Caregivers of individuals with intellectual and developmental disabilities (IDD) often end up having their medical and psychological well-being compromised due to the stressful nature of caregiving, especially when those in their care engage in aggressive behavior. In this study, we provided caregivers with mindfulness-based training to enable them to better manage their psychological well-being and, through this, to also enhance specific indices of quality of life of the individuals in their care. Thus, the aim of the present study was to evaluate in a randomized controlled trial (RCT) the comparative effectiveness of Mindfulness-Based Positive Behavior Support (MBPBS) and Training-as-Usual (TAU) for caregivers in a congregate care facility for individuals with severe and profound IDD. The comparative effects of the two training conditions were assessed in terms of caregiver variables care recipient variable (number of aggressive events), and agency variables Results showed that MBPBS was significantly more effective than TAU in enabling the caregivers to manage their perceived psychological stress, and to reduce the use of physical restraints and stat medications for aggressive behavior of the individuals in their care. In addition, there were significant reductions in aggressive events by the individuals in their care, 1:1 staffing of individuals with aggressive behavior, and staff turnover. Furthermore, the MBPBS training was significantly more cost-effective than the TAU training. If replicated in future RCT studies, MBPBS may provide an effective means of enhancing socially acceptable bidirectional engagement of caregivers and care recipients within a person-centered context.

Caregivers of individuals with intellectual and developmental disabilities are often stressed due to the demands of the job, including the nature and severity of challenging behaviors of the clients, work conditions, degree of management support for the staff, and the demands of implementing some interventions under adverse conditions. Mindfulness-Based Positive Behavior Support (MBPBS) and PBS alone have been shown to be effective in assisting caregivers to better manage the challenging behaviors of clients with intellectual and developmental disabilities. The aim of the present study was to undertake a head-to-head assessment of the effectiveness of MBPBS and PBS alone in a 40-week randomized controlled trial. Of the 123 caregivers who met inclusion criteria, 60 were randomly assigned to MBPBS and 63 to PBS alone, with 59 completing the trial in the MBPBS condition and 57 in the PBS alone condition. Results showed both interventions to be effective, but the caregiver, client, and agency outcomes for MBPBS were uniformly superior to those of PBS alone condition. In addition, the MBPBS training was substantially more cost-effective than the PBS alone training. The present results add to the evidence base for the effectiveness of MBPBS and, if independently replicated, could provide an integrative health care approach in the field of intellectual and developmental disabilities.

Employees in the disability sector are subject to a range of stressors in the work place and it is important that employers provide stress-management interventions to optimize coping and psychological wellbeing of these staff. The purpose of this preliminary study was to evaluate the impact of a group-based training program, known as 'Occupational Mindfulness', on employee coping and wellbeing within a disability service in Australia. The study involved a longitudinal observational design. Thirty-four participants (22 managers and 12 disability support workers, aged 23 to 60 years) completed a range of mindfulness and psychological wellbeing measures prior to commencement of the Occupational Mindfulness (OM) training program and immediately following completion of the program. The program was positively evaluated by participants and found to be associated with significant increases in positive affect and the mindfulness facet of observing. In contrast, extrinsic job satisfaction decreased significantly from baseline to post-training, while negative affect, perceived stress, anxiety and negative emotional symptoms increased significantly. Depressive state, intrinsic job satisfaction, general job satisfaction, satisfaction with life, burnout, compassion satisfaction, compassion fatigue, compassion for others, self compassion and the four mindfulness facets of describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience did not change significantly from baseline to post-training. Participants reported enhanced awareness of signs and sources of stress, and positive changes in self-care attitudes and behaviours and interactions with clients and colleagues. Reasons for the seemingly paradoxical findings of highly favourable participant evaluation of the OM training program alongside increases in perceived stress, anxiety, negative emotional symptoms and negative affect and decreases in job satisfaction immediately following the program are discussed. O verall, the OM program yielded a range of benefits to participants and holds significant potential to be transferred to other work settings in the future.

Background People with an intellectual disability whose behaviours are perceived to be of serious harm to themselves or others are at risk of being subjected to restrictive interventions. Prevalence rates are difficult to determine, as most research is unable to draw on the results of population-level data.Method The current study reports on the use of chemical and mechanical restraint and seclusion in the State of Victoria, Australia, over a 12-month period. Results The majority of people included were subjected to chemical restraint. The use of restraint was found to be routine rather than a strategy of last resort. Consistent with findings in the UK and USA, those subjected to restrictive interventions were more likely to be young males with multiple disabilities, including autism. Conclusions Systemic policy and procedural developments are needed to address current use of restrictive interventions, together with a longitudinal study to evaluate the effectiveness, of alternative, non-restrictive strategies.

Persons with acquired brain injury require continuing care and support in various aspects of their lives. Although the care and support are predominantly provided by family members, little is known about the respite that these carers require to continue the care on a daily basis. This study aims to address the lack of data on respite care and people with acquired brain injury from the perspective of carers. Survey methodology was used to gather information from carers who were members of a peak brain injury association in New South Wales, Australia. The responses of 85 carers were analysed using logistic regression and frequency counts. The characteristics of carers were consistent with the research literature on respite and acquired brain injury, with carers being mainly female and there being a reliance on an informal network to assist in the care. Carers also reported that caring prevented them from obtaining gainful employment. Several factors were significantly associated with the use of respite, these were carers' single marital status; and the person with acquired brain injury's severity of disability, high level of dependency and number of days spent in coma. Carers also reported other factors that might influence them to use respite and they identified their expectations of respite. This study highlights carers' perspective on respite that is an under-researched area in acquired brain injury and reiterates ongoing need for respite.

SStructured 'communicative temptation' procedures administered by a clinician were compared to unstructured parent-child interactions in sampling intentional communicative acts in 11 subjects with intellectual disability. The subjects were assessed twice over a 5-7-month period. The results indicated that the structured condition was more effective in sampling Requests and Comments, with more Requests than Comments produced. The unstructured condition was more effective in sampling responses, but only during the second assessment. Although there was no difference in the total number of intentional communicative acts produced across assessment times, there was an increase in the use of linguistic forms during the second assessment: that is, the subjects used more speech and signs and fewer gestures and general vocalisations during the second assessment than the first. The findings suggest the usefulness of combining structured and unstructured conditions in providing information on the variety of children's communicative acts and the linguistic level at which these are expressed.L'on a compare' des proctde's structure's 'd'incitation a la communication' administre's par un clinicien a des interactions non structure'es entre parents et enfants lors d'une collecte d'actes communicatifs intentionnels auprb de 11 subjets souffrant de de'ficits intellectuels. Les sujets ont recu deux e'valuations successives au cours d'une pe'riode de 5 d 7 mois. Les re'sultats indiquent que l'e'tat structure' Ctait plus efficace pour ricolter des demandes et des commentaires, et que davantage de demandes avaient e'te' produites que de commentaires. L'e'tat non structuri n'e'tait plus efficace pour la re'colte de re'ponses que lors de la deui2me Cvaluation. I1 n'y a pas eu de diffe'rence dans le nombre total d'actes communicatifs intentionnels d'une Cvaluation d l'autre; cependant on a assist6 d un acroissement de l'usage de formes linguistiques lors de la seconde, en ce que les sujets ont utilisk a ce moment-la davantage de langage et de signes, et moins de gestes et de vocalisations ge'ne'rales. Ces re'sultats donnent une indication de l'utilite' qu'il y a a combiner la structure et l'absence de structure pour obtenir des renseignements sur la varie'te' des actes communicatifs des enfants et sur le niveau linguistique de leur expression.In einer Stichprobe intendierter Kommunikationshandlungen von 11 geistig behinderten Kindern wurden strukturierte Verfahren zum 'kommunikativen Entlocken' von klinishem Personal durchgefiihri und mit den unstrukturierten Interacktionen zwischen Eltern und Kindern verglichen. Die Kinder wurden zweimal wahrend einer 5-7-monatigen Periode bewertet. Die Ergebnisse zeigten, dap die strukturierte Bedingung fiir die Elizitation von Bitten und Kommentaren effektiver war; es wurden mehr Bitten a[s Kommentare ausgesprochen. Die unstrukturierte Bedingung rief insgesamt mehr Enviderungen hevor, jedoch nur wahrend der zweiten Bewertungsphase. Obwohl SAMPLING COMMUNICATIVE BEHAVIOURS 107 insgesamt die Anzah...

Accessible summary  The staff who are paid to support people with an intellectual disability in Australia are called disability support workers.  As part of their job, disability support workers give out medications when the doctor says to. Some of these medications are used to help people with disability to calm down when they are angry. Often, these medications are not for treating any illness. These medications can sometimes make people feel very ill. In the past, the staff who used to give out these medications were nurses, but nurses do not do this job anymore.  This study asked disability support workers what they think they need to know about the medications they give out.  Most of the disability support workers said they needed to know more about these medications if they were to keep people safe, and it would also help them to talk to the doctors about what these medications are for when they go to appointments with people with a disability. SummaryDisability support workers are the predominant workforce employed to support people with an intellectual disability in Australia. Many support workers are required to assist people they support to take psychotropic medications in the form of chemical restraint. Support workers in Australia receive limited education and training in this area and as a result may miss important information about effects of medication on the people they support. In this study, we asked support workers about their education and training needs around chemical restraint. Our results showed that while the majority of support workers feel they are provided with good support from their co‐workers and supervisors, they feel they need more specific information regarding the side effects of psychotropic medication and its alternatives. Finding ways to support the support workers is crucial if we are to minimise the use of chemical restraint and provide best support possible to people with disabilities.

Trauma admission rate is significantly associated with temperature. Taking weather forecasts into account may be important for planning of care provision, staffing, and resource allocation in trauma units and emergency departments.