Adapted DBT programme for individuals with intellectual disabilities and problems managing emotions: staff awareness training (original) (raw)
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Journal of Applied Research in Intellectual Disabilities, 2013
Background The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. Method To explore their views and expectations of cognitive behaviour therapy (CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions. Results Thematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long-term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well-being for their service users and expressed a wish for longerterm involvement of the therapist. Conclusions The results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well-being.
Journal of Intellectual Disability - Diagnosis and Treatment, 2016
The service is providing supported living for a number of people, male and female, age 21 to 55, who all have intellectual disability and a range of extra needs. These include physical disability, communication difficulties, trauma related personality difficulties, self-harming behaviour and aggression towards others. They are all perceived to have emotional developmental needs, all having suffered traumatic experiences in early childhood, causing developmental delay. All have difficulties with relationships associated with attachment disorders. All direct support staff are trained in models of emotional development and how to assess the emotional level, which leads to identifying the needs. Managers of services are alto trained to support the staff to provide the level of support needed, and to understand the systemic effects of trauma so as to be able to provide trauma-informed-care. The training, supervision, support and individual therapy for clients, where needed, is provided by psychologists and psychotherapists trained in Disability Psychotherapy. The comprehensive approach allows people with very complex and distressed behaviour to live in ordinary housing in the community. Data is provided on 10 people, the history, the initial problem behaviour and the present position after being provided with the emotionally nurturing environment.
1985
Th i s t h e s i s s t a r t s with the o b s e r v a t i o n t h a t i f m e n t a l l y d i s a b l e d i n d i v i d u a l s are to e s t a b l i s h a p l a c e f o r themselves i n the community and s u c c e s s f u l l y cope w i t h the accompanying s t r e s s , they must, w i t h i n t h e i r own range o f c a p a b i l i t i e s , (1) l e a r n t o r e c o g n i z e t h e i r emotions, and (2) l e a r n t o express these emotions i n s o c i a l l y a c c e p t a b l e ways. The t h e s i s then attempts t o explore whether t h i s i s a r e a l i z a b l e g o a l . A review o f the l i t e r a t u r e r e v e a l s t h a t , i n s p i t e o f i t s importance to the mainstreaming p r o c e s s , the emotional development o f m e n t a l l y handicapped i n d i v i d u a l s has r e c e i v e d scant a t t e n t i o n toy p s y c h o l o g i s t s , s p e c i a l educators, or c o u n s e l l o r s . Some o f the reasons f o r t h i s are e x p l o r e d i n c l u d i n...
Mindfulness, 2012
The present study pilot tested a mindfulness and acceptance-based work stress reduction intervention for intellectual disability staff. The intervention combined Acceptance and Commitment Training (ACT) with instruction in applied behavior analysis. This combined intervention was compared to a control condition consisting of applied behavior analysis training only. Considering both distressed and nondistressed participants, between-group differences were observed only for participants who reported that they had been consistently applying the techniques they had learned. In addition, ACT group participants with higher levels of psychological distress at pretest showed greater reductions in psychological distress from pretest to follow-up when compared to their control group counterparts. A concurrent decrease in the believability of burnout-related thoughts was observed in the ACT group from pretest to follow-up, relative to the control group. These results support and extend previous research on ACT interventions for intellectual disability staff.
The risk factors for young people with intellectual disabilities developing a mental health disorder are higher than those found in the general population, yet training is very rarely available to frontline staff. A recent study in the United Kingdom cited prevalence rates of mental ill health among adults with intellectual disabilities ranging from 35.2 to 40.9%, depending upon the sensitivity of the diagnostic tool used . The ability to identify mental health problems is crucial to early intervention, but is particularly difficult when the symptoms of intellectual disability often mask emerging problems and confound differential diagnosis. The literature relating to mental health training focuses largely on changes in knowledge base and attitude, falling short of considering the primary focus of training-its impact upon practice and how this ultimately benefits people with intellectual disabilities. This study highlights the need for training, considers a training package provided to all frontline (direct care) staff in a residential school in the United Kingdom, catering to young people between the ages of 6 and 19 with severe intellectual disabilities, and investigates the impact of training upon practice and its influence upon the organization.
British Journal of Clinical Psychology, 2010
Background. People with intellectual disabilities (ID) experience similar or even higher rates of mental health problems than the general population and there is a need to develop appropriate treatments. Cognitive behaviour therapy (CBT) is effective for a wide range of disorders in the general population. However, there is some evidence that people with ID may lack the cognitive skills needed to take part in CBT. Aims. To test if people with ID can learn skills required for CBT, specifically the ability to distinguish between thoughts, feelings, and behaviours and to link thoughts and feelings (cognitive mediation). Method. A randomized independent groups design was used to examine the effect of training in CBT on two tasks measuring CBT skills. Thirty-four adults with ID were randomly allocated to the experimental condition ðN ¼ 18Þ or to the control condition ðN ¼ 16Þ. CBT skills were assessed blind at baseline and after the intervention. Results. The training led to significant improvements in participants' ability to link thoughts and feelings, and this skill was generalized to new material. There was no effect of training on participants' ability to distinguish amongst thoughts, feelings, and behaviours. People with ID can, therefore, learn some skills required for CBT. This implies that preparatory training for CBT might be useful for people with ID. The results might be applicable to other groups who find aspects of CBT difficult. Establishing valid estimates of the prevalence of mental health problems amongst people who have intellectual disabilities (ID) has been problematic and wide variations
Health technology assessment (Winchester, England), 2018
Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). 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). 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. Community ID services in England. Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-C)]. Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. Carer-reported changes...
PLOS ONE
Background Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. Aims To conduct a process evaluation of a national clinical trial investigating the impact of PBSbased staff training on the level of challenging behaviour in adults with intellectual disability. Method The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Results Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention.
Trials, 2017
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. This is a cluster randomised two-arm trial of WCW training versus a waiting list control. Overall, 118 residential settings will be recruited and ra...