Limbu B, Deb S, Bradshaw J, Cooper V
Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
The Tizard Centre, University of Kent, Canterbury, UK.
J Intellect Disabil Res. 2025 Jul;69(7):630-638. doi: 10.1111/jir.13236. Epub 2025 Mar 26.
Overmedication of adults with intellectual (learning) disabilities, particularly the off-licence use of psychotropic medicines for behaviours that challenge in the absence of a psychiatric disorder, is a major public health concern and an example of health inequalities. In the United Kingdom, we coproduced online training resources backed up by face-to-face training for support staff (direct care workers) called SPECTROM involving all stakeholders, including adults with intellectual disabilities and their families, to help reduce the overmedication and implement NHS England's STOMP initiative.
In a feasibility cluster randomised controlled trial, we trained service managers and support staff using two core modules of SPECTROM, namely, (a) Medicine/STOMP and (b) Alternatives to Medicine (ATM) using an online platform. These two core modules introduced 12 other modules and other online resources. We assessed trainees' knowledge of psychotropic medicines using the Psychotropic Knowledge Questionnaire-Revised (PKQ-R) and their attitude to behaviours that challenge using the Management of Aggression and Violence Attitude Scale-Revised-Intellectual Disabilities (MAVAS-R-ID) using a pre-post training design.
The research team delivered SPECTROM training to 18 service managers and 122 support staff. Of the 140 trainees, 126 completed PKQ-R at baseline before and within 4 weeks after the training. There was a post-training improvement in PKQ-R scores in 42 of the 43 questions (97.7%), 22 of which were statistically significant differences (p < 0.001). The MAVAS-R-ID was completed at baseline and within 4 weeks of training by 125 trainees. The MAVAS-R-ID total score showed statistically significant post-training improvements (p < 0.01). Individual domain score analysis showed a statistically significant improvement in one of the five domains related to attitude regarding the use of medicine for behaviours that challenge.
The SPECTROM training seems to improve staff knowledge of psychotropic medicine, at least in the short-term, and attitude towards behaviours that challenge, particularly concerning the use of psychotropic medicine.
对成年智障（学习障碍）患者过度用药，尤其是在不存在精神障碍的情况下，将精神药物用于应对挑战性行为的非许可使用，是一个重大的公共卫生问题，也是健康不平等的一个例子。在英国，我们共同制作了在线培训资源，并为支持人员（直接护理人员）提供面对面培训，该培训名为SPECTROM，涉及所有利益相关者，包括成年智障患者及其家庭，以帮助减少过度用药，并实施英国国家医疗服务体系（NHS）英格兰的STOMP倡议。
在一项可行性整群随机对照试验中，我们使用在线平台，通过SPECTROM的两个核心模块，即（a）药物/STOMP和（b）药物替代方法（ATM），对服务经理和支持人员进行培训。这两个核心模块引入了另外12个模块和其他在线资源。我们采用培训前-培训后设计，使用修订后的精神药物知识问卷（PKQ-R）评估学员对精神药物的知识，并使用修订后的智障患者攻击与暴力管理态度量表（MAVAS-R-ID）评估他们对挑战性行为的态度。
研究团队为18名服务经理和122名支持人员提供了SPECTROM培训。在140名学员中，126人在培训前及培训后4周内完成了PKQ-R基线测试。43个问题中的42个（97.7%）在培训后PKQ-R得分有所提高，其中22个有统计学显著差异（p<0.001）。125名学员在基线时及培训后4周内完成了MAVAS-R-ID测试。MAVAS-R-ID总分在培训后有统计学显著提高（p<0.01）。单个领域得分分析显示，在与使用药物应对挑战性行为的态度相关的五个领域中的一个领域有统计学显著改善。
SPECTROM培训似乎至少在短期内提高了工作人员对精神药物的知识，以及对挑战性行为的态度，特别是关于精神药物的使用。
