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Intellectual Disabilities With Other Behavioral SymptomsNCT03917329

Evaluation of an ACT and PBS Group for Parents and Education Staff

A study testing ACT and PBS group workshop in people with Intellectual Disabilities With Other Behavioral Symptoms and Acceptance Processes, run by University of Edinburgh at 2 sites in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Parents and education staff who work with children with intellectual disabilities (ID) are known to be at a higher risk of experiencing psychological distress. This study evaluates whether a therapeutic group for parents and education staff who work with children with ID is effective in reducing psychological distress… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
ACT and PBS group workshop
Could I receive a placebo?
No, everyone receives an active treatment
How many people
37 participants
Where
2 sitesUnited Kingdom
Study dates
29 Mar 2019to 16 Dec 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Parent or Guardian of a Child aged 5-18 with a diagnosis of an Intellectual Disability/Learning Disability and experience of challenging behaviour.
  • OR an employee working in a school for children with additional support needs, directly working with children with diagnosed Intellectual/Learning Disabilities.
  • Must speak English fluently.
  • Must be able to provide informed consent.

Who cannot join

  • Temporary staff members (contract remaining of less than six months).
  • Parents or Education Staff aged less than 18 years old.
  • Parents or Education staff that have a diagnosis of an ID, such that they would not be able to understand the group materials or questionnaires and complete them independently.
  • Individuals who are not able to provide informed consent.

Trial locations and contacts

2 sites in 1 country.

United Kingdom2 sites
  • CAMHS-LD, NHS Lothian

    Edinburgh, Midlothian, EH9 2AR

  • Edinburgh City Council

    Edinburgh, various

Other trials in United Kingdom

About this study

Official title: An Evaluation of an ACT and PBS Group for Parents and Education Staff of Children and Young People With an Intellectual Disability

Parents and education staff who work with children with intellectual disabilities (ID) are known to be at a higher risk of experiencing psychological distress. This study evaluates whether a therapeutic group for parents and education staff who work with children with ID is effective in reducing psychological distress and if so, how it does this and who it works for. The group will include two components: an Acceptance and Commitment Therapy (ACT) section and a section about positive behaviour support (PBS). ACT is a psychological therapy, the aim of which is to help people to live their lives based on what matters to them, whilst learning new ways of managing difficult thoughts and feelings.

The PBS section aims to help participants to learn how to use positive strategies to reduce challenging behaviour. Both interventions have been shown to be effective on their own, but this study will examine if combining the two is helpful. Parents of children with ID and education staff who work closely with children with ID attending chosen schools or learning disability child and adolescent mental health services in NHS Lothian will be invited to participate in the study. The group will take place on three half days. Participants will complete questionnaires on the first and last day of the group and six weeks after it has finished. The questionnaires will be about psychological distress, confidence in caring for children with ID and seeing if the group changed how they cope with thoughts and feelings. Participants will also be invited to a focus group, which will think about if the intervention was helpful, and if so how it helped. If the group is effective, the investigators would hope to research the intervention in more depth with the aim of it being offered more widely in the future.

Read the detailed description

Study Design

The study has a mixed methods design. The mixed methods approach allows the utilisation both quantitative and qualitative approaches to gain a greater level of detail than either one methodology would allow for individually, and for the results to support a firmer conclusion if the differing methodologies corroborate each other.

Protocol

The Learning Disability Child and Adolescent Mental Health Service (LD-CAMHS) service in NHS Lothian (National Health Service board located in Scotland) and schools for children with special educational needs in the City of Edinburgh Council area will be invited to participate in the study. Senior education staff (Headteachers or Deputy Headteachers) and LD-CAMHS clinicians will be asked to identify potential participants based on the study inclusion and exclusion criteria. They will then be asked to provide potential participants with the participant information sheet and discuss this with them, inviting potential participants to ask any questions that they may have. LD-CAMHS clinicians and education staff are suitable for this role as they are likely to be aware of children's diagnoses and whether the family have reported that their child presents with challenging behaviour, or aware of education staff's role and length of their remaining contract. Examples and a definition of challenging behaviour will be provided as a general guide to support the identification of participants. Interested potential participants will be given a minimum of 24 hours to consider whether they want to participate.

If interested in taking part, participants will be asked to complete and return a contact details form to their LD-CAMHS clinician or to senior education staff. The research team will contact the clinicians and senior education staff at agreed time intervals (e.g. once a week) to see if there are forms to be collected. In the contact details form, participants will be asked to indicate what time of day suits them best to be contacted. Participants will then receive a telephone call from the researcher to answer any questions they may have and to discuss their availability to attend the ACT and PBS group (e.g. would during or after school hours be preferable, are there certain days of the week that would suit them best, would location be a barrier).

Groups will aim to have 10 participants, with the expectation that some participants will choose to drop out of the study at this point, probably reducing the group size to approximately 6 to 8 participants. Participants will be allocated to attend a group based on their participant number, whether they are education staff or a parent, their location and availability. Participants will be sent a letter advising of the dates and location of their allocated group sessions and focus group. Should participants contact the researcher to advise that they cannot attend on these dates, they will be re-allocated to an alternative group if possible.

The ACT and PBS group will take place in a community setting such as an appropriate room in a school or in an NHS building. Participants will complete the study consent form with the study researchers on an individual basis before the first group session begins. This will provide a further opportunity for participants to ask any questions that they may have, and for the study researchers to ensure that participants are fully informed about the study and that they are making an informed decision to participate. Participants will then complete a battery of measures at the beginning of the first group session, at the end of the third group session and at the beginning of the focus group, which will take place six weeks after the last group session. Should a participant choose not to take part in the focus group, they will be sent a copy of the questionnaires by post and asked to return them by post via a returns envelope provided, or to their LD-CAMHS clinician or school.

The group workshop will run for three mornings, afternoons or evenings over three consecutive weeks (e.g. three Friday mornings). The sessions will last for approximately three to three and a half hours, with a break and refreshments in between. The group sessions will include taking part in exercises such as mindfulness, having group discussions, learning about new ways of managing difficult thoughts and feelings, and learning about new ways of supporting challenging behaviours in a positive way. Participants can decide not to take part in a component of the group should they prefer not to. Education staff and parents will attend separate groups. The group sessions will be facilitated by the study researchers, namely, a Trainee Clinical Psychologist and Clinical Psychologist who have both completed relevant ACT and PBS teaching and training and have experience in working with these psychological interventions.

The focus group will take place approximately six weeks later and will take approximately one hour in a similar setting as the therapy group. The group will be facilitated by a researcher who did not facilitate the participants' therapy group, to increase the likelihood that they will feel able to discuss the group freely. This researcher may be a LD-CAMHS clinician. The group will be audio-recorded with an NHS Lothian encrypted and password protected audio recorder, to allow for the group discussion to be transcribed and analysed. Participants who do not attend one or more of the group sessions will be welcome to attend the remaining sessions if they so wish but will be excluded from any relevant analyses. Participants may take part in the focus group if they have attended at least one group session.

Number of Participants

  • The investigators will aim to recruit approximately 40 participants to the study (10 participants allocated to four groups).
  • Number of sites involved: The investigators anticipate that there will be 8 (LD-CAMHS and up to 7 schools for children with special educational needs).
  • Length of recruitment period: Estimated at approximately six to eight months.

Sample Size Calculation

Power calculations were performed utilising G-Power 3.1. The statistical analysis was set to be a with a within-between interaction, with two groups and three measurement points. The alpha level was set to 0.05 and power to 0.80, as per convention. The effect size previously reported for psychological distress in a similar study was medium to large. To be conservative, the power calculation for this study was performed with a medium effect size (f=0.25), which suggested a total sample size of 28 participants. Therefore, this study will aim to have four groups with ten participants each. This would mean recruiting 40 participants, with the expectation that 12 would be lost to attrition.

Proposed Analyses

The mean, standard deviation and range of the demographic variables and dependent variables will be reported. The percentage of missing data across the measures will also be reported.

Regarding quantitative data, the statistical analysis will be completed using SPSS software. Data will be explored to ensure that test assumptions are met. Each dependent variable will then be analysed with repeated measures analyses of variance (ANOVA) with a within-between interaction, with significant effects further evaluated appropriately.

Regarding qualitative data, the focus group interview transcripts will be analysed with thematic analysis.

Management of Missing Data

Should the level of missing data be minimal (<5%), the data will be assumed to be missing at random and a suitable method of imputation (most likely multiple imputation due to the small sample size) will be used to manage this appropriately. Should a higher level of missing data occur, the missing data will be analysed to examine whether it is missing at random or not. A suitable method of imputation will then be used.

Adverse Events

Should multiple participants present with high levels of persistent distress that appear to be related to participating in the group, this will be reviewed by the Chief investigator and researchers.

Being tested
ACT and PBS group workshop
Keywords
Parents, Education staff, Teachers, Intellectual Disability, Learning Disability, Positive Behaviour Support, Acceptance and Commitment Therapy, Group Therapy, Children, Psychological Distress
Medical subject headings
Behavior, Burnout, Professional, Intellectual Disability, Learning Disabilities

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ACT and PBS group workshopOther

    Acceptance and Commitment Therapy and Positive Behaviour Support Group Workshop. Three sessions of approximately three hour duration. Groups will consist of 5-10 parents or 5-10 members of education staff. The group will include both didactic and experiential elements.

Study groups in NCT03917329
Study groupRoleWhat they receive
ACT and PBS group workshopOtherThe intervention in this study is an Acceptance and Commitment Therapy (ACT) and Positive Behaviour Support (PBS) group workshop for parents and education staff of children with intellectual disabilities.
Receives: Other: ACT and PBS group workshop

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Depression Anxiety and Stress Scale 21 item (DASS-21)

    The DASS-21 is a 21 item outcome measure of psychological distress, and as such can measure change in psychological distress when multiple measurements are taken. The DASS-21 has three subscales of depression (range 0-21), anxiety (range 0-20) and stress (range 0-21), where higher scores are indicative of higher levels of psychological distress. The scores are multiplied by two to be comparable to the longer form of this measure, the DASS-42.

    Measured: Pre-intervention (day 1, immediately before first group session), Post-intervention (at two weeks, day 15, at the end of the third group session) and at a six-week follow up (before the focus group).

Secondary outcomes (3)
  1. Copenhagen Burnout Inventory (CBI)

    The CBI is a 19 item outcome measure of burnout and as such measures changes in burnout. The CBI has three subscales of personal burnout (range 0-100), work related burnout (range 0-100), and client related burnout (range 0-100). In each subscale, scores 50-74 are indicative of moderate burnout, scores 75-99 are indicative of high levels of burnout, and a score of 100 is indicative of severe levels of burnout.

    Measured: Pre-intervention (day 1, immediately before first group session), Post-intervention (at two weeks, day 15, at the end of the third group session) and at a six-week follow up (before the focus group).

  2. Comprehensive Assessment of Acceptance and Commitment Therapy Processes (ComPACT)

    ComPACT is a 23 item outcome measure of ACT processes and as such measures changes in ACT processes over time. ComPACT has a range of possible scores between 0 and 138, where higher scores are indicative of higher levels of psychological flexibility. The measure has three subscales - openess to experience (range 0-60), behavioural awareness (range 0-30) and valued action (range 0 to 48).

    Measured: Pre-intervention (day 1, immediately before first group session), Post-intervention (at two weeks, day 15, at the end of the third group session) and at a six-week follow up (before the focus group).

  3. Challenging Behaviour Self-Efficacy Scale (CBSES)

    CBSES is a 5 item outcome measure of self-efficacy for managing challenging behaviour, and as such measures changes in this self-efficacy over time. The range of scores is 0 to 35, where higher scores are indicative of higher levels of self-efficacy for managing challenging behaviours in children with learning disabilities.

    Measured: Pre-intervention (day 1, immediately before first group session), Post-intervention (at two weeks, day 15, at the end of the third group session) and at a six-week follow up (before the focus group).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Apr 2019
  2. Study start29 Mar 2019
  3. Primary completion16 Dec 2019
  4. Study completion16 Dec 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Participants will take part in a three session Acceptance and Commitment Therapy and Positive Behaviour Support group workshop and a focus group at a six week follow-up point. Pre-intervention, post-intervention and follow-up quantitative outcome questionnaire data will be gathered.
Masking
None (open label)
Enrolment
37 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03917329
Sponsor's protocol ID
251260
Status last verified
Mar 2020
First submitted
6 Nov 2018
Last updated
25 Mar 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.

    PubMed 17695343
  • Cunningham, J. B., & McCrum-Gardner, E. (2007). Power, effect and sample size using GPower: Practical issues for researchers and members of research ethics committees. Evidence Based Midwifery, 5(4), 132-136.

  • McConachie DA, McKenzie K, Morris PG, Walley RM. Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities. Res Dev Disabil. 2014 Jun;35(6):1216-27. doi: 10.1016/j.ridd.2014.03.005. Epub 2014 Mar 28.

    PubMed 24685937

Questions about this trial

What is this clinical trial studying?

A study testing ACT and PBS group workshop in people with Intellectual Disabilities With Other Behavioral Symptoms and Acceptance Processes, run by University of Edinburgh at 2 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Depression Anxiety and Stress Scale 21 item (DASS-21) (time frame: Pre-intervention (day 1, immediately before first group session), Post-intervention (at two weeks, day 15, at the end of the third group session) and at a six-week follow up (before the focus group).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03917329, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Mar 2020.

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