Challenging Behaviour Clinical Trial
Official title:
Effects of a Web-based Training Programme for Professional Carers Working With People With Learning Disabilities Who Exhibit Challenging Behaviour
The interaction between people with intellectual disabilities and professional carers is
often influenced by communicative difficulties contributing challenging behaviours.
Aim: The aim of this study is to evaluate a web-based training program aimed at improving
carers' abilities to interact with people with learning disabilities who exhibit challenging
behaviours and to explore carers' experiences of participating in such a program.
Method: This study has a cross-sectional design. Sample: The study will be conducted in
twenty special community-based accommodations, group-homes, in Sweden that each houses 4-8
residents. The staff in the group-homes is working independently with the manager located at
distance.The staff (N=221) in this study works with people with intellectual disabilities who
has different functional levels, from moderate to profound intellectual disabilities. They
have different educational backgrounds: from basic nursing education at the college level to
university degree.
Intervention: The intervention consists of a web-based training program, available for all
staff working in special accommodations for people with intellectual disabilities. The
web-based training program focuses on strengthening the carers' communication skills.
Procedure: The social Services authorities and the managers from each home agreed to the
project. The carers have given their informed consent to attend the study. The participants
will by their own during working hour go through the web-based program. The time to complete
the web-based training program is estimated at approximately ten hours.
Data-analysis: Descriptive statistics will be used for demographic data. Proportions will be
compared to the chi-square test. The mean values between the groups will be compared by
t-test or Mann-Whitney's U-test, as appropriate. Changes in the mean between and in the
groups will be compared with paired t-test. Double-sided significance test will be used
throughout. Data will be presented at a group level.
A literature review shows that the interaction between adult persons with intellectual
disabilities and professional carers is a complex combination of verbal and non-verbal
expressions. Attempts to communicate often lead to misunderstandings from both parties, as
well as challenging behaviors such as aggression and violence. The literature shows that
challenging behavior often leads to physical constraints. Literature studies also emphasize
the importance of education, knowledge and support for staff. Therefore, we want to
investigate whether it is possible to reduce challenging behavior through education on causes
of challenging behavior and successful interaction for carers in special housing.
Aim: To study the effects of a web-based training program to increase staff's ability to
better communicate and interact with persons with intellectual disabilities and challenging
behaviors.
Method: The study has a cross-sectional design.
Intervention: The intervention was inspired by an evidence-based conceptual model for staff
training in challenging behaviour. The intervention consists of a web-based training program,
available for all carers working in special accommodations for people with intellectual
disabilities.
The web-based training program focuses on strengthening the carers' communication skills.
Video lectures on the definitions, characteristics and causes of challenging behaviour will
be given. Video lectures will also be given on the importance of the carers' views on their
values, emotions, abilities and attitude towards people with intellectual disabilities, and
on the impact that workplace culture and environmental factors have on the quality of
interactions. The web-based training program also includes written cases that gives the
participants an opportunity to reflect upon approaches supporting a successful interaction.
It also covers factors to consider when mental illness and challenging behaviour occur. The
web-based training program includes the opportunity to follow the carers' activity regarding
time and frequency of studying. The time to complete the web-based training program is
estimated at approximately ten hours.
Context: The study will be conducted in twenty special community-based accommodations,
group-homes, in Sweden that each houses 4-8 residents. The residents has their own private
rooms, but shares a communal space with a living room and a kitchen with a dining table. The
staff in the group-homes is working independently with the manager located at distance.
Participants:The carers in this study works with people with intellectual disabilities who
has different functional levels, from moderate to profound intellectual disabilities. They
have different educational backgrounds: from basic nursing education at the college level to
university degree.
Procedure: Prior to handing out the questionnaires, staff will receive information regarding
the study and that participation is voluntary. The questionnaires will be distributed in hand
and returned in pre-paid envelopes. Two reminders will be sent out to the participants. The
project is approved by The Regional Ethical Review Board in Gothenburg, approval number;
355-17. The social Services authorities and the managers from each home agreed to the
project. The carers have given their informed consent to attend the study. A project group is
established with representatives from the Social Services authorities and the researchers.
The implementation of the intervention will be discussed in the project group every second
month throughout the study period.
Instruments: This study is planned into three phases. Baseline measures using the Checklist
of Challenging Behaviour (CCB). This instrument is translated from English to Swedish and
re-translated by experts in the field. It describes 32 observed behaviours relating to CB,
for example, verbal, and physical aggression. Scores for items on the instrument range from 1
(the behaviour has not occurred) to 5 (the behaviour occurs daily or more often). The CCB has
an acceptable level of content validity and reliability. In the second phase, the
intervention will be implemented. The third phase will take place after the intervention with
a follow-up period directly after the intervention and after approximately three months in
order to analyse effects of the intervention.
At baseline and at follow-up, the instruments will be handed out to the carers to answer. The
Job Demand-Control and Social Support (JDC-S) instrument. The JDC-S is a commonly used for
investigating psychosocial working environments. This instrument has three major dimensions.
First, it measures job demands, which includes psychological stressors such as time pressure,
and item scores range from 1 to 4, with higher values indicating higher demands. Second, it
measures job control on a scale of 1 to 4, with higher values indicating more perceived
control over the job situation. Third, it measures social support, again on a scale of 1 to
4, with higher values indicating higher perceived support from co-workers and managers. In
the JDC-S, high demands and low control indicate a high job strain. According to Cronbach's
alpha a level of 0.73 for the dimension job demands, 0.52 for job control, and 0.81 for
social support was reported.
The Controllability Beliefs Scale (CBS) is a 15-item instrument measuring the attribution of
control in situations with CB. This instrument was used to measure carers' values and
approaches to people with LD. Items were scored on a 5-point scale with anchored ratings from
strongly agree (1) to strongly disagree (5). A two-factor structure, suggesting positive and
negative attributions of control, and good internal reliability (Cronbach's alpha for total
score = 0.89, 0.92 for the negative subscale and 0.73 for the positive subscale).
The Ways of Coping Questionnaire (WOCQ) measured the use of coping strategies employed by the
carers. The instrument was used in this study to measure the intervention's effects in
reducing feelings such as shame and guilt in the carers and in strengthening professional
care. In this 40-item version of the WOCQ, translated into Swedish, participants were asked
to reflect upon how they would manage specific challenging situations. The items were divided
into emotion-focused coping skills and problem-focused coping skills. Each subscale was
answered on a 4-point Likert scale ranging from (0) does not apply to (3) used a great deal.
The instrument was used and tested in a Swedish context with a Cronbach's alpha ranging from
0.63 to 0.89 and has shown acceptable values (> 0.7) on all subscales except for the
subscales confrontational coping (0.59) and self-controlling (0.47).
Statistical analysis: Data processing and statistical calculations will be performed in the
Statistical Package for Social Sciences (SPSS 23) statistics. Proportions will be compared to
the chi-square test. The mean values between the groups will be compared by t-test or
Mann-Whitney's U-test, as appropriate. Changes in the mean between and in the groups will be
compared with paired t-test. Double-sided significance test will be used throughout. Data
will be presented at a group level.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Active, not recruiting |
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