Training staff to promote self-management in people with intellectual disabilities

The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities: a systematic literature review

PURPOSE

People with physical disabilities often require lifetime support and experience challenges to maintain or (re)define their level of independence. Assistive living technologies (ALT) are promising to increase independent living and execution of activities of daily living (ADL). This paper provides a systematic literature review that aims to analyse the present state of the literature about the impact of ALT on perceived independence of people with a physical disability receiving long-term care.

MATERIALS AND METHODS

Databases Embase, Medline, and Web of Science were searched for eligible studies from 2010 or later.

RESULTS

Nine studies were included, of which seven qualitative, one quantitative, and one mixed methods. Quality was generally high. ALT enabled participants to execute ADL. We found six themes for the impact of ALT on perceived independence: feeling enabled, choice and control, feeling secure, time alone, feeling less needy, and participation.

CONCLUSIONS

ALT appears to impact perceived independence in many ways, exceeding merely the executional aspect of independence. Existing research is limited and quite one-sided. More large-scale studies are needed in order to inform care organisations how to implement ALT, especially considering societal developments and challenges impacting long-term care.

A model for fostering community capacity to support adults with intellectual disabilities who engage in challenging behaviour: A scoping review

Developmental support agencies support many adults with intellectual disabilities in the community. Unfortunately, these adults often exhibit high rates of challenging behaviour, which present significant pressures on these service providers. Agencies need to develop effective means of increasing their capacity to provide quality support. Previous systematic reviews found that training staff in positive behaviour supports can improve outcomes; however, the factors facilitating training's effects, long-term effectiveness, and outcomes for service users have yet to be determined. We conducted a scoping review of 98 journal articles and book chapters to develop a model for fostering capacity development drawing from Organizational Behaviour Management and Knowledge Translation theories. Some relevant factors include features of the inner and outer organizational contexts, training approaches (e.g., behavioural skills training & in-situ coaching), ongoing support and feedback. This model may lead to more effective and enduring treatment programs and improved support for adults with intellectual disabilities.

[Tools to strengthen organizational health literacy in the health care sector]

BACKGROUND

The National Action Plan to Improve Health Literacy calls for user-friendly and health-competent development of health care at all levels. After the first years of focusing on individual health literacy, the focus is increasingly on organizational health literacy. Organizational health literacy addresses different standards (e. g., management, communication, staff, users or patients) and levels in the organization (i.e., organizational, staff and user level). Numerous tools already exist to strengthen health literacy in hospitals. However, previous studies have rarely focused on a differentiated overview of tools to strengthen organizational health literacy by health literacy standards and differentiated by level of organization, staff and users. The article has two goals, one of which is to search for and review existing tools to strengthen organizational health literacy in health care institutions. In addition, selected tools for strengthening organizational health literacy for health care institutions, differentiated according to the eight fields of action and the three organizational levels (i.e., institution, staff, users), will be presented.

METHOD

A search was carried out to identify tools on strengthening health literacy in facilities of health care. All the tools identified were reviewed, selected according to previously defined inclusion and exclusion criteria and assigned to the level (institution, employees or patients/clients and their relatives) as well as the eight fields of action of organizational health literacy.

RESULTS

We found a total of N=191 tools for health care facilities. After taking into account the inclusion and exclusion criteria, a total of n=60 tools were selected and differentiated according to the level and standard of organizational health literacy. Some of these tools could be assigned to more than one field of action. Most tools (n=37) were found for Standard 5 "Health-competent communication users", while the lowest number of tools were identified for Standard 7 "Promoting the health literacy of employees" (n=4). Differentiation by level (i. e., organizational, staff, patients or clients) shows that there is a smaller number of tools for employees (n=43) compared to the level of the organization (n=76) or users (n=65).

DISCUSSION

Overall, the study shows that numerous tools already exist to strengthen organizational health literacy for hospitals, in particular, and for health care settings, in general. In the future, however, it will be necessary to develop and test tools for individual standards of health literate organizations in health care facilities. Further, internationally provided and tested tools have to be adapted and piloted for the German-speaking countries and health care settings in order to address the health literacy of staff, users and their relatives in a sustainable manner.

CONCLUSION

The development of health literate settings requires effort from health care organizations. Thus, tools for strengthening organizational health literacy should be provided and implemented by also focusing on the level of organization, staff and users so that the individual health literacy of users can be addressed and improved in the long-run.

Caregivers evaluate independence in individuals with Down syndrome

Independence is both a sense of autonomy and self-reliance coupled with the skills to complete tasks without assistance. Questionnaire of caregivers of individuals with Down syndrome asked about factors related to independence on six topics: safety, communication, self-care, daily living, social/leisure, and vocational/employment. Responses from 408 caregivers to an independence questionnaire were received, and summarized using means and frequencies. Top goals by topic were safety from sexual abuse, communicating wants and needs, toileting independently, living independently/semi-independently, engaging in leisure time appropriately, and reading and writing. Independence is a complex, multifactorial phenomenon which varies among individuals with DS.

Description of Daily Living Skills and Independence: A Cohort from a Multidisciplinary Down Syndrome Clinic

Levels of independence vary in individuals with Down syndrome (DS). We began this study to describe the current life skills in our clinic population of children and adults with DS. We collected and reviewed demographics, living situation, and life skills from an electronic intake form used in clinic procedures. Descriptive statistics for this cohort study included mean, standard deviation, and frequencies. From 2014–2020, 350 pediatric and 196 adult patients (range 0–62 years) with a first visit to the Massachusetts General Hospital Down Syndrome Program are described. Pediatric patients were most often enrolled in school, and in an inclusion setting. Adult patients were most often participating in a day program, living with family, and wanted to continue living with family in the future. Most (87%) of adults with DS communicated verbally, though fewer could use written communication (17%). Life skills of greatest importance to adolescents and adults with DS included: learning about healthy foods (35%), preparing meals (34%), providing personal information when needed (35%), and describing symptoms to a doctor (35%). Life skills for patients with DS are varied; those associated with a medical appointment, such as sharing symptoms with the doctor, could improve for greater independence.

Opportunities, barriers, and recommendations in down syndrome research

BACKGROUND

Recent advances in medical care have increased life expectancy and improved the quality of life for people with Down syndrome (DS). These advances are the result of both pre-clinical and clinical research but much about DS is still poorly understood. In 2020, the NIH announced their plan to update their DS research plan and requested input from the scientific and advocacy community.

OBJECTIVE

The National Down Syndrome Society (NDSS) and the LuMind IDSC Foundation worked together with scientific and medical experts to develop recommendations for the NIH research plan.

METHODS

NDSS and LuMind IDSC assembled over 50 experts across multiple disciplines and organized them in eleven working groups focused on specific issues for people with DS.

RESULTS

This review article summarizes the research gaps and recommendations that have the potential to improve the health and quality of life for people with DS within the next decade.

CONCLUSIONS

This review highlights many of the scientific gaps that exist in DS research. Based on these gaps, a multidisciplinary group of DS experts has made recommendations to advance DS research. This paper may also aid policymakers and the DS community to build a comprehensive national DS research strategy.

A Systematic Review of the Assessment of Support Needs in People with Intellectual and Developmental Disabilities

An evaluation of support needs is fundamental to the provision of services to people with intellectual and developmental disabilities. Services should be organized by considering the support that people need to improve their quality of life and enforce their rights as citizens. This systematic review is conducted to analyze the rigor and usefulness of the available standardized tools for assessing support needs, as well as the uses of their results. Several databases were consulted, including Web of Sciences, Scopus, PubMed, ProQuest Central, PsycInfo, ERIC, and CINAHL, and the 86 documents that met the review criteria were organized into four sections: (a) measurement tools, (b) descriptive/correlational studies, (c) predictive studies, and (d) interventions. The results showed that age, level of intellectual disability, adaptive behavior skills, the number and type of associated disabilities, and medical and behavioral needs affected the support needs of people with disabilities. Quality of life outcomes have been predicted by the individual’s support needs, explaining a significant percentage of their variability. The findings are useful in guiding assessments and planning interventions. Further research should address the effectiveness of specific support strategies and the development of social policies and indicators for inclusion that involve assessing support needs.

Self-management interventions for people with intellectual disabilities: A systematic review

OBJECTIVE

People with intellectual disabilities (ID) often experience difficulties managing their affairs. This study reviewed self-management interventions for people with mild to moderate ID, studying interventions' effectiveness and applied behavioural change techniques (BCTs).

METHODS

A systematic literature search was conducted in PubMed, PsychINFO, Web of Science, Embase, Emcare, Cochrane, and ProQuest. Data were extracted on study, intervention, and participant characteristics, and results.

RESULTS

Of the 681 studies retrieved, 36 met the inclusion criteria. Most studies used case study designs and small samples. There were eight randomised controlled trials and one non-randomised study. Studies were mostly of moderate quality (Mixed Methods Appraisal Tool). Twenty-two interventions targeted a singular practical skill for a specific context. In allinterventions, the provider applied several BCTs; in 13 studies participants were also trained to apply BCTs themselves. In all studies, improvements in self-management were reported, which mostly maintained over time (n = 20). If measured, generalisation to other settings was also found.

CONCLUSIONS

Future studies should aim for a higher methodological quality and couldconsider targeting more generic self-management and a wider application of BCTs by people with ID themselves.

PRACTICE IMPLICATIONS

The findings suggest that training can promote self-management in people with ID.

Improving the participation of adults with visual and severe or profound intellectual disabilities: a process evaluation of a new intervention

BACKGROUND

While the participation of adults with visual and severe or profound intellectual disabilities (VSPID) in society and community life is important, evidence-based interventions to improve their participation are lacking. We conducted a process evaluation of the implementation of 'Care for Participation+' (CFP+), a new intervention targeting the attitudes of direct support professionals (DSPs) toward the participation of adults with VSPID, within a residential facility in the Netherlands.

METHODS

CFP+ was inspired by the Boston Psychiatric Rehabilitation Approach and adapted by adopting a new definition and operationalization of the concept of participation for adults with VSPID. Following systematic training, 16 DSPs of adults with VSPID were able to apply key elements of CFP+ to explore diverse roles and activities for this population, facilitating their self-management, teaching them necessary skills for participation, and organizing support. Our process evaluation entailed an investigation of the delivered dose, reach, fidelity, and adaptation of CFP+ during and after the CFP+ intervention. We also evaluated the mechanisms of impact and context using questionnaires, assignments, documentation, interviews, and a logbook.

RESULTS

The intended dose, reach, and fidelity relating to the implementation of CFP+ were not achieved. Despite this fact, an assessment of the mechanisms of impact indicated that assignments of CFP+ were well (75%) or reasonably well (17%) understood by DSPs. CFP+ was applied by DSPs to stimulate self-management (83% of DSPs), new activities (100%), enhanced involvement in existing activities (67%) and to explore new roles (50%) for adults with VSPID. A negative contextual factor mentioned by the trainer and manager was the DSPs' lack of commitment to the training program. Another negative contextual factor mentioned by DSPs was the lack of time for implementing CFP+.

CONCLUSIONS

CFP+ provides new opportunities to improve the participation of adults with VSPID. Despite the non-optimal conditions for implementing CFP+ and the DSPs' general reluctance to apply the new intervention, some have actively used CFP+ within the residential facility. Future studies should focus on the outcomes of CFP+ regarding attitudinal changes among DSPs relating to the participation of adults with VSPID and their quality of life.

Psychological treatment strategies for challenging behaviours in neurodevelopmental disorders: what lies beyond a purely behavioural approach?

PURPOSE OF REVIEW

Challenging behaviour shown by individuals with neurodevelopmental disorders (NDDs) has a major negative impact. There is robust evidence for the efficacy of treatments based on applied behaviour analysis. However, such approaches are limited in important ways - providing only part of the whole solution. We reviewed the literature to provide an overview of recent progress in psychological treatments for challenging behaviour and how these advance the field beyond a purely behavioural approach.

RECENT FINDING

We identified 1029 articles via a systematic search and screened for those implementing a psychological intervention with individuals with NDD (or caregivers) and measuring the potential impact on challenging behaviour. Of the 69 included studies published since 2018, more than 50% implemented a purely behavioural intervention. Other studies could generally be categorized as implementing parent training, meditation, skill training or technology-assisted interventions.

SUMMARY

Greater consideration of the interplay between behavioural and nonbehavioural intervention components; systematic approaches to personalization when going beyond the behavioural model; mental health and broad social communication needs; and models that include cognitive and emotional pathways to challenging behaviour; is needed to advance the field. Furthermore, technology should not be overlooked as an important potential facilitator of intervention efforts.

Perceptions and understandings of self-determination in the context of relationships between people with intellectual disabilities and social care professionals

This study examines perceptions and understandings of self-determination in the context of relationships between people with intellectual disabilities and social care professionals. We held focus group discussions to explore the views and experiences of 10 residents and 10 professionals at three facilities for people with intellectual disabilities located in Western Switzerland. Participants perceived and understood self-determination in terms of decision-making, social skills, procedures, identity, self-consciousness, autonomy, freedom, barriers, and facilitators. The research process highlighted the shifting and situational nature of the concept, as well as the importance of self-determination for people with intellectual disabilities. The findings also highlight the importance of discussion and reflection on the concept of self-determination and its benefits for people with intellectual disabilities.

Development of the Leiden Independence Questionnaire for Support Staff: a measure of staff behaviour regarding promoting independence of people with intellectual disabilities

BACKGROUND

Support staff of adults with intellectual disability (ID) play an important role in promoting independence in home and community settings. However, little is known about the types of behaviours staff should use to promote independence and instruments that assess such behaviour do not yet exist. The aim of this study was therefore to develop and initially validate a reliable questionnaire that measures the degree to which support staff display behaviours that promote independence in people with ID.

METHOD

The Leiden Independence Questionnaire for Support Staff (LIQSS) was constructed to measure the extent to which support staff promote independence in people with ID. The LIQSS was completed by 142 staff members working with people with ID. For the psychometric evaluation of the LIQSS, a principal component analysis was performed with an oblique rotation in all items. Next, the principal component analysis was performed with a forced three-component extraction, and three sub-scales were computed. To assess internal consistency, Cronbach's α was calculated for each of the sub-scales.

RESULTS

The LIQSS was found to consist of three internally consistent (Cronbach's α was respectively 0.92, 0.79 and 0.76) and meaningful components: (1) communication, agreements and coordination; (2) positive encouragement and tailoring; and (3) supporting independent performance. The final 22 items had factor loadings between 0.44 and 0.91 on their corresponding component and a minimal difference in loading to the other factors of 0.20.

CONCLUSIONS

The LIQSS appears to be an instrument with positive face validity and reliability (internal consistency) that assesses the degree to which support staff promote independence in people with ID. To increase the instrument's value for both scientific research and clinical practice, studies should focus on the further validation of the LIQSS.

Effects of a self-management training for people with intellectual disabilities

BACKGROUND

To help people with intellectual disabilities lead a more independent life, it is important to promote their self-management. This study evaluated the effectiveness of a self-management training for people with intellectual disabilities directed at independent functioning in daily life.

METHOD

In the training, 17 people with intellectual disabilities worked on personal self-management goals covering a wide range of everyday affairs. Primary outcome measures focused on goal attainment, independence and support needs. Moreover, outcomes regarding psychopathological behaviour and quality of life were explored. Data were collected before and at the start of the training, and 3, 6, 9 and 12 months later.

RESULTS

The training contributed to the attainment of self-management goals and to the reduction in support needs (p < 0.01). There were no changes in independence, psychopathological behaviour and quality of life.

CONCLUSIONS

Results indicate that the training supports people with intellectual disabilities to self-manage their daily affairs.