Can the Behaviour Intervention Plan Quality Evaluation, Version 2, be simplified for use by stakeholders with limited experience of positive behaviour support?

BACKGROUND: Behaviour support plan (BSP) quality auditing tools like the Behaviour Intervention Plan Quality Evaluation, Version 2 (BIPQEII), assess the quality of a BSP from the perspective of technical compliance with behavioural principles. However, these principles may be inaccessible to interested stakeholders with limited experience and knowledge of positive behaviour support (PBS). The aim of this study was to test if a simplified version of the BIPQEII [the Behaviour Support Plan Audit Tool (BSPA-tool)] offers a reliable and valid assessment of a BSP's technical compliance with behavioural principles when used by professional stakeholders with varying levels of PBS experience and knowledge. METHODS: Four scorers rated 50 de-identified BSPs using the BSPA-tool, with one scorer also rating the BSPs using the BIPQEII. Four weeks later, each scorer rated 25 of the 50 BSPs again using the BSPA-tool. Prior to BSP scoring, a group of PBS practitioners provided feedback on the BSPA-tool's content validity. RESULTS: The BSPA-tool was found to have acceptable content and parallel-form validity; however, acceptable internal consistency and inter-rater and intra-rater reliability were dependent on PBS experience/knowledge, that is, scorers with more experience/knowledge achieved more acceptable levels of reliability. CONCLUSIONS: This study confirms that even with simplification, BSP quality auditing tools based on technical compliance with behavioural principles are still only accessible to stakeholders with extensive experience/knowledge of PBS. To engage less-experienced stakeholders in BSP quality auditing processes, new audit tools need to be developed that focus on other aspects of BSP quality (e.g. readability and consultation).

Severity of cognitive disability and mental health court determinations about fitness to stand trial.

BACKGROUND: Little is known about the socio-demographic, clinical and legal determinants of mental health court decisions of unsoundness of mind and unfitness to stand trial for people with cognitive disability. We aimed to estimate the association between severity of cognitive disability and mental health court determinations of unsoundness or unfitness and describe the socio-demographic, clinical and legal factors that predict these determinations. METHODS: Case file data were extracted on 92 individuals who had a criminal case referred to the Queensland Mental Health Court between 1 January 2013 and 31 December 2014 due to cognitive disability. We fit a modified multivariable Poisson regression model to estimate the association between severity of cognitive impairment and mental health court determination, controlling for socio-demographic, clinical and legal factors. RESULTS: Adjusting for covariate effects, severity of cognitive impairment was positively associated with being found unfit to stand trial (adjusted prevalence risk ratio = 1.57; 95% confidence interval: 1.07, 2.33; P = 0.023), and comorbid psychotic disorder predicted an increased risk of being found unsound of mind at the time of offence (adjusted prevalence risk ratio = 3.63; 95% confidence interval: 1.38, 9.54; P = 0.009) by the Queensland Mental Health Court. CONCLUSIONS: Severity of cognitive disability is associated with determinations of unfitness but does not predict determinations of unsoundness in the Queensland Mental Health Court. Psychiatric assessments of cognitive impairment play a pivotal role in mental health court determinations for people with cognitive disability.

What qualities are valued in residential direct care workers from the perspective of people with an intellectual disability and managers of accommodation services?

BACKGROUND: To date, the descriptions of a 'good' direct care worker used to recruit workers for disability services have largely been drawn up by managerial professionals in charge of hiring supports for people with disabilities. However, previous research highlights that these professionals conceptualise a 'good' direct care worker differently from service users with an intellectual disability (ID), with professionals placing an emphasis on describing workers with a range of practical skills and knowledge and service users placing an emphasis on describing workers with interpersonal skills. The aim of this research was to replicate this finding using a methodological approach that rectifies some of the weaknesses of previous research in this field. METHOD: Semi-structured interviews were conducted to explore the qualities that are valued in residential direct care workers (RDCWs) from the perspective of seven residents with ID and seven managers of accommodation services located in metropolitan Melbourne, Australia. RESULTS: Thematic and chi-squared analysis confirmed the findings of previous research with residents with an ID placing more of an emphasis on the interpersonal behaviours of RDCWs in their descriptions compared to the managers. CONCLUSIONS: The interpersonal skills of a potential worker along with their practical skills and knowledge must be considered when recruiting RDCWs. It is also implied that given the different conceptualisation of a 'good' direct care worker across service users and professionals, increased service user participation in the organisation of appropriate supports is warranted.

Review: a systematic review of quality of life measures for people with intellectual disabilities and challenging behaviours.

BACKGROUND: The quality of life (QOL) construct is proposed as a method to assess service outcomes for people utilising disability services. With this in mind, the aim of this study was to conduct a systematic review of available QOL measures for people with intellectual disability (ID) to pinpoint psychometrically sound measures that can be routinely used for service evaluation. METHOD: A systematic search of the disability literature published between 1980 and 2008 was conducted in order to identify appropriate QOL tools for use within an Australian context. Twenty-four QOL instruments were identified and each instrument was then evaluated against a set of psychometric and measurement criteria. RESULTS: Six of the instruments examined were deemed to be psychometrically sound on the available information. No instruments were found that specifically assess QOL for people with ID who exhibit challenging behaviour. Most of the instruments assess QOL from a subjective perspective, use a questionnaire format and measure only some (not all) of the eight theoretically accepted domains of QOL. CONCLUSIONS: More instruments that measure QOL need to be developed and rigorously validated. This is especially the case for high-needs disability populations like those individuals that exhibit challenging behaviour or have severe to profound ID, as it is questionable whether existing measures can be used with these populations.

Why do families relinquish care? An investigation of the factors that lead to relinquishment into out-of-home respite care.

BACKGROUND: Families/carers relinquishing the care of family members with a disability into the care of out-of-home respite facilities is an under-researched area in the disability field. With this in mind, the aim of this study was to explore the factors that lead to families relinquishing care, the potential early indicators that families are considering relinquishment; the factors that may prevent relinquishment and the outcomes for families/carers after relinquishment occurs. METHOD: Thirty-two client files (of individuals for whom families have relinquished their care in a defined 12-month period) were reviewed for information around their relinquishment into out-of-home respite care facilities for an extended stay. Staff members involved with these families (a total of 17) were also interviewed to provide more information. RESULTS: A thematic analysis of the results found that the factors that led to relinquishment could be categorised into: (1) characteristics inherent to the individual with intellectual disability; (2) characteristics inherent to the family/carer; and (3) characteristics associated with the support context that the carer/family is currently experiencing. It was also found that families'/carers' experienced positive outcomes after relinquishment had occurred; however, feelings of guilt and mourning were initially felt. CONCLUSIONS: Extra supports (e.g. increased respite care, planning for movement of the family member into out-of-home permanent accommodation and case management) and positive interventions such as parent training were highlighted as potential strategies to achieve more lasting benefits from short-stay out-of-home respite care.