Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations

Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interve...

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Bibliographic Details
Published in:PloS one Vol. 18; no. 5; p. e0285590
Main Authors: Royston, Rachel, Naughton, Stephen, Hassiotis, Angela, Jahoda, Andrew, Ali, Afia, Chauhan, Umesh, Cooper, Sally-Ann, Kouroupa, Athanasia, Steed, Liz, Strydom, Andre, Taggart, Laurence, Rapaport, Penny
Format: Journal Article
Language:English
Published: United States Public Library of Science 18.05.2023
Public Library of Science (PLoS)
Subjects:
Adolescent
Adult
Adults
Aggressive behavior
Aggressiveness (Psychology)
Behavior disorders
Biology and Life Sciences
Care and treatment
Caregivers
Caregivers - psychology
Configurations
Dementia
Dementia disorders
Embedding
Employee development
Employee motivation
Humans
Intellectual disabilities
Intellectual Disability - therapy
Intervention
Interviews
Medicine and Health Sciences
Mental disorders
Mental Health
Mental retardation
Motivation
Patient outcomes
Population Groups
Quality of life
Reviews
Social Sciences
Teams
Young adults
United Kingdom
England
Scotland
United Kingdom > UK
Northern Ireland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations. This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation. The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. CRD42020203055.
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Competing Interests: The authors have declared that no competing interests exist.
Current address: Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0285590