Evaluating staff training: Taking account of interactions between staff and clients with intellectual disability and challenging behaviour

Abstract

Background Hastings (2010) has recently emphasised 3 aspects in the training of staff who serve clients with mild to moderate intellectual disability and challenging behaviour (CB): Staff attitudes, self-awareness, and clients' perspectives. This study investigates whether programs include these aspects.

Method A systematic search yielded 11 relevant articles.

Results Generally, all programs aimed to improve staff knowledge and skills. Client variables concerned frequencies and severities of CB. None of the studies included clients' perspectives or staff attitudes and self-awareness.

Conclusions The fact that staff attitudes and awareness or clients' perspectives were not among the main goals of the training studies suggests that recent views of effective treatment of CB are not yet the object of scientific study. Given the acknowledgment of these aspects, it is warranted that future research focuses upon these recent insights.     

How mental health literacy and experience of mental illness relate to stigmatizing attitudes and social distance towards people with depression or psychosis: A cross-sectional study

Background Evidence suggests that mental health literacy among the public is low, and stigmatizing attitudes are widespread. So far the effects of anti-stigma campaigns are small, and studies demonstrate that negative attitudes have been quite stable through recent decades. Aims To investigate the relationships between mental health literacy, experience of mental illness and stigmatizing attitudes/social distance towards people with depression or psychosis. Methods A cross-sectional study in which staff members from public services in Sweden (n?=?1027) completed questionnaires covering demographic data, self-reported experience of mental illness, identification of a vignette for depression or psychosis, beliefs about helpful interventions for the illness presented in the vignette, and attitudes and social distance towards people with the illness. Results About 50% of participants could identify depression and less than 40% psychosis. A higher degree of mental health literacy was related to less stigma and social distance but mainly towards people with depression. A similar relationship was shown for having personal or family experience of mental illness and attitudes/social distance. Negative attitudes and social distance were significantly higher in all aspects measured towards a person with psychosis than a person with depression. Conclusions A higher degree of mental health literacy relates to more positive attitudes and less desire for social distance towards people with depression. The differences between depression and psychosis should be taken into account in anti-stigma interventions.     

Tolerability and suitability of brief group mindfulness-oriented interventions in psychiatric inpatients: a pilot study

Objective: Mindfulness-oriented therapies have a positive impact on patients' overall well-being and alleviate many psychiatric conditions. However, little is known about their use in people with severe mental illness. We aimed to identify which clinical and sociodemographic factors are associated with suitability/tolerability of a brief group mindfulness-oriented therapy.

Methods: This retrospective study examines pre-/post-data from 40 psychiatric inpatients who underwent one session of a 10-min mindfulness-oriented group intervention between January and March 2014. The main outcome was ‘suitability for and tolerating the brief mindfulness-oriented group intervention’. We assessed potential correlates of the main outcome, including female gender, shorter hospitalisation, the absence of psychosis and good pre-morbid functioning.

Results: The intervention was well tolerated (92.5%) and 50% of patients met both of our relatively stringent suitability and tolerability criteria. Sociodemographic and clinical variables were not associated with suitability/tolerability. Tai chi was the most suitable/tolerable compared to body scan and mindful eating (76.5% vs. 35.7% vs. 22.2%, Fisher's exact p?=?0.01, Bonferroni p?Conclusions: Brief group mindfulness therapy interventions are very well tolerated and often suitable for acutely hospitalised psychiatric inpatients, including those with acute psychosis. Mindfulness-oriented intervention with an active component (e.g., tai chi, mindful walking) may potentially be best suited for this population.     

Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India

Each culture influences the perceptions of illness and pathways to health care that its members follow. Non-biomedical beliefs about psychosis and treatment are reported from the developing world. This study explored people’s perceptions on psychosis to understand local perceptions of the condition. Focus group discussions were conducted with people who have relatives with psychosis (in five focus groups), with members of the general public (in four focus groups), and with patients who had recovered from psychosis (one group) in Vellore, South India. These discussions were recorded, transcribed and analyzed. Participants recognized psychosis as an illness category, and viewed indigenous healing methods as complementary to allopathic treatments. Multiple and apparently contradictory beliefs on different aspects of psychosis were often simultaneously held by participants. People in the community were more likely to express negative views about mental illness. Relatives of patients with psychosis wanted more support from mental health professionals and community in combating stigma against mental illness. Results of this study reveal the complex nature of illness perspectives among patients with psychosis, their relatives and community. Bio-medical and indigenous beliefs are simultaneously held by a significant number of people who often seek help from both modern and traditional health systems at the same time. The results indicate the need for better understanding of local perceptions of psychosis.     

Values and Psychological Acceptance as Correlates of Burnout in Support Staff Working With Adults With Intellectual Disabilities

There is growing evidence that acceptance and mindfulness interventions for support staff in intellectual disability (ID) services can have beneficial mental health outcomes for staff themselves and individuals with ID. However, there are few data focusing on the relevance of related psychological processes for support staff well-being. The purpose of this research was to contribute to the evidence base and to introduce a new measure of staff values in ID services: the Support Staff Values Questionnaire (SSVQ-ID). Fifty-nine support staff completed a measure of psychological acceptance (the Acceptance and Action Questionnaire), the SSVQ-ID, and the Maslach Burnout Inventory. The acceptance and values measures had good internal consistency and statistically significant associations with dimensions of burnout. The results suggest that further research on acceptance and mindfulness process variables is warranted along with interventions designed to increase support staff resilience, especially when working with clients with dual diagnosis.     

Staff strategies and explanations for intervening with challenging behaviours: a replication in a community sample

Carers' beliefs about challenging behaviours may partially determine their behavioural responses to them. The present study replicated previous work on the beliefs of institution staff and their explanations about interventions for challenging behaviours (Hastings 1996) with a sample of 56 community staff. Many immediate intervention strategies, and the staff motivation for these choices, were in conflict with behavioural approaches to challenging behaviour and would be considered counter-habilitative from this perspective. Staff were able to describe appropriate longer-term interventions. These basic findings confirmed those of previous research with institution staff. However, tentative comparisons suggested that community staff were more likely than institution staff (from previous research) to describe interventions involving the building of relationships with service users and the identification of the underlying causes of the behaviours.     

Health beliefs link to duration of untreated psychosis and attitudes to later treatment in early psychosis

Background: Health beliefs influence health behaviours and have been shown to influence outcomes in a variety of illnesses, treatments and preventative interventions. Aims: We aimed to measure health beliefs in first episode psychosis with the hypotheses that their structure would resemble that in physical illness (diabetes) and would correlate with prior duration of untreated psychosis and later attitudes to treatment. Method: The Multidimensional Health Locus of Control scale was used in a sample of 50 people with schizophrenia during the first episode and at 18-month follow-up, 51 diabetic controls and 51 normal controls. Results: Schizophrenia patients, both at first episode and 18 months later, had a pattern of health beliefs that was similar to those of the patients with diabetes and significantly different to the normal controls. There were significant associations between internal locus of control score and short DUP, and between external locus of control score and a positive attitude to medication as measured by the Drug Attitudes Inventory. Conclusions: Health beliefs in first episode schizophrenia correlate with determinants of outcome. Accepted: 9 December 2002 Correspondence to Dr. Clifford Haley     

Improving Mental Health Services Through the Measurement of Attitudes and Knowledge of Mental Health Professionals and the General Population in Cyprus

Despite the magnitude of mental health problems worldwide, many cases of deinstitutionalization have failed to achieve their targets for a number of reasons including lack of appropriate community psychiatric services and lack of knowledge of new approaches. Therefore, the purpose of this study is to identify the attitudes, beliefs, and mental health literacy of mental health professionals and the general population toward mental illness. Method: The Attitudes toward the Severe Mental Illness (ASMI) scale was administered in both mental health professionals (n = 311) and to the general population (n = 933) to compare stereotypes and optimism with regard to mental health patients and their abilities to integrate into the society. Results: The results indicate that the general population holds less negative stereotypes (M = 2.55, SD = 0.61) than mental health professionals (M = 1.93, SD = 0.59), t(734) = 13.34, p < .001, d = 1.04. However, mental health professionals are less optimistic about the competences of a patient with a mental illness (M = 1.92, SD = 0.61) than the general population (M = 2.2, SD = .37), t(854) = 8.1, p < .001, d = .56. Discussion: The use of scales, such as the ASMI, not only make it possible to map out attitudes and views but also to measure mental health professionals' beliefs toward inclusion of these people. Results indicate that the core of the treatment needs to be shifted from the medical compliance to the satisfaction of psycho-social needs of service users. Finally, educational programs targeted at secondary education and young adults may lead to lower rates of social isolation and include more incidents of social integration.     

Mental health supported accommodation services in England and in Italy: a comparison

Purpose

England and Italy are considered pioneers in the development of community mental health services. Both have implemented supported accommodation services for those with more complex needs, which can be broadly categorized into three main types with similar specification. The aim of this study was to compare the characteristics of these services and their users in England and Italy.

Methods

Data from two cross-sectional surveys of supported accommodation services undertaken across England and in Verona, Italy (England—619 service users from 87 services; Verona—167 service users from 25 services) were compared.

Results

Service users in the two samples had similar socio-demographic and clinical characteristics; most were male, unmarried and unemployed, with a primary diagnosis of schizophrenia or other psychosis and over 15 years contact with mental health services. Supported accommodation occupancy was high in both samples. The actual length of stay was greater than the expected length of stay for all three service types but overall turnover was similar between countries (p = 0.070). Across services, total needs and quality of life were higher for Italian compared to English service users (p < 0.001 for both) but, unmet needs were lower amongst English service users (p < 0.001). Around 40% in both samples moved to more independent accommodation successfully within 30 months.

Conclusions

England and Italy have similar mental health supported accommodation pathways to assist those with more complex needs to gain skills for community living, but individuals tend to require longer than expected at each stage.

     

Mindfulness and emotion regulation in older and young adults

Objectives: Research shows that dispositional mindfulness is associated with metrics of overall well-being, with enhanced emotion regulation potentially underlying these salutary effects. However, the role of regulation strategy use remains poorly understood. In this study, we examined age-variant associations between dispositional mindfulness, emotion regulation strategies, and emotion dysregulation.

Method: Self-report data were collected from 50 older and 50 young adults on mindfulness, emotion dysregulation, and recent strategy use. For the current study, we examined if cognitive reappraisal, experiential suppression, and thought avoidance use mediated the association between mindfulness and emotion dysregulation.

Results: Thought avoidance, but not reappraisal or suppression strategies, partially mediated the association between mindfulness and emotion dysregulation. Age group moderated the observed mediation, such that for young adults, lower mindfulness was associated with greater use of thought avoidance, and in turn with greater emotion dysregulation (e.g., difficulties engaging in goal-directed behavior in the face of strong emotions).

Conclusion: The current cross-sectional study suggests that reduced avoidance of thoughts may partially explain the relationship between trait mindfulness and enhanced emotion regulation, with this mediational pathway being stronger for young compared with older adults.     

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

BackgroundBecause of the problems measuring subjective well-being in people with severe and profound intellectual disabilities, there are no studies to date which explore the factors contributing to the subjective well-being in these groups. We wanted to explore the client and service characteristics contributing to the subjective well-being of persons with severe and profound intellectual disabilities, as measured by the MIPQ (Ross & Oliver, 2003).Materials and methodsThe MIPQ was completed for 360 persons with severe or profound intellectual disabilities by a member of the direct support staff. They also provided us with information on client, service and informant characteristics.ResultsWe found that the subjective well-being of persons with profound intellectual disabilities was lower than the subjective well-being of people with mild, moderate or severe intellectual disabilities or people without disabilities. Client and informant characteristics but no service characteristics were found to have an influence on the subjective well-being of people with severe and profound intellectual disabilities.ConclusionAs it is important for policy making to identify residence service and staff factors related to subjective well-being of persons with severe and profound intellectual disabilities, further research should try to identify these factors, taking in account the client characteristics that are found to be related to subjective well-being in this study.     

Care staff training based on person-centered care and dementia care mapping,and its effects on the quality of life of nursing home residents with dementia

Objectives: To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home.

Methods: An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention).

Results: The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p < 0.001, respectively); over 50% of the residents had better WIB values. The behavior category ‘interactions with others’ in DCM also demonstrated a significant increase in the third round compared to the first round (p = 0.041).

Conclusion: Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.     

Staff-focused interventions to increase referrals for depression in aged care facilities: A cluster randomized controlled trial

Objective: While there is evidence that depression training can improve the knowledge of staff in residential care facilities, there is an absence of research determining whether such training translates into practice change. This study aimed to evaluate the impact of staff training and the introduction of a protocol for routine screening and referral for depression on the numbers of residents detected and referred by care staff for further assessment.

Method: A cluster randomized controlled design was used to compare the referral rates for residents in seven facilities randomly allocated into one of three conditions: staff training, staff training plus a screening and referral protocol and wait-list control. Participants were 216 aged care residents (M age?=?87 years), who agreed to a 12-month audit of their facility file.

Results: Staff training on its own did not increase the rate of referrals for depression; however, staff training plus the screening protocol and referral guidelines did lead to a significant increase in the number of residents who were referred to a medical practitioner for further assessment. However, this increase in care staff referrals did not result in substantial changes in the treatment prescribed for residents.

Conclusion: Staff training in depression, supplemented with a protocol for routine screening and guidelines on referring residents, can improve pathways to care. However, strategies to overcome barriers to appropriate subsequent treatment of depression are required for staff-focused initiatives to translate into better outcomes for depressed older adults. Methodological limitations of this study are discussed.     

"Well it's like someone at the other end cares about you." A qualitative study exploring the views of users and providers of care of contact-based interventions following self-harm

Objective

We investigated the views of service users and staff regarding contact-based interventions (e.g., letters, telephone calls or crisis cards) following self-harm.

Method

Self-harm patients recently discharged from an emergency department were selected using purposive sampling (n=11). Clinical staff from relevant service areas and voluntary staff took part in a focus group and individual interviews (n=10). Interviews were transcribed and thematic analyses were conducted using methods of constant comparison to ensure that emergent themes remained grounded in the data.

Results

Most service users and staff participants identified the period of time directly after discharge as the time of greatest need. A contact-based intervention was viewed by service users as a gesture of caring, which counteracted feelings of loneliness. Delivery by mental health specialists was preferred, initially by phone, but letters were considered helpful later. The intervention should be both genuine in delivery and linked to current services. Potential barriers included means of accessing the service and threats to privacy.

Conclusion

The findings suggest that an appropriate design for an intervention might be the provision of an information leaflet, telephone calls (soon after discharge), then letters (offering continuity of contact). Aspects of value and concern expressed by service users should be helpful to clinicians and service providers.     

Therapist correlates of attitudes toward sexual minority individuals,affirmative counseling self-efficacy,and beliefs about affirmative practice

Objective: The purpose of this study was to examine the influence of training in sexual minority issues, professional identification, and gender on attitudes toward lesbian, gay, and bisexual individuals, affirmative counseling self-efficacy, and beliefs about affirmative practice among mental health practitioners in the USA. Method: We used the Internet to recruit a nationwide sample of 443 heterosexual psychologists (n = 270), clinical social workers (n = 110), and marriage and family therapists (n = 63) residing in the USA. Results: When controlling for years of practice experience and age, results from structural equation modeling analysis showed that training was associated with more affirmative attitudes, higher levels of affirmative counseling self-efficacy, and more positive beliefs. Female therapists reported more affirmative attitudes and higher levels of affirmative counseling self-efficacy than male therapists. Professional identification did not predict any criterion variables, when controlling for years of practice experience and age. Conclusion: Findings suggest that it will be important for educational and training initiatives to consider the effect of gender role socialization on attitudes and affirmative counseling self-efficacy, especially among beginning male therapists.     

Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training

Objective: Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory.

Background: Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients.

Design: Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy.

Results: The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method.

Conclusions: Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.     

Indigenous beliefs and attitudes to AIDS precautions in a rural South African community: An empirical study

Background: It was recently hypothesized that indigenous belief systems might have a bearing on attitudes toward HIV/ AIDS prevention in Southern Africa (1).Purpose: This article comprises the first empirical test of the hypothesis.Methods: Participants (n = 407) lived in a remote rural area of KwaZulu Natal, South Africa, and were divided into younger (18–24 years) and older (35–45 years) cohorts. All participants completed a questionnaire measuring Attitudes to AIDS Precautions, indigenous knowledge, indigenous beliefs about ancestral protection, and indigenous beliefs about illness.Results: Indigenous beliefs pertaining to health behavior emerged as multidimensional in both structure and effect. Among older participants, there were significant associations between indigenous belief measures and Attitudes to AIDS Precautions. In this group, a strong belief in ancestral protection was associated with more negative Attitudes to AIDS Precautions, whereas a strong belief in traditional explanations for illness was associated with more positive Attitudes to AIDS Precautions. The indigenous beliefs measures were not associated with Attitudes to AIDS Precautions among younger participants.Conclusions: The data lend modest support to the hypothesis that indigenous beliefs have a measurable association with attitudes to AIDS prevention, although these associations may be diminishing across generations. Further research, exploring a wider range of indigenous beliefs and focusing on actual precautionary behaviors rather than attitudes, seems merited. Arum Bydawell, Delisiwe Dlamini, Doris Dubazane, Sibongile Mabaso, Benedictor Setipa, and Zodwa Zondo collected the data on which this study is based. The research was made possible by a grant from the Spencer Foundation. Comments made by two anonymous reviewers are gratefully acknowledged. The statements made and the views expressed are our sole responsibility.