Reducing antipsychotic medication in ID using QI methodology
| DOI | https://doi.org/10.1108/AMHID-11-2018-0046 |
| Date | 12 June 2019 |
| Pages | 113-122 |
| Published date | 12 June 2019 |
| Author | Rebecca Rose Conway,Bhathika Perera,Ken Courtenay,Spyros Tsolakidis,Sheetal Gopal |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Reducing antipsychotic medication in ID
using QI methodology
Rebecca Rose Conway, Bhathika Perera, Ken Courtenay, Spyros Tsolakidis and
Sheetal Gopal
Abstract
Purpose –Research highlights that antipsychotic medications are prescribed more in people with
Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological
interventions recomm ended as alternatives, thei r application can be challeng ing due to heterogeneity of the
patient group. The pur pose of this paper is to discuss app lication of quality improvemen t (QI) methodology
in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of
antipsychotic medica tion.
Design/methodology/approach –Two interventions were introduced as “tests of change”;an“Attention-
Deficit Hyperactivity Disorder (ADHD) clinic”and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global
Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total an tipsychotic use)
were used to assess the interventions, with each being reviewed as per QI methodology guidelines.
Findings –There was an improvement in CGI scores for both interventions. MOAS scores reduced for those
attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce
for the PBS clinic, so there was no reduction in medication for this group.
Originality/value –Based on the introduction of pilot clinics, this paper provides a commentary on how QI
interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of
patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and
challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper
demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no
existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations,
emphasising scope for future research and service evaluation.
Keywords Quality improvement, Intellectual disability, Challenging behaviour, ADHD,
Positive behaviour support, Reducing antipsychotic medication
Paper type Research paper
Introduction
It is estimated that nearly 2.7 per cent of the UK population has a diagnosis of Intellectual Disability
(ID); (Hatton et al., 2015) with a large proportion of this population displaying challenging behaviour
(Sheehan et al., 2015). Challenging behaviour is a socially constructed term, defining socially
unacceptable behaviour of a frequency, severity and duration which poses a risk to the safety of the
individual or others (Emerson and Bromley, 1995). Around 18 per cent of people w ith ID are
estimated to present with challenging behaviour, such as self-injurious, aggres sive,destructive and/
or stereotyped behaviours (Bowring et al., 2016). Lowe et al. (2007) further reports that people with
ID present with multiple behavioural difficulties, with behaviours considered less severe still having
major impact on their social adjustment and functioning. Identification and provision of effective
interventions is therefore important for providing support for this group of people.
Assessing and managing challenging behaviour
Assessing challenging behaviour consists of functional analysis to gain understanding of the
reasons behind specific behaviours, with further multidisciplinary assessments for more complex
Received 25 November 2018
Revised 3 April 2019
Accepted 29 May 2019
Rebecca Rose Conway,
Bhathika Perera,
Ken Courtenay, Spyros
Tsolakidis and Sheetal Gopal
are all based in Mental Health
Services, North London, UK.
DOI 10.1108/AMHID-11-2018-0046 VOL. 13 NO. 3/4 2019, pp.113-122, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE113
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