Page 86 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 4
Behavioural problems
The Behavior Problems Inventory (BPI; Rojahn et al., 2001) indexes the
frequency and severity of a problem behaviour. Both the frequency and
severity scores can be derived from the total BPI score. The frequency
score of the problem behaviour (51 items) was measured on a 5-point
Likert scale (0 = never, 1 = monthly, 2 = weekly, 3 = daily, and 4 = hourly).
The severity score of the problem behaviour (51 items) was measured on
a 3-point Likert scale (1 = mild problem, 2 = moderate problem, 3 = severe
problem). Total scores for both frequency and severity were calculated, with
higher scores denoting more frequency/severity of problematic behaviour.
In our study, we used the Dutch version of the BPI, which has adequate to
good psychometric properties including good inter-rater, intra-rater, internal
consistency, and convergent validity (Dumont et al., 2014). A professional
caregiver who had regular contact with the participants completed the BPI.
Involuntary care
Involuntary care measures is defined as: ‘Any care opposed by a client or
client-representative’ (Staatsblad, 2018) and were recorded by professional
caregivers of the participants in the ‘Involuntary care reporting system’ in
clients’ electronic files. This system was documented for each participant,
and both predetermined (multidisciplinary agreed) involuntary care (e.g.
‘bedroom door locked at night’) and incidents of involuntary care (e.g. ‘fixation
by professional caregivers’). A study by Schippers et al. (2018a, 2018b) on
the ‘Involuntary Care Reporting System’ of ‘s Heeren Loo demonstrated that
involuntary care could be reliably recorded with this system. All recorded
involuntary care was extracted from participants’ electronic client files.
Intensive EMDR-therapy and procedure
The participants received EMDR therapy twice daily for a maximum of two
weeks from six therapists. Three therapists were certified ‘EMDR Europe
practitioners’, while the other three had completed the basic and advanced
EMDR courses accredited by the Dutch EMDR Association. All therapists
had treated at least 20 clients with MID-BIF for PTSD before the start of
the study. The authors were not involved as therapists in the current study.
Treatment integrity was monitored by the first author and an accredited
supervisor from the Dutch EMDR Association (third author) through three
supervision sessions during the baseline phase and three supervision
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