Relationship continuity and understanding challenging behaviours in spouses/partners of those with an acquired brain injury

This thesis is submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at the University of Birmingham. The thesis consists of two volumes which illustrate research (Volume I) and clinical work (Volume II). All identifying information has been anonymised to ensure confidentiality. Volume I This first volume contains three chapters. The first is a systematic review of the research literature regarding carers’ attributions of challenging behaviour in care-recipients with dementia. The second is a research study examining the association between spousal carers’ perceptions of relationship continuity, and their understanding and management of challenging behaviour, for partners with an acquired brain injury. The third is a public dissemination document providing an accessible overview of the research study. Volume II This second volume contains four clinical practice reports (CPRs) and an abstract of a fifth CPR which was presented orally. The first CPR describes the assessment and formulation of a 48-year-old man with mild learning disabilities who was experiencing anxiety and low mood, from cognitive behavioural and systemic perspectives. The second is a service evaluation of a dementia-friendly inpatient unit, identifying the barriers and facilitators to good care. The third is a single-case experimental design of a 33-year-old man in a medium-secure forensic service who experienced anxiety. The fourth describes a piece of leadership and consultation work, regarding how hospice staff cope with grief. The final CPR is an abstract of an oral presentation of a case study of a graded exposure intervention with a 16-year-old female

Development and psychometric evaluation of the Birmingham Relationship Continuity Measure for acquired brain injury

Relationship continuity/discontinuity refers to whether a spouse/partner experiences their current relationship with someone with an acquired brain injury (ABI) as a continuation of their loving pre-injury relationship or as radically changed. The aim of this study was to adapt a questionnaire measure of continuity/discontinuity from dementia research for use in an ABI context and to evaluate the psychometric properties of this adaptation. The questionnaire was adapted in response to feedback from a focus group of ABI caregivers. Its psychometric properties were then evaluated in two studies involving partners of people with ABI. The measure showed high internal consistency (alpha = .956 in Study 1 and .963 in Study 2), test-retest reliability (intra-class correlation = .960 in Study 1) and discriminative power (Ferguson’s delta = .975 in Study 1 and .963 in Study 2). Evidence of construct validity was provided by a predicted pattern of correlations with other relationship questionnaires. Exploratory factor analysis suggested that the questionnaire is unidimensional. A valid and reliable quantitative measure of relationship continuity/discontinuity will enable more robust evaluation of suggestions about this construct that have been made in qualitative studies (e.g. that discontinuity is associated with a greater sense of caregiver burden).N/

Relationship continuity and person-centred care: An exploratory mixed-methods investigation of spousal partners’ responses to the challenging care needs of those with acquired brain injury

Some partners of people with an acquired brain injury experience the person with the injury and their relationship as continuous with the pre-injury person and relationship, but others experience the person and relationship as very different to what went before. Previous qualitative research has suggested that the experience of continuity may promote a more person-centred approach to how partners respond to challenging care needs. Given the value of triangulating evidence, this exploratory study used a mixed-methods design to investigate this suggestion. Twenty-six partners of people with an acquired brain injury completed the Birmingham Relationship Continuity Measure and a semi-structured interview about their response to challenging care needs. Interviews were coded and scored to provide a measure of the extent to which the participants’ understanding, management and emotional responses showed a person-centred approach. The findings supported the hypothesis. Greater continuity was significantly correlated with a more person-centred approach. Associating relationship continuity and person-centred care is a novel approach to the issue of how family relationships may impact on care quality. Person-centred care can have important benefits for both the giver and receiver of care. Whether it can be promoted through fostering a sense of continuity in the relationship merits further investigation