Search results
1 – 10 of 32The purpose of this study is to identify clinically meaningful groups of Health of the Nation Scales Learning Disabilities (HONOS-LD) single-item scales that might be used as…
Abstract
Purpose
The purpose of this study is to identify clinically meaningful groups of Health of the Nation Scales Learning Disabilities (HONOS-LD) single-item scales that might be used as short scales that are more reliable than single-item scale scores and more focused than the sum of scale scores. The single-item scales are likely to be unreliable in many applications. The sum of scale scores is a heterogeneous measure that is not a good representative of any specific difficulties that people who have intellectual disabilities may have and the effects of interventions on any specific difficulties may be masked by fluctuations in the ratings of other scales.
Design/methodology/approach
A total of 2,109 pseudonymised complete HONOS-LD ratings were factor-analysed using principal factor extraction and oblimin rotation. Three-, four- and five-factor rotated patterns were examined.
Findings
Three factors that each have three or more strong loadings (≥|0.50|) were identified that jointly included 11 single-item scales: one representing problems with cognitive competencies, one representing depressive phenomena or other mood problems and one representing problems with social competencies. A weaker factor that represents behaviour that challenges services is indicated; it includes five single-item scales. Both the cognitive competencies and social competencies groups of items were also reported in a previous study by Skelly and D’Antonio (2008) and may be stable. The present study’s factor representing behavioural difficulty has some similarity to Skelly and D’Antonio’s “functional behaviour and attachment disturbance” group. In other respects, the present study and the previous study differ.
Research limitations/implications
The outcomes of these factor analyses indicate that some of the single-item scales can be combined into groups. However, the specific groups found in this study must be regarded as possibly unstable because of the likelihood of weak inter-rater reliability in HONOS-LD data and differences between this analysis and Skelly and D’Antonio’s. Further research is needed to support or modify them.
Practical implications
The cognitive competence and social competence groups of items may be used as subscales if they are convenient. The groups representing mood and behavioural problems should be supported by further research before being used.
Originality/value
This is the second published factor analysis of the HONOS-LD and includes a much larger data set than the first. It has some similarities to and differences from the first and is a further step in the process of identifying useful groupings of HONOS-LD single-item scales.
Details
Keywords
Adam Clifford and Francesca Georgina Kemp
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in…
Abstract
Purpose
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation.
Design/methodology/approach
Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis.
Findings
Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence.
Research limitations/implications
Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources.
Originality/value
The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.
Details
Keywords
Allan Skelly, Caoimhe McGeehan and Robert Usher
The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base.
Abstract
Purpose
The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base.
Design/methodology/approach
The study is a systematic open trial of flexible-length psychodynamic therapy offered in an urban community to 30 people with mild and moderate ID, presenting with significant emotional distress on the Psychological Therapies Outcome Scale for people with intellectual disabilities (PTOS-ID). Allocation to therapy was made according to an established stepped care approach according to need, and the mean number of sessions was 22.03 (range 7–47). Treatment fidelity was checked via notes review and cases excluded from analysis where there were other significant psychological interventions.
Findings
On both self-report (PTOS-ID) and independent ratings (Health of the Nation Outcome Scales-Learning Disability (HoNOS-LD)) recipients of therapy: did not improve while waiting for therapy; improved significantly during therapy, with large pre–post effect sizes; and retained improvements at six-month follow-up.
Research limitations/implications
While it is important to conduct further controlled trials, the findings provide support for previous studies. High rates of abuse and neglect were found in the sample, suggesting that more trauma-informed and relational approaches should be explored for this client group.
Originality/value
No other study of this size has been completed which used dedicated standardised outcome measures, with this therapy type, with both waiting list and follow-up control and with account of model fidelity.
Details
Keywords
Katherine Dewey, Sean Evans, Sarah Horsley and Ellis Baker
Intensive support teams (ISTs) are often poorly understood, despite reports of their effectiveness in managing behaviour that challenges for individuals with an intellectual…
Abstract
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.
Details
Keywords
Ashley Guinn, Sujeet Jaydeokar, Jane McCarthy, Ashok Roy and Angela Hassiotis
Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within…
Abstract
Purpose
Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services.
Design/methodology/approach
The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets.
Findings
In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services.
Research limitations/implications
Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners.
Originality/value
This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.
Details
Keywords
A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a…
Abstract
Purpose
A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.
Design/methodology/approach
This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.
Findings
The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.
Originality/value
This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.
Details
Keywords
Laura Neijmeijer, Hubert Korzilius, Hans Kroon, Henk Nijman and Robert Didden
Recent research on flexible assertive community treatment (FACT) for individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) has shown…
Abstract
Purpose
Recent research on flexible assertive community treatment (FACT) for individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) has shown positive results. This paper aims to identify which client variables are associated with treatment outcome of FACT.
Design/methodology/approach
Analyses were performed on assessments made during a six-year longitudinal study in The Netherlands. Data comprised assessments of 281 clients with at least 2 measurements. Treatment outcome was measured by the learning disability version of the Health of the Nation Outcomes Scales. Demographic variables and dynamic risk variables of the short version of the Dynamic Risk Outcome Scales were selected as potential predictor variables of outcome. Data were analysed using linear mixed models.
Findings
Limited awareness of the need for treatment, limited treatment motivation and cooperation, limited social skills, impulsivity and substance abuse were significantly associated with worse treatment outcome. None of the demographic variables influenced treatment outcome significantly, and neither did intelligence quotient or having a judicial or civil measure.
Research limitations/implications
Because of the observational design, no causal inferences can be drawn.
Practical implications
This study produces guidelines regarding nature and scope of the treatment supply and the competences of professionals working in FACT MID/BIF teams.
Originality/value
This paper encourages other countries to make assertive outreach available for people with MID/BIF on a larger scale, taking into account the acquired insights.
Details
Keywords
Widely varying rates for the prevalence of psychiatric disorder have been reported in the previous published literature. The aims of this study were to describe the prevalence of…
Abstract
Widely varying rates for the prevalence of psychiatric disorder have been reported in the previous published literature. The aims of this study were to describe the prevalence of psychiatric disorders in a random sample of adults with moderate to profound learning disabilities living in the community, and to explore the socio‐clinical factors associated with psychiatric disorders.A process of active case finding was undertaken to identify adults with learning disabilities. A random sample of 240 was taken of whom 121 were found to have moderate to profound learning disabilities at interview. Information was collected on socio‐demographics, service use, physical health, medication use, and life events. Standardised instruments were used to assess psychiatric symptoms, problem behaviour, and severity of learning disabilities. Diagnoses were generated using four diagnostic systems: clinical, DC‐LD, DCR‐10 and DSM‐IV.Higher rates of psychiatric disorder are reported than in previous published studies in the general population and in studies with people with learning disabilities living in the community. Further investigation of the effect of diagnostic system on prevalence rates, and associations of psychiatric disorder are warranted.
Details
Keywords
Sophie Inchley-Mort, Khadija Rantell, Charlotte Wahlich and Angela Hassiotis
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…
Abstract
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.
Details
Keywords
This purpose of this paper is to outline how a combination of different psychological models may inform formulation and treatment, and the benefits for the client and the…
Abstract
Purpose
This purpose of this paper is to outline how a combination of different psychological models may inform formulation and treatment, and the benefits for the client and the therapist of working in this way.
Design/methodology/approach
This is a single case study, describing an integrative approach in which psychodynamic ideas were used to inform cognitive-behavioural treatment.
Findings
The integrated approach reported here not only allowed the client to develop his skills in problem solving and taking different perspectives, but also to take a more active role in decisions about his life.
Practical implications
Integrative approaches may be of particular use for individuals who have not shown a full response to interventions based on a single theoretical model. Malan's triangles of insight provide a clear structure to psychodynamic formulation that is easily accessible to emerging psychodynamic practitioners.
Originality/value
Little previous research has described integrative approaches for psychological difficulties in people with an intellectual disability. The approach outlined in this study describes reasons for using an integrative approach, provides one example of how different models may be combined in practice, and describes ways in which the integrative approach enriched the intervention.
Details