Developing a Logic Model for the Triple‐C Intervention: A Practice‐Derived Intervention to Support People with Intellectual Disability and Challenging Behavior

Abstract

Partly due to a lack of evidence-based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be "good practice"-to develop evidence based on practical knowledge. This study describes the Dutch practice-based intervention Triple-C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice-based nature of Triple-C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple-C professionals and to develop an understanding of the mechanisms of change for Triple-C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple-C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple-C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence-based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice-based intervention like Triple-C is an important first step toward producing an evidence base for interventions developed from clinical practice.

A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours

“…This study has value for researchers and practitioners, as the ecological perspective provides insight into recent studies on implementing and maintaining active support in various services, which have concluded that hands-on training and managerial leadership seem to be crucial organizational aspects (Beadle-Brown, Bigby, & Bould, 2015;Bigby & Beadle-Brown, 2018;Bigby, Bould, Iacono, Kavanagh, & Beadle-Brown, 2019;Deveau & McGill, 2016a, 2016b. As Bould, Beadle-Brown, Bigby, and Iacono (2016) (Deveau and McGill, 2019;Deveau, Gore, & McGill, 2020;Olivier-Pijpers, et al, 2018;Schippers, 2019;Tournier et al, 2020;Walker, 2012). During organizational changes, continuous discussions on aligning staff attitudes with the organizational vision, staff training in positive attitudes and reduced restraint use, and sufficient information about residents' needs to enhance resident-staff bonding are also necessary (Olivier-Pijpers, Cramm, & Nieboer, 2019;Philips & Rose, 2010;Walker, 2012).…”

“…This created a “messy” situation that negatively impacted management of challenging behaviour. Research indicates support from managers and psychologists through practice leadership, with frequent formal and informal staff contact, is vital for improving management of challenging behaviours and building a coherent team culture, leading to staff receiving and sharing guidance on how to provide support in line with residents’ behaviours (Deveau & McGill, 2019; Deveau, Gore, & McGill, 2020; Olivier‐Pijpers, et al, 2018; Olivier‐Pijpers et al, 2019; Tournier, Hendriks, Jahoda, Hastings, & Embregts, 2020).…”

“…Second, during years of employee and resident relocations, or transitioning to self‐organising staff teams, organization members remained at a distance from each other at the mesosystem level, affecting resident–staff bonding at the onto‐ and microsystem levels, which in turn limited management of challenging behaviour. To bond with residents and act positively towards them during incidents with challenging behaviours, staff members need consistent, positive working relationships with managers and psychologists, based on clear organizational values and team culture (Olivier‐Pijpers, Cramm, & Nieboer, 2019; Ravoux, Baker, & Brown, 2012; Tournier et al, 2020).…”

“…budget cuts, self-organising staff teams) led to changes within staff teams and how they functioned, as indicated in the focus groups and meeting records. (Deveau & McGill, 2019;Deveau, Gore, & McGill, 2020;Olivier-Pijpers, et al, 2018;Olivier-Pijpers et al, 2019;Tournier, Hendriks, Jahoda, Hastings, & Embregts, 2020). changes (Deveau & Leitch, 2020;Ravoux, et al, 2012;Tournier et al, 2020).…”

“…(Deveau & McGill, 2019;Deveau, Gore, & McGill, 2020;Olivier-Pijpers, et al, 2018;Olivier-Pijpers et al, 2019;Tournier, Hendriks, Jahoda, Hastings, & Embregts, 2020). changes (Deveau & Leitch, 2020;Ravoux, et al, 2012;Tournier et al, 2020). Furthermore, a stable and well-informed multidisciplinary team is the base for continual staff education and required for successful long-term changes made to prevent challenging behaviours (Walker, 2012).…”