We have posted a number of times about the developing evidence base for the use of psychological therapies with people with learning disabilities. The Improving Access to Psychological Therapies (IAPT) programme in the NHS produced some clear positive practice guidance, in 2009 but early indications have been that barriers still exist and that in order to better respond to people with learning disabilities “reasonable adjustments need to be made not only at the direct clinical level but also throughout the system, from service commissioning to outcomes.”
The authors of the current study were concerned about one particular barrier to progress – the confidence of clinicians and therapists. They set out to look at how this might be measured by testing the development of the Therapy Confidence Scale–Intellectual Disabilities [TCS-ID]).
What they did was to develop a questionnaire which was completed by 181 clinicians who had therapy as a significant part of their role. These clinicians were also not primarily working with people with learning disabilities.
The sample was not a random one, but a sample of convenience taken from training groups in academic and NHS clinical contexts.
The professions involved included, amongst others, Community mental health nurse, Counsellor, Occupational therapist, Social worker, Clinical psychologist and Psychological mental health worker.
They used the scale with 60 people in four training groups and took pre and post measures to test the sensitivity to change.
The Therapy Confidence Scale–Intellectual Disabilities (TCS-ID) itself identifies
- key stages in therapeutic relationship development,
- therapy ending
The scale asks people to rate their confidence at each stage on a five point scale from ‘not confident’, through to highly confident’.
What they found was that if participants had received training in working with people with learning disabilities and specifically had therapeutic experience with people with learning disabilities, then it resulted in them being more confident in working with people with intellectual disabilities. Where people had just had general experience of working with people with learning disabilities this did not increase their confidence.
Participants who said they used dynamic or analytic therapy and those who said they used an eclectic therapy approach said they were significantly more confident and those using a Cognitive Behavioural Therapy approach said they were significantly less confident in working therapeutically with people with learning disabilities.
The researchers also used the scale with the four training groups, using the scale at the beginning and end of each training period. They found there was a significant increase in confidence following the training.
Interestingly, the group of twenty-four trainee psychological well-being practitioners (PWP) received a half day’s training during their core training was significantly more confident than a group of ten therapists in secondary care mental health services received one day’s training and eighteen therapists in a non-Improving Access to Psychological Therapies primary care service for people with intellectual disabilities received two day’s training.
Conclusion and Comment
As confidence of therapists continues to be a barrier to offering talking therapies to people with learning disabilities, it is important to have a way of measuring change in confidence as a result of training and experience. This study suggests that the Therapy Confidence Scale–Intellectual Disabilities is a psychometrically sound and can be used in this way.
There were some interesting findings in relation to levels of confidence in different skills. It appeared that the three highest rated items for confidence were in relation to the skills of listening, empathy and forming therapeutic relationships which could be viewed as generic skills. The lowest rated items for confidence however were in using assessments and explaining results of assessment, which could be said to relate to areas of practice where therapists may need specialist knowledge.
The fact that the researchers had to use a convenience sample rather than a randomly selected sample is a problem with the methodology, and it would be interesting to see the impact on confidence of training at a later time post intervention, but overall the study suggests that the TCS-ID could be a useful outcome measure for training clinicians to work with people with learning disabilities.
Dagnan, D., Masson, J., Cavagin, A., Thwaites, R. and Hatton, C. (2014), The Development of a Measure of Confidence in Delivering Therapy to People with Intellectual Disabilities. Clin. Psychol. Psychother. [abstract]