpers
- Centre for Consultation and Expertise, Australielaan 14, 3526AB, Utrecht, The Netherlands.
| | - J M Cramm
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - A P Nieboer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
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Tournier T, Hendriks AH, Jahoda A, Hastings RP, Embregts PJCM. Developing a Logic Model for the Triple‐C Intervention: A Practice‐Derived Intervention to Support People with Intellectual Disability and Challenging Behavior. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tess Tournier
- Tilburg University Tilburg The Netherlands
- ASVZ Sliedrecht The Netherlands
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Hastings RP, Totsika V, Hayden NK, Murray CA, Jess M, Langley E, Margetson JK. 1000 Families Study, a UK multiwave cohort investigating the well-being of families of children with intellectual disabilities: cohort profile. BMJ Open 2020; 10:e032919. [PMID: 32051311 PMCID: PMC7045113 DOI: 10.1136/bmjopen-2019-032919] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The 1000 Families Study is a large, UK-based, cohort of families of children with intellectual disability (ID). The main use of the cohort data will be to describe and explore correlates of the well-being of families of children with ID, including parents and siblings, using cross-sectional and (eventually) longitudinal analyses. The present cohort profile intends to describe the achieved cohort. PARTICIPANTS Over 1000 families of UK children with ID aged between 4 and 15 years 11 months (total n=1184) have been recruited. The mean age of the cohort was 9.01 years old. The cohort includes more boys (61.8%) than girls (27.0%; missing 11.1%). Parents reported that 45.5% (n=539) of the children have autism. Most respondents were a female primary caregiver (84.9%), and 78.0% were the biological mother of the cohort child with ID. The largest ethnic group for primary caregivers was White British (78.5%), over half were married and living with their partner (53.3%) and 39.3% were educated to degree level. FINDINGS TO DATE Data were collected on family, parental and child well-being, as well as demographic information. Wave 1 data collection took place between November 2015 and January 2017, primarily through online questionnaires. Telephone interviews were also completed by 644 primary caregivers. FUTURE PLANS Wave 2 data collection is ongoing and the research team will continue following up these families in subsequent waves, subject to funding availability. Results will be used to inform policy and practice on family and child well-being in families of children with ID. As this cohort profile aims to describe the cohort, future publications will explore relevant research questions and report key findings related to family well-being.
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Affiliation(s)
- Richard P Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Vasiliki Totsika
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Victoria, Australia
- Division of Psychiatry, University College London, London, UK
| | - Nikita K Hayden
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
| | - Caitlin A Murray
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
| | - Mikeda Jess
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
| | - Emma Langley
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
| | - Jane Kerry Margetson
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, West Midlands, UK
- Cerebra, Carmarthen, UK
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Bhopti A, Brown T, Lentin P. Opportunities for participation, inclusion and recreation in school-aged children with disability influences parent occupations and family quality of life: A mixed-methods study. Br J Occup Ther 2019. [DOI: 10.1177/0308022619883480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Parents of children with disabilities experience long-term loss of occupations and increased caregiving responsibilities, which affect their individual and family quality of life. There is limited knowledge about the factors that influence the family quality of life of families when their child with disability is at school. This study examined the relationships between family quality of life, disability-related supports provided and parental occupations, and identified factors influencing family quality of life. Method A mixed-methods approach was utilised using the Beach Center Family Quality of Life Survey, a demographic questionnaire ( n = 50) and 12 qualitative interviews. Descriptive analyses and Spearman’s Rho correlations were conducted. Both sets of data were analysed and triangulated. Findings Participants reported high satisfaction with their family quality of life, with strong associations between parental occupations and family quality of life. Four qualitative themes highlighted that their family quality of life was hard, challenging and fluctuating; however, there were positives about having a child with disability, and receiving services and supports (formal and informal) for their child with disability helped family quality of life. In spite of this, caregiving was long-term and impacted their everyday occupations, challenging their family quality of life. Conclusion This study concludes that even though parents of a school-aged child with disability are happy to adopt the caregiver role and appreciate the positives of having a child with disability, lack of support within the mainstream schooling system and prolonged caregiving has a detrimental impact on the parents’ occupations, their health and wellbeing, and consequently on their family quality of life. Inadequate opportunities for recreation and lack of resources to manage persistent behaviours of concern highlight unequal participation opportunities for school-aged children with disabilities.
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Affiliation(s)
- Anoo Bhopti
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - Primrose Lentin
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
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Nijs S, Taminiau EF, Frielink N, Embregts PJCM. Stakeholders' perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 68:25-34. [PMID: 35173961 PMCID: PMC8843164 DOI: 10.1080/20473869.2019.1690859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 06/14/2023]
Abstract
INTRODUCTION People with an intellectual disability (ID) are at risk of developing challenging behavior. Although previous research provided important insights into how to support people with an ID and challenging behavior, it remains unclear what various stakeholders consider to be the most essential aspects to further improve their support. METHOD Statements regarding aspects perceived necessary to improve the support to people with an ID and challenging behavior were collected in focus groups. Afterwards participants individually prioritized and clustered these statements, resulting in concept maps for people with an ID, direct support workers, and psychologists. Since only three relatives participated in the entire concept mapping procedure, no concept map could be composed based on their input. RESULTS Participants generated 200 statements. In the concept map of clients, statements were mentioned regarding relational aspects, providing clarity and structure, characteristics of support staff, and professional attitude of direct support workers. Direct support workers provided statements related to their own personal competencies, the necessity of feeling supported and appreciated, and a physical safe environment. Psychologists provided statements regarding their support for direct support workers, the support for the clients, the perspective on the client, and their role as psychologists. CONCLUSION The results of this study may be a starting point to foster increased evidence based practice for the support for persons with an ID and challenging behavior. Moreover, it provides opportunities to create care founded on mutual attunement, based on listening to each other's ideas and insight into perspectives and needs of various stakeholders.
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Affiliation(s)
- S. Nijs
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E. F. Taminiau
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - N. Frielink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - P. J. C. M. Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Dunn K, Kinnear D, Jahoda A, McConnachie A. Mental health and well-being of fathers of children with intellectual disabilities: systematic review and meta-analysis. BJPsych Open 2019; 5:e96. [PMID: 31694727 PMCID: PMC6854361 DOI: 10.1192/bjo.2019.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers. AIMS The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population. METHOD A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria. RESULTS Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10). CONCLUSIONS There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.
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Affiliation(s)
- Kirsty Dunn
- Research Assistant, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Deborah Kinnear
- Senior Lecturer, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Andrew Jahoda
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
| | - Alex McConnachie
- Professor, Mental Health and Wellbeing Group, University of Glasgow, UK
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Nag HE, Hoxmark LB, Nærland T. Parental experiences with behavioural problems in Smith-Magenis syndrome: The need for syndrome-specific competence. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:359-372. [PMID: 31046579 PMCID: PMC6734585 DOI: 10.1177/1744629519847375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
The experience of having a rare disorder was summarised in a large study as 'falling outside the vast field of knowledge of the professionals'. Parents (31 mothers and 17 fathers) of 32 persons with Smith-Magenis syndrome (SMS) participated in this study. A phenomenological approach was used to analyse the data into topics and themes. Four themes emerged: behavioural challenges displayed, parents' strategies for meeting the challenging behaviours, parents' experiences of their own competence and parents' experiences of professionals' competence and understanding regarding children with SMS and their behaviour challenges. We found that parents of children with SMS experience that they are exposed to severe challenging behaviours from their child. The parents believe that they experience more misunderstandings with professionals and that the challenging behaviours increase because there are some specific characteristics of SMS that professionals are not aware of or do not consider in their support services.
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Affiliation(s)
- Heidi Elisabeth Nag
- Frambu Resource Centre for Rare Disorders, Norway; University of Stavanger, Norway
| | | | - Terje Nærland
- Oslo University Hospital, Norway; University of Oslo, Norway
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Dew A, Collings S, Dowse L, Meltzer A, Smith L. 'I don't feel like I'm in this on my own': Peer support for mothers of children with intellectual disability and challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:344-358. [PMID: 31018752 DOI: 10.1177/1744629519843012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article reports on the peer support experiences of mothers with a son or daughter with intellectual disability and challenging behaviour. Engagement in parent peer support programs can improve family quality of life and may have multifaceted benefits at the interpersonal, intra-individual self-change and sociopolitical levels. Thirteen mothers were interviewed about their experiences of participating in a parent peer support program. Thematic analysis focused on the process elements of the program that contributed to its effectiveness in providing support to parents. There were three process-related themes: the role of a paid coordinator, diversity of engagement strategies and matching of peer support partners. Mothers appreciated the opportunities provided to engage in a range of strategies tailored to individual preferences, time and capacity constraints, supported by the paid coordinator. One-to-one peer support proved difficult to sustain given the challenges mothers faced in their day-to-day lives.
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Affiliation(s)
| | - Susan Collings
- UNSW Sydney, Australia
- The University of Sydney, Australia
| | | | | | - Louisa Smith
- UNSW Sydney, Australia; University of Wollongong, Australia
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Cook T, Noone S, Thomson M. Mindfulness-based practices with family carers of adults with learning disability and behaviour that challenges in the UK: Participatory health research. Health Expect 2019; 22:802-812. [PMID: 31187580 PMCID: PMC6737767 DOI: 10.1111/hex.12914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/07/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Family carers of adults with learning disability and behaviours that challenge lead complex and stressful lives. Their caring role can leave them isolated and unsupported. In the UK, effective services designed to build resilience for people in long-term caring roles are lacking. There are none (to our knowledge) designed using a participatory health research (PHR) approach with family carers and professionals. OBJECTIVE With positive behaviour support (PBS) and mindfulness and acceptance and commitment therapy (ACT) as key elements, a PHR approach was used to understand the basis for a successful course that supported the capabilities and resilience of family members in long-term caring roles. DESIGN The research was guided by the principles of PHR with participation as the defining principle throughout. Central to the research were reflexive conversations (communicative spaces) where diverse knowledges were shared and critiqued. FINDINGS Mindfulness/ACT can change long-standing response behaviours and build personal resilience and improve mental health. Elements enabling positive change included a facilitation approach for collaborative reflexivity and the complementary, interactive approach to collaborative enquiry for learning and decision making afforded by PHR. DISCUSSION The use of PHR accessed knowledges that would have been lost to more traditional, professional-expert driven processes and facilitated change in constructs for action for both professionals and family carers. Findings challenge service providers to consider how experiential knowledge has agency in professional practice and service design. Reflection on the PHR process across the FaBPos project led to a re-consideration of quality issues in relation to PHR and participation.
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Affiliation(s)
- Tina Cook
- Department of Disability and Education, Liverpool Hope University, Liverpool, UK
| | - Steven Noone
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, UK
| | - Megan Thomson
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, UK
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Shanahan PJ, Palod S, Smith KJ, Fife‐Schaw C, Mirza N. Interventions for sleep difficulties in adults with an intellectual disability: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:372-385. [PMID: 30628125 PMCID: PMC6850627 DOI: 10.1111/jir.12587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID). METHOD Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non-randomised Studies - of Interventions. Nine studies (n = 97) were eligible for inclusion in the review. RESULTS There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo-controlled randomised controlled trial for the use of melatonin. CONCLUSIONS This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.
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Affiliation(s)
- P. J. Shanahan
- Department of Psychological Sciences, School of Psychology, Faculty of Health and MedicineUniversity of SurreyGuildfordUK
- Neurodevelopmental ServicesYour Healthcare CICSurbitonUK
| | - S. Palod
- Neurodevelopmental ServicesYour Healthcare CICSurbitonUK
| | - K. J. Smith
- Department of Psychological Sciences, School of Psychology, Faculty of Health and MedicineUniversity of SurreyGuildfordUK
| | - C. Fife‐Schaw
- Department of Psychological Sciences, School of Psychology, Faculty of Health and MedicineUniversity of SurreyGuildfordUK
| | - N. Mirza
- Sutton and Merton Mental Health Intellectual Disability TeamJubilee Health CentreWallingtonUK
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Coetzee O, Adnams C, Swartz L. A psychodynamic understanding of parental stress among parents of children with learning and developmental disability and behaviours that challenge. PSYCHODYNAMIC PRACTICE 2018. [DOI: 10.1080/14753634.2018.1526106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ockert Coetzee
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Colleen Adnams
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Leslie Swartz
- Stellenbosch University, Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch, South Africa
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Hastings RP, Gillespie D, Flynn S, McNamara R, Taylor Z, Knight R, Randell E, Richards L, Moody G, Mitchell A, Przybylak P, Williams B, Hunt PH. Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:798-813. [PMID: 30033655 DOI: 10.1111/jir.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co-produced Who's Challenging Who? training delivered by people with ID to staff. METHOD This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow-up at six and 20 weeks post-randomisation. PARTICIPANTS two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. PRIMARY OUTCOME Self-reported Staff Empathy for people with Challenging Behaviour Questionnaire. ANALYSIS intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600. RESULTS 118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: -938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19). CONCLUSIONS This is the first large-scale RCT of a co-produced training course delivered by people with ID. Findings indicated a small positive (but statistically non-significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
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Affiliation(s)
- R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - D Gillespie
- Centre for Trials Research, Cardiff University, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - R McNamara
- Centre for Trials Research, Cardiff University, UK
| | - Z Taylor
- Royal Mencap Society, London, UK
| | - R Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, UK
| | - L Richards
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - G Moody
- Centre for Trials Research, Cardiff University, UK
| | - A Mitchell
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - P Przybylak
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - B Williams
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
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Hatton VA. Staff awareness training: improving knowledge and confidence of autism spectrum disorders and intellectual disabilities in a locked rehabilitation unit. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-04-2018-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to present a training package which was delivered to improve staff members’ knowledge and confidence of autism spectrum disorders (ASD) and intellectual disabilities (ID).
Design/methodology/approach
The training was facilitated in a locked rehabilitation unit for adult males, many of whom had diagnoses of ASD and/or ID. With all staff receiving an invite, 25 attended which was the majority of the staff team. This included staff from housekeeping, nursing and catering.
Findings
To evaluate the effectiveness of the training, a survey and short assessment was administered before and after training. This revealed an improvement in both perceived knowledge and confidence of ASD and ID, as well as actual knowledge. Follow-up interviews also revealed some evidence of sustained learning and practice changes.
Research limitations/implications
Based on these findings, it is recommended that further face-to-face training is delivered at this locked rehabilitation unit to further improve professional practice.
Originality/value
This paper provides value to other inpatient settings as it highlights to practitioners how face-to-face training can significantly improve staff members knowledge and confidence of developmental disorders.
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Lowe R, Barcellos C, Brasil P, Cruz OG, Honório NA, Kuper H, Carvalho MS. The Zika Virus Epidemic in Brazil: From Discovery to Future Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E96. [PMID: 29315224 PMCID: PMC5800195 DOI: 10.3390/ijerph15010096] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
The first confirmed case of Zika virus infection in the Americas was reported in Northeast Brazil in May 2015, although phylogenetic studies indicate virus introduction as early as 2013. Zika rapidly spread across Brazil and to more than 50 other countries and territories on the American continent. The Aedesaegypti mosquito is thought to be the principal vector responsible for the widespread transmission of the virus. However, sexual transmission has also been reported. The explosively emerging epidemic has had diverse impacts on population health, coinciding with cases of Guillain-Barré Syndrome and an unexpected epidemic of newborns with microcephaly and other neurological impairments. This led to Brazil declaring a national public health emergency in November 2015, followed by a similar decision by the World Health Organization three months later. While dengue virus serotypes took several decades to spread across Brazil, the Zika virus epidemic diffused within months, extending beyond the area of permanent dengue transmission, which is bound by a climatic barrier in the south and low population density areas in the north. This rapid spread was probably due to a combination of factors, including a massive susceptible population, climatic conditions conducive for the mosquito vector, alternative non-vector transmission, and a highly mobile population. The epidemic has since subsided, but many unanswered questions remain. In this article, we provide an overview of the discovery of Zika virus in Brazil, including its emergence and spread, epidemiological surveillance, vector and non-vector transmission routes, clinical complications, and socio-economic impacts. We discuss gaps in the knowledge and the challenges ahead to anticipate, prevent, and control emerging and re-emerging epidemics of arboviruses in Brazil and worldwide.
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Affiliation(s)
- Rachel Lowe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
- Barcelona Institute for Global Health (ISGLOBAL), Doctor Aiguader, 88, 08003 Barcelona, Spain.
| | - Christovam Barcellos
- Institute of Health Communication and Information, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
| | - Oswaldo G Cruz
- Scientific Computation Program, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
| | - Nildimar Alves Honório
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
- Núcleo Operacional Sentinela de Mosquitos Vetores-Nosmove/Fiocruz, Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Marilia Sá Carvalho
- Scientific Computation Program, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.
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McKenzie K, Mayer C, Whelan KJ, McNall A, Noone S, Chaplin J. The views of carers about support for their family member with an intellectual disability: With a focus on positive behavioural approaches. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e56-e63. [PMID: 28695628 DOI: 10.1111/hsc.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
This qualitative study explored the views of family carers about the support that their adult children with an intellectual disability had received in relation to their behaviour that challenged. There was a particular focus on positive behavioural support (PBS), although some participants spoke more generally in terms of positive approaches. Semi-structured interviews with eight family carers were analysed using inductive thematic analysis. Four key themes were identified. Good support, of which PBS was an example, was seen as both having reduced behaviours that challenged and having a wider positive impact on the quality of life of the individual and their families. Key features highlighted were: technical knowledge and skill; a strong value base of warmth, acceptance and respect; a collaborative, consistent approach; open communication; and the extension of support to the family carer when needed. It was recognised that there is a need for broad systemic change and for the application of a workforce development model that takes account of the needs of staff, carers and those working in wider systems that have contact with people with an intellectual disability.
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Affiliation(s)
| | - Claire Mayer
- Northumbria University, Newcastle, UK
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Anne McNall
- Northern Design Centre, Abbott's Hill, Northumbria University, Gateshead, UK
| | - Steve Noone
- St George's Park, Northumberland, Tyne and Wear NHS Foundation Trust, Morpeth, Northumberland, UK
| | - Jill Chaplin
- Hartside, St Nicholas Hospital, Newcastle upon Tyne, UK
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Van Riper M, Knafl GJ, Roscigno C, Knafl KA. Family management of childhood chronic conditions: Does it make a difference if the child has an intellectual disability? Am J Med Genet A 2017; 176:82-91. [PMID: 29140588 DOI: 10.1002/ajmg.a.38508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/26/2017] [Indexed: 11/09/2022]
Abstract
The purpose of this analysis was to assess the applicability of the Family Management Measure (FaMM) to families in which there was a child with an intellectual disability versus a chronic condition. Drawing on data from 571 parents of children with a chronic physical condition and 539 parents of children with Down syndrome, we compared the two groups across the six FaMM scales. After accounting for the covariate effects of race, ethnicity, family income, and child age, we found significant differences in four of the six FaMM scales, with parents of children with Down syndrome reporting a significantly more positive view on the Condition Management Effort and View of Condition Impact scales and a significantly less positive view on the Child's Daily Life and Condition Management Ability scales than parents of children with a chronic physical condition. There were no significant differences between groups on the Family Life Difficulty and the Parental Mutuality scales. The analysis provided evidence of the applicability of the FaMM for studying families in which there is a child with Down syndrome and its utility in identifying the common and unique challenges of family management between the groups.
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Affiliation(s)
- Marcia Van Riper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - George J Knafl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cecelia Roscigno
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen A Knafl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Randell E, Hastings RP, McNamara R, Knight R, Gillespie D, Taylor Z. Effectiveness of the 'Who's Challenging Who' support staff training intervention to improve attitudes and empathy towards adults with intellectual disability and challenging behaviours: study protocol for a cluster randomised controlled trial. Trials 2017; 18:460. [PMID: 28982380 PMCID: PMC5629774 DOI: 10.1186/s13063-017-2175-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Findings suggest approximately one in six people with intellectual disability engage in ‘challenging behaviours’, which include aggression towards others/property and self-injurious actions. In residential settings, actions of staff members can make challenging behaviours more likely to occur, or make these behaviours worse. In particular, negative attitudes from members of staff and lack of understanding about the reasons for challenging behaviour are contributory factors. ‘Who’s Challenging Who?’ (WCW) training is designed to emphasise the role of staff in residential settings as a challenge also to people with intellectual disability. The course is delivered jointly by a trainer with intellectual disability who has been labelled as having challenging behaviour, along with a trainer without intellectual disability. Methods This is a cluster randomised two-arm trial of WCW training versus a waiting list control. Overall, 118 residential settings will be recruited and randomised on a 1:1 ratio. Within each setting, two members of staff will be invited to take part in the trial. Participants will complete assessments at baseline and at 6 and 20 weeks. WCW is a half day initial training course with some follow-on coaching to ensure implementation. The primary outcome is changes in staff empathy towards people with challenging behaviour. Secondary outcomes at the staff level include confidence, attitudes and work-related well-being. Secondary outcomes at the residential setting level include recorded incidents of aggressive challenging behaviour, and use of any restrictive practices. Discussion If the results of the cluster randomised trial are positive, we will disseminate the findings widely and make all training manuals and materials freely available for anyone in intellectual disability services (and beyond) to use. Our training approach may have wider implications in other areas of social care. It may also provide a generally applicable model for how to train people with intellectual disability to act as co-trainers in intellectual disability social care settings. People with intellectual disability and challenging behaviour have already been involved centrally with the design, development and pilot evaluation of WCW and will also be fully involved throughout this trial. Trial registration Registered on the International Standard Randomised Controlled Trial Number registry on 8th December 2015: ISRCTN53763600. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2175-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Roseanna Knight
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Zachary Taylor
- Royal Mencap Society, Unit 7 Sundon Business Park, Dencora Way, Luton, UK
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Ryan C, Quinlan E. Whoever shouts the loudest: Listening to parents of children with disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 2:203-214. [DOI: 10.1111/jar.12354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
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Mitchell F, Stalker K, Matthews L, Mutrie N, Melling C, McConnachie A, Murray H, Melville CA. A qualitative exploration of participants’ experiences of taking part in a walking programme: Perceived benefits, barriers, choices and use of intervention resources. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31 Suppl 1:110-121. [DOI: 10.1111/jar.12326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Fiona Mitchell
- Physical Activity and Health Research Group; University of Strathclyde; Glasgow UK
| | - Kirsten Stalker
- Glasgow School of Social Work; University of Strathclyde; Glasgow UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit; Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences; Moray House School of Education; University of Edinburgh; Edinburgh UK
| | - Chris Melling
- Head of Learning Disability Services; West CHCP Glasgow; Glasgow UK
| | - Alex McConnachie
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Heather Murray
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Craig A. Melville
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
- Institute of Health and Wellbeing; Mental Health and Wellbeing; University of Glasgow; Glasgow UK
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Zarhin D. Delaying and seeking care for obstructive sleep apnea: The role of gender, family, and morality. Health (London) 2016; 22:36-53. [PMID: 27895102 DOI: 10.1177/1363459316677625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social scientists have proposed various theories as to when, why, and how people come to seek medical care for multiple conditions. Yet, there is still little empirical research to illustrate the pathways into and out of care, especially for chronic illness. This article contributes to this body of work by exploring individuals' reasons for delaying and seeking care for obstructive sleep apnea, which despite being the most diagnosed sleep disorder, has been largely neglected by social scientists. Drawing upon in-depth interviews with 65 Jewish-Israeli obstructive sleep apnea patients, this study shows how intersections of gender, family, and morality shape and are shaped by care-seeking behavior. The analysis reveals that married men claim they do not do health, thereby reaffirming their masculinity, but they maintain moral status because their wives do much of their illness work for them. Unmarried men, however, claim to be more vigilant in their pursuit of health and present it as one of their responsibilities. Women acknowledge they have the double burden of protecting their own health as well as that of their loved ones, and often feel that they are incapable of meeting these social expectations. However, men and women are able to maintain moral status by explaining their neglect of health as resulting from their attempts to care for significant others. Finally, married women differ from men and unmarried women in their motivations for seeking care. In keeping with their gender roles, married women emphasize disturbance to others whereas men stress disturbance to self.
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Affiliation(s)
- Dana Zarhin
- Tel Aviv University, Israel; Brandeis University, USA
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47
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Lovell B, Wetherell MA. The psychophysiological impact of childhood autism spectrum disorder on siblings. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:226-234. [PMID: 26720849 DOI: 10.1016/j.ridd.2015.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The negative impact of caring for a child with autism spectrum disorder (ASD) on parents' psychophysiological functioning has been widely evidenced. However, siblings, who also face emotional, social and physical challenges associated with having a brother/sister with ASD, have been less widely studied. This study examined the psychophysiological impact of childhood ASD on siblings. METHODS A sample of 25 siblings of children with ASD (and their mothers) and a control group of 20 siblings of neuro-typical children (and their mothers) completed questionnaires assessing: (a) demographic and lifestyle information, (b) family characteristics, (c) child behaviour problems, (d) social support and (e) depressive symptomology. Saliva samples were collected at several time points on two consecutive days, and estimates of the cortisol awakening response (CAR), diurnal cortisol slope and mean diurnal cortisol output were derived. RESULTS Total depressive symptoms were higher in siblings of children with ASD compared with controls. Group differences with respect to depressive symptomology were driven more by emotional than functional problems. With respect to physiological functioning, groups were comparable on all cortisol indices. In siblings of children with ASD, social support, especially from parents and close friends, predicted total depressive symptoms, as did the behaviour problems of their brother/sister with ASD. CONCLUSION Siblings of children with ASD experience greater emotional problems and overall depressive symptoms compared with a control group. Interventions that enhance social support, as well as helping siblings better understand the behaviour problems of their brother/sister with ASD, might be effective for alleviating depressive symptoms.
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Affiliation(s)
- Brian Lovell
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
| | - Mark A Wetherell
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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