Can the Behaviour Intervention Plan Quality Evaluation, Version 2, be simplified for use by stakeholders with limited experience of positive behaviour support?

BACKGROUND

Behaviour support plan (BSP) quality auditing tools like the Behaviour Intervention Plan Quality Evaluation, Version 2 (BIPQEII), assess the quality of a BSP from the perspective of technical compliance with behavioural principles. However, these principles may be inaccessible to interested stakeholders with limited experience and knowledge of positive behaviour support (PBS). The aim of this study was to test if a simplified version of the BIPQEII [the Behaviour Support Plan Audit Tool (BSPA-tool)] offers a reliable and valid assessment of a BSP's technical compliance with behavioural principles when used by professional stakeholders with varying levels of PBS experience and knowledge.

METHODS

Four scorers rated 50 de-identified BSPs using the BSPA-tool, with one scorer also rating the BSPs using the BIPQEII. Four weeks later, each scorer rated 25 of the 50 BSPs again using the BSPA-tool. Prior to BSP scoring, a group of PBS practitioners provided feedback on the BSPA-tool's content validity.

RESULTS

The BSPA-tool was found to have acceptable content and parallel-form validity; however, acceptable internal consistency and inter-rater and intra-rater reliability were dependent on PBS experience/knowledge, that is, scorers with more experience/knowledge achieved more acceptable levels of reliability.

CONCLUSIONS

This study confirms that even with simplification, BSP quality auditing tools based on technical compliance with behavioural principles are still only accessible to stakeholders with extensive experience/knowledge of PBS. To engage less-experienced stakeholders in BSP quality auditing processes, new audit tools need to be developed that focus on other aspects of BSP quality (e.g. readability and consultation).

Repeatability vs complexity: kinematic comparison between a dressage simulator and real horses

Riding simulators are designed to replicate movement of a horse for the purpose of assessment and training of horse riders, but little is known about their similarity in replicating movement of horses. This study tested the validity of a dressage simulator, by measuring cycle/stride duration, range and symmetry of displacement of the simulator and comparing displacement vectors to that of real horses trotting on a treadmill. A reflective marker was placed on the midline of the simulator at the estimated level of the 18th thoracic vertebrae (T18), and over the T18 spinous process of ten horses. The simulator displacement was recorded in trot mode, while the real horses trotted at a comfortable speed on a treadmill. Displacements in three axes of motion were measured using 10 high-speed video cameras sampling at 240 Hz. Correlation tests showed high levels of statistical repeatability and symmetry of the simulator between multiple runs. Mean cycle/stride duration of the simulator was significantly faster than the group of horses by 0.17 s. Significant differences between the simulator and horses were shown in overall displacement in two axes, the simulator displaying 70% greater displacement in the mediolateral axis, 22% greater displacement in the craniocaudal axis, but displaying 12% less movement in the dorsoventral axis, which was not statistically significant. Displacement trajectories showed similarities in the frontal plane, displaying a butterfly-shaped sequence, but clear differences in the sagittal plane, with the horses showing an oval pattern of displacement and the simulator a clear linear displacement. Caution must therefore be taken with assumptions that riders will move in the same way on a simulator as they would on a real horse.

Severity of cognitive disability and mental health court determinations about fitness to stand trial

BACKGROUND

Little is known about the socio-demographic, clinical and legal determinants of mental health court decisions of unsoundness of mind and unfitness to stand trial for people with cognitive disability. We aimed to estimate the association between severity of cognitive disability and mental health court determinations of unsoundness or unfitness and describe the socio-demographic, clinical and legal factors that predict these determinations.

METHODS

Case file data were extracted on 92 individuals who had a criminal case referred to the Queensland Mental Health Court between 1 January 2013 and 31 December 2014 due to cognitive disability. We fit a modified multivariable Poisson regression model to estimate the association between severity of cognitive impairment and mental health court determination, controlling for socio-demographic, clinical and legal factors.

RESULTS

Adjusting for covariate effects, severity of cognitive impairment was positively associated with being found unfit to stand trial (adjusted prevalence risk ratio = 1.57; 95% confidence interval: 1.07, 2.33; P = 0.023), and comorbid psychotic disorder predicted an increased risk of being found unsound of mind at the time of offence (adjusted prevalence risk ratio = 3.63; 95% confidence interval: 1.38, 9.54; P = 0.009) by the Queensland Mental Health Court.

CONCLUSIONS

Severity of cognitive disability is associated with determinations of unfitness but does not predict determinations of unsoundness in the Queensland Mental Health Court. Psychiatric assessments of cognitive impairment play a pivotal role in mental health court determinations for people with cognitive disability.

A comparison of the position of elite and non-elite riders during competitive show jumping

The purpose of this study was to compare the jumping positions of elite riders (within the top 150 of the British Showjumping rankings) with non-elites (unranked). Video footage of 10 elite and 10 non-elite riders jumping a one stride double combination (a vertical followed by a square oxer) within a 1.20 m competition was analysed. Four angles were measured: the angle between the trunk and the vertical (TRUNKvert), the hip angle (HIP), the angle of the thigh to the horizontal (THIGHhoriz) and the angle of the lower leg to the horizontal (LOWER LEGhoriz). Differences in the angles at five points throughout the double combination and the changes in angles between points were compared using Mann-Whitney U tests. The effect of fence (vertical versus oxer) within groups (elite and non-elite) was also compared. The level of significance was set at P<0.05. HIP angle was significantly smaller on approach to the vertical (P=0.019) and significantly greater when approaching the oxer (P=0.001) for elite riders compared to non-elites. During approach to the oxer compared to the vertical elites had a greater HIP angle (P=0.007), whereas non-elites had smaller HIP (P=0.005) and THIGHhoriz (P=0.005) angles. During suspension, non-elite riders had a greater HIP (P=0.01) over the vertical and smaller LOWER LEGhoriz angle over the oxer (P=0.028) than elite riders. There were significant differences in change in HIP, THIGHhoriz and LOWER LEGhoriz angles between elite and non-elite riders between approach to and suspension over the oxer (P=0.007). During suspension, only elite riders showed an effect of fence with a greater HIP angle (P=0.005) and smaller TRUNKvert angle (P=0.013) over the oxer. Key differences in angles and change in angles exist between elite and non-elite riders. This information is useful in characterising elite rider position and identifying areas of interest for future study.

Why do families relinquish care? An investigation of the factors that lead to relinquishment into out-of-home respite care

BACKGROUND

Families/carers relinquishing the care of family members with a disability into the care of out-of-home respite facilities is an under-researched area in the disability field. With this in mind, the aim of this study was to explore the factors that lead to families relinquishing care, the potential early indicators that families are considering relinquishment; the factors that may prevent relinquishment and the outcomes for families/carers after relinquishment occurs.

METHOD

Thirty-two client files (of individuals for whom families have relinquished their care in a defined 12-month period) were reviewed for information around their relinquishment into out-of-home respite care facilities for an extended stay. Staff members involved with these families (a total of 17) were also interviewed to provide more information.

RESULTS

A thematic analysis of the results found that the factors that led to relinquishment could be categorised into: (1) characteristics inherent to the individual with intellectual disability; (2) characteristics inherent to the family/carer; and (3) characteristics associated with the support context that the carer/family is currently experiencing. It was also found that families'/carers' experienced positive outcomes after relinquishment had occurred; however, feelings of guilt and mourning were initially felt.

CONCLUSIONS

Extra supports (e.g. increased respite care, planning for movement of the family member into out-of-home permanent accommodation and case management) and positive interventions such as parent training were highlighted as potential strategies to achieve more lasting benefits from short-stay out-of-home respite care.