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      Stakeholders’ perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study

      research-article
      , , ,
      International Journal of Developmental Disabilities
      Taylor & Francis
      intellectual disability, challenging behaviors, support, concept mapping

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          Abstract

          Introduction

          People with an intellectual disability (ID) are at risk of developing challenging behavior. Although previous research provided important insights into how to support people with an ID and challenging behavior, it remains unclear what various stakeholders consider to be the most essential aspects to further improve their support.

          Method

          Statements regarding aspects perceived necessary to improve the support to people with an ID and challenging behavior were collected in focus groups. Afterwards participants individually prioritized and clustered these statements, resulting in concept maps for people with an ID, direct support workers, and psychologists. Since only three relatives participated in the entire concept mapping procedure, no concept map could be composed based on their input.

          Results

          Participants generated 200 statements. In the concept map of clients, statements were mentioned regarding relational aspects, providing clarity and structure, characteristics of support staff, and professional attitude of direct support workers. Direct support workers provided statements related to their own personal competencies, the necessity of feeling supported and appreciated, and a physical safe environment. Psychologists provided statements regarding their support for direct support workers, the support for the clients, the perspective on the client, and their role as psychologists.

          Conclusion

          The results of this study may be a starting point to foster increased evidence based practice for the support for persons with an ID and challenging behavior. Moreover, it provides opportunities to create care founded on mutual attunement, based on listening to each other’s ideas and insight into perspectives and needs of various stakeholders.

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          Most cited references46

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          Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

          Objectives To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. Design Cohort study. Setting 571 general practices contributing data to The Health Improvement Network clinical database. Participants 33 016 adults (58% male) with intellectual disability who contributed 211 793 person years’ data. Main outcome measures Existing and new records of mental illness, challenging behaviour, and psychotropic drug prescription. Results 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16 242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10 000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10 000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10 000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P<0.001), and new prescriptions of antipsychotics declined by 4% (3% to 5%) per year P<0.001) between 1999 and 2013. New prescriptions of mood stabilisers also decreased significantly. The rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour (incidence rate ratio 2.08, 95% confidence interval 1.90 to 2.27; P<0.001), autism (1.79, 1.56 to 2.04; P<0.001), and dementia (1.42, 1.12 to 1.81; P<0.003) and in those of older age, after control for other sociodemographic factors and comorbidity. Conclusions The proportion of people with intellectual disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with intellectual disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.
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            Concept mapping: an introduction to structured conceptualization in health care.

            Structured conceptualization is a specific form of concept mapping that is a mixed methods participatory approach that combines group processes (brainstorming, sorting, group interpretation) with a sequence of multivariate statistical analyses (multidimensional scaling, hierarchical cluster analysis). Concept mapping's relevance to health care quality and services is described. The basic steps and analysis sequence in the concept mapping method are outlined and a brief example of the results for a health planning project are presented. Several examples of the use of concept mapping in health are provided.
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              Challenging behaviours in adults with an intellectual disability: A total population study and exploration of risk indices.

              Considerable variation has been reported in the prevalence and correlates of challenging behaviour (CB) in adults with intellectual disabilities (ID). To provide a robust estimate of prevalence, we identified the entire administrative population of adults with ID in a defined geographical area and used a behaviour assessment tool with good psychometric properties.
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                Author and article information

                Journal
                Int J Dev Disabil
                Int J Dev Disabil
                International Journal of Developmental Disabilities
                Taylor & Francis
                2047-3869
                2047-3877
                25 November 2019
                2022
                25 November 2019
                : 68
                : 1
                : 25-34
                Affiliations
                Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University , Tilburg, The Netherlands
                Author notes

                This article has been republished with minor changes. These changes do not impact the academic content of the article.

                Correspondence to: S. Nijs, Academic Collaborative Center Living with an Intellectual Disability, Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University , Box 90153, 5000 LE Tilburg, The Netherlands. Email: s.l.p.nijs@ 123456uvt.nl
                Author information
                https://orcid.org/0000-0003-1064-9359
                https://orcid.org/0000-0001-8489-8409
                Article
                1690859
                10.1080/20473869.2019.1690859
                8843164
                35173961
                8e072820-0820-4620-ab26-5c8ff88acd85
                © The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

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                Page count
                Figures: 3, Tables: 2, Pages: 10, Words: 7269
                Categories
                Research Article
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                intellectual disability,challenging behaviors,support,concept mapping

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