Mindfulness in Practice (MIP):
The development and evaluation of
a new mindfulness group for staff in
learning disability services
A Project Partnership
The story so far….
Who we all are
A first project
Our plans for the future
Overview of Project
• Consultancy arrangement with Tizard Centre, 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.
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:
o Supporting those with complex needs like challenging behaviour (Hastings, 2002)
o 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:
o Individual’s wellbeing (reflected in emotional distress and sickness),
o The functioning of the service (reflected in absenteeism and staff turnover) (Hatton
& Emerson, 1998; Razza, 1993)
o The quality of care provided to service-users (Lawson & O-Brien, 1994; Rose, Jones
& Fletcher, 1998a; Rose, Jones & Fletcher, 1998b).
o The nature of support work also relies on the development of a
positive relationship between staff and service-users (see Hastings,
2010).
o 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).
o 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.
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).
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
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?
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 manner through
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.
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.
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.
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.
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.
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 (preintervention 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 (preintervention median 13; post-intervention median 18).
DASS Scores pre and post intervention for both groups
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).
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:
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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
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,”
What might this all mean?
A small,
initial study but a suggestions that:
1. Possible to teach staff mindfulness skills via a relatively brief, direct and practical
2. The approach is well received and acceptable to staff and (anecdotally) allows
them to enhance their professional practice
3. 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?
o Further development and support from group members
o Delivering further groups
o Whole-service approaches
Questions, thoughts, ideas?