PhD study

‘Organisational environment and challenging behaviour in people with intellectual disabilities’

CCE has started a PhD study in 2016, which is a collaboration with the Erasmus School of Health Policy and Management in Rotterdam (Erasmus University). The study subject is ‘Influence of the organisational environment on challenging behaviour in people with intellectual disabilities’.

This PhD consists of five studies:

1. Literature review

2. Qualitative study based on interviews with professionals

3. Qualitative study based on interviews with residents and family members

4. Qualitative study based on longitudinal study into organisations

5. Quantitative study of the organisational environment and residents displaying challenging behaviour

Abstract 1 – literature review

Organisational environment and challenging behaviour in services for people with intellectual disabilities: A review of the literature

V.C. Olivier-Pijpers, J. M. Cramm, W. H. E. Buntinx and A.P. Nieboer (2018) ALTER, European Journal of Disability Research

Background

This literature review explores the relationship between the organisational environment of residential disability services and challenging behaviour in people with intellectual disabilities (ID) using Bronfenbrenner’s ecological theory as a theoretical framework.

Method

Literature published between 2000–2016 was retrieved, using a scoping study with the search terms ‘intellectual disability’, ‘challenging behaviour’, and ‘organisation’.

Results

At all layers of Bronfenbrenner’s ecological theory, relationships were identified. Organisational aspects affect staff and residents with ID and challenging behaviour ranging from overall disability policy and budget systems (macrosystem), to organisational philosophy, leadership, power structure, staff coaching and working methods (exosystem), to staff beliefs and attitudes(microsystem) and client characteristics (ontosystem).

Conclusions

The use of an ecological model for residents with ID and challenging behaviour helps to identify organisational environment aspects that influence challenging behaviour in residents with ID. Under-standing organisational environments in terms of their ecology enhances evidence-based provision of quality supports to this population.

Abstract 2 – interviews with professionals

Influence of the Organisational Environment on Challenging Behaviour in People with Intellectual Disabilities: Professionals’ Views

V.C. Olivier-Pijpers, J.M. Cramm and A. P. Nieboer (2018)

JARID, Journal of Applied Research in Intellectual Disabilities

Background

We examined the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID) to increase understanding of the quality of support services for people with ID.

Method

Twenty-one professionals and managers from four specialised Dutch disability service organisations were interviewed. Data were analysed with a grounded theory approach, using Bronfenbrenner’s ecological theory as a sensitising frame.

Results

The organisational environment (i.e. vision, values, sufficient resources) is related via the support service (i.e. providing stability, constant awareness) to residents’ challenging behaviour, and is also linked directly to challenging behaviour (e.g. living environment, values). Organisations are restricted by national regulations, negative media attention, and changing societal values, which negatively influence quality of support.

Conclusions

The creation of a supportive organisational environment for staff, who in turn can provide quality support services to residents with demanding care needs, was found to prevent challenging behaviour in people with ID.

Abstract 3 - interviews with residents and family members

Residents’ and resident representatives’ perspectives on the influence of the organisational environment on challenging behaviour

V.C. Olivier-Pijpers, J.M. Cramm and A.P. Nieboer (2020)

Research in Development Disabilities

Background

This study explored the perspectives of residents of residential disability service organisations and resident representatives on the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID).

Method

Sixteen residents and representatives from four specialised Dutch disability service organisations were interviewed. Data were analysed using a grounded theory approach, with a sensitising frame based on Bronfenbrenner’s ecological theory.

Results

Some organisational factors (e.g. staff turnover, insufficient finances) can have negative effects on interactions among residents and staff and family members, resulting in more challenging behaviour, but other organisational factors (e.g. shared vision, values and expectations, competent staff) can positively influence staffs’ attitudes and actions, which in turn helps to manage challenging behaviour in people with ID.

Conclusions

Residents’ and representatives’ perspectives provide a better understanding of the positive and negative influences of the organisational environment on challenging behaviour in people with ID.

Abstract 4 - Qualitative study based on longitudinal study into organisations

Multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours

Vanessa Charissa Olivier‐Pijpers, Jane Murray Cramm, Wouter Landman, Anna Petra Nieboer (2020)

JARID, Journal of Applied Research in Intellectual Disabilities

Background

The present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents’ support and subsequently their challenging behaviours.

Method

In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method.

Results

Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members’ ability to change; clear boundaries between formal and informal caregivers; and staff’s feelings of being unheard.

Conclusions

Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.

Abstract 5 - quantitative study of the organisational environment and residents displaying challenging behaviour

Cross-sectional investigation of relationships between the organisational environment and challenging behaviours in support services for residents with intellectual disabilities

V.C. Olivier-Pijpers, J.M. Cramm b , A.P. Nieboer (2020)

Heliyon

Background

This study was conducted to assess relationships between the organisational environment and three types of challenging behaviour (self-injurious, aggressive/destructive and stereotypical) in support services for residents with intellectual disabilities using ecological theory.

Method

A cross-sectional questionnaire-based design was used to identify relationships between ecological system aspects at multiple levels (micro-, meso-, exo-, macro- and chronosystems) and challenging behaviours of residents. A questionnaire was distributed to care professionals and managers working in specialised Dutch service organisations for residents with intellectual disabilities and challenging behaviour. The data were examined by Pearson correlation and multivariate regression analyses.

Results

The questionnaire was completed by 922 respondents from 21 organisations. Responses revealed that organisational aspects at the micro-, meso-, exo- and macrosystem levels play roles in residents' challenging behaviour. These aspects range from staff members' ability to sensitively interact with residents to grouping of residents with challenging behaviour, and staff turnover.

Conclusions

In the prevention and management of challenging behaviour of residents with intellectual disabilities, the consideration of ecological aspects at all system levels in the organisational environment is required.