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Challenging behaviours: prevalence and topographies
- Authors:
- LOWE K., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 51(8), August 2007, pp.625-636.
- Publisher:
- Wiley
Variations in reported prevalence of challenging behaviour indicate the need for further epidemiological research to support accurate planning of future service provision. All services providing for people with learning disabilities across seven unitary authorities, with a total population of 1.2 million, were screened to identify people with challenging behaviour. Interviews were conducted with primary carers to gain data on identified individuals' characteristics and support. Measures designed for a similar study conducted in Manchester University were incorporated to allow direct comparison with earlier findings, together with standardized tools to assess adaptive behaviour and social impairment. In total, 4.5 (2.5–7.5) people per 10,000 population were rated as seriously challenging, representing 10% (5.5–16.8%) of the learning disability population; the most prevalent general form was other difficult/disruptive behaviour, with non-compliance being the most prevalent topography. The majority showed multiple behaviours and multiple topographies within each general behaviour category. Also identified were substantial numbers of additional people reported as presenting challenging behaviours at lower degrees of severity. Prevalence rates for seriously challenging behaviours were comparable to those reported in the earlier studies, thus confirming previous findings. The prevalence of less serious challenging behaviour also has major clinical significance and emphasizes the need for enhanced understanding and skills among personnel within primary- and secondary-tier health, education and social care services, and for strengthening the capacity of community teams to provide behavioural expertise.
Assessment of challenging behaviours with the Nisonger Child Behavior Rating Form: agreement/disagreement between frequency and severity ratings
- Authors:
- MAKHLUF Yasmin Farage, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 46(4), 2021, pp.370-374.
- Publisher:
- Taylor and Francis
Background: The Nisonger Child Behavior Rating Form (NCBRF) allows for the assessment of frequency and severity of challenging behaviours of individuals with ID with one combined rating. However, frequency and severity rating of challenging behaviours may be in disagreement. Therefore, the efficacy of frequency and severity independent ratings for each NCBRF item was investigated. Method: Professional caregivers of 105 individuals with ID completed the NCBRF with separate frequency and severity ratings and the Vineland-II. Results: Magnitudes of correlation coefficients between frequency and severity rating of each NCBRF item were mostly trivial, small, or medium. However, the differences between the magnitude of the corresponding correlation coefficients of frequency and severity rating of each NCBRF item when related to the Vineland-II adaptive behaviour dimensions were rarely statistically significantly. Conclusions: Despite the need for further comparisons with other challenging behaviour scales, the separate use of frequency and severity ratings seems to be useful. (Edited publisher abstract)
Very frequent physical aggression and vocalizations in nursing home residents with dementia
- Authors:
- VELDWIJK-ROUWENHORST Annelies E., et al
- Journal article citation:
- Aging and Mental Health, 25(8), 2021, pp.1442-1451.
- Publisher:
- Taylor and Francis
Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items ‘hitting’, pushing’, ‘biting’ and ‘kicking’ of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on ‘screaming’ and ‘making strange noises’. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. Results: We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63–2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23–12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04–3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951–0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08–2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34–5.68) and euphoria (OR = 2.01, 95% CI: 1.22–3.31). Conclusion: Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life. (Edited publisher abstract)
Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands
- Authors:
- LEONTJEVAS Ruslan, et al
- Journal article citation:
- Aging and Mental Health, 25(7), 2021, pp.1314-1319.
- Publisher:
- Taylor and Francis
Objectives: From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners’ involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff. Methods: A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews. Results: Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = –2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news. Conclusions: Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously. (Edited publisher abstract)
Family caregivers’ liability for damage inflicted by persons with dementia under their care: a study of the 2016 Japanese Supreme Court ruling
- Author:
- MURAYAMA Kayo
- Journal article citation:
- Journal of Social Welfare and Family Law, 43(2), 2021, pp.143-152.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
By analysing the 2016 Japanese Supreme Court case concerning family caregivers’ liability for damages caused by a person with dementia who was killed by a train while wandering, this article suggests how to address similar cases in the future, considering the rights of persons with dementia to live in the community. The Court absolved the deceased’s wife and son from liability and defined four criteria to find a person liable for damages: (a) the caregiver’s living, mental, and physical conditions; (b) the conditions of the caregiver’s involvement with a person with a mental disability; (c) the nature and incidence of the problematic behaviours of the person with a mental disability; and (d) the circumstances surrounding their supervision and care. This was the Supreme Court’s first presentation of the criteria for establishing liability for a ‘Person Equivalent to a Supervisor’. To guarantee the rights of a person with dementia to live in the community, the burden on family caregivers must be reduced, and the range of caregivers broadened to include non-family providers. The Court sought to reduce the caregivers’ burden, and if these criteria are applied appropriately, the human rights of dementia patients and caregivers will be protected. (Edited publisher abstract)
The use of therapeutic untruths by staff supporting people with an intellectual disability who display behaviours that challenge
- Authors:
- MCKENZIE Karen, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 34(1), 2021, pp.28-35.
- Publisher:
- Wiley
Background: Therapeutic untruths (TU) are used in dementia services to de‐escalate distressing situations. The present authors explored the use of TU by care staff supporting people with an intellectual disability who displayed behaviours that challenged. Method: Data were collected from 126 staff (female = 72.2%; mean age = 41.9 years, SD = 10.7) via an online survey in relation to three areas: responses to three scenarios, reported use of different forms of TU and ratings of perceived effectiveness of, and level of comfort using, each type. Results: 96% of participants reported using TU themselves and observing their colleagues doing likewise. Models that included perceived effectiveness of, and level of staff comfort with using, different TU were significant, although only perceived effectiveness significantly independently contributed to the model. Conclusion: The use of TU was common, with levels consistent with those found in dementia services. The limitations and implications of the findings are discussed. (Edited publisher abstract)
Developing a logic model for the Triple‐C intervention: a practice‐derived intervention to support people with intellectual disability and challenging behavior
- Authors:
- TOURNIER Tess, et al
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 17(4), 2020, pp.297-307.
- Publisher:
- Wiley
Partly due to a lack of evidence‐based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be “good practice”—to develop evidence based on practical knowledge. This study describes the Dutch practice‐based intervention Triple‐C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice‐based nature of Triple‐C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple‐C professionals and to develop an understanding of the mechanisms of change for Triple‐C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple‐C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple‐C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence‐based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice‐based intervention like Triple‐C is an important first step toward producing an evidence base for interventions developed from clinical practice. (Edited publisher abstract)
Care pathways for people with intellectual disabilities who present with behaviours that challenge
- Authors:
- ROY Ashok, BAKER Peter, CARMICHAEL Sue
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.99-107.
- Publisher:
- Emerald
Purpose: Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”. Design/methodology/approach: This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges. Findings: It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again. Originality/value: Standards in relation to care pathways are presented. (Edited publisher abstract)
Capable environments
- Authors:
- McGILL Peter, et al
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.109-116.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to outline the role played by different aspects of the social, physical and organisational environments in preventing behaviour described as challenging in people with learning disabilities. Design/methodology/approach: Conceptual elaboration drawing on research and practice literature. Findings: Community placements for people with learning disabilities should develop the characteristics of capable environments. Such characteristics are associated with prevention of challenging behaviour and improved quality of life outcomes. Originality/value: The notion of the capable environment may help to shift the focus from the individual who displays behaviour described as challenging to the characteristics of the social, physical and organisational supports that they receive. (Edited publisher abstract)
Coming home: a report on out-of-area placements and delayed discharge for people with learning disabilities and complex needs
- Author:
- MacDONALD Anne
- Publisher:
- Scotland. Scottish Government
- Publication year:
- 2018
- Pagination:
- 71
- Place of publication:
- Edinburgh
This two-year project, commissioned by the Scottish Government, collected national data on people with learning disabilities who have additional complex needs, and who are either placed out-of-area, or are within hospital-based assessment and treatment units, classed as delayed discharge. It aimed to gather information on the issues and suggest support solutions and actions that could improve outcomes for people with learning difficulties who have been unable to receive appropriate support in their communities. The project found that there were 705 people out-of-area in Scotland from 30 HSCPs, Of the group, 79 were placed out of Scotland and 453 were identified as being placed out-of-area not through choice. Challenging behaviour, and the impact that challenging behaviour has on service breakdown or hospital admission was a key issue for people with learning disabilities and complex needs. This was partly due to a lack of coordinated responses. Key elements contributing to good support for people with learning disabilities and complex needs were identified as: person-centred approaches, environments which support communication, active support and full lives, positive behavioural support, suitable accommodation, skilled and motivated staff, and good management and practice leadership. The report makes recommendations for Integrated Health Authorities, Health and Social Care Partnerships and the Scottish Government. It calls for a transformational change approach, with all stakeholders working together to address the issue. (Edited publisher abstract)