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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)
The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications
- Authors:
- LAVIGNA Gary W., WILLIS Thomas J.
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 37(3), September 2012, pp.185-195.
- Publisher:
- Taylor and Francis
Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. However, questions have been raised as to PBS effectiveness, costs, and accessibility. This review examined the efficacy of 12 outcome studies encompassing 423 cases. Findings indicated that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community. The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment. Implications for practice are discussed.
The clinical management and prevention of pica: a retrospective follow-up of 41 individuals with intellectual disabilities and pica
- Authors:
- WILLIAMS Don E., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.210-215.
- Publisher:
- Wiley
Pica is a very dangerous form of self-injurious behaviour because one occurrence can be lethal. This study describes an intervention for people with intellectual disabilities and pica that included comprehensive management of the environment as well as behaviour treatment over a 9-year period. Over a 9-year period, nine surgeries for pica-related incidents occurred prior to intervention; over the 9 years of intervention, pica surgeries were eliminated. Eighty-five percent of participants experienced a 75–100% reduction in pica. Sixteen participants still had restrictive procedures including oral hygiene, overcorrection, contingent personal restraint, contingent mechanical restraint and visual screening with goggles. All continuous mechanical restraint that had been used in baseline was eliminated. People with intellectual disabilities and dangerous pica can be protected on a long-term basis from serious harm if proper management and clinical interventions are both employed. Although restrictive interventions were used on a long-term basis, they were contingent upon a pica incident or pica attempts, which occurred much lower than in baseline sessions. Resident rights were protected throughout the intervention.
Positive behavioural support: definition, current status and future directions
- Authors:
- ALLEN David, et al
- Journal article citation:
- Tizard Learning Disability Review, 10(2), April 2005, pp.4-11.
- Publisher:
- Emerald
Summarises the historical development of positive behavioural support. Describes the main features of this approach and outlines the evidence for its effectiveness. Discusses reasons that relatively few people with learning disabilities and challenging behaviour appear to have access to this form of therapeutic intervention, and makes recommendations for future development.
Moral questions
- Author:
- TURNBULL John
- Journal article citation:
- Nursing Times, 7.12.94, 1994, p.59.
- Publisher:
- Nursing Times
Argues that the evidence for using positive interventions in all cases is not yet convincing.
Systematic review of restraint interventions for challenging behaviour among persons with intellectual disabilities: focus on effectiveness in single-case experiments
- Authors:
- HEYVAERT Mieke, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 27(6), 2014, pp.493-510.
- Publisher:
- Wiley
Background: This article, the first in a two-part series, focuses on the effectiveness of restraint interventions (RIs) for reducing challenging behaviour (CB) among persons with intellectual disabilities. The second article focuses on experiences with RIs for CB among people with intellectual disabilities. Methods: A mixed-methods research synthesis involving statistical meta-analysis and qualitative meta-synthesis techniques was applied to synthesize 76 retrieved articles. This first article reports on the meta-analysis of 59 single-case experiments on effectiveness of RIs for CB among people with intellectual disabilities. Results and Conclusions: The RIs reported on in the single-case experiments were on average highly effective in reducing CB for people with intellectual disabilities, and this reduction in CB was statistically significant. However, the effects vary significantly over the included participants, and the published data and reported outcomes are rather unrepresentative of the everyday use of RIs among persons with intellectual disabilities. (Edited publisher abstract)
Solution-focused brief therapy with people with mild intellectual disabilities: a case series
- Authors:
- ROEDEN John M., et al
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 8(4), December 2011, pp.247-255.
- Publisher:
- Wiley
People with intellectual disabilities often present with additional psychological problems. Solution-focused brief therapy (SFBT) is a form of behaviour therapy that focuses on desired behaviour rather than on the existing problem behaviour. This case study explored 10 applications of SFBT with people with a mild intellectual disability (MID) from a service provider of children and adults with ID in the Netherlands. SFBT sessions varied between 2 and 14 hours per week. Measurements taken before, after, and during a 6-week follow up included an assessment of quality of life and assessment of maladaptive behaviour as well as goal attainment according to people with MID and their carers. Findings revealed that SFBT treatments contributed to improvements in psychological functioning and decreases in maladaptive behaviour. The positive changes evident after SFBT proved sustainable during follow-up. Treatment strategies and therapeutic alliances employed were usually assessed as positive by the participants. The authors concluded that the study indicated the effectiveness of SFBT for people with MID.
Positive goals for positive behavioural support: interventions to improve the quality of life for people with learning disabilities whose behaviour challenges
- Authors:
- FOX Peter, EMERSON Eric
- Publisher:
- Pavilion
- Publication year:
- 2010
- Pagination:
- 80p., CD ROM
- Place of publication:
- Brighton
This resource is written to help with the selection and evaluation of outcomes of intervention for people with learning disabilities whose behaviour presents challenges for services. The authors cover a range of potential outcomes, enabling selection of those which are most relevant in order to evaluate progress towards achieving those outcomes. They look at both the personal and social consequences of the person's challenging behaviour and the effect of interventions on these quality of life factors, rather than simply focusing on attempting to reduce the challenging behaviour itself. The book is designed to act as an addition to existing assessment and intervention processes and documentation, and can be adapted to suit individual circumstances. Sections include: positive goals and positive behavioural support (PBS); development of positive goals; and how to use positive goals. It is aimed at carers, clinical psychologists, psychiatrists, behaviour therapists, community learning disability nurses, social workers, care managers, members of community learning disability teams and members of challenging behaviour teams. The resource is presented in ring-bound format with a CD-rom containing video clips and photo stories.
Frequency of use and characteristics of people with intellectual disabilities subject to physical interventions
- Authors:
- McGILL Peter, MURPHY Glynis, KELLY-PIKE Amanda
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.152-158.
- Publisher:
- Wiley
This study sought to clarify the frequency and circumstances of physical intervention (PI) use and gather data on the characteristics of individuals subject to PI. Data on individuals subject to PI were gathered by postal questionnaire completed by service providers from three samples: people who (i) had attended a PI conference and/or purchased a PI policy document; (ii) operated in a specific geographical area of England and (iii) operated specialist assessment and treatment settings for children/adults with intellectual disabilities throughout the UK. Frequent PI use was reported. Restraint was most commonly reported – monthly or more frequently with most individuals. Overall, those receiving PI were more likely to be young, male, not legally restricted and identified as having an autistic spectrum disorder than those who did not receive PI. The relatively frequent use of PI is consistent with routine rather than last resort use. Such use carries risk of physical and psychological damage. Service providers should systematically reduce the frequency of use of PI.
Can brief workshop interventions change care staff understanding of challenging behaviours?
- Authors:
- DOWEY Alan, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(1), January 2007, pp.52-57.
- Publisher:
- Wiley
The working culture surrounding challenging behaviour may have a strong effect on staff behaviour. As a first step to influencing staff talk about challenging behaviour, the aim of the present study was to explore whether a 1-day training workshop could have an effect on staff causal explanations. Fifty-four front line staff, in six separate groups, completed an adapted version of the Self-Injury Behavioural Understanding Questionnaire (SIBUQ; Oliver et al. 1996) both before and after a 1-day training workshop. The workshops were based on principles of Applied Behaviour Analysis. The SIBUQ comprised questions about causes of challenging behaviours presented in 11 short scenarios. The four possible response options for each scenario reflected behaviourally correct, behaviourally incorrect, internal emotional, and internal organic causal explanations. The number of correct behavioural causal hypotheses increased significantly from pre- to post-training. The proportion of incorrect causal explanations that were behavioural in orientation also increased significantly from pre- to post-training. Staff causal explanations for challenging behaviour can be changed using a relatively brief intervention. Further research is needed to establish whether such changes can be used to influence working culture in challenging behaviour services.