Steps to Effective Problem-Solving in group homes (original) (raw)
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ObjectivesApproximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome (CMO) configurations.MethodsThis review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review.ResultsFive databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 CMOs; 1. Working with the person displayi...
The British Journal of Psychiatry, 2013
There is a strong body of empirical and theoretical work linking anger and aggression. 1 Anger regulation is a problem for many people with intellectual disabilities and is associated with significant problems of aggression. 2-4 Consequences of aggression include exclusion from services, breakdown of residential placements, involvement with the criminal justice system and adverse effects on the psychological well-being of care staff 5 and family carers 6,7 and potentially the quality of care they provide. Cognitive-behavioural therapy (CBT) is the treatment of choice for common mental health problems, 10 and widening access to CBT is seen as a major policy priority. 11 However, the delivery of CBT to people with intellectual disabilities is underdeveloped and evidence of its effectiveness in this population is lacking. Apart from two small trials in depression, 12,13 anger is the only psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities. Large effect sizes have typically been reported. 3,14 However, these studies have a number of methodological shortcomings, including some or all of: non-random allocation to groups; small numbers of participants, therapists and treatment sites; limited range of assessments; absence of a therapy manual; and where a manual was used, no assessment of the fidelity of the intervention.
The present study investigated on the prevalence of challenging behaviours in individuals with intellectual and developmental disabilities (IDD). Many researches support the view that challenging behaviours are provoked by residential settings. Subscribing to the same view, in the current investigation, drawing a cohort sample (Parents’ homes: 64, Institutions: 64) after controlling for age and gender in individuals with IDD of two different residential setting (Parents’ homes: 261, Institutions: 191), differences in their challenging behaviours were compared. The prevalence (yes or no) of various forms in challenging behaviours was obtained and differences were ascertained with statistical significance. With the exception of odd/repetitive, individuals living in institutions showed more aggression, self-injury, disruptive and destructive forms of challenging behaviours, when compared with their parents’ homes counterparts. The study reported overall prevalence rate of nearly 40% (from a sample of 452 individuals with IDD) exhibiting one or more forms of challenging behaviours. The highly prevalent behaviours were leaves the seat [without permission or purpose] (39%), laughs or giggles for no reason (34%), interrupts while talking (30%), makes vocal noises (29%), kicks/pushes/bangs on others (29%), obsessed to certain objects or activities (28%), wanders off [from assigned time or place] (27%), fondles genitals (27%), snatches things from others (26%) and uses bizarre speech [echolalia/slurred/talking to self] (26%). The least prevalent behaviours -ranging from 4% to 9%- included inappropriate contact with members of opposite sex, pokes eye/ear/nose on self, pulls own hair, peels/pinches/scratches skin on self, tell lies/twists truth, picks nose & eats non-food items, coils hair [own/others], sucks thumb and steals objects. The authors recommended to create center based services that would integrate behaviour therapy with special education services for intervention of challenging behaviours in individuals with IDD.
2023
Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. We conducted 42 semi-structured interviews with adults with intellectual disabilities who display aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors in addressing aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting Open Peer Review Approval Status
Journal of Intellectual Disability Research, 2012
Background Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. Methods A systematic review of peer-reviewed literature published between 1980-2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. Results There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. Conclusions It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.
Understanding of Behavioral Problems Among Young Persons with Intellectual Disability: A Self-Report
Journal of Neurosciences in Rural Practice, 2022
Background Behavioral problems among young persons with intellectual disabilities (IDs) are pronounced, and it has been of significant concern for field practitioners. Different investigators have used various techniques and methods to study behavioral problems among persons with intellectual disabilities. Objective The study was conducted to examine the concept of behavioral problems from persons with intellectual disabilities. Materials and Methods Persons with ID (n = 13) with DSM 5 diagnosis of mild ID (IQ: 50–69) in ages ranging from 16 to 27 years were selected. For the present study, the qualitative method using Focused Group Discussion (FGD) was used. Results The results suggest that persons with intellectual disabilities have an adequate understanding of their behavioral problems and can make efforts to control their anger and aggression. Conclusion The study's findings showed that persons with an intellectual disability did not have knowledge of only the concept of beh...
The inservice training module, developed as part of the Child-Centered Inservice Training Project (Syracuse, New York) is designed for use with educators providing services for students with developmental disabilities and behavior problems. The module comprises six units which incorporate theory, demonstration, practice, and feedback and is intended to be presented over approximately 10 hours. The model stresses effective behavior change in a manner which is both humane and normalized. A decision process is outlined which can be used to plan appropriate interventions to address a particular student's behavior problems. On-site follow-up to demom_trate specific strategies and feedback is also encouraged. The six units address: the educative approach (introduction); the educative approach applied to behavior problems (an overview); identifying priority target behaviors and making intervention decisions; assessing behavior and determining function; intervention and crisis management; and evaluation and outcomes. Appended are sample data collection forms and a sample case study. Contains 8 references. (DB)