Short-term Psycho-Education for Carers To Reduce Over Medication of people with intellectual disabilities: Programme Development Project (SPECTROM PDP)
Year: 2025
Type: report
Study design: Clinical Trial
Abstract: Background Overmedication of people with intellectual disabilities, particularly the off-licence use of psychotropic medicines for behaviours that challenge (BtC), is a significant public health concern. To address this issue, NHS England in the UK launched an initiative called ‘STopping Over-Medication of People with learning disabilities, autism or both (STOMP)’. However, limited resources are available to implement STOMP. Staff who support adults with intellectual disabilities play a pivotal role in the prescribing process. Thus, properly training staff should reduce the number of staff requests for medicines for BtC. Previous field tests on SPECTROM (N=60) showed a positive impact, but none of these were RCTs. Thus, there is a need for a feasibility RCT before a large-scale RCT. Aims The primary aim of the study was to evaluate the feasibility of conducting an appropriately powered cluster randomised controlled trial (RCT) involving SPECTROM. Methods Clusters (community homes and supported living accommodations) were randomised to SPECTROM or the control arm in a 2:1 ratio. Only participants in the SPECTROM arm received the SPECTROM training. Both groups received the standard training from their organisations. SPECTROM is a hybrid/blended learning program comprising 14 modules and includes internal and external resources. Two of these 14 modules were used for face-to-face training, through which the other modules and resources were introduced. These two core modules are Medicine/STOMP and Alternatives to medication (ATM). Anonymised psychotropic medicine prescriptions were collected pre and post-training at six months to detect any signal of SPECTROM’s effect. Changes in staff attitude toward BtC and psychotropic knowledge were assessed by analysing pre- and post-training data at 4 weeks and 6 months using the Management of Aggression and Violence Attitudes Scale-Revised-Intellectual Disabilities (MAVAS-R-ID) and the Psychotropic Knowledge Questionnaire-Revised (PKQ-R). A mixed-methods process evaluation involving a questionnaire and two focus groups, one with service managers (n = 7) and one with support staff (n = 7), was conducted to assess the barriers and facilitators of SPECTROM training. Results 26 homes were randomised to the SPECTROM and 13 in the control arm. SPECTROM training was delivered to 140 staff. The training sessions were delivered online via MS Teams by the research team, each lasting 4 hours. There was a greater total antipsychotic and antidepressant dose reduction at the six-month follow-up in the SPECTROM (7.5% and 2.4%, respectively) compared to the control arm (2.7% and 1.2%, respectively). There was a significant improvement in the overall PKQ-R scores (p<0.001) and MAVAS-R-ID scores at four weeks (p<0.01). The change-over-time analysis revealed a significant difference in mean scores across three different time points for both PKQ-R and MAVAS-R-ID scores (p < 0.001). The focus groups identified the following themes: a) improved knowledge, b) improved self-confidence, c) facilitated self-reflection, d) empowered staff to advocate for people they support, e) better attitude on medicine use for BtC, f) improved the support they provide, and (g) challenges of SPECTROM training. Conclusion The findings of this feasibility study support progression to a larger and more definitive RCT. Trial registration: Name of the registry: ISRCTN; Trial registration number: ISRCTN71712166; date of registration: 24.01.24; URL of trial registry: https://doi.org/10.1186/ISRCTN71712166 Plain English summary Background More people with learning disabilities (LD) and autism receive mental health medicines than others, often for behaviours that challenge (BtC). These medicines are licensed for mental illnesses like schizophrenia, not for BtC without a psychiatric illness. Support staff play an important role in this process. So, staff training should improve BtC management. We worked with various stakeholders to develop SPECTROM (Short-term psychoeducation for caregivers to help reduce the overmedication of people with intellectual disabilities) training for staff. Aim The main aim was to assess whether it's possible to deliver the SPECTROM training within organisations and show whether a large-scale trial of SPECTROM is possible. Methods Six organisations in England and Wales that support adults with LD in community settings participated. From these six organisations, support staff and home managers from 26 community homes received the SPECTROM training and staff from 13 community homes did not. All community homes received their usual training offered by the organisations. SPECTROM was delivered to 140 staff and service managers. Results More adults with LD had their medicine reduced or stopped by the prescriber in the group that received SPECTROM training compared to the group that didn’t receive the training. Staff found the training useful, which increased staff knowledge, improved their attitude towards BtC and gave them the confidence to speak to prescribers. Dissemination, outputs and impacts A dissemination workshop was held, attended by 33 staff members and one family member. The results of the study presented showed that SPECTROM helped to improve staff knowledge and attitude toward BtC. Patient and Public Involvement The Tizard Centre Learning Disability Advisory Group were involved and provided feedback throughout the project. Conclusion The results show that SPECTROM is beneficial to staff, and a larger trial of SPECTROM is possible. The training also helped reduce the use of mental health medications. Summary of Research Findings Introduction Overmedication of people with intellectual disabilities, particularly the off-licence use of psychotropic medicines for behaviours that challenge, such as verbal aggression, physical aggression to others or property, or self-injury in the absence of a psychiatric diagnosis, is a significant public health concern (Mehta To address this issue, NHS England in the UK a ‘STopping Over-Medication of People with Learning or Both the of psychotropic use not in the three of adults with intellectual disabilities to receive psychotropic medicines the of is in adults with intellectual disabilities for which the are of antipsychotic prescriptions are as mental is in of they are for behaviours that challenge antipsychotic medicine use the of such as and which a of and reduce one of adults with intellectual disabilities who had at one and had three The study also found in or in and in of participants with and one or more were in and of support staff for medicine to control behaviours that challenge in the and are psychotropic training them to their knowledge of them to address behaviours that challenge without using the and them the confidence to psychotropic a towards the reduction of overmedication and of the To address these in the UK an SPECTROM (Short-term for to the of People with training for support staff to help reduce the of psychotropic medicines adults with intellectual disabilities for staff and caregivers are in such as autism and Two found of staff training the of behaviours that challenge in people with intellectual disabilities However, none of these training were to reduce the of psychotropic medicine in adults with intellectual The training staff and in to in with training for staff antipsychotic dose reduction in with possible to from this of and a of antipsychotic reduction adults with intellectual disabilities with such as the SPECTROM training. Two pre- and post-training field tests of SPECTROM involving in the UK and found significant post-training improvement in psychotropic knowledge and staff attitude in the medication of attitude to behaviours that challenge However, none of these were RCTs. conducted a feasibility RCT involving SPECTROM training. The study to on the feasibility of conducting a large-scale and controlled trial (RCT) involving SPECTROM. The study is a and a feasibility cluster randomised controlled trial The the We the of to randomised and feasibility study was by the Research UK The study was conducted using the following A workshop to assess the service to in the RCT. A feasibility cluster RCT. community home and supported living for adults with intellectual disabilities at one received psychotropic medicine in different of England and Wales a data six involved primary data in the of psychotropic medicine prescriptions for in the randomised community The the of the knowledge of psychotropic medicines using the PKQ-R Knowledge and their attitude towards the behaviours that challenge using MAVAS-R-ID of Aggression and Violence Scale-Revised-Intellectual at and four weeks and six months post-training in the arm. The was on the follow-up but also six-month follow-up data to assess any time and to evaluate any 4 A process evaluation to assess SPECTROM barriers and of positive and of in training, and of the to focus groups with a of SPECTROM training participants and an online questionnaire using the online which was to We also an online questionnaire online to the control arm participants to assess workshop to the findings and for a large-scale RCT. The following feasibility were assessed in the of the SPECTROM training to the to the to and and the of The number of available support staff and adults with who in the definitive RCT. The of the staff to The of the service organisations to their staff for SPECTROM training. psychotropic data from each and data for a The of an to and the trial to and of the in the (community homes and supported living for adults with intellectual in the in each Patient and Public Involvement and participants Support staff, service and within service organisations that support adults with intellectual disabilities in community settings were for A in each the and service managers within their organisations, who the staff they for and service was to a staff from one community living at one with intellectual disabilities received psychotropic The in the study was the SPECTROM training a hybrid/blended learning online resources by face-to-face training. The training was delivered to service their staff and the SPECTROM 14 with internal and external resources. Two of these 14 modules were used for face-to-face training, through which the other modules and resources were introduced. These two core modules are Medicine/STOMP and Alternatives to medication (ATM). These two core modules were delivered online in two All were to both core were also to the SPECTROM online resources and use SPECTROM in their analysis the study was not did not any using the primary data on the psychotropic and dose used analysis to the of in total dose and to any dose reduction was in both the training and groups at six months To the total dose reduction at the six-month the dose of antipsychotic medicines to a dose possible. the antidepressant medicine dose to dose to the total dose reduction at These data were used to the for a large-scale RCT. We the pre- and post-training scores of the PKQ-R at four weeks and six months and the MAVAS-R-ID at four weeks post-training using the as the data were not MAVAS-R-ID data were at six months and were using To a to the analysis of PKQ-R scores (p = and the analysis for MAVAS-R-ID (p = Changes time were from participants who had data at three time points at four weeks and six months on PKQ-R and MAVAS-R-ID with a analysis using the and a of was used to time for the PKQ-R was used to the MAVAS-R-ID We data using to the number and of for each in the We focus group data using a analysis We used to with data Two and the data to the of the A facilitated the focus groups with support staff and service managers online All focus groups and were conducted and and to We to PKQ-R and MAVAS-R-ID data at as as at four three and six months However, were to data at the follow-up to staff and We also to assess SPECTROM use through a However, to staff time this was not possible. collected SPECTROM data through The was to participants in SPECTROM training six months training. on SPECTROM was also collected the focus We a focus group with service managers in the control arm who did not receive SPECTROM training to assess to whether participants in the control group received any on SPECTROM or resources. However, service managers to in this focus group to a of using a the participants they had to or knowledge of any SPECTROM training and resources online online questionnaire was to in the control We to with adults with intellectual disabilities who in community homes staff received SPECTROM training, as as their to their and the of the training on particularly in with adults with intellectual disabilities and their However, adults with intellectual disabilities to the research through the Disabilities Advisory Group service managers were to adults with intellectual disabilities and their to in the Patient and Public Involvement The involved adults with intellectual disabilities, their family and support staff. family and one training of a are also We the SPECTROM training and medicine use for BtC with a group of adults with intellectual disabilities, who supported the and that staff should them in any their medicine people concern the of the medicine they that the staff should their medicine to them in that they they are and also of to in an which the with intellectual disabilities were involved throughout the and feedback was via the Tizard Centre Learning Disability Advisory Group was of adults with intellectual disabilities and three to four is a group that feedback on research group of medicines for BtC, and these medicines The group on an of the and the and on the SPECTROM All the were and by the research Results The progression was to from more than of the service organisations was as from six of the service organisations of SPECTROM training was using and focus group The analysis of focus group data with a of service managers and support staff in SPECTROM revealed that the found the training to and to their The training also helped to improve self-reflection, confidence in with behaviours that challenge without using knowledge of psychotropic medicines and their empowered them to advocate on of the adults with intellectual disabilities they support, and improved the support they provided for people with intellectual disabilities the participants who found the training a better of psychotropic medicine a better of behaviours that challenge, improvement in their improved their with people they support and with people they support, improved their with service and improved their with members as a of the training. to SPECTROM training and resources was using and focus group The of two of training sessions delivered by a using a questionnaire showed to the training 140 attended the number of training online sessions on core modules and one of the two core an of A of used SPECTROM resources and the training. to of the which to a medicine by in of these in a reduction in medicine use in of these of used the of for of of used the Aggression used the of and psychotropic medicine of a To a through both and service organisations from a in England and and of staff to randomised was to support staff and service managers from at (community homes and supported living for adults with intellectual disabilities at one is psychotropic We randomised staff and service managers from community homes and supported living of a of an of support staff in each community home was to at support staff and service managers. 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Author: Tom Hutchinson
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4414072941