Using an interdisciplinary approach to training to develop the quality of communication with adults with profound learning disabilities by care staff

A systematic review of research on staff training as an intervention to develop communication in children and adults with profound intellectual and multiple disabilities

INTRODUCTION

This paper aims to identify to what extent staff training interventions are successful in enhancing the development of communication skills in people with profound intellectual and multiple disabilities.

METHODS

A systematic review was undertaken, conforming to PRISMA guidelines. English language, peer reviewed, empirical studies of staff training interventions to enhance the communication of people with profound intellectual and multiple disabilities were included. Databases Scopus, Web of Science, Proquest, Linguistics and Language Behaviour Abstracts (LLBA) and Medline were searched in July 2015 and updated in December 2022. Quality appraisal was conducted on 13 studies using Crowe's Critical Appraisal Tool (CCAT).

RESULTS

Few good quality evaluations of interventions were found. Challenges to research rigour included the diversity of people with profound intellectual and multiple disabilities, small sample sizes, intervention intensity and the management of fidelity.

CONCLUSIONS

Manualised and bespoke interventions showed promise in improving staff communication and responsiveness.

Improving interactions between parents, teachers, and staff and individuals with developmental disabilities: a review of caregiver training methods and results

Individuals with developmental disabilities (DD) depend on caregivers to meet physical, emotional, and social needs. This makes relationships with caregivers particularly important to quality of life. Without intervention, social interactions may be limited and ineffective, affecting relationships with caregivers and thus quality of life for individuals with DD. Training may improve interactions between caregivers and individuals with DD. Training content and methods, however, are heterogenous. A review was conducted to identify common elements and methods and analyze variables shown to be most effective in improving outcomes for caregivers and individuals with DD. In general, studies of professional caregiver training (e.g. teachers, staff members) focused primarily on increasing positive interactions or praise, while parent training studies focused more broadly on parenting skills, of which positive interaction was one facet. Training methods differed, but there was some evidence to suggest that those studies that included some element of in situ practice and feedback yielded more robust effects. While caregiver acceptability and/or satisfaction surveys were administered in the majority of studies, fewer studies attempted to measure the satisfaction of individuals with DD. Future research topics are presented in light of these findings.

Diagnosis and management of Cornelia de Lange syndrome: first international consensus statement

Cornelia de Lange syndrome (CdLS) is an archetypical genetic syndrome that is characterized by intellectual disability, well-defined facial features, upper limb anomalies and atypical growth, among numerous other signs and symptoms. It is caused by variants in any one of seven genes, all of which have a structural or regulatory function in the cohesin complex. Although recent advances in next-generation sequencing have improved molecular diagnostics, marked heterogeneity exists in clinical and molecular diagnostic approaches and care practices worldwide. Here, we outline a series of recommendations that document the consensus of a group of international experts on clinical diagnostic criteria, both for classic CdLS and non-classic CdLS phenotypes, molecular investigations, long-term management and care planning.

Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review

PURPOSE

The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability.

METHOD

Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence.

RESULTS

A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies.

CONCLUSIONS

There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.

Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability

BACKGROUND

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.

METHODS

Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life.

RESULTS

All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference.

CONCLUSIONS

Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life.

How adults with a profound intellectual disability engage others in interaction

Using video records of everyday life in a residential home, we report on what interactional practices are used by people with severe and profound intellectual disabilities to initiate encounters. There were very few initiations, and all presented difficulties to the interlocutor (support staff; the recording researcher); one (which we call 'blank recipiency') gave the interlocutor virtually no information at all on which to base a response. Only when the initiation was of a new phase in an interaction already under way (for example, the initiation of an alternative trajectory of a proposed physical move) was it likely to be successfully sustained. We show how interlocutors responded to initiations verbally, as if to neuro-typical speakers - but inappropriately for people unable to comprehend, or to produce well-fitted next turns. This mis-reliance on ordinary speakers' conversational practices was one factor that contributed to residents abandoning the interaction in almost all cases. We discuss the dilemma confronting care workers.

Health professionals working effectively with support workers to enhance the quality of support for adults with intellectual disabilities: A meta-ethnography

BACKGROUND

Paid support workers are often central to the quality of life of adults with intellectual disabilities. Health and social care professionals increasingly carry out interventions indirectly through those support workers and therefore need to understand how best to collaborate.

METHODS

This article synthesizes findings from the qualitative research of others investigating health professionals' work with support staff. From sixty-two articles retrieved from a database and journal search, seven met inclusion criteria and a meta-ethnographic synthesis allowed construction of an interpretive line-of-argument.

RESULTS

Thirteen themes within the articles were synthesized into three over-archingconstructs, suggesting that professionals should collaborate by providing effective leadership, working in partnership with support workers and managers and recognizing the influence of organizational structures and context.

CONCLUSIONS

As these constructs seem reflective of important components of teamwork, a "line-of-argument" is proposed that it could be helpful for professionals to view themselves as part of a "team" with support workers.

Video Feedback in Key Word Signing Training for Preservice Direct Support Staff

PURPOSE

Research has demonstrated that formal training is essential for professionals to learn key word signing. Yet, the particular didactic strategies have not been studied. Therefore, this study compared the effectiveness of verbal and video feedback in a key word signing training for future direct support staff.

METHOD

Forty-nine future direct support staff were randomly assigned to 1 of 3 key word signing training programs: modeling and verbal feedback (classical method [CM]), additional video feedback (+ViF), and additional video feedback and photo reminder (+ViF/R). Signing accuracy and training acceptability were measured 1 week after and 7 months after training.

RESULTS

Participants from the +ViF/R program achieved significantly higher signing accuracy compared with the CM group. Acceptability ratings did not differ between any of the groups.

CONCLUSION

Results suggest that at an equal time investment, the programs containing more training components were more effective. Research on the effect of rehearsal on signing maintenance is warranted.

Interprofessional education: effects on professional practice and healthcare outcomes (update)

BACKGROUND

The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care.

OBJECTIVES

To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention.

SEARCH METHODS

For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format.

MAIN RESULTS

This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care.

AUTHORS' CONCLUSIONS

This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.

Transfer of training: the missing link in training and the quality of adult social care

Recent UK social care reforms characterised by a policy of increasing personalisation and choice in adult social care have been accompanied by major reorganisation and investment in workforce training and development. There is an assumed link between training and the quality of care received. This assumption has a long pedigree in social care, but rarely does it receive the scrutiny necessary for us to understand better the nature of this relationship. This paper focuses on the potential for in-service training to contribute to the transformation in social care as expected by policy-makers. Reviewing recent findings from the evaluation of training in social care shows that problems continue to persist in demonstrating that training results in changes in practitioner behaviour back on the job. Findings within the social care literature mirror those found more widely in suggesting learner characteristics, intervention design, and delivery and the workplace environment combine to influence whether training transfers to use on the job. The argument advanced here is that without a focus on the transfer of training, the contribution of training to quality of care outcomes will remain illusory. A shift is required in policy-makers' mindsets away from training, to a focus on training transfer in directing workforce development strategies. It might then be possible to begin to identify how and in what configurations training may be associated with quality of care outcomes.

Effects of video-feedback interaction training for professional caregivers of children and adults with visual and intellectual disabilities

BACKGROUND

Individuals in group homes may experience poor quality of social interaction with their professional caregivers, limiting their quality of life. The video-based Contact programme may help caregivers to improve their interaction with clients.

METHOD

Seventy-two caregivers of 12 individuals with visual and intellectual disabilities received a training programme and four individual video-feedback sessions. Quality of interaction was independently measured in an AB-design across subjects with two baseline and three intervention observations, using a time sampling coding system for interactive behaviour as well as a rating for affective mutuality.

RESULTS

From baseline to intervention, significant increases were found for the frequency with which caregivers confirmed the signals of clients, for the proportion of initiatives taken by clients that were responded to by the caregivers, and the affective mutuality as a quality of the interaction. No significant increase in client responsiveness was observed. Caregivers evaluated the intervention as useful and feasible.

CONCLUSIONS

The start of the Contact programme coincided with improved quality of interaction between professional caregivers and clients with visual and intellectual disabilities in group homes. Further research is necessary regarding the generalisability, long-term effects and effects on quality of life.

Interaction between persons with profound intellectual and multiple disabilities and their partners: a literature review

BACKGROUND

High quality interactions are of crucial importance for quality of life of persons with profound intellectual and multiple disabilities (PIMD). This literature review describes and synthesises studies addressing the interaction between persons with PIMD and their partners.

METHOD

A computerised literature search using defined inclusion criteria yielded 15 articles.

RESULTS

The literature analysis revealed four components important in interactions: sensitive responsiveness, joint attention, co-regulation, and an emotional component. The abilities and disabilities, interactive behaviours, and personality of persons with PIMD influence these interactions. Additional influences are the partners' interactive strategies, knowledge, and perceptions and the context of the interaction.

CONCLUSIONS

An overview model integrates the results and forms a vehicle to facilitate our understanding of interactions with persons with high support needs. Methodological analyses of the studies show lacunae in current research. This review offers a starting point to guide future research and intervention.

The Kirkpatrick model: A useful tool for evaluating training outcomes

BACKGROUND

Services employing staff to support people with disability usually provide training in a range of areas including communication and managing challenging behaviour. Given that such training can be costly and time-consuming, it is important to evaluate the evidence presented in support of such programs. Efficacy in clinical practice is measured using evidence-based practice. However, there is currently no model that is widely used to compare and evaluate training programs despite the large number of training programs reported each year.

METHOD

Six studies published in the last decade that reported the outcomes of communication-based training and six that reported on the outcomes of challenging behaviour training were evaluated using the 4-level Kirkpatrick model.

RESULTS

Comparison of the levels of evidence is made for these 12 studies.

CONCLUSION

The Kirkpatrick model provides one technique for appraisal of the evidence for any reported training program and could be used to evaluate whether a training program is likely to meet the needs and requirements of both the organisation implementing the training and the staff who will participate.

Interprofessional education: effects on professional practice and health care outcomes

BACKGROUND

Patient care is a complex activity which demands that health and social care professionals work together in an effective manner. The evidence suggests, however, that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way to improve collaboration and patient care.

OBJECTIVES

To assess the effectiveness of IPE interventions compared to education interventions in which the same health and social care professionals learn separately from one another; and to assess the effectiveness of IPE interventions compared to no education intervention.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 1999 to 2006. We also handsearched the Journal of Interprofessional Care (1999 to 2006), reference lists of the six included studies and leading IPE books, IPE conference proceedings, and websites of IPE organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client and/or healthcare process outcomes.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed the eligibility of potentially relevant studies, and extracted data from, and assessed study quality of, included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. Consequently, the results are presented in a narrative format.

MAIN RESULTS

We included six studies (four RCTs and two CBA studies). Four of these studies indicated that IPE produced positive outcomes in the following areas: emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; management of care delivered to domestic violence victims; and mental health practitioner competencies related to the delivery of patient care. In addition, two of the six studies reported mixed outcomes (positive and neutral) and two studies reported that the IPE interventions had no impact on either professional practice or patient care.

AUTHORS' CONCLUSIONS

This updated review found six studies that met the inclusion criteria, in contrast to our first review that found no eligible studies. Although these studies reported some positive outcomes, due to the small number of studies, the heterogeneity of interventions, and the methodological limitations, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. More rigorous IPE studies (i.e. those employing RCTs, CBA or ITS designs with rigorous randomisation procedures, better allocation concealment, larger sample sizes, and more appropriate control groups) are needed to provide better evidence of the impact of IPE on professional practice and healthcare outcomes. These studies should also include data collection strategies that provide insight into how IPE affects changes in health care processes and patient outcomes.

Perceptions of communication before and after a speech pathology intervention for an adult with intellectual disability

BACKGROUND

The aim of this study was to explore, from the perspective of key communication partners, the meaning of a communication intervention and associated changes for an adult with severe intellectual disability (ID).

METHOD

The parents and key support workers of Mark, a 22-year-old man with ID and complex communication needs, were interviewed. The interviews were conducted prior to and following a speech pathology intervention and were guided by a communication inventory based on the concept of social networks. Interview transcripts were analysed qualitatively, with a focus on the subjective meaning of communication changes. These changes were explored according to both the specific information sought through the inventory and additional information provided.

RESULTS

The findings were organised into three key themes relating to Mark, his familiar communication partners (i.e., parents and disability support workers), and the community. Information obtained from the interviews indicated that Mark's reported communication level remained stable across the intervention. However, an in-depth analysis of the interview transcripts revealed some gains in his communication skills. From the perspective of Mark's familiar communication partners, key sub-themes emerged which were related to changes in ascription of responsibility for developing skills and strategies to enhance Mark's communication. Furthermore, greater participation by Mark in his home community was evident.

CONCLUSIONS

The findings are discussed in terms of the assessment of an individual's communication through interactions with communication partners, and how changes associated with an intervention can be best understood from analysis of rich data.

Quality-enhancing interventions for people with profound intellectual and multiple disabilities: a review of the empirical research literature

BACKGROUND

This study provides an overview of empirical research on the effectiveness of quality-enhancing interventions for people with profound intellectual and multiple disabilities (PIMD).

METHOD

Through computerised searches of the PsycINFO and ERIC databases, and using several search criteria specifically relating to the target group and to the subject of this review, 16 studies were identified.

RESULTS

The interventions described are targeted at the physical and material well-being, emotional well-being, social interactions, choices, and personal development of individuals with PIMD, but do not address community participation and rights. The majority of the studies report positive effects of the interventions on staff and/or client behaviour. However these effects should be interpreted with caution because of methodological and other considerations.

CONCLUSIONS

Current research gives only limited insight into the effectiveness of quality-enhancing interventions for people with PIMD. To foster evidence-based practice, further studies of larger groups and with more robust designs are warranted. The potential differential effects associated with client characteristics and the context of the implementation should also be considered.

Identifying expressions of pleasure and displeasure by persons with profound and multiple disabilities

BACKGROUND

The aim of this study was to explore a procedure for drafting individualised profiles of how people with profound multiple disabilities express pleasure and displeasure.

METHOD

There were 6 participants with profound multiple disabilities. The procedure involved an observational analysis of videotaped critical incidents by a researcher and a questionnaire for parents and support workers.

RESULTS

The procedure is useful for making an individualised profile of the ways a person with profound multiple disabilities expresses his/her pleasure and displeasure. Despite the significant correlation between parents, support workers and the researcher, each has a complementary contribution to make in identifying affective expressions. People with profound multiple disabilities especially use sounds and facial expressions to express pleasure and displeasure and positive or negative moods.

CONCLUSIONS

The procedure may be useful in services or schools for learning more about the affective communication of these individuals, to determine their specific interests, and to evaluate the effects of living and support characteristics on their wellbeing.

Effect of training on attitudes and expertise of optometrists towards people with intellectual disabilities

PURPOSE

To determine whether participation in an educational programme, which comprised both lectures and supervised patient contacts, did more to improve the attitudes, expertise, knowledge and confidence of optometrists and student optometrists towards people with intellectual disabilities (ID) compared with receiving didactic lectures only.

METHODS

Optometrists and student optometrists were invited to take part in vision screening. A series of lectures were provided followed by supervised practice for a minimum of 2 days. A questionnaire was administered before the commencement of the training, and afterwards, in order to assess the impact of the training. The results were compared with a group of control subjects who received similar lectures without the clinical experience.

RESULTS

For both groups there were statistically significant improvements in self-reported knowledge of ophthalmic complications of ID, confidence in working with people with ID, and there was a significantly reduced perceived need for further training after the courses. There was a significantly better result for the group experiencing patient contact particularly in respect of self-reported attitudes towards people with ID. Confidence in dealing with people with ID was related to the number of such patients seen over the last year.

CONCLUSIONS

Training incorporating clinical experience, and using real patients, is particularly effective, although there is still benefit in providing lecture type courses. It is recommended that, whenever possible, courses are provided that offer hands-on experience with real patients. There is a need for further research using validated attitudinal scales to investigate the attitudes of optometrists to people with ID.

Primary health care provision for adults with a learning disability

BACKGROUND

During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability.

RESEARCH AIM

To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities.

RESEARCH METHOD

A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate.

RESULTS

Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team.

CONCLUSION

This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.