Adults with learning disabilities who show aggression will receive a personalised treatment package designed with their input, tested against standard care in a trial of 410 people across England, Scotland and Northern Ireland. Aggression in adults with learning disabilities is common, persistent, and a major reason for emergency care and psychiatric hospital admission. Current behavioural treatments fail many people, who end up on long-term antipsychotics with no guarantee of improvement. The research team does not know why some people respond to treatment and others do not, or which components of care work best for whom. If the personalised package proves effective, it could give the NHS a practical, evidence-based alternative to medication for managing aggression. That would mean fewer hospital admissions, better quality of life for the individual and their carers, and reduced strain on emergency services. The trial includes a cost-effectiveness analysis, so the NHS would know whether the approach is worth implementing at scale. The project also produces a training manual, making it possible for community teams to deliver the package in routine care.
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Research aim: To develop and test in a randomised controlled trial a personalised treatment package for aggression for adults with learning disability that can be implemented in the NHS. Background: Aggression in adults with learning disability is common and persistent over time. Moderate to severe aggression is considered a public health problem, major reason for emergency care and admission to psychiatric hospitals. It has significant impacts on quality of life of the individual, the family carers and and the paid carers. The current treatment approach is behavioural but many do not respond to it and remain on long term antipsychotics. Hence, we propose a programme to make use of quantitative and qualitative methods to explore the heterogeneity in response in adults with learning disability who display aggression and to develop a personalised multimodal approach to treatment. Objectives: 1) to identify key features of adults with learning disabilities, their family and paid carers and the environment that respond differentially to existing treatments for aggression; 2) to identify individual and contextual predictors of aggression to inform the treatment package content; 3) to conduct a qualitative study to deepen understanding of the reasons for good or poor outcomes for aggression and quality of life; 4) to work with family and adults with learning disability (experts by experience) to develop the personalised treatment package for aggression and to test its feasibility; 5) to conduct a randomised controlled trial with an internal pilot to test the clinical and cost effectiveness of the personalised treatment package. Methods: We propose 4 workstreams (WS) over 66 months as follows: WS1 (months 1-16): A rapid realist review (RRR) to examine why, for whom, and in what circumstances complex intervention programmes for aggression are most successful including key components of the interventions and the setting within which they are delivered. Up to 40 qualitative interviews with adults with mild learning disability, family carers, paid carers, health and social care professionals and service managers, to examine experience of care and measures of success or failure of interventions and care. WS2: (months 1-12): a retrospective cohort study using the Clinical Record Interactive Search database to examine predictors of contacts with crisis services including admissions over 8 years. Synthesis of evidence from WS1 and 2: month 16. WS3 (months 16-24). co-design of intervention with adults with learning disability, their family and paid carers and professionals to co-design the personalised treatment package and its training manual; feasibility testing. Lead in for cluster RCT: months 20-26 WS4 (months 26-62): A cluster randomised controlled trial (n=410) in 3 UK countries (England, Scotland and Northern Ireland) to test the clinical and cost effectiveness of the personalised treatment package; process evaluation, Months 62-66: data analysis, interpretation and report to funder. Internal pilot (10 months) report: month 37/38 Anticipated Impact and Dissemination: Impact through improved outcomes and treatment delivery and implementation in routine care; peer-reviewed publications; other targeted dissemination; engagement through social media; policy makers and clinical commissioning liaison.
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