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Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?
- Authors:
- WEBB Elanor Lucy, et al
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 13(1), 2022, pp.32-44.
- Publisher:
- Emerald
Purpose: Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting. Design/methodology/approach: Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk. Findings: Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed). Research limitations/implications: The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship. Originality/value: To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population. (Edited publisher abstract)
“You’re changing the pattern”: cognitive analytic team formulation with learning disabilities care staff
- Authors:
- RUSSELL Rowena B., THEODORE Kate, LLOYD Julie
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 16(1), 2022, pp.53-66.
- Publisher:
- Emerald
Purpose: This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach: Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings: Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications: Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value: This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach. (Edited publisher abstract)
A logic model of the implementation of a regional workforce strategy in positive behavioural support
- Authors:
- NOONE Steve, BRANCH Alison, SHERRING Melissa
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.185-193.
- Publisher:
- Emerald
Purpose: Positive behavioural support (PBS) as a framework for delivering quality services is recognised in important policy documents (CQC, 2020; NICE, 2018), yet there is an absence in the literature on how this could be implemented on a large scale. The purpose of this paper is to describe a recent implementation of a workforce strategy to develop PBS across social care and health staff and family carers, within the footprint of a large integrated care system. Design/methodology/approach: A logic model describes how an initial scoping exercise led to the production of a regional workforce strategy based on the PBS Competence Framework (2015). It shows how the creation of a regional steering group was able to coordinate important developmental stages and integrate multiple agencies into a single strategy to implement teaching and education in PBS. It describes the number of people who received teaching and education in PBS and the regional impact of the project in promoting cultural change within services. Findings: This paper demonstrates a proof of concept that it is possible to translate the PBS Competency Framework (2015) into accredited courses. Initial scoping work highlighted the ineffectiveness of traditional training in PBS. Using blended learning and competency-based supervision and assessment, it was possible to create a new way to promote large-scale service developments in PBS supported by the governance of a new organisational structure. This also included family training delivered by family trainers. This builds on the ideas by Denne et al. (2020) that many of the necessary building blocks of implementation already exist within a system. Social implications: A co-ordinated teaching and education strategy in PBS may help a wide range of carers to become more effective in supporting the people they care for. Originality/value: This is the first attempt to describe the implementation of a framework for PBS within a defined geographical location. It describes the collaboration of health and social care planners and a local university to create a suite of courses built around the PBS coalition competency framework. (Edited publisher abstract)
Commentary on “a logic model for the implementation of a regional workforce strategy in positive behavioural support”",
- Author:
- TOMLINSON Serena Rose Louisa
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.194-198.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on “A logic model for the implementation of a regional workforce strategy in Positive Behavioural Support”. Design/methodology/approach: This commentary provides a discussion of the importance of evaluating positive behaviour support (PBS) training and key issues relating to this. This provides a springboard from which researchers/practitioners may consider these issues when designing and evaluating PBS training courses. Findings: Three main issues are explored: the necessary diversity and breadth of PBS training approaches, the outcome domains to be evaluated and wider systemic issues that may influence PBS training and evaluation of its effectiveness. Originality/value: Effective PBS implementation requires robust training. To achieve this, it will be important for the field to overcome issues relating to the evaluation of training approaches. (Edited publisher abstract)
Including people with intellectual disabilities in the development of their own positive behaviour support plans
- Author:
- BREEZE James
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.199-205.
- Publisher:
- Emerald
Purpose: People with intellectual disabilities are not routinely involved in the assessment of their behaviours that challenge, as this is often completed by a proxy respondent and the health-care professional. This is contrary to guidance stating that everyone should be involved in the planning of their care. This paper aims to show how health-care professionals can support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the subsequent development of their own positive behaviour support (PBS) plans. Design/methodology/approach: A non-systematic review of the existing literature on improving the engagement of people with learning disabilities in health-care planning, and specifically PBS planning, was undertaken. Appropriate papers were included in this paper. Findings: There are several evidence-based methods to improve people’s engagement in the assessment of their own behaviours that challenge and then the development of their PBS plans. These methods are discussed in terms of their application to supporting people to communicate and involving them in the process of developing a valid and meaningful PBS plan. This is a relatively new focus within the literature, and further research should focus on increasing engagement in the process, as well as monitoring how co-production affects PBS outcomes. Originality/value: This paper summarises some of the approaches used to support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the development of their own PBS plans. This should encourage health-care professionals to consider how to use alternative and augmentative communication strategies to facilitate co-production in their own clinical practice. (Edited publisher abstract)
"Commentary on “Including people with intellectual disabilities in the development of their own positive behaviour support plans”
- Authors:
- LEE Steven, STEWART Kitty
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.206-211.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to broaden the discussion on some of the barriers and solutions for co-production in positive behaviour support (PBS) planning as identified in the paper “Including people with intellectual disabilities in the development of their own Positive Behaviour Support Plans”. Design/methodology/approach: Drawing on the literature associated with co-production in PBS planning, this commentary will reflect on the wider systems and culture needed to enable successful implementation of this way of working. Findings: Co-production in PBS planning is recommended as part of best practice guidelines. However, there is limited research in the area of co-production with regards to PBS and use of augmentative and alternative communication methods. Collaboration among speech and language therapy and PBS practitioners is an important factor for co-production to achieve the best outcomes for people with learning disabilities who display behaviours of concern. Along with identifying a range of communication tools/strategies needed for PBS assessment/planning, it also requires a whole systems approach and culture shift to ensure the necessary foundations are in place. Originality/value: Co-production in PBS planning remains an under practiced way of working. This commentary builds on the barriers and solutions identified for co-production and provides further insight into what might be needed to achieve this in health and social care settings. (Edited publisher abstract)
Change processes within team formulations in intellectual disabilities services: what do multi-disciplinary staff find helpful?
- Authors:
- HYMERS Gemma, DAGNAN Dave, INGHAM Barry
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(6), 2021, pp.241-252.
- Publisher:
- Emerald
Purpose: A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events. Design/methodology/approach: Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis. Findings: The key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”. Originality/value: Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development. (Edited publisher abstract)
The informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge: commentary
- Author:
- BEADLE-BROWN Julie
- Journal article citation:
- Tizard Learning Disability Review, 26(3), 2021, pp.169-173.
- Publisher:
- Emerald
Design/methodology/approach: It provides a brief narrative review of the literature on the factors that determine the quality of life of people with intellectual disabilities, including the impact of culture. Findings: Key to ensuring good quality of life outcomes is support that is facilitative, enabling and empowering which can compensate for severity of disability and improve people’s experiences. This approach is called Active Support. Improving quality of life is a key part of preventing and responding to behaviours that challenge. Culture is an important factor in ensuring staff are motivated to work in such ways but is likely to be intertwined with many other factors. Originality/value: This paper summarises the key literature on what is needed to improve outcomes for people with intellectual disabilities. It introduces the importance of exploring how the different dimensions of culture interact and how culture, practice, processes and structures might work in a much more complex and intertwined fashion than previously conceptualised. (Edited publisher abstract)
The informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge
- Authors:
- BANKS Faye, et al
- Journal article citation:
- Tizard Learning Disability Review, 26(3), 2021, pp.160-168.
- Publisher:
- Emerald
Purpose: Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach: Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings: Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value: To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK. (Edited publisher abstract)
Building capable environments using practice leadership
- Authors:
- HUME Linda, KHAN Nadia, REILLY Martin
- Journal article citation:
- Tizard Learning Disability Review, 26(1), 2021, pp.1-8.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to outline the development and piloting of a training intervention for social care staff that uses a capable environments framework to improve the quality of staff support. Design/methodology/approach: A single case study was used to evaluate changes in the quality of staff support and in levels of engagement and challenging behaviour for one of the individuals supported. Findings: The case study demonstrates the usefulness of the capable environments framework as a model for training and development of support planning. Staff provided more positive interaction and support to the individual, who displayed increased participation in activities and reductions in the occurrence and episodic severity of challenging behaviour. Originality/value: Capable environments is a systematic, theoretically-driven approach, which is focussed on the quality of support design and provision for people with intellectual disability. The use of such a framework as an intervention assists staff in the provision of effective personalised supports, a foundation for positive behaviour support. (Edited publisher abstract)