Mindfulness in Practice (MIP): The development and evaluation of a new mindfulness group for staff in learning disabili

1. Mindfulness in Practice (MIP): The development and evaluation of a new mindfulness group for staff in learning disability servicesA Project Partnership

2. The story so far…. Who we all are A firstproject Our plans for the future

3. Overview of Project • Consultancy arrangement with TizardCentre, co-funded by MCCH Society Limited and Avenues Group. • Comprised the development of a new mindfulness group for staff working in services that support those with profound and multiple learning disabilities and those with learning disabilities who display behaviour that challenges. • Included a controlled evaluation, comparing emotional wellbeing and mindfulness skills before and after the group. • A number of positive changes were found for staff who had taken part in the mindfulness group, relative to a control group of staff, with important consequences for staff wellbeing and work performance.

4. Why support emotional Wellbeing of Staff? Front line staff members working ID services often experience stress and burnout (Devereux, Hastings & Noone, 2009; Robertson et al, 2005) especially when: • Supporting those with complex needs like challenging behaviour (Hastings, 2002) • Appropriate support from colleagues and the employing organisation is not in place (Gray-Stanley & Muramatsu, 2011; dyer & Quine, 1998; Ito, Kurita & Shiiya, 1999; Hatton et al, 1999). Occupational stress within these settings may have a threefold negative impact: • Individual’s wellbeing (reflected in emotional distress and sickness), • The functioning of the service (reflected in absenteeism and staff turnover) (Hatton & Emerson, 1998; Razza, 1993) • The quality of care provided to service-users (Lawson & O-Brien, 1994; Rose, Jones & Fletcher, 1998a; Rose, Jones & Fletcher, 1998b).

5. The nature of support work also relies on the development of a positive relationship between staff and service-users (see Hastings, 2010). • But staff behaviour may be influenced by a variety of emotional reactions, attributions and cognitive appraisals regarding the people they support (Jones, & Hastings, 2003; Noone, Jones, & Hastings, 2003; Hastings, 2002). • Close associations between staff member’s negative emotional reactions and avoidant coping strategies (Mitchell & Hastings, 2001; Hastings & Brown, 2002a; Hastings & Brown 2002b) both of which may limit the potential for positive staff/service-user interactions.

6. Why a Mindfulness-Approach? • Only a small number of intervention studies have attempted to provide therapeutic/training support to staff in ID services to help reduce the experience of stress and emotional difficulties. • Most recently, mindfulness-based groups have been suggested to be of particular benefit to staff. • Studies here include findings from a pilot Acceptance Commitment Therapy group that were reported by Noone and Hastings (2004) and replicated and extended by Smith and Gore (2012). • There is also promising evidence that increasing levels of mindfulness amongst staff, leads to quality of life benefits (indicated by observed correlates of happiness) for people with profound and multiple disabilities (Singh et al, 2004).

7. What is Mindfulness? • An awareness of the present moment • A non-judgemental stance towards experience • Difficult thoughts and emotions are common to all of us • Through developing mindfulness we can develop different ways to respond to these thoughts and experiences

8. Why a new group? What can be done to make mindfulness as clear and practical as possible? How can we maximise on use of mindfulness practice amongst staff members in their professional and personal lives? How can we make directly relevant to those who work in LD services?

9. Mindfulness in Practice 1) Drew on a number of previously developed mindfulness and acceptance-based approaches 2) Designed to be clear and accessible, presenting concepts of mindfulness in a straight forward and practical mannerthrough encouraging relatively brief but regular practices 3) Explicitly aimed to help staff plan, practice and refine mindfulness skills outside of each session in home and work environments, with the intention of enhancing emotional wellbeing, the quality of individual relationships and the effectiveness of service-user support.

10. 4) Consisted of 6, 1 hour sessions run on a weekly basis that covered three main areas of mindfulness: • Developing a 10 minute daily practice • Mindful-awareness in daily activities • Grounding in the present moment during times of difficulty (SOF) 5) In each session the group were supported to develop their understanding and practice of one or more of the three areas through a combination of guided experiential exercise, facilitated discussion and structured exercises to help generalise principles and practices across the following weeks. 6) All group members were provided with a mindfulness log that included session summaries, recording sheets and useful tips.

11. Running the group • The group was run in Medway during January/February 2013 by Dr Nick Gore. • Attended by 11 staff drawn from both organisations. • Attendance was high and catch up sessions were provided on the small number of occasions that a group member was unable to attend. • The majority of group members had not previously met one another.

12. The Evaluation Participants • Mindfulness Group 7 people (3 males, 4 females; median age 36; worked an average of 7.5 years in services - 4 in services for people who display challenging behaviour and 3 with those who have profound and multiple learning disabilities. • Control Group 9 people (1 male, 8 females; median age 41; worked an average of 5 years in services - 5 of whom worked in services for people with profound and multiple learning disabilities and 4 for those who displayed behaviour that challenges • Whilst the proportion of males and females in each group varied, the groups were reasonably well matched and there was no significant difference between groups in terms of age (U = 35.00, p = 0.371) or years of experience in services (U = 26.5, p = .595). Ethical approval for the evaluation was granted from the Tizard Centre Ethics Committee prior to commencing the project.

13. Measures (before group and in weeks following the last session) The Kentucky Inventory of Mindfulness Skills (Baer, Smith and Allen, 2004): This is a 39-item self-report inventory used in the assessment of mindfulness skills that is made up of 4 sub-scales. The scale is widely used in mindfulness research and has established reliability and validity. It takes approximately 10 minutes to complete. High scores indicate increased levels of mindfulness. In the current project all items were summed to provide an overall score. The Depression and Anxiety Stress Scales – short form (Lovibond & Lovibond, 1995): This is a 21 item self-report inventory that is used to assess psychological wellbeing on subscales of depression, anxiety and stress. It has established reliability and validity and takes approximately 10 minutes to complete. Low scores indicate increased emotional wellbeing. In the current project all items were summed to provide an overall score.

14. What we found Time point 1 (pre intervention) • No significant difference between the groups on either the DASS (U = 38.5, p = .470) or the KIMS (U = 40, p = 0.408). This further suggests that the groups were well matched for statistical purposes Comparisons between time point 1 and 2 • Mindfulness Group scored significantly higher on the KIMS (pre-intervention median 122, post-intervention median 145) (X = 8.00, p = .018) suggesting improved levels of mindfulness. No change for Control Group • No significant difference for either group in DASS scores between these time points • However was non-significant, reduction in DASS scores for the mindfulness group between these time points (pre-intervention median 11; post-intervention median, 9) and an non-significant increase in scores (suggestive of a decline in emotional wellbeing) for the control group (pre-intervention median 13; post-intervention median 18).

15. DASS Scores pre and post intervention for both groups

16. Time point 2 (post-intervention) • At time point 2 the control group scores on the DASS were significantly higher than those who had received the mindfulness intervention (U = 57.5, p = .003).

17. Other outcomes….. • Anecdotal reports from staff who attended the group and others in the organisation who were involved appeared highly positive and described a ‘buzz’ of motivation and energy. • In the final sessions staff reported a number of changes that they had experienced including: • Increased ability to cope with stressors both at work and home • Improvements in sleeping and other aspects of physical health • Reduced smoking • Increased concentration abilities • Improved communication with other staff (including during handovers and when writing notes) • Enhanced relationships with service-users • The identification of new communication strategies and positive ways of supporting service-users • Increased sense of purpose and work related motivation • Commitment to continuing to develop mindfulness-based practices and to share these ideas with others

18. Anecdotal reports from staff who attended the group “…………….it really focusses my mind to concentrate on the issue in hand and stops me clouding my mind with other thoughts. I feel that it is very beneficial when related to the people that we support as it means that I give total concentration during all tasks instead of worrying about other issues such as staffing, budgets etc.” “Over those six weeks I confirmed the strength and impetuousness of my mind and how to ease the flow when my mind was eager to drift off to places that were unnecessary and unhelpful.  I am thankful and fortunate that I experienced mindfulness when I did and people have said to me (including my wife), that I seem more relaxed and calm than before which just goes to show that Mindfulness training didn’t just benefit me but also the people involved in my life,”

19. What might this all mean? A small, initial study but a suggestions that: • Possible to teach staff mindfulness skills via a relatively brief, direct and practical • The approach is well received and acceptable to staff and (anecdotally) allows them to enhance their professional practice • At a time when some staff are experiencing increases in levels of stress and other emotional difficulties, those who have been helped to develop mindfulness skills appear more resilient Next Steps? • Further development and support from group members • Delivering further groups • Whole-service approaches

20. Questions, thoughts, ideas?