Psychodynamic training for senior intellectual disability practitioners in the UK: a mixed methods evaluation study

This mixed methods evaluation reports on the impact of training intellectual disability nurses and social workers to understand, and work with trauma from a psychodynamic perspective with people with intellectual disabilities who present with challenging behaviour; a project jointly funded by the commissioners of this evaluation, and the Winterbourne View Joint Improvement Programme in the UK. The evaluation needs to be placed within a contemporary context of intellectual disability services in the UK. This context includes a recent BBC Panorama investigation into the abuse inflicted upon residents of Winterbourne View Hospital for people with intellectual disabilities with challenging behaviours (BBC, 2011). A subsequent serious case review found a background of inadequate staffing, poor leadership, training, and recruitment (Flynn, 2012). It is regrettable that this incident was not isolated; rather it was the latest exposure in a lineage of similar failings in standards of care for people with intellectual disabilities. For example, the Health Care Commission found that at the Merton and Sutton NHS Trust people with intellectual disabilities were fed too quickly to enjoy their food at mealtimes, some people only had a few hours activity a week, care plans were only available for a minority of people, there was evidence of poor communication with people with intellectual disabilities, as well as unsatisfactory environments with inadequate access, poor furnishings and insufficient space (Health Care Commission, 2007). An enquiry in Cornwall investigated over 64 incidents of abuse over a five-year period to October 2005. Here it was found that all patients were abused but two were targeted frequently (Health Care Commission and CSCI, 2006). Finally, findings of a recent parliamentary joint select committee noted its disappointment at the continued abuse of people with intellectual disabilities and, ‘that it continues ten years after the Human Rights Act 1998’ (House of Lords House of Commons Joint Committee on Human Rights, 2008). In was in this context that RESPOND5 and Hertfordshire County Council, Adult Social Care sought to explore the impact of training on senior practitioners through a project using a psychodynamic perspective that would focus on past trauma as the root of challenging behaviour, encouraging them to work in new ways and involve the networks of other staff that surround the individual in the therapeutic process