Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities

Athanasia Kouroupa; Leila Hamza; Aisha Rafiq; Angela Hassiotis; Penny Rapaport; Andrew Jahoda; Laurence Taggart; Liz Steed; Sally-Ann Cooper; Craig Melville; Louise Marston; Rachel Royston; Afia Ali

doi:10.3310/nihropenres.13437.1

Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities

NIHR Open Res. 2023 Aug 14:3:40. doi: 10.3310/nihropenres.13437.1. eCollection 2023.

Authors

Affiliations

¹ Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK.
² Assessment and Intervention Team, Barnet Enfield and Haringey Mental Health NHS Trust, London, England, UK.
³ School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
⁴ Ulster University, Coleraine, Northern Ireland, UK.
⁵ Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, England, UK.
⁶ Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, England, UK.
⁷ Unit for Social and Community Psychiatry, Queen Mary University of London, London, England, UK.

Abstract

Background: Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects, but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change.

Methods: We conducted 42 semi-structured interviews with adults with intellectual disabilities and aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach.

Results: Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors of psychosocial interventions to address aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions addressing aggressive challenging behaviour in adults with intellectual disabilities.

Conclusions: Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.

Keywords: Intellectual disabilities; aggression; challenging behaviour; community care; interventions; qualitative methods.

Plain language summary

The current study looked at what factors that lead to good outcomes from therapies that aim to reduce aggressive challenging behaviour in adults with learning disabilities. We also looked at the factors that may prevent positive change ( i.e., reduction in aggressive challenging behaviour). We interviewed 42 people including 14 adults with learning disabilities, 13 carers (6 family; 7 paid) and 13 professionals across the UK. All stakeholders agreed that supportive relationships between the person with a learning disability and their therapist, staff consistent, personalised therapy and involvement of the person with a learning disability and their carer(s) in care planning facilitate the reduction of aggressive challenging behaviour. On the other hand, differences in expectations between professionals and carers, personal reasons ( e.g. being the right timing for a person), and the way community learning disability services currently run may stop people from having the opportunity to take part in therapy are barriers to positive change such as reduction of aggressive challenging behaviour. The study findings highlight the valued components that maximise the positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.

Grants and funding

This project is funded by the National Institute for Health Research (NIHR) under its [‘Programme Grants for Applied Research’ (Grant Reference Number NIHR200120)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.