View in EDS HTML Full Text PDF Full Text

Aggressive Challenging Behaviour in Adults with Intellectual Disability Following Community Resettlement

Saved in:
Bibliographic Details
Title: Aggressive Challenging Behaviour in Adults with Intellectual Disability Following Community Resettlement
Language: English
Authors: Bhaumik, S., Watson, J. M., Devapriam, J., Raju, L. B., Tin, N. N., Kiani, R., Talbott, L., Parker, R., Moore, L., Majumdar, S. K., Ganghadaran, S. K., Dixon, K., Gupta, A. Das, Barrett, M., Tyrer, F.
Source: Journal of Intellectual Disability Research. Mar 2009 53(3):298-302.
Availability: Blackwell Publishing. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8599; Fax: 781-388-8232; e-mail: customerservices@blackwellpublishing.com; Web site: http://www.blackwellpublishing.com/jnl_default.asp
Peer Reviewed: Y
Page Count: 5
Publication Date: 2009
Document Type: Journal Articles
Reports - Research
Descriptors: Mental Retardation, Land Settlement, Drug Use, Foreign Countries, Aggression, Behavior Problems, Adults, Residential Care, Relocation, Measures (Individuals), Hospitals, Role, Environmental Influences
Geographic Terms: United Kingdom (England)
DOI: 10.1111/j.1365-2788.2008.01111.x
ISSN: 0964-2633
Abstract: Background: Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach. Method: The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement. Results: All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P less than 0.001). This reduction remained (but did not decrease further) at 1-year follow-up. Conclusions: Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.
Abstractor: As Provided
Number of References: 21
Entry Date: 2009
Accession Number: EJ828614
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHhzxVwtijOkfTigAgYnWLOAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDJGFzwydgindHF5klAIBEICBmguIjY5G9Qc9s933Q7GRfSDzY6R_lkjF5Ncubrh2C3AbwsilftAWrus6tzLYYg3wfIgSU6Cul5C8Ns1GQdCFTvwpQMAXqf2oKBNNbbuRFrdT7vpwqYfYIW9ej0LGE4v_ZX6LZMblpXrk8aw7iaS0I6k8CkuhxGvchVmapWeAyOgoW30V8ZT7vaP_jUvTUy-2wVLOZmZj9S0dq4Y=
Text:
  Availability: 1
  Value: <anid>AN0036518950;eul01mar.09;2019Jun04.10:46;v2.2.500</anid> <title id="AN0036518950-1">Brief report: Aggressive challenging behaviour in adults with intellectual disability following community resettlement. </title> <p>Background  Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long‐term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person‐centred approach. Method  The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long‐stay hospital and 6 months and 1 year after community resettlement. Results  All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1‐year follow‐up. Conclusions  Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.</p> <p>Keywords: aggression; deinstitutionalisation; hospital; community; intellectual disability</p> <p>Aggressive challenging behaviour (verbal aggression, destructiveness, self‐injury and physical aggression) is common in adults with intellectual disability (ID) and is a major contributor of the more widely researched challenging behaviour ([<reflink idref="bib5" id="ref1">5</reflink>]). The government's commitment to the closure of all NHS long‐term care facilities by the year 2010 in England ([<reflink idref="bib3" id="ref2">3</reflink>]) has raised concerns about how to manage this behaviour in the wider community, particularly where it risks causing harm to others.</p> <p>A number of reviews have been carried out to assess the effect of moving from institutional to community‐based settings ([<reflink idref="bib4" id="ref3">4</reflink>]; [<reflink idref="bib19" id="ref4">19</reflink>]; [<reflink idref="bib8" id="ref5">8</reflink>]). Generally, improved outcomes following resettlement have been observed in terms of increased adaptive behaviour, greater community participation and increased contact with friends and family. However, the evidence for a corresponding decrease in challenging behaviour has been inconsistent. One of the difficulties with studying this area is that the prevalence of challenging behaviour tends to be higher in institutional settings because people who display challenging behaviours are more likely to be admitted and to remain in these settings ([<reflink idref="bib9" id="ref6">9</reflink>]). However, institutional settings themselves have also been found to provoke feelings of anger, helplessness and frustration ([<reflink idref="bib1" id="ref7">1</reflink>]), which are associated with aggressive behaviour ([<reflink idref="bib17" id="ref8">17</reflink>]) and one might therefore expect to see a reduction in aggressive challenging behaviour following community resettlement.</p> <p>Evidence for the effective management of challenging behaviour has also been inconsistent in this population. Antipsychotic drugs are frequently prescribed for challenging behaviour in long‐term care facilities ([<reflink idref="bib13" id="ref9">13</reflink>]; [<reflink idref="bib10" id="ref10">10</reflink>]), particularly in people with ID who have been moved from institutional to community‐based placements ([<reflink idref="bib11" id="ref11">11</reflink>]). However, recent evidence suggests that antipsychotic agents may not be as effective as previously thought for challenging behaviour ([<reflink idref="bib18" id="ref12">18</reflink>]), which has led to recommendations for research into alternative strategies.</p> <p>The aims of the present study were to assess whether there was a change in aggressive challenging behaviour in adults with ID following community resettlement using a person‐centred approach. We also aimed to investigate any changes in psychotropic drug use over this time period.</p> <hd id="AN0036518950-2">Methods</hd> <p>This was a study of the last 51 adult residents to leave a long‐stay hospital in Leicestershire and be relocated to a number of community‐based placements between 2004 and 2006. The hospital was purpose‐built in 1985 to accommodate adults with ID who had long‐term care needs and included a large proportion of people with severe challenging behaviour and profound and multiple disabilities. The study was approved by the institutional review board and was conducted under Good Clinical Practice guidelines. Two participants were not included in the subsequent analysis because they died prior to their first assessment following resettlement. Of those remaining, 36 (73%) were men (mean age 50.8; range 31–73 years) and 13 (27%) were women (mean age 49.3; range 35–96 years). All participants were white and generally fell into the more severe end of the ID spectrum (as determined using the Vineland Scale ([<reflink idref="bib15" id="ref13">15</reflink>]): 34 individuals (69%) had profound ID; 11 (22%) had severe ID; three (6%) had moderate ID and one individual (2%) had mild ID. Many individuals also had co‐existing health problems; 36 (73%) were incontinent, two (4%) had a hearing impairment; 17 (35%) had a visual impairment; 30 (61%) had mobility problems and 32 (65%) suffered from epilepsy.</p> <p>Aggressive challenging behaviour was assessed using the Modified Overt Aggression Scale (MOAS) ([<reflink idref="bib20" id="ref14">20</reflink>]; [<reflink idref="bib6" id="ref15">6</reflink>]). The MOAS was designed to measure four types of aggression: verbal aggression; destructiveness (aggression towards objects); self‐injury (aggression towards self) and physical aggression (aggression towards others) among people with psychiatric disorders. It has been found to have good psychometric properties in terms of test–retest reliability and inter‐rater reliability in the general adult population ([<reflink idref="bib14" id="ref16">14</reflink>]; [<reflink idref="bib7" id="ref17">7</reflink>]) and good inter‐rater reliability in the adult ID population ([<reflink idref="bib12" id="ref18">12</reflink>]). The scale involves scoring each type of aggressive challenging behaviour as a score ranging from 0 (absence of behaviour) to 4 (severe behaviour). For this study, we used the MOAS to assess aggressive challenging behaviour at baseline (defined as 6 months prior to discharge from hospital) and at 6 months and 1 year following community resettlement. Assessments were carried out with the individual's formal carer (members of staff in the hospital or community setting as appropriate) by specialist health professionals. At baseline, 76% (<emph>n</emph> = 37) of participants had an overall MOAS score of 4 or more (median score 16) and thus fulfilled the criteria for having aggressive challenging behaviour. More than two‐thirds (67%) of participants were also taking psychotropic drugs for mental health problems or challenging behaviour at baseline (mean number of drugs 1.8), most commonly low‐dose antipsychotic agents [27% (<emph>n</emph> = 13) typical; 20% (<emph>n</emph> = 10) atypical and 6% (<emph>n</emph> = 3) both], which were prescribed to more than half (53%) of individuals.</p> <p>Prior to relocating patients a multi‐disciplinary group of specialist health and social care professionals met regularly to discuss the intended resettlement process. Residents, their family members (where possible), advocates (for residents who were unable to express their views independently) and formal carers were all involved in the decision‐making process. A person‐centred approach was adopted whereby residents were encouraged to discuss their preferences and needs, so that suitable placements could be chosen. All adults were relocated to supported living accommodation, community residential homes or nursing homes. The majority of residents (<emph>n</emph> = 38; 78%) were moved to supported living accommodation (individual flats within a complex for people with ID developed through needs assessment, in collaboration with housing services, support services and the individual) with a mean number of residents of 9.7 (range 3–16). A further six individuals (12%) were relocated to group residential homes (mean number of residents 5.8; range 4–15). The remaining five individuals (10%) were relocated to nursing homes (mean number of residents 14.6; range 5–21).</p> <hd id="AN0036518950-3">Statistical analysis</hd> <p>Statistical analyses were adapted to a repeated measures design. Differences between absolute scores on the MOAS scale at baseline and post‐relocation were compared using the Wilcoxon signed‐ranks test. All analyses were carried out in Stata version 9.0 ([<reflink idref="bib16" id="ref19">16</reflink>]).</p> <hd id="AN0036518950-4">Results</hd> <p>We observed statistically significant reductions in MOAS scores at 6‐month post‐resettlement for people moving to supported living (<emph>n</emph> = 38), residential homes (<emph>n</emph> = 6), nursing homes (<emph>n</emph> = 5) and the group as a whole (Table 1). These reductions were seen for all four types of aggressive behaviour, in both men and women and in those aged 50 years or over and under 50 years. Absolute MOAS scores, reduced for 39 individuals, remained the same for five individuals and increased for four individuals. No further change was seen at follow‐up. The use of psychotropic medication remained unchanged over the study period.</p> <p>1 Aggressive challenging behaviour (median overall MOAS score) and psychotropic drug use among former residents of a long‐stay hospital following resettlement in the community</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Characteristic</bold></th><th><bold>Baseline</bold></th><th><bold>Six months</bold></th><th><bold><italic>P</italic></bold>†</th><th><bold>One year</bold></th><th><bold><italic>P</italic></bold>‡</th></tr></thead><tbody valign="top"><tr><td>Aggressive challenging behaviour</td></tr><tr><td>Median overall MOAS score</td></tr><tr><td> All participants (<italic>n</italic> = 49)</td><td>16.0</td><td>3.0</td><td><0.001</td><td>2.0</td><td>0.47</td></tr><tr><td> Men (<italic>n</italic> = 36)</td><td>12.5</td><td>1.5</td><td><0.001</td><td>1.0</td><td>0.86</td></tr><tr><td> Women (<italic>n</italic> = 13)</td><td>16.0</td><td>4.0</td><td>0.002</td><td>3.0</td><td>0.29</td></tr><tr><td> Age* < 50 (<italic>n</italic> = 25)</td><td>16.0</td><td>3.0</td><td><0.001</td><td>3.0</td><td>0.60</td></tr><tr><td> Age ≥ 50 (<italic>n</italic> = 24)</td><td>15.0</td><td>2.5</td><td><0.001</td><td>0.5</td><td>0.13</td></tr><tr><td> Moved to supported living (<italic>n</italic> = 38)</td><td>15.0</td><td>3.5</td><td><0.001</td><td>1.5</td><td>0.04</td></tr><tr><td> Moved to residential home (<italic>n</italic> = 6)</td><td>16.0</td><td>0.0</td><td>0.05</td><td>1.0</td><td>0.09</td></tr><tr><td> Moved to nursing home (<italic>n</italic> = 5)</td><td>16.0</td><td>9.0</td><td>0.04</td><td>3.0</td><td>0.48</td></tr><tr><td>Psychotropic drug use</td></tr><tr><td> Percentage on psychotropic drugs (<italic>n</italic>)</td><td>67% (33)</td><td /><td>65% (32)</td><td>1.00</td></tr><tr><td> Percentage on antipsychotic drugs (<italic>n</italic>)</td><td>53% (26)</td><td /><td>55% (27)</td><td>0.32</td></tr><tr><td> (Median BNF equivalent dose¶)</td><td>(24%)</td><td /><td>(22%)</td><td>–</td></tr><tr><td> Percentage on antidepressant drugs (<italic>n</italic>)</td><td>24% (12)</td><td /><td>22% (11)</td><td>0.32</td></tr><tr><td> Percentage on hypnotic/anxiolytic drugs</td><td>18% (9)</td><td /><td>18% (9)</td><td>1.00</td></tr><tr><td> Percentage on mood stabilising drugs</td><td>14% (7)</td><td /><td>10% (5)</td><td>0.16</td></tr></tbody></table> </ephtml> </p> <p>1 *  Age on 1 March 2004.</p> <ulist> <item>2 †   Test for a difference between characteristic at baseline and 6 months after resettlement.</item> <item>3 ‡   Test for a difference between characteristics at 6 months and 12 months after resettlement.</item> <item>4 ¶   Percent of British National Formulary (BNF) recommended dose.</item> <item>5 MOAS, Modified Overt Aggression Scale.</item> </ulist> <hd id="AN0036518950-5">Discussion</hd> <p>Our findings reveal a strong and fairly consistent reduction in observed aggressive challenging behaviour in residents of a long‐stay hospital 6 months and 1 year following community resettlement and differ somewhat from previous studies which have generally shown little change in challenging behaviour after deinstitutionalisation ([<reflink idref="bib4" id="ref20">4</reflink>]; [<reflink idref="bib19" id="ref21">19</reflink>]; [<reflink idref="bib8" id="ref22">8</reflink>]). An overall reduction in aggressive challenging behaviour was seen in 80% of participants and only four individuals' behaviour worsened.</p> <p>Our study is limited to a small sample size and lack of a control group. We are unable to assess whether a similar reduction in challenging behaviour would have been seen had participants remained in hospital. Residents were aware of the imminent resettlement plans and some became unsettled prior to relocation, which may have increased their reported levels of aggressive challenging behaviour at baseline and thus led to an overestimation of the reduction in aggressive challenging behaviour we have observed. We are also unable to control for potential reporting bias as both carers and professionals were committed to the new policy.</p> <p>Nonetheless, it is unlikely that the reduction in verbal aggression, destructiveness, self‐injury and physical aggression we have observed can be totally explained by these limitations. It is possible that factors found to be associated with relocation, such as improved quality of life, greater community participation and increased contact with friends and family ([<reflink idref="bib5" id="ref23">5</reflink>]; [<reflink idref="bib2" id="ref24">2</reflink>]; [<reflink idref="bib19" id="ref25">19</reflink>]; [<reflink idref="bib8" id="ref26">8</reflink>]) played a role in reducing anger and frustration and thus led to a decrease in aggressive challenging behaviour in our population. The reduction in aggressive challenging behaviour we have observed may also be due to careful advanced planning and the person‐centred approach adopted by care home staff, social workers and other specialist health professionals. It is likely that the success of resettlement depends on appropriate consideration of individual needs. There is no 'one placement fits all' solution; any two individuals relocated to the same setting are unlikely to have the same outcome.</p> <p>Finally, we hope that this study will highlight the importance of finding appropriate placements for people with ID who are relocated in the community. In a broader context, further work is needed to examine the role of the environmental setting in the exacerbation or reduction of aggressive challenging behaviour.</p> <hd id="AN0036518950-6">Acknowledgements</hd> <p>We gratefully acknowledge the Leicestershire Partnership NHS Trust and the Department of Health Policy Research Programme who provided funding for this study. We would also like to thank all clients, carers and health professionals involved in the relocation process.</p> <ref id="AN0036518950-7"> <title> References </title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext> Black L., Cullen C. & Novaco R. W. (1997) Anger assessment for people with mild learning disabilities in secure settings. In: Cognitive‐Behaviour Therapy for People with Learning Disability (eds B. Stenfert Kroese, D. Dagnan & K. Loumidis), pp. 33 – 52. Routledge, London.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref24" type="bt">2</bibl> <bibtext> Dagnan D., Ruddick L. & Jones J. (1998) A longitudinal study of the quality of life of older people with intellectual disability after leaving hospital. Journal of Intellectual disability Research 42, 112 – 21.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref2" type="bt">3</bibl> <bibtext> Department of Health (2006) Our Health, Our Care, Our Say: A New Direction for Community Services. HMSO, London.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref3" type="bt">4</bibl> <bibtext> Emerson E. & Hatton C. (1996) Deinstitutionalisation in the UK and Ireland: outcomes for service users. Journal of Intellectual and Developmental Disability 21, 17 – 37.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref1" type="bt">5</bibl> <bibtext> Emerson E., McGill P. & Mansell J. (1994) Severe Learning Disabilities and Challenging Behaviours – Designing High Quality Services. Chapman & Hall, London.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref15" type="bt">6</bibl> <bibtext> Kay S. R., Wolkenfeld F. & Murrill L. M. (1988) Profiles of aggression among psychiatric patients: I. nature and prevalence. Journal of Nervous and Mental Disease 176, 539 – 46.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref17" type="bt">7</bibl> <bibtext> Kho K., Sensky T., Mortimer A. & Corcos C. (1998) Prospective study into factors associated with aggressive incidents in psychiatric acute admission wards. British Journal of Psychiatry 172, 38 – 43.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref5" type="bt">8</bibl> <bibtext> Kim S., Larson S. A. & Lakin K. C. (2001) Behavioural outcomes of deinstitutionalisation for people with intellectual disability: A review of studies conducted between 1980 and 1999. Journal of Intellectual & Developmental Disability 26, 35 – 50.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref6" type="bt">9</bibl> <bibtext> Lakin K. C., Hill B. K., Hauber F. S., Bruinicks R. H. & Heal L. W. (1983) New admissions to a national sample of public residential facilities. American Journal of Mental Retardation 88, 13 – 20.</bibtext> </blist> <blist> <bibtext> McGillivray J. A. & McCabe M. P. (2005) The relationship between residence and the pharmacological management of challenging behavior in individuals with intellectual disability. Journal of Developmental and Physical Disabilities 17, 311 – 25.</bibtext> </blist> <blist> <bibtext> Molyneux P., Emerson E. & Caine A. (1999) Prescription of psychotropic medication to people with intellectual disabilities in primary health care settings. Journal of Applied Research in Intellectual Disabilities 12, 46 – 57.</bibtext> </blist> <blist> <bibtext> Oliver P. C., Crawford M. J., Rao B., Reece B. & Tyrer P. (2007) Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behaviour: a reliability study. Journal of Applied Research in Intellectual Disabilities 20, 368 – 72.</bibtext> </blist> <blist> <bibtext> Robertson J., Emerson E., Gregory N., Hatton C., Kessissoglou S. & Hallam A. (2000) Receipt of psychotropic medication by people with intellectual disability in residential settings. Journal of Intellectual Disability Research 44, 666 – 76.</bibtext> </blist> <blist> <bibtext> Sorgi P., Ratey J., Knoedler D. W., Markert R. J. & Reichman M. (1991) Rating aggression in the clinical setting a retrospective adaptation of the Overt Aggression Scale: preliminary results. Journal of Neuropsychiatry 3, 552 – 6.</bibtext> </blist> <blist> <bibtext> Sparrow S. S., Balla D. A. & Cicchetti D. V. (1984) Vineland Adaptive Behavior Scales: Interview edition, Survey Form. American Guidance Service, Circle Pines, Minnesota.</bibtext> </blist> <blist> <bibtext> StataCorp (2005) Stata User's Guide, Release 9. Stata Corporation, College Station, Texas.</bibtext> </blist> <blist> <bibtext> Tyrer F., McGrother C. W., Thorp C. F., Donaldson M., Bhaumik S., Watson J. M. et al. (2006) Physical aggression towards others in adults with learning disabilities: prevalence and associated factors. Journal of Intellectual Disability Research 50, 295 – 304.</bibtext> </blist> <blist> <bibtext> Tyrer P., Oliver‐Africano P. C., Ahmed Z., Bouras N., Cooray S., Deb S. et al. (2008) Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet 371, 57 – 63.</bibtext> </blist> <blist> <bibtext> Young L., Sigafoos J., Suttie J., Ashman A. & Grevell P. (1998) Deinstitutionalisation of persons with intellectual disabilities: a review of Australian studies. Journal of Intellectual and Developmental Disability 23, 155 – 70.</bibtext> </blist> <blist> <bibtext> Yudofsky S. C., Silver J. M., Jackson W., Endicott J. & Williams D. (1986) The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry 143, 35 – 9.</bibtext> </blist> </ref> <aug> <p>By S. Bhaumik; J. M. Watson; J. Devapriam; L. B. Raju; N. N. Tin; R. Kiani; L. Talbott; R. Parker; L. Moore; S. K. Majumdar; S. K. Ganghadaran; K. Dixon; A. Das Gupta; M. Barrett and F. Tyrer</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib19" firstref="ref4"></nolink> <nolink nlid="nl2" bibid="bib17" firstref="ref8"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref9"></nolink> <nolink nlid="nl4" bibid="bib10" firstref="ref10"></nolink> <nolink nlid="nl5" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref12"></nolink> <nolink nlid="nl7" bibid="bib15" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib20" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib12" firstref="ref18"></nolink> <nolink nlid="nl11" bibid="bib16" firstref="ref19"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ828614
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Aggressive Challenging Behaviour in Adults with Intellectual Disability Following Community Resettlement
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Bhaumik%2C+S%2E%22">Bhaumik, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Watson%2C+J%2E+M%2E%22">Watson, J. M.</searchLink><br /><searchLink fieldCode="AR" term="%22Devapriam%2C+J%2E%22">Devapriam, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Raju%2C+L%2E+B%2E%22">Raju, L. B.</searchLink><br /><searchLink fieldCode="AR" term="%22Tin%2C+N%2E+N%2E%22">Tin, N. N.</searchLink><br /><searchLink fieldCode="AR" term="%22Kiani%2C+R%2E%22">Kiani, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Talbott%2C+L%2E%22">Talbott, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Parker%2C+R%2E%22">Parker, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Moore%2C+L%2E%22">Moore, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Majumdar%2C+S%2E+K%2E%22">Majumdar, S. K.</searchLink><br /><searchLink fieldCode="AR" term="%22Ganghadaran%2C+S%2E+K%2E%22">Ganghadaran, S. K.</searchLink><br /><searchLink fieldCode="AR" term="%22Dixon%2C+K%2E%22">Dixon, K.</searchLink><br /><searchLink fieldCode="AR" term="%22Gupta%2C+A%2E+Das%22">Gupta, A. Das</searchLink><br /><searchLink fieldCode="AR" term="%22Barrett%2C+M%2E%22">Barrett, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Tyrer%2C+F%2E%22">Tyrer, F.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Mar 2009 53(3):298-302.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Blackwell Publishing. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8599; Fax: 781-388-8232; e-mail: customerservices@blackwellpublishing.com; Web site: http://www.blackwellpublishing.com/jnl_default.asp
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 5
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2009
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Land+Settlement%22">Land Settlement</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Aggression%22">Aggression</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Residential+Care%22">Residential Care</searchLink><br /><searchLink fieldCode="DE" term="%22Relocation%22">Relocation</searchLink><br /><searchLink fieldCode="DE" term="%22Measures+%28Individuals%29%22">Measures (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Role%22">Role</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+Kingdom+%28England%29%22">United Kingdom (England)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1365-2788.2008.01111.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0964-2633
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach. Method: The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement. Results: All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P less than 0.001). This reduction remained (but did not decrease further) at 1-year follow-up. Conclusions: Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 21
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2009
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ828614
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ828614
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1365-2788.2008.01111.x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 298
    Subjects:
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Land Settlement
        Type: general
      – SubjectFull: Drug Use
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Aggression
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Residential Care
        Type: general
      – SubjectFull: Relocation
        Type: general
      – SubjectFull: Measures (Individuals)
        Type: general
      – SubjectFull: Hospitals
        Type: general
      – SubjectFull: Role
        Type: general
      – SubjectFull: Environmental Influences
        Type: general
      – SubjectFull: United Kingdom (England)
        Type: general
    Titles:
      – TitleFull: Aggressive Challenging Behaviour in Adults with Intellectual Disability Following Community Resettlement
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Bhaumik, S.
      – PersonEntity:
          Name:
            NameFull: Watson, J. M.
      – PersonEntity:
          Name:
            NameFull: Devapriam, J.
      – PersonEntity:
          Name:
            NameFull: Raju, L. B.
      – PersonEntity:
          Name:
            NameFull: Tin, N. N.
      – PersonEntity:
          Name:
            NameFull: Kiani, R.
      – PersonEntity:
          Name:
            NameFull: Talbott, L.
      – PersonEntity:
          Name:
            NameFull: Parker, R.
      – PersonEntity:
          Name:
            NameFull: Moore, L.
      – PersonEntity:
          Name:
            NameFull: Majumdar, S. K.
      – PersonEntity:
          Name:
            NameFull: Ganghadaran, S. K.
      – PersonEntity:
          Name:
            NameFull: Dixon, K.
      – PersonEntity:
          Name:
            NameFull: Gupta, A. Das
      – PersonEntity:
          Name:
            NameFull: Barrett, M.
      – PersonEntity:
          Name:
            NameFull: Tyrer, F.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 03
              Type: published
              Y: 2009
          Identifiers:
            – Type: issn-print
              Value: 0964-2633
          Numbering:
            – Type: volume
              Value: 53
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Intellectual Disability Research
              Type: main
ResultId 1