Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior.

BACKGROUND: Psychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AIMS: The current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. METHODS AND PROCEDURES: Seventy-two children (aged 9-18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children's externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. OUTCOMES AND RESULTS: The results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 - 3) and TA-BB (M = 4.11; SD = 0.32; range 1 - 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). CONCLUSIONS AND IMPLICATIONS: The current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF.

Eudaimonic well-being in individuals with mild to moderate intellectual disability.

BACKGROUND: Subjective well-being research in individuals with intellectual disability (ID) has a large hedonic focus and eudaimonic well-being is understudied in this population. Knowledge on eudaimonic well-being of individuals with ID is however necessary to improve their experienced well-being and support them in leading meaningful and flourishing lives. AIMS: The current study adopted a qualitative design to examine whether and how people with ID experience elements of eudaimonic well-being. METHODS AND PROCEDURES: Eleven adults with mild to moderate ID participated in individual semi-structured interviews about their subjective well-being. Interviews with their relatives and their direct support providers were conducted to contextualize the data. OUTCOMES AND RESULTS: By means of an interpretative phenomenological analysis, social relationships, accomplishment, purpose and balance, individuality, autonomy, and growth could be identified as relevant elements of eudaimonic well-being. Eudaimonic well-being of individuals with ID seemed to be mediated by acceptance of others. CONCLUSIONS AND IMPLICATIONS: The results provide insight in eudaimonic indicators of well-being, expanding the current view on well-being in individuals with ID. Efforts to use these elements in the care and support for individuals with ID are discussed.

Development and psychometric assessment of a psychological well-being instrument for adults with mild intellectual disability or borderline intellectual functioning.

BACKGROUND: Measuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being. AIMS: The current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF. METHODS AND PROCEDURES: The instrument (SPWB-ID) was adapted from Ryff's scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF. OUTCOMES AND RESULTS: The trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores. CONCLUSIONS AND IMPLICATIONS: The SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Cultural competence in lifelong care and support for individuals with intellectual disabilities.

Objectives: Although an extensive amount of research has been devoted to models defining cultural competence of healthcare professionals in short-term care, there is unclarity about the cultural competencies that professionals providing lifelong care and support should have. The current study aimed to explore which cultural competencies are used by these healthcare professionals, and whether these competencies enabled them to make cultural adaptations to their regular care practices.Design: To investigate cultural competencies and cultural adaptations, semi-structured in-depth interviews were conducted with eight professionals who provide lifelong care and support to individuals with intellectual disabilities. Five cultural competencies were explored: awareness, knowledge, skills, motivation, and encounters.Results: A thematic analysis of the interviews revealed that professionals providing lifelong care and support used all cultural competencies in their care practices. Moreover, our analysis suggested that these competencies could be categorized as either practical or analytical cultural competencies. Although these competencies were conditional in order to make cultural adaptations to care practices, the presence of cultural competencies did not automatically lead to these cultural adaptations.Conclusions: All five cultural competencies were used by professionals in lifelong care and support. Our analysis revealed that both practical and analytical cultural competencies were essential in providing culturally sensitive lifelong care and support. We additionally suggest that the cultural competence of professionals is necessary, but not sufficient, for making cultural adaptations to lifelong care and support for individuals with intellectual disabilities. In many cases, other factors also played a role in a professional's final decision to adapt their care practices.

Providers' perspectives on factors complicating the culturally sensitive care of individuals with intellectual disabilities.

BACKGROUND: Culturally sensitive care is essential for improving healthcare for ethnic minorities with intellectual disabilities (ID), who require intensive, sometimes lifelong, care and support. AIMS: The present study aimed to uncover factors that may complicate the delivery of culturally sensitive care for ethnic minorities with ID, which have not previously been studied for this group. METHODS AND PROCEDURES: By means of in-depth interviews with care professionals we identified these factors at the care receiver, professional, and institutional levels. OUTCOMES AND RESULTS: Eight factors were found to complicate the delivery of culturally sensitive care: abilities of the individuals with ID, communication with the family of the care receiver, cultural competency of the professional, personal attitude and experience of the professional, job position and responsibilities of the professional, resources, legislation and protocols, and the team of colleagues. The factors at the care receiver level were specific for the delivery of culturally sensitive care to individuals with ID. CONCLUSIONS AND IMPLICATIONS: In addition to the complicating factors previously identified for other forms of culturally sensitive healthcare, we identified novel complicating factors for the care of individuals with ID. Future research should investigate how these complicating factors could be overcome.