Noud Frielink

Modification of motivational interviewing for use with people with mild intellectual disability and challenging behaviour

Abstract Background Motivational interviewing is a promising method to increase treatment motivation for people with mild intellectual disability and challenging behaviour. The purpose of the present study was to identify how professionals could adapt motivational interviewing techniques for use with clients. Method We conducted semistructured qualitative interviews and focus groups with 26 clients, parents, and professionals. A general inductive approach led to the identification of multiple core themes. Results The authors recommend several modifications to accommodate motivational interviewing for use with clients: adapt to language level, adjust to cognitive abilities, and control for social desirability of responding. In addition, certain characteristics of professionals were also found to be critical for effective motivational interviewing: trustworthiness, engagement, acceptance, empathy, and honesty. Conclusions Concrete recommendations for the adaptation of the motivational interviewing techniques for use with people with mild intellectual disability and challenging behaviour are identified. Certain characteristics of professionals are also critical for maximising the treatment motivation of clients.

The human degree of care. Professional loving care for people with a mild intellectual disability: an explorative study.

BACKGROUND Research has shown that care staff are not always able to offer quality care. Commercialisation and market forces within the care sector are often pointed to as an explanation for this shortcoming. In the present study, insight is gained into the possible connections between the commercialisation of care, on the one hand, and the shrinkage of possibilities and motivation to offer professional loving care, on the other hand, from the perspective of care staff working with people with mild intellectual disabilities. METHOD Semi-structured qualitative interviews were conducted with 28 care staff working with people with mild intellectual disabilities. Scientific research methods were combined with normative ethical reflection to examine the internal morals of the care staff. RESULTS According to participating care staff, an affiliation with and recognition of the client form the basis for professional loving care. Care staff recognise that their profession is increasingly being built upon manageability and accountability, and this is making their jobs more difficult. CONCLUSION We conclude that care staff perceive the precedence given to the smooth running of production processes over investment in direct contact with clients to be a real threat to the quality of care. Concerns about declining motivation and loss of work satisfaction as a result of the commercialisation of care are only partly acknowledged by care staff. While shrinkage of space for professional loving care is recognised, one can hardly speak of declining motivation.

Psychometric Properties of the Basic Psychological Need Satisfaction and Frustration Scale – Intellectual Disability (BPNSFS-ID)

The Basic Psychological Need Satisfaction and Frustration Scale – Intellectual Disability (BPNSFS-ID), an adapted version of the original BPNSFS (Chen, Vansteenkiste, et al., 2015), operationalizes satisfaction and frustration with the three basic psychological needs according to self-determination theory (SDT): autonomy, relatedness, and competence. The current study examined the psychometric properties of the BPNSFS-ID in a group of 186 adults with mild to borderline intellectual disability (MBID). The results indicated an adequate factorial structure of the BPNSFS-ID, comprising the satisfaction and frustration of each of the three needs. The associations between BPNSFS-ID subscales autonomy, relatedness, and competence and the self-determination subscale of the Personal Outcome Scale (POS), the De Jong Gierveld Loneliness Scale, and the General Self-Efficacy Scale – 12 (GSES-12), supported the construct validity. In addition, the BPNSFS-ID demonstrated high internal consistency (&agr; = .92) and 2-week test-retest reliability (r = .81 for the composite subscale autonomy, r = .69 for the composite subscale relatedness, and r = .85 for the composite subscale competence). Overall, the BPNSFS-ID proved to be a valid and reliable measure of basic psychological need satisfaction and need frustration among people with MBID.

Autonomy Support, Need Satisfaction, and Motivation for Support Among Adults With Intellectual Disability: Testing a Self-Determination Theory Model

The tenets of self-determination theory as applied to support were tested with structural equation modelling for 186 people with ID with a mild to borderline level of functioning. The results showed that (a) perceived autonomy support was positively associated with autonomous motivation and with satisfaction of need for autonomy, relatedness, and competence; (b) autonomous motivation and need satisfaction were associated with higher psychological well-being; (c) autonomous motivation and need satisfaction statistically mediated the association between autonomy support and well-being; and (d) satisfaction of need for autonomy and relatedness was negatively associated with controlled motivation, whereas satisfaction of need for relatedness was positively associated with autonomous motivation. The self-determination theory provides insights relevant for improving support for people with intellectual disability.

Distinguishing subtypes of extrinsic motivation among people with mild to borderline intellectual disability

BACKGROUND According to self-determination theory, motivation is ordered in types, including amotivation, extrinsic motivation and intrinsic motivation. Self-determination theory defines four subtypes of extrinsic motivation: external motivation, introjected motivation, identified motivation and integrated motivation. Although it has been argued theoretically that the different types of motivation are universally applicable, Reid et al. () proposed a dichotomy of broad subtypes of extrinsic motivation for people with intellectual disability (ID) due to their cognitive limitations. The current study challenges this proposal by testing whether the four subtypes of extrinsic motivation can be differentiated among people with ID as well. METHOD The subtypes of extrinsic motivation were measured using two adapted versions of the Self-Regulation Questionnaire, one regarding exercise and one regarding support. In total, 186 adults with mild to borderline ID participated in the study. RESULTS Results supported the distinction between the four subtypes of extrinsic motivation regarding both exercise and support. In addition, the correlation coefficients supported a quasi-simplex pattern of correlations among the subtypes, indicating that adjacent subtypes were more closely related than non-adjacent subtypes. Moreover, the study showed sufficient Cronbachs alphas and test-retest reliabilities for early stage research. CONCLUSIONS Overall, the results of the current study provide initial evidence for the universality of the four subtypes of extrinsic motivation across populations with and without ID.

Met eHealth naar duurzame zorg op maat

SamenvattingDoor een toename van de zorgkosten en een grotere nadruk op participatie en zelfredzaamheid van zorggebruikers, wordt het noodzakelijk de zorg anders te organiseren. eHealth geldt daarbij als een belangrijk alternatief. eHealth is het gebruik van nieuwe informatie- en communicatietechnologieën (voornamelijk internet-technologie) om gezondheid en gezondheidszorg te ondersteunen of te verbeteren.1Tijdens de Tranzo zorgsalon “Met eHealth naar duurzame zorg op maat” in juli jl. stond dit onderwerp centraal. Sprekers waren Nienke Beekers (adviseur eHealth bij Nictiz), Karin van den Berkmortel (zorginnovatie adviseur bij GGzE) en Gert-Jan Borghuis (programmamanager “Registratie aan de bron”).