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Positive Behavioural Support as an alternative to medication
- Authors:
- LEE Ruth M., Rhodes Jennifer A.
- Journal article citation:
- Tizard Learning Disability Review, 24(1), 2019, pp.1-8.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to demonstrate how Positive Behavioural Support (PBS) can be used as an alternative to psychotropic medication to improve the quality of life of an individual with a learning disability and behaviour described as challenging. Design/methodology/approach: A single case design was utilised. A unique PBS stopping over medication of people with a learning disability, autism or both (STOMP) clinic model was developed and PBS was used in line with National Institute for Health and Care Excellence (NICE) guidance. This included functional behavioural assessment, to support understanding of the reasons behind behaviour described as challenging, and a gradual medication reduction. Findings: This case study found that antipsychotic medication used to manage behaviour that challenges could be safely reduced and individual quality of life increased when PBS was used as an alternative. Originality/value: STOMP is a project supported by NHS England aimed at reducing the inappropriate prescribing of psychotropic medication to manage behaviour that challenges. NICE guidance recommends that behaviour should be more appropriately understood through PBS. More research is needed to demonstrate how the two work together for safe medication reduction and improved quality of life. (Edited publisher abstract)
Challenging behaviour: a training pack to develop good practice in working with people with learning disabilities whose behaviour is described as challenging
- Authors:
- HARDY Steve, JOYCE Theresa
- Publisher:
- Pavilion
- Publication year:
- 2010
- Pagination:
- 271p., bibliog.
- Place of publication:
- Brighton
This training resource aims to ensure that the workforce have the capabilities to provide effective and ethical support to people with learning disabilities who have challenging behaviour. It uses a person-centred support approach, emphasising the need for individualised interventions, understanding needs and environmental implications. Modules cover topics such as: understanding and assessing challenging behaviour; interventions; supportive strategies; reactive strategies; cognitive approaches; use of mediation; working with families; active support; mental health problems; and challenging behaviour and offending. Each module is divided into individual sessions, providing details of topics to discuss, time taken per session and resources to use. An accompanying CD-ROM contains slides and handouts that can be printed off. Relevant for front line staff in health and social care settings, and professionals in training.
The use of restrictive interventions in Victoria, Australia: population data for 2007-2008
- Authors:
- WEBBER Lynne S., et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 35(3), September 2010, pp.199-206.
- Publisher:
- Taylor and Francis
In Victoria, Australia, all disability service providers who use restrictive interventions are required by the Disability Act (2006) to register with the Senior Practitioner, appoint an Authorised Program Officer to monitor the use of these practices within their own service, and report the use of chemical and mechanical restraints and seclusion to the Senior Practitioner using the Restrictive Intervention Data System (RIDS). The data included in this paper summarise findings from the first 12 months of the RIDS as collated at March 2009. During the year from July 2007 to June 2008, approximately 9% of people who were receiving a disability service were subjected to a restrictive intervention which included about twice as many males as females. The proportion of males subject to restrictive intervention was higher (65%) than would have been expected based on the proportion of males with an intellectual disability receiving a funded disability service in Victoria (58%). Most subjects (98%) were reported to have either an intellectual disability and/or an acquired brain injury, and the majority had more than one disability. The majority were subjected to some form of chemical restraint. Chemical restraint constituted 96% of routine interventions and 57% of PRN and emergency interventions combined. Mechanical restraint was used in 9% of subjects and seclusion in 7%. Limitations of the data are discussed.
Understanding learning disability and dementia: developing effective interventions
- Author:
- KERR Diana
- Publisher:
- Jessica Kingsley
- Publication year:
- 2007
- Pagination:
- 198p., bibliog.
- Place of publication:
- London
The increased longevity of the population at large also means that the number of people with a learning disability is living longer, and the numbers of these people developing dementia will continue to increase. Service providers, planners, doctors, social workers, carers and direct support staff need to be equipped with relevant knowledge prior to the onset of the condition, so they can devise appropriate therapeutic interventions and coping strategies for managing the effects of dementia, including health and medication management and palliative care. This book will provide essential knowledge for anyone involved in the provision of services, assessment of need and direct care and support for dementia sufferers who also have a learning disability.
Bespoke STOMP training for learning disability teams - Does it work?
- Authors:
- NANCARROW Thomas, et al
- Journal article citation:
- British Journal of Learning Disabilities, 47(3), 2019, pp.181-187.
- Publisher:
- Wiley
Background: Intellectual disability (ID) is associated with polypharmacy particularly off‐label psychotropics for “challenging behaviour.” NHS England introduced the “stopping over medication of people with a learning disability (LD), autism or both” (STOMP) initiative. As ID services are a professionally diverse group, it is important to know whether teams have suitable knowledge to deliver STOMP. The impact of delivering bespoke STOMP training was evaluated. Methods: A 21‐item multiple‐choice questionnaire was distributed to three specialist ID teams in the south‐west of England. Current best practice and national guidance knowledge on psychotropic medication use in ID were assessed. One team received bespoke training covering the content of the questionnaire prior to completion. Results: Survey participation was 44% (21/48) by the trained team, 34% (15/44) and 70% (7/10) in the untrained teams. The trained team participants scored over 80% on 19/21 questions compared to 15/21 and 16/21 in the untrained teams. Subspeciality analysis of pooled data (n = 43) showed nursing scored more than 80% on 16/21 questions, psychology 15/21 and allied health professionals (AHPs) 19/21. Nursing and psychology both reported STOMP to be a priority. Majority responded “yes” to potentially being involved in STOMP. Conclusions: Better STOMP knowledge and understanding of best practice and guidelines are associated with training. Nursing and psychology are essential to STOMP delivery but scored lower than AHPs. This study recommends semi‐structured STOMP training developed locally with national underpinnings for all specialist ID teams, particularly focussed on front‐line staff directly involved in the management of challenging behaviour. (Edited publisher abstract)
Commentary on “Positive Behavioural Support as an alternative to medication”
- Author:
- ROBINSON Dave
- Journal article citation:
- Tizard Learning Disability Review, 24(1), 2019, pp.9-12.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from the perspective of Dimensions, a national provider of social care support to people with learning disabilities and/or autism. As a supporter of the NHS England STOMP campaign, Dimensions recognises that people with learning disabilities and/or autism who have displayed “challenging behaviours” are at risk of being wrongly or over prescribed psychotropic medications intended to control that behaviour, and encourages the use of non-medical support strategies as an effective alternative to psychotropic medications. Design/methodology/approach: Dimensions surveyed the approximately 1,400 people with learning disabilities and/or autism for whom they provide 24-h support. The survey was intended to assess the extent of use of psychotropic medications and the level of adherence to NICE “best practice” guidelines. The survey was the precursor to an awareness raising campaign and development of an operational toolkit intended to inform and empower people supported, families and colleagues to take a more proactive role in the prescription and review of psychotropic medications. Findings: In total, 54 per cent of people surveyed were being prescribed psychotropic medication, of whom 97 per cent had been prescribed one or more medications for at least six months. Around 51 per cent were having six monthly multi-disciplinary reviews and around 31 per cent had not had a multi-disciplinary review within the preceding 12 months. Only 13 per cent of people taking psychotropic medication had a plan in place that was specifically aimed at reducing or stopping the medication. Originality/value: Empowering people to participate in and challenge clinical decision making can have a transformative effect on the lives of a group of people who have experienced a significant negative impact from prolonged use of psychotropic medications. (Edited publisher abstract)
Stopping over-medication of people with intellectual disability, Autism or both (STOMP) in England part 1 – history and background of STOMP
- Authors:
- BRANFORD David, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 13(1), 2019, pp.31-40.
- Publisher:
- Emerald
Purpose: The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme. Design/methodology/approach: The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both. Findings: The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours. Originality/value: STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both. (Publisher abstract)
Stopping over-medication of people with an intellectual disability, autism or both (STOMP) in England part 2 – the story so far
- Authors:
- BRANFORD David, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 13(1), 2019, pp.41-51.
- Publisher:
- Emerald
Purpose: The STOMP programme – stopping the over-medication of people with an intellectual disability, autism or both is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants. Part 1 presented the historical background to the use of psychotropic drugs for people with an intellectual disability, autism or both. The purpose of this paper (Part 2) is to present the approach adopted to reduce over-medication (the “Call to Action”) and the progress so far at the half way stage. Design/methodology/approach: The “Call to Action” methodology is described in a Manchester University report – mobilising and organising for large-scale change in healthcare “The Right Prescription: A Call to Action on the use of antipsychotic drugs for people with dementia”. Their research suggested that a social mobilising and organising approach to change operates could provide a mechanism for bringing about change where other approaches had failed. Findings: The adoption of the “Call to Action” methodology has resulted in widespread acknowledgement across intellectual disability practice that overuse of psychotropic medication and poor review was resulting in over-medication. Many individual local programmes are underway (some are described in this paper) however to what extent the overall use of psychotropic drugs has changed is yet to be evaluated. Originality/value: STOMP is part of an English national agenda – transforming care. The government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities autism or both who have a mental illness or whose behaviour challenges services. This paper describes a new approach to stopping the over-medication of people with an intellectual disability, autism or both. (Publisher abstract)
Reducing the use of restrictive practices with people who have intellectual disabilities: a practical approach
- Author:
- ALLEN David
- Publisher:
- British Institute of Learning Disabilities
- Publication year:
- 2011
- Pagination:
- 67p., bibliog.
- Place of publication:
- Kidderminster
This practical guide looks at how to reduce the use of physical restraint and other restrictive practices, such as seclusion and medication, when working people with intellectual disabilities. First it discusses what is known about how often restrictive practice are used and their impact on people who have intellectual disabilities. Key individual and organisational factors that can lead to a reduction in restrictive practices are then outlined. The potential role of positive behavioural support in reducing restrictive practices is also considered. Finally a suggested project template for reducing restrictive practices in organisations is described.
A meta-analysis of intervention effects on challenging behaviour among persons with intellectual disabilities
- Authors:
- HEYVAERT M., MAES B., ONGHENA P.
- Journal article citation:
- Journal of Intellectual Disability Research, 54(7), July 2010, pp.634-649.
- Publisher:
- Wiley
This meta analysis reviewed the distinct biological, psychotherapeutic and contextual interventions used to treat challenging behaviour among persons with ID and analysed the intervention effects and moderating variables. A literature search was conducted using the databases ERIC, PsycINFO, Web of Science and Medline. A random-effects meta-analysis was carried out, supplemented with sensitivity, subgroup, meta-regression and publication bias analyses. Eighty articles were identified, of which 30 contained sufficient data to enable statistical meta-analysis. Eighteen described a biological, 13 a psychotherapeutic and nine a contextual intervention, either applied alone or combined. The overall standardised mean difference was 0.671. As shown by sensitivity analysis, this summary effect size was robust. Assessed through subgroup and meta-regression analysis, all tested moderators showed no statistically significant association with the treatment effects. After applying several analysis techniques the authors concluded that their meta-analysis did not suffer excessively from publication bias effects. It is concluded that several biological, psychotherapeutic and contextual interventions effectively reduce challenging behaviours among persons with ID.