P.J.C.M. Embregts

Training staff serving clients with intellectual disabilities: A meta-analysis of aspects determining effectiveness

The last decades have seen increased emphasis on the quality of training for direct-care staff serving people with intellectual disabilities. Nevertheless, it is unclear what the key aspects of effective training are. Therefore, the aim of the present meta-analysis was to establish the ingredients (i.e., goals, format, and techniques) for staff training that are related to improvements of staff behaviour. Our literature search concentrated on studies that were published in a period of 20 years. Fifty-five studies met the criteria, resulting in 502 single-subject designs and 13 n>1 designs. Results revealed important information relevant to further improvement of clinical practice: (a) the combination of in-service with coaching-on-the-job is the most powerful format, (b) in in-service formats, one should use multiple techniques, and verbal feedback is particularly recommended, and (c) in coaching-on-the-job formats, verbal feedback should be part of the program, as well as praise and correction. To maximize effectiveness, program developers should carefully prepare training goals, training format, and training techniques, which will yield a profit for clinical practice.

Substance abuse, coping strategies, adaptive skills and behavioral and emotional problems in clients with mild to borderline intellectual disability admitted to a treatment facility: A pilot study

Many clients with mild to borderline intellectual disability (ID) who are admitted to a treatment facility show serious problems in alcohol and/or drugs use. In the present case file study, we explored differences in coping strategies, adaptive skills and emotional and behavioral problems between clients who showed substance abuse and clients who did not. There were no differences in adaptive skills between groups. However, compared to clients without substance abuse, those who abused substances showed a more palliative coping style, and had more severe emotional and behavior problems such as anxiety/depression and intrusive thoughts and aggressive and antisocial behaviors. Implications for treatment are discussed.

Training Emotional Intelligence Related to Treatment Skills of Staff Working with Clients with Intellectual Disabilities and Challenging Behaviour.

BACKGROUND Staff working with clients with intellectual disabilities (ID) who display challenging behaviour may contribute to the continuation of this behaviour, because it causes emotional reactions such as anxiety, anger and annoyance, which may prohibit adequate response behaviour. To enhance staff behaviour and treatment skills a training that aimed at improving emotional intelligence (EQ) was developed. AIM The goal of this study was to assess whether an EQ training in combination with a video-feedback training programme improves emotional intelligence of staff working with clients with ID and challenging behaviour. METHODS Participants were 60 staff members working with individuals with ID and challenging behaviour. Thirty-four staff members participated in a 4-month training programme and 26 constituted the control group. A pretest-posttest control group design was used. Effectiveness was assessed by using the Dutch version of the Bar-On EQ-i and the judgments of experts on emotional intelligence. RESULTS Emotional intelligence of the experimental group changed significantly more than that of the control group. Judgments of experts on emotional intelligence indicated that the change of emotional intelligence of the experimental group improved positively. CONCLUSIONS The positive effect of the training programme on emotional intelligence is consistent with previous research on emotional intelligence and suggests that emotional intelligence of staff working with clients with ID and challenging behaviour can be influenced by training.

Contextual variables affecting aggressive behaviour in individuals with mild to borderline intellectual disabilities who live in a residential facility.

BACKGROUND Aggression is a common type of problem behaviour in clients with mild to borderline intellectual disability who live in a residential facility. We explored contextual events that elicit aggressive behaviour and variables that were associated with such events. METHOD Respondents were 87 direct-care staff members of 87 clients with aggressive behaviour who lived in a residential facility. Staff members completed the Contextual Assessment Inventory (CAI) and a questionnaire on demographic information and types, frequency and severity of aggressive behaviour. Internal consistency of the total CAI was excellent (alpha = 0.95), and Cronbach alphas for the CAI sub-scales ranged from 0.75 to 0.93. Inter-rater agreement for the CAI could be considered good (mean intra-class correlation coefficient = 0.63). RESULTS Both social and task-related events were reported to evoke aggressive behaviour of clients most often. Negative interactions, task characteristics and daily routines relatively often evoked aggressive behaviour while an uncomfortable environment, medication, illness and physiological states (i.e. physical and biological events) evoked aggressive behaviour least often. Mean CAI sub-scale scores were significantly related to gender, IQ and frequency of aggressive behaviour. CONCLUSION The present study extends our knowledge regarding events that are associated with an increased probability of aggressive behaviour. Knowledge of these contextual variables may be helpful in designing programmes (e.g. applied behaviour analysis, social skills training and cognitive behavioural therapies) for the management and prevention of aggressive behaviour in clients with mild to borderline intellectual disability who live in a residential facility.

Social information processing in boys with autistic spectrum disorder and mild to borderline intellectual disabilities

BACKGROUND Children with autistic spectrum disorders (ASD) and mild to borderline intellectual disability (ID) have less adaptive behaviour and more behaviour problems than children with mild to borderline ID. Social information processing appears to be an important mechanism in the explanation of the socially inadequate behaviour of children with mild to borderline ID; however, little is known about the social information processing skills of children with ASD and mild to borderline ID. METHOD In the present study, a total of 136 boys in the age of 10-14 years participated; 26 with ASD (specifically Pervasive Developmental Disorder--Not Otherwise Specified) and mild to borderline ID, 54 with mild to borderline ID without ASD and 56 typically developing boys. They completed the Social Problem Solving Test to measure their social information processing. RESULTS The research results show boys with PDD-NOS and mild to borderline ID to differ from typically developing boys in their encoding of information; they focus on negative and emotional information in the social situation. They differ from boys with mild to borderline ID in response generation, evaluation of inadequate solutions (aggressive and submissive responses) and assertive response decision. CONCLUSIONS The present study extends our knowledge regarding social information processing of children with ASD (PDD-NOS) and mild to borderline ID. This knowledge may be helpful in designing and adapting programmes (e.g. social skills training, self-management training) for the management of behaviour problems and development of adaptive behaviour of children with ASD and mild to borderline ID.

Reliability of the Child Behavior Checklist for the Assessment of Behavioral Problems of Children and Youth with Mild Mental Retardation.

The assessment of psychopathology in persons with mental retardation requires reliable and valid instruments. In the present study, the reliability of the Child Behavior Checklist was determined, using data of 42 children and youth with mild mental retardation, with ages from 10 to 18 years. Kappa coefficients and intra-class correlations were computed to determine the reliability at item level and syndrome level. At item level, mean kappas for inter-rater and test-retest reliability were 0.267 and 0.52, respectively. At syndrome level, mean intra-class correlations for inter-rater and test-retest reliability were 0.493 and 0.775, respectively. These results suggest that the Child Behavior Checklist may not always represent a reliable checklist for the assessment of psychopathology among children and youth with mild mental retardation.

Aggressive behavior in individuals with moderate to borderline intellectual disabilities who live in a residential facility: an evaluation of functional variables

We explored functional variables for aggressive behavior in 87 individuals with moderate to borderline intellectual disability who lived in a residential facility. For this purpose we used the Questions About Behavioral Function scale (QABF; Matson, J., & Vollmer, T. (1995). Questions About Behavioral Function (QABF). Baton Rouge, LA: Scientific Publications). Results show that in most clients subscales describing social function (i.e., Attention, Escape/Avoidance, Tangible) had significantly higher mean scores than subscales describing non-social function (i.e., Self-stimulation, Physical discomfort). Except for gender, there were no significant associations between mean subscale scores and client variables, such as psychiatric disorder, age, level of intellectual disability. Female clients had higher mean scores on subscales of Attention, Self-stimulation, and Physical discomfort than male clients. Results of our study suggest that in most cases, aggressive behavior is positively/negatively reinforced by social events. Implications for functional assessment and function-based treatment of aggressive behavior in these clients are discussed.

Behavior problems in children with mild intellectual disabilities: An initial step towards prevention

To develop prevention activities, an analysis is conducted of child and parent characteristics that occur significantly more often among children with a mild intellectual disability and behavior problems than among children with a mild intellectual disability and no behavior problems and their families. The sample consisted of 45 children attending schools for special education. Data were collected from the children, their parents, and their teachers. The instruments used are the Dutch version of the Parenting Stress Index, the Nijmegen Child-Rearing Situation Questionnaire and the Strengths and Difficulties Questionnaire for parents, teachers and children. On the basis of the results of parents on the Strengths and Difficulties Questionnaire, the research sample was divided into one group of children with behavior problems and one group without behavior problems. Parents of the children with behavior problems were found to feel less competent, more socially isolated, less satisfied about their relationship with their partner, and indicate more negative life occurrences than the parents of the children without behavior problems. Characteristics in the area of adaptability, mood, distractibility/hyperactivity, demandingness, reinforcement of parents, and acceptability were found to contribute to the total stress in the child-parent relationship for those children with behavior problems and their parents. On the basis of these results prevention activities will be developed and tested on their effectiveness.

The relation between intrapersonal and interpersonal staff behaviour towards clients with ID and challenging behaviour: a validation study of the Staff–Client Interactive Behaviour Inventory

BACKGROUND Interpersonal staff behaviour is one of the instigating factors associated with challenging behaviour in clients with intellectual disabilities (ID). There are several studies focusing on the influence of intrapersonal staff characteristics - such as beliefs, attributions and emotional reactions - on staff behaviour. Little is known, however, about interpersonal staff behaviour itself. This study describes the development and validation of the Staff-Client Interactive Behaviour Inventory (SCIBI), measuring both intrapersonal and interpersonal staff behaviour in response to challenging behaviour in clients with ID. METHOD A total of 292 staff members, employed in residential and community services, completed the SCIBI for 34 clients with ID and challenging behaviour. RESULTS Confirmatory factor analysis of a seven-factor model - with assertive control, hostile, friendly and support-seeking interpersonal behaviour; proactive thinking; self-reflection; and critical expressed emotion as reliable factors - showed an exact fit to the data, indicating construct validity and reliability of the SCIBI. A series of multilevel regression analyses showed higher age of the client to be negatively associated with assertive control. Job experience, level of education, type and sex of staff predicted interpersonal behaviour. Also, intrapersonal staff behaviour, including critical expressed emotion, proactive thinking and self-reflection, predicted interpersonal behaviour. CONCLUSIONS The SCIBI can be used to identify staff intrapersonal and interpersonal behaviour towards clients with ID and challenging behaviour. Results obtained with the SCIBI can provide new directions for individual client treatment plans and staff training programmes.

Structural and functional characteristics of the social networks of people with mild intellectual disabilities

In the research on people with intellectual disabilities and their social networks, the functional characteristics of their networks have been examined less often than the structural characteristics. Research on the structural characteristics of their networks is also usually restricted to the size and composition of the networks, moreover, with little attention to such characteristics as the variety, accessibility, length and origin of the relationships or the frequency and initiation of the contacts. A comprehensive examination of both the structural and functional characteristics of the social networks of 33 people with intellectual disabilities was therefore undertaken. The social networks of the individuals who all lived in the community varied from 4 to 28 members (mean 14.21); 42.65% of the network members were family members, 32.84% acquaintances and 24.51% professionals. Remarkable is the high frequency of contact with network members; the finding that the participants considered themselves to be the main initiator of contact more often than the other members of their networks as the main initiators; the high scores assigned to neighbours and professionals for functional characteristics; and the relatively low scores assigned to network members for the connection characteristic of the social networks. The important role of professionals in the social networks of people with mild intellectual disabilities and practical implications to facilitate their social inclusion are discussed.