Steps to Effective Problem Solving

项目总结/摘要 攻击性/挑战性行为（AC/Bs）是智力障碍者的一个主要公共卫生问题。 残疾人（ID）住在集体之家。精神病住院和监禁的一个主要原因， A/CB对医疗保健系统、机构和家庭来说是昂贵的。社会问题解决培训 针对ID患者的项目已经产生了积极的行为结果，但大多数都是在临床或 法医设置。没有一项是以社区为基础的预防干预措施，没有一项检查A/CB是否 参与者的集体之家和工作环境减少，没有一个涉及成本效益。在我们 初步工作，我们修改了一个有效的SPS培训计划，使用输入的个人ID和 寄宿工作人员，作为对集体之家环境的预防性干预。有效解决问题的步骤 （STEPS）包括住宅工作人员，并使用组家庭环境，以促进行为改变。的 本临床试验的目的是测试STEPS对ID患者的疗效。具体目标是1） 评估STEPS干预措施在集体家庭中的有效性，以提高SPS技能并减少儿童的A/CB 与注意力控制营养计划相比，从基线到12周，24周和36周， 控制A/CB的行为决定因素（人口统计学，机构/家庭环境，当前健康状况）。（二） 评估SPS支持环境的中介作用（居民工作人员SPS技能，团体家庭水平 SPS技能和团队凝聚力）对SPS技能的提高和A/CB的减少。3)评价 STEPS相对于常规护理的成本效益在集体家庭中的A/CB事件。.一个集群随机 将采用临床试验设计，将36个集体之家（18名男性，18名女性）随机分配至 步骤或注意力控制。我们将招募180名轻度至中度ID的人，至少18岁 （大约每个家庭5人），每个家庭至少有两名住宿工作人员（每个家庭2-3人）。SPS成果 将使用爱荷华州家庭互动评定量表（IFIRS）个人水平问题解决量表进行评估 解决问题的任务。A/CB结局将使用IFIRS二元交互作用量表（一般）进行评估 适应不良指数（机构，工作环境）和事件报告（机构）。将评估中介效应 适用于居住区工作人员，修订了SPS清单-简表和IFIRS个人水平问题解决 量表;通过IFIRS组级问题解决量表评估组家庭级SPS技能; 通过干预量表的群体环境的凝聚力分量表的凝聚力。费用- 评估STEPS的有效性时，将考虑参与者承担的A/CB费用， 家庭、项目、团体之家、医疗保健系统和公共服务。STEPS将与常规护理进行比较， （行为事件的控制组成本）。我们希望能证明STEPS是一种预防性的行为策略 减少ID患者的A/CB，提高其护理的成本效益， SPS研究进展。

Project Summary/Abstract Aggressive/challenging behaviors (AC/Bs) are a major public health problem for individuals with intellectual disabilities (ID) living in group homes. A leading reason for psychiatric hospitalizations and incarcerations, A/CBs are costly to the healthcare system, agencies and families. Social problem solving (SPS) training programs for individuals with ID have had positive behavioral results, but most were conducted in clinical or forensic settings. None were community-based preventive interventions, none examined whether A/CBs decreased in participants’ group homes and work settings, and none addressed cost effectiveness. In our preliminary work, we modified an effective SPS training program, using input from individuals with ID and residential staff, as a preventive intervention for the group home setting. Steps to Effective Problem-solving (STEPS) includes residential staff and uses the group home environment to facilitate behavior change. The purpose of this clinical trial is to test the efficacy of STEPS for individuals with ID. Specific aims are to 1) Assess the efficacy of the STEPS intervention in group homes to improve SPS skills and reduce A/CBs of the individuals with ID compared to an attention-control nutrition program from baseline to 12, 24 and 36 weeks, controlling for behavioral determinants of A/CBs (demographics, agency/home environment, current health). 2) Assess the mediating effect of the support environment for SPS (residential staff SPS skills, group home level SPS skills, and group cohesiveness) on the improvement of SPS skills and reductions in A/CBs. 3) Evaluate cost effectiveness of STEPS relative to usual care for A/CB incidents in group homes. .A cluster-randomized clinical trial design will be used in which 36 group homes (18 male, 18 female) will be randomly assigned to STEPS or attention-control. We will recruit 180 individuals with mild to moderate ID, at least 18 years old (approximately 5 per home), and at least two residential staff from each home (2-3 per home). SPS outcomes will be assessed with Iowa Family Interactions Rating Scales (IFIRS) Individual-level Problem-solving Scales and the Problem-solving Task. A/CB outcomes will be assessed with IFIRS Dyadic-interaction Scales, General Maladaptive Index (agency, work settings), and incident reports (agency). Mediating effects will be assessed for residential staff with SPS Inventory Revised- Short Form and IFIRS Individual-level Problem-Solving Scales; for group home level SPS skills by IFIRS Group Level Problem-Solving scales; and for group cohesiveness by the Cohesiveness subscale of Group Environment for the Intervention Scale. Cost- effectiveness of STEPS will be evaluated taking into account costs of A/CBs borne by the participant and family, program, group home, healthcare system, and public services. STEPS will be compared to usual care, (control group costs of behavior incidents). We expect to show STEPS to be a preventive behavioral strategy to reduce A/CBs among individuals with ID, improve the cost effectiveness of their care and make an important incremental advance in SPS research.