scholarly journals Abstract : stomp in HPFT

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S220-S220
Author(s):  
Anu Sharma ◽  
Kamalika Mukherji ◽  
Chetan Shah
Keyword(s):  
Data Collection ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Clinical Sample ◽  
Challenging Behaviour ◽  
Psychological Therapies ◽  
Nice Guidance ◽  
The Individual ◽  
Community Team ◽  
The Impact

AimsAnalyse the pattern of psychotropic drug use and deprescribing (in the context of STOMP) in people with Intellectual disability and Challenging behaviour in Hertfordshire community team(s) during 2016-17. STOMP stands for Stopping Over Medication in People with Learning Disability, Autism or both.BackgroundPublic Health England in 2015 estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability, autism or both were taking prescribed psychotropics without appropriate clinical indications . HPFT signed up to the STOMP pledge in 2017 to actively review psychotropic prescribing in line with NICE guidance alongside patients, carers and professional partnerships. This audit provides the outcomes of applying the STOMP Pledge to clinical practice.MethodData collection for the current audit occurred over Q1-5 in 2016–2017. All patients with Intellectual Disabilities on psychotropic medication were reviewed in psychiatric clinics. Awareness was raised about STOMP in teams. A semi-structured tool was developed based on the Self assessment framework published by the ID faculty RCPsych and prospective data were collected after each outpatient visit.Result347 patients were prescribed psychotropic medication and reviewed quarterly between 2016-2017. 96 patients were prescribed antipsychotics for challenging behaviour. Other prescribed medications included mood stabilisers, anticonvulsants, anti-depressants and benzodiazepines. Common antipsychotics used: Risperidone (63), Aripiprazole (14), Quetiapine (9), Olanzapine (4); Chlorpromazine (2). Four patients were maintained on two antipsychotics in varying combinations. The data collection tool noted that alternatives to medication were tried in 32 cases. Deprescribing occurred in 41 casesConclusionThis study represents an attempt to capture the impact of the STOMP principles in a clinical sample. Various alternatives to medications were pursued in the sample such as positive behaviour support, sensory integration, psychological therapies, social support. Younger adults (under 30 years) represented the largest proportion of cases where medication was increased. Adults over 30 years represented the largest proportion of cases where a STOMP reduction occurred. This may reflect the individual factors at play. Younger people with ID and /or Autism are more likely to experience changes in support and structure at transition, whilst older adults may have more physical comorbidities that may influence this decision.zcvv

scholarly journals Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

2004 ◽  
Vol 28 (12) ◽  
pp. 447-450 ◽  
Author(s):  
Tom Marshall
Keyword(s):  
Side Effects ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Duration Of Treatment ◽  
Community Learning ◽  
Disability Service ◽  
People With Dementia ◽  
Multiple Drugs

Aims and MethodThe aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author.ResultsA total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs were used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started.Clinical ImplicationsChallenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.

More than pictures: developing an accessible resource

2017 ◽  
Vol 22 (2) ◽  
pp. 57-65 ◽  
Author(s):  
Lois Cameron ◽  
Rhona Matthews
Keyword(s):  
Learning Disability ◽  
Design Methodology ◽  
Development Process ◽  
Evidence Base ◽  
Content Type ◽  
Communication Framework ◽  
The Individual ◽  
The Impact ◽  
The Relationship ◽  
Communication Resource

Purpose The purpose of this paper is to describe the process of developing an accessible communication resource which enables people with a learning disability to reflect on their lives and raise issues of concern. Design/methodology/approach The process of making the resource and the facets that contribute to making it accessible are explored, e.g. design specification, the relationship between pictures and meaning, the order in which concepts are presented. The paper goes on to describe how the resource is put into practice using the format of a “Talking Mat”.® Talking Mats is a communication framework which has a strong evidence base that shows it improves the quality and quantity of information a person with a learning disability gives in a conversation. It provides practitioners with a consistent framework to support implementation. The impact of using the resource is explored through feedback from practitioners trained to use it and the stories that resulted. Findings A well-constructed resource can support people with a learning disability to express their views on what matters to them at a specific time and raise concerns they may have. The individual views that have emerged from people are varied. This resource enabled them to be genuinely included in planning the steps required to bring about positive change in their lives. Originality/value There is much emphasis on the development of accessible resources in the field of learning disability but little on the actual development process and the context of how resources are introduced. This paper aims to contribute to this knowledge base.

scholarly journals ‘When you are a data collector you must expect anything’. Barriers, boundaries and breakthroughs: insights from the South African data-collection experience

2019 ◽  
Vol 27 (2) ◽  
pp. 54-62
Author(s):  
Kathryn Roberts ◽  
Sarah Gordon ◽  
Lorraine Sherr ◽  
Jackie Stewart ◽  
Sarah Skeen ◽  
...  
Keyword(s):  
Data Collection ◽  
Data Gathering ◽  
Well Being ◽  
Research Process ◽  
Future Research ◽  
Structured Interviews ◽  
Middle Income ◽  
Data Collector ◽  
The Individual ◽  
The Impact

The impact of the research process on the researcher is an emerging topic of interest. Data collection in most low- and middle-income countries (LMICs) is often the responsibility of community members who are identified and trained specifically for data collection. When research involves data on mental health and social well-being, data collectors may have specific competency needs and the task of data gathering may impact data collectors. This study aims to explore the experiences and needs of data collectors within South Africa using qualitative methods to examine the impact of data collection on data collectors. Nineteen data collectors, involved in face-to-face data collection, completed semi-structured interviews exploring their insights, attitudes and experiences. Thematic analysis revealed barriers and challenges associated with research, complexities regarding boundaries within the participant-data collector relationship and the benefits of being involved with research for the individual and the community. Numerous challenges and opportunities are outlined. Findings expose the beneficial and often overlooked contribution of data collectors and warrants key considerations in the planning and implementation of future research to ensure adequate support and standardization of practice.

scholarly journals Impact of a community-based ‘challenging behaviour’ service on bed occupancy

1995 ◽  
Vol 19 (11) ◽  
pp. 660-662 ◽  
Author(s):  
David Perry ◽  
Vallepur H. R. Krishnan ◽  
Sidhartha Tewari ◽  
Colin Cowan ◽  
Ashok Roy
Keyword(s):  
Learning Disability ◽  
Challenging Behaviour ◽  
Bed Occupancy ◽  
Patient Assessment ◽  
Behavioural Disturbance ◽  
Community Based ◽  
New Community ◽  
The Impact

People with learning disability and behavioural disturbance can be difficult to treat in the community, frequently requiring specialist in-patient assessment. The impact which a new community-based ‘challenging behaviour service’ has had on a district's in-patient bed use is described.

Positive Behavioural Support as an alternative to medication

2019 ◽  
Vol 24 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Ruth M. Lee ◽  
Jennifer A. Rhodes ◽  
David Gerrard
Keyword(s):  
Quality Of Life ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Single Case ◽  
Inappropriate Prescribing ◽  
Single Case Design ◽  
Content Type ◽  
Behavioural Support ◽  
Nice Guidance

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.

scholarly journals A survey of the use of seclusion and physical restraint at school and at home for children under the care of the NHS Lanarkshire CAMHS – learning disability team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S222-S222
Author(s):  
Sukhmeet Singh ◽  
Judith McKie
Keyword(s):  
Learning Disability ◽  
Physical Restraint ◽  
Challenging Behaviour ◽  
National Guidelines ◽  
Safe Place ◽  
Rights Of The Child ◽  
Retrospective Audit ◽  
The Individual ◽  
Small Team ◽  
At Home

AimsTo attempt to quantify the use of seclusion and restraint for young people managed by the NHS Lanarkshire CAMHS Learning Disability team.BackgroundThere has been increasing interest in the use of seclusion and restraint in children with learning disabilities, reflected by various news reports in the UK and USA. A survey of parents conducted by the Challenging Behaviour Foundation (2019) found that 35% of disabled children (n = 204) had been regularly physically restrained and a further 21% had been regularly secluded. The use of restrictive practice in children is contradictory to the UN Convention on the Rights of the Child as well as the conclusion of a recent report conducted by the Scottish Children's Commissioner titled “No Safe Place” which called on schools to stop using restraint and seclusion until national guidelines and standards were in place. No data were submitted to the Children's Commissioner from Lanarkshire. Anecdotally there was an impression in the team that restrictive practices were widely used at school and home.MethodThe NHS Lanarkshire CAMHS-LD team is a small team caring for children aged 5–18 years with moderate to severe/profound learning disability with mental disorder and/or severe challenging behaviour. The methodology for this retrospective audit relied on reviewing patient case notes and speaking with involved clinicians. We discussed each individual patient on their respective caseload as to whether the child had been restrained or secluded at home or at school.ResultAll 108 children from the caseload were included in the audit of whom 52.8% had been either restrained or secluded. 24.1% of children were both restrained and secluded at school, while 15.8% were restrained and secluded at home. These patients were complex. 86.1% had Autistic Spectrum Disorder and 55.6% had another comorbidity, such as ADHD.ConclusionThe figures are broadly similar to those in the Challenging Behaviour Foundation report. The team knew all of the individual patients very well and review them across a variety of settings such as school and home with instances of seclusion and restraint being directly witnessed by clinicians. Nevertheless, there is the issue of recall bias. These findings will be shared with NHS Lanarkshire management for further discussion and dissemination. .

scholarly journals Effectiveness of Group Behavioural Activation for Depression: A Pilot Study

2017 ◽  
Vol 45 (4) ◽  
pp. 401-418 ◽  
Author(s):  
Stephen Kellett ◽  
Mel Simmonds-Buckley ◽  
Paul Bliss ◽  
Glenn Waller
Keyword(s):  
Pilot Study ◽  
Group Treatment ◽  
Evidence Base ◽  
Drop Out ◽  
Behavioural Activation ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Initial Depression ◽  
The Individual ◽  
The Impact

Background: The evidence base for behavioural activation (BA) is mainly grounded in the individual delivery method, with much less known about the impact of group delivery. Aims: To conduct a pilot study of behavioural activation in groups (BAG) for depression delivered in a routine service setting, in order to explore acceptability, effectiveness and predictors of outcome. Methods: The manualized group treatment format was delivered in a Primary Care mental health setting, at step three of an Improving Access to Psychological Therapies (IAPT) service. BAG was facilitated by cognitive behavioural psychotherapists, and outcome measures (depression, anxiety and functional impairment) were taken at each session. Seventy-three participants were referred and treated within nine groups. Results: BAG was an acceptable treatment generating a low drop-out rate (7%). Significant pre–post differences were found across all measures. There was a moderate to large depression effect size (d+ = 0.74), and 20% met the criteria for a reliable recovery in depression. Greater severity of initial depression and attendance of at least four BAG sessions predicted better outcomes. Conclusions: BAG appears to be an effective depression treatment option that shows some clinical promise. Further larger and more controlled studies are nevertheless required.

Accent Policy and Accent Modification Enterprises as Potential Indicators of Intercultural Power Relations: A Call for an Updated Research Agenda

2013 ◽  
Vol 3 (1) ◽  
pp. 22-33 ◽  
Author(s):  
Brynne D. Ovalle ◽  
Rahul Chakraborty
Keyword(s):  
International Relations ◽  
Identity Construction ◽  
Social Theory ◽  
Power Relations ◽  
Linguistic Diversity ◽  
Cultural Organization ◽  
Using Data ◽  
The Individual ◽  
The Impact ◽  
The Relationship

This article has two purposes: (a) to examine the relationship between intercultural power relations and the widespread practice of accent discrimination and (b) to underscore the ramifications of accent discrimination both for the individual and for global society as a whole. First, authors review social theory regarding language and group identity construction, and then go on to integrate more current studies linking accent bias to sociocultural variables. Authors discuss three examples of intercultural accent discrimination in order to illustrate how this link manifests itself in the broader context of international relations (i.e., how accent discrimination is generated in situations of unequal power) and, using a review of current research, assess the consequences of accent discrimination for the individual. Finally, the article highlights the impact that linguistic discrimination is having on linguistic diversity globally, partially using data from the United Nations Educational, Scientific and Cultural Organization (UNESCO) and partially by offering a potential context for interpreting the emergence of practices that seek to reduce or modify speaker accents.

Investigating the Relationship Between Self-Esteem and Stigma Among Young Adults With History of Suicide Attempts

Crisis ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 265-270 ◽  
Author(s):  
Meshan Lehmann ◽  
Matthew R. Hilimire ◽  
Lawrence H. Yang ◽  
Bruce G. Link ◽  
Jordan E. DeVylder
Keyword(s):  
Young Adults ◽  
Suicide Attempts ◽  
Self Esteem ◽  
High Risk Population ◽  
High Functioning ◽  
People With Mental Illness ◽  
History Of ◽  
The Individual ◽  
The Impact ◽  
The Relationship

Abstract. Background: Self-esteem is a major contributor to risk for repeated suicide attempts. Prior research has shown that awareness of stigma is associated with reduced self-esteem among people with mental illness. No prior studies have examined the association between self-esteem and stereotype awareness among individuals with past suicide attempts. Aims: To understand the relationship between stereotype awareness and self-esteem among young adults who have and have not attempted suicide. Method: Computerized surveys were administered to college students (N = 637). Linear regression analyses were used to test associations between self-esteem and stereotype awareness, attempt history, and their interaction. Results: There was a significant stereotype awareness by attempt interaction (β = –.74, p = .006) in the regression analysis. The interaction was explained by a stronger negative association between stereotype awareness and self-esteem among individuals with past suicide attempts (β = –.50, p = .013) compared with those without attempts (β = –.09, p = .037). Conclusion: Stigma is associated with lower self-esteem within this high-functioning sample of young adults with histories of suicide attempts. Alleviating the impact of stigma at the individual (clinical) or community (public health) levels may improve self-esteem among this high-risk population, which could potentially influence subsequent suicide risk.

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