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To examine the feasibility and acceptability of NIDUS-Family, a 6–8 session manualised, individually tailored, modular intervention supporting independence at home for people with dementia; and explore participants' and facilitators' experiences of the intervention. In this single group multi-site feasibility study, trained, supervised non-clinically qualified graduates (facilitators) delivered NIDUS-Family to family carer and people living with dementia dyads. We recruited participants from GP practices and memory services in London and Bradford. We completed quantitative outcomes pre- and post-intervention; and conducted qualitative interviews with participants and facilitators. Our pre-specified main outcomes were proportion of potential participants approached who agreed to participate, intervention adherence and acceptability to family carers, and facilitator fidelity to the manual. We recruited 16 dyads (57% of those approached); 12 (75%) completed the intervention. Of 12 participants rating intervention acceptability, 9 (75%) agreed or strongly agreed that it had helped; 2 (18%) neither agreed nor disagreed and 1 (8%) disagreed. Mean facilitator fidelity was high (81.5%). Dyads set on average 3.9 goals; these most commonly related to getting out and about and increasing activity/hobby participation (n = 10); carer wellbeing (n = 6), managing physical complaints (n = 6); meal preparation/cooking (n = 5); and reducing irritability, frustration or aggression (n = 5). Almost all secondary outcomes changed in a direction indicating improvement. In our qualitative analysis we identified three overarching themes; relationships facilitate change, goal-focused versus manualised approach and balancing the needs of carers and people with dementia. NIDUS-Family was feasible and acceptable to participants. Following refinements, testing in a pragmatic trial is underway. [ABSTRACT FROM AUTHOR]

Measuring therapists' adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome. [ABSTRACT FROM AUTHOR]

Background: As both epilepsy and challenging behaviour are highly prevalent in adults with intellectual disability (ID) it is important to explore any potential relationships between the two to inform patient care. The aim of the present study was to investigate the relationship between epilepsy factors and challenging behaviour in adults with ID. Method: The sample was drawn from a clinical trial cohort (n = 246), with all participants displaying challenging behaviour across the range of ID. We described sociodemographic and clinical status (seizure types, seizure frequency and drug burden) in 70 participants with epilepsy (EP). We investigated differences in and predictors of challenging behaviour and mental ill-health, measured by the Aberrant Behaviour Checklist-Community and the Mini Psychiatric Assessment Schedule for Adults with Developmental Disabilities respectively, between participants with and without epilepsy (NEP). Results: More male participants were identified with epilepsy (EP = 76% and NEP = 61%, p =.026) and the EP group had lower adaptive behaviour scores than their NEP counterparts (Mean (SD) EP = 44.4 (24.1), NEP = 51.7 (25.0), p =.04). EP participants showed significantly less lethargy as measured by the Aberrant Behaviour Checklist-Community than NEP participants (Mean (SD) EP = 11.9 (7.4) and NEP = 15.1 (9.9); t-test p =.02). Younger age and poorer adaptive functioning were associated with challenging behaviour (beta=−.520, p <.001 and beta=−0.30, p <.001, respectively). Conclusions: These findings indicate that epilepsy does not appear to be associated with challenging behaviour in adults with ID. Therefore, while management of epilepsy is very important in a clinical context, it is essential that professionals should further elucidate reasons for the presentation of such behaviours in order to provide timely and targeted interventions. [ABSTRACT FROM AUTHOR]

Introduction: The Resident Choice Assessment Scale (RCAS) is used to assess choice availability for adults with intellectual disabilities (ID). The aim of the study was to explore the factor structure, construct validity, and internal consistency of the measure in community settings to further validate this tool. Method: 108 paid carers of adults with ID living in supported accommodation and residential care facilities in urban, rural, and semirural areas in England completed the RCAS. Exploratory factor analyses were performed and the construct validity and internal consistency of the emerging factors were assessed. Results: Principal axis factoring with oblique rotations suggested a scale with two factors (Everyday Choices and Participation in Household Activities) which explained 45% of the variance; the factors showed favorable construct validity as they identified significant differences between those living in residential care homes compared with supported living; the factors also differentiated between people with different levels of intellectual impairment with less choice and participation in domestic activities for those with more severe ID compared to their counterparts with moderate and mild impairment. Five items did not load onto any factor, suggesting that these could be dropped from the scale when administered in community settings, thus resulting in an 18-item measure (RCAS-18). Conclusion: The RCAS-18 may provide a useful measure to assess choice availability for people with ID supported by paid carers in the community. The revised measure may be more suitable in capturing choice than the original version for use in community samples. [ABSTRACT FROM AUTHOR]