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Purpose: Intensive support teams (ISTs) are often poorly understood, despite reports of their effectiveness in managing behaviour that challenges for individuals with an intellectual disability. This paper aims to contribute to the understanding of ISTs through evaluating one IST's process and their use of positive behaviour support (PBS) as an intervention. Design/methodology/approach: Participants were obtained from the ISTs discharge database, and pre- and post-intervention data from these participants was used for analysis. Findings: Three-paired sample t-tests found that there were significant differences between pre- and post-scores on the behaviour problem inventory, Health of the Nation Outcomes Scale for people with Learning Disabilities and periodic service reviews, which measure quality of targeted, individualised support. This indicates that challenging behaviour frequency and severity were lower post-intervention, quality of life improved post-intervention and staff teams implemented recommended strategies more consistently by the end of the intervention. Originality/value: This service evaluation captured data over seven-year period, which helps to contribute to the understanding of the effectiveness of ISTs and the PBS framework. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties. Design/methodology/approach: Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews. Findings: Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of "critically low" quality. Thus, there are significant problems with the evidence base. Originality/value: To the best of the authors' knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place. [ABSTRACT FROM AUTHOR]

Purpose: Research highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication. Design/methodology/approach: Two interventions were introduced as "tests of change"; an "Attention-Deficit Hyperactivity Disorder (ADHD) clinic" and "Positive Behaviour Support (PBS) clinic". Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines. Findings: There was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group. Originality/value: Based on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are applicable to persons with neurodevelopmental disorders (NDD). Design/methodology/approach – Despite the lack of consistent literature focused on this population, the authors have considered the available general literature on the third generation of CBTs and analysed core issues of the processes within the context of intellectual disabilities and Autism spectrum disorder. Findings – The evidence from typical developing population studies and the emerging literature specific to people with NDD is convincing, but there is a need for studies exploring how and when these therapeutic approaches can be applicable. Two behavioural approaches of third generation therapies – acceptance and commitment therapy and mindfulness-based CBT – appear to have the most potential to be adapted for robust intervention for the broad spectrum of persons with NDD. Research limitations/implications – The number of studies and methodologies applied are a clear limitation and the present paper is only exploratory. Originality/value – The paper supports clinicians to use the emerging protocols, and to replicate and implement procedures and techniques. [ABSTRACT FROM AUTHOR]

Purpose: The over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to discuss the application of the methodology of clinical audit within community learning disability mental health services to adapt interventions including optimising prescribing practice and behavioural interventions aiming to reduce behaviour that challenges in people with learning disabilities. Design/methodology/approach: Questionnaire-based review of documentation in electronic patient records, covering relevant audit standards in line with NICE and Royal College of Psychiatrists, was carried out in the North Essex Community Learning Disability Service, Hertfordshire Partnership NHS Foundation Trust. The audit included patients on the caseload of consultant psychiatrists. Findings: The audit demonstrated that the prescribing of psychotropic medication was within BNF maximum limits for all patients, evidence of "consent" procedures was being followed in the majority, and there was some evidence of deprescribing attempts.Improvement was required in several areas e.g. undocumented off label prescribing in a significant proportion of patients. Objective measures to record the severity of behaviours and the effects of the medication were being used by clinicians in only a small proportion of patients. A significant proportion of patients have prescribed medication in the absence of appropriate psychological or environmental interventions. Originality/value: As a result of the audit findings, the action plan made recommendations such as the development of a database for tracking the prescribing of psychotropic medicines and routine use of standardised measures. This action has been supported by the pharmacy team. Positive developments include a clinical psychologist taking on the role of leading the development of behavioural intervention strategies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to draw upon a range of material to improve the understanding of disengagement with everyday life, by some individuals who have learning disabilities and mental health difficulties. Illustrative incidents from historical clinical cases are utilised, to consider whether this reframing may enhance the interpretation of presenting behaviours. Design/methodology/approach – Key recurring themes within transpersonal literature were reviewed, relevant to adults with behaviour indicating a degree of disengagement from everyday life. These were grouped into Physical Realm, Psychosocial Realm and Realm of Being. Illustrative examples of behaviour are reviewed and re-interpreted within this framework. Findings – These examples generated plausible interpretations for the presenting behaviours within this framework of the Three Realms. These interpretations support a fresh understanding of the quality of the individual's inner experience. This paper suggests a potential framework to consider the way in which some individuals may experience a different quality of consciousness than the usual. Practical implications – Use of the Three Realms for behaviour interpretation should result into a more empathetic and client-centred approach that could reduce the need for aversive approaches, lessening risk for the client and any employing organisation. The identification of behaviours that signal participation in the Realm of Being could be defined and evaluated with the potential to be used to inform the nature and content of the support provided. Originality/value – This paper, rooted in clinical examples, offers an original synthesis with reasons to include the immaterial realm in the perspective of the human condition. This could benefit people with substantial episodes of disconnection from the Physical Realm and everyday culture and those who support them. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT programme facilitated at a low-security psychiatric hospital for men with intellectual disability. Through the presentation of programme development, evaluation and revision, a more thorough and transparent understanding of the process involved can be disseminated. Design/methodology/approach: The programme lasted approximately 14 months and covered all four modules. N = 5, all-male, ages ranged between 23 and 57 years old. All detained under the MHA (1983) with a primary diagnosis of Mild ID with comorbid psychiatric diagnoses including mental illness, autism spectrum disorders and personality disorder. To evaluate routine effectiveness a pre-post comparison within groups design was used. A standardised GAS approach provided a template to score the degree to which identified goals were achieved over the intervention for participants. Findings: Wilcoxon signed-rank tests were used due to data not meeting parametric assumptions regarding normal distribution. Except for the mindfulness module, all modules saw pre to post programme psychometric results in the desired direction, evidencing skills acquisition. Coping in crisis and managing feelings modules outcomes neared statistical significance, with the module of people skills demonstrating statistical significance (p < 0.05). Originality/value: Upon examination of the results, it appears as though the second edition pilot programme, displayed initially promising results. The clinical and statistical aspects of the programme are explored, in the hope that clinicians may consider the programme's application and utility within various clinical contexts, in addition to gaining insight into the process of programme development and refinement. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the place of medication in the management of challenging behaviour in people with intellectual disability by considering it in the context of the whole system around the person and by considering the challenges of implementing best practice guidance. Design/methodology/approach – The paper identify factors that are barriers to implementing appropriate best clinical practice guidelines (such as "Challenging behaviour: a unified approach") in relation to medication intervention. The paper explores current policy and recommendations on how to improve services for people with intellectual disability and challenging behaviour and make suggestions about how to ensure better compliance with existing guidelines and improve service delivery. Findings – Better integration of services, access to specialist interventions including applied behavioural analysis and understanding communication are all essential to reducing the use of medication, as is the need for reactive, personalised and skilled social care provision. Originality/value – The paper will help professionals and those involved in the provision of service to people with challenging behaviour to focus on areas of improvement and ensure that available resources are maximised to deliver the best outcome for them. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to determine the effectiveness of an adapted dialectical behaviour therapy (DBT) treatment programme for individuals with an intellectual disability, via completion of a service evaluation. Design/methodology/approach: Outcome measurements were competed at pre-, post- and 12 months follow-up, and the effectiveness of the intervention was assessed using a Friedman analysis. Findings: Findings demonstrated that the treatment group showed significant differences in their "psychological distress" scores, but no significant differences were found in their "psychological well-being", "anxiety" or "quality of life" (WHO-QOL) scores over time. Originality/value: Overall, the current study adds to the small but growing literature that supports using the skills training group part of DBT as a stand-alone psychological intervention when working with people with an intellectual disability. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to review the current literature on working with young people with intellectual disabilities who commit arson. Design/methodology/approach – A review of assessment methods and interventions involving young people with intellectual disabilities who start fires was completed. It explores the trends across the population of firesetters as a whole and also compares how treatment implications may differ for young people with and without an intellectual disability. Findings – The paper outlines the core risk factors to be investigated within an assessment of a young firesetter with intellectual disabilities. In terms of treatment, the best current approach appears to be a combination of education and cognitive behavioural approaches including social skills training. Other treatment modalities, e.g. joint interventions provided by fire services and mental health services, are also discussed. Originality/value – Given the lack of available literature on young firesetters with intellectual disabilities it is hoped that this paper will be useful in guiding clinicians working in this area and also prompt future research regarding treatment with this client group. [ABSTRACT FROM AUTHOR]

Purpose: Positive behaviour support (PBS) is currently considered best practice for managing challenging behaviour in young people with intellectual and developmental disabilities. A key principle of PBS is that all members of the person's support network participate in the assessment and intervention. It is, therefore, important to understand what factors act as facilitators or barriers to family engagement; however, research in this area is limited. The purpose of this paper is to conduct a novel piece of qualitative research analysis into experiences of family members of young people who have received family-based PBS. Design/methodology/approach: Eight parents of a young person with an intellectual or developmental disability who had received PBS were interviewed about their experiences and factors they found helpful and hindering in terms of their engagement. Thematic analysis allowed a detailed and robust interpretation of the qualitative data. Findings: Five superordinate themes were identified, namely, PBS is more than just strategies, considering the family context, the therapist/family relationship, acknowledging challenges and the ongoing nature of the problem and supporting family member change. Research limitations/implications: Although research was rigorously conducted, the small sample size mean findings should be considered preliminary. Originality/value: The literature related to family engagement in PBS is limited and largely based on the opinions of professionals. This study identified factors that parents themselves felt were helpful and hindering in terms of their engagement and offers practical suggestions for services and future research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication. Design/methodology/approach: A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge. Findings: There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication. Practical implications: This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams. Originality/value: This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging. [ABSTRACT FROM AUTHOR]

Purpose: Fidelity data in clinical trials are not only necessary for appraising the internal and external validity, but also could provide useful insights how to improve the application of an intervention in everyday settings. The purpose of this paper is to understand the current literature of fidelity measurements in complex interventions for people with intellectual disabilities (ID) and behaviours that challenge. Design/methodology/approach: The electronic databases MEDLINE, Embase, PsycINFO, Web of Science and CINAHL Plus were searched for studies published between 1990 to 2017 that have mentioned fidelity in randomised controlled trials of complex interventions for people with ID and behaviours that challenge based on positive behaviour support or applied behaviour analysis principles. The authors also searched the grey literature and reference lists. Findings: Five randomised controlled trials were included in the review. The authors found variable and inconsistent fidelity measurements reported in the studies. The most frequently provided fidelity elements found in four out of five studies were adherence of implementation, dose and some aspects of quality of delivery. Research limitations/implications: Research recommendations for a standardised approach of measuring fidelity in such studies are suggested. Originality/value: The first review of such type that confirms the paucity of research measuring fidelity in complex interventions in this population. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a routine evaluation of clinical effectiveness of an adapted DBT informed skills programme (“I Can Feel Good”; Ingamells and Morrissey, 2014), run on both male and female intellectual disability wards of a medium security psychiatric hospital.Design/methodology/approach A pre–post evaluation study of routine clinical practice was undertaken utilising staff report scales collected as the primary source of evaluation.Findings Findings show a positive shift regarding each module for both gender groups. Due to observed baseline differences between gender groups, data were separated and analysed separately. Non-parametric statistical analysis demonstrates statistically significant improvement across three modules for the male sample (managing feelings, coping in crisis and people skills) and two modules for the female sample (managing feelings and people skills).Originality/value There appears to be subtle outcome differences regarding this programme for both gender groups across modules. Potential reasons for this are discussed, along with clinical reflections regarding gender differences and adaptations. Reflections upon future revisions including the integration of the new DBT skills (Linehan, 2014) are made in light of these findings. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

Purpose – Positive behaviour support has been positioned by current government policy as an important intervention for people with intellectual disabilities who display behaviours that challenge services. However, little is known about service user or carer opinions towards the use of this kind of model. The paper aims to discuss this issue. Design/methodology/approach – Opinions and experiences of 25 carers and six service users were collected through semi-structured interview as part of the evaluation of an enhanced service, Complex Behaviour Service, based on positive behaviour support principles. Findings – Content analysis indicated that the service was seen as acceptable and useful and that positive experiences of the service linked to: frequency and availability of the service; talking about behaviour and being listened to; understanding, and change in, the service user, carer and behaviour. Originality/value – This adds to the small but growing literature on service user and carer opinions towards specific interventions and highlights themes that future services could consider in delivering evidence-based care. [ABSTRACT FROM AUTHOR]