The relationship between challenging behaviour, burnout and cognitive variables in staff working with people who have intellectual disabilities

Abstract

OverviewThis thesis is submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (Clin. Psy. D.) at the University of Birmingham. It is comprised of two volumes and includes a research study and reports of clinical work while on placement during clinical training.Volume I includes a literature review paper and an empirical paper. The literature review examines the literature on stress in staff who work with people with intellectual disabilities and challenging behaviour in order to address the question of whether there is an association between challenging behaviour and stress. The empirical paper follows on from the literature review in that it examines whether the relationship between challenging behaviour and staff burnout is for the instructions for authors). Finally, Volume I also contains a public domain briefing paper detailing the findings of the literature review and research study.Volume II includes five Clinical Practice Reports describing work completed on adult, child, learning disability and forensic placements. The reports describe a case study of a 59 year old woman with a mild learning disability presenting with generalized anxiety formulated from both cognitive and psychodynamic perspectives, a single-case experimental design study of a 10 year old boy with an autistic spectrum disorder and challenging behaviour where a behavioural intervention was implemented, a case study of a 13 year old boy with Obsessive Compulsive Disorder from a cognitive-behavioural perspective, a small scale service related research project exploring the barriers to implementing early warning signs work in a Community Mental Health Team setting, and an abstract providing a summary of an oral presentation of a 25 year old man with schizoaffective disorder in a medium secure forensic setting implementing a cognitive intervention. In order to ensure anonymity names and identifying information have been altered or omitted. AcknowledgementsFirstly I would like to thank all the participants who kindly took the time to complete the questionnaires for this study. I would also like to thank all the home managers and services I have liaised with who have been extremely helpful in the organisation of the study.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

“…A similarly sized correlation (albeit non-significant because the sample was smaller) was reported by Mills and Rose. 134 However, although there was a small correlation between key worker ratings of controllability and severity of challenging behaviour, we found no relationship between controllability ratings and IQ, consistent with earlier studies. 135,136 Therefore, increased control cannot explain why more able service users were rated as more angry.…”

“…157,175 Within these complex organisations, staff groups function within hierarchies and a variety of environments. Challenging behaviour is stressful for staff, 22,134 but their ability to cope is a function of their perceptions of self-efficacy, 152 and can be influenced by organisational factors such as supervision and support. 205 An organisational climate that has a good 'person-environment' fit promotes better job satisfaction for staff and potentially better outcomes for clients.…”

Burnout among nurses working in social welfare centers for the disabled

“…In accordance, the findings of a systematic review that included fifteen studies from six countries, showed that the levels of burnout did not differ to a significant degree from those of the normative sample as described by Mashlach, with the exception of Depersonalization scores that were higher [29]. As far as factors and determinants of burnout of personnel in units for people with disabilities, challenging client behavior is the most frequently reported stressor [23, 30]. In addition, personality traits like neurotic behavior, extraversion and being very self conscious may be predictors of burnout, as is also lack of social support [31].…”

User Violence and Nursing Staff Burnout

“…For example, Isaksson, Graneheim, Richter, Eisemann, and Åström (2008) detected that nurses who had been exposed to violence scored higher in burnout. Subsequently, other authors qualified this fact, indicating that this positive association occurred particularly with emotional exhaustion and cynicism (Chung & Harding 2009;Howard, Rose, & Levenson, 2009;Mills & Rose, 2011). Hensel, Lunsky, and Dewa (2012) stated that between 7% and 24% of the workers do suffer burnout or are at high risk of burnout due to aggressions experienced.…”