Factors associated with staff stress and work satisfaction in services for people with intellectual disability

Ensuring that All that Glistens is Gold: ACTing with Integrity

Tarbox, Szabo, and Aclan (Behavior Analysis in Practice, 1-22, 2020) provide a compelling rationale for the inclusion of Acceptance and Commitment Training (ACTraining) within the scope of behavior analytic practice to address experiential avoidance in clients and parents. We agree with the main tenets of the authors' argument, and suggest that ACTraining may be particularly beneficial if applied with frontline staff in behavior analytic service settings. We provide a brief overview on the precedent for ACT in the workplace, but conclude by underscoring the need for considerable curricular development in graduate training programs so that behavior analysts can implement ACT with integrity.

Exploring the experience of working relationships for support workers of adults with intellectual disabilities

BACKGROUND

Research suggests that a better awareness of how staff who directly support people with intellectual disabilities experience their working relationships, will contribute to understanding staff wellbeing and the quality of care they offer. This study aimed to gain insights into the lived experiences of support workers in supported living services in England.

METHOD

Six support workers participated in semi-structured interviews, about their working relationships with service-users and colleagues. Data was analysed using interpretative phenomenological analysis.

RESULTS

Six interconnected themes emerged: The essence of good relationships; a trusting relationship as the vehicle for meeting service-users' needs; belonging to the support team; the organisational context of relationships; the social context of relationships; 'a fine balancing act'.

CONCLUSIONS

The findings provide insights into staff wellbeing, indicating that developing supportive, trusting relationships with both service-users and colleagues, plays an important role in delivering effective care. Potential implications for service providers are discussed.

Challenges and responsibilities in the medication management process in 24/7 group housing services for adults with intellectual disability: Interviews with nurses

Staff in 24/7 group housing services for adults with intellectual disability are responsible for ensuring safe medication management processes and supporting the residents in their health-related issues. Ten interviewed nurses reported several challenges in the medication management process emerging at the staff level, the level of the group home, and the level of the social and healthcare system, and were often related to issues in communication and responsibility. They reported a variety of complex tasks in the medication management process, for which they need a multiple skill set. They also act as healthcare advocates for residents, but healthcare services do not always match residents' needs. Training for social and healthcare professionals, access to healthcare services and the collaboration of social and healthcare services should be improved to provide the people with intellectual disability the best possible pharmacotherapy and healthcare.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

The utility of 'Ding Ding Lok' in rehabilitation service for adult persons with intellectual disability: A thematic analysis on reports by service staff

This article introduces 'Ding Ding Lok' (DDL), a group game especially designed for persons affected by mild-to-moderate intellectual disability and explores its utility in rehabilitation service settings in Hong Kong. Reports from service staff who participated in the pilot project were analysed using thematic analysis. Two key questions were explored: (1) staff members' perceived benefits of the game for service users and (2) source of enjoyment for staff members in the game process. Results of the thematic analysis generated four themes, including 'Social Repertoire Expansion', 'Exercising Cognitive Abilities', 'Leisure & Recreation' and 'Personal growth' for the first question on perceived benefits and five themes including 'Positive interactions', 'Users' positive feelings', 'Increased understanding', 'Game design' and 'Users' improvement' for the second question on source of enjoyment for staff members. On the whole, DDL was perceived to be highly beneficial for the service users and were regarded as very enjoyable to the participating service staff.

Exposure to challenging behaviours and burnout symptoms among care staff: the role of psychological resources

BACKGROUND

Staff supporting individuals with intellectual disabilities are at risk of burnout symptoms. Evidence suggests an association between exposure to challenging behaviours of individuals with intellectual disabilities and burnout symptoms of staff, but the protective role of staff psychological resources in this relation has been understudied.

METHOD

We investigated the association between exposure to challenging behaviours and burnout symptoms of staff and the direct and moderating effects of several psychological resources. Staff (N = 1271) completed an online survey concerning burnout symptoms (subscale Emotional Exhaustion of the Maslach Burnout Inventory), exposure to challenging behaviours and a range of potential psychological resources. We examined main and moderating effects with multilevel analyses. In order to control for the multiple comparisons, P values corrected for false discovery rate (PFDR ) were reported.

RESULTS

We found a direct relation between exposure to challenging behaviours and increased levels of burnout symptoms in staff (b = .15, t(670) = 4.466, PFDR  < .0001). Perceived supervisor social support (b = -.97, t(627) = -7.562, PFDR  < .0001), staff self-efficacy (b = -.23, t(673) = -3.583, PFDR  < .0001), resilience (b = -.19, t(668) = -2.086, PFDR  < .05) and extraversion (b = -.20, t(674) = -3.514, PFDR  < .05) were associated with reduced burnout symptoms. None of the proposed psychological resources moderated the association between exposure to challenging behaviours and burnout symptoms of staff.

CONCLUSIONS

Of the psychological resources found to be associated with reduced risk of burnout symptoms, staff self-efficacy and access of staff to supervisor social support seem to be the factors that can be influenced best. These factors thus may be of importance in reducing the risk of developing burnout symptoms and improving staff well-being, even though the current study was not designed to demonstrate causal relations between psychological resources and burnout symptoms.

Who thrives as a direct support professional? Personal motivation and resilience in direct support

Direct support professionals (DSPs) are an essential part of the lives of people with intellectual and developmental disabilities (IDD). High rates of DSP turnover and vacancy have spurred much research into the occupational stress and burnout experienced by DSPs. There are, however, DSPs who remain motivated by and successful in the profession. Less research has been done on what makes these DSPs resilient to the same stressors that negatively affect other DSPs. The present study used the tenets of sensitivity theory to examine the relationships between motivation and outcome measures relevant to DSP success, namely vocational strain, depersonalization, and personal accomplishment. The motive of family related positively and vengeance related negatively with the three outcome variables. To a lesser extent, citizenship and social contact were positively related and prestige was negatively correlated with outcomes. The relevance of these findings and their potential applications to DSP recruitment and training are discussed.

Using mindfulness to improve quality of life in caregivers of individuals with intellectual disabilities and autism spectrum disorder

OBJECTIVES

Caring for individuals with intellectual disabilities (ID) or autism spectrum disorder (ASD) can be gratifying as well as stressful. Professional staff employed as caregivers often report compromised mental and physical wellbeing due to the stressful nature of working with clients who exhibit aggressive and destructive behaviors. Prolonged work-related stress results in diminished quality of life for the caregivers. The aim of the present study was to evaluate the comparative effects of three programs-mindfulness program, psychoeducational program, and inservice training-as-usual-on the quality of life of professional caregivers who provide services to adolescent and adult clients with ID and ASD.

METHODS

Professional caregivers (N = 216) were randomized into three experimental conditions, and trained in mindfulness, psychoeducation, and inservice training-as-usual. The effects of the training on the caregivers' quality of life were assessed in terms of perceived stress, compassion satisfaction, compassion fatigue (i.e. burnout, secondary traumatic stress), and symptoms of depression at the end of 32 weeks of implementation.

RESULTS

Perceived stress, burnout, and secondary traumatic stress decreased significantly in the mindfulness condition, followed by psychoeducation, but not in the inservice training-as-usual condition. Compassion satisfaction increased significantly in the mindfulness condition, followed by psychoeducation, but not in the inservice training-as-usual condition. Symptoms of depression, which were rated in the borderline clinical range prior to intervention, decreased significantly to within normal levels in the mindfulness condition, decreased minimally in the psychoeducation condition, and showed no change in the training-as usual condition.

CONCLUSIONS

A 3-day training in mindfulness meditations and associated contemplative practices provides a better basis for enhancing caregivers' quality of life than psychoeducation or inservice training-as-usual.

Factors associated with positive work experience among professionals supporting people with intellectual disabilities: a comparative analysis of three welfare organisations in Sweden

Given the crucial role professionals play in maintaining the well-being of people with intellectual disabilities, their views on work satisfaction are relevant to analyse. A comparative analysis that takes into account the support provided in different welfare organisations can be of certain importance. The aim is to analyse the most common aspects of professional work satisfaction in work with people with intellectual disabilities in schools, healthcare, and social services, and to apply a comparative analysis of such experience taking into account respondents' organisational affiliations. Data were collected using a digital questionnaire. Given the aim of the study, we drew on one open-ended question: 'describe aspects of your work that are most satisfactory for you'. The analysis shows that respondents associated positive work experience with seven aspects: autonomy, competence, nature of the work, collaboration, trust and recognition, work environment, and service users. Findings indicate that discretion is an important facet of work satisfaction among respondents in all three organisations. Flexibility, autonomy in decision-making, the ability to plan and act within certain institutional and legal frameworks, and the ability to prioritise among daily work assignments are empirical examples of this.

Role-related stress and perceptions of the keyworker role among professionals supporting adults with intellectual disabilities

Purpose

Individuals with intellectual disabilities who are users of day and residential services will often be assigned at least one “keyworker”, a staff member who is expressly responsive to their needs and responsible for co-ordinating services with them. Keyworkers are often given their role because it is a norm in their organisation. However, given the emotionally intensive workload involved in co-ordinating care for a single individual, little attention is given to the potential stress burden of being a keyworker. The paper aims to discuss this issue.

Design/methodology/approach

A cross-sectional survey study was conducted of professionals’ perceptions of the keyworker role and of levels of workplace well-being. The authors first examine differences between keyworkers and their colleagues along measures of role perception and well-being. The authors then present a new measure of keyworkers’ duties and boundaries (Key-DAB) capturing perceptions of the keyworker role by keyworkers and other staff. The measure was administered to a sample of staff (n=69) from an Irish provider of services for adults with intellectual disabilities. Alongside the new scale, the authors administered established measures of workplace well-being and locus of control (LoC) to examine construct validity and assess if perception of keyworking could be related to stress.

Findings

Some differences were detected between keyworkers and non-keyworkers: keyworkers had more internally oriented LoC and experienced lower work pressure than non-keyworking colleagues. The Key-DAB measure possessed favourable psychometric properties, including high internal reliability. External validity was also shown as keyworkers’ scale scores were related to LoC and to role demands. Results suggested: that keyworkers who are clear about what is expected of the keyworker are more satisfied with their role and perceive keyworking as beneficial to them; that role ambiguity and role conflict can undo these potential benefits and render the keyworker’s role a potentially hazardous one.

Originality/value

The authors recommend that employers provide clear guidelines and explicit training to keyworkers and suggest that the measures may be effective tools for ongoing assessment of keyworkers’ role clarity.

A qualitative analysis of the experience of staff employed within the forensic disability sector in Victoria, Australia

BACKGROUND

This paper explores the experience of staff employed within forensic disability across Victoria in an attempt to better understand service needs in this field. The complex needs of individuals with disabilities involved in the criminal justice system or presenting with offence-related behaviours suggest that there is a requirement to improve services directed towards forensic disability.

METHODS

Four semi-structured group interviews, determined by geographical location, were completed with employees (n = 14) within the Australian Community Support Organisation, with an average of 5 years of forensic disability experience. Data were analysed based on thematic analysis.

RESULTS

Five themes were revealed. Three pre-existing themes were emphasized that included client complexity; poor responses from external services; and funding, and two novel themes labelled as staff well-being and responses to risk.

CONCLUSIONS

Recommendations include multiagency collaboration, funding forensic disability services, development of best practice initiatives and advocacy.

An integrative model of the subjective well-being of staff working in intellectual disability services

BACKGROUND

The detrimental effects of caregiving have been well documented. In order to compensate for the disadvantages of caring, research has also tried to identify factors associated to caregivers' subjective well-being (SWB).

AIMS

We aim at presenting an integrative model of SWB.

METHODS AND PROCEDURES

Sample consisted of 228 staff working with people with intellectual disabilities. Measures employed included three different components of self-care (social, internal and physical), mental and physical health, conscientiousness, hope, and life satisfaction. The model aimed to explain SWB, measured by life satisfaction, by several variables (self-care, mental and physical health, and conscientiousness), while checking for the role of hope as a partial mediator of these relationships.

OUTCOMES AND RESULTS

Results show an overall good fit of the model: χ²(6) = 12.274, p =  .056; CFI = .953; RMSEA = .077 [.000, .139], hence establishing the first model of prediction of SWB of staff in services for people with intellectual disabilities.

CONCLUSIONS AND IMPLICATIONS

Social self-care, mental health and conscientiousness were capable of explaining life satisfaction but only through hope, that is, these factors did not have significant direct effects. The presence of hope may be then necessary for these factors to benefit staff. Strengths and limitations are discussed.

Work-related stress and well-being of direct care workers in intellectual disability services: a scoping review of the literature

Background: Understanding the nature of work-related stress and burnout among intellectual disability care staff is important to protect the well-being of these workers and encourage their retention in the sector. Though reviews of specific aspects of this literature have been conducted no article has sought to fully chart the range and nature of this research. Objective: This article addresses this gap by synthesizing the findings of such research with consideration to the future implications for protecting the well-being of care workers. Methods: A scoping review of the published literature was undertaken using a framework described in a previous article. Results: The findings of this review are presented thematically across six primary categories: challenging behavior; reciprocity; coping and stress; role issues; individual differences; and settings. A seventh theme, namely the positive aspects of intellectual disability care work was also identified through this process and is discussed. Conclusion: Occupational stress and strain is an internationally experienced issue in this sector. Challenging behavior and inequality in the relationships between staff and their clients, their colleagues, and their organization appear to exert a significant impact on the stress and well-being of workers in this sector. Excessive workplace demands, a low level of control, and a lack of support have been shown to be related to higher levels of stress and burnout among intellectual disability care workers.

Comparative Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) and Positive Behavior Support (PBS) in a Randomized Controlled Trial

Caregivers of individuals with intellectual and developmental disabilities are often stressed due to the demands of the job, including the nature and severity of challenging behaviors of the clients, work conditions, degree of management support for the staff, and the demands of implementing some interventions under adverse conditions. Mindfulness-Based Positive Behavior Support (MBPBS) and PBS alone have been shown to be effective in assisting caregivers to better manage the challenging behaviors of clients with intellectual and developmental disabilities. The aim of the present study was to undertake a head-to-head assessment of the effectiveness of MBPBS and PBS alone in a 40-week randomized controlled trial. Of the 123 caregivers who met inclusion criteria, 60 were randomly assigned to MBPBS and 63 to PBS alone, with 59 completing the trial in the MBPBS condition and 57 in the PBS alone condition. Results showed both interventions to be effective, but the caregiver, client, and agency outcomes for MBPBS were uniformly superior to those of PBS alone condition. In addition, the MBPBS training was substantially more cost-effective than the PBS alone training. The present results add to the evidence base for the effectiveness of MBPBS and, if independently replicated, could provide an integrative health care approach in the field of intellectual and developmental disabilities.

Validation of an instrument to assess the delivery of patient-centred care to people with intellectual disabilities as perceived by professionals

BACKGROUND

Patient/Person Centred Care (PCC) has achieved widespread attention which resulted in the identification of eight dimensions of PCC: Respect for the patients' values, preferences and expressed needs; information and education; access to care; emotional support to relieve fear and anxiety; involvement of family and friends; continuity and secure transition between healthcare settings; physical comfort; coordination of care. An instrument to assess patient centeredness of care delivery according to these eight dimensions among professionals is however lacking. The main objective of this study is therefore to develop and validate an instrument to assess the eight PCC dimensions among professionals providing care to institutionalized People With Intellectual Disabilities (PWIDs).

METHODS

This cross-sectional survey study was conducted in a disability care centre in the region Twente in the Netherlands, the Twentse Zorgcentra. All professionals delivering care to institutionalized PWIDs (n = 1146) were invited to participate. An instrument was developed to assess the eight dimensions of PCC, which was tested among 464 professionals (response rate = 40%). We tested the instrument by means of structural equation modelling, and examined its validity and reliability.

RESULTS

Indices of the 35-item PCC version are satisfactory but showed that the model left room for improvement and shortening of the instrument (RMSEA >0.06 and CFI < 0.95). Confirmatory factor analyses revealed good indices of fit with the 24-item PCC-instrument among professionals. Internal consistency of the overall instrument was also good.

CONCLUSIONS

The psychometric properties of the 24-item PCC-instrument were satisfactory, rendering it a valid and reliable instrument for assessing the eight dimensions of PCC among professionals providing care to institutionalized PWIDs.

The importance of person-centred care and co-creation of care for the well-being and job satisfaction of professionals working with people with intellectual disabilities

BACKGROUND

Person-centred care and co-creation of care (productive interactions between clients and professionals) are expected to lead to better outcomes for clients. Professionals play a prominent role in the care of people with intellectual disabilities at residential care facilities. Thus, person-centred care and co-creation of care may be argued to lead to better outcomes for professionals as well. This study aimed to identify relationships of person-centred care and co-creation of care with the well-being and job satisfaction of professionals working with people with intellectual disabilities (PWID).

METHODS

A cross-sectional survey was conducted in 2015 among professionals working at a disability care organisation in the Netherlands. All 1146 professionals involved in the care of people with intellectual disabilities who required 24-hours care were invited to participate. The response rate was 41% (n = 466).

RESULTS

Most respondents (87%) were female, and the mean age was 42.8 ± 11.5 years (22-65). The majority of respondents (70%) worked ≥22 hours per week and had worked for the organisation for ≥5 years (88%). Most of the respondents (76.8%) were direct care workers either in residential homes (59.3%) or in day activities (17.5%). After controlling for background variables, person-centred care and co-creation of care were associated positively with job satisfaction and well-being of professionals.

CONCLUSIONS

The provision of person-centred care and co-creation of care may lead to better well-being and job satisfaction among professionals working with PWID. This finding is important, as such professionals often experience significant levels of work stress and burnout.

Improving Quality of Life Outcomes in Supported Accommodation for People with Intellectual Disability: What Makes a Difference?

BACKGROUND

The quality of life (QOL) of people with intellectual disability living in supported accommodation services is variable, influenced by many possible factors. Various frameworks have attempted to identify these factors without assigning value, direction of influence or relative impact on outcomes.

METHODS

A realist review of the literature aimed to expose different propositions about variables influencing QOL outcomes and review the strength of supporting evidence for these, to identify their relative influence. Evidence was reviewed for and against each of five clusters.

RESULTS

Evidence was strongest for the presence of staff practices (use of Active Support), front-line management practice (use of practice leadership), culture (enabling and motivating), human resources policies and practice (that support front-line leaders and recruitment of staff with the right values), adequate resources, and small, dispersed and homelike settings.

CONCLUSIONS

The evidence informs policy and practice but in some clusters remains limited, warranting further research which measures outcomes on all QOL domains.

Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour: A further examination and partial replication

BACKGROUND AND AIMS

Practice leadership (PL) style of frontline management has been shown to be associated with better experiences for staff working with people who may exhibit challenging behaviours (Deveau & McGill, 2014). This study aimed to examine additional staff experience factors with a different, larger sample and to partially replicate the findings of (Deveau & McGill, 2014).

METHODS

This study was a survey of staff self-reported data collected as part of a larger study. Information was collected on PL and staff experiences of: stress, turnover, job satisfaction and positive work experiences.

RESULTS AND CONCLUSIONS

The results broadly supported Deveau and McGill (2014) and demonstrated an association between PL and greater job satisfaction and positive experiences for staff. Results on staff turnover were inconsistent. The positive impact of PL on staff experience was further supported by this study. Suggestions are made for further research.

IMPLICATIONS

These findings suggest further research is needed to examine the potential of interventions in frontline management/leadership practice to improve staff experience of working in challenging environments.

Chiropractors' perception of occupational stress and its influencing factors: a qualitative study using responses to open-ended questions

BACKGROUND

Job stress and emotional exhaustion have been shown to have a negative impact on the helping professional. The development and causal relations of job stress and emotional exhaustion are rather unclear in the chiropractic profession. The objective of this study is to understand the main sources of occupational stress and emotional exhaustion among doctors of chiropractic.

METHODS

Analysis of the written responses to web-based open-ended questionnaire was performed using an interpretive research methodology. Additionally, cross tabulation and Chi square statistical tests were conducted to match and couple the demographic data with the categorical themes.

RESULTS

Fourteen professional stress categories emerged from the 970 completed surveys. "Managed Care Organization regulation", "Managed Care reimbursement" and "Scope of Practice Issues" were the most common stressors that negatively influenced chiropractors' professional and personal lives. The results of the categorical analysis suggests that age, marital status, number of years in practice and location of practice may have an influence on the category of stress reported by chiropractors.

CONCLUSIONS

The qualitative approach revealed common, conventional and culture-specific job stressors in doctors of chiropractic. Notably, these findings suggest an association between third-party payer influences (increased regulation/decreased reimbursement) with that of increased job stress. Further research will be undertaken to refine the stress and satisfaction parameters and address stress interventions.

Evaluation of the Work Safety and Psychosocial Wellbeing of Disability Support Workers

This study investigated organisational factors impacting disability support worker (DSW) psychosocial wellbeing and work safety to understand the relationship between wellbeing, using measures of burnout and job satisfaction, and work conditions and safety performance. This study also investigated factors predicting wellbeing using the Job Demand-Control-Support (JDCS) model. A sample of 87 DSWs completed normed measures of burnout, work conditions, and safety climate. Results showed DSWs experienced significantly higher personal and work-related burnout but significantly lower client-related burnout. Although the JDCS model components did not all predict any single wellbeing measure, they each predicted aspects of burnout and job satisfaction, with these wellbeing measures associated with safety performance. Findings highlighted the importance of monitoring worker job demands, support availability, and job control to improve safety performance. Compared to normative data, DSWs were experiencing significantly higher role conflict, the negative impact of which was effectively moderated by support for personal and work-related burnout and job satisfaction. Findings suggest the need to consider DSW work conditions, and particularly work practices contributing to role conflict, as well as increasing support for DSWs to prevent the development of personal and work-related burnout. Findings suggest further research associated with client-related burnout is required.

Exposure to aggressive behaviour and burnout in direct support providers: The role of positive work factors

Many direct support providers (DSPs) are exposed to aggressive behaviour in their work supporting adults with developmental disabilities service recipients. This is a work environment factor that has been linked to job burnout. The objective of this study was to examine the impact of positive work factors on emotional exhaustion (EE) among DSPs who are exposed to aggressive behaviour. Survey responses from 671 DSPs who were working in community service settings for adults with developmental disabilities, and were exposed to aggressive behaviour at least monthly were examined. Hierarchical linear regression examined the direct contribution and moderating role of positive work factors (self-efficacy for dealing with aggression and work contributions) on EE measured with the Maslach Burnout Inventory-Human Services Survey, after controlling for demographics, occupational variables, exposure to aggression and negative emotional reactions to aggression. Results showed that younger age, more experience, more depression/anger emotions in response to aggression, lower self-efficacy and low positive work contributions were significantly associated with EE. Positive work motivation was a moderator of exposure to aggression and EE. When work motivations were low, DSPs were more negatively affected by higher exposure to aggression. These findings suggest that in addition to addressing the negative emotional reactions to the aggressive behaviour encountered at work, it is also important to foster positive work factors which may be protective against EE.

Mediating the relation between workplace stressors and distress in ID support staff: comparison between the roles of psychological inflexibility and coping styles

The present study examined how different patterns of coping influence psychological distress for staff members in programs serving individuals with intellectual disabilities. With a series of path models, we examined the relative usefulness of constructs (i.e., wishful thinking and psychological inflexibility) from two distinct models of coping (i.e., the transactional model and the psychological flexibility models, respectively) as mediators to explain how workplace stressors lead to psychological distress in staff serving individuals with intellectual disabilities. Analyses involved self-report questionnaires from 128 staff members (84% female; 71% African American) from a large, state-funded residential program for individuals with intellectual and physical disabilities in the southern United States of America. Cross-sectional path models using bootstrapped standard errors and confidence intervals revealed both wishful thinking and psychological inflexibility mediated the relation between workplace stressors and psychological distress when they were included in separate models. However, when both variables were included in a multiple mediator model, only psychological inflexibility remained a significant mediator. The results suggest psychological inflexibility and the psychological flexibility model may be particularly useful for further investigation on the causes and amelioration of workplace-related stress in ID settings.

Perceptions of positive contributions and burnout in community developmental disability workers

Research on staff supporting individuals with intellectual and developmental disabilities (IDD) tends to focus on negative aspects of the work. This study expanded on previous research on the positive consequences that work in the IDD field has on staff using a brief version of the Staff Positive Contributions Questionnaire with 926 staff. Factor analysis suggested two factors: General positive contributions and Positive work motivation. Positive work motivation was associated with high levels of personal accomplishment, but shared limited variance with the other two burnout dimensions (emotional exhaustion, depersonalization). Findings lend support to the idea that we need to consider both positive and negative aspects of work life. This brief scale may be a useful index of how staff benefit from their work.

Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities

Support staff working with individuals with intellectual disability (ID) and challenging behaviour experience high levels of work-related stress. Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress. This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour. Support staff (n=120) were randomly assigned to a workshop intervention condition (n=66) or to a waiting list control condition (n=54). Measurements were completed at three time points (pre-, post and 6 week follow-up) for: psychological distress, well-being, perceived work stressors, thought suppression, and emotional avoidance/psychological inflexibility.

MAIN FINDINGS

The intervention led to significantly greater reductions in distress in the intervention group than in the control group. This was largely maintained at 6 week follow-up. This effect was more pronounced amongst a subsample that had shown higher levels of psychological distress at baseline. Thought suppression was found to reduce significantly in the intervention group between post intervention and follow-up, although no significant change was found in well-being or experiential avoidance/psychological inflexibility. Overall, results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress.

A systematic review on assessment instruments for dementia in persons with intellectual disabilities

AIM

This work describes an extensive systematic literature review on assessment instruments for dementia in persons with intellectual disability (ID). Existing instruments for the detection of dementia in persons with ID were collected and described systematically. This allows a direct and quick overview of available tools. Additionally, it contributes to the availability and usability of information about these instruments, thus enhancing further developments in this field.

METHODS

A systematic literature search in five databases (CINAHL, PsycInfo, PubMed, Scopus, and Web of Science) was conducted. In order to include gray literature an invisible college approach was used. Relevant studies were identified and selected using defined inclusion and exclusion criteria. After the selection process all instruments were coded and classified. It was determined which concepts they assess, whether they were especially developed or adapted for persons with ID, and whether they were designed to assess dementia. The selection of relevant papers, as well as the coding of instruments was done independently by two researchers.

RESULTS

In total, 97 records met the search criteria. Out of these, 114 different instruments were extracted. There were 79 instruments to be completed by the person with ID, and 35 informant-based instruments. Additionally, four test batteries were found. Some of these instruments were neither designed for the assessment of dementia, nor for persons with ID.

CONCLUSIONS

There are a variety of different tools used for the assessment of dementia in ID. Nevertheless, an agreed-upon approach or instrument is missing. Establishing this would improve the quality of assessment in clinical practice, and benefit research. Data collected would become comparable and combinable, and allow research to have more informative value.

Emotional intelligence, emotions, and feelings of support staff working with clients with intellectual disabilities and challenging behavior: an exploratory study

Working with clients who show challenging behavior can be emotionally demanding and stressful for support staff, because this behavior may cause a range of negative emotional reactions and feelings. These reactions are of negative influence on staff wellbeing and behavior. Research has focused on negative emotions of staff. However, a distinction between emotions and feelings has never been made in the research field of intellectual disabilities. Negative emotions and feelings may be regulated by emotional intelligence, a psychological construct that takes into account personal style and individual differences. The purpose of this study was to explore the relationship between emotional intelligence on the one hand and emotions and feelings on the other. Participants were 207 support staff serving clients with moderate to borderline intellectual disabilities and challenging behavior. Emotional intelligence, emotions, and feelings were measured with questionnaires. The results show that emotional intelligence, emotions, and feelings are related. However, found relationships were weak. Most significant relations were found between feelings and stress management and adaptation elements of emotional intelligence. Because the explored variables can change over time they call for a longitudinal research approach.

Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: a review of the literature

Social skills are important treatment targets for individuals with autism spectrum disorders (ASD) across the lifespan. However, few treatments are available for adolescents and adults with ASD who also have severe to profound intellectual disability (S/PID). Several social skill interventions have been described that may improve social skills in this population, including video modeling, developmental, peer-mediated, behavioral, and structured teaching interventions. However, significant challenges in research design and methodology exist across these studies. This paper reviews research examining social skill interventions for youth and adults with ASD and S/PID and points out weaknesses and challenges in this literature. We propose a developmental framework of adapting early childhood interventions for use with youth and adults with ASD and S/PID as one starting point for intervention development.

Psychosocial work-related predictors and consequences of personal burnout among staff working with people with intellectual disabilities

The purposes of this study were to investigate the potential predictors of personal burnout among staff working with people with intellectual disabilities and to investigate whether personal burnout is associated with health and work-related outcomes. A cross-sectional survey was carried out in 2011 in 30 residential facilities in northern Germany (N = 409, response rate 45%). The German standard version of the Copenhagen Psychosocial Questionnaire was used. In a multiple logistic regression analysis, we identified factors which were predictive of personal burnout, such as work-privacy conflict (OR = 1.04, 95% CI 1.03, 1.05), emotional demands (OR = 1.03, 95% CI 1.01, 1.05), role conflicts (OR = 1.02, 95% CI 1.02, 1.03), job insecurity (OR = 1.03, 95% CI 1.01, 1.05) and feedback (OR = 0.98, 95% CI 0.97, 0.99). These factors explained 49% of the total variance. Higher levels of personal burnout were significantly correlated with higher rates of intention to leave the job and cognitive stress symptoms (p<.01). Low values of personal burnout were associated with greater job satisfaction, good general health, and higher satisfaction with life (p<.01). The present study indicates that improving the psychosocial work environment at the organizational level may reduce personal burnout and may also diminish unfavorable outcomes, such as intention to leave or job dissatisfaction.

Inputs and outcomes: what do staff in services for people with intellectual disabilities perceive they bring to and receive from their work-based relationships?

A number of studies involving staff working in services for people with intellectual disabilities have utilised equity theory as a theoretical framework. According to this theory, people evaluate social relationships through the comparison of inputs and outcomes, respectively, with what a person brings to and receives from a relationship. Little is known about what constitute inputs and outcomes for staff working in services for people with intellectual disabilities. Semi-structured interviews were conducted with 15 staff to find out what constitute inputs and outcomes for staff who work with people with intellectual disabilities. The interviews were conducted in the first half of 2008 in the United Kingdom. Data were analysed using template analysis. A wide range of inputs and outcomes was identified by staff, which were grouped under high-level themes relating to relationships with their employers, their co-workers and the service users. The utility of the findings, in terms of informing future research, is discussed.

Uncovering dimensions of culture in underperforming group homes for people with severe intellectual disability

Culture recurs as an important but under-investigated variable associated with resident outcomes in supported accommodation for people with intellectual disability. This study aimed to conceptualize the potential dimensions of culture in all group homes and describe the culture in underperforming group homes. A secondary analysis, using an inductive interpretative approach, was undertaken of a large qualitative data set from a study that had used ethnographic and action research methods to explore the quality of life outcomes for residents in 5 small group homes. Five categories were developed: misalignment of power-holder values with organizations espoused values, otherness, doing for not with, staff centered, and resistance. Differences from institutional culture are discussed, and the potential of the findings as a starting point to consider culture in high performing group homes and develop a quantitative measure of culture.

Exposure to client aggression and burnout among community staff who support adults with intellectual disabilities in Ontario, Canada

BACKGROUND

Studies have shown that staff who support adults with intellectual disabilities (ID) are exposed to challenging behaviour in their work including client aggression. Exposure to aggressive behaviour has been associated with staff stress and burnout. Study samples have been small however, and there has been very little data exploring this issue among North American staff.

METHODS

A cross-sectional survey which included demographics, measures of frequency and severity (including perceived severity and a standardised severity score) of exposure to client aggression and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was completed by 926 community staff who support adults with ID in Ontario, Canada. Relationships between demographic variables and exposure to aggression were examined with descriptive statistics. Pearson correlations were used to analyse exposure variables and MBI-HSS scores.

RESULTS

Nearly all staff reported being exposed to client aggression in the prior 6 months. Mean MBI-HSS scores were comparable to previously published data in similar populations with the exception of a higher score in the personal accomplishment domain. All measures of exposure to aggression were significantly positively correlated with MBI-HSS scores in the emotional exhaustion and depersonalisation dimensions of burnout.

CONCLUSIONS

The prevalence of burnout in this North American sample is comparable to what has been reported in similar populations in other locations, although these staff may have a higher sense of accomplishment with regard to their work. Findings from this large sample support the evidence that exposure to client aggression affects staff emotional well-being but is by no means the only important factor. Further study is needed to explore the differences and similarities reported here as well as other contributing factors which will guide the implementation of effective strategies to improve staff well-being.

Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services

BACKGROUND

A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members' perspectives of managing clients with challenging behaviours in residential services.

MATERIALS AND METHODS

Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members' immediate responses to clients' difficult behaviours and their decision-making processes.

RESULTS

The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved.

CONCLUSIONS

Staff members' responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future.

Does organizational climate impact upon burnout in staff who work with people with intellectual disabilities? A systematic review of the literature

Staff stress and burnout is a prominent area of research in relation to services for people with intellectual disabilities. The aim of this article is to review the literature in relation to organizational climate in order to investigate whether there is a relationship between organizational variables and staff burnout. A systematic literature search yielded 21 articles which fell into two categories. Earlier studies tended to focus on deinstitutionalization, whereas later studies appeared to be influenced by work-stress theories, including 'person-environment fit' and demand control. Overall, it was found that an organizational climate that has a better 'person-environment' fit promotes greater job satisfaction and reduced burnout. Future research could focus upon the social or therapeutic aspects of the environment within services for people with intellectual disabilities to address an area of research which appears to have been overlooked.

The fabric of engagement: the engagement and personality of managers and professionals in human and developmental disability services

Employee engagement is a complex and dynamic process that reflects each individual's unique, personal relationship with work. Engaged employees have a clear and defining connection to the organization's mission and purpose, and employee engagement is reflected in behaviors that meet or exceed expectations of service in the workplace. The purpose of this study was to explore relationships between personality and engagement among professionals and managers providing services to people with developmental disabilities. In particular, the authors investigated relationships between the 5-factor model of personality (FFM) and William Kahn's model of employee engagement encompassing physical, emotional, and cognitive components.

Stress, depression, workplace and social supports and burnout in intellectual disability support staff

BACKGROUND

Staff providing support to people with intellectual disabilities are exposed to stressful work environments which may put them at an increased risk of burnout. A small prior literature has examined predictors of burnout in disability support staff, but there is little consensus. In this study, we examined direct and indirect associations between work stressors (i.e. challenging client behaviour), staff emotional response to the behaviour (i.e. perceived stress, anxiety, depression), social and organisational support resources, and staff burnout.

METHODS

A short survey examined client behaviour, staff psychological stress, anxiety, depression, social support (number, satisfaction), organisational support and burnout in 80 disability support staff in a community setting.

RESULTS

Burnout levels were similar to or slightly lower than normed values for human services staff. Cross-sectional regression analyses indicated that depression symptoms and organisational support were related to worse emotional exhaustion and depersonalisation, whereas less social support was related to less personal accomplishment. Social support satisfaction (but not social support number or organisational support) moderated between high psychological stress to less emotional exhaustion.

CONCLUSIONS

Taken together, these results suggest that depression symptoms and low organisational support were frequently concurrent with burnout symptoms. Furthermore, worker's personal and organisational supports may have helped bolster their sense of personal accomplishment, and buffered against the potential for emotional exhaustion.

Work stress and depression among direct support professionals: the role of work support and locus of control

BACKGROUND

Although work stress can impede the capacity of direct support professionals and contribute to mental health challenges, external (i.e. work social support) and internal resources (i.e. an internal locus of control) have been shown to help DSPs cope more actively. We examined how work stress was associated with depression, with a particular focus on the role of resources.

METHOD

Direct support professionals (n = 323) who serve adults with intellectual and developmental disabilities from five community-based organisations completed a cross-sectional, self-administered survey which measured work stress, work support, locus of control, and depression.

RESULTS

Multiple regression analyses demonstrated that work stress was positively associated with depression, while resources were negatively associated with depression. In particular, work support moderated the effects of client disability stress, supervisory support lessened the effects of role conflict, and locus of control moderated the effects of workload.

CONCLUSIONS

Such findings suggest the importance of external and internal resources for staff mental health. This research underscores the need for strong work social support systems and interventions to help staff manage work stressors.

Social support and coping as mediators or moderators of the impact of work stressors on burnout in intellectual disability support staff

Theories applied to work stress predict that coping will mediate and support will moderate the impact of work demands on worker well-being. We explored the mediating and moderating effects of coping and support on the relationship between perceived work demands and burnout in support staff working with adults with intellectual disabilities. Ninety-six support staff completed questionnaires that measured demographic factors, perceived work demands, coping, support, and burnout. A sub-sample participated in a follow-up 22 months later. Cross-sectional regression analyses revealed a relationship between work demands and emotional exhaustion burnout that reduced when wishful thinking coping was introduced as a predictor. Exploration of multiple mediator effects using bootstrap methods revealed that wishful thinking partially mediated the relationship between work demands and emotional exhaustion but practical coping did not. Practical coping had a main effect relationship with personal accomplishment, and there was evidence that support moderated the impact of work demands on personal accomplishment (although not fully consistent with theory). Study variables, other than personal accomplishment, were stable over 22 months but no longitudinal relationships between coping and burnout was found. These findings emphasise the importance of coping in managing work demands and for the development of burnout in support staff.

Applying equity theory to staff working with individuals with intellectual disabilities

BACKGROUND

This paper provides an overview of the empirical research on equity theory amongst staff working in services for individuals with intellectual disabilities (ID).

METHOD

Relevant articles were identified by using the PsycINFO computerised database and by conducting manual searches of reference lists.

RESULTS

Six studies were identified and reviewed. Staff often report that they feel under-benefited in their work-based relationships. Associations were found between staff equity perceptions and staff outcomes such as burnout, absenteeism and intention to leave.

CONCLUSION

Previous research findings on staff outcomes are discussed within the context of equity theory. The implications of staff equity perceptions for ID services are discussed and possible directions for future research are forwarded. It is suggested that equity theory may have some utility as a theoretical starting point from which to develop a comprehensive theory to integrate various strands of research on staffing.