Physical interventions for adults with intellectual disabilities: survey of use, policy, training and monitoring

Background: Perceived problems around the use of Physical Intervention to manage challenging behaviour have led to UK initiatives to encourage policy development and accredited training. However, information on PI use and the impact of these initiatives remains limited. Method:Adult residential services within an English region were sent a questionnaire regarding physical intervention use, policy, staff training and monitoring/management. Results:Physical intervention use was reported by 47% of the services. Of services using physical intervention, 65% reported having a policy governing its use and 79% reported providing staff training. Where restrictive physical intervention was used, comparable figures were 82% for policy and 84% for training. Physical intervention use was reported to be monitored in some way by 94% of services. Opinions offered supported the reduction of physical intervention use. Conclusions: Physical intervention use is widespread. National guidance on policy and training is widely followed though unimplemented by a minority. The time may be right to more explicitly aim for a reduction in PI use within services

A scoping review of empirical literature on people with intellectual disability in Nigeria

Intellectual disability (ID) is an emerging field of research in Nigeria. This review seeks to identify what has been published in order to describe the evidence and to identify the major gaps in knowledge and practice. A systematic search of five databases and an African disability journal yielded 15 papers that reported on empirical studies related to people with ID in Nigeria. Fifteen studies across the databases and journal searched met the inclusion criteria. The participants included adults and children with ID and their families. Twelve of the papers employed quantitative methods, two were qualitative and one was a mixed methods study. There is a paucity of empirical research on people with ID in Nigeria, thus emphasising the need for more primary research about people with ID living in Nigeria. Nigeria is estimated to have the largest population of people with disabilities in Africa; however, this review found limited empirical work regarding their lives, prevalence and care. This limited evidence hinders the understanding of the challenges people with an intellectual disability face and potentially inhibit the creation of policy-oriented solutions to their plights in a globalised world

Exploring new ways of thinking about and developing staff practice: the role of modes of thinking

Purpose: Nobel Prize winner Daniel Kahneman’s work on modes of “thinking” provides a comprehensive text which is little explored in respect of work with people who have an intellectual or developmental disability. This paper aims to explore the potential of this work to change staff development and practice. Design/Methodology: Key themes from Thinking Fast, and Slow (Kahneman, 2011) are described and applied to current staff practice. Findings: Modes of thinking are relevant and important to understanding and improving manager and staff practice. Originality: To our knowledge this is the first attempt to describe and understand staff thinking and practice using Kahneman’s ideas

Senior manager decision‐making and interactions with frontline staff in intellectual disability organisations: A Delphi study

Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face‐to‐face and non‐face‐to‐face contacts with staff and decision‐making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short‐term reactive and long‐term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra‐organisational focused upon meeting legal and regulatory demands and intra‐organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations

Organisational impact on the use of restrictive measures: The perspective of Swedish front‐line managers

Background: Restrictive measures (RM) are prevalent in services for people with intellectual disabilities. This study investigates managerial awareness of RM and the nature of organisational supports required to reduce their use. Method: A survey asked front‐line managers and staff what (RM) were used, their purpose, impact and importance (10‐item Likert scales) and what organisational changes were required (free text). Responses were analysed using descriptive methods and content analysis. Results: Managers reported a lower use of RM, compared with staff. According to managers, RM were mainly used to keep service users from harm, their use having a significant impact. Opportunities to change practices were limited by a lack of resources and organisational support. Conclusion: Front‐line managers seem to lack the capacity to address the use of RM due to organisational drift; limited manager time and opportunity to allocate resources; inadequate environments; and lack of skilled staff, knowledge and relevant professional input

Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour: a further examination and partial replication

Background and Aims Practice leadership (PL) style of frontline management has been shown to be associated with better experiences for staff working with people who may exhibit challenging behaviours (Anonymous, 2014). This study aimed to examine additional staff experience factors with a different, larger sample and to partially replicate the findings of (Anonymous, 2014). Methods This study was a survey of staff self-reported data collected as part of a larger study. Information was collected on PL and staff experiences of: stress, turnover, job satisfaction and positive work experiences. Results and Conclusions The results broadly supported Deveau & McGill (2014) and demonstrated an association between PL and greater job satisfaction and positive experiences for staff. Results on staff turnover were inconsistent. The positive impact of PL on staff experience was further supported by this study. Suggestions are made for further research. Implications These findings suggest further research is needed to examine the potential of interventions in frontline management/leadership practice to improve staff experience of working in challenging environments. What this paper adds. Firstly, to the somewhat limited research literature on management/leadership in intellectual and developmental disabilities. Secondly, contributes additional evidence that a PL style of frontline management has beneficial effects upon frontline staff’s experience of working in challenging environments i.e. suggests a new intervention in an important area of policy and practice. Thirdly, suggests that the IDD sector needs to place more emphasis upon frontline management development and practice

Staff training in physical interventions: a literature review

BackgroundRestrictive practices are used frequently by frontline staff in a variety of care contexts, including psychiatric hospitals, children’s services, and support services for older adults and individuals with intellectual and developmental disabilities. Physical restraint has been associated with emotional harm, physical injury to staff and consumers, and has even resulted in death of individuals in care environments. Various interventions have been implemented within care settings with the intention of reducing instances of restraint. One of the most common interventions is staff training that includes some physical intervention skills to support staff to manage crisis situations. Despite physical intervention training being used widely in care services, there is little evidence to support the effectiveness and application of physical interventions. This review will examine the literature regarding outcomes of staff training in physical interventions across care sectors.MethodA systematic search was conducted following PRISMA guidelines using Cochrane Database, Medline EBSCO, Medline OVID, PsychINFO, and the Web of Science. Main search keywords were staff training, physical intervention, physical restraint. The MMAT was utilised to provide an analytical framework for the included studies.Results and discussionSeventeen articles have been included in this literature review. The included studies take place in a range of care settings and comprise a wide range of outcomes and designs. The training programmes examined vary widely in their duration, course content, teaching methods, and extent to which physical skills are taught. Studies were of relatively poor quality. Many descriptions of training programmes did not clearly operationalise the knowledge and skills taught to staff. As such, it is difficult to compare course content across the studies. Few papers described physical interventions in sufficient detail. This review demonstrates that, although staff training is a ‘first response’ to managing health and safety in care settings, there is very little evidence to suggest that staff training in physical intervention skills leads to meaningful outcomes

Exploring the role and lived experiences of people with disabilities working in the agricultural sector in northern Nigeria the agricultural sector in northern Nigeria

Background: It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities. Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector. Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria. Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included ‘forced to and for survival’. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments. Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programmes in Nigeria. Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities

Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: A cluster randomized controlled trial of setting-wide positive behaviour support

Background: Improving the quality of social care through the implementation of setting-wide positive behaviour support (SWPBS) may reduce and prevent challenging behaviour. Method: Twenty-four supported accommodation settings were randomized to experimental or control conditions. Settings in both groups had access to individualized PBS either via the organisation’s Behaviour Support Team or from external professionals. Additionally, within the experimental group, social care practice was reviewed and improvement programmes set going. Progress was supported through coaching managers and staff to enhance their performance and draw more effectively on existing resources, and through monthly monitoring over 8–11 months. Quality of support, quality of life and challenging behaviour were measured at baseline and after intervention with challenging behaviour being additionally measured at long-term follow-up 12–18 months later. Results: Following intervention there were significant changes to social care practice and quality of support in the experimental group. Ratings of challenging behaviour declined significantly more in the experimental group and the difference between groups was maintained at follow-up. There was no significant difference between the groups in measurement of quality of life. Staff, family members and professionals evaluated the intervention and its outcomes positively. Conclusions: Some challenging behaviour in social care settings may be prevented by SWPBS that improves the quality of support provided to individuals

Prevalence, conservation and functional analysis of Yersinia and Escherichia CRISPR regions in clinical Pseudomonas aeruginosa isolates

Here, we report the characterization of 122 Pseudomonas aeruginosa clinical isolates from three distinct geographical locations: Dartmouth Hitchcock Medical Center in New Hampshire, USA, the Charles T. Campbell Eye Microbiology Lab at the University of Pittsburgh Medical Center, USA, and the Aravind Eye Hospital in Madurai, India. We identified and located clustered regularly interspaced short palindromic repeats (CRISPR) in 45/122 clinical isolates and sequenced these CRISPR, finding that Yersinia subtype CRISPR regions (33 %) were more prevalent than the Escherichia CRISPR region subtype (6 %) in these P. aeruginosa clinical isolates. Further, we observed 132 unique spacers from these 45 CRISPR that are 100 % identical to prophages or sequenced temperate bacteriophage capable of becoming prophages. Most intriguingly, all of these 132 viral spacers matched to temperate bacteriophage/prophages capable of inserting into the host chromosome, but not to extrachromosomally replicating lytic P. aeruginosa bacteriophage. We next assessed the ability of the more prevalent Yersinia subtype CRISPR regions to mediate resistance to bacteriophage infection or lysogeny by deleting the entire CRISPR region from sequenced strain UCBPP-PA14 and six clinical isolates. We found no change in CRISPR-mediated resistance to bacteriophage infection or lysogeny rate even for CRISPR with spacers 100 % identical to a region of the infecting bacteriophage. Lastly, to show these CRISPR and cas genes were expressed and functional, we demonstrated production of small CRISPR RNAs. This work provides both the first examination to our knowledge of CRISPR regions within clinical P. aeruginosa isolates and a collection of defined CRISPR-positive and -negative strains for further CRISPR and cas gene studies