Exploring links between
expressed emotion, challenging
behaviour and burnout in
learning disability frontline
staff.
Emma Mc Donnell
Aim of Study:
1.
Replicate previous research findings that there is a
relationship between high burnout (BO) and high
expressed emotion(EE) in frontline staff working in the
area of intellectual disability.
2.
Determine if level of training in challenging behaviour
(CB) management effects attributions made by staff of
the causes of CB
3.
Examine whether attribution style can predict high
levels of EE in staff and therefore also create a link to a
relationship to high BO
Expressed Emotion
Measures emotional climate of the family:
 Hostility
 Criticism
 Emotional over-involvement
(Vaughan & Leff, 1976)
Expressed Emotion &
Intellectual Disabilities
Research indicates that frontline staff can
display high levels of expressed emotion (EE)
as they typically spend large amounts of time
with the same groups of clients leading to
similar levels of high EE as those of family
carers .
(Weigel et al. 2006; Stanhope & Solomon, 2007; Dennis & Leach, 2007).
Challenging Behaviour
Rates of CB in the intellectual disability
population vary from between
 10% as indicated by Lowe et als Welsh study
(2007)
 28% in Mc Clean & Walsh’s Irish study (1995)
Attribution Theory
The fundamental attribution error posits that
people are more likely to make personality
based attributions for causes of behaviour
rather than attribute behaviour to situational
factors.
(Weigel et al. 2006)
Attribution Theory & Frontline
Staff
 Staff attitudes to causes of CB have indicated
that staff beliefs about the cause of CB affect the
way in which they interact with clients
presenting with such behaviour
(Tierney et al. 2007)
 Staff have been noted to have elevated EE
scores towards clients who they perceive as
having more control over their CB
(Weigel et al. 2006)
Staff Burnout
 Emotional exhaustion
 Depersonalisation
 Personal accomplishment
(Maslach et al, 1996)
Method & Materials
Participants (N=221): 108 completed surveys
 Staff who had worked with at least one client whose
behaviour they perceived as challenging for a minimum
of a year were included in the analysis.
Materials:
 Lime Survey, an open source survey application, was
used to create an online survey which was hosted on the
intranet server
Measures:
1.
Demographic information
2.
Checklist of Challenging Behaviour CCB
(Harris et al. 1994)
3. Challenging Behaviour Attributions Scale CHABA
(Hastings, 1997)
4.
Level of Expressed Emotion (LEE) Scale Carer Version
(Kararian et al. 1990)
5.
Maslach Burnout Inventory Human Services Survey
MBI-HSS (Maslach & Jackson, 1996)
Results: Demographics
Gender mix of participants
Age range of participants
Highest Level of Staff Formal Education
Attainment:
Education Level
Frequency
%
Junior Certificate
1
0.5%
Leaving Certificate
6
3.2%
Certificate
14
7.5.%
Diploma
29
15.4%
Degree
123
65.4%
Masters
12
6.4%
Doctorate
1
0.5%
Total
N=186
Staff Participation Levels in Types of
Challenging Behaviour Courses and Frequency:
Type of CB course
Frequency
%
Challenging Behaviour
3 Day Course
147
66.5%
TIPS
43
19.5%
Mark 2
55
24.9%
Studio 3
93
41.6%
Total: N= 221
Expressed Emotion Scores:
Staff Burnout Scores:
Logistic Regression Analysis:1
Estimating factors that influence high/low EE
A logistic regression analysis was used to predict the probability of high EE
scores in staff being linked with elevated BO scores in one of its three domains:
-
Emotional exhaustion,
-
Depersonalisation
-
Personal Accomplishment.
 The results indicate that high EE predicts high emotional exhaustion.
 Staff that are presenting with emotional exhaustion are more likely to
have elevated EE scores.
 The coefficient on the emotional exhaustion variable is positive and
significant at p=.012
Logistic Regression Analysis:2
The same model was also used to calculate which of the three
attribution dimensions of the CHABA scale would be correlated
to staff with high EE scores.
 Internal / external
 Controllable / uncontrollable
 Stable / unstable
 The coefficient on the internal variable was positive
and significant p=.049
 This indicates that staff who have high EE scores are eight
times more likely to be making internal attributions.
Discussion:
EE & CB Training
 High EE was evident in 51.85% of staff in this
study, this appears to be within the limits found
in other studies that range from 31% to 66%
(Dennis & Leach, 2007; Langdon et al. 2007).
 No significant difference was found between the
EE scores of trained versus untrained staff in the
area of CB. This is contrary to previous research
that suggests that less formally trained staff
have higher EE scores (Dennis & Leach, 2007; Van Humbeeck et
al. 2001).
Discussion:
Attribution style & EE
 Results indicate that staff with elevated EE
scores are eight times more likely to be making
internal attributions for causes of CB in clients.
 This result corresponds very positively to
previous research in the area which suggests a
link between internal attribution of client CB by
staff is correlated to high EE scores in staff (Tierney
et al. 2007; Sharrock et al. 1990; Weigel et al. 2006).
Discussion:
EE & Staff Burnout
 This study corresponds with previous research
suggesting that high levels of some elements of
BO are present in frontline staff and that this can
be linked to high EE scores.
 This study corroborates the finding of a link
between elevated EE scores and high scores on
the BO measure in a much greater sample
 n=108 versus n=10.
(Dennis & Leach, 2007)
Discussion:
Effects of Staff Burnout
 The results of this study indicate a strong link
between internal attributional style of staff towards
clients CB, consequently elevated EE scores
developing in these individuals and leading to BO in
the area of emotional exhaustion.
 The effect of BO on intellectual disability services is
large with higher rates of absenteeism, staff
turnover and low morale leading to a more stressful
working environment (Dennis & Leach, 2007).
Limitations:
Approximately 10% of frontline staff completed the survey,
however there was a skew in the sample with the majority
of participants in their 20’s or 30’s:
 The benefit of using a method that greatly increases
numbers of participants outweighs the slightly skewed
nature of the sample.
 The anonymity afforded by this methodology does have
its benefits with participants more likely to respond
honestly about a sensitive work area.
Future Research:
 CB training courses: no significant effect found in the
low versus high EE groups with regard to the effect
of CB training.
 The results indicate that present CB management
training had little effect on staff attributions.
 As staff attributions to the internal causes of CB can
now be demonstrated to predict high EE scores the
impact of improving training to shift staff beliefs
towards external attributions should warrant further
research.
Conclusion:
Lowering EE environments has a two-fold
effect with both staff and client benefitting
from a more positive interaction. Ultimately
improving the training and support provided
to staff working in with challenging behaviour
in the area of intellectual disability improves
the quality of care and the quality of life for
service-user.