Abstract
Objectives: Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations.
Methods: This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review.
Results: Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation.
Conclusion: The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed.
Prospero registration number: CRD42020203055.
Methods: This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review.
Results: Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation.
Conclusion: The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed.
Prospero registration number: CRD42020203055.
| Original language | English |
|---|---|
| Article number | e0285590 |
| Number of pages | 24 |
| Journal | PLOS ONE |
| Volume | 18 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 18 May 2023 |
| Externally published | Yes |
Bibliographical note
Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to extend a special thanks to all the contributors and members of our expert panel, LRG and study team. We would also like to thank the members of our patient advisory groups who contributed to this review. We thank Fernanda Fenn Torrente (trained medical student) for her contributions to appraising the rigour of each record for the quality assessment. Funding Information: Funding:Thispaperpresentsindependent researchcommissionedandfundedbythe NationalInstituteforHealthResearch(NIHR) ProgrammeGrantsforAppliedResearch(grant number;NIHR200120).Thisawardwasreceived byAH,AJ,AA,UC,SC,LS,AS,LT&PR.Theviews expressedarethoseoftheauthorsandnot necessarilythoseoftheNIHRortheDepartmentof HealthandSocialCare.Thefundershadnorolein studydesign,datacollectionandanalysis,decision topublish,orpreparationofthemanuscript. Publisher Copyright: © 2023 Royston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Keywords
- Adolescent
- Adult
- Caregivers
- Humans
- Intellectual Disability
- Mental Health
- Motivation
- Population Groups
Access to Document
- Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations
Copyright 2023 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.