An Exploration of Costs of Community‐Based Specialist Health Service Provision for the Management of Aggressive Behaviour in Adults with Intellectual Disabilities

Unwin, Gemma; Deb, Shoumitro; Deb, Tanya

doi:10.1111/jar.12241

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Results from focus group interviews showed that most participants saw the physician as the leading professional in discontinuation of antipsychotics and described the psychologists role less explicitly. This finding is in line with the outcomes of a cost‐effectiveness study for the management of aggressive behaviour of Unwin and colleagues, who concluded that there is an overreliance on medication and psychiatrists, and a relatively lesser involvement from other multidisciplinary team members such as nurses and clinical psychologists (Unwin, Deb, & Deb, ). This was not reflected in the results of our survey item regarding the required psychologists expertise in the process of discontinuation of antipsychotics.…”

Section: Discussionsupporting

confidence: 84%

Support staff’s perceptions of discontinuing antipsychotics in people with intellectual disabilities in residential care: A mixed‐method study

Kleijwegt

Pruijssers

Jong-Bakker

et al. 2019

Research Intellect Disabil

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BackgroundAlthough there is little evidence on their efficacy regarding challenging behaviour, antipsychotics are the most used psychotropic drugs in residential intellectually disabled people. Discontinuation is possible for some residential clients with intellectual disabilities. This study aimed to gain insight into support staff's perceptions of discontinuing antipsychotics in residential clients with intellectual disabilities.MethodFour focus groups were conducted in this mixed‐methods study, followed by a survey.ResultsA large majority of support staff perceive antipsychotics to be effective in controlling challenging behaviour. Support staff regarded themselves as willing to contribute to the discontinuation of antipsychotics, but were more confident about achieving reductions.ConclusionsThe attitude of the majority of support staff towards discontinuation provides a good basis for regularly reviewing antipsychotics use. A reduction plan should include preliminary steps, methods of monitoring and evaluating the process, and establishing measures for dealing with possible crises.

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Section: Discussionsupporting

confidence: 84%

Support staff’s perceptions of discontinuing antipsychotics in people with intellectual disabilities in residential care: A mixed‐method study

Kleijwegt

Pruijssers

Jong-Bakker

et al. 2019

Research Intellect Disabil

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“…Unwin and colleagues postulated that the lack of input from community nurses may have been caused by conflicting demand on their time to carry out many tasks that are not directly related to their professional role. 31 Carers' role Almost a quarter (22.4%) of respondents reported that concern felt by support staff and of family carers was a barrier to antipsychotic withdrawal. A number of authors have highlighted the influence of staff perception on the withdrawal process.…”

Section: Barriers and Support Requirement For A Successful Antipsychomentioning

confidence: 99%

UK psychiatrists’ experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism

et al. 2020

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Background A high proportion of adults with intellectual disabilities are prescribed off-licence antipsychotics in the absence of a psychiatric illness. The National Health Service in England launched an initiative in 2016, ‘Stopping over-medication of people with a learning disability [intellectual disability], autism or both’ (STOMP), to address this major public health concern. Aims To gain understanding from UK psychiatrists working with adults with intellectual disabilities on the successes and challenges of withdrawing antipsychotics for challenging behaviours. Method An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disability (estimated 225). Results Half of the 88 respondents stated that they started withdrawing antipsychotics over 5 years ago and 52.3% stated that they are less likely to initiate an antipsychotic since the launch of STOMP. However, since then, 46.6% are prescribing other classes of psychotropic medication instead of antipsychotics for challenging behaviours, most frequently the antidepressants. Complete antipsychotic discontinuation in over 50% of patients treated with antipsychotics was achieved by only 4.5% of respondents (n = 4); 11.4% reported deterioration in challenging behaviours in over 50% of patients on withdrawal and the same proportion (11.4%) reported no deterioration. Only 32% of respondents made the diagnosis of psychiatric illness in all their patients themselves. Family and paid carers’ concern, lack of multi-agency and multidisciplinary input and unavailability of non-medical psychosocial intervention are key reported factors hampering the withdrawal attempt. Conclusions There is an urgent need to develop national guidelines to provide a framework for systematic psychotropic drug reviews and withdrawal where possible.

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“…In comparing various models of specialist disability service provision -for example, weighing up different forms of community living or contrasting institutional and community-based settings -two broad approaches are evident in the literature. First, many studies conduct cross-sectional surveys of two or more support models, collecting detailed data on service characteristics and costs through survey questionnaires (Unwin, Deb and Deb, 2017;Cronin and Bourke, 2017;Larson et al, 2013;Chou et al, 2008;Knapp et al, 2005;Hallam et al, 2002;Stancliffe and Keane, 2000;Hatton et al, 1995). While this method can account for differences in user characteristics between support models to some extent, it is ultimately limited to comparing support for two different groups of users at a single point in time.…”

Section: Approaches In Academic Literaturementioning

confidence: 99%

Specialist support for persons with disabilities living in the community: Review of international practice

Domhnaill¹,

Lyons²,

McCoy³

2020

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The mission of the Economic and Social Research Institute is to advance evidencebased policymaking that supports economic sustainability and social progress in Ireland. ESRI researchers apply the highest standards of academic excellence to challenges facing policymakers, focusing on 12 areas of critical importance to 21st Century Ireland. The Institute was founded in 1960 by a group of senior civil servants led by Dr T. K. Whitaker, who identified the need for independent and in-depth research analysis to provide a robust evidence base for policymaking in Ireland. Since then, the Institute has remained committed to independent research and its work is free of any expressed ideology or political position. The Institute publishes all research reaching the appropriate academic standard, irrespective of its findings or who funds the research. The quality of its research output is guaranteed by a rigorous peer review process. ESRI researchers are experts in their fields and are committed to producing work that meets the highest academic standards and practices. The work of the Institute is disseminated widely in books, journal articles and reports. ESRI publications are available to download, free of charge, from its website. Additionally, ESRI staff communicate research findings at regular conferences and seminars. The ESRI is a company limited by guarantee, answerable to its members and governed by a Council, comprising 14 members who represent a cross-section of ESRI members from academia, civil services, state agencies, businesses and civil society. The Institute receives an annual grant-in-aid from the Department of Public Expenditure and Reform to support the scientific and public interest elements of the Institute's activities; the grant accounted for an average of 30 per cent of the Institute's income over the lifetime of the last Research Strategy. The remaining funding comes from research programmes supported by government departments and agencies, public bodies and competitive research programmes.

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An Exploration of Costs of Community‐Based Specialist Health Service Provision for the Management of Aggressive Behaviour in Adults with Intellectual Disabilities

Cited by 9 publications

References 22 publications

Support staff’s perceptions of discontinuing antipsychotics in people with intellectual disabilities in residential care: A mixed‐method study

Support staff’s perceptions of discontinuing antipsychotics in people with intellectual disabilities in residential care: A mixed‐method study

UK psychiatrists’ experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism

Specialist support for persons with disabilities living in the community: Review of international practice

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