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Modification of motivational interviewing for use with people with mild intellectual disability and challenging behaviour
- Authors:
- FRIELINK Noud, EMBREGTS Petri
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 38(4), 2013, pp.279-291.
- Publisher:
- Taylor and Francis
Background: Motivational interviewing is a promising method to increase treatment motivation for people with mild intellectual disability and challenging behaviour. The purpose of the present study was to identify how professionals could adapt motivational interviewing techniques for use with clients. Method: The authors conducted semistructured qualitative interviews and focus groups with 26 clients, parents, and professionals. A general inductive approach led to the identification of multiple core themes. Results: The authors recommend several modifications to accommodate motivational interviewing for use with clients: adapt to language level, adjust to cognitive abilities, and control for social desirability of responding. In addition, certain characteristics of professionals were also found to be critical for effective motivational interviewing: trustworthiness, engagement, acceptance, empathy, and honesty. Conclusions: Concrete recommendations for the adaptation of the motivational interviewing techniques for use with people with mild intellectual disability and challenging behaviour are identified. Certain characteristics of professionals are also critical for maximising the treatment motivation of clients. (Publisher abstract)
How do we prevent another Winterbourne? A literature review
- Author:
- WRIGHT Sally
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(6), 2013, pp.3-14.
- Publisher:
- Emerald
Purpose – The purpose of this paper is to focus on the precipitants of physical and psychological abuse of individuals with intellectual disabilities in order to understand why mistreatment continues to be prevalent. In particular, the importance of contributing factors were explored such as challenging behaviour and lack of staff training, in an attempt to prevent another “Winterbourne”. Design/methodology/approach – A literature search using the search terms “Intellectual disability”, “learning disability”, “abuse”, “challenging behaviour” and “residential” was conducted. Articles were included using the criteria: adults with intellectual disabilities, concentration on neglect and physical abuse, abuse by staff members and articles written within the last 15 years. Using these criteria, a total of 19 articles were isolated. Additional articles were located through reference to citation lists. In total, 31 relevant articles were identified. Findings – The majority of research agrees that a meaningful increase in risk of abuse does exist for individuals with intellectual disabilities. There is a lack of recent empirical evidence discussing the incidence of abuse, potential causes and the long-term impact of staff training in reducing the incidence of abuse. These gaps may be due to the subjective definition of abuse, the current “reactive” approach to abuse, the ability of perpetrators to hide mistreatment and difficulty in quantifying the difference that increased staff training has on performance. More research is required to adequately protect individuals with intellectual disabilities in the residential setting. Originality/value – The paper highlights gaps in the current literature and identifies potential areas that could be improved in order to reduce the prevalence of abuse in residential care. (Edited publisher abstract)
The use of community treatment orders in an intellectual disability service
- Authors:
- PERERA Bhathika, SHAIKH Abdul, SINGH Niraj
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(3), 2013, pp.129-134.
- Publisher:
- Emerald
An audit was conducted among Consultant Psychiatrists in intellectual disability psychiatry in Nottinghamshire Healthcare NHS Trust to explore how Community Treatment Orders (CTOs) are used in people with intellectual disability in the UK. Each consultant was asked to provide information on demographic data of their patients on CTOs, reasons for being on a CTO, conditions specified, patients' capacity to consent and their understanding of their CTOs. Conditions of CTOs were analysed using thematic analysis. There were 17 CTOs done for patients with intellectual disability from November 2008 to May 2011. Mean age was 38 with a range of 20-59. All patients had a mild or moderate intellectual disability. Only a small percentage of patients had a diagnosis of schizophrenia. More than 50 per cent had a diagnosis of pervasive developmental disorder (PDD). All patients had behavioural problems as a reason for being on a CTO. About one third of patients did not have any understanding of their CTOs. Themes of conditions were focused on providing a structured life to prevent relapse of the mental disorder. The study highlights that CTOs are used differently in the intellectual disability population. CTOs are adapted to use for patients with behavioural challenges and PDD in an intellectual disability population. This contrasts with its common use to manage non-compliance with medication in patients with schizophrenia in the general adult population. This paper also suggests the main themes of conditions which clinicians can use when deciding on CTO conditions. (Edited publisher abstract)
Does engagement in meaningful occupation reduce challenging behaviour in people with intellectual disabilities? A systematic review of the literature
- Authors:
- BALL Jo, FAZIL Qulsom
- Journal article citation:
- Journal of Intellectual Disabilities, 17(1), 2013, pp.64-77.
- Publisher:
- Sage
- Place of publication:
- London
Recently, there has been much debate about the best way to manage challenging behaviour. Although national guidance highlights the importance of meaningful occupation, it is unclear to what extent this helps. This systematic review of the literature evaluated the evidence base for using occupation as a means to reduce challenging behaviour in individuals with intellectual disability. By searching a range of databases, electronic resources and web pages, 13 relevant articles were identified. Additionally, experts in the field were contacted, hand searches were performed and citation searches were carried out. These 13 articles were critically appraised and analysed. Although the amount of research identified was limited and the methodological quality was variable, some broad themes arose. A skilled and structured approach for carrying out occupation may be effective in reducing challenging behaviour. The authors concluded that more robust research is needed before definitive conclusions can be drawn.
Towards the prevention of behavioural and psychiatric disorders in people with intellectual disabilities
- Authors:
- ALLEN David, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 26(6), 2013, pp.501-514.
- Publisher:
- Wiley
Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas. (Publisher abstract)
Evaluating staff training: taking account of interactions between staff and clients with intellectual disability and challenging behaviour
- Authors:
- OORSOUW Wietske M. W. J. van, EMBREGTS Petri J.C.M., BOSMAN Anna M.T.
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 38(4), 2013, pp.356-364.
- Publisher:
- Taylor and Francis
Background: Three aspects in the training of staff who serve clients with mild to moderate intellectual disability and challenging behaviour (CB) have been emphasised: Staff attitudes, self-awareness, and clients' perspectives. This study investigates whether programmes include these aspects. Method: A systematic search yielded 11 relevant articles. Results: Generally, all programmes aimed to improve staff knowledge and skills. Client variables concerned frequencies and severities of CB. None of the studies included clients' perspectives or staff attitudes and self-awareness. Conclusions: The fact that staff attitudes and awareness or clients' perspectives were not among the main goals of the training studies suggests that recent views of effective treatment of CB are not yet the object of scientific study. Given the acknowledgment of these aspects, it is warranted that future research focuses upon these recent insights. (Publisher abstract)
Learning disabilities census report: England, 30th of September 2013
- Author:
- HEALTH AND SOCIAL CARE INFORMATION CENTRE
- Publisher:
- Health and Social Care Information Centre
- Publication year:
- 2013
- Pagination:
- 28
- Place of publication:
- Leeds
This report presents initial findings from the 2013 Learning Disability Census, which provides a snapshot of inpatients with learning disabilities, autistic spectrum disorder and/or challenging behaviour, and the services they receive. The survey was one of the initiatives commissioned in response to the abuse at Winterbourne View Hospital. Sections cover the profile of service users; ward security level and length of stay; service users by region, local authority and distance between residence and placement; and types of provider. The Census data was collected on 30 September 2013. Responses from 104 provider organisations were received on behalf of 3,250 service users. (Edited publisher abstract)
The place of medication for challenging behaviour: a whole system perspective
- Authors:
- BAMIDELE Kunle, HALL Ian
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(6), 2013, pp.325-332.
- Publisher:
- Emerald
This article explores the place of medication in the management of challenging behaviour in people with intellectual disability by considering it in the context of the whole system around the person and by considering the challenges of implementing best practice guidance. The article identifies factors that are barriers to implementing appropriate best clinical practice guidelines (such as “Challenging behaviour: a unified approach”) in relation to medication intervention. It also explores current policy and recommendations on how to improve services for people with intellectual disability and challenging behaviour and make suggestions about how to ensure better compliance with existing guidelines and improve service delivery. Better integration of services, access to specialist interventions including applied behavioural analysis and understanding communication are all essential to reducing the use of medication, as is the need for reactive, personalised and skilled social care provision. (Edited publisher abstract)
Staff responses to behaviour that challenges: The role of knowledge, attributions, and emotion regulation style
- Author:
- WISHART Judith
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 38(3), 2013, pp.205-214.
- Publisher:
- Taylor and Francis
Background: In this study, the authors explored the extent to which the knowledge and attributions of support staff predicted their reported helping behaviour in relation to people with an intellectual disability who displayed challenging behaviour (CB), and whether emotion regulation style moderated the relationship between attributions and this helping behaviour. Method: Participants (N = 107) completed self-report measures of knowledge of the meaning and management of CB, causal attributions and behavioural response to CB, and emotion regulation style. Results: Knowledge and helpful attributions were significantly correlated with reported helping behaviour; however, in a regression analysis with both predictors, only knowledge significantly contributed to the variance. No moderating effect was found for emotion regulation styles on the relationship between attributions and reported helping behaviour. Conclusion: Knowledge was the only significant predictor of reported positive staff approaches in managing CB, giving some support for the provision of staff training aimed at increasing knowledge, rather than changing attributions. (Publisher abstract)
An initial evaluation of direct care staff resilience workshops in intellectual disabilities services
- Authors:
- INGHAM Barry, et al
- Journal article citation:
- Journal of Intellectual Disabilities, 17(3), 2013, pp.3 214-222.
- Publisher:
- Sage
- Place of publication:
- London
The emotional responses to challenging behaviour of direct care staff who support people with intellectual disabilities is thought to be an important mediating factor within the stress experienced by staff and a potential maintaining factor in challenging behaviour. A brief workshop to improve direct care staff resilience was developed and initially evaluated using a measure of emotional reaction to challenging behaviour and a measure of burnout. It was found that negative emotional reactions to challenging behaviour significantly reduced following the workshop, but a measure of burnout did not. This may indicate the usefulness of this intervention with direct care staff in managing their emotional reactions to challenging behaviour. However, further development and evaluation of such interventions with direct care staff is required to explore ways of impacting upon burnout and managing the display of challenging behaviour. (Publisher abstract)