Influence of the organizational environment on challenging behaviour in people with intellectual disabilities: Professionals’ views

Abstract

People with intellectual disabilities are at increased risk of developing challenging behaviour, defined by Emerson (2001, p. 3) as: culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or results in the person being denied access to ordinary community facilities.Challenging behaviour includes physical aggression, problematic sexual behaviour, self-injury, destructiveness and stereotypical behaviour. These behaviours threaten the quality of life of people with intellectual disabilities and those in their support systems and often lead to exclusion from society. People with intellectual disabilities and challenging behaviour are also at greater risk of ineffective treatment, abuse and high rates of restraint and medication (Allen, Lowe, Moore,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: We examined the influence of the organizational environment on challenging behaviour in people with intellectual disabilities to increase understanding of the quality of support services for people with intellectual disabilities.Method: Twenty-one professionals and managers from four specialized Dutch disability service organizations were interviewed. Data were analysed with a grounded theory approach, using Bronfenbrenner's ecological theory as a sensitizing frame. Results:The organizational environment (i.e., vision, values, sufficient resources) is related via the support service (i.e., providing stability, constant awareness) to residents' challenging behaviour and is also linked directly to challenging behaviour (e.g., living environment, values). Organizations are restricted by national regulations, negative media attention and changing societal values, which negatively influence quality of support. Conclusions:The creation of a supportive organizational environment for staff, who in turn can provide quality support services to residents with demanding care needs, was found to prevent challenging behaviour in people with intellectual disabilities. K E Y W O R D Schallenging behaviour, ecological theory, grounded theory, intellectual disability, organizational environment, service organization | 611

“Look, all our hard work is paying off”: A qualitative evaluation of a system‐wide, workforce development model to promote positive behavioural support

“…(p38). Since that time, other authors have highlighted the influence on CB and PBS of the wider organizational and social systems within which staff and those being supported operate (Olivier-Pijpers, Cramm, & Nieboer, 2019). A few researchers have taken account of some of these wider factors in their PBS interventions (e.g.…”

Cross-sectional investigation of relationships between the organisational environment and challenging behaviours in support services for residents with intellectual disabilities

“…At the microsystem level, for example, the stability of the relationship between a resident and a staff member results in trust, and subsequently in less stress for the resident, positively influencing challenging behaviour. The anxiety of staff members is linked negatively to residents' challenging behaviour because of the tension it creates in the staff member's actions toward residents ( Willems et al., 2012 ; Olivier-Pijpers et al., 2018 , 2019 ). The involvement of family members in a resident's daily life and support services may also influence challenging behaviour, as family members are able to advocate for support of the resident's specific needs ( Olivier-Pijpers et al., 2019 ).…”

“…The anxiety of staff members is linked negatively to residents' challenging behaviour because of the tension it creates in the staff member's actions toward residents ( Willems et al., 2012 ; Olivier-Pijpers et al., 2018 , 2019 ). The involvement of family members in a resident's daily life and support services may also influence challenging behaviour, as family members are able to advocate for support of the resident's specific needs ( Olivier-Pijpers et al., 2019 ). At the mesosystem level, for example, the ability of the staff to manage daily agitations of a given resident and between other residents in the group may influence challenging behaviour, as agitation in the group home can trigger such behaviour.…”

“…Furthermore, staff members who feel that they are permitted to make mistakes in providing support to residents are better able to learn from these mistakes and adjust their actions in subsequent incidents involving challenging behaviour ( Knotter et al., 2013 ; Olivier-Pijpers et al., 2019 ). Exosystem aspects that seem to be associated with challenging behaviour include the management's leadership style, coaching by psychologists, a supportive team environment for care professionals, a positive organisational culture and the translation of personnel policies into daily practices; all of these aspects provide the staff guidance on proper support of residents, resulting in the occurrence of fewer incidents involving challenging behaviour ( Dilworth et al., 2011 ; Allen et al., 2013 ; Deveau and McGill, 2016 , 2019 ; Bigby and Beadle-Brown, 2018 ; McGill et al., 2018 ; Olivier-Pijpers et al., 2018 ; Olivier-Pijpers et al., 2019 ). Macrosystem aspects linked to challenging behaviour include negative media attention to bad practices, which results in a focus on control instead of trust of staff members to support residents, in turn negatively influencing challenging behaviour ( Olivier-Pijpers et al., 2019 ).…”

Senior manager decision‐making and interactions with frontline staff in intellectual disability organisations: A Delphi study

“…More recently, a series of research studies employing qualitative interview methods with frontline managers has been published. For example, examining frontline managers' perceptions of their role in providing a supportive 'environment' for staff practice with service users to enable 'engagement in meaningful activities' (Berlin Hallrup, Kumlien, & Carlson, 2018;Bradshaw, Beadle-Brown, Richardson, Whelton, & Leigh, 2018) and to manage challenging behaviours (Deveau & McGill, 2016a;Olivier-Pijpers, Cramm, & Nieboer, 2018).…”