Towards a framework in interaction training for staff working with clients with intellectual disabilities and challenging behaviour

Emotional Reactions of Professionals to Challenging Behaviors in People with Intellectual and Developmental Disability

Professionals working with people with intellectual and developmental disability (IDD) can be exposed to challenging behaviors (CBs), which may result in professionals exhibiting emotional reactions that can impact their practices. This study examined these reactions and analyzed how they are influenced by the individual characteristics of people with IDD (gender, age, and level of IDD) and the variables related to CB (type of behavior and its frequency and behavioral function). A total of 125 professionals assessed 293 people with IDD who exhibited CBs. The professionals were asked to complete the Behavior Problems Inventory-Short Form, the Emotional Reactions to Challenging Behavior Scale, and the Questions About Behavior Function measure. It was revealed that positive emotional reactions predominated over negative ones. Significant results were found regarding the level of disability and the age of people with IDD. Emotional reactions were related to the severity of CBs, especially self-injurious and aggressive/destructive behavior, as well as certain behavioral functions. The severity of CBs and the age of people with IDD emerge as key predictors of the emotional reactions of professionals. In short, these reactions vary according to different variables, highlighting the importance of interventions that address professionals' emotional needs.

Factors affecting the feelings of safety among individuals with mild intellectual disabilities and severe challenging behaviour in residential care: A qualitative study of professional and service users' perspectives

Background: This study focuses on what feeling safe means for people with mild intellectual disabilities and severe challenging behaviour, and which factors affect their sense of safety. Method: Thematic analysis was used to analyse data collected during (1) ethnographic longitudinal research and (2) interviews and focus groups among professionals and service users. Results: Feelings of safety can relate to three main themes: (1) a physical environment that reduces risks and temptations; (2) a reliable, predictable, and supportive environment; and (3) an accepting environment that enables service users to establish a normal life. An analysis of which factors affect service users' sense of safety identified 20 themes (e.g. team climate) and 34 subthemes (e.g. interactions with other service users). Conclusions: A range of interconnected factors can affect service users' feelings of safety. Future research should explore what organisations and external actors (e.g. the police) can do to promote those feelings.

Building high-quality interpersonal staff-client relationships with people with severe to profound intellectual disabilities and challenging behavior: Insights of professionals and relatives

Background: Staff-client relationships impact the quality of support and life of people with severe to profound intellectual disabilities and challenging behavior, but are challenging to build due to clients' intense, complex and varying support needs. The present study explores the perspectives of professionals and relatives on what affects these interpersonal relationships. Method: 17 professionals and 11 relatives participated in focus groups and interviews. Data collection and analysis was performed in collaboration with a co-researcher. Data were synthesized thematically. Results: Interpersonal relationships constituted equivalence, striving for mutual understanding, trust and exploring clients' potential. The combination of staff characteristics (enthusiasm/passion, patience, resilience, creativity/humor, flexibility) and expertise (knowledge, vulnerability/sincerity, self-reflection) enabled staff to build these relationships. The importance of involving relatives was addressed. Contextual influences included the team (cooperation, flexibility, culture), organization (cooperation, boundary conditions) and setting (predictability, interior/atmosphere). Conclusions: The findings make practical knowledge explicit and scientifically underpinned for this specific population.

Consultations for refractory cases in mental health services: a descriptive study

BACKGROUND

Yearly, almost six percent, which is more than 1,000.000 people, in the Netherlands receive mental health treatment, which usually improves their quality of life. Concurrently, mental healthcare professionals recognize clinically refractory cases in which improvement fails to occur, with severe ongoing burdens for patients. The Dutch Centre for Consultation and Expertise (CCE) is available to support such refractory cases. The Dutch government's (financial) facilitation of consultation through the CCE is unique in the world. CCE consultations provide therefore unique insight into and an overview of refractory cases in mental health services. The objective of this study was to gain insight into the commonalities underlying the reasons for CCE consultations and the solutions proposed that play roles in (the reduction of) refractory cases for which consultation has been requested.

METHODS

This descriptive study was conducted with quantitative and qualitative data from 472 CCE consultations in the Netherlands. Using descriptive statistics and thematic content analysis, four exemplary situations were distilled from the qualitative data.

RESULTS

Most (83%) cases in the sample could be explained with four exemplary situations involving self-harm (24.2%), aggression (21.8%), self-neglect (24.4%), and socially unacceptable behavior (12.5%), respectively. Each situation could be characterized by a specific interaction pattern that unintentionally maintained or aggravated the situation. At the time of closure of the consultation applicants' questions had been answered and their situations had improved in 60.4% of cases.

CONCLUSIONS

This study offers an overview of approaches that provided new perspectives for patients and professionals in many refractory cases in the Dutch mental health services.

Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research

BACKGROUND

People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized.

OBJECTIVE

This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings.

METHODS

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis.

RESULTS

Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation.

CONCLUSIONS

The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.

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

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.

Exploring the association of staff characteristics with staff perceptions of quality of life of individuals with intellectual disabilities and challenging behaviours

Background

This study aimed to examine the associations between individual staff and staff team characteristics and quality of life of individuals with intellectual disabilities and challenging behaviours.

Method

With multilevel analyses, we examined educational level, experience, attitudes and behaviours of 240 staff members, in relation to their perception of quality of life of 152 individuals with intellectual disabilities and challenging behaviours they cared for.

Results

Two individual staff characteristics were related to better quality of life: higher educational and self‐reflection levels. Of the team characteristics, higher educational level, higher self‐efficacy and more friendly behaviour were associated with better quality of life. Unexpectedly, higher staff‐individual ratio was related to lower quality of life.

Conclusions

Both individual staff and staff team characteristics are associated with quality of life, indicating the need to take staff team characteristics into account when examining quality of life.

Spanish Validation of the Emotional Reactions to Challenging Behaviours Scale in Employees Working with People Exhibiting Intellectual Disabilities

The Emotional Reactions to Challenging Behaviours Scale (ERCBS) was designed to evaluate the emotional states of support staff facing challenging behaviours from recipients. Employees working with People Exhibiting Intellectual Disability (PEIDs) are exposed to challenging behaviours. Exposure to challenging behaviours can affect the occupational well-being of these employees. It is thus important for investigators to have instruments assessing employees' emotional reactions to challenging behaviours reliably and validly. In this study, we translated the ERCBS into Spanish and inquired into the psychometric and structural properties of the adapted instrument. We relied on a sample of 232 employees working with PEIDs. Confirmatory factor analysis indicated that the ERCBS was best modelled as a two-factor measure involving a negative emotion factor and a positive emotion factor. The two factors were highly correlated (0.547), suggesting that a distinction between "emotional" and "non-emotional" individuals might be relevant when using the ERCBS. Alpha and omega reliabilities were satisfactory. ERCBS scores did not differ between men and women. ERCBS scores correlated negatively with participants' age and years of service with PEIDs. Our study suggests that the Spanish version of the ERCBS can be used to assess emotional reactions to challenging behaviours among employees working with PEIDs.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Quality of Working Life, Psychosocial Factors, Burnout Syndrome and Emotional Intelligence

The objective of this work is to study the quality of working life associated to psychosocial factors and risks, burnout syndrome and emotional intelligence, as well as being able to detect predictors of the said syndrome. The sample consisted of 311 professionals working in direct contact with an intellectual disability from 15 associations of Extremadura (Spain). The Spanish version of the CESQT questionnaire was administered to evaluate burnout syndrome, the Wong & Law Emotional Intelligence Scale (WLEIS) was used to evaluate emotional intelligence, while the UNIPSICO Battery was used to evaluate the psychosocial factors of demands (work–family conflict and psychosomatic problems) and resources, such as social support and work satisfaction. The results indicate average values of burnout, revealing that work satisfaction, emotional intelligence, and social support are related to burnout syndrome. In addition, there are also positive correlations between psychosomatic symptoms and work–family conflict. Satisfaction at work, social support, and emotional intelligence (intrapersonal and interpersonal perception, use and regulation of emotions) predict burnout syndrome. What is more, the psychosomatic symptoms and work–family conflict explain, respectively, 17% and 17.9% of their variance. Thus, there is a need to develop intervention programs that encourage social support and the conciliation of family life, as well as training skills related to emotional intelligence, such as communication and conflict resolution.

Stakeholders' perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study

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.

Discovery awareness for staff supporting individuals with intellectual disabilities and challenging behaviour: is it helpful and does it increase self-efficacy?

Discovery awareness (DA) is an approach to using video within structured meetings to help staff become more mindful, aware and interested in a client they are supporting who has intellectual disabilities and challenging behaviour. The objective was to evaluate whether, and how, DA is helpful for staff in both inpatient and community settings, and whether it increases self-efficacy in working with people with challenging behaviour. A two-phase mixed method design was employed. For phase 1, forty staff who took part in one of seven single DA meetings completed the Challenging Behaviour Self-Efficacy Scale pre- and post-DA. In addition, post-DA, participants completed an Adapted Helpful Aspects of Therapy Scale (AHAT). For phase 2, six participants completed a follow-up Change Interview; 3-12 weeks after DA. Descriptive statistics reveal participants found events in the DA 'greatly helpful'. The changes identified varied in whether they were expected or not, but were unlikely to occur without DA and 'very important'. Statistical analysis showed no significant changes in self-efficacy following the DA. A thematic analysis on the qualitative data generated by the change interviews and AHAT identified three main themes: Impact on interaction; DA is unique and valuable; and the power of the process. The latter had three subthemes: a structure to facilitate change, making use of the content and reflective space to promote learning. Attendance at a single DA meeting does not increase staff perceptions of self-efficacy, however, staff find the process of DA helpful as it encourages reflection on their interactions with individuals with intellectual disability and challenging behaviour and attuning of their interactions, though further research is needed.

Engagement in carers of persons with intellectual disabilities: the role of self-efficacy and emotional intelligence

Purpose: Different research papers into various occupational groups demonstrate the importance of engagement for the wellbeing of both employees and organizational results. However, the study of this phenomenon and that of other positive factors in professional staff caring for persons with intellectual disabilities is scarce. For this reason, the objective of this work was to test a theoretical model concerning the relationship between engagement, a positive factor, and self-efficacy in carers of persons with an intellectual disability, using emotional intelligence as a mediating variable.Materials and methods: Three hundred and eleven carers participated in the study. Self-report measures with adequate psychometric properties were provided to evaluate engagement, self-efficacy, and emotional intelligence.Results and conclusions: The structural equation models (SEM) showed a significant relation between self-efficacy and engagement. In addition, one of the dimensions of emotional intelligence, namely the use of emotions (UOE), was a full mediator in this relationship. The other dimensions showed no relation to engagement. Thus, the UOE was a fundamental factor for self-efficacy to imply engagement. For this reason, intervention programs in wellbeing and health in the workplace should include specific training in this skill among their objectives.Implications for rehabilitationCarers are very important persons in the lives of individuals with intellectual disabilities.There was a significant relationship between self-efficacy and engagement and use of emotions was a full mediator in this relationship.The intervention programs should include training the emotional intelligence among their objectives in order to optimize engagement.

The role of emotion regulation, coping, self-reflection and insight in staff interaction with patients with a diagnosis of personality disorder in forensic settings

WHAT IS KNOWN ON THE SUBJECT?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Insight, emotion-focused coping and emotion regulation of staff influence the interaction between staff and these patients. Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back-up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion-focused coping) on the contrary needed more support from their patients. Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion-focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance-focused coping), they behave in a less hostile manner towards their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In order to provide compassionate care for their patients, staff ought to be trained in self-compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back-up from their patients. Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn-out or compassion fatigue due to ignoring their own needs and boundaries. ABSTRACT: Introduction Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim To test whether coping, self-reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method Using a cross-sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results Insight and emotion-focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion-focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance-focused coping with less hostile behaviour. Conclusion Insight, emotion-focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice Enhancing self-compassion may improve insight and reduce emotion-focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low.

Is the amount of exposure to aggressive challenging behaviour related to staff work-related well-being in intellectual disability services? Evidence from a clustered research design

BACKGROUND

Previous research has demonstrated an association between aggressive challenging behaviour (CB) and reductions in work-related well-being for intellectual disability (ID) support staff. Much of this research has used subjective measures of CB.

AIMS

To examine whether exposure to aggressive CB is associated with reduced work-related well-being in staff working in ID residential settings across the UK.

METHODS AND PROCEDURE

A cross-sectional analysis was undertaken as part of a randomised trial; 186 staff from 100 settings completed questionnaires on their CB self-efficacy, empathy, positive work motivation, and burnout. Objective measures of aggressive CB in the preceding 16 weeks were collected from each setting.

OUTCOMES AND RESULTS

There was little association between staff exposure to aggressive CB and work-related well-being. Clustering effects were found for emotional exhaustion and positive work motivation, suggesting these variables are more likely to be influenced by the environment in which staff work.

CONCLUSIONS AND IMPLICATIONS

The level of clustering may be key to understanding how to support staff working in ID residential settings, and should be explored further. Longitudinal data, and studies including a comparison of staff working in ID services without aggressive CB exposure are needed to fully understand any association between aggressive CB and staff well-being.

Improving empathy and self-efficacy in caregivers of persons with intellectual disabilities, using m-learning (HiSense APP-ID): study protocol for a randomized controlled trial

Background

A secure attachment with one or more caregivers is one of the most important predictors of cognitive development and emotional wellbeing. Persons with intellectual disabilities (ID) have extra need for secure relationships with primary caregivers but can find making connections difficult. This study aims to explore the effect of a non-invasive m-learning intervention on the empathy and self-efficacy of caregivers, in view of improving attachment relationships with persons with ID.

Methods

A randomized controlled trial (RCT) will be conducted to assess the efficacy of the HiSense APP-ID. The study will include 100 parents/relatives and 100 professional caregivers of adults with mild or moderate ID (18 years and older). Of both groups of participants, half will complete the m-learning intervention. Data will be collected before the intervention starts, immediately after completion of the m-learning, and 1 month after the intervention. Participants will complete questionnaires concerning knowledge about attachment theory, empathy and self-efficacy (primary outcome measures) and social validity (secondary measures).

Discussion

The intervention aims to increase caregiver understanding of attachment theory and to improve empathy and self-efficacy, which may lead to better care and less stress in social interactions. The HiSense APP-ID is an m-learning intervention that can be done independently on any digital device. The course is therefore easily accessible for caregivers of persons with ID. The current study will provide insight into the effectiveness of the intervention for parents/family members and professional caregivers of persons with mild or moderate ID.

Trial registration

Nederlands Trial Register, NTR 6944. Registered on 16 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2772-7) contains supplementary material, which is available to authorized users.