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Flexible assertive community treatment for individuals with mild intellectual disability or borderline intellectual functioning: client variables associated with treatment outcome
- Authors:
- NEIJMEIJER Laura, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 14(6), 2020, pp.199-212.
- Publisher:
- Emerald
Purpose: Recent research on flexible assertive community treatment (FACT) for individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) has shown positive results. This paper aims to identify which client variables are associated with treatment outcome of FACT. Design/methodology/approach: Analyses were performed on assessments made during a six-year longitudinal study in The Netherlands. Data comprised assessments of 281 clients with at least 2 measurements. Treatment outcome was measured by the learning disability version of the Health of the Nation Outcomes Scales. Demographic variables and dynamic risk variables of the short version of the Dynamic Risk Outcome Scales were selected as potential predictor variables of outcome. Data were analysed using linear mixed models. Findings: Limited awareness of the need for treatment, limited treatment motivation and cooperation, limited social skills, impulsivity and substance abuse were significantly associated with worse treatment outcome. None of the demographic variables influenced treatment outcome significantly, and neither did intelligence quotient or having a judicial or civil measure. Research limitations/implications: Because of the observational design, no causal inferences can be drawn. Practical implications: This study produces guidelines regarding nature and scope of the treatment supply and the competences of professionals working in FACT MID/BIF teams. Originality/value: This paper encourages other countries to make assertive outreach available for people with MID/BIF on a larger scale, taking into account the acquired insights. (Edited publisher abstract)
Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour
- Authors:
- TENNEIJ N. H., KOOT H. M.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(2), February 2008, pp.114-124.
- Publisher:
- Wiley
Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared. During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1–34), and 12% in auto-aggressive incidents (range per client 1–92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women. Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
Behavioural treatment of severe food refusal in five toddlers with developmental disabilities
- Authors:
- DE MOOR J., DIDDEN R., KORZILIUS H.
- Journal article citation:
- Child: Care, Health and Development, 33(6), November 2007, pp.670-676.
- Publisher:
- Wiley
Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. A behavioural treatment package was implemented in an outpatient setting for the treatment of severe food refusal in five toddlers with developmental disabilities. During the course of treatment, treatment principles were generalized to parents in the home setting. Treatment resulted in oral acceptance of a variety of food items in each child and was successfully generalized. Treatment effects were maintained during follow-up between 3 and 12 months. Tube feeding was discontinued in each child and health status of each child improved. Behavioural treatment may be highly effective in establishing oral food intake in children with developmental disabilities (in the absence of organic causes). As a side-effect of this treatment, tube-feeding may be discontinued and general heath status improved.
Quality of diagnosis and treatment plans after using the ‘diagnostic guideline for anxiety and challenging behaviours’ in people with intellectual disabilities: a comparative multiple case study design
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, pp.305-316.
- Publisher:
- Wiley
Background: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. Materials and Methods: A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. Results: The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Conclusions: Working with the ‘Diagnostic Guideline for Anxiety and CB’ leads to improved diagnoses and treatment plans compared with care as usual. (Publisher abstract)
Introduction to the Dutch De Borg institutions
- Author:
- ROOS Jacqueline
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 1(1), April 2010, pp.29-32.
- Publisher:
- Emerald
In the Netherlands there are different facilities for the treatment and care of mentally disabled people: ordinary care institutions where people live and work; mental health care institutions that provide treatment; and specialised treatment units for people with learning disabilities and severe challenging behaviour. In this article the author introduces De Borg, a collaboration of five institutions in the Netherlands for adults with mild learning disabilities (intellectual disabilities) and severe problem behaviour. These institutions have different backgrounds: one is a TBS facility (a special forensic psychiatric facility); one a mental health care; and three for mentally disabled people. All five organisations offer temporary treatment, where clients come in from other institutions and prisons, and, after treatment, leave – normally to lower care institutions for the mentally disabled. A total of 224 beds are available for inpatient treatment and 800 places for outpatients. Previously, all facilities were either low or high security, but there are currently plans to build a medium secure unit for patients with learning disabilities. The author presents some results of the research that has taken place in the treatment units about the characteristics of the clients, and concludes with recent developments in De Borg institutions, such as the creation of a common ‘vision on treatment and treatment programmes’ and the improvement of treatment programmes.
Integrative treatment in persons with intellectual disability and mental health problems
- Author:
- DOSEN A.
- Journal article citation:
- Journal of Intellectual Disability Research, 51(1), January 2007, pp.66-74.
- Publisher:
- Wiley
Clinical experience has proven thus far that a monodisciplinary treatment approach to behavioural and psychiatric problems in persons with intellectual disability (ID), such as psychotropic medication or behaviour modification programmes, has yielded limited success. It is clear that the complexity of behavioural and psychiatric problems in this population calls for a treatment approach from different perspectives. This article describes a multidimensional treatment approach to the persons with ID who suffer from behaviour problems and psychiatric disorders. Four dimensions – biological, psychological, social and developmental – are represented as well in an integrative diagnosis as in an integrative treatment, embodied by cooperation of different professionals, such as a psychiatrist, psychologist, pedagogues, social worker, nurse and, where possible, the person's caretakers. The developmental dimension receives a salient attention of assessors. By introducing the developmental dimension in diagnostics and treatment, the bio-psycho-social dimensions are set in a new context, more appropriate for persons with ID. The integrative treatment should not be primarily directed towards the symptoms of the disorder but towards restoring a person's mental well-being. The disorder is combated through treatment of the underlying processes that have led to its onset. Different treatment methods from different perspectives may be applied. Strategy and methodological procedures of an integrative treatment are discussed by way of case presentations.