Service User Behavior Research Articles

Conceptual framework for a comprehensive competence in managing challenging behaviour: The views of trained instructors.

WHAT IS KNOWN ON THE SUBJECT?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff-related factors associated with service user aggression, and staff attitudes and perceptions towards violence. The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements. Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint. We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues. Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management. Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. ABSTRACT: Introduction Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management-related competences and create a conceptual framework for comprehensive competence. Method An explorative-descriptive qualitative approach with purposive sampling (N=22), semi-structured interviews and abductive content analysis. Results Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories-knowledge, skills, attitude, confidence and ethical sensitivity-and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training.

Bureaucratic Reform Barriers: A Case Study on the One Stop-Integrated Service Office in Bone Regency

This research aimed at identifying the barriers to the implementation of bureaucratic reform, exploring the factors that cause these obstacles and offering some solutions to improve licens-ing administration services, this research applied the descriptive-qualitative approach using the case study design. Techniques of collecting data included interview, observation, and documen-tation. Instruments in this research, added the researcher himself (key device), an informant who was selected based on purposive sampling technique. Data analysis was based on "interactive models," including data collection, condensation, data presentation, and verifica-tion and concluding. The results showed that bureaucratic reform obstacles in licensing ser-vices, among others include, red tape and understaffing, while the internal environment in the bureaucracy and the various service user behavioral characteristics, were identified as critical barriers to bureaucratic reform. To that end, this research recommends conducting bureaucra-cy reform in all aspects, both internal to change bureaucracy itself) and external (induce changes in the characteristics of service user behavior).

Categorizing Users of Cloud Services

Many services, e.g., in education and research, have witnessed increased productivity and scalability, mainly because of the growing prevalence of online platforms. To accelerate this progression, a detailed understanding of user interactions with these complex systems is instrumental. Current approaches for analyzing service user behavior have two main limitations: (a) unsupervised learning methods do not discriminate behavior meaningfully and scale poorly; and (b) surveys as input data probe only intentions. We introduce a framework to analyze user behavior in complex cloud services. Our objectives are (a) a computationally lean method to cope with large data sets and (b) for the input data to be free of assumptions. We define three data-driven metrics based only on the size and volume of data, using nested arrangements of zero and infinity norms. Using threshold analysis, user behavior data is categorized over one metric and subsequently verified over the other two metrics. We apply this method to analyze the behavior of users of nanoHUB services, the world’s largest cyber-infrastructure for nanotechnology research and education. As input, actual user decisions are employed. The introduced frequency metric leads to a dispersion of usage duration. The resulting separated power and casual user categories are validated over the diversity and intensity metrics. Moreover, subcategories of previously unknown classroom users are identified. These findings allow policy makers to optimally tailor educational programs to such uncoordinated groups. Given nanoHUB’s size, its leading role in educational services, and the approach’s data-driven nature, the presented method is applicable to a wide range of cloud services.

Discovering User Behavior: Applying Usage Statistics to Shape Frontline Services

This investigation sought to develop a broad view of discovery service user behavior by analyzing vendor-provided and Google Analytics usage data from discovery service implementations at two Indiana University campuses. The results of this analysis demonstrate how usage data can communicate both intermediary and end results of user interactions within discovery services. The findings reveal user behavior trends, which may be used to develop strategies to improve information literacy instruction techniques, as well as discovery service interface enhancements.

Understanding How Case Managers Use ‘Sabotage’ as a Frame for Clinically Difficult Situations

Case managers are among the direct service providers responsible for engaging people with severe mental illnesses. Understanding how they interpret and respond to clinically difficult situations can inform ways to intervene and reduce service disengagement. This qualitative study explored clinically difficult situations when case managers invoked the term “sabotage”. Interviews were conducted with 21 case managers and analyzed by co-coders focusing on how case managers used the term sabotage to describe service user behavior. Themes that emerged were attributing sabotage to; fear of success, fear of attaining what you desire, avoidance of responsibility and change, and a lack of structured support. Drawing on the concepts of clinical case management and mental health recovery, we consider implications for the training and supervision of case managers and how services are structured.

Dialectical Behaviour Therapy with female forensic patients with borderline personality disorder: Preliminary findings from a pilot study

Background:dmissions to secure mental health services aim to treat both mental illness and the offending behaviour of service users. Dialectical Behaviour Therapy (DBT) is an emerging therapy within secure services for personality disordered service users. This pilot study explores the impact DBT had with female patients located in a secure service in Wales.Aims:To identify any treatment benefits of DBT for a sample of female forensic patients in Wales.Methods:DBT was adapted to meet the needs of the forensic setting and patient needs. Measures exploring anger, anxiety, depression, hopelessness and social problem solving were gathered from participants pre and post intervention.Results:Results indicated significant reduction in post intervention ratings for depression, hopelessness and anxiety, with large effect sizes in the desired direction reported on other measures, excluding social problem solving.Conclusions and implications for practice:DBT appears to have had a greater impact on the affective experiences of participants and less impact on the cognitive processes related to social problem solving. Findings are discussed in terms of clinical practice significance.

Neo-coporatist governance of homeless services in Dublin: Reconceptualization, incorporation and exlusion

This article examines neo-corporatist arrangements for governance of homeless services in Dublin, which are modelled on parallel arrangements for the negotiation of economic and social policy nationally. It reveals that these two policy making structures have achieved similar outcomes - policies which are neo-liberal in orientation, but not entirely so. Achieving the aims of this unusual marriage of corporatism and neo-liberalism necessitated the redefinition of the causes of and solutions to homelessness from the structuralist to the individualist and the incorporation of formerly independent third sector service providers into the influence of the state. This process has been opposed by some third sector groups but supported by others who see opportunities in these reforms for their organizations. The outcomes of this process have been largely positive - levels of homelessness have fallen for instance - but not entirely so. Lack of attention to tackling the structural causes of homelessness has led to under provision of long-term accommodation for homeless people, while overemphasis on its individual causes and consequently on controlling the behaviour of service users has excluded some `challenging' clients from access to services.

Trapped in risky behaviour: Empowerment, disabled people and sexual health

The concept of empowerment within care environments has brought the issue of informed choice onto professionals’ and users’ agendas. However, this principle can be frustrated by a range of factors that reveal the tension between the autonomy of service users to take risks and the responsibility of service providers to assess and protect users from risks. This tension between users and providers has been noted within many areas of service but may become heightened where the outcome of risk-related action may be perceived as damaging. The authors’ own research indicated that sexual health education is one such area. Findings presented in this paper reveal that lack of clarity around responsibility for, and efficacy of, sexual health education has negative effects on the choices and behaviour of service users. The relationship between disabled service users and service providers is confused, particularly over issues of responsibility for identifying and addressing sexual health need. Further, organisational policies and structures can frustrate service providers’ attempts to develop and respond to sexual health education. This can create an environment where the emphasis is on risk avoidance or even denial of risk-related behaviour rather than risk protection.