“You’re changing the pattern”: cognitive analytic team formulation with learning disabilities care staff

Purpose This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach.

EMDR therapy with people who have intellectual disabilities: process, adaptations and outcomes

Purpose Emerging evidence indicates that adapted eye movement desensitisation and reprocessing (EMDR) can be useful for people with intellectual disabilities in treating post-traumatic stress disorder (PTSD). However, the required adaptations are not described in enough detail across the literature, making it difficult for therapists to easily adapt EMDR for people with intellectual disabilities. This paper aims to address this by describing 14 clinical cases, along with outcome data for six people, and the views of five people with intellectual disabilities about EMDR. Design/methodology/approach A total of 14 people with mild or moderate intellectual disabilities and varied experiences of trauma were offered EMDR by one clinical psychologist in a UK NHS setting; nine people completed EMDR therapy, six people provided outcome data with pre-post measures and five people were asked two questions about EMDR therapy. Findings Adaptations are described. The outcome data indicate reductions in symptoms of PTSD following EMDR intervention. EMDR was liked and perceived as useful. Originality/value This paper provides details about adaptations that can be made to the standard EMDR protocol, reports the views of service users about EMDR and adds evidence that EMDR reduces symptoms of PTSD in people who have intellectual disabilities.

Relationship between quality of life and physical fitness in adults with intellectual disabilities

Purpose People with intellectual disabilities have lower levels of physical fitness compared with peers without intellectual disability, because of the high levels of sedentary behaviour in this population. This study aims to know the relationship between quality of life and physical fitness in adults with intellectual disability. Design/methodology/approach Ninety-six adults with intellectual disability were assessed with quality of life questionnaire and physical fitness tests, which involve balance, muscle strength, flexibility and aerobic condition. Findings Adults with higher self-reported levels of quality of life reported higher levels of physical fitness in balance, muscular strength and flexibility. In contrast, in aerobic condition were not found significant correlations with self-reported quality of life. Originality/value These findings support the hypothesis that people with intellectual disability with lower levels of physical fitness could influence in their levels of quality of life. This insight is useful for improving treatments to improve physical fitness in this population.

Understanding the mental health experiences of adult men with intellectual disabilities in Singapore

Purpose This study aims to explore the experiences of people with intellectual disabilities in Singapore receiving inpatient mental health treatment. To date, there has not been any research that examines the views and experiences of this population in Singapore. The research examines how the participants view their mental health problems and their experiences of the services they received. Design/methodology/approach A qualitative design was chosen to address the research question. Six adult men with intellectual disabilities were recruited from the tertiary hospital and interviewed. The transcripts of these interviews were analysed using interpretative phenomenological analysis. Findings Four super-ordinate themes were identified; awareness of mental health problems; yearn for a life outside the ward; interacting with other people and finding purpose. Originality/value The participants reported that they struggled with being segregated from their families and communities following an inpatient admission. They were able to report on the emotional difficulties that they experienced and hoped to find employment after their discharge from the hospital. They talked about reconstructing their self-identity and forming friendships to cope with their hospital stay. This research is one of its kind carried out in a non-western society and the findings are discussed in the light of how mental health professionals can best support people with intellectual disabilities during their inpatient treatment.

The development and evaluation of an integrated intensive support service

Purpose This paper aims to describe the development and evaluation of integrated intensive support service (ISS) for adults with learning disabilities who have complex needs and are at risk of admission to an inpatient unit. Design/methodology/approach Existing services were remodelled. The service explored external service models and established an integrated ISS comprising intensive community support and intensive support beds. Findings Data indicates that the majority of people referred to the service avoid both admission to an inpatient unit and placement breakdown. Most people admitted to the inpatient unit are not known to community services. Length of stay has significantly reduced. Practical implications Other services can use the information to remodel how to provide intensive support and avoid admission to an inpatient unit. Originality/value It demonstrates how remodelling can drive improvements to reduce placement breakdown and risk of admission.

Exploring maintaining gains following therapy during the coronavirus pandemic with adults with an intellectual disability

Purpose The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value This is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase.

A survey of complex trauma in families who have children and adults who have a learning disability and/or autism

Purpose There is an established literature supporting the idea that families who have children and adults who have a learning disability and/or autism have a greater vulnerability to mental health problems or poor psychological health. There are shortcomings in this literature in that there is a little consideration of the impact the families interaction with services has on their well-being. It is argued that complex post-traumatic stress disorder (CPTSD), with its focus on prolonged chronic exposure to trauma experiences and the recognition that this can occur in adulthood, may well be an appropriate framework to enable a better understanding of the experiences of families. Design/methodology/approach A total of 214 family members completed a co-produced online survey in relation to potential traumatic events, impacts and support. Findings The experiences of family carers of children and adults with a learning disability and/or who are autistic would appear to be multi-layered and complex, with many experiencing a wide range of traumatic events with the associated emotional and personal sequela. The reported responses are consistent with CPTSD with 10% of having received a diagnosis of PTSD. Their experience was that the system failed not only to provide support but also created additional trauma. Practical implications A trauma-informed approach needs to be adopted by agencies and professionals that serve families to ensure they understand their potential contribution to the trauma families experience. Originality/value To the best of the authors’ knowledge, this is the first study that has attempted to examine the experience of families using the framework of CPTSD.

Change processes within team formulations in intellectual disabilities services: what do multi-disciplinary staff find helpful?

Purpose A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events. Design/methodology/approach Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis. Findings The key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”. Originality/value Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development.

Compassion in custody: developing a trauma sensitive intervention for men with developmental disabilities who have convictions for sexual offending

Purpose This paper aims to provide a description of a trauma sensitive intervention for men who have committed sexual offences. The intervention aims to support men to process and make sense of their own experience of trauma before inviting them to acknowledge their role in causing harm to others. The intervention draws on compassion focussed therapy (CFT) as the overarching therapeutic modality. Design/methodology/approach As part of a service evaluation changes in routine repeat measures completed by service users were analysed prior to joining the intervention and after 12 months of intervention. Service users were encouraged to provide regular feedback relating to their experience of the intervention at regular intervals. This feedback was collated and patterns were identified collaboratively to understand the context for assessed change in the measures. Findings Prior to the intervention men reported high levels of shame and limited experiences of guilt (as compassion for others). Early findings indicate that men experience less shame and increased experiences of guilt after 12 months. An increase in insight into risk was also evident. Service user feedback pointed towards a more engaging therapeutic style and highlighted the importance of both a collaborative and trauma sensitive approach. Originality/value This is the first evaluative description of forensic CFT for sexual offending. Findings offer insight into potential future directions for forensic interventions with this population.