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Navigating care together: developing a collaborative checklist to improve care for children with intellectual
Hayley Linda Trower1, Chris Oliver2, Leah E Bull3
1Warwick Medical School, University of Warwick, Coventry, UK. Hayley.trower@warwick.ac.uk.
Insights
Patient and Public Involvement (PPI) was used to develop The Behaviour Checklist, a tool for identifying and monitoring challenging behaviors in children with intellectual disabilities. This collaborative approach ensured the checklist is practical for parents, carers, and clinicians.
Area of Science:
- Intellectual Disability Research
- Patient and Public Involvement (PPI) in Research
- Behavioral Science
Background:
- Patient and Public Involvement (PPI) is crucial in research but often overlooked in intellectual disability (ID) contexts.
- Barriers to PPI in ID research need addressing to ensure inclusivity.
- This study focused on developing a tool to support identification and monitoring of challenging behaviors in children with moderate-to-profound ID.
Purpose of the Study:
- To collaboratively develop The Behaviour Checklist with parents/carers and clinicians.
- To create a user-friendly tool for identifying and monitoring causes of challenging behaviors in children with moderate-to-profound intellectual disability.
- To ensure the checklist is practical and relevant for both service users and providers.
Main Methods:
- Utilized consultation, collaboration, and user-controlled research principles.
- Established a Checklist Development Group with parents/carers, clinicians, and researchers.
- Incorporated feedback from focus groups and followed the GRIPP2-SF reporting framework.
Main Results:
- PPI significantly refined the checklist's purpose, functionality, clarity, and visual design.
- Checklist items and guidance notes were revised for better real-world alignment and lay comprehension.
- The checklist was recognized as an aide memoire for identifying patterns, structuring conversations, monitoring changes, and supporting clinical decision-making.
Conclusions:
- Collaborative development with parents/carers and clinicians resulted in a scientifically valid and practically relevant tool.
- PPI strengthened stakeholder relationships and collaboration potential.
- The Behaviour Checklist is ready for pilot testing and has the potential to improve outcomes for children with ID and their families.
Background:
While Patient and Public Involvement (PPI) has been increasingly integrated into research, its application in intellectual disability contexts can sometimes be overlooked due to perceived barriers. This study describes the collaborative development of The Behaviour Checklist, a tool designed to help parents/carers and clinicians identify and monitor causes of behaviours that challenge in children with moderate-profound intellectual disability.
Methods:
The study utilised consultation, collaboration, and user-controlled research, as outlined by INVOLVE. A Checklist Development Group of parents/carers, clinicians, and researchers reviewed and revised Version 1 of the checklist during monthly meetings over eight months. Feedback from two additional focus groups comprising parents/carers and clinicians was incorporated to refine usability, content, and relevance. The process followed the GRIPP2-SF reporting framework to ensure quality and consistency.
Results:
PPI contributed significantly to the checklist development by refining its purpose, functionality, item clarity, and visual format. For example, checklist items were revised to better align with real-world experiences, and guidance notes were simplified for lay comprehension. Feedback emphasised the checklist's role as an aide memoire for identifying behavioural patterns and structuring clinical conversations. Parents/carers also highlighted its potential for monitoring changes, and supporting formal applications, while clinicians noted its utility in clinical decision-making. The finalised checklist was prepared for a pilot study, to assess its feasibility and acceptability.
Conclusions:
The involvement of parents/carers and clinicians positively influenced the checklist's design, fostering a resource that balances scientific validity with practical relevance for service users and providers. PPI also strengthened relationships between stakeholders, paving the way for future collaboration. The checklist is ready for feasibility and acceptability testing and has the potential to improve outcomes for children with intellectual disabilities and their families by facilitating better understanding and management of behaviours that challenge.
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