Randell Elizabeth, Hastings Richard P, McNamara Rachel, Knight Roseanna, Gillespie David, Taylor Zachary
Centre for Trials Research, Cardiff University, Cardiff, UK.
Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK.
Trials. 2017 Oct 5;18(1):460. doi: 10.1186/s13063-017-2175-1.
Findings suggest approximately one in six people with intellectual disability engage in 'challenging behaviours', which include aggression towards others/property and self-injurious actions. In residential settings, actions of staff members can make challenging behaviours more likely to occur, or make these behaviours worse. In particular, negative attitudes from members of staff and lack of understanding about the reasons for challenging behaviour are contributory factors. 'Who's Challenging Who?' (WCW) training is designed to emphasise the role of staff in residential settings as a challenge also to people with intellectual disability. The course is delivered jointly by a trainer with intellectual disability who has been labelled as having challenging behaviour, along with a trainer without intellectual disability.
This is a cluster randomised two-arm trial of WCW training versus a waiting list control. Overall, 118 residential settings will be recruited and randomised on a 1:1 ratio. Within each setting, two members of staff will be invited to take part in the trial. Participants will complete assessments at baseline and at 6 and 20 weeks. WCW is a half day initial training course with some follow-on coaching to ensure implementation. The primary outcome is changes in staff empathy towards people with challenging behaviour. Secondary outcomes at the staff level include confidence, attitudes and work-related well-being. Secondary outcomes at the residential setting level include recorded incidents of aggressive challenging behaviour, and use of any restrictive practices.
If the results of the cluster randomised trial are positive, we will disseminate the findings widely and make all training manuals and materials freely available for anyone in intellectual disability services (and beyond) to use. Our training approach may have wider implications in other areas of social care. It may also provide a generally applicable model for how to train people with intellectual disability to act as co-trainers in intellectual disability social care settings. People with intellectual disability and challenging behaviour have already been involved centrally with the design, development and pilot evaluation of WCW and will also be fully involved throughout this trial.
Registered on the International Standard Randomised Controlled Trial Number registry on 8th December 2015: ISRCTN53763600 .
研究结果表明，约六分之一的智障人士存在“挑战性行为”，包括对他人/财产的攻击行为以及自我伤害行为。在住宿机构中，工作人员的行为可能会使挑战性行为更易发生，或使其恶化。特别是，工作人员的消极态度以及对挑战性行为原因缺乏理解是促成因素。“谁在挑战谁？”（WCW）培训旨在强调住宿机构中工作人员的角色，因为这对智障人士来说也是一种挑战。该课程由一名曾被认定有挑战性行为的智障培训师和一名非智障培训师联合授课。
这是一项将WCW培训与等待名单对照进行的整群随机双臂试验。总体而言，将招募118个住宿机构并按1:1比例随机分组。在每个机构中，将邀请两名工作人员参与试验。参与者将在基线、6周和20周时完成评估。WCW是一个为期半天的初始培训课程，并提供一些后续指导以确保实施。主要结果是工作人员对有挑战性行为者的同理心变化。工作人员层面的次要结果包括信心、态度和与工作相关的幸福感。住宿机构层面的次要结果包括记录在案的攻击性行为事件以及任何限制措施的使用情况。
如果整群随机试验的结果是积极的，我们将广泛传播研究结果，并使所有培训手册和材料可供智障服务领域（及其他领域）的任何人免费使用。我们的培训方法可能在社会护理的其他领域具有更广泛的意义。它还可能为如何培训智障人士在智障社会护理环境中担任联合培训师提供一个普遍适用的模式。有挑战性行为的智障人士已深度参与WCW的设计、开发和试点评估，并且在整个试验过程中也将全面参与。
于2015年12月8日在国际标准随机对照试验编号注册库注册：ISRCTN53763600 。
