Sandy Toogood, Gemma Drury, Karen Gilsenan, Dave Parry, Kevin Roberts and Simon Sherriff
Client engagement increases substantially when staff teams implement active support. The impact of active support on challenging behaviour is less clear. There are grounds for…
Abstract
Client engagement increases substantially when staff teams implement active support. The impact of active support on challenging behaviour is less clear. There are grounds for believing that active support procedures could in some cases neutralise environmental conditions known to evoke challenging behaviour. We implemented a three‐phase clinical intervention to increase engagement and reduce passive and challenging behaviour. In phase 1 we trained staff to deliver inviting activity‐based instruction at eye level. In phase 2 we introduced activity support plans to increase client choice and control. In phase 3 staff used peer‐monitoring procedures to consolidate implementation. We measured staff behaviour and client outcome across the three phases of intervention and at follow‐up. Staff provided warm and inviting activity‐based instruction at eye level more frequently after participating in phase 1 on‐site training. The proportion of activity‐based interactions with choice increased when activity plans were introduced in phase 2. Engagement replaced passive and challenging behaviour. Staff observations suggested changes were maintained over the short run. Our own observations indicated decay at 22 months. Our data suggest that active support procedures can make challenging behaviour less likely by altering antecedent conditions that reliably evoke such behaviour. Without sustained effort, interventions are susceptible to decay.
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Gemma Kerfoot, Zandra Bamford and Sarah Amelia Jones
The aim of this paper is to highlight the challenges in evaluating psychological input into acute wards using more traditional methods; and also to provide an example of how it is…
Abstract
Purpose
The aim of this paper is to highlight the challenges in evaluating psychological input into acute wards using more traditional methods; and also to provide an example of how it is possible to evaluate such services capturing outcomes at multiple levels.
Design/methodology/approach
Data were gathered from multiple levels including staff, patients and the wider organisation mainly using self report questionnaires. The paper looks at the impact on satisfaction, service utilisation, development of recovery principles, quality of therapeutic environment and alliance with treatment teams following the introduction of a dedicated psychology team.
Findings
The results show positive trends in patient experiences of the ward environment, alliance with treating teams and staff recovery principles, along with reduced readmission rates and length of stay in hospital. Qualitative data demonstrate the value of the service to both staff and patients.
Research limitations/implications
Much of the data do not meet the criteria for more sophisticated statistical analysis.
Originality/value
The paper provides an example of evaluation of a contemporary model of service delivery for which there is currently a limited evidence base and looks to stimulate current thinking on the practice of mental health service delivery.