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1 – 9 of 9Jack Purrington, Arthur Nye and Nigel Beail
The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress…
Abstract
Purpose
The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic.
Design/methodology/approach
A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews.
Findings
Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy.
Originality/value
This is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase.
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Jack Purrington and Nigel Beail
The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the…
Abstract
Purpose
The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy.
Design/methodology/approach
A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores.
Findings
Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size.
Originality/value
This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic.
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Gregg Harry Rawlings, Kevin Paul Wright, Keeley Rolling and Nigel Beail
Services are increasingly exploring the use of remote conferencing to deliver psychological interventions, which have become particularly important given the COVID-19 pandemic and…
Abstract
Purpose
Services are increasingly exploring the use of remote conferencing to deliver psychological interventions, which have become particularly important given the COVID-19 pandemic and infection control guidelines. This paper aims to explore the feasibility, acceptability and preliminary effectiveness of delivering psychological therapy remotely to adults with intellectual disabilities (ID).
Design/methodology/approach
As part of routine practice within an adult ID community health service, this paper develops a six-session programme based on compassion-focused therapy (CFT) and delivered it to six clients. Clients completed the psychological therapy outcome scale for ID 2nd edition, at assessment, pre- and post-therapy, as well as a feasibility and acceptability measure.
Findings
Six clients engaged in telephone therapy; four clients individually, while the remaining two were supported by their caregiver. Most clients found the intervention helpful, enjoyable and were pleased that they received telephone-delivered psychological therapy. A reduction was observed at post-therapy in distress (g = 0.33) and risk (g = 0.69). No difference was reported in psychological well-being. Five clients were subsequently discharged from psychological therapy.
Originality/value
To the knowledge, this is the first study examining the use of telephone therapy (including CFT) for individuals with ID. Findings add to the growing evidence suggesting individuals with ID can benefit from receiving adapted psychological therapies. Research is required to further explore the effectiveness of remote-therapies, who would most likely benefit from this approach and how remote treatments could be used within existing pathways.
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Lucy Bateman, Andrea Flood, Deanna Jayne Gallichan and Leonardo De Pascalis
Insecure and unresolved attachments have been linked to poorer psychological health and interpersonal functioning for people with intellectual disabilities (IDs), but research in…
Abstract
Purpose
Insecure and unresolved attachments have been linked to poorer psychological health and interpersonal functioning for people with intellectual disabilities (IDs), but research in this area is limited, especially for adults. Studies using the Adult Attachment Projective (AAP) have been restricted to clinical samples, where insecure and unresolved attachments are typically more prevalent. The purpose of this study is to compare clinical and non-clinical groups of adults with IDs on the AAP, plus measures of psychological health and interpersonal functioning, to investigate whether group differences found in the typically developing population are also present for adults with IDs.
Design/methodology/approach
A cross-sectional, between-group design was used. Adults with IDs (clinical group n = 11 and non-clinical group n = 13) completed measures of attachment, psychological distress/positive well-being and interpersonal functioning. Attachment classifications were compared in the clinical versus non-clinical groups. Measures of psychological distress, positive well-being and interpersonal functioning were compared between those with insecure-organised versus unresolved classifications.
Findings
No participants were classified as secure, and there were high rates of unresolved attachment. There were no differences between clinical and non-clinical groups with regards to the distribution of insecure-organised (i.e. dismissing or preoccupied) versus unresolved classifications. There were no differences between groups with regards to psychological distress, positive well-being or interpersonal functioning. The authors consider limitations in the method of group differentiation and suggest further research to better understand the development of internal working models of attachment in this population.
Originality/value
To the best of the authors’ knowledge, this study is one of only three to examine attachment state of mind in adults with IDs using the AAP and the first to examine differences between clinical and non-clinical groups.
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Robert John Searle, Ianiv Borseti and Katy-May Price
The purpose of this paper is to determine the effectiveness of an adapted compassion-focused therapy (CFT) group treatment programme for individuals with an intellectual…
Abstract
Purpose
The purpose of this paper is to determine the effectiveness of an adapted compassion-focused therapy (CFT) group treatment programme for individuals with an intellectual disability (ID), specifically aimed to help address maladaptive conceptualisations of masculinity.
Design/methodology/approach
Outcome measurements were competed at pre- and post-group and the effectiveness of the intervention were assessed using a Wilcoxon signed ranks test.
Findings
Findings demonstrated that the treatment group showed significant differences in their “gender role conflict” subscales including the Success, Power, Control and “Restrictive Affectionate Behavior Between Men” subscales; however, no significant differences were found on the Restrictive Emotionality or Conflicts Between Work and Leisure subscales. Furthermore, no significant differences were found on participants psychological well-being, psychological distress, anxiety, self-compassion or quality of life measures.
Research limitations/implications
Limitations include that a lack of qualitative information regarding outcomes, a lack of control group and a small number of participants may have impacted the outcome of the research.
Practical implications
The Men’s Masculinity group had a positive impact on the participant’s sense of success, power and control, so it could be considered that this group enabled participants to feel more powerful and in control of their difficulties which is associated with the “drive” system of CFT.
Originality/value
Overall, this study adds to the small but growing literature that supports using CFT groups as a stand-alone psychological intervention when working with people with an ID.
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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.
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Thomas Richard Gourley and Luke Yates
Psychometrically sound measures are essential for clinical practice to provide appropriate therapeutic input. Vlissides et al. (2016) reviewed measures used in psychological…
Abstract
Purpose
Psychometrically sound measures are essential for clinical practice to provide appropriate therapeutic input. Vlissides et al. (2016) reviewed measures used in psychological therapies with people who have intellectual disabilities (ID). This paper aims to review the evidence for the psychometric properties of recent clinical measures published since/overlooked by Vlissides et al. (2016).
Design/methodology/approach
A literature search was conducted to identify relevant clinical measures. Experts in the field also were contacted. Twenty papers were identified, relating to five novel clinical measures: psychological therapies outcome scale – intellectual disabilities, clinical outcome in routine evaluation – learning disabilities scale 30, quality of early relatedness rating scale, scale of emotional development – short and the Frankish assessment of the impact of trauma.
Findings
Evidence was found supporting a proportion of the psychometric properties of each measure, and some measures were found to be useful in directing interventions and informing clinical decisions. None of the measures identified, however, are yet to be fully psychometrically investigated, requiring further research.
Originality/value
To the best of the authors’ knowledge, this paper is the first to review the evidence of psychometric properties for these five emerging clinical measures and as such contributes an original perspective on their current state and requirements for future development.
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Henry Briscoe, Sarah Ashworth and Lyn Shelton
Individuals with an intellectual disability (ID) develop mental health difficulties at similar rates to individuals in the general population. Using Patient Reported Outcome…
Abstract
Purpose
Individuals with an intellectual disability (ID) develop mental health difficulties at similar rates to individuals in the general population. Using Patient Reported Outcome Measures can help track deterioration and improve the outcomes of individuals seeking help for their difficulties. The Clinical Outcome in Routine Evaluation-Learning Disabilities (CORE-LD) is a multi-trait measure of psychological distress which has shown moderate test-rest reliability. However, the CORE-LD is yet to be validated for the population it was designed for. Therefore the purpose of this paper is to establish the concurrent validity of the CORE-LD in a population of individuals with a diagnosis of mild–moderate ID.
Design/methodology/approach
Participants with a diagnosis of mild–moderate ID, as well as other co-morbidities, were recruited from two UK inpatient hospitals and asked to complete the CORE-LD and its general population counterpart the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM).
Findings
Statistically significant differences were found regarding the CORE-LD across gender, with females scoring higher on the CORE-LD than males. There was no significant difference between security levels. The overall mean scores on each measure were moderately correlated. The data from this analysis suggest a significant positive correlation (rs=0.68).
Originality/value
This initial study’s findings have demonstrated the CORE-LD may have concurrent validity, and further replication studies in larger and more diverse samples are needed.
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Robert John Searle and Ianiv Borseti
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…
Abstract
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.
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