The Talbot Group, in association with the British Institute of Learning Disability (BILD), organised a symposium and conference on supporting people with intellectual disabilities (ID) and challenging behaviour, in the City North Hotel, Dublin, on 27-28 November 2013. Dr Tony Woods, CEO of the Talbot Group, and Ann Chivers, CEO of BILD, welcomed participants to the two-day event. Dr Woods said that the Talbot Group were delighted to host this, their inaugural conference on current evidence-based best practice approaches to supporting adults with intellectual disabilities. Topics covered during the two days included: trauma-informed care, positive behaviour support (PBS) and working with bereavement.
Dr Edwin Jones, who is based in Cardiff, gave an excellent overview of the model of PBS used by his team to support people with ID and challenging behaviour. He explained that PBS arose out of concerns with traditional models of service delivery. PBS, on the other hand, has a clear value based and utilises behavioural approaches to enhance service users’ quality of life. It does this by treating people with respect and providing them with opportunities to develop and maintain relationships, make choices, participate in the community, and engage in meaningful activities. Edwin emphasised the importance of practice leadership, effective staff training and regular monitoring and evaluation of PBS plans.
Dr Brodie Paterson, University of Stirling, Scotland, gave an insightful presentation on trauma-informed care. He noted that many service users have experienced trauma in the form of physical and emotional abuse, severe neglect, repeated abandonment, sudden separation and loss, and exposure to violence. Staff who support people with challenging behaviour can also experience trauma in the form of disrespect, anger and physical attacks by clients. These events produce strong emotions that need to be understood and carefully managed or they will have an adverse effect on people lives and the quality of service delivered. Brodie emphasised the importance of values such as open communication, non-violence, democracy, social responsibility, emotional intelligence and social learning for services that support people with ID and challenging behaviour. He also advocated the use of creative activities, safe touch, specialist therapies, mindfulness and the promotion of secure attachments as a way of promoting recovery from trauma.
Dr Philip Dodd from St Michael’s House Services spoke about complicated grief among people with ID. Philip distinguished between normal grief that occurs following the death of a close family member and complicated grief. In the latter, the person displays a persistent yearning for or preoccupation with the deceased and shows intense sorrow and emotional pain. This can be characterised by a sense of numbness, emptiness, anger, bitterness, purposelessness and disbelief, for more than six months or a year after the death. Findings from research show that people with ID do grieve, have some understanding of death, display a variety and range of reactions, and can experience significant ‘separation anxiety’. Promising treatments for complicated grief include pre-loss preparation for the death and aftercare for the survivors, talk therapies such as CBT and brief integrated psychodynamic psychotherapy, and medication.
Prof Richard Hastings from Bangor University, Wales, gave a very worthwhile presentation and workshop on mindfulness and the evidence for this approach for people with challenging behaviour and their carers. Mindfulness is an approach that is best experienced, but it can be defined as ‘being fully present in the here and now’ or ‘the awareness and non-judgmental acceptance by a clear, calm mind of one’s moment-to-moment experience without either pursuing the experience or pushing it away’. The ‘soles of the feet’ approach to mindfulness has been effectively adapted for people with a moderate ID and higher cognitive ability, and ASD. Emerging findings show that mindfulness exercises are effective in reducing aggressive behaviour in people with ID and autism, reducing inappropriate sexual arousal, and managing anxiety in people with ASD. Courses and training in mindfulness for parents and staff have been linked with reductions in self-reported stress, anxiety, depression and negative affect, improvements in self-compassion, reduced challenging behaviours and more observed signs of happiness and social skills in the children and adults of carers who were trained.
Dr Brian McClean, who works with Acquired Brain Injury Ireland, gave two excellent presentations on the use of PBS for individuals with significant challenging behaviours, mental health problems and ID. He emphasised the importance of loving relationships, emotional warmth, privacy, personal control, a real sense of belonging, self-worth and home, as well as employment, community inclusion and participation. In his workshop, Brian described a behaviour support plan that he developed for a man who exhibited extreme levels of disturbed behaviour while living in a number of large residential institutions. The PBS plan had five themes: a low arousal environment, rapport building, visual scheduling, effective communication supports and differential reinforcement. It resulted in the individual acquiring a home of his own and engaging in meaningful employment that reflected his interests and talents.
In conclusion, the Talbot Group and BILD are to be congratulated for organising an excellent, well-attended and timely conference on ‘Supporting people through challenges’. This conference certainly provided staff and carers with up-to-date knowledge on evidence-based best practice approaches for supporting people with behaviours that challenge.