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A qualitative study of the practice‐related decision‐making of intensive interaction practitioners
- Authors:
- FIRTH Graham, GLYDE Megan, DENBY Gemma
- Journal article citation:
- British Journal of Learning Disabilities, 49(2), 2021, pp.117-128.
- Publisher:
- Wiley
Background: This study looked to investigate the sometimes conscious and sometimes intuitive decision-making processes of Intensive Interaction practitioners. More specifically, this study set out to develop a rich description of how practitioners make judgements when developing a dynamic repertoire of Intensive Interaction strategies with people with severe or profound learning difficulties and/or autism, how this decision-making process is enacted in practice and what issues inform such decisions. Materials and Methods: This research followed a “Template Analysis” qualitative methodology, informed by semi-structured interviews with 13 experienced Intensive Interaction Practitioners (who had completed the Intensive Interaction Coordinators course as administered by the Intensive Interaction Institute). The participants included the following: speech and language therapists, parents, teachers, residential care staff and managers, and a clinical psychologist. Results: The findings of this study indicate why and how certain decisions are made by experienced practitioners before, during and after engagement in Intensive Interaction. Such decision-making is indicated as sometimes being intuitive in nature, sometimes more conscious, sometimes moving between the two cognitive states as differing issues arise. Practitioner decision-making was focused on a number of issues, including specific learning or care “agendas”; practitioner confidence and knowledge; environmental considerations; individual learner characteristics and behaviour; learner attention, “attunement” and arousal levels; building a shared “repertoire”; and issues of available time. Conclusions: The issue of how novice Intensive Interaction practitioners may best be supported to more quickly and confidently develop improved Intensive Interaction practices is discussed, proposing the development of a cyclical process of experiential learning and supported reflection. (Edited publisher abstract)
Third‐wave therapies and adults with intellectual disabilities: a systematic review
- Authors:
- PATTERSON Christopher Wynne, WILLIAMS Jonathan, JONES Robert
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 32(6), 2019, pp.1295-1309.
- Publisher:
- Wiley
Background: Third‐wave therapies appear to produce positive outcomes for people without intellectual disabilities. This systematic review aimed to establish which third‐wave therapies have been adapted for adults with intellectual disabilities and whether they produced positive outcomes. Method: Four databases were searched systematically (PsycINFO, Web of Science, MEDLINE and PubMed), yielding 1,395 results. Twenty studies (N = 109) met the present review's inclusion/exclusion criteria. Results: Included studies used mindfulness‐based approaches, dialectical behaviour therapy, compassion focused therapy and acceptance and commitment therapy. Due to considerable heterogeneity in the designs and outcome measures used, a meta‐analysis was not possible. Conclusions: Evidence indicated that third‐wave therapies improved mental health symptoms for some and improved challenging/offending behaviour, smoking and mindfulness/acceptance skills for most. These findings must be interpreted with caution due to the low methodological quality of included studies. Future research should build on the current evidence base, using scientifically rigorous designs and standardized measures. (Publisher abstract)
An open trial of psychodynamic psychotherapy for people with mild-moderate intellectual disabilities with waiting list and follow up control
- Authors:
- SKELLY Allan, McGEEHAN Caoimhe, USHER Robert
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(5-6), 2018, pp.153-162.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base. Design/methodology/approach: The study is a systematic open trial of flexible-length psychodynamic therapy offered in an urban community to 30 people with mild and moderate ID, presenting with significant emotional distress on the Psychological Therapies Outcome Scale for people with intellectual disabilities (PTOS-ID). Allocation to therapy was made according to an established stepped care approach according to need, and the mean number of sessions was 22.03 (range 7–47). Treatment fidelity was checked via notes review and cases excluded from analysis where there were other significant psychological interventions. Findings: On both self-report (PTOS-ID) and independent ratings (Health of the Nation Outcome Scales-Learning Disability (HoNOS-LD)) recipients of therapy: did not improve while waiting for therapy; improved significantly during therapy, with large pre–post effect sizes; and retained improvements at six-month follow-up. Research limitations/implications: While it is important to conduct further controlled trials, the findings provide support for previous studies. High rates of abuse and neglect were found in the sample, suggesting that more trauma-informed and relational approaches should be explored for this client group. Originality/value: No other study of this size has been completed which used dedicated standardised outcome measures, with this therapy type, with both waiting list and follow-up control and with account of model fidelity. (Publisher abstract)
Computer‐assisted cognitive behavioural therapy: the experiences of adults who have an intellectual disability and anxiety or depression
- Authors:
- COONEY Patricia, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 31(6), 2018, pp.1032-1045.
- Publisher:
- Wiley
Background: Despite its evidence base in the general population, computerized cognitive behavioural therapy (cCBT) has not yet been adapted for use with people with intellectual disability. This study aimed to explore the experiences of adults with an intellectual disability who played a cCBT programme. Method: Twenty‐four adults (with a mild or moderate intellectual disability and clinically significant anxiety or depression) who were in the treatment arm of a pilot randomized controlled trial evaluating the cCBT programme were individually interviewed. Thematic analysis was used to analyse and report themes within the data. Results: Participants found playing the programme to be an enjoyable and novel experience and that it was challenging and helpful. It allowed them to develop and reflect on relationships and increased their awareness of thoughts, feelings and behaviours. Conclusions: Combining technology with CBT is an effective way to reduce barriers to accessing mental health interventions and technology for this population. (Edited publisher abstract)
Psychological interventions for anger and aggression in people with intellectual disabilities in forensic services
- Author:
- BROWNE Claire
- Journal article citation:
- Aggression and Violent Behavior, 39, 2018, pp.1-14.
- Publisher:
- Elsevier
This systemic review investigates the current evidence for the effectiveness of anger and/or aggression interventions for people with intellectual disabilities (ID) in receipt of forensic mental health services. Due to the prevalence within this population of difficulties with anger and aggression, and the associated substantial individual and societal consequences, the provision of psychological interventions has become increasingly common. However, no critical synthesis of the empirical evidence relating to their effectiveness has previously been conducted. Sixteen peer-reviewed controlled trials or case series designs published between 2001 and 2016 met the inclusion criteria. The results highlight an emerging evidence base for the use of CBT in improving anger regulation, and for a range of psychological therapies in reducing aggressive behaviour. However, consistent methodological shortcomings limit the generalisability of findings and currently preclude firm conclusions on effectiveness. Recommendations are made for future research to address these shortcomings, including clearly-defined adaptations, adequately powered sample sizes, carefully designed baselines and follow-up periods. Despite the current status of evidence, the review provides an accessible and objective foundation to inform decision-making by service commissioners and clinicians providing anger and aggression interventions to people with ID. (Publisher abstract)
Intellectual disabilities and ACT: feasibility of a photography-based values intervention
- Authors:
- BOULTON Natalie Elizabeth, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(1), 2018, pp.11-21.
- Publisher:
- Emerald
Purpose: There is limited evidence regarding clinical effectiveness of therapeutic interventions for people with intellectual disabilities (ID). Previous research has highlighted challenges regarding adaptation of Acceptance and Commitment Therapy (ACT) for people with ID. Central to ACT is a focus on living in congruence with individual core values. The concept of values is abstract and difficult for people with a limited verbal understanding to comprehend, and yet this approach holds much promise for people with ID. The paper aims to discuss these issues. Design/methodology/approach: The current study outlines the adaptations undertaken to facilitate making the concept of values more accessible to people with ID. It also explores the feasibility of the adapted approach to the values component. Findings: This trial has shown that it is possible to isolate a single component of ACT and adapt it for use with people with ID. The findings highlight the potential feasibility of a value-based approach for people with ID augmented through the use of participant-produced photography to enhance conceptual understanding of the values component of ACT. Research limitations/implications: Findings were reliant on self-report data, which may result in inaccurate reporting and may be influenced by social demands. Given the diverse and unique presentations of people with ID, the inclusion and exclusion criteria limits the extent to which the current findings may be generalised to people with ID more widely.Practical implications: Participant-produced photography may be directly applied to clinical practice, with implied benefits of improving access to, and meaningful engagement with psychological therapies for people with ID. Development of (and ability to articulate) a readily available and easily accessible values system, during times of adversity, represents a key implication arising from the current trial. Originality/value: The current study shows that people with intellectual disability can be helped to appreciate abstract concepts such as personal core values. It also shows the potential to work through the medium of personal photography to explore the feasibility of the adapted approach to the values component – potentially a logical preliminary step towards an ACT-ID evidence base. To the authors’ knowledge, this novel approach is the first of its kind in the ID literature. (Edited publisher abstract)
A review of the pharmacological management of sexually offending behaviour in learning disabled offenders
- Authors:
- SLOAN Stephanie, BREWSTER Eleanor
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 8(4), 2017, pp.166-175.
- Publisher:
- Emerald
Purpose: The management of sexual offending is a major challenge, particularly in men who have an intellectual disability. Psychological therapies have been shown beneficial, and programmes designed for use in the general population have been adapted for use in offenders who have an intellectual disability. There is also a role for pharmacological management, although the quality of evidence for this is noticeably lacking, most likely associated with the ethical and legal issues encountered in conducting well designed and controlled trials in this area. The purpose of this paper is to look at the pharmacological management options available. Design/methodology/approach: A literature search of electronic databases was undertaken. Additionally, the references lists for identified papers were examined for any further relevant publications. Findings: The two main categories of drugs used in the management of inappropriate sexual behaviour are the testosterone-lowering drugs and the psychotropic drugs. Most trials were open and utilised self-report measures of drug effectiveness, limiting their usefulness. Most trials noted beneficial effect. Side effect profiles and patient adherence can limit the effectiveness of anti-libidinal medication in practice. Originality/value: There is very limited evidence available for the use of pharmacological agents in the management of inappropriate sexual behaviour, owing to the lack of adequately controlled clinical trials. New studies are therefore required, particularly of larger sample sizes, longer durations, and examining characteristics of those who benefit from pharmacological treatment, although the ethical issues of conducting such studies is duly acknowledged. (Publisher abstract)
Improving access to psychological therapies for people with intellectual disabilities – role of a reference group in achieving change
- Authors:
- DODD Karen, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 11(5/6), 2017, pp.173-186.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the importance of equal access to Improving Access to Psychological Therapies (IAPT) for people with intellectual disabilities. Design/methodology/approach: The paper identifies barriers to access and shows how a reference group can work to solve the barriers and increase access. Findings: The paper evaluates the authors’ progress to date and how the authors plan to continue to take the work forward. Practical implications: The paper highlights some of the factors responsible for the authors’ success and gives information that will be helpful to other areas who are interested in facilitating equal access. Originality/value: The paper demonstrates how the focus of a reference group can drive improvements across services to improve access for people with intellectual disabilities to IAPT services. (Publisher abstract)
Working with persons with an intellectual disability: the transferential process between therapist and client and the systems they inhabit
- Authors:
- COTTER Padraig, HOLLWEY Sara, CARR Alan
- Journal article citation:
- Tizard Learning Disability Review, 22(3), 2017, pp.136-143.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID). Design/methodology/approach: A review of the literature was conducted, followed by a discussion. Findings: No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ. Research limitations/implications: Research is needed to further current understanding of these issues. Practical implications: An awareness of these issues amongst practitioners and other key members of a PWID’s system is important. Originality/value: This is the first review and commentary on these issues. (Publisher abstract)
A systematic review of behavioral health interventions for sex offenders with intellectual disabilities
- Author:
- MAROTTA Phillip L.
- Journal article citation:
- Sexual Abuse a Journal of Research and Treatment, 29(2), 2017, pp.148-185.
- Publisher:
- Sage
This article reviews evaluation studies of programs designed to treat sex offenders with intellectual and developmental disabilities (IDD) published in peer-reviewed journals between 1994 and 2014. Eighteen treatment evaluation studies were identified from the United States, the United Kingdom, Australia, and New Zealand. Cognitive-behavioural treatments were the most commonly delivered treatment modality to sex offenders with IDD. Other less common treatments were dialectical behavioural therapy, problem solving therapy, mindfulness, and relapse prevention. No randomised controlled trials were identified. The most common designs were multiple case studies and pre- and post-treatment assessments with no control and repeated measures follow-up. Small sample sizes, no control groups, and wide variation in treatment length and follow-up time complicate the qualitative synthesis of study findings. Short follow-up times introduce the potential for bias in conclusions surrounding treatment efficacy for many of the studies reviewed in this analysis. The review concludes that overall quality of studies examining treatments for sex offenders with IDD is poor and requires further development before rendering firm conclusions about the effectiveness of interventions for this population. (Edited publisher abstract)