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HELP with Emotional and Behavioural Concerns

HELP with Emotional and Behavioural Concerns

Introduction

This tool helps primary care providers and others supporting adults with intellectual and developmental disabilities to understand contributing factors when these adults present with emotional distress and behavioural concerns. It provides a systematic and sequential exploration of four areas relating to biopsychosocial circumstances that might underlie or be contributing to emotional distress and behaviours of concern, including behaviours that challenge: Health, Environment, Lived Experiences, and Psychiatric Disorders (HELP). Apply this tool with scrutiny, repeated as necessary over time.

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The HELP approach explained

In the video H.E.L.P. When Behaviours Communicate Distress, psychiatrist Dr. Elspeth Bradley introduces the HELP approach that you can use when a person with intellectual and developmental disabilities presents with behaviours that indicate distress. She explains how all behaviour is communication and how to unpack this. By Curriculum of Caring, McMaster University, Hamilton, 2015. [13:03 minutes]

H.E.L.P. When Behaviours Communicate Distress from Anthony Levinson on Vimeo.

Publications

Learn how to use this information in your practice, from selected articles in the Canadian Family Physician special issues 1 (Vol 64: S1-78, April 2018) and 2 (Vol 65, S1-66) on Primary care of adults with intellectual and developmental disabilities.

HELP for behaviours that challenge in adults with intellectual and developmental disabilities

Clinical leads

Elspeth Bradley, MB BS PhD FRCPC FRCPsych, is a psychiatrist and psychotherapist in intellectual and developmental disabilities (IDD). She is an Associate Professor at the University of Toronto and currently holds courtesy appointments at The Centre for Addiction and Mental Health and at St Michael’s Hospital, Toronto. Dr. Bradley has had the pleasure of contributing to the Developmental Disabilities Primary Care Program since its inception in 2005 and of working with people with intellectual and developmental disabilities and autism (ASD) for several decades in the UK and Canada. Published research includes outcomes from a population-based study of psychiatric disorders in adolescents with IDD and ASD; clinical research has drawn attention to complexities in diagnosing psychiatric disorders in people with IDD and ASD, in the absence of an understanding of their lived experience and mental distress consequent to adjusting to frequent disruptions and adversity in their daily lives. Her current focus on trauma, triggers and emotional engagement as a necessary pre requisite to any psychiatric evaluation, is described in a recently co-authored book Responsive Communication: Combining attention to sensory issues with using body language (intensive Interaction) to interact with autistic adults and children

Kerry Boyd, MD FRCPC, Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ontario. Her clinical work includes working with people who have developmental disabilities. Education and research initiatives have focused on promoting inclusion and care for people with IDD. As an AMS Phoenix Fellow she brought expertise together as Curriculum of Caring course developer. More information on the Curriculum of Caring.

Working group members

Maureen Kelly, MPA, nurse (retired).

Marika Korossy, BA, retired as librarian from Surrey Place. During forty+ years she supported generations of physicians and allied health care providers, in clinical, research, teaching and scholarly undertakings by identifying and providing published evidenced-based practice in the care of people with IDD and ASD.  Collaborations included curriculum planning and delivery of under- and postgraduate training in medicine and psychiatry, joint Surrey Place-University of Toronto programs; supporting the medical genetics program’s multiple clinical and research activities and engaging in continued professional development of multidisciplinary group learning initiatives as well as coauthoring publications in these spheres. Marika promoted the development of an academic print and digital Library at Surrey Place as a unique Canadian resource in matters related to developmental disabilities.  She provided stewardship for the Primary Care Program scholarly and clinical resources, supported by a data referencing system designed to encourage easy access by clinician authors associated with this Program.

Dr. Yona Lunsky is Director of the Azrieli Adult Neurodevelopmental Centre, and Senior Scientist at the Centre for Addiction and Mental Health. She directs the Health Care Access and Developmental Disabilities Program (H-CARDD) which brings research, policy and practice together to improve the health of adults with developmental disabilities. She is a Professor in the Department of Psychiatry at the University of Toronto and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES), Toronto.

This is an update to a previous version of this tool, published A Guide to Understanding Behavioural Problems and Behavioural Concerns in Adults with Developmental Disabilities, which was published in: Sullivan WF, Developmental Disabilities Primary Care Initiative Scientific and Editorial Staff, editors. Tools for the primary care of people with developmental disabilities. Toronto: MUMS Guideline Clearing House; 2011, p. 67-74.

  • Supporting materials

    The HELP approach explained

    In the video H.E.L.P. When Behaviours Communicate Distress, psychiatrist Dr. Elspeth Bradley introduces the HELP approach that you can use when a person with intellectual and developmental disabilities presents with behaviours that indicate distress. She explains how all behaviour is communication and how to unpack this. By Curriculum of Caring, McMaster University, Hamilton, 2015. [13:03 minutes]

    H.E.L.P. When Behaviours Communicate Distress from Anthony Levinson on Vimeo.

    Publications

    Learn how to use this information in your practice, from selected articles in the Canadian Family Physician special issues 1 (Vol 64: S1-78, April 2018) and 2 (Vol 65, S1-66) on Primary care of adults with intellectual and developmental disabilities.

    HELP for behaviours that challenge in adults with intellectual and developmental disabilities

  • Meet the team

    Clinical leads

    Elspeth Bradley, MB BS PhD FRCPC FRCPsych, is a psychiatrist and psychotherapist in intellectual and developmental disabilities (IDD). She is an Associate Professor at the University of Toronto and currently holds courtesy appointments at The Centre for Addiction and Mental Health and at St Michael’s Hospital, Toronto. Dr. Bradley has had the pleasure of contributing to the Developmental Disabilities Primary Care Program since its inception in 2005 and of working with people with intellectual and developmental disabilities and autism (ASD) for several decades in the UK and Canada. Published research includes outcomes from a population-based study of psychiatric disorders in adolescents with IDD and ASD; clinical research has drawn attention to complexities in diagnosing psychiatric disorders in people with IDD and ASD, in the absence of an understanding of their lived experience and mental distress consequent to adjusting to frequent disruptions and adversity in their daily lives. Her current focus on trauma, triggers and emotional engagement as a necessary pre requisite to any psychiatric evaluation, is described in a recently co-authored book Responsive Communication: Combining attention to sensory issues with using body language (intensive Interaction) to interact with autistic adults and children

    Kerry Boyd, MD FRCPC, Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ontario. Her clinical work includes working with people who have developmental disabilities. Education and research initiatives have focused on promoting inclusion and care for people with IDD. As an AMS Phoenix Fellow she brought expertise together as Curriculum of Caring course developer. More information on the Curriculum of Caring.

    Working group members

    Maureen Kelly, MPA, nurse (retired).

    Marika Korossy, BA, retired as librarian from Surrey Place. During forty+ years she supported generations of physicians and allied health care providers, in clinical, research, teaching and scholarly undertakings by identifying and providing published evidenced-based practice in the care of people with IDD and ASD.  Collaborations included curriculum planning and delivery of under- and postgraduate training in medicine and psychiatry, joint Surrey Place-University of Toronto programs; supporting the medical genetics program’s multiple clinical and research activities and engaging in continued professional development of multidisciplinary group learning initiatives as well as coauthoring publications in these spheres. Marika promoted the development of an academic print and digital Library at Surrey Place as a unique Canadian resource in matters related to developmental disabilities.  She provided stewardship for the Primary Care Program scholarly and clinical resources, supported by a data referencing system designed to encourage easy access by clinician authors associated with this Program.

    Dr. Yona Lunsky is Director of the Azrieli Adult Neurodevelopmental Centre, and Senior Scientist at the Centre for Addiction and Mental Health. She directs the Health Care Access and Developmental Disabilities Program (H-CARDD) which brings research, policy and practice together to improve the health of adults with developmental disabilities. She is a Professor in the Department of Psychiatry at the University of Toronto and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES), Toronto.

  • Version history

    This is an update to a previous version of this tool, published A Guide to Understanding Behavioural Problems and Behavioural Concerns in Adults with Developmental Disabilities, which was published in: Sullivan WF, Developmental Disabilities Primary Care Initiative Scientific and Editorial Staff, editors. Tools for the primary care of people with developmental disabilities. Toronto: MUMS Guideline Clearing House; 2011, p. 67-74.

All rights reserved. No part of this website may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the copyright owner, Surrey Place. Contact the Developmental Disabilities Primary Care Program at Surrey Place at ddpcp@surreyplace.ca for permission to adapt information and tools to your local practice setting.