Martin Campbell

Staff training and challenging behaviour: who needs it?

Staff working directly with people who have challenging behaviour in learning disability services need to be D good at what they do. These staff are trained by their employers to manage and to treat challenging behaviours and to improve the quality of life of people in their care. While such training is generally well evaluated by care staff, there is limited evidence that training alone changes poor attitudes or improves staff performance. Training has not been linked to quality of outcomes for service users. From research on treating challenging behaviour, achieving maintenance of behavioural gains after treatment has been discontinued is the exception rather than the rule. Can the same be said for maintaining gains achieved through staff training in the area of challenging behaviour? This discussion article reviews the value of training for staff working with people with challenging behaviour.

Workforce development and challenging behaviour : training staff to treat, to manage or to cope?

Staff working directly with adults’ challenging behaviours in learning disability services need to be very good at what they do. They also need to want to do the job. A theory—practice gap exists, however, between what is known about effective, evidence-based approaches and whether and how these are used in person-centred community services. Many frontline staff working with people with the most serious challenging behaviours do not have the skills to implement programmes to change behaviour. This discussion article reviews workforce development in the context of clinical and service guidelines and asks whether the legitimate purview of frontline staff is treating challenging behaviour, managing it or simply coping with it on a daily basis, whilst maintaining the best quality of life possible for service users.

Psychological therapies for people with intellectual disabilities: comments on a Matrix of evidence for interventions in challenging behaviour

BACKGROUND Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. METHODS A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. RESULTS There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. CONCLUSIONS It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.

Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review

ABSTRACT The healthcare setting is a rich learning environment for students to experience interprofessional working (IPW) and interprofessional education (IPE). However, opportunities for IPE are limited, and student experiences of effective IPW are varied. This raises the question of how IPW and IPE are valued by health or social care professionals. A search of the literature was carried out to identify studies of health and social care staff attitudes to IPW and IPE. This review provides a summary of the main factors found to influence attitudes and the strengths and limitations of these studies. Professional background and prior IPE experience were identified as the influencing factors for which there is most evidence. The main limitations of the studies accessed included a focus on the value of IPE for staff, as opposed to students, and a limited number of studies considering the relationship between attitudes to IPW and the value placed on IPE. It is important that health and social care professionals lead by example by working collaboratively and providing students with opportunities for IPE. Identifying the variables influencing attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for students learning in the healthcare setting.

A survey of learning disability inpatient services in Scotland in 2007.

A national review of learning disability services in Scotland, The Same As You? recommended that Health Boards should close all long stay beds by 2005 and reduce assessment and treatment places to specified levels. A psychiatry-led service planning study was carried out in 2007 to find out whether these recommendations had been met. The extent of delayed discharges was also investigated. All 15 Health Boards in Scotland responded and supplied the requested information. There were 388 adults with learning disabilities within inpatient services, 91 of whom were within forensic learning disability services. The age, gender, reasons for admission and length of stay are reported for this inpatient population. Recommendations are made for future recording of delayed discharges and the adequacy of the number of assessment and treatment inpatient places in Scotland is discussed.

A pilot project: evaluating community nurses' knowledge and understanding of the Adult Support and Protection (Scotland) Act 2007

Purpose – This papers aim is to evaluate understanding and knowledge of the Adult Support and Protection (Scotland) Act 2007 in a sample of community nurses working in learning disability services in Scotland.Design/methodology/approach – Ten community nurses who worked in learning disability services in one NHS area were tested at two time points, four months apart using a questionnaire designed for this study by researchers and practitioners. Level of previous national training in the Adult Support and Protection Act and length of time working with people with learning disabilities were recorded. Three domains of adult protection were included in the questionnaire: Principles of the Act and definitions; Adults at risk of harm; Protection, assessment, removal and banning orders.Findings – Questionnaire scores varied widely overall and across the three domains. There was no correlation between individual scores and training or length of work experience. The level of knowledge was below what might have be...

Changing day services Do you agree

Models of day services for people with intellectual disabilities in Scotland are changing, with the purpose, content and availability being reviewed. There has been concern that a move to more flexible ‘alternative day opportunities’ is driven more by reduced budgets than a policy of modernising day services in response to individual needs. During a day services review, a questionnaire was used to rate and to collect views on existing services from 60 carers, service users and staff. This included evaluating day activities available, care plans, opening times, transport and the most valued aspects of existing day services. Respondents indicated general satisfaction with existing day services, although half believed that day services should be reviewed. The most valued parts of day services were forming and building friendships, and a safe place to go. Day services are highly valued by families and service users. Recommendations are made for a robust and transparent review process.

Adult protection training for community nurses: evaluating knowledge following delivery using participant-favoured training methods

Purpose – The purpose of this paper is to measure nurses’ knowledge about Adult Support and Protection (Scotland) Act 2007 before and after a one-day training course using participants’ favoured methods of training activities. Design/methodology/approach – A repeated measures design was used to evaluate the impact of a one-day Adult Support and Protection training on pre-training knowledge of community nurses across one NHS area. Participants’ favoured methods of training activities were used in the training. Participants were community nurses working in learning disability, mental health, older peoples services, acute services, substance misuse, and accident and emergency. All completed a training needs analysis and training preferences study. Individual and group scores on an Adult Support and Protection knowledge questionnaire were analysed pre- and post-training. Findings – There was a statistically significant increase in scores post-training (Wilcoxons signed-ranks test). Individual increases rang...

A National Review of Health Services for People with Intellectual Disabilities in Scotland

*Dr Martin Campbell, BA, TFQE, PhD Senior Teaching Fellow, School of Psychology, University of St. Andrews, St Andrews KY16 9JP, UK Tel: +44 (0)1334 462084 Fax: +44 (0)1334 463042 Email: mc1@st-andrews.ac.uk Dr Margaret Whoriskey, MBE, BA, M.Phil., C.Psychol., PhD Asst. Director, Joint Improvement Team, Scottish Executive, Edinburgh, UK Dr Ros Lyall MBChB, MPhil, MBA, MRCPsych. Consultant Psychiatrist, NHS Lothian, Edinburgh, UK Mr Alex Davidson BA Head of Adult Services, Social Work Resources, South Lanarkshire Council, UK Mr Michael McCue BA Complex Needs Services Manager Glasgow Learning Disability Partnership, Glasgow, UK * For Correspondence Introduction

Adult protection in Scotland in 1857 and in 2015: what have we learned?

Purpose – The purpose of this paper is to compare recent developments in adult protection legislation, policy and practice in Scotland in 2015 with the first attempts at protection of adults at risk of harm, in 1857-1862, with a particular focus on people with learning disabilities. Design/methodology/approach – The paper uses comparative historical research, drawing on primary archive material from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers. Findings – Growing public awareness of the extent of neglect and abuse, and the need for overarching legislation were common factors in the development of both the “The Lunacy Act” of 1857 and the Adult Support and Protection (Scotland) Act of 2007. Both pieces of legislation also had the common aim of “asylum”, and shared some other objectives. Practical implications – Total prevention of abuse of vulnerable adults is an aspiration in law and in policy. There is an evidence base of ef...