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Restraint of adults with intellectual disabilities: a critical review of the prevalence and characteristics associated with its use
- Authors:
- FITTON Lucy, JONES Dominic Ryan
- Journal article citation:
- Journal of Intellectual Disabilities, 24(2), 2020, pp.268-283.
- Publisher:
- Sage
- Place of publication:
- London
Background: As part of their care, adults with intellectual disabilities are often subject to restrictive interventions including restraint. Method: A review examining the prevalence of restraint use with people with intellectual disabilities and the characteristics associated with its use. Results: The seven papers identified used quantitative methodologies and had cross-sectional designs. Prevalence rates of restraint ranged from 11% to 78%, multiple forms of restraint were common. Most studies focused on characteristics within the person with an intellectual disability, three considered external factors. Challenging behaviour was the most consistent characteristic associated with the use of restraint, but how this was defined varied. Conclusions: The review highlights a need for more consistent means of defining and measuring restraint and its associated characteristics. Future research into this area may also want to focus on the context of restraint such as whether it is the least restrictive option used. (Publisher abstract)
Changing the face of challenging behaviour services: the Special Projects Team
- Authors:
- ALLEN David, et al
- Journal article citation:
- British Journal of Learning Disabilities, 34(4), December 2006, pp.237-242.
- Publisher:
- Wiley
The background to a unique initiative for people with challenging behaviour in Wales is described. The Special Projects Team (SPT) was established in the context of increasing knowledge of effective treatment responses, but lack of widespread expertise as well as growing crisis within challenging behaviour services. Unlike previous innovative approaches, the SPT is designed to focus on the development of new services and demonstration projects as well enhancing local knowledge through training and research, and encouraging collaborative developments by working with partners across agencies and across all sectors. The vision of the ideal multi-component, comprehensive, tiered system of support services is outlined, as are the project brief and principal objectives. Key activities in the initial years have encompassed resettlement, a major epidemiological and service mapping study, the development of the first of a series of accredited training courses, research reviews, and the establishment of formal links with other organizations, including the formation of the Unit for Development in Intellectual Disabilities. Aims for the next phases of the Team are highlighted.
Sharing 'good stories' about people
- Author:
- CRAYDEN Stephen
- Journal article citation:
- Community Living, 7(4), April 1994, pp.13-14.
- Publisher:
- Hexagon Publishing
Describes a practical workshop on Gentle Teaching which took place in a residential setting for six people with learning difficulties who also have challenging behaviour.
Drugs may meet service needs - but they fail the clients
- Author:
- WALSH Paul
- Journal article citation:
- Community Living, 7(2), October 1993, pp.18-19.
- Publisher:
- Hexagon Publishing
Reports on SE Kent HA's approach to severe behaviour disorder, which has developed several drug-reduction programmes with emphasis on client needs and not service needs.
Meeting the challenge
- Author:
- PHILPOT Terry
- Journal article citation:
- Community Care, 14.11.91, 1991, pp.20-21.
- Publisher:
- Reed Business Information
Reports on the use of skills and development therapy in working with people with challenging behaviour.
The challenge of the environment
- Author:
- FRANKISH Pat
- Journal article citation:
- Community Living, 2(1), July 1988, pp.18-19.
- Publisher:
- Hexagon Publishing
Challenging behaviour can be reduced by better communication and a therapeutic environment.
Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities: a systematic review
- Authors:
- BELLEMANS Tina, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 44(1), 2019, pp.121-130.
- Publisher:
- Taylor and Francis
Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population. Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence. Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control. Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure “Soles of the Feet”, is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT’s mechanisms of action (e.g., improved interoceptive awareness) is warranted. (Edited publisher abstract)
Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life
- Authors:
- GERBER F., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 55(9), September 2011, pp.918-932.
- Publisher:
- Wiley
Behavioural challenges have limited research using quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study combine QoL measures and objective observations of challenging behaviours (CB) to evaluate changes in adults with ASD and ID treated in different residential programmes in Switzerland. The authors hypothesised that a decrease in CB would be related to an improved QoL. This 45-month study followed 31 adults with ASD and ID who had been integrated into two residential programmes Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2–19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the No-PAMS group, ABC scores did not change and the IQVMR total score decreased. Further analysis partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC.
Health service inpatient units for people with intellectual disabilities and challenging behaviour or mental health problems
- Authors:
- MANSELL Jim, RITCHIE Fiona, DYER Ricinda
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 23(6), November 2010, pp.552-559.
- Publisher:
- Wiley
This paper presents findings from a survey was carried out of NHS and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes. Results revealed that services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and from relatives. In low secure units, they had more adult protection referrals. The authors concluded that the number of people who have finished treatment emphasises the importance of developing housing in the community with sufficiently skilled support. The number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close.
Answering a call for help
- Author:
- CALDWELL Phoebe
- Journal article citation:
- Learning Disability Today, April 2010, pp.16-18.
- Publisher:
- Pavilion
- Place of publication:
- Hove
This article describes the use of ‘Intensive Interaction Plus’ to work with people with challenging behaviour. It explains that challenging behaviour can be the result of sensory differences resulting in sensory overload, so that behaviour considered to be challenging is actually the result of stress and fear triggered by sensory distortions. Intensive Interaction Plus is a person-centred approach involving the use of a variety of therapeutic approaches rather than simply using body language. It requires a shift of viewpoint to understand that that the patient may be viewing reality in a quite different way. This technique can be used across the whole spectrum of non-verbal people with autism, learning disability, multiple disability, and even dementia. The article describes 4 case studies in which the author worked with staff to focus on what was setting off the negative behaviour of the people involved and thus to recognise and deal with the underlying triggers.