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  • Tilburg University

    Challenging relationships

    Willems, A.P.A.M.

    Document version: Publisher's PDF, also known as Version of record

    Publication date: 2016

    Link to publication

    Citation for published version (APA): Willems, A. P. A. M. (2016). Challenging relationships: Staff interactions in supporting persons with intellectual disabilities and challenging behaviour. Maastricht: Datawyse/Universitaire Pers Maastricht.

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    Download date: 14. Mar. 2020


  • CHALLENGING RELATIONSHIPS Staff interactions in supporting persons with intellectual disabilities and challenging behaviour

    Arno Willems

  • Het onderzoek beschreven in dit proefschrift werd uitgevoerd binnen Tranzo, Tilburg School for Social and Behavioral Sciences, Tilburg University.

    Het onderzoek beschreven in dit proefschrift werd deels gefinancierd door MFCG-Limburg.

    Het drukken van dit proefschrift werd mede mogelijk gemaakt door Koraal Groep.

    Het beeld op de omslag heeft Margo Janssen voor mij gemaakt. Ze laat het gieten in brons. © Copyright Arno Willems, Heel, 2016 ISBN 978 94 6159 598 0 Drukwerk: Datawyse | Universitaire Pers Maastricht All rights reserved. No part of this dissertation may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.


    U PM


    Staff interactions in supporting persons with intellectual disabilities and challenging behaviour


    ter verkrijging van de graad van doctor aan Tilburg University op gezag van de rector magnificus, prof. dr. E.H.L. Aarts,

    in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie

    in de aula van de Universiteit op vrijdag 11 november 2016 om 14.00 uur


    Arnold Pieter Augustinus Maria Willems

    geboren op 20 december 1958 te Schinnen

  • Promotores: prof. dr. P.J.C.M. Embregts prof. dr. A.M.T. Bosman Copromotor: dr. A.H.C. Hendriks Overige leden van de Promotiecommissie: prof. dr. B. Maes prof. dr. B.K.G. van Meijel prof. dr. Ch. van Nieuwenhuizen prof. dr. S. Vandevelde dr. P.S. Sterkenburg

  • in de mooie stilte van heel samen ligt alleen als diepste uitdaging (30 april 2016)

  • voor Margo voor hoe jij heelt

    voor hoe jij uitdaagt

  • 9


    Chapter 1 General introduction 11

    Chapter 2 The relation between intrapersonal and interpersonal staff behaviour towards clients with ID and challenging behaviour: A validation study of the Staff-Client Interactive Behaviour Inventory 35

    Chapter 3 Measuring staff behavior towards clients with ID and challenging behavior: Further psychometric evaluation of the Staff-Client Interactive Behavior Inventory (SCIBI) 53

    Chapter 4 The analysis of challenging relations: Influences on interactive behaviour of staff towards clients with intellectual disabilities 71

    Chapter 5 Towards a framework in interaction training for staff working with clients with intellectual disabilities and challenging behaviour 87

    Chapter 6 Dynamic patterns of three staff members interacting with a client with an intellectual disability and challenging behaviour: Suggestions for coaching 111

    Chapter 7 General discussion 139

    Summary 161 Samenvatting 171 Dankwoord 181 Curriculum Vitae 187 Publications 189

  • 11

    Chapter 1 General introduction


    Chapter 1 General introduction




    Like everybody else, individuals with intellectual disabilities experience periods of being distressed, when the fit between their personal capacity (both strengths/resilience and weaknesses/vulnerabilities) and their social and physical environment (both possibilities and demands) is limited (Delespaul, Milo, Schalken, Boevink, & Van Os, 2016; Wehmeyer, 2013). This imbalance is usually diagnosed as a mental disorder or defined as challenging behaviour, which can be a great burden for the individuals with an intellectual disability, for their relatives, the professionals and other members of their social network, and may even lead to exclusion from community life (Van Oorsouw, 2013). People with an intellectual disability can be diagnosed with almost any one of present-day mental disorders (Fletcher, Loschen, Stavrakaki, & First, 2007). Forms of challenging behaviour consist of externalizing behaviours such as aggression and destruction as well as internalizing behaviours such as social withdrawal and self-injurious behaviour (Emerson, 1995). Challenging behaviour is present in 10-15% of all people with intellectual disabilities and more severe levels of challenging behaviour are found in 5-10% (Kiernan et al, 1997).

    People with intellectual disabilities run a risk of developing mental disorders or challenging behaviour three times higher than people without (Dekker, Koot, Van der Ende, & Verhulst, 2002; Emerson et al., 1997; Einfeld et al., 2006; Wallander, Dekker, & Koot, 2003). This higher risk is partly explained by their limited intellectual capacities and social-adaptive capabilities, such as insufficient reasoning and communication skills. Other aspects that contribute to challenging behaviour are increased risks of traumatic or negative life histories, impoverished social networks, lack of meaningful activity or employment, sensory or health problems, and genetic syndromes (Hastings, et al., 2013).

    Although diagnoses and definitions of challenging behaviour are useful as a general and internationally shared language, they only prove their value when clear support needs can be determined and useful types of support or treatment can be provided (Van Os, 2014). The focus of my daily work as a clinical psychologist in MFCG-Limburg is giving advice concerning support or treatment to staff. MFCG-Limburg is a multidisciplinary consultative team on mental disorders and challenging behaviour for organizations supporting people with intellectual disabilities. Support staff and their supervising psychologists in these organizations face difficulties in their task and responsibility of restoring this imbalance in people with intellectual disabilities and even more, in supporting them in their search for well-being and mental health. Support staff also experience higher levels of stress, burnout and mental health problems, when working with people with intellectual disabilities and challenging behaviour (Hensel, Lunsky, & Dewa, 2013; Shead, Scott, & Rose, 2016; Smyth, Healy, & Lydon, 2015).

    In this thesis, I will focus on support staff who are the backbone of the support for people with all levels of intellectual disabilities and challenging behaviour, with the



    purpose of empowering them in the challenging care they provide, by offering them training, coaching, and team consultation. MFCG-Limburg recognized the significance of the role of support staff in treating challenging behaviour and partly funded the research presented in this thesis that started in 2009.


    Looking at support or care from an ethical point of view, people who need support in their lives, especially when they are behaviourally or mentally off-balance, depend on other people for that support (Reinders, 2000). In case of people with intellectual disabilities, this other person is often a professional caregiver. Moreover, in case of severe challenging behaviour or lower levels of intellectual functioning, professional long-lasting support has not been an autonomous choice of the person himself. This dependency means that professional caregivers need to be reliable for, sensitive and attuned to, compassionate with, and interested in the people they care for (Baart, 2001; Leget, 2006; Van Heijst, 2005). And it is precisely this emphasis on the value and quality of the professional-client relationship that is at the very heart of a rather new paradigm in care eth