Reliability and Feasibility of Systematic Registration of Coercive Measures in Care for People With Intellectual Disabilities

Policies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration

Social information processing, normative beliefs about aggression and parenting in children with mild intellectual disabilities and aggressive behavior

Background High levels of aggressive behavior in children with mild intellectual disabilities to borderline intellectual functioning (MID-BIF) are associated with deviant social information processing (SIP) steps. The current study investigated deviant SIP as a mediating mechanism linking both children’s normative beliefs about aggression and parenting to aggressive behavior in children with MID-BIF. Additionally, the mediating role of normative beliefs about aggression in linking parenting and deviant SIP was investigated. Methods 140 children with MID-BIF in community care in the Netherlands, their parent(s) or caretaker(s), and their teacher participated in this cross-sectional study. Structural equation modeling was performed to test mediations. Models were run separately for parent and teacher reports of aggression, and included three deviant SIP steps (interpretation, response generation, response selection). Results A total indirect effect through deviant SIP steps was found from normative beliefs about aggression to teacher-reported aggression, but not to parent-reported aggression. An indirect effect was found from positive parenting through normative beliefs about aggression to deviant SIP. Conclusion The results of this study suggest that, next to deviant SIP and parenting, normative beliefs about aggression may be a relevant intervention target for children with MID-BIF and aggressive behavior

Explaining risk factors for successful family supervision orders: families with intellectual disabilities in child protection in the Netherlands

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection

Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior

BACKGROUND: Psychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AIMS: The current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. METHODS AND PROCEDURES: Seventy-two children (aged 9-18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children's externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. OUTCOMES AND RESULTS: The results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 - 3) and TA-BB (M = 4.11; SD = 0.32; range 1 - 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). CONCLUSIONS AND IMPLICATIONS: The current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF

Clustering of health and risk behaviour in immigrant and indigenous Dutch residents aged 19–40 years

Objectives\ud Studies on the co-occurrence, ‘clustering’ of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults.\ud \ud Methods\ud A representative sample (N = 2,982; response 71%) of the Dutch population aged 19–40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch.\ud \ud Results\ud Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rule-breaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity.\ud \ud Conclusions\ud This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people\u

The social information processing test SIVT provides insight into individual differences in social information processing by children and adolescents with behaviour problems

The Social Information Processing (SIP) test (called SIVT in Dutch) is an interactive, digital, diagnostic instrument developed for the understanding of social-cognitive processes in children and adolescents with behaviour problems. The current study presents the psychometric properties of the SIVT for internal consistency, inter-rater reliability, content validity and criterion validity, and provides insight into individual scores for diagnostic interpretation.The main study included 187 children (aged 8–12, mean age = 10.96; 42% female) and 224 adolescents (aged 13–17, mean age = 15.20; 46% female) ranging from mild intellectual disability to borderline or average intellectual functioning. A second study investigating norm scores included 232 children (mean age = 10.93, 47% female) and 242 adolescents (mean age = 15.17, 52% female) from the general Dutch population.Results showed adequate and good values for reliability and validity in the child and adolescent versions of the SIVT. Several results are discussed, and the interpretation of individual scores, the integration between SIP steps and relations with behaviour are explained. This study thereby provides new insights and guidelines for individualised care in diagnostics, guidance and treatment

Social schemas linkages with social information processing: similarities found for youth with mild intellectual disability, borderline IQ, and average IQ

Introduction: Negative social schemas (SS) about the world and the self are found to link with social information processing (SIP) of new situations. If and how SS and SIP associate for youth with mild intellectual disability (MID: IQ50–70), borderline intelligence (BIQ:71–84), and average intelligence (AIQ≥85) is however unclear. Similarities and differences in these linkages were examined for youth with MID compared to peers. Methods: 232 13-to-17-year-olds participated (M=15.2SD=1.33,54% male). Wechsler’s scales of intelligence measured IQ (Wechsler,1949;1955). SS were assessed with the Youth Personality Inventory-Mistrust scale (Luteijn et al., 2005), Childhood Narcissism-scale (Thomaes et al., 2008), and Sensitivity to Disrespect-scale (MacDonald,2008). Videos with social problem situations assessed SIP-steps: intent attribution, response-generation, self-efficacy for aggression. Results: For all youth, higher mistrust related to higher self-efficacy for aggression. Sensitivity to disrespect linked with higher hostile intent attribution. Narcissism characteristics associated with higher hostile intent attribution and self-efficacy for aggression. Relations between SS and SIP were found above and beyond influences of IQ on SIP and were similar across IQ-groups. Implications: These results provide insight in similar cognitive processes from SS to SIP in youth with MID compared with their peers. Future cognitive-behavioural treatments may include this knowledge on similar cognitive processes instead of focusing on differences when treating youth with MID. Keywords: Social cognitive schemas, Social information processing, Mild intellectual disability, Borderline intelligenc