scholarly journals A new service model in East Lothian community learning disability team: evaluation of service with and without specialist positive behaviour support team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S309-S309
Author(s):  
Saima Asif ◽  
Andrew McKechanie
Keyword(s):  
Intellectual Disability ◽  
Learning Disability ◽  
Individual Case ◽  
Challenging Behaviour ◽  
Service Model ◽  
Community Learning ◽  
Complex Behaviour ◽  
Health And Social Care ◽  
Support Team ◽  
Positive Behaviour Support

AimsTo evaluate the provision of services to patients with challenging behaviour in East Lothian Community Learning Disability population with and without specialist behaviour support team.BackgroundBehaviour that proves to be a challenge to manage (Challenging behaviour) is not uncommon in adults with intellectual disability and has a reported prevalence of 10–15%.1,2Positive behaviour support (PBS) is recommended as evidence-based intervention for adults with intellectual disability who have challenging behaviour. East Lothian community learning disability team (CLDT) underwent a change in service model for people with challenging behaviour. This change followed a Health and Social care partnership agreement that behaviour support and management could be provided by multidisciplinary CLDT rather than region-wide specialist team.MethodData collection was split into two cycles. First cycle looked retrospectively at six months prior to exit of Specialist Positive Behaviour Support Team (SPBST). Second cycle looked prospectively at 6 months after exit of SPBST.In first cycle, data were collected doing retrospective review of cases known and referred to SPBST. This included calculating time spent on each individual case by SPBST and by CLDT. SPBST provided information in the form of hours spent on each individual case for patients identified by them. For CLDT, electronic medical records system (TRAK) was used by looking at appointment entries on TRAK. For second cycle, newly developed Complex Behaviour pathway was used to identify the patients. Data were collected by using TRAK system as in the first cycle for CLDT.Data collected in both cycles was compared at the end of second cycle.ResultIn first cycle, 5 patients were managed jointly by SPBST and CLDT in 96.4 hours over six months and average clinical time spent on each patient was 19 hours. SPBST spent a total of 59 hours and CLDT spent 40 clinical hours. In second cycle, 12 patients were managed by CLDT alone in 130 hours over six months and average clinical time spent on each patient was nearly 11 hours.ConclusionResults of this evaluation suggest that SPBST had been providing significant contribution to East Lothian CLDT not only with their expertise but also with clinical time. More than 50 % of total clinical time spent on the patients with challenging behaviour in first cycle, was provided by SPBST. This is also evidenced in second cycle where there is an increase in clinical time of some professions when SPBST was withdrawn.

Commentary on “Causing trouble: the language of learning disability and challenging behaviour”

2016 ◽  
Vol 21 (3) ◽  
pp. 150-153
Author(s):  
Bob Marks
Keyword(s):  
Learning Disabilities ◽  
Learning Disability ◽  
Design Methodology ◽  
Social Constructionist ◽  
Challenging Behaviour ◽  
Community Learning ◽  
Content Type ◽  
Potential Benefits ◽  
Positive Behaviour Support ◽  
The Way

Purpose – The purpose of this paper is to consider the findings of the research studies on referral to a community learning disability team presented in “Causing trouble: the language of learning disability and challenging behaviour”. Design/methodology/approach – The commentary is based on a review of the article and associated literature. Findings – The studies were undertaken from a social constructionist perspective. It is argued that the use of language in referral texts and the way they represent people with learning disabilities and challenging behaviour is influenced by wider social and historical ideas of what is accepted knowledge. The analysis of these texts contributes to the understanding of how outmoded responses to challenging behaviour are maintained and has potential benefits when used in the context of positive behaviour support. Originality/value – The commentary considers the studies presented from a practitioner perspective.

scholarly journals Transfer and transition referrals of patients with intellectual disability from children's services to adult community learning disability teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S103-S103
Author(s):  
Jalil-Ahmad Sharif
Keyword(s):  
Intellectual Disability ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Limited Information ◽  
Children's Services ◽  
Term Care ◽  
Community Learning ◽  
Children’S Services ◽  
Support Plan ◽  
Transition Support

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

scholarly journals Service provision in Scotland for people with an intellectual disability who have, or are at risk of developing, dementia

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 736-749 ◽  
Author(s):  
Karen McKenzie ◽  
Dale Metcalfe ◽  
Amanda Michie ◽  
George Murray
Keyword(s):  
At Risk ◽  
Intellectual Disability ◽  
Learning Disability ◽  
Service Provision ◽  
Disability Services ◽  
Health Board ◽  
Common Elements ◽  
Online Questionnaire ◽  
Community Learning ◽  
Direct Assessment

This research aimed to identify current national provision by health services in Scotland in relation to proactive screening and reactive assessment for people with an intellectual disability in Scotland who have, or are at risk of developing, dementia. Staff from 12 intellectual disability services, representing the 11 health board areas in Scotland, completed an online questionnaire which asked about proactive screening and reactive assessment for people with intellectual disability who had, or were at risk of developing, dementia as well as suggested areas for improvement. All of the areas provided services for people with intellectual disability who have, or are at risk of developing, dementia, but differed as to whether this was reactive, proactive or both. Nine services offered intervention following diagnosis. The most common elements used across both proactive screening and reactive assessment were conducting a health check, using a general dementia questionnaire designed for people with an intellectual disability and direct assessment with the person. Clinical psychology and community learning disability nurses were the professions most likely to be involved routinely in both proactive screening and reactive assessments. The psychometric properties of the most commonly used assessments of cognitive and behavioural functioning were mixed. The areas of improvement suggested by practitioners mainly related to ways of improving existing pathways. This research represents the first step in providing an overview of service provision in Scotland. There was some inconsistency in relation to the general and specific components which were involved in proactive screening and reactive assessment. Implications for service provision are discussed.

scholarly journals Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

2004 ◽  
Vol 28 (12) ◽  
pp. 447-450 ◽  
Author(s):  
Tom Marshall
Keyword(s):  
Side Effects ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Duration Of Treatment ◽  
Community Learning ◽  
Disability Service ◽  
People With Dementia ◽  
Multiple Drugs

Aims and MethodThe aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author.ResultsA total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs were used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started.Clinical ImplicationsChallenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.

scholarly journals Clinical and cost effectiveness of staff training in the delivery of positive behaviour support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

2020 ◽  
Author(s):  
André Strydom ◽  
Alessandro Bosco ◽  
Victoria Vickerstaff ◽  
Rachael Hunter ◽  
Angela Hassiotis
Keyword(s):  
Autism Spectrum Disorder ◽  
Randomised Trial ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Cluster Randomised Trial ◽  
Challenging Behaviour ◽  
Treatment As Usual ◽  
Life Years ◽  
Health And Social Care ◽  
Positive Behaviour Support

Abstract Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n=11 clusters) or to treatment as usual (TAU; n=12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = -2.10, 95% CI: -11.3 7.13, p =0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.Trial registrationClinicalTrials.gov: NCT01680276

scholarly journals Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

2018 ◽  
Vol 212 (3) ◽  
pp. 161-168 ◽  
Author(s):  
Angela Hassiotis ◽  
Michaela Poppe ◽  
Andre Strydom ◽  
Victoria Vickerstaff ◽  
Ian S. Hall ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Staff Training ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Challenging Behaviour ◽  
Treatment As Usual ◽  
Cluster Randomised ◽  
Positive Behaviour Support ◽  
Randomised Controlled

BackgroundStaff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.AimsTo evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).MethodWe carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.ResultsNo treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.ConclusionsStaff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.Declaration of interestNone.

Complex Behaviour Service: enhanced model for challenging behaviour

2014 ◽  
Vol 8 (4) ◽  
pp. 219-227 ◽  
Author(s):  
Sophie Inchley-Mort ◽  
Khadija Rantell ◽  
Charlotte Wahlich ◽  
Angela Hassiotis
Keyword(s):  
Usual Care ◽  
Group Differences ◽  
Challenging Behaviour ◽  
Mental Health Needs ◽  
Complex Behaviour ◽  
Content Type ◽  
Clinical Benefits ◽  
People With Intellectual Disabilities ◽  
Positive Behaviour Support ◽  
Challenging Behaviours

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.

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