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Mullins L, Scott V. A model for fostering community capacity to support adults with intellectual disabilities who engage in challenging behaviour: A scoping review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:1085-1106. [PMID: 35848498 DOI: 10.1177/17446295221114619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Developmental support agencies support many adults with intellectual disabilities in the community. Unfortunately, these adults often exhibit high rates of challenging behaviour, which present significant pressures on these service providers. Agencies need to develop effective means of increasing their capacity to provide quality support. Previous systematic reviews found that training staff in positive behaviour supports can improve outcomes; however, the factors facilitating training's effects, long-term effectiveness, and outcomes for service users have yet to be determined. We conducted a scoping review of 98 journal articles and book chapters to develop a model for fostering capacity development drawing from Organizational Behaviour Management and Knowledge Translation theories. Some relevant factors include features of the inner and outer organizational contexts, training approaches (e.g., behavioural skills training & in-situ coaching), ongoing support and feedback. This model may lead to more effective and enduring treatment programs and improved support for adults with intellectual disabilities.
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Affiliation(s)
- Laura Mullins
- Department of Applied Disability Studies, Brock University, St Catharines, ON, Canada
| | - Victoria Scott
- Department of Applied Disability Studies, Brock University, St Catharines, ON, Canada
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Gulliver SB, Pennington ML, Cardenas M, Lewis JE, Cammarata CM, Leto F, Ostiguy WJ, Meyer EC, Kimbrel NA. Stamp Out Stigma: a national campaign to decrease stigma and increase behavioral health in fire service. Cogn Behav Ther 2023; 52:625-640. [PMID: 37489115 DOI: 10.1080/16506073.2023.2233695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Firefighters are at risk for behavioral health problems; however, mental health stigma is a barrier to seeking treatment. Although effective treatments exist, many firefighters report that internal stigma prohibits presentation for effective care. This study aimed to decrease stigma about behavioral health in fire service through the development and delivery of a peer-led anti-stigma intervention campaign called Stamp Out Stigma (SOS). SOS consisted of three related phases. During Phase 1 (n = 12), we produced testimonials and piloted the videos with firefighters to determine which were most compelling. During Phase 2 (n = 23), we beta-tested our training curriculum with two departments, resulting in a significant decrease in internalized stigma but not in self-stigma. During Phase 3 (n = 73), we presented the curriculum to two cohorts of firefighters. Participation in the SOS workshop was associated with a significant decrease in firefighters' self-stigma from pre-, M = 22.7, SD = 6.3, to post-workshop, M = 20.8, SD = 5.5, t(66) = 3.2, p = 0.002. Participation in the SOS workshop was associated with a significant decrease in firefighters' internalized stigma, M = 2.0, SD = 0.5, to post-workshop, M = 1.8, SD = 0.4, t(66) = 2.8, p = 0.007. The SOS approach to stigma reduction is promising for modifying negative attitudes toward mental health and treatment seeking among professional firefighters.
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Affiliation(s)
- Suzy B Gulliver
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
- Department of Psychiatry & Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA
| | | | - Megan Cardenas
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
| | - Jordan E Lewis
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
| | - Claire M Cammarata
- New York City Fire Department Counseling Services Unit, New York, NY, USA
| | - Frank Leto
- New York City Fire Department Counseling Services Unit, New York, NY, USA
| | | | - Eric C Meyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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3
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Lajante M, Del Prete M, Sasseville B, Rouleau G, Gagnon MP, Pelletier N. Empathy training for service employees: A mixed-methods systematic review. PLoS One 2023; 18:e0289793. [PMID: 37578963 PMCID: PMC10424876 DOI: 10.1371/journal.pone.0289793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
Following the surge for empathy training in service literature and its increasing demand in service industries, this study systematically reviews empirical papers implementing and testing empathy training programs in various service domains. A mixed-methods systematic review was performed to identify and describe empathy training programs and discuss their effectiveness in service quality, service employees' well-being, and service users' satisfaction. Included papers met those eligibility criteria: qualitative, quantitative, or mixed-methods study; one training in empathy is identifiable; described training(s) developed for or tested with service employees dealing with service users. We searched health, business, education, and psychology databases, such as CINAHL, Medline ABI/Inform Global, Business Source Premier, PsycINFO, and ERIC. We used the Mixed-Method Assessment Tool to appraise the quality of included papers. A data-based convergent synthesis design allowed for the analysis of the data. A total of 44 studies published between 2009 to 2022 were included. The narrative presentation of findings was regrouped into these six dimensions of empathy training programs: 1) why, 2) who, 3) what, 4) how, 5) where, and 6) when and how much. Close to 50% of studies did not include a definition of empathy. Four main empathic competencies developed through the training programs were identified: communication, relationship building, emotional resilience, and counseling skills. Face-to-face and group-setting interventions are widespread. Our systematic review shows that the 44 papers identified come only from health services with a predominant population of physicians and nurses. However, we show that the four empathic skills identified could be trained and developed in other sectors, such as business. This is the first mixed-methods, multi-disciplinary systematic review of empathy training programs in service research. The review integrates insights from health services, identifies research limitations and gaps in existing empirical research, and outlines a research agenda for future research and implications for service research.
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Affiliation(s)
- Mathieu Lajante
- The emoLab, Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Marzia Del Prete
- Department of Economic Sciences and Statistics, University of Salerno, Fisciano, Salerno, Italy
| | | | - Geneviève Rouleau
- Nursing Department, Université du Québec en Outaouais, Québec, Canada
| | | | - Normand Pelletier
- Business & Economics Librarian, Université Laval, Quebec City, Canada
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Silarova B, Brookes N, Palmer S, Towers A, Hussein S. Understanding and measuring the work-related quality of life among those working in adult social care: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1637-1664. [PMID: 35066964 PMCID: PMC9543435 DOI: 10.1111/hsc.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
The main aim of this scoping review was to understand how work-related quality of life (WRQoL) in adult social care has been defined and measured in the literature and to map key components of WRQoL among those working in adult social care and similar contexts. The scoping review included studies that: 1- focused on WRQoL/work-related wellbeing (and their synonyms); and 2- included adult social care or community health care. We searched existing evidence from November 2019 until July 2020 through an electronic literature search of eight major databases complemented by the grey literature, searching the reference lists and by contacting our existing network of experts in the field. In addition, we repeated the searches to identify any relevant literature published in 2021. Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. In total, we included 68 publications. These publications indicate that there is an absence of agreement on a definition and measurement of WRQoL in adult social care. Based on a thematic analysis we identified six key components of WRQoL: organisational characteristics; job characteristics; mental wellbeing and health; physical wellbeing and health; spill-over from work to home; and professional identity. In summary, at the moment, there is no agreement on what WRQoL is and how to measure it in adult social care. As a result, there is very limited evidence on how to improve WRQoL among people working in adult social care. However, this scoping review suggests that there are six key components of WRQoL that researchers may consider to include in their future studies.
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Affiliation(s)
- Barbora Silarova
- Personal Social Services Research UnitUniversity of KentCornwallis CentralCanterburyUK
| | - Nadia Brookes
- Personal Social Services Research UnitUniversity of KentCornwallis CentralCanterburyUK
- Present address:
Centre For Health Services StudiesGeorge Allen WingCornwallis BuildingUniversity of KentCanterburyCT2 7NFUK
| | - Sinead Palmer
- Personal Social Services Research UnitUniversity of KentCornwallis CentralCanterburyUK
| | - Ann‐Marie Towers
- Centre For Health Services StudiesGeorge Allen WingCornwallis BuildingUniversity of KentCanterburyUK
| | - Shereen Hussein
- Personal Social Services Research UnitUniversity of KentCornwallis CentralCanterburyUK
- Present address:
Faculty of Public Health PolicyLondon School of Hygiene & Tropical MedicineLondonWC1E 7HTUK
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Deb S, Limbu B. Support staff liaising effectively with family caregivers: Findings from a co-design event and recommendation for a staff training resource. Front Psychiatry 2022; 13:977442. [PMID: 36245872 PMCID: PMC9555056 DOI: 10.3389/fpsyt.2022.977442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
A high proportion of people with intellectual disabilities (ID) and autism spectrum disorder (ASD) are prescribed psychotropic medications such as antipsychotics, antidepressants etc., outside their licensed indications, primarily for the management of behaviors that challenge (BtC) in the absence of a psychiatric disorder. Examples of BtC are aggression to people and property or self-injury. BtC could be challenging to manage and may cause the person with ID/ASD and their caregivers distress, breakdown of community placement leading to hospitalization, and restrictive practices such as restraint or inappropriate medication use. Caregivers play a pivotal role in the prescribing process. However, many family caregivers feel that they have not been fully involved in the shared decision-making process about the care planning of their relatives with ID/ASD. To address the public health concern regarding the overuse of off-license prescribing in people with ID/ASD, we have recently developed a training programme called SPECTROM (Short-term Psycho-Education for Carers To Reduce OverMedication of people with intellectual disabilities) for direct care staff who support people with ID/ASD within community settings. We used co-production and a modified Experience-Based Co-Design (EBCD) method to develop SPECTROM, which involved a literature review, four focus groups and a co-design event day involving 26 stakeholders. Recommendations from the co-design event day were analyzed by a Programme Development Group (PDG) consisting of 21 stakeholders who made the final recommendations to the project team regarding the contents and the format of SPECTROM, which was finalized after receiving feedback from further 59 stakeholders. SPECTROM has web-based resources introduced through two core modules in face-to-face workshops/training. A small field test found SPECTROM was effective in improving staff's knowledge of psychotropic medications and attitude toward BtC and people with ID (p < 0.05). One of the 14 STOMP modules is "Effective liaison with family carers and advocates". In this paper, we have presented data from the co-design event day recommendations for this particular module. The group recommended ways to improve collaborative working and effective shared decision-making with family caregivers and people with ID/ASD.
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Affiliation(s)
- Shoumitro Deb
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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Gupta B, Li D, Dong P, Acri MC. From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings. J Eval Clin Pract 2021; 27:1429-1445. [PMID: 33565177 DOI: 10.1111/jep.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices. METHOD We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020. RESULTS Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change. CONCLUSIONS Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.
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Affiliation(s)
- Brinda Gupta
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dongze Li
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peiyu Dong
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary C Acri
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
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McKenzie K, Murray G, Martin R, Murray A, Metcalfe D. A quantitative evaluation of a regional Positive Behavioural Support workforce development approach. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1641-1654. [PMID: 34196450 DOI: 10.1111/jar.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/13/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research suggests that providing staff with input in relation to Positive Behavioural Support (PBS) can have beneficial outcomes. Much of this research, however, fails to take account of systemic issues and does not include a control group. METHOD We used a non-randomised, controlled group design to evaluate accredited PBS programmes, delivered as part of a systemic, regional and workforce development approach. We compared outcomes of those attending the programmes (n = 240) with a control group (n = 54), pre- and post-intervention and at 3-months follow-up. RESULTS The programme and its wider impact were rated positively. Significant intervention effects were found for staff practice and retention, but not for staff knowledge and attributions, or behaviours that challenge and quality of life of those being supported. CONCLUSIONS The results are discussed in the context of the study limitations and restrictions resulting from the Covid-19 pandemic.
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Affiliation(s)
- Karen McKenzie
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
| | - George Murray
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK.,NHS Lothian, Edinburgh, UK
| | - Rachel Martin
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Aja Murray
- Department of psychology, University of Edinburgh, Edinburgh, UK
| | - Dale Metcalfe
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
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Klaver M, van den Hoofdakker BJ, Wouters H, de Kuijper G, Hoekstra PJ, de Bildt A. Exposure to challenging behaviours and burnout symptoms among care staff: the role of psychological resources. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:173-185. [PMID: 33331049 PMCID: PMC7839462 DOI: 10.1111/jir.12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- M. Klaver
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - B. J. van den Hoofdakker
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - H. Wouters
- General Practitioners Research InstituteGroningenThe Netherlands
| | - G. de Kuijper
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - P. J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - A. de Bildt
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
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Flynn S, Hastings RP, Gillespie D, McNamara R, Randell E. Trainer and support staff's experiences of engaging with the Who's Challenging Who? challenging behaviour training course. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:367-380. [PMID: 30606072 DOI: 10.1177/1744629518821789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Who's Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees' and trainers' experiences of the WCW. METHODS Semi-structured interviews were undertaken with managers (n = 7), support staff (n = 6) and the WCW trainers (n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Two cross-cutting themes were drawn from the data: (1) valued roles of the trainers, whereby trainers and trainees benefited from the training being coproduced and delivered by people with IDs, and (2) beyond the training, within which trainees reported that they were engaging in increased reflection about their past and current practice. CONCLUSIONS Being trained by people with IDs and CB appears to be a useful method, which can lead to perspective taking and reflection about supporting people with IDs and CB.
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Olivier L, Sterkenburg P, van Rensburg E. The effect of a serious game on empathy and prejudice of psychology students towards persons with disabilities. Afr J Disabil 2019; 8:328. [PMID: 31049304 PMCID: PMC6489198 DOI: 10.4102/ajod.v8i0.328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background Much has been done regarding the promotion of equality in rights in terms of legislation, but persons with disabilities remain marginalised in society. Negative attitudes and prejudice contribute towards numerous challenges for persons with disabilities. Objectives This study investigated the level of empathy and prejudice of students towards persons with disabilities, and the effect of the use of a serious game to enhance empathy and reduce prejudice. Method A randomised controlled experiment with pre-test, post-test and follow-up test was used. Availability sample (N = 83) of psychology university students (22% males; 78% females) was divided into an experimental group that played the serious game The World of Empa and two control groups. The first control group received texts on case studies and information on reacting in a sensitive and responsive way, and the second control group received no intervention. Results Participants have average levels of empathy (score: 32 to 52) and strong prejudice (score: 0.08 to −0.87) towards persons with disabilities. The intervention results in a slight short-term effect for prejudice and sub-scale measurements of empathy. A slight improvement was noted in participants’ ability to transpose themselves imaginatively into the experience of disabled characters. Conclusion The findings contribute to the understanding of empathy as a dynamic component that can be positively influenced by, for example, a serious game. These results have teaching implications on the facilitation of empathy. The short-term effect on empathy and prejudice towards persons with disabilities may contribute to bridge the inequality experienced by persons with disabilities. Keywords empathy; prejudice; serious games; persons with disabilities; psychology students.
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Affiliation(s)
- Linda Olivier
- School of Psychosocial Behavioural Sciences: Psychology, North-West University, Potchefstroom, South Africa
| | - Paula Sterkenburg
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Public Health research institute (APH), Amsterdam, the Netherlands.,Bartiméus, Doorn, the Netherlands
| | - Esmé van Rensburg
- School of Psychosocial Behavioural Sciences: Psychology, North-West University, Potchefstroom, South Africa
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall I, Crabtree J, Omar R, King M, Hunter R, Bosco A, Biswas A, Ratti V, Blickwedel J, Cooper V, Howie W, Crawford M. Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT. Health Technol Assess 2019; 22:1-110. [PMID: 29596045 DOI: 10.3310/hta22150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING Community ID services in England. PARTICIPANTS Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months' follow-up (n = 184), the mean ABC-CT difference between arms was not significant (-3.70, 95% CI -9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. LIMITATIONS The main limitations were low treatment fidelity and reach of the intervention. CONCLUSIONS Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. TRIAL REGISTRATION This study is registered as NCT01680276. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, UK
| | - Andre Strydom
- Division of Psychiatry, University College London, London, UK
| | | | - Ian Hall
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit, London, UK
| | - Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Leicester, UK
| | - Victoria Ratti
- Division of Psychiatry, University College London, London, UK
| | | | | | - William Howie
- South West London and St George's Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Springfield University Hospital, London, UK
| | - Mike Crawford
- Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
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12
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Flynn S, Hastings RP, Gillespie D, McNamara R, Randell E. Is the amount of exposure to aggressive challenging behaviour related to staff work-related well-being in intellectual disability services? Evidence from a clustered research design. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 81:155-161. [PMID: 29678313 DOI: 10.1016/j.ridd.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/13/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Previous research has demonstrated an association between aggressive challenging behaviour (CB) and reductions in work-related well-being for intellectual disability (ID) support staff. Much of this research has used subjective measures of CB. AIMS To examine whether exposure to aggressive CB is associated with reduced work-related well-being in staff working in ID residential settings across the UK. METHODS AND PROCEDURE A cross-sectional analysis was undertaken as part of a randomised trial; 186 staff from 100 settings completed questionnaires on their CB self-efficacy, empathy, positive work motivation, and burnout. Objective measures of aggressive CB in the preceding 16 weeks were collected from each setting. OUTCOMES AND RESULTS There was little association between staff exposure to aggressive CB and work-related well-being. Clustering effects were found for emotional exhaustion and positive work motivation, suggesting these variables are more likely to be influenced by the environment in which staff work. CONCLUSIONS AND IMPLICATIONS The level of clustering may be key to understanding how to support staff working in ID residential settings, and should be explored further. Longitudinal data, and studies including a comparison of staff working in ID services without aggressive CB exposure are needed to fully understand any association between aggressive CB and staff well-being.
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Affiliation(s)
| | - Richard P Hastings
- CEDAR, University of Warwick, United Kingdom; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - David Gillespie
- Centre for Trials Research, Cardiff University, United Kingdom
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, United Kingdom
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Hastings RP, Gillespie D, Flynn S, McNamara R, Taylor Z, Knight R, Randell E, Richards L, Moody G, Mitchell A, Przybylak P, Williams B, Hunt PH. Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:798-813. [PMID: 30033655 DOI: 10.1111/jir.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co-produced Who's Challenging Who? training delivered by people with ID to staff. METHOD This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow-up at six and 20 weeks post-randomisation. PARTICIPANTS two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. PRIMARY OUTCOME Self-reported Staff Empathy for people with Challenging Behaviour Questionnaire. ANALYSIS intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600. RESULTS 118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: -938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19). CONCLUSIONS This is the first large-scale RCT of a co-produced training course delivered by people with ID. Findings indicated a small positive (but statistically non-significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
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Affiliation(s)
- R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - D Gillespie
- Centre for Trials Research, Cardiff University, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - R McNamara
- Centre for Trials Research, Cardiff University, UK
| | - Z Taylor
- Royal Mencap Society, London, UK
| | - R Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, UK
| | - L Richards
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - G Moody
- Centre for Trials Research, Cardiff University, UK
| | - A Mitchell
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - P Przybylak
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - B Williams
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall IS, Crabtree J, Omar RZ, King M, Hunter R, Biswas A, Cooper V, Howie W, Crawford MJ. Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial. Br J Psychiatry 2018; 212:161-168. [PMID: 29436314 DOI: 10.1192/bjp.2017.34] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability. Aims To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276). METHOD We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants. RESULTS No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = -2.14, 95% CI: -8.79, 4.51) or secondary outcomes. CONCLUSIONS Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour. Declaration of interest None.
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Affiliation(s)
- Angela Hassiotis
- University College London Division of Psychiatry,UK and Camden and Islington NHS Foundation Trust,UK
| | | | - Andre Strydom
- King's College London and South London and the Maudsley NHS Foundation Trust,UK
| | | | - Ian S Hall
- Tower Hamlets Community Learning Disability Service,Mile End Hospital,London,UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service,Mile End Hospital,London,UK
| | - Rumana Z Omar
- Department of Statistical Science,University College London,UK
| | - Michael King
- University College London Division of Psychiatry,UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit,UK
| | - Asit Biswas
- Leicestershire Partnership National Health Service Trust,Directorate of Learning Disabilities,Frith Hospital,Leicester,UK
| | | | - William Howie
- Wandsworth Community Mental Health Intellectual Disabilities Team,Springfield Hospital,UK
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Randell E, Hastings RP, McNamara R, Knight R, Gillespie D, Taylor Z. Effectiveness of the 'Who's Challenging Who' support staff training intervention to improve attitudes and empathy towards adults with intellectual disability and challenging behaviours: study protocol for a cluster randomised controlled trial. Trials 2017; 18:460. [PMID: 28982380 PMCID: PMC5629774 DOI: 10.1186/s13063-017-2175-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Findings suggest approximately one in six people with intellectual disability engage in ‘challenging behaviours’, which include aggression towards others/property and self-injurious actions. In residential settings, actions of staff members can make challenging behaviours more likely to occur, or make these behaviours worse. In particular, negative attitudes from members of staff and lack of understanding about the reasons for challenging behaviour are contributory factors. ‘Who’s Challenging Who?’ (WCW) training is designed to emphasise the role of staff in residential settings as a challenge also to people with intellectual disability. The course is delivered jointly by a trainer with intellectual disability who has been labelled as having challenging behaviour, along with a trainer without intellectual disability. Methods This is a cluster randomised two-arm trial of WCW training versus a waiting list control. Overall, 118 residential settings will be recruited and randomised on a 1:1 ratio. Within each setting, two members of staff will be invited to take part in the trial. Participants will complete assessments at baseline and at 6 and 20 weeks. WCW is a half day initial training course with some follow-on coaching to ensure implementation. The primary outcome is changes in staff empathy towards people with challenging behaviour. Secondary outcomes at the staff level include confidence, attitudes and work-related well-being. Secondary outcomes at the residential setting level include recorded incidents of aggressive challenging behaviour, and use of any restrictive practices. Discussion If the results of the cluster randomised trial are positive, we will disseminate the findings widely and make all training manuals and materials freely available for anyone in intellectual disability services (and beyond) to use. Our training approach may have wider implications in other areas of social care. It may also provide a generally applicable model for how to train people with intellectual disability to act as co-trainers in intellectual disability social care settings. People with intellectual disability and challenging behaviour have already been involved centrally with the design, development and pilot evaluation of WCW and will also be fully involved throughout this trial. Trial registration Registered on the International Standard Randomised Controlled Trial Number registry on 8th December 2015: ISRCTN53763600. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2175-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Roseanna Knight
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Zachary Taylor
- Royal Mencap Society, Unit 7 Sundon Business Park, Dencora Way, Luton, UK
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Antonsson H, Graneheim UH, Isaksson U, Åström S, Lundström MO. Evaluation of a Web-Based Training Program for Professional Carers Working With People With Learning Disabilities and Challenging Behavior: A Pilot Study with SSED-Design. Issues Ment Health Nurs 2016; 37:734-743. [PMID: 27351080 DOI: 10.1080/01612840.2016.1189636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.
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Affiliation(s)
| | - Ulla Hällgren Graneheim
- b Umeå University , Department of Nursing , Umeå , Sweden , University West , Department of Health Sciences , Trollhättan , Sweden.,c University West , Department of Health Sciences , Trollhättan , Sweden
| | - Ulf Isaksson
- a University of Umeå , Department of Nursing , Umeå , Sweden
| | - Sture Åström
- b Umeå University , Department of Nursing , Umeå , Sweden , University West , Department of Health Sciences , Trollhättan , Sweden.,c University West , Department of Health Sciences , Trollhättan , Sweden
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Simplican SC, Leader G, Kosciulek J, Leahy M. Defining social inclusion of people with intellectual and developmental disabilities: an ecological model of social networks and community participation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:18-29. [PMID: 25543997 DOI: 10.1016/j.ridd.2014.10.008] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Abstract
Social inclusion is an important goal for people with intellectual and developmental disabilities, families, service providers, and policymakers; however, the concept of social inclusion remains unclear, largely due to multiple and conflicting definitions in research and policy. We define social inclusion as the interaction between two major life domains: interpersonal relationships and community participation. We then propose an ecological model of social inclusion that includes individual, interpersonal, organizational, community, and socio-political factors. We identify four areas of research that our ecological model of social inclusion can move forward: (1) organizational implementation of social inclusion; (2) social inclusion of people with intellectual and developmental disabilities living with their families, (3) social inclusion of people along a broader spectrum of disability, and (4) the potential role of self-advocacy organizations in promoting social inclusion.
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Affiliation(s)
- Stacy Clifford Simplican
- MSU-DOCTRID (Michigan State University - Daughters of Charity - Technology, Research Into Disability) Research Institute, Hegarty Fellow Program, Michigan State University, USA; Department of Counseling, Educational Psychology and Special Education, Michigan State University, USA
| | - Geraldine Leader
- Department of Psychology, National University of Ireland, Galway, Ireland.
| | - John Kosciulek
- MSU-DOCTRID (Michigan State University - Daughters of Charity - Technology, Research Into Disability) Research Institute, Hegarty Fellow Program, Michigan State University, USA; Department of Counseling, Educational Psychology and Special Education, Michigan State University, USA
| | - Michael Leahy
- MSU-DOCTRID (Michigan State University - Daughters of Charity - Technology, Research Into Disability) Research Institute, Hegarty Fellow Program, Michigan State University, USA; Department of Counseling, Educational Psychology and Special Education, Michigan State University, USA
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