Abstract:Background: The Who’s Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees’ and trainers’ experiences of the WCW. Methods: Semi-structured interviews were undertaken with managers ( n = 7), support staff ( n = 6) and the WCW trainers ( n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. R… Show more
“…There also continued to be a notable lack in assessing the perspectives of people with disabilities in training that directly affects their lives (as initially identified by van Oorsouw et al, 2013a, 2013b). Promisingly, a few training programs incorporated adults with disabilities as trainers (Flynn, Hastings, Gillespie, et al, 2019; Flynn, Hastings, McNamara, et al, 2019; Hastings et al, 2018).…”
Developmental support agencies support many adults with intellectual disabilities in the community. Unfortunately, these adults often exhibit high rates of challenging behaviour, which present significant pressures on these service providers. Agencies need to develop effective means of increasing their capacity to provide quality support. Previous systematic reviews found that training staff in positive behaviour supports can improve outcomes; however, the factors facilitating training’s effects, long-term effectiveness, and outcomes for service users have yet to be determined. We conducted a scoping review of 98 journal articles and book chapters to develop a model for fostering capacity development drawing from Organizational Behaviour Management and Knowledge Translation theories. Some relevant factors include features of the inner and outer organizational contexts, training approaches (e.g., behavioural skills training & in-situ coaching), ongoing support and feedback. This model may lead to more effective and enduring treatment programs and improved support for adults with intellectual disabilities.
“…There also continued to be a notable lack in assessing the perspectives of people with disabilities in training that directly affects their lives (as initially identified by van Oorsouw et al, 2013a, 2013b). Promisingly, a few training programs incorporated adults with disabilities as trainers (Flynn, Hastings, Gillespie, et al, 2019; Flynn, Hastings, McNamara, et al, 2019; Hastings et al, 2018).…”
Developmental support agencies support many adults with intellectual disabilities in the community. Unfortunately, these adults often exhibit high rates of challenging behaviour, which present significant pressures on these service providers. Agencies need to develop effective means of increasing their capacity to provide quality support. Previous systematic reviews found that training staff in positive behaviour supports can improve outcomes; however, the factors facilitating training’s effects, long-term effectiveness, and outcomes for service users have yet to be determined. We conducted a scoping review of 98 journal articles and book chapters to develop a model for fostering capacity development drawing from Organizational Behaviour Management and Knowledge Translation theories. Some relevant factors include features of the inner and outer organizational contexts, training approaches (e.g., behavioural skills training & in-situ coaching), ongoing support and feedback. This model may lead to more effective and enduring treatment programs and improved support for adults with intellectual disabilities.
“…Verbatim interview transcripts were analysed using Thematic Analysis (Braun and Clarke, 2006). The results from this study (Flynn et al , 2019) suggested that being trained by people with LD and CB The impact of the WCW training There were positive impacts for both the trainees (support staff and managers) and the trainers, and some of these are represented here: “I found it interesting, and for somebody with learning disabilities to be there and put their point of view across was interesting. It makes you see things from their point of view and not your own” (Lauren a , Support staff) “Yes definitely – I think it definitely helped [the support staff] understand a little bit more about how they were impacting on the service users” (Alice, Service manager) “Psychologically it got a lot off my chest because […] I’ve had to boil a lot of the stuff up” (Jonathan, trainer with LD) “I didn’t think on the money side it was going to be that much.…”
Section: Evaluation Of Who’s Challenging Who?mentioning
confidence: 90%
“…Verbatim interview transcripts were analysed using Thematic Analysis (Braun and Clarke, 2006). The results from this study (Flynn et al, 2019) suggested that being trained by people with LD and CB encouraged support staff to reflect on their own practice, and the impact that they have on the behaviours of the people they support. Although trainees often indicated that they had been engaging in increased reflection on their practice, they did not see this as a tangible outcome of the training.…”
Section: Evaluation Of Who's Challenging Who?mentioning
Purpose
The purpose of this paper is to outline the development, piloting and evaluation of the Who’s Challenging Who? (WCW) training intervention for social care staff to improve their empathy and attitudes towards people with learning disabilities (LD) and challenging behaviour (CB).
Design/methodology/approach
A phased approach was taken to the development and testing of the intervention. Initially, the existing literature was reviewed, the theoretical background of the intervention was developed, and then the intervention was designed. A pilot study was undertaken, followed by further development, and a large-scale randomised controlled trial (RCT).
Findings
WCW had a small positive effect on staff empathy 20 weeks after the intervention, and small to moderate effects for other staff reported outcomes (e.g. positive empowerment attitudes and positive work motivation). Being trained by people with LD and CB encouraged staff to reflect on the impact they have on the people they support. The trainers with LD valued their role, and saw benefits beyond this (e.g. friendships).
Research limitations/implications
It is possible to carry out high-quality RCT evaluations of social care practice, and research should continue to generate evidence in this way, as in healthcare settings. However, there were difficulties in retaining participants.
Practical implications
People with LD can be actively involved in the co-production and delivery of social care training.
Social implications
Employment and a fair wage can increase the confidence and empowerment of people with LD.
Originality/value
This is the first large-scale RCT of an intervention that aimed to improve empathy/change attitudes in social care staff who work with people with LD and CB.
“…Informed by attachment and social learning theories (Bandura, 1978; Bowlby, 1988), and by the normalization principle (Wolfensberger, 1983), they developed Triple‐C in Dutch practice. One of the founders' central ideas is that human behavior is determined by the interaction between an individual and his or her environment, as challenging behavior can be seen as a response to a challenging environment (Flynn, Hastings, Gillespie, McNamara, & Randell, 2019; Hastings et al, 2018). Therefore, an empathic, understanding and compassionate response to challenging behavior is needed.…”
Partly due to a lack of evidence-based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be "good practice"-to develop evidence based on practical knowledge. This study describes the Dutch practice-based intervention Triple-C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice-based nature of Triple-C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple-C professionals and to develop an understanding of the mechanisms of change for Triple-C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple-C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple-C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence-based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice-based intervention like Triple-C is an important first step toward producing an evidence base for interventions developed from clinical practice.
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