Evaluating neuropsychologically informed rehabilitation training for staff within a high secure intellectual disability service

2020 ◽  
Vol 11 (2) ◽  
pp. 61-73
Author(s):  
Phyllis Annesley ◽  
Zoe Hamilton ◽  
Roisin Galway ◽  
Samantha Akiens ◽  
Rachel Hicks ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Thematic Analysis ◽  
Challenging Behaviour ◽  
Content Type ◽  
Staff Members ◽  
Training Post ◽  
People With Intellectual Disabilities ◽  
Day Services ◽  
One Year

Purpose Neuropsychologically informed rehabilitation (NIR) is one approach to supporting people with intellectual disabilities, cognitive impairment and challenging behaviour. This study aims to evaluate a five-day training course in NIR for staff working with adult male offenders with intellectual disabilities in a high secure hospital. The impacts on both the staff who undertook the training and the patients with challenging behaviour were explored. Design/methodology/approach Participants were psychology, nursing and day services staff and male patients. The staff completed a post-training questionnaire and three measures at pre-NIR training, post-NIR training and one-year follow-up. Patients completed four questionnaire measures within the same periods. Findings NIR training was positively evaluated by staff. Staff members’ perceived efficacy in working with challenging behaviour significantly increased post-training which was maintained at follow-up. Thematic analysis showed that the training staff members built their confidence, knowledge and skills. Because of these being high to start with, the study could not evidence statistically significant changes in these. Thematic analysis yielded two main themes, namely, benefits and quality of training, each with their own subthemes. The impacts of the training on patients were difficult to assess related to various factors. Research limitations/implications The knowledge and confidence measures used were limited in scope with an experienced staff group and required development. Practical implications NIR training could assist staff in other secure and community settings in working with people with intellectual disabilities and challenging behaviours. Originality/value This study positively contributes to an area that requires more research.

Commentary on “A family’s battle to understand ‘challenging behaviour’”

2017 ◽  
Vol 22 (2) ◽  
pp. 105-108
Author(s):  
Joann Kiernan
Keyword(s):  
Intellectual Disabilities ◽  
Design Methodology ◽  
Local Communities ◽  
Challenging Behaviour ◽  
Content Type ◽  
People With Intellectual Disabilities ◽  
Individuals With Intellectual Disabilities

Purpose The purpose of this paper is to provide a commentary on issues raised in the paper “A family’s battle to understand ‘challenging behaviour’”. Design/methodology/approach Drawing on literature associated with issues identified in the paper this commentary will reflect on the evidence associated with providing specialist support to people with intellectual disabilities and challenging behaviour. Findings Families, individuals and services are unable to access timely and appropriate specialist support for individuals with intellectual disabilities and challenging behaviour. As individuals go on to develop behaviours associated with a lack of intervention their levels of vulnerability increase due to their exclusion from services and their local communities. Originality/value The commentary provides a discussion on the issues faced by individuals and their families in relation to intellectual disabilities and challenging behaviour.

scholarly journals Trainer and support staff’s experiences of engaging with the Who’s Challenging Who? challenging behaviour training course

2019 ◽  
Vol 24 (3) ◽  
pp. 367-380 ◽  
Author(s):  
Samantha Flynn ◽  
Richard P Hastings ◽  
David Gillespie ◽  
Rachel McNamara ◽  
Elizabeth Randell
Keyword(s):  
Intellectual Disabilities ◽  
Thematic Analysis ◽  
Perspective Taking ◽  
Current Practice ◽  
Support Staff ◽  
Challenging Behaviour ◽  
Structured Interviews ◽  
Training Course ◽  
People With Intellectual Disabilities

Background: The Who’s Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees’ and trainers’ experiences of the WCW. Methods: Semi-structured interviews were undertaken with managers ( n = 7), support staff ( n = 6) and the WCW trainers ( n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. Results: Two cross-cutting themes were drawn from the data: (1) valued roles of the trainers, whereby trainers and trainees benefited from the training being coproduced and delivered by people with IDs, and (2) beyond the training, within which trainees reported that they were engaging in increased reflection about their past and current practice. Conclusions: Being trained by people with IDs and CB appears to be a useful method, which can lead to perspective taking and reflection about supporting people with IDs and CB.

scholarly journals CFT & people with intellectual disabilities

2018 ◽  
Vol 12 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Mark Hardiman ◽  
Corrina Willmoth ◽  
James J. Walsh
Keyword(s):  
Intellectual Disabilities ◽  
Small Sample ◽  
Common Humanity ◽  
Post Intervention ◽  
Content Type ◽  
Self Compassion ◽  
Depth Analysis ◽  
People With Intellectual Disabilities ◽  
Compassion Scale

Purpose The purpose of this paper is to assess the effects of compassion-focussed therapy (CFT) on anxiety in a small sample of adults with intellectual disability. Design/methodology/approach A mixed-methods design was employed. Participants (n=3) completed questionnaire measures of anxiety and self-compassion on three occasions: pre-intervention, post-intervention and, at three months follow-up. Post-intervention, they also took part in recorded interviews that were analysed using interpretive phenomenological analysis. Findings were then synthesised to develop a comprehensive understanding of their overall experience. Findings Final data synthesis revealed five themes: participant anxiety decreased (reliable for all participants); the faulty self; improved positive compassionate attitudes; increased sense of common humanity; and mindful distraction techniques. Research limitations/implications This research paper offers in-depth analysis of three participants’ experiences rather than reporting in less detail about a larger number of participants. The self-compassion scale required considerable support and reasonable adaptation to be used with these clients. Originality/value Only two other studies have explored the use of CFT with people with intellectual disabilities.

A comparison of dementia assessment services for people with intellectual disabilities

2021 ◽  
Vol 26 (3) ◽  
pp. 134-141
Author(s):  
Emile Gardner ◽  
Sean Slater
Keyword(s):  
Intellectual Disabilities ◽  
Service Provision ◽  
Design Methodology ◽  
Assessment Instruments ◽  
Systematic Screening ◽  
Content Type ◽  
People With Intellectual Disabilities ◽  
Assessment Frequency ◽  
Insight Into

Purpose This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value To the best of the authors’ knowledge, this is the first paper to compare dementia assessment provision between different services in England.

Staff training on formulation and fire-setting in people with intellectual disabilities

2015 ◽  
Vol 9 (6) ◽  
pp. 371-380
Author(s):  
Amy Tostevin ◽  
Abdul Shaikh
Keyword(s):  
Functional Analysis ◽  
Intellectual Disabilities ◽  
Staff Training ◽  
Theoretical Background ◽  
Analysis Model ◽  
Content Type ◽  
Staff Members ◽  
History Of ◽  
People With Intellectual Disabilities ◽  
Fire Setting

Purpose – The purpose of this paper is to present the development and evaluation of an original training package for staff members on fire-setting in people with intellectual disabilities. It also included training on functional analysis as a model of formulating the fire-setting behaviour. The quality and effectiveness of the training was assessed and is reported in this paper. Design/methodology/approach – The training was delivered on a ward for people with intellectual disabilities in a UK NHS Trust Low Secure Hospital and was attended by various members of the multidisciplinary team for the ward. The workshop consisted of four modules: theoretical background of fire-setting, the functional analysis model of fire-setting formulation, offence-paralleling behaviours in secure settings and a case study practice. Level of self-reported understanding of the various aspects of the training was measured by an evaluation questionnaire completed pre and post training. Findings – The results of this study showed that following the training there was a significant increase in self-reported understanding of staff members. The participants reported an increase in understanding of fire-setting, functional analysis and formulation of individuals with an intellectual disability and history of fire-setting. Originality/value – This study highlights the potential for staff training to increase awareness of fire-setting behaviours by people with intellectual disabilities. The staff training in formulation would encourage their involvement in development of team formulations and may subsequently increase their understanding of such individuals.

An open trial of psychodynamic psychotherapy for people with mild-moderate intellectual disabilities with waiting list and follow up control

2018 ◽  
Vol 12 (5/6) ◽  
pp. 153-162 ◽  
Author(s):  
Allan Skelly ◽  
Caoimhe McGeehan ◽  
Robert Usher
Keyword(s):  
Intellectual Disabilities ◽  
Psychodynamic Psychotherapy ◽  
Evidence Base ◽  
Waiting List ◽  
Open Trial ◽  
Stepped Care ◽  
Self Report ◽  
Content Type ◽  
People With Intellectual Disabilities

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.

scholarly journals The Ealing Intensive Therapeutic and Short Breaks Service: an update five years on

2019 ◽  
Vol 24 (2) ◽  
pp. 56-63 ◽  
Author(s):  
Heather Dilks-Hopper ◽  
Chloe Jacobs ◽  
Catherine Sholl ◽  
Caroline Falconer ◽  
Nick Gore
Keyword(s):  
Young People ◽  
Intellectual Disabilities ◽  
Design Methodology ◽  
Best Practice ◽  
Challenging Behaviour ◽  
Practice Model ◽  
Content Type ◽  
Service Models ◽  
People With Intellectual Disabilities ◽  
Over Time

Purpose The purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS). Design/methodology/approach The challenges the service has faced are reviewed, including the service’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service. Findings The ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families. Originality/value Despite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a best-practice model. Few prior articles have provided an account of how innovative service models are maintained and evolve over time.

scholarly journals Two cases of Acceptance and Commitment Therapy leading to rapid psychological improvement in people with intellectual disabilities

2019 ◽  
Vol 13 (6) ◽  
pp. 257-267 ◽  
Author(s):  
Mark A. Oliver ◽  
Matthew Selman ◽  
Samuel Brice ◽  
Rebecca Alegbo
Keyword(s):  
Clinical Practice ◽  
Intellectual Disabilities ◽  
Acceptance And Commitment Therapy ◽  
Qualitative Data ◽  
Routine Clinical Practice ◽  
Content Type ◽  
Acceptance And Commitment ◽  
People With Intellectual Disabilities ◽  
Practical Implications

Purpose The purpose of this paper is to show that Acceptance and Commitment Therapy (ACT) may have utility with this client group in routine clinical practice. Design/methodology/approach This uncontrolled double case study describes the targeting of ACT processes with people referred to a mental health service for people with intellectual disabilities because of distressing intrusive thoughts. It includes qualitative data to illustrate the opinions of the participants eight weeks after the end of therapy. Findings Both clients described rapid relief from distress, with some additional untargeted benefits emerging too. The participants provided follow-up qualitative data in which they described how the therapy had helped them as well as areas where it had not. Research limitations/implications This paper presents uncontrolled case studies selected from routine clinical practice. They were selected due to their similarity of outcome and will not represent the experience of every client treated this way. Practical implications The practical implications are that a therapy often considered to rely on the use of metaphors and the manipulation of complex metacognitions may be useful for people with more limited verbal and cognitive ability if the therapy is adapted to meet their level of ability. Originality/value There has been very little published on using ACT with an intellectual disabilities population. This paper has originality value in that it illustrates the application of the approach in routine clinical practice. Additionally, the qualitative follow-up allows the participants’ voices to be heard about their experience of this approach.

scholarly journals Group-based cognitive–behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial

2013 ◽  
Vol 203 (4) ◽  
pp. 288-296 ◽  
Author(s):  
Paul Willner ◽  
John Rose ◽  
Andrew Jahoda ◽  
Biza Stenfert Kroese ◽  
David Felce ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Anger Management ◽  
Care Staff ◽  
Treatment Manual ◽  
Service Users ◽  
Anger Control ◽  
Cluster Randomised ◽  
Cognitive Behavioural ◽  
People With Intellectual Disabilities

BackgroundMany people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements.AimsTo evaluate the effectiveness of a cognitive–behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities.MethodA cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773).ResultsThe intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% Cl −1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour.ConclusionsThe intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.

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