Prevalence rates for seriously challenging behaviours were comparable to those reported in the earlier studies, thus confirming previous findings. The prevalence of less serious challenging behaviour also has major clinical significance and emphasizes the need for enhanced understanding and skills among personnel within primary- and secondary-tier health, education and social care services, and for strengthening the capacity of community teams to provide behavioural expertise.

Background  Positive behavioural support is increasingly viewed as the preferred service approach for people who challenge, but skills are insufficiently widespread. The need for effective staff training has been highlighted as a key factor in high quality service provision, with investigators recommending a multidimensional approach to increase effectiveness and produce changes in work performance. Method  Attitudes and knowledge of registered (qualified nurses) and non‐registered (unqualified nursing assistants) staff in specialist health care services were assessed via self‐completion questionnaires before and after the delivery of a newly accredited taught course in PBS and at a 1‐year follow‐up. Results  Significant increases in knowledge were evident immediately after the training for both groups, with further increases evident over time for the non‐registered staff who completed the qualification. Initial changes in attributions immediately after training reverted to baseline levels over time. Enduring change occurred in perceived confidence, which significantly increased both for registered and non‐registered staff. Conclusions  The training had a positive effect on knowledge and perceived confidence but little enduring effect on attributions or emotional responses. The importance of training conducted in conjunction with allied changes in organizational systems to ensure ongoing management attention is discussed.

Identifying predictors for out of area placement can be used to highlight deficiencies in local services and individuals at increased risk of exclusion from local services.

Patients with cancer soon discover that there is much more to the cost of treatment than hospital and physician bills. Out-of-packet expenses for transportation, food supplements, over-the-counter medications, distractions, telephone bills, insurance premiums--at a time when employment may be out of the question--can be a significant drain on family finances. Women with regional breast cancer reported their estimates of out-of-pocket expenses incurred during 1 month of outpatient chemotherapy. All women in the study were covered by some form of insurance. Mean monthly out-of-pocket costs were $360 (SD = $346), and ranged from $36 to $1224. Additional costs for wigs, special events, gifts, and alternative treatment incurred since diagnosis, ranged from $20 to $3700. These costs excluded expenses for health providers. Very low and very high expenditures may indicate risks concealed from providers that may have subsequent impact on long-term capacity to sustain treatment. Nurses can help families anticipate expenses and prioritize referrals to community agencies.

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Background Intrusive reactive strategies (physical restraint, emergency medication and seclusion) are frequently used procedures in the management of challenging behaviour. The present study identifies predictors for reactive strategy use in an attempt to more clearly delineate at risk service users. Method Eight hundred and thirty-nine agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Full data were available for 901 participants. Univariate and multivariate statistics were employed to identify predictors for reactive strategy use. Results The individuals most at risk of the use of reactive strategies were those who were subject to formal detention under the Mental Health Act (restraint and sedation), had more severe challenging behaviour (seclusion), showed destructive behaviour (restraint and seclusion) were placed out of area (seclusion) and had behavioural plans in place for specific topographies (restraint and sedation). Conclusions Individual differences such as challenging behaviour and service practices, such as detention under the Mental Health Act, predicted the use of restrictive procedures. The identification of those service users most at risk of reactive strategy use may enable the specific targeting of therapeutic interventions that may reduce or eliminate their use.

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BackgroundThere are an estimated 125,000 deaf people in the UK who use British Sign Language (BSL) as their main form of communication, but there are no child mental health screening instruments that are accessible to deaf children whose first or main language is BSL (or to deaf adults reporting on children). This study sought to develop a new BSL translation of a commonly used mental health screening tool (Strengths and Difficulties Questionnaire, SDQ), with versions available for deaf young people (aged 11–16 years), parents and teachers. The psychometric properties of this translation, and its validity for use with the deaf signing UK population, were also investigated.Objectives(1) To translate the SDQ into BSL; and (2) to use this new version with a cohort of deaf children, deaf parents and deaf teachers fluent in BSL across England, and validate it against a ‘gold standard’ clinical interview.MethodsThis study was split into two broad phases: translation and validation. The BSL SDQ was developed using a rigorous translation/back-translation methodology with additional checks, and we have defined high-quality standards for the translation of written/oral to visual languages. We compared all three versions of the SDQ (deaf parent, deaf teacher and deaf young person) with a gold standard clinical interview by child mental health clinicians experienced in working with deaf children. We also carried out a range of reliability and validity checks.ResultsThe SDQ was successfully translated using a careful methodology that took into account the linguistic and cultural aspects of translating a written/verbal language to a visual one. We recruited 144 deaf young people (aged 11–16 years), 191 deaf parents of a child aged either 4–10 or 11–16 years (the child could be hearing or deaf) and 77 deaf teachers and teaching assistants. We sought deaf people whose main or preferred language was BSL. We also recruited hearing participants to aid cross-validation. We found that the test–retest reliability, factor analysis and internal consistency of the three new scales were broadly similar to those of other translated versions of the SDQ. We also found that using the established multi-informant SDQ scoring algorithm there was good sensitivity (76%) and specificity (73%) against the gold standard clinical interview assessment. The SDQ was successfully validated and can now be used in clinical practice and research. Factor analysis suggests that the instrument is good for screening for mental health problems but not for the identification of specific disorders, and so should be used as a screening instrument. It will also enable outcomes to be monitored.ConclusionsA BSL version of the SDQ can now be used for national studies screening for mental health problems in deaf children. This will help us better understand the needs of deaf children and will enable earlier detection of mental health difficulties. It can also be used within clinical settings to monitor outcomes.Future workFuture work may focus on using the SDQ in epidemiological research, and developing new assessment instruments for deaf children to improve assessment methods in the deaf population.FundingThe National Institute for Health Research Health Services and Delivery Research programme.