Adapting the protocol for Narrative Exposure Therapy for adults with mild intellectual disabilities

Marlow, Katie (2021) Adapting the protocol for Narrative Exposure Therapy for adults with mild intellectual disabilities. DClinPsy thesis, University of Nottingham.

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Abstract

Background: The rise of trauma-informed care in health services in the UK has highlighted the need for patients to receive care that considers trauma and includes referral for trauma-focused treatment where appropriate (Sweeney et al., 2016). Adults with Intellectual Disabilities (ID) are more vulnerable to developing post-traumatic stress disorder (PTSD) than the general population (Fletcher et al., 2016), however, research exploring effective trauma-focused therapies within this population is limited. Narrative Exposure Therapy (NET; Schauer et al., 2011) is recommended by the National Institute for Health and Care Excellence (2018) to treat PTSD in adults. There is a lack of research exploring firstly, the effectiveness of NET among adults with ID and secondly, what adaptations are required for this population.

Study aim: To adapt the protocol for NET for delivery with adults with Mild ID.

Research questions:

• How can NET be adapted for adults with Mild ID to create a new protocol (IDNET) for further investigation in clinical practice?

• What are the views of service users on the IDNET therapy materials developed and how can they be incorporated?

• What are the views of professionals on using NET in ID services and on the adapted protocol (IDNET), and how can they be incorporated?

Methods: Stage one of the study involved systematically adapting the NET protocol for adults with Mild ID in collaboration with a service user group who provided feedback on the ‘easy read’ therapy materials developed. Stage two involved gaining professionals’ views on the adapted protocol and on the use of NET in ID services, to inform subsequent amendments to the protocol. This comprised a focus group of Clinical Psychologists (CPs) specialising in ID and an expert panel of NET clinicians. The framework approach was conducted on the focus group data.

Results: A new protocol was developed (IDNET) which comprised recommendations for how NET could be adapted for adults with Mild ID. This included information sheets and handouts in ‘easy read’ format which mapped onto the psychoeducational examples in the NET manual. Eight CPs and three NET clinicians provided feedback on IDNET which led to amendments. Two key core concepts were developed as a result of applying FA to the focus group: ‘Optimism and motivation to adapt NET for people with ID’ and ‘Factors related to NET in practice’. Issues raised by professionals regarding the delivery of IDNET highlighted further research questions for when the adapted protocol is trialled in practice.

Discussion: This research is the first attempt to systematically adapt NET for adults with ID, in collaboration with a number of different expert groups including service users. Professionals were optimistic about IDNET, however, they highlighted a number of issues which require further consideration. These include the impact of adaptations to NET (for example, extending the lifeline exercise, involving caregivers) on the client, the way NET is delivered and the theory underpinning NET. Future research should aim to trial IDNET in practice to explore feasibility and effectiveness in reducing symptoms of PTSD among adults with ID.

Item Type: Thesis (University of Nottingham only) (DClinPsy)
Supervisors: Schröder, Thomas
Tickle, Anna
Renton, Jess
Keywords: Narrative Exposure Therapy; Treatment of post-traumatic stress disorder; Intellectual diability
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 66692
Depositing User: Marlow, Katie
Date Deposited: 08 Dec 2021 04:40
Last Modified: 08 Dec 2021 04:40
URI: http://eprints.nottingham.ac.uk/id/eprint/66692

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