Effects of a Web-based Training Programme Focusing on Challenging Behaviour
Condition: Challenging Behaviour
Study type: Interventional

Summary: 
      The interaction between people with intellectual disabilities and professional carers is
      often influenced by communicative difficulties contributing challenging behaviours.

      Aim: The aim of this study is to evaluate a web-based training program aimed at improving
      carers' abilities to interact with people with learning disabilities who exhibit challenging
      behaviours and to explore carers' experiences of participating in such a program.

      Method: This study has a cross-sectional design. Sample: The study will be conducted in
      twenty special community-based accommodations, group-homes, in Sweden that each houses 4-8
      residents. The staff in the group-homes is working independently with the manager located at
      distance.The staff (N=221) in this study works with people with intellectual disabilities who
      has different functional levels, from moderate to profound intellectual disabilities. They
      have different educational backgrounds: from basic nursing education at the college level to
      university degree.

      Intervention: The intervention consists of a web-based training program, available for all
      staff working in special accommodations for people with intellectual disabilities. The
      web-based training program focuses on strengthening the carers' communication skills.

      Procedure: The social Services authorities and the managers from each home agreed to the
      project. The carers have given their informed consent to attend the study. The participants
      will by their own during working hour go through the web-based program. The time to complete
      the web-based training program is estimated at approximately ten hours.

      Data-analysis: Descriptive statistics will be used for demographic data. Proportions will be
      compared to the chi-square test. The mean values between the groups will be compared by
      t-test or Mann-Whitney's U-test, as appropriate. Changes in the mean between and in the
      groups will be compared with paired t-test. Double-sided significance test will be used
      throughout. Data will be presented at a group level.
    

Detailed description: 
      A literature review shows that the interaction between adult persons with intellectual
      disabilities and professional carers is a complex combination of verbal and non-verbal
      expressions. Attempts to communicate often lead to misunderstandings from both parties, as
      well as challenging behaviors such as aggression and violence. The literature shows that
      challenging behavior often leads to physical constraints. Literature studies also emphasize
      the importance of education, knowledge and support for staff. Therefore, we want to
      investigate whether it is possible to reduce challenging behavior through education on causes
      of challenging behavior and successful interaction for carers in special housing.

      Aim: To study the effects of a web-based training program to increase staff's ability to
      better communicate and interact with persons with intellectual disabilities and challenging
      behaviors.

      Method: The study has a cross-sectional design.

      Intervention: The intervention was inspired by an evidence-based conceptual model for staff
      training in challenging behaviour. The intervention consists of a web-based training program,
      available for all carers working in special accommodations for people with intellectual
      disabilities.

      The web-based training program focuses on strengthening the carers' communication skills.
      Video lectures on the definitions, characteristics and causes of challenging behaviour will
      be given. Video lectures will also be given on the importance of the carers' views on their
      values, emotions, abilities and attitude towards people with intellectual disabilities, and
      on the impact that workplace culture and environmental factors have on the quality of
      interactions. The web-based training program also includes written cases that gives the
      participants an opportunity to reflect upon approaches supporting a successful interaction.
      It also covers factors to consider when mental illness and challenging behaviour occur. The
      web-based training program includes the opportunity to follow the carers' activity regarding
      time and frequency of studying. The time to complete the web-based training program is
      estimated at approximately ten hours.

      Context: The study will be conducted in twenty special community-based accommodations,
      group-homes, in Sweden that each houses 4-8 residents. The residents has their own private
      rooms, but shares a communal space with a living room and a kitchen with a dining table. The
      staff in the group-homes is working independently with the manager located at distance.

      Participants:The carers in this study works with people with intellectual disabilities who
      has different functional levels, from moderate to profound intellectual disabilities. They
      have different educational backgrounds: from basic nursing education at the college level to
      university degree.

      Procedure: Prior to handing out the questionnaires, staff will receive information regarding
      the study and that participation is voluntary. The questionnaires will be distributed in hand
      and returned in pre-paid envelopes. Two reminders will be sent out to the participants. The
      project is approved by The Regional Ethical Review Board in Gothenburg, approval number;
      355-17. The social Services authorities and the managers from each home agreed to the
      project. The carers have given their informed consent to attend the study. A project group is
      established with representatives from the Social Services authorities and the researchers.
      The implementation of the intervention will be discussed in the project group every second
      month throughout the study period.

      Instruments: This study is planned into three phases. Baseline measures using the Checklist
      of Challenging Behaviour (CCB). This instrument is translated from English to Swedish and
      re-translated by experts in the field. It describes 32 observed behaviours relating to CB,
      for example, verbal, and physical aggression. Scores for items on the instrument range from 1
      (the behaviour has not occurred) to 5 (the behaviour occurs daily or more often). The CCB has
      an acceptable level of content validity and reliability. In the second phase, the
      intervention will be implemented. The third phase will take place after the intervention with
      a follow-up period directly after the intervention and after approximately three months in
      order to analyse effects of the intervention.

      At baseline and at follow-up, the instruments will be handed out to the carers to answer. The
      Job Demand-Control and Social Support (JDC-S) instrument. The JDC-S is a commonly used for
      investigating psychosocial working environments. This instrument has three major dimensions.
      First, it measures job demands, which includes psychological stressors such as time pressure,
      and item scores range from 1 to 4, with higher values indicating higher demands. Second, it
      measures job control on a scale of 1 to 4, with higher values indicating more perceived
      control over the job situation. Third, it measures social support, again on a scale of 1 to
      4, with higher values indicating higher perceived support from co-workers and managers. In
      the JDC-S, high demands and low control indicate a high job strain. According to Cronbach's
      alpha a level of 0.73 for the dimension job demands, 0.52 for job control, and 0.81 for
      social support was reported.

      The Controllability Beliefs Scale (CBS) is a 15-item instrument measuring the attribution of
      control in situations with CB. This instrument was used to measure carers' values and
      approaches to people with LD. Items were scored on a 5-point scale with anchored ratings from
      strongly agree (1) to strongly disagree (5). A two-factor structure, suggesting positive and
      negative attributions of control, and good internal reliability (Cronbach's alpha for total
      score = 0.89, 0.92 for the negative subscale and 0.73 for the positive subscale).

      The Ways of Coping Questionnaire (WOCQ) measured the use of coping strategies employed by the
      carers. The instrument was used in this study to measure the intervention's effects in
      reducing feelings such as shame and guilt in the carers and in strengthening professional
      care. In this 40-item version of the WOCQ, translated into Swedish, participants were asked
      to reflect upon how they would manage specific challenging situations. The items were divided
      into emotion-focused coping skills and problem-focused coping skills. Each subscale was
      answered on a 4-point Likert scale ranging from (0) does not apply to (3) used a great deal.
      The instrument was used and tested in a Swedish context with a Cronbach's alpha ranging from
      0.63 to 0.89 and has shown acceptable values (> 0.7) on all subscales except for the
      subscales confrontational coping (0.59) and self-controlling (0.47).

      Statistical analysis: Data processing and statistical calculations will be performed in the
      Statistical Package for Social Sciences (SPSS 23) statistics. Proportions will be compared to
      the chi-square test. The mean values between the groups will be compared by t-test or
      Mann-Whitney's U-test, as appropriate. Changes in the mean between and in the groups will be
      compared with paired t-test. Double-sided significance test will be used throughout. Data
      will be presented at a group level.
    

Intervention name(s): Web-based training for staff
Intervention type(s): Behavioral
Intervention description(s): This web-based training program is focusing on strengthening the carers' communication skills. Video lectures on the definitions, characteristics and causes of challenging behavior will be given. Video lectures will also be given on the importance of the carers' views on their values, emotions, abilities and attitude towards people with intellectual disabilities and on the impact that workplace culture and environmental factors have on the quality of interactions. The program also includes written cases that gives the participants opportunities to reflect upon approaches supporting a successful interaction. It also covers factors to consider when mental illness and challenging behavior occur. The time to complete the web-based training program is estimated at approximately ten hours.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Intervention arm: web-based training for staff working with people with intellectuall disabilities and challenging behaviour Other: control arm
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Interaction; challenging behaviour; training