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

Rachel Royston; Stephen Naughton; Angela Hassiotis; Andrew Jahoda; Afia Ali; Umesh Chauhan; Sally-Ann Cooper; Athanasia Kouroupa; Liz Steed; Andre Strydom; Laurence Taggart; Penny Rapaport; Weifeng Han

doi:10.1371/journal.pone.0285590

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

Rachel Royston
, Stephen Naughton
, Angela Hassiotis
, Andrew Jahoda
, Afia Ali
, Umesh Chauhan
, Sally-Ann Cooper
, Athanasia Kouroupa
, Liz Steed
, Andre Strydom
, Laurence Taggart
, Penny Rapaport
, Weifeng Han (Editor)

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

389 Downloads (Pure)

Abstract

Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Prospero registration number: CRD42020203055.

Original language	English
Article number	e0285590
Pages (from-to)	1-24
Number of pages	25
Journal	PLoS ONE
Volume	18
Issue number	5
Early online date	18 May 2023
DOIs	https://doi.org/10.1371/journal.pone.0285590
Publication status	Published online - 18 May 2023

Bibliographical note

Funding Information:
This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to extend a special thanks to all the contributors and members of our expert panel, LRG and study team. We would also like to thank the members of our patient advisory groups who contributed to this review. We thank Fernanda Fenn Torrente (trained medical student) for her contributions to appraising the rigour of each record for the quality assessment.

Funding Information:
Funding:Thispaperpresentsindependent researchcommissionedandfundedbythe NationalInstituteforHealthResearch(NIHR) ProgrammeGrantsforAppliedResearch(grant number;NIHR200120).Thisawardwasreceived byAH,AJ,AA,UC,SC,LS,AS,LT&PR.Theviews expressedarethoseoftheauthorsandnot necessarilythoseoftheNIHRortheDepartmentof HealthandSocialCare.Thefundershadnorolein studydesign,datacollectionandanalysis,decision topublish,orpreparationofthemanuscript.

Publisher Copyright:
© 2023 Royston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding

Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to extend a special thanks to all the contributors and members of our expert panel, LRG and study team. We would also like to thank the members of our patient advisory groups who contributed to this review. We thank Fernanda Fenn Torrente (trained medical student) for her contributions to appraising the rigour of each record for the quality assessment. Funding Information: Funding:Thispaperpresentsindependent researchcommissionedandfundedbythe NationalInstituteforHealthResearch(NIHR) ProgrammeGrantsforAppliedResearch(grant number;NIHR200120).Thisawardwasreceived byAH,AJ,AA,UC,SC,LS,AS,LT&PR.Theviews expressedarethoseoftheauthorsandnot necessarilythoseoftheNIHRortheDepartmentof HealthandSocialCare.Thefundershadnorolein studydesign,datacollectionandanalysis,decision topublish,orpreparationofthemanuscript. Publisher Copyright: © 2023 Royston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Adolescent
Adult
Caregivers
Humans
Intellectual Disability
Mental Health
Motivation
Population Groups

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1371/journal.pone.0285590

pone.0285590.s005.pdfFinal published version, 185 KBLicence: CC BY

Cite this

Royston, R., Naughton, S., Hassiotis, A., Jahoda, A., Ali, A., Chauhan, U., Cooper, S.-A., Kouroupa, A., Steed, L., Strydom, A., Taggart, L., Rapaport, P., & Han, W. (Ed.) (2023). Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations. PLoS ONE, 18(5), 1-24. Article e0285590. Advance online publication. https://doi.org/10.1371/journal.pone.0285590

@article{fd56f4b6dfd2486a9f35df03703256e0,

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

abstract = "Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Prospero registration number: CRD42020203055.",

keywords = "Adolescent, Adult, Caregivers, Humans, Intellectual Disability, Mental Health, Motivation, Population Groups",

author = "Rachel Royston and Stephen Naughton and Angela Hassiotis and Andrew Jahoda and Afia Ali and Umesh Chauhan and Sally-Ann Cooper and Athanasia Kouroupa and Liz Steed and Andre Strydom and Laurence Taggart and Penny Rapaport and Weifeng Han",

note = "Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT \& PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT \& PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to extend a special thanks to all the contributors and members of our expert panel, LRG and study team. We would also like to thank the members of our patient advisory groups who contributed to this review. We thank Fernanda Fenn Torrente (trained medical student) for her contributions to appraising the rigour of each record for the quality assessment. Funding Information: Funding:Thispaperpresentsindependent researchcommissionedandfundedbythe NationalInstituteforHealthResearch(NIHR) ProgrammeGrantsforAppliedResearch(grant number;NIHR200120).Thisawardwasreceived byAH,AJ,AA,UC,SC,LS,AS,LT\&PR.Theviews expressedarethoseoftheauthorsandnot necessarilythoseoftheNIHRortheDepartmentof HealthandSocialCare.Thefundershadnorolein studydesign,datacollectionandanalysis,decision topublish,orpreparationofthemanuscript. Publisher Copyright: {\textcopyright} 2023 Royston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2023",

month = may,

day = "18",

doi = "10.1371/journal.pone.0285590",

language = "English",

volume = "18",

pages = "1--24",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "PLoS",

number = "5",

}

Royston, R, Naughton, S, Hassiotis, A, Jahoda, A, Ali, A, Chauhan, U, Cooper, S-A, Kouroupa, A, Steed, L, Strydom, A, Taggart, L, Rapaport, P & Han, W (ed.) 2023, 'Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations', PLoS ONE, vol. 18, no. 5, e0285590, pp. 1-24. https://doi.org/10.1371/journal.pone.0285590

TY - JOUR

T1 - Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations

AU - Royston, Rachel

AU - Naughton, Stephen

AU - Hassiotis, Angela

AU - Jahoda, Andrew

AU - Ali, Afia

AU - Chauhan, Umesh

AU - Cooper, Sally-Ann

AU - Kouroupa, Athanasia

AU - Steed, Liz

AU - Strydom, Andre

AU - Taggart, Laurence

AU - Rapaport, Penny

A2 - Han, Weifeng

N1 - Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant number; NIHR200120). This award was received by AH, AJ, AA, UC, SC, LS, AS, LT & PR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to extend a special thanks to all the contributors and members of our expert panel, LRG and study team. We would also like to thank the members of our patient advisory groups who contributed to this review. We thank Fernanda Fenn Torrente (trained medical student) for her contributions to appraising the rigour of each record for the quality assessment. Funding Information: Funding:Thispaperpresentsindependent researchcommissionedandfundedbythe NationalInstituteforHealthResearch(NIHR) ProgrammeGrantsforAppliedResearch(grant number;NIHR200120).Thisawardwasreceived byAH,AJ,AA,UC,SC,LS,AS,LT&PR.Theviews expressedarethoseoftheauthorsandnot necessarilythoseoftheNIHRortheDepartmentof HealthandSocialCare.Thefundershadnorolein studydesign,datacollectionandanalysis,decision topublish,orpreparationofthemanuscript. Publisher Copyright: © 2023 Royston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/5/18

Y1 - 2023/5/18

N2 - Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Prospero registration number: CRD42020203055.

AB - Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Prospero registration number: CRD42020203055.

KW - Adolescent

KW - Adult

KW - Caregivers

KW - Humans

KW - Intellectual Disability

KW - Mental Health

KW - Motivation

KW - Population Groups

UR - https://www.scopus.com/pages/publications/85159762793

U2 - 10.1371/journal.pone.0285590

DO - 10.1371/journal.pone.0285590

M3 - Article

C2 - 37200247

SN - 1932-6203

VL - 18

SP - 1

EP - 24

JO - PLoS ONE

JF - PLoS ONE

IS - 5

M1 - e0285590

ER -

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

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this