Feldman M A, Atkinson L, Foti-Gervais L, Condillac R
Department of Child and Youth Studies, Brock University, St.Catherines, Ontario, L2S 3AI, Canada.
J Intellect Disabil Res. 2004 Jan;48(1):60-8. doi: 10.1111/j.1365-2788.2004.00578.x.
Although effective, humane treatments exist for persons with intellectual disabilities (ID) who have challenging behaviour, little research has examined the extent to which clients receive formal, documented vs. undocumented interventions.
Caregivers (of 625 persons with ID living in community and institutional residences in Ontario, Canada) were interviewed to examine the prevalence of different types of interventions.
Overall, 55% of the 2506 different interventions (for 1464 target behaviours) were informal (i.e. lacking documented input from a professional, written intervention plans, and systematic evaluation). No significant differences emerged on formality of intervention across participant gender, age, level of ID, and type of residence. There were significantly more informal than formal behavioural interventions and counselling/psychotherapy, and no significant difference in the overall prevalence of formal and informal intrusive procedures. Behaviour control medications were paired more often with formal (67%) than informal interventions for dangerous behaviours. Formal interventions were associated with higher caregiver-reported estimates of behavioural improvement, higher inter-rater agreement on the descriptions of an individual client's target behaviours and interventions, and more caregiver training and supervision.
The low levels of intervention accountability, training and supervision may place many clients with challenging behaviour at increased risk for ineffective and unnecessary restrictive interventions, and physical abuse. The results of this survey stimulated the government to write province-wide standards (that have yet to be implemented).
尽管存在针对有挑战行为的智障人士的有效且人道的治疗方法，但很少有研究考察服务对象接受正式、有记录的干预与无记录干预的程度。
对（居住在加拿大安大略省社区和机构住所的625名智障人士的）照料者进行访谈，以考察不同类型干预措施的普遍性。
总体而言，针对1464种目标行为的2506种不同干预措施中，55%为非正式干预（即缺乏专业人员的书面投入、书面干预计划和系统评估）。在参与者性别、年龄、智障程度和居住类型方面，干预的正式程度没有显著差异。非正式行为干预和咨询/心理治疗比正式的显著更多，正式和非正式侵入性程序的总体普遍性没有显著差异。对于危险行为，行为控制药物与正式干预（67%）搭配的频率高于非正式干预。正式干预与照料者报告的行为改善估计值较高、不同评估者对个体服务对象目标行为和干预措施描述的一致性较高以及更多的照料者培训和监督相关。
干预的问责制、培训和监督水平较低，可能使许多有挑战行为的服务对象面临无效和不必要的限制性干预以及身体虐待风险增加。这项调查结果促使政府制定全省范围的标准（尚未实施）。
