The deinstitutionalization of the intellectually disabled (ID) and their transition to community living in New York State necessitated training initiatives for staff to manage challenging behaviors safely and humanely. However, the use of physical interventions to control self-injury and physical aggression may have become organizationally habituated, and limited research has compared programs that use physical versus nonphysical interventions. This mixed-method, comparative case study compared a restraint-free day habilitation program with one that used physical interventions, examining the differences in reducing self-injury, aggression, and types of interventions applied. Qualitative differences in philosophical approach to behavior intervention strategies and staff training protocols were examined using semi-structured interviews with employees (n ¬=11). Insufficient sample size precluded inferential analyses, but descriptively the results revealed more incidents of physical assault and self-injury in the program that used physical interventions. Further, behaviors ceased without intervention more frequently than they did in the restraint-free program. Qualitative results revealed shared qualities of person-centered organizational culture across both programs. These results suggest that an organizational culture that incorporates training and staff support in the use of restraint-free strategies may influence the type and frequency of challenging behaviors in this population. This study promotes positive social change by providing information that the Office of Persons with Developmental Disabilities can use to inform the development of ID-serving agency policies and staff training protocols to promote safety, respect, and well-being in ID persons who access community learning services.

This study investigates the effects of implementing Collaborative Strategic Reading–High School (CSR–HS) on reading comprehension and challenging behavior outcomes for three high school students with Autism Spectrum Disorder (ASD). Using a combined single subject research design consisting of a delayed, concurrent multiple-baseline and an alternating treatments with reversal, three high school students with ASD were paired with neurotypical reading partners to learn and use reading strategies with informational text two to three times per week. The alternating treatment conditions were CSR-HS with choice of text (i.e., CSR-HS-C) and CSR-HS without the opportunity to choose the reading text (i.e., CSR-HS-NC). Daily comprehension checks were collected and visually inspected along with data on occurrences of various challenging behaviors exhibited by each participant during intervention. Fidelity of implementation was also measured. Increased reading comprehension scores and decreased incidences of challenges behaviors were detected for the three participants upon implementation of intervention conditions. As for the influence of the choice component on the measured outcomes, no clear differentiation between conditions was observed in terms of reading comprehension gains and reduction in challenging behavior across the three participants, suggesting that the addition of choice did not show an added value to CSR-HS intervention. / text

<b>Background:</b> Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario's three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. <b>QUANTITATIVE STUDY</b> <b>Objectives:</b> To investigate the prevalence, risk factors, social and medical characteristics of pica. To determine how pica is managed in terms of hours of supervision, receipt of interventions, and psychotropic medication. <b>Methods:</b> Secondary data analysis was performed on two samples as part of cross-sectional study: 1008 persons with ID from Ontario's facilities and 420 community-dwelling adults with ID from southwestern Ontario. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID)?a comprehensive and standardized instrument that measures a variety of domains for support planning. Bivariate and multivariate analyses were restricted to the facility sample due to the small size of persons with pica in the community. <b>Results:</b>The overall prevalence of pica was 22. 0% and 3. 3% in the facilities and the community, respectively. Logistic regression analysis showed that being male, cognitive functioning, autism, and being non-verbal were associated with a higher odds of having pica, whereas activities of daily living (ADL) was a protective factor. A quadratic relationship was observed between cognitive function and pica: the risk of pica increased with severity of cognitive impairment up to moderate to severe levels of impairment and then diminished among those with very severe cognitive impairment. Behaviour management, self-care skills, and 8 hours or more of one-to-one supervision were more likely to be provided to persons with pica. Compared to persons without pica, persons with pica had higher rates of being prescribed antipsychotic medication. Surprisingly, pica was not associated with higher rates of gastrointestinal health problems, with the exception of acid reflux. The negative social outcomes of pica, however, were many: pica was associated with higher odds of not having a strong and supportive relationship with family, lack of contact with family or other close relations, and absence of participation in social and recreational activities. <b>QUALITATIVE STUDY</b> <b>Objective:</b> To determine the support needs of adults with ID and pica from the perspective of direct-care staff of facility and community settings. <b>Methods</b>: Through two focus groups, the perspectives of four staff from Huronia Regional Centre (HRC), and six staff from community agencies from southwestern Ontario were examined. Transcripts were analyzed thematically for factors that facilitated or hindered the management of pica. <b>Results:</b> Qualitative data revealed three categories that underpinned reduction in pica: preventative measures (environmental controls, close supervision, and the provision of alternative activities), formal supports, and familiarity with the individual. On the other hand, inadequate staff support, lower functioning level of the individual, and lack of knowledge acted as barriers to managing and reducing pica. These barriers were associated with persons participating in fewer recreational activities and community outings, and in some cases the use of mechanical restraints. Barriers specific to each setting in the management of pica were also illuminated. Staff in both settings tended to be self-sufficient and isolated in managing this complex behaviour. <b>Conclusions:</b> Results suggest that attention should be equally paid to the potential social consequences of pica rather than solely to its health risks. Higher staff to client ratios, and training and education for staff to provide more active support to promote individuals' engagement in recreational activity and community integration is needed. Key recommendations also focus on educating and training staff on the risk factors and appropriate management of pica. Improving the collaboration and knowledge exchange among developmental service agencies is also recommended to enhance the management of pica among caregivers. Lastly, the community at large needs education on pica to foster more inclusive community living for those with ID.

Young people’s challenging behaviour in the school classroom and elsewhere has long been subject to research and policy attention. Despite inherent definitional difficulties, challenging behaviour is often constructed as a product of an individual young person’s pathology (whether biologically, psychologically or socially determined). Adopting an alternative starting point, this study focuses on a youth work setting and conceptualises challenging behaviour as something created in and through social interaction. The aim of this study is to contribute to a contextualised understanding of challenging behaviour as a social phenomenon that ordinarily arises when working with young people. As an exploratory study of everyday youth work practices, a year-long ethnographic study was conducted of an open-access youth club, located in a Scottish secondary school. Data were generated through participant observation, interviews, question sheets and written evaluation records. The data were analysed to identify significant themes facilitating the construction of a meaningful and accurate account of challenging interactions in this youth club. The thesis suggests that ‘doing’ and drawing attention to challenging behaviour functions to delineate the boundaries around acceptable and unacceptable behaviour in the youth club. Challenging behaviour plays a substantial role in the social interactions of this setting, linked to personal and professional identities. The youth club is described as a chaotic (dynamic, bodily and playful) space, where challenging behaviour is expected and normalised yet it is still identified and disciplined. The study suggests it is difficult to reach a subjective contextual definition of challenging behaviour because although certain types of behaviour are repeatedly acknowledged as problematic, in practice there are inconsistencies in whether and how these behaviours are challenged. Challenging interactions are argued to emerge in the negotiation of control over the behaviour of self and others. The research indentified ‘humour’ and ‘playfulness’ as significant in the construction, diffusion and emotional management of recurring challenging interactions. The study concludes that it is fruitful to conceptualise challenging behaviour as a social phenomenon - something created in the moment - in advancing an understanding of the complexity of working with young people perceived to be challenging. The findings, and limitations, of this study suggest that it would be useful to conduct further research into: the emotional aspects of challenging interactions; potential age and gender differences in negotiating challenging interactions; and the relationship between challenging behaviour, creativity and transformative actions.

Section 1. Literature Review. Methodological limitations in the existing research are discussed and future research ideas are proposed to enable a more holistic understanding of direct care staff's experiences.;Section 2. Research Report. The aim was to explore the experiences of staff who have worked with learning disabled patients who also have a diagnosed borderline personality disorder. A free association narrative interview approach was used to analyse the accounts of eight direct care staff (Hollway and Jefferson, 2000). Working with patients who have a learning disability and a diagnosed borderline personality disorder is emotionally demanding. Participants did not appear comfortable in sharing their personal emotional experiences. It was thought this was because these were very painful and staff were concerned they would be criticised for voicing negative feelings about these patients. Staff appeared to manage their painful emotional experiences of their work by using a number of psychological defence mechanisms. These included projecting and expressing their negative feelings onto the organisation, and/or by trying to forget and repress these negative experiences. Organisational factors can be problematic and need to be addressed to reduce the obstacles staff experience in their work with patients who have a learning disability and also a borderline personality disorder. However, when staff comment upon these organisational factors they may also be indirectly expressing the emotional impact these patients are having upon them. Once the organisational factors have been addressed staff may begin to feel more supported and safe enough to explore the painful emotional reactions they have experienced in their work with their patients without the fear of being criticised by others.

Teacher-student relationships can influence the academic, social, and behavioral adjustment of children and youth. Students with emotional/behavioral disorders (EBD) experience poor quality relationships with teachers. The current study explores the importance of working alliance (i.e., agreement on tasks and goals, bond) among teachers and their students. Seventy-six teacher-student dyads completed measures of classroom working alliance, perceptions of the student-teacher relationship, student engagement, and student behavior (i.e., externalizing and internalizing behavior). Findings indicated that (a) students and teachers have weak agreement about the quality of their alliance, (b) working alliance was associated with student engagement, and (c) students’ externalizing symptomology predicted teacher ratings of alliance. Interpretation of these findings, study limitations, and suggestions for future research and practice are discussed.

Current government statistics show that the fastest growing ages for exclusion in English schools is in children between five and seven years old (DfE, 2013). This trend of young children being excluded for behaviour difficulties can have long term consequences for the children and their families, and has costs to society (Castle & Parsons, 1997). It has also been found that children with challenging behaviour can attract less sympathy than other areas of difficulty (Ofsted, 2010). There is limited research regarding parents' experiences of engaging with school staff when issues are raised about their child's behaviour, particularly when the children are being referred to external agencies. In the present study, three mothers of young children, whose child had been referred to the Educational Psychology Service for challenging behaviour, were interviewed. The method used to examine the interview data is Interpretative Phenomenological Analysis (IPA) as it aims to explore the experiences of the mothers from their interpretation of the situation. Although the mothers had diverse experiences of working with school staff and external professionals with regard to their child's challenging behaviour they provided evidence for five key superordinate themes, which are: development of shared understanding; the child as an individual; the role of being a parent; finding solutions; and social perceptions of behaviour. Implications for theory are discussed in order to further develop a model of working with parents which challenges some the inherent disempowerment and difficulties of managing within the compulsory education system. Implications for practice are explored to consider how school staff and professionals need to develop their communication strategies to enable parents to have access to information, to actively listen to the views of parents, and for parents to be actively involved and work collaboratively in the child's best interests. Further research to identify the relative influence of themes in the present findings would enable targeting of resources to improve the outcomes for young children with challenging behaviour in school.

In many societies there is a stigma surrounding menstruation. It is often perpetuated through representations in advertisements as well as lack of open discussions. This thesis investigates ways that people are presenting menstruation on the social media platform Instagram and concludes that this is a space which allows the normative menstruation discourse to be challenged. Instagram is a widely used app that allows users to interact with others through sharing photos and has the potential to be a space for empowerment and challenging dominant ideologies. Publicly accessible photos were collected from the app using hashtags related to menstruation and menstrual activism, as well as menstrual activist accounts and menstrual product accounts. The results of a qualitative content analysis reveal numerous themes which challenge or reinforce the stigmas: Empowerment, Solidarity, Resistance, Normalizing Periods, Women’s Health, Standard/Normative, Eco-Friendly and Marketing.

Parents who have children with challenging behavior may feel stressed, overwhelmed and at a loss for solutions. Challenging behavior can cause problems with children’s relationships with others and their school success. There are many resources for schools and children with special needs; however, resources for parents for young children (ages 3 to 5) with challenging behavior are limited. This study examined the impact of a 6-week intervention to coach parents to use strategies that encouraged children to develop skills that helped them to express frustration and solve problems in positive ways. Parents were better able to understand what the children were communicating with their behaviors, and what supports they needed in order to get their needs met in an appropriate way. Challenging behavior decreased for the children who participated. They also were better able to communicate their needs and handle disappointment.

In early childhood classrooms, transitions are often targeted as times of the day during which teachers encounter problems with deficiencies in child engagement, as well as frequent occurrences of challenging behavior. Studies to date on improving child behavior during in-class transitions have focused on providing supports for individual children, as well as on reducing transition duration. The present study evaluated the effects of systematic transition strategies, as applied to three Head Start preschool classrooms during targeted in-class transitions. Strategies encompassed an accumulation of antecedent and consequent manipulations and were selected on the basis of environmental fit with individual classroom environments. Participants included three Head Start preschool teachers and their respective students, all three to five years of age. The dependent measures examined in the study included mean percent classroom engagement and percent occurrence of challenging behavior, measured across all phases of the study (i.e., baseline, coaching and independent implementation). Results, evaluated in a multiple baseline probe across classrooms, indicated that with implementation of systematic transition strategies, mean percentages of classroom engagement within intervention phases (i.e., coaching and independent implementation) were higher and relatively more stable than those observed in baseline, within and across all three participating classrooms. Furthermore, mean percent occurrences of challenging behavior were lower and relatively more stable within phases of intervention (i.e., coaching and independent implementation) than those observed in baseline, within and across all three participating classrooms. Data on the accuracy with which teachers implemented selected strategies (i.e., treatment integrity) were also documented and presented in the context of results obtained. Implications for future research are discussed, in light of the limitations and findings of the current investigation.