Where there is no evidence: implementing family interventions from recommendations in the NICE guideline 11 on challenging behaviour in a South African health service for adults with intellectual disability

Abstract

BackgroundLow- and middle-income countries often lack the fiscal, infrastructural and human resources to conduct evidence-based research; similar constraints may also hinder the application of good clinical practice guidelines based on research findings from high-income countries. While the context of health organizations is increasingly recognized as an important consideration when such guidelines are implemented, there is a paucity of studies that have considered local contexts of resource-scarcity against recommended clinical guidelines.MethodsThis paper sets out to explore the implementation of the NICE Guideline 11 on family interventions when working with persons with intellectual disability and challenging behavior by a group of psychologists employed in a government health facility in Cape Town, South Africa.ResultsIn the absence of evidence-based South African research, we argue that aspects of the guidelines, in particular those that informed our ethos and conceptual thinking, could be applied by clinical psychologists in a meaningful manner notwithstanding the relative scarcity of resources.ConclusionWe have argued that where guidelines such as the NICE Guidelines do not apply contextually throughout, it remains important to retain the principles behind these guidelines in local contexts. Limitations of this study exist in that the data were drawn only from the clinical experience of authors. Some of the implications for future research in resource-constrained contexts such as ours are discussed. Smaller descriptive, qualitative studies are necessary to explore the contextual limitations and resource strengths that exist in low- and middle-income settings, and these studies should be more systematic than drawing only on the clinical experience of authors, as has been done in this study.

Respite care models and practices for persons with intellectual disability: A scoping review

“…Understanding that caregivers value and need respite care (Lunsky et al 2014 ; Nuri et al 2020 ), an implication is that researchers should study the extent and provision of respite care services offered in LMICs. Researchers and service providers also need to establish if existing HICs respite care offerings, practices and principles can meet the needs of service users in LMICs contexts, and if not, how to setup services to run responsively, appropriately, cost-effectively and sustainably (Coetzee et al 2019 ).…”

“…Intervention should be offered as early as possible and based on individual and family needs(Kiernan et al 2019). Evidence of good practice in HICs with this subset of the ID population can be used and informed by research on how to adapt the model to different settings without losing the essence of what works(Coetzee et al 2019). Ministry of Health 2017) Nuri et al (2020).…”

Developing a psychoeducational programme for caregivers of people with intellectual disability

“…Inadequate medical and care support often leads to referrals to healthcare professionals and social workers. However, there remains a shortage of appropriately qualified healthcare professionals in the field of ID (Coetzee et al 2019 ).…”

“…They argue that the provision of community care is insufficient, as demonstrated by the high rates of hospital admissions and the reliance on police and prison services. Coetzee et al ( 2019 ) support this perspective, stating that limited training opportunities are available for caregivers of individuals with ID in South Africa. Moreover, the literature reveals a lack of integration of ID-related programmes into academic and in-service training for practitioners in South Africa (Kleintjes et al 2020 ; Smith Da Walt et al 2018 ).…”