Abstract
Background
Aggressive challenging behaviour is prevalent in adults with an intellectual disability and is associated with over-medication, physical ill-health and psychiatric hospitalisation. We urgently need interventions that can moderate this behaviour and improve quality of life in this population. We report on the development and modelling of a 7-module tailored manualised psychological intervention to support adults who display aggressive challenging behaviour in community settings (hence referred to as the PETAL therapy).
Method
The PETAL therapy was designed following an extensive review of existing management provisions and was co-produced with carers with lived experience and self-advocates with an intellectual disability. A logic model was developed to illustrate the theoretical approach behind the development of the PETAL intervention. A single arm multi-site modelling study was conducted in England to test the delivery and acceptability of the PETAL intervention. Seventeen NHS healthcare professionals were trained during a two-day training programme and were regularly supervised to deliver the therapy in up to 14 weeks. Following completion, we conducted qualitative interviews with stakeholders and explored the intervention’s fidelity and acceptability.
Results
We held seven co-production meetings and developed the PETAL therapy, consisting of the following modules: Getting to know the person, understanding aggressive challenging behaviour, communication, emotions, a calm environment, carer wellbeing and healthy habits. We then recruited ten dyads or triads (person with a learning disability and 1–2 carers) to participate in a modelling study to test delivery aspects and measure fidelity. Nineteen stakeholders were interviewed, and the findings were analysed deductively using Normalisation Process Theory and its four domains: coherence, cognitive participation, collective action and reflexive monitoring.
Conclusion
The PETAL therapy was possible to deliver in community services with high fidelity and was acceptable. The PETAL manual and training programme have been reviewed and refined and a cluster randomised controlled trial is underway.
Plain Language Summary
Background
Some adults with a learning disability show behaviours that challenge, including behaviours such as hitting that could harm others or destroying objects or property. These behaviours can lead to the increased use of medication, poor health and the person being excluded from community activities. This is why it is important to find ways to better support people who show these behaviours.
Method
We designed a new therapy to reduce these behaviours called ‘PETAL therapy’. We did this by looking at therapies that are already available and bringing together research experts, carers with lived experience and self-advocates with a learning disability to develop the therapy together. We then tested the delivery of the PETAL therapy within NHS learning disability services in England. We trained 17 NHS healthcare professionals to deliver the therapy and then interviewed therapists, service managers, carers and people with a learning disability to find out how the therapy went and what they thought.
Results
The PETAL therapy was delivered to 10 adults with a learning disability and their carers in up to 14 weeks. The therapy has 7 modules which looked at getting to know the person, understanding behaviour, communication, emotions, a calm environment, carer wellbeing and healthy habits. We then interviewed 19 people and grouped what they said into themes that looked at how the therapy worked in practice. We used this feedback to make improvements to the therapy manual and the training of therapists.
Conclusion
We found that we were able to deliver the PETAL therapy within NHS services and most people thought it was helpful and useful. The next stage of the project is to test the therapy on a larger scale using a UK-wide trial.
Keywords
intellectual disability, aggressive challenging behaviour, intervention development, adults, therapy
Aggressive challenging behaviour is prevalent in adults with an intellectual disability and is associated with over-medication, physical ill-health and psychiatric hospitalisation. We urgently need interventions that can moderate this behaviour and improve quality of life in this population. We report on the development and modelling of a 7-module tailored manualised psychological intervention to support adults who display aggressive challenging behaviour in community settings (hence referred to as the PETAL therapy).
Method
The PETAL therapy was designed following an extensive review of existing management provisions and was co-produced with carers with lived experience and self-advocates with an intellectual disability. A logic model was developed to illustrate the theoretical approach behind the development of the PETAL intervention. A single arm multi-site modelling study was conducted in England to test the delivery and acceptability of the PETAL intervention. Seventeen NHS healthcare professionals were trained during a two-day training programme and were regularly supervised to deliver the therapy in up to 14 weeks. Following completion, we conducted qualitative interviews with stakeholders and explored the intervention’s fidelity and acceptability.
Results
We held seven co-production meetings and developed the PETAL therapy, consisting of the following modules: Getting to know the person, understanding aggressive challenging behaviour, communication, emotions, a calm environment, carer wellbeing and healthy habits. We then recruited ten dyads or triads (person with a learning disability and 1–2 carers) to participate in a modelling study to test delivery aspects and measure fidelity. Nineteen stakeholders were interviewed, and the findings were analysed deductively using Normalisation Process Theory and its four domains: coherence, cognitive participation, collective action and reflexive monitoring.
Conclusion
The PETAL therapy was possible to deliver in community services with high fidelity and was acceptable. The PETAL manual and training programme have been reviewed and refined and a cluster randomised controlled trial is underway.
Plain Language Summary
Background
Some adults with a learning disability show behaviours that challenge, including behaviours such as hitting that could harm others or destroying objects or property. These behaviours can lead to the increased use of medication, poor health and the person being excluded from community activities. This is why it is important to find ways to better support people who show these behaviours.
Method
We designed a new therapy to reduce these behaviours called ‘PETAL therapy’. We did this by looking at therapies that are already available and bringing together research experts, carers with lived experience and self-advocates with a learning disability to develop the therapy together. We then tested the delivery of the PETAL therapy within NHS learning disability services in England. We trained 17 NHS healthcare professionals to deliver the therapy and then interviewed therapists, service managers, carers and people with a learning disability to find out how the therapy went and what they thought.
Results
The PETAL therapy was delivered to 10 adults with a learning disability and their carers in up to 14 weeks. The therapy has 7 modules which looked at getting to know the person, understanding behaviour, communication, emotions, a calm environment, carer wellbeing and healthy habits. We then interviewed 19 people and grouped what they said into themes that looked at how the therapy worked in practice. We used this feedback to make improvements to the therapy manual and the training of therapists.
Conclusion
We found that we were able to deliver the PETAL therapy within NHS services and most people thought it was helpful and useful. The next stage of the project is to test the therapy on a larger scale using a UK-wide trial.
Keywords
intellectual disability, aggressive challenging behaviour, intervention development, adults, therapy
| Original language | English |
|---|---|
| Pages (from-to) | 10 |
| Journal | NIHR open research |
| Volume | 5 |
| DOIs | |
| Publication status | Published - 27 Jan 2025 |