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Kouroupa A, Hamza L, Rafiq A, Hassiotis A, Rapaport P, Jahoda A, Taggart L, Steed L, Cooper SA, Melville C, Marston L, Royston R, Ali A. Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities. NIHR OPEN RESEARCH 2023; 3:40. [PMID: 37881460 PMCID: PMC10593323 DOI: 10.3310/nihropenres.13437.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/27/2023]
Abstract
Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects, but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. Methods We conducted 42 semi-structured interviews with adults with intellectual disabilities and aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Results Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors of psychosocial interventions to address aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions addressing aggressive challenging behaviour in adults with intellectual disabilities. Conclusions Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.
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Affiliation(s)
- Athanasia Kouroupa
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Leila Hamza
- Assessment and Intervention Team, Barnet Enfield and Haringey Mental Health NHS Trust, London, England, UK
| | - Aisha Rafiq
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Angela Hassiotis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Penny Rapaport
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Andrew Jahoda
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Liz Steed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, England, UK
| | - Sally-Ann Cooper
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Craig Melville
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Louise Marston
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, England, UK
| | - Rachel Royston
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Afia Ali
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, England, UK
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Wilson NJ, Barratt M, Jorgensen M, Limbu B, Donley M, Buchholtz M, Smith V, Deb S. Training support workers about the overmedication of people with intellectual disabilities: an Australian pre-post pilot study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:519-530. [PMID: 36880447 DOI: 10.1111/jir.13023] [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: 08/03/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context. METHODS The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training. RESULTS Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points. CONCLUSIONS SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.
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Affiliation(s)
- N J Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury Campus, Richmond, NSW, Australia
| | - M Barratt
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury Campus, Richmond, NSW, Australia
| | - M Jorgensen
- Practice Quality Division, NDIS Quality and Safeguards Commission, Parramatta, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - B Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - M Donley
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - M Buchholtz
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - V Smith
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - S Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
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Shoumi Deb S, Limbu B, Nancarrow T, Gerrard D, Shankar R. The UK psychiatrists' experience of rationalising antipsychotics in adults with intellectual disabilities: A qualitative data analysis of free-text questionnaire responses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:594-603. [PMID: 36808782 DOI: 10.1111/jar.13083] [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: 08/16/2022] [Revised: 12/13/2022] [Accepted: 01/19/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Overprescribing of off-licence psychotropic medications, particularly antipsychotics, for challenging behaviours in people with intellectual disabilities without a psychiatric disorder is a significant public health concern. In the United Kingdom, the National Health Service England launched an initiative in 2016, 'STopping Over-Medication of People with learning disabilities, autism or both (STOMP)', to address this concern. STOMP is supposed to encourage psychiatrists in the United Kingdom and elsewhere to rationalise psychotropic medication use in people with intellectual disabilities. The current study aims to gather UK psychiatrists' views and experience of implementing the STOMP initiative. METHODS An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disabilities (estimated 225). Two open-ended questions allowed participants to write comments in response to these questions in the free text boxes. One question asked about the challenges psychiatrists faced locally to implement STOMP, and the other asked for examples of successes and positive experiences from the process. The free text data were analysed using a qualitative method with the help of the NVivo 12 plus software. RESULTS Eighty-eight (estimated 39%) psychiatrists returned the completed questionnaire. The qualitative analysis of free-text data has shown variation within services in the experience and views of the psychiatrists. In areas with good support for STOMP implementation provided through adequate resources, psychiatrists reported satisfaction in the process with successful antipsychotic rationalisation, better local multi-disciplinary and multi-agency working, and increased awareness of STOMP issues among the stakeholders such as people with intellectual disabilities and their caregivers and multidisciplinary teams, and improved quality of life caused by reduced medication-related adverse events in people with intellectual disabilities. However, where resource utilisation is not optimum, psychiatrists seemed dissatisfied with the process with little success in medication rationalisation. CONCLUSIONS Whereas some psychiatrists are successful and enthusiastic about rationalising antipsychotics, others still face barriers and challenges. Much work is needed to achieve a uniformly positive outcome throughout the United Kingdom.
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Affiliation(s)
- Shoumitro Shoumi Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, Truro, Cornwall, UK
| | - Bharati Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, Truro, Cornwall, UK
| | - Tom Nancarrow
- University of Exeter Medical School, Truro, Cornwall, UK
| | | | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, Cornwall, UK
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Barratt M, Jorgensen M, Deb SS, Limbu B, Donley M, Buchholtz M, Smith V, Wilson N. Staff perceptions following a training programme about reducing psychotropic medication use in adults with intellectual disability: The need for a realistic professional practice framework. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:486-496. [PMID: 36655535 DOI: 10.1111/jar.13070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adults with intellectual disability are at higher risk of being administered psychotropic medications. The UK-developed SPECTROM (Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities) training programme educates disability support workers on psychotropic medications and alternatives to these medications. METHOD Interviews were conducted with 10 participants who took part in the pilot SPECTROM training programme to elicit their views on the programme and its appropriateness in an Australian context. RESULTS The key theme was 'Need for a psychotropic medication practice framework'. Four sub-themes were Broad satisfaction with the SPECTROM training programme; Disability support workers acknowledging the limitations of their scope of practice; Empowering training through prescriptive and reflective methods and; Need for future mentoring from Multi-Disciplinary Team members in the application of new knowledge. CONCLUSIONS Participants felt that whilst they could improve their knowledge and attitudes surrounding psychotropic medication administration for behaviours of concern through SPECTROM training, a national practice framework is needed to execute its goals at scale.
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Affiliation(s)
- Macey Barratt
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Mikaela Jorgensen
- Practive Quality Division, NDIS Quality and Safeguards Commission, Parramatta, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Shoumitro Shoumi Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Bharati Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Mandy Donley
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Moira Buchholtz
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Victoria Smith
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Nathan Wilson
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
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de Kuijper G, de Haan J, Deb S, Shankar R. Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Experts by Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15637. [PMID: 36497711 PMCID: PMC9736624 DOI: 10.3390/ijerph192315637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
People with intellectual disabilities (PwID) are frequently prescribed long-term antipsychotics for behaviours that challenge (BtC) despite the lack of proven effectiveness and the increased risks for side effects of these medications in this population. National and international good clinical practice guidelines recommend deprescribing antipsychotics for BtC, which is often not successful due to environmental and other factors. The involvement of all stakeholders, including PwID, is crucial for deprescribing. However, studies showed that PwID and/or their families are often not involved in decision-making regarding the (de)prescribing of antipsychotics despite their desire to get involved. Moreover, studies on the views of PwID regarding their experiences of withdrawing from antipsychotics are lacking. The aim of this study was to gain insight into the views of PwID by investigating their experiences of discontinuation of long-term prescribed antipsychotics for BtC. A qualitative study was set up. Seven experts by experience with mild intellectual disabilities were interviewed. After six interviews, data saturation was achieved. Interviews were transcribed verbatim. Using phenomenological analysis, themes on lived experiences were extracted. Each consecutive interview was analysed. The four main themes extracted from the interviews were the quality of treatment, knowledge and information about psychotropics and the process of withdrawal, support from the participants' environment and the coping style of the interviewees themselves.
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Affiliation(s)
- Gerda de Kuijper
- GGZ-Drenthe/Centre for ID and Mental Health, 9404 LL Assen, The Netherlands
- Academic Collaboration ID and Mental Health, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
| | - Joke de Haan
- GGZ-Drenthe/Centre for ID and Mental Health, 9404 LL Assen, The Netherlands
| | - Shoumitro Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London SW7 2BX, UK
| | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth, Plymouth PL4 8AA, UK
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Limbu B, Deb SS. Support staff liaising effectively with professionals for the rational use of psychotropics for behaviours that challenge in adults with intellectual disabilities: Findings from a co-design event. Front Psychiatry 2022; 13:954522. [PMID: 36245886 PMCID: PMC9559865 DOI: 10.3389/fpsyt.2022.954522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Experience Based Co-Design (EBCD) and co-production are interdisciplinary collaborative approaches to improve health care services by involving all stakeholders. These approaches capture the experiences of all stakeholders who come in contact with services and use experiences as evidence to promote and implement service changes. The use of psychotropic medications for behaviours that challenge (BtC) in people with intellectual disabilities (ID) is a complex issue because of its off-licence use and use in combination with other medications for physical and psychiatric co-morbidities, which leads to overmedication of people with ID. As support staff plays a pivotal role in the prescribing for people with ID, we have developed a staff training programme, SPECTROM, to help reduce overmedication. A project team developed SPECTROM under the guidance of a Programme Development Group (PDG) consisting of 21 stakeholders. The PDG analysed data from a literature review, four focus groups and a co-design event day involving 26 stakeholders. In this paper, we have presented data based on the findings from the co-design event day, primarily on the issue of support staff effectively liaising with professionals such as doctors, nurses, and other community learning disability team members. In-depth information and recommendations were proposed at the co-design event, which helped develop the draft SPECTROM. The draft was finalised after receiving feedback from 56 stakeholders. Co-production and a modified EBCD can be successfully used to create training interventions and improve health care services. More research should utilise co-production and EBCD and use service users' experiences to develop interventions and improve health care services.
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Affiliation(s)
- Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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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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