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The Learning Dis Elf

@LearningDisElf

Follow me to keep up to date with learning disabilities & intellectual disabilities research. Cousin of the famous @Mental_Elf 🌳🌤

 The Woodland and Oxford
thelearningdisabilitieself.net/
Joined March 2011
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At the end of the PETAL therapy there are review sessions and something to take-away; a letter about the therapy for other health professionals. There are also home practice tasks set by the person with ID and their carers #PETALprogramme
Image from The Learning Dis Elf (@LearningDisElf)
Image from The Learning Dis Elf (@LearningDisElf)
Image from The Learning Dis Elf (@LearningDisElf)
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And last but not least, healthy habits are also really important #PETALprogramme
Being healthy Activity Social Enjoyment

ALT Being healthy Activity Social Enjoyment

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Caring wellbeing is also important #PETALprogramme
Improving wellbeing Managing stress Support networks

ALT Improving wellbeing Managing stress Support networks

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Communication, emotions and a calm environment #PETALprogramme
Communicating with professionals, the person with learning disability, the person's caring network. Using communication passports

ALT Communicating with professionals, the person with learning disability, the person's caring network. Using communication passports

Linking thoughts, feelings and behaviour Mindfulness Mood diaries

ALT Linking thoughts, feelings and behaviour Mindfulness Mood diaries

Distracting and calming activities Relaxation activities Calm down tools

ALT Distracting and calming activities Relaxation activities Calm down tools

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Understanding aggressive challenging behaviour: de-escalation and managing risk #PETALprogramme
1. Move person away 2. Talk to them 3. Try to help

ALT 1. Move person away 2. Talk to them 3. Try to help

1. Move person away 2. Create a calm environment

ALT 1. Move person away 2. Create a calm environment

Risk management plan Carers know how to de-escalates situations Reactive strategies used only as a last-resort Carers know where to get more help

ALT Risk management plan Carers know how to de-escalates situations Reactive strategies used only as a last-resort Carers know where to get more help

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Replying to @LearningDisElf @PETALProgramme
The PETAL Therapy Manual (which may still be adapted further) currently includes modules on: 1. Getting to know the person 2. Understanding aggressive challenging behaviour 3. Communication 4. Emotions 5. A calm environment 6. Carer wellbeing 7. Healthy habits #PETALprogramme
Communication Likes and dislikes Network Behaviour Other therapies Health

ALT Communication Likes and dislikes Network Behaviour Other therapies Health

Is someone ready to change?

ALT Is someone ready to change?

Trigger → Behaviour → Response

ALT Trigger → Behaviour → Response

Predicting behaviour: Confused Irritable Boisterous Verbal threats Physical threats Attacking objects

ALT Predicting behaviour: Confused Irritable Boisterous Verbal threats Physical threats Attacking objects

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Replying to @LearningDisElf @PETALProgramme
People working on the @PETALprogramme have developed a PETAL Therapy Manual, as well as a carer workbook and service user workbook #PETALprogramme
Image from The Learning Dis Elf (@LearningDisElf)
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Our final speakers are Brendan Leahy and Dr Rachel Royston - @PETALProgramme Manager at @UCLPsychiatry who are going to tell us about the development of the PETAL therapy with testimonials from family carers and adults with mild intellectual disabilities #PETALprogramme
PErsonalised Treatment packages for Adults with Learning disabilities who display aggression in community settings (PETAL) The PETAL therapy Community Support for Challenging Behaviour - #PETALprogramme webinar Rachel Royston & Brendan Leahy

ALT PErsonalised Treatment packages for Adults with Learning disabilities who display aggression in community settings (PETAL) The PETAL therapy  Community Support for Challenging Behaviour - #PETALprogramme webinar Rachel Royston & Brendan Leahy

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Final conclusions of this @PETALprogramme presentation from @likahassiotis #PETALprogramme
Aggression and its associations are complex and multifaceted Interventions may not fully address modifiable underpinning factors Unpacking the typologies of challenging behaviour is the next “big” research topic that can lead to new approaches to treatment The PETAL programme is attempting to do so by introducing novel ways of conceptualising intervention development for aggression

ALT Aggression and its associations are complex and multifaceted Interventions may not fully address modifiable underpinning factors Unpacking the typologies of challenging behaviour is the next “big” research topic that can lead to new approaches to treatment The PETAL programme is attempting to do so by introducing novel ways of conceptualising intervention development for aggression

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These are the areas for improvement identified by the @PETALprogramme #PETALprogramme
Image from The Learning Dis Elf (@LearningDisElf)
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According to the @PETALprogramme this is what does NOT work, says @likahassiotis #PETALprogramme 1. Inadequate staffing resources 2. Inadequate environment 3. Interventions not having desired effect
Lack of knowledge, skills and training High turnover of staff and professionals Lack of ‘chemistry’ with support staff Perception of professionals being unhelpful/ lack of engagement Not being offered support, being declined support or carers having to fight for help

ALT Lack of knowledge, skills and training High turnover of staff and professionals Lack of ‘chemistry’ with support staff Perception of professionals being unhelpful/ lack of engagement Not being offered support, being declined support or carers having to fight for help

Accommodation in need of repair Home environment or current placement not suitable – lack of controlled environment; too many residents Lack of availability of clinic rooms

ALT Accommodation in need of repair Home environment or current placement not suitable – lack of controlled environment; too many residents Lack of availability of clinic rooms

Service user ‘not ready’ for intervention or lacking motivation or limited understanding Unpredictability of behaviour may make interventions more difficult No change in behaviour despite psychological input Poor implementation of strategies (e.g. PBS) Medication not always helpful

ALT Service user ‘not ready’ for intervention or lacking motivation or limited understanding Unpredictability of behaviour may make interventions more difficult No change in behaviour despite psychological input Poor implementation of strategies (e.g. PBS) Medication not always helpful

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Replying to @LearningDisElf @likahassiotis @PETALProgramme
According to @PETALprogramme this is what works, says @likahassiotis #PETALprogramme 1.Collaborative working with professionals 2.Skills & competence of professionals & staff 3.Perceived benefits of psychological & psychiatric intervention 4.Engagement in meaningful activities
Different professionals/ agencies working together to ensure consistency Involvement of carers Multidisciplinary meetings Challenging decisions if not happy Involvement of service users Nominated contact person Information sharing

ALT Different professionals/ agencies working together to ensure consistency Involvement of carers Multidisciplinary meetings Challenging decisions if not happy Involvement of service users Nominated contact person Information sharing

Professionals’ understanding the reasons for the behaviour Developing a good relationship - friendly approach to service user Working with the person over time and different settings Consistency of support staff

ALT Professionals’ understanding the reasons for the behaviour Developing a good relationship - friendly approach to service user Working with the person over time and different settings Consistency of support staff

Greater understanding of condition by service user Therapy as an outlet to help service users express themselves Service users developing strategies to manage their anger Reduction in challenging behaviour & use of medication Carers provided with tools to help manage behaviour Medication helping to improve mood and sleep Complimentary to behavioural approaches

ALT Greater understanding of condition by service user Therapy as an outlet to help service users express themselves Service users developing strategies to manage their anger Reduction in challenging behaviour & use of medication Carers provided with tools to help manage behaviour Medication helping to improve mood and sleep Complimentary to behavioural approaches

A way of managing or reducing problem behaviours Helping to lift mood Opportunities to socialise / make friends

ALT A way of managing or reducing problem behaviours Helping to lift mood Opportunities to socialise / make friends

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Replying to @LearningDisElf @likahassiotis @PETALProgramme
These are the most commonly used interventions for aggressive behaviour #PETALprogramme Two-thirds of people receive medication, says @likahassiotis Psychological, social and alternative interventions are sometimes not available and generally not used much
Psychiatric: medication, regular reviews Psychological: Anger management, PBS, CBT, Mindfulness, DBT, Group therapy Social: walks, gardening, swimming, social groups, education, day centre Alternative: Art therapy, Occupational therapy, Nursing input, Physiotherapy, Music therapy

ALT Psychiatric: medication, regular reviews Psychological: Anger management, PBS, CBT, Mindfulness, DBT, Group therapy Social: walks, gardening, swimming, social groups, education, day centre Alternative: Art therapy, Occupational therapy, Nursing input, Physiotherapy, Music therapy

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Replying to @LearningDisElf @likahassiotis @PETALProgramme
These are the (internal and external) triggers identified by the people who participated in the study #PETALprogramme
Image from The Learning Dis Elf (@LearningDisElf)
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Replying to @LearningDisElf @likahassiotis @PETALProgramme
These are the types of aggressive challenging behaviour identified by the @PETALProgramme review of the literature and semi-structured interviews with people with ID, their carer (paid or family carer) and a health professional from 3 UK countries #PETALprogramme
Image from The Learning Dis Elf (@LearningDisElf)
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Replying to @LearningDisElf @likahassiotis @PETALProgramme
So the @PETALProgramme aims to "examine contextual factors that may influence response to psychological interventions in adults with intellectual disabilities and aggressive challenging behaviour" #PETALprogramme
To examine contextual factors that may influence response to psychological interventions in adults with intellectual disabilities and aggressive challenging behaviour Factors associated with a good outcome (what worked) Factors that led to a poor outcome or were unhelpful (what did not work) Any unmet needs (what could be improved)

ALT To examine contextual factors that may influence response to psychological interventions in adults with intellectual disabilities and aggressive challenging behaviour Factors associated with a good outcome (what worked) Factors that led to a poor outcome or were unhelpful (what did not work) Any unmet needs (what could be improved)

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Replying to @LearningDisElf @likahassiotis @PETALProgramme
At the #PETALprogramme webinar @likahassiotis is providing some background information about aggressive challenging behaviour in people with intellectual disabilities
Aggression: Any behaviour directed towards others that has an intention to cause harm, whereas the target does not expect to be harmed and is motivated to avoid the harm Examples: verbal and physical aggression, property damage and destructiveness, disruptive and antisocial behaviour, overactivity, temper tantrums, screaming Instrumental Aggression vs. Hostile Aggression

ALT Aggression: Any behaviour directed towards others that has an intention to cause harm, whereas the target does not expect to be harmed and is motivated to avoid the harm Examples: verbal and physical aggression, property damage and destructiveness, disruptive and antisocial behaviour, overactivity, temper tantrums, screaming Instrumental Aggression vs. Hostile Aggression

1:6 individuals with intellectual disability eligible to receive services display challenging behaviour 8.3% display aggressive challenging behaviour Prevalence of aggression varies in different settings Aggression accounts for >40% of emergency care presentations in children and young people

ALT 1:6 individuals with intellectual disability eligible to receive services display challenging behaviour 8.3% display aggressive challenging behaviour Prevalence of aggression varies in different settings Aggression accounts for >40% of emergency care presentations in children and young people

Person and situation factors affect feelings, thoughts, and arousal. Feelings, thoughts, and arousal influence appraisal and decision-making processes. Appraisal and decision-making processes affect aggressive or nonaggressive behavior. Biological and environmental factors influence aggression The General Aggression Model has been applied to many domains

ALT Person and situation factors affect feelings, thoughts, and arousal. Feelings, thoughts, and arousal influence appraisal and decision-making processes. Appraisal and decision-making processes affect aggressive or nonaggressive behavior. Biological and environmental factors influence aggression The General Aggression Model has been applied to many domains

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Our next speaker is Professor Angela Hassiotis @likahassiotis from @UCLPsychiatry, Consultant Psychiatrist at the Camden Learning Disabilities Service & Co-Chief Investigator of the #PETALprogramme. This will be a presentation of the @PETALprogramme grant
Aggressive challenging behaviour: the PETAL Programme

ALT Aggressive challenging behaviour: the PETAL Programme

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