Portrait of Dr Nick Gore

Dr Nick Gore

Senior Lecturer in Learning Disability

About

Dr Gore is a senior lecturer, clinical psychologist and researcher in the field of learning disability.  He began work at Tizard in 2007 motivated by the Centre's commitment to high quality research and innovative teaching programmes.  

He has held a variety of teaching and consultancy roles and has completed and developed research that aims to increase both the evidence base for supporting people with intellectual and developmental disabilities and actual use of this in practice. He has had several split posts and secondments with the NHS working as a clinical psychologist to support both children and adults with intellectual disabilities.

Research interests

Dr Gore has a broad range of research interests:

  • behaviour that challenges
  • positive behaviour support
  • emotional wellbeing and support for staff and family carers
  • early intervention and Positive approaches to support
  • alternatives to the use of residential schooling
  • service frameworks and pathways relating to these areas

Dr Gore was recently funded by a doctoral research fellowship from the National Institute of Health Research working on a series of projects relating to the use of positive behavioural support for children in NHS contexts.  

Teaching

Nick has lectured, convened, tutored and supervised across the majority of undergraduate and postgraduate programmes as well as supervising a number of PhD students.  He currently teaches on the postgraduate programmes in PBS and ABA.

Supervision

Nick has supervised a number of PhD students to successful completion. He currently supervises several PhD students whose work focuses on PBS, early intervention, caregivers and children with disabilities. 

Professional

  • Chartered member of the British Psychological Society
  • Registered with the Health Professional council
  • core member of the Challenging Behaviour National Strategy Group
  • member of the project management team at the Sharland Foundation Developmental Disabilities ABA Research and Impact network (SF-DARIN)   
  • Founding member of the PBS Academy
  • Trustee to Challenging Behaviour Foundation


Publications

Article

  • Dilks-Hopper, H., Jacobs, C., Sholl, C., Gore, N. and Falconer, C. (2019). The Ealing Intensive Therapeutic and Short Breaks Service: an update five years on. Tizard Learning Disability Review [Online] 24:56-63. Available at: https://dx.doi.org/10.1108/TLDR-09-2018-0027.
    The purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS). Design/methodology/approach– Thechallengestheservicehasfacedarereviewed,includingtheservice’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service. Findings – The ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families. Originality/value – Despite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a bestpracticemodel.Fewpriorarticleshaveprovidedanaccountofhowinnovativeservicemodelsaremaintained and evolve over time.
  • Gore, N. and McGill, P. (2019). Making it Meaningful: Caregiver Goal Selection in Positive Behavioral Support. Journal of Child and Familiy Studies [Online] 28:1703-1712. Available at: http://dx.doi.org/10.1007/s10826-019-01398-5.
    Objectives
    Positive Behavioral Support (PBS) is considered the treatment framework of choice for children with intellectual and developmental disabilities (IDD) at risk of behavior that challenges. PBS demands stakeholder engagement, yet little research has explored goal formation in this context for caregivers of children with IDD.

    Methods
    We used Talking Mats and semi-structured interviews to support 12 caregivers of children with IDD who displayed behaviours that challenge, to develop goals for PBS. Interviews covered quality of life for caregivers and their child, adaptive and challenging aspects of child behavior, and aspects of caregiver’s own behavior.

    Results
    Caregivers were able to form individualised and meaningful goals in relation to all domains, demonstrating rich insight into personal needs and needs of their child. The process of forming goals was psychologically and emotionally complex given prior experiences and needs of participants but effectively supported by the interview method.

    Conclusions
    We conclude that goal formation in PBS requires careful consideration and structuring but has the potential to support effective working relationships and ensure assessment and intervention is aligned with the needs and aspirations of families.
  • Vereenooghe, L., Flynn, S., Hastings, R., Adams, D., Chauhan, U., Cooper, S., Gore, N., Hatton, C., Hood, K., Jahoda, A., Langdon, P., McNamara, R., Oliver, C., Roy, A., Totsika, V. and Waite, J. (2018). Interventions for mental health problems in children and adults with severe intellectual disabilities: A systematic review. BMJ Open [Online] 8:1-12. Available at: http://dx.doi.org/10.1136/bmjopen-2018-021911.
    Objective: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatments options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking-therapies, and difficulties reporting drug side-effects.
    Design: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index, and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.
    Participants: Study samples included at least 70 % children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.
    Interventions: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition.
    Outcomes: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.
    Results: We retrieved 41,232 records, reviewed 573 full-text articles and identified 5 studies eligible for inclusion: 3 studies evaluating pharmacological interventions, and 2 studies evaluating psychological interventions. Study designs ranged from double-blind placebo-controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards, and a lack of follow-up data.
    Conclusions: Mental ill-health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, whilst researchers
  • Tomlinson, S., Gore, N. and McGill, P. (2018). Training Individuals to Implement Applied Behavior Analytic Procedures via Telehealth: A Systematic Review of the Literature. Journal of Behavioral Education [Online] 27:172-222. Available at: https://doi.org/10.1007/s10864-018-9292-0.
    The purpose of this article is to summarize literature relating to training individuals to implement applied behavior analytic procedures via telehealth and identify any gaps in the evidence base for this type of support. A systematic literature search revealed 20 articles focusing on training individuals to implement specific ABA techniques via telehealth. The Evaluative Method (Reichow et al. in J Austism Dev Disord 38:1311–1319, 2008; Reichow, in: Reichow, Doehring, Cicchetti, Volkmar (eds) Evidence-based practices and treatments for children with autism, Springer, New York, Reichow 2011) was used to assess the methodological quality of included articles. Results indicated that individuals were trained to implement a range of techniques, including assessments, targeted interventions, and specific teaching techniques. Socially significant outcomes were reported for clients in the form of reduced challenging behavior and increased skills. Trainee fidelity following training via telehealth was variable, and barriers related to the use of telehealth were highlighted. Where evaluated, cost and travel burdens were considerably lower than support provided in-person. The emerging literature is promising and suggests that telehealth may be an effective means of training individuals in ABA techniques; however, wider issues and practical implications related to the use of telehealth should be considered and are discussed as it relates to ABA providers.
  • Bradshaw, J., Gore, N. and Darvell, C. (2018). Supporting the direct involvement of students with disabilities in functional assessment through use of Talking Mats®. Tizard Learning Disability Review [Online] 23:111-116. Available at: https://doi.org/10.1108/TLDR-01-2018-0004.
    Purpose
    Bowring et al. describe ways of using the Behavior Problems Inventory – Short Form, illustrating how to use clinical norms to evaluate change. This commentary focuses on the importance of considering information gained directly from people with intellectual and developmental disabilities (IDD) during assessment. The paper aims to discuss these issues.

    Design/methodology/approach
    A pilot project involved interviews with four children with IDD. A Talking Mats® (TM) framework was used to gather children’s views regarding challenging behaviours (CBs) and variables relevant to a functional behavioural assessment, such as things they found to be reinforcing, things that set the occasion for CB and things that helped prevent this.

    Findings
    The children were able to provide information and insight into several areas that are influential in the maintenance of behaviour that challenges. Some of this information may not have been obtainable from other sources or informants using traditional assessment methods alone.

    Originality/value
    Gathering the views of people with IDD is important. The Convention on the Rights of Persons with Disabilities (United Nations, 2009) states that people have the right to be heard. Many people with IDD have difficulties communicating. A TM framework is one method by which people may be able to express their views. Taking the views of the individual into account during the process of gathering information about behaviours that challenge should lead to greater understanding of the functions of any behaviours and therefore to more targeted, acceptable and effective forms of support.
  • Tomlinson, S., McGill, P., Gore, N. and Humphreys, J. (2017). Trends in the provision of residential educational placements available for young people with learning disabilities/autism in England. Tizard Learning Disability Review [Online] 22:222-229. Available at: https://doi.org/10.1108/TLDR-07-2017-0028.
    Purpose: Little is known about the characteristics of residential educational settings for young people with intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics and experiences of the young people attending such settings rather than the setting itself; therefore, an overview of national provision is needed. The paper aims to discuss these issues.

    Design/methodology/approach: As part of a larger project, data were collected for all residential schools and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for 30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of the main project, settings offering placements only to young people aged under 16 were excluded. Data were collected from a range of sources, including school/college websites, Ofsted and Department for Education resources, and liaison directly with the setting.

    Findings – In total, 342 residential educational settings were identified with 57 of these offering post-16 provisions only. A range of data is presented about these settings, including location, placement numbers and types available, age range catered for, special educational needs categories registered for, governance arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings.

    Originality/value – These data provide a national overview of residential educational settings for young people with IDD. This enables a clearer picture of the location and type of provision offered and allows comparisons both within and between areas.
  • Flynn, S., Vereenooghe, L., Hastings, R., Adams, D., Cooper, S., Gore, N., Hatton, C., Hood, K., Jahoda, A., Langdon, P., McNamara, R., Oliver, C., Roy, A., Totsika, V. and Waite, J. (2017). Measurement tools for mental health problems and mental well-being in people with severe or profound intellectual disabilities: A systematic review. Clinical Psychology Review [Online] 57:32-44. Available at: https://doi.org/10.1016/j.cpr.2017.08.006.
    Mental health problems affect people with intellectual disabilities (ID) at rates similar to or in excess of the non-ID population. People with severe ID are likely to have persistent mental health problems. In this systematic review (PROSPERO 2015:CRD42015024469), we identify and evaluate the methodological quality of available measures of mental health problems or well-being in individuals with severe or profound ID. Electronic searches of ten databases identified relevant publications. Two reviewers independently reviewed titles and abstracts of retrieved records (n=41,232) and full-text articles (n=573). Data were extracted and the quality of included papers was appraised. Thirty-two papers reporting on 12 measures were included. Nine measures addressed a broad spectrum of mental health problems, and were largely observational. One physiological measure of well-being was included. The Aberrant Behavior Checklist, Diagnostic Assessment for the Severely Handicapped Scale-II and Mood, Interest and Pleasure Questionnaire are reliable measures in this population. However, the psychometric properties of six other measures were only considered within a single study – indicating a lack of research replication. Few mental health measures are available for people with severe or profound ID, particularly lacking are tools measuring well-being. Assessment methods that do not rely on proxy reports should be explored further.
  • Murphy, G., Chiu, P., Triantafyllopoulou, P., Barnoux, M., Blake, E., Cooke, J., Forrester-Jones, R., Gore, N. and Beecham, J. (2017). Offenders with intellectual disabilities in prison: what happens when they leave?. Journal of Intellectual Disability Research [Online] 61:957-968. Available at: http://dx.doi.org/10.1111/jir.12374.
    People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. This study followed up men with ID who were leaving prisons in England. The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. 70% were above the clinical cut-off for anxiety and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community and many had been re-interviewed by police. Community teams need to provide better support to this very vulnerable group.
  • Gore, N. and Baker, P. (2017). Mental health as motivational operation: Service-user and caregiver emotional states in the context of challenging behaviour. International Journal of Positive Behavioural Support [Online] 7:15-23. Available at: http://www.ingentaconnect.com/contentone/bild/ijpbs/2017/00000007/00000001/art00003.
    This brief conceptual paper seeks to address the role of mental health and the experience of negative life events in the positive behavioural support framework in relation to the behaviour of both service users and caregivers and some of the implications this may suggest for intervention. It is argued that the conceptualisation of mental health related variables as motivating operations is parsimonious at a theoretical and practical level and may create one way of generating further synergies within the field of IDD.
  • Evans, T. and Gore, N. (2016). Staff behaviours valued by service users: views of people whose behaviour challenges. International Journal of Positive Behavioural Support [Online] 6:4-11. Available at: https://www.ingentaconnect.com/content/bild/ijpbs/2016/00000006/00000002/art00002.
    Background: Research suggests that staff support and interactions with people with intellectual disabilities are important for the individual's quality of life and may also influence behaviours that challenge. To date, research has focused on professionals' perceptions of the behaviours of good support staff. In contrast, this study examines the perspectives of people with intellectual disabilities and behaviour that challenges.

    Method: Seventeen people with intellectual disabilities and behaviour that challenges were interviewed about their views using a semi-structured approach. Comments generated were analysed using a qualitative thematic methodology.

    Results: Participants described various positive staff behaviours, most notably being 'kind'. They valued being helped, staff understanding what was important to them and staff making time for them. Participants also described behaviours that they did not value, including staff being too controlling, being too busy or not providing enough support and being disrespectful in how they spoke to them.

    Conclusions: Implications of the results for service provision, staff recruitment and staff deployment are discussed.
  • Lemmi, V., Knapp, M., Gore, N., Cooper, V., Jackson Brown, F., Reid, C. and Saville, M. (2016). What is standard care for people with learning disabilities and behaviour that challenges and what does it cost?. British Journal of Learning Disabilities [Online] 44:309-321. Available at: http://dx.doi.org/10.1111/bld.12168.
    Background: We describe current care arrangements in England for children, young people and adults with learning disabilities and behaviour that challenges, and estimate their comparative costs.

    Materials and Methods: A two-round Delphi exercise was performed in March and April 2014, followed by a costing exercise.

    Results: The study finds a mixed picture: participants reported that 60–87% of children, 66–88% of young people and 34–47% of adults were likely to be living within the community. Annual cost of care would range between £39 612 and £74 876 for children, between £35 235 and £52 832 for young people and between £81 478 and £94 799 for adults.

    Conclusion: While residential-based care may continue to be necessary for respite or for individuals with particular needs, community-based care may be an economically attractive alternative, supporting the inclusion of people with learning disabilities and behaviour that challenges within their communities, potentially at a lower cost.
  • Reid, C., Gill, F., Gore, N. and Brady, S. (2015). New ways of seeing and being: Evaluating an acceptance and mindfulness group for parents of young people with intellectual disabilities who display challenging behaviour. Journal of Intellectual Disabilities [Online] 20:1-13. Available at: http://dx.doi.org/10.1177/1744629515584868.
    The current study presents findings from an acceptance and commitment therapy-based intervention for family carers of children who have an intellectual/developmental disability and display high levels of challenging behaviour. The parent well-being workshops consist of two workshops incorporating acceptance and mindfulness-based exercises and discussions. Semi-structured interviews were conducted with five family carers following attendance of the workshops. Participants found the workshops useful and reported that they were better able to cope with stress. They also described how they had incorporated mindfulness into their daily lives and how their practice had had positive effects on their own well-being and on those around them (e.g. their child). Implications of the findings are discussed with emphasis on how the workshops can be included within a positive behaviour support framework. Future directions include a more robust quantitative evaluation, inclusion of follow-up sessions and the application of the workshops with other client groups and in other delivery formats.
  • Gore, N., Emerson, E. and Brady, S. (2015). Rates of breastfeeding and exposure to socio-economic adversity amongst children with intellectual disability. Research in Developmental Disabilities [Online] 39:12-19. Available at: https://doi.org/10.1016/j.ridd.2014.12.028.
    Children with intellectual disability are at increased risk of experiencing poor health relative to their typically developing peers. Previous research indicates that exposure to socio-economic disadvantage contributes towards this disparity but that additional factors (including parenting practices) may be involved in mediating/moderating pathways. This study examined duration of breastfeeding amongst children with and without intellectual disability by a secondary analysis of data from the UK Millennium Cohort Study. Children with intellectual disability were significantly less likely to have been ever breastfed; breastfed exclusively or at all at 3 months or breastfed at all at 6 months relative to children without intellectual disability. None of these differences remained significant when other psycho-social risk factors for reduced breastfeeding were controlled for. The study adds to both the sparse literature on breastfeeding practices amongst families of children with intellectual disability and research demonstrating relationships between socio-economic disadvantage and wellbeing for children with intellectual disability.
  • Gore, N., Hastings, R. and Brady, S. (2014). Early intervention for children with learning disabilities: making use of what we know. Tizard Learning Disability Review [Online] 19:181-189. Available at: http://dx.doi.org/10.1108/TLDR-08-2013-0037.
    Purpose
    – The purpose of this paper is to present a rationale for increasing initiatives for early intervention of emotional and behaviour difficulties.

    Design/methodology/approach
    – The authors draw on existing literature regarding rates of emotional and behavioural difficulties together with risk factors and processes related to the development of such difficulties.

    Findings
    – Rates of emotional and behavioural difficulties amongst children with learning and developmental difficulties are high. A combination of factors relating to the child, the family system, and wider social contexts is likely to account for this.

    Research limitations/implications
    – Increased attempts to provide early intervention to children with learning and developmental disabilities together with their families are warranted. Recommendations are made regarding how the development of such supports might best be taken forward.

    Originality/value
    – Whilst drawing on pre-existing literature, the value of this paper is the way in which this has been drawn together to provide an overview of risk and development of behavioural and other difficulties amongst children with learning/developmental disabilities.
  • Miller, P., Hands, M., Gore, N. and Brady, S. (2013). The Autism Champions Project: strengthening capacity within and across schools. Good Autism Practice 14:33-37.
    This paper presents a model of support to staff which was developed by an educational outreach team. The model aims to improve knowledge and resources within mainstream schools to better support pupils on the autism spectrum. Key members of staff (champions) from each school were selected and given a seven session training programme. Following this, they were mentored and supported to develop individual projects within their school. Examples of these projects included developing lunchtime clubs, creating pupil profiles and establishing a parent support group. This resulted in an increase in staff confidence and skills, a reduction in challenging behaviour and improved outcomes for students. Case study examples are given to support the findings and a second implementation phase with a new cohort of champions and a formal evaluation is planned.
  • Reid, C., Sholl, C. and Gore, N. (2013). Seeking to prevent residential care for young people with intellectual disabilities and challenging behaviour: examples and early outcomes from the Ealing intensive therapeutic and short break service. Tizard Learning Disability Review [Online] 18:171-178. Available at: http://dx.doi.org/10.1108/TLDR-01-2013-0003.
    Purpose
    – The purpose of this paper is to present early outcomes and case examples from the Ealing Intensive Therapeutic and Short Break Service.

    Design/methodology/approach
    – The service was piloted over a period of 3.5 years during which clinical data were collected for young people at risk of a move to residential care.

    Findings
    – There were positive outcomes for young people with intellectual disabilities and challenging behaviour who were seen through the service with residential placements prevented in the vast majority of cases.

    Originality/value
    – These early outcomes highlight the importance of providing intensive therapeutic intervention with short breaks in order to prevent family placement breakdown.
  • Allen, D., McGill, P., Hastings, R., Toogood, S., Baker, P., Gore, N. and Hughes, J. (2013). Implementing positive behavioural support: changing social and organisational contexts. International Journal of Positive Behavioural Support [Online] 3:32-41. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00005?crawler=true.
    Abstract:
    Background: Social and organisational contexts have a major influence on both challenging behaviour and interventions designed to ameliorate such behaviour and improve quality of life.

    Method and materials: A non-systematic review was conducted in order to identify social and organisational factors that impact upon positive behavioural support (PBS) intervention.

    Results: A series of micro and macro influences on intervention effectiveness were identified. Possibilities for improving intervention effectiveness that extend the scope of traditional behavioural interventions were discussed.

    Conclusions: Implications and opportunities for building capacity at an individual service user, organisational and cultural level are highlighted.
  • Denne, L., Noone, S., Gore, N., Toogood, S., Hughes, J., Hastings, R., Allen, D., Baker, P. and McGill, P. (2013). Developing a core competencies framework for positive behavioural support: issues and recommendations. International Journal of Positive Behavioural Support [Online] 3:24-31. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00004?crawler=true.
    Background: Widespread adoption of positive behavioural support (PBS) will stand and fall on the extent to which we can develop a competent workforce. The case for the development of a competence framework for PBS is presented.

    Method and materials: We review the role that competence frameworks play in evidence-based practice and outline some of the ways in which they have been defined and structured. We describe the process used to develop the UK Autism Education Competence Framework (ABACF) and discuss the particular issues that need to be considered when developing a competence framework specifically for PBS.

    Results: We propose a conceptual model illustrating what a PBS competence framework might look like and suggest a process for its development.

    Conclusions: Competence frameworks are one means of translating evidence into practice. To be effective they must be an integral part of all aspects of service provision and must be grounded in the defining components of the discipline they describe.
  • Hastings, R., Allen, D., Baker, P., Gore, N., Hughes, J., McGill, P., Noone, S. and Toogood, S. (2013). A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities. International Journal of Positive Behavioural Support [Online] 3:5-13. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00002?crawler=true.
    Background: To be able to define positive behavioural support (PBS), describe PBS interventions and clarify the individual and organisational competencies needed to support PBS, a clear underlying conceptual framework is needed to identify why challenging behaviours occur.

    Method and materials: Non-systematic review and discussion of the state of research and theoretical evidence focusing on vulnerability factors for challenging behaviours, maintaining processes, and the social impact of challenging behaviour.

    Results: Understanding challenging behaviour is related most strongly to context. First, challenging behaviours are defined in terms of their social effects. Second, vulnerability factors for challenging behaviour include some biological factors, but mainly psycho-social risks relating to the life situation and inequalities experienced by people with developmental disabilities. Third, social contextual processes are primarily responsible for maintaining challenging behaviours.

    Conclusions: PBS is a broad approach to understanding and intervention referring to multiple contributing factors and processes. To describe PBS without reference to an underlying theoretically grounded conceptual framework would lead to an impoverished version of the approach.
  • Gore, N., McGill, P., Toogood, S., Allen, D., Hughes, J., Baker, P., Hastings, R., Noone, S. and Denne, L. (2013). Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support [Online] 3:14-23. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00003.
    Background: In light of forthcoming policy and guidance in the UK regarding services for people who display behaviour that challenges, we provide a refreshed definition and scope for positive behavioural support (PBS). Through doing this we aim to outline a framework for the delivery of PBS that is of practical and strategic value to a number of stakeholders.

    Method and materials: We draw extensively on previous definitions of PBS, relevant research and our professional experience to create a multi-component framework of PBS, together with an overall definition and a breakdown of the key ways in which PBS may be utilised.

    Results: The framework consists of ten core components, categorised in terms of values, theory and evidence-base and process. Each component is described in detail with reference to research literature and discussion regarding the interconnections and distinctions between these.

    Conclusions: We suggest the framework captures what is known and understood about best practice for supporting people with behaviour that displays as challenging and may usefully inform the development of competences in PBS practice, service delivery, training and research.
  • Smith, M. and Gore, N. (2012). Outcomes of a ’Train the Trainers’ Approach to an Acceptance Based Stress Intervention in a Specialist Challenging Behaviour Service. International Journal of Positive Behavioural Support [Online] 2:39-48. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2012/00000002/00000001/art00006.
    Background: The application of acceptance and commitment therapy (ACT) principles to occupational stress is a relatively recent development, and a pilot study by Noone and Hastings (2009) suggests it may be a helpful approach with staff in ID services. The aims of the present study were to replicate the workshop format developed by Noone and Hastings and to expand on this by training a group of 'ACT novices', recruited from the workforce, to deliver the training.

    Method and materials: A total of 72 staff working in specialist challenging behaviour services participated in one of six workshops (consisting of a whole day and a half-day follow-up six weeks later) which were staggered over a six-month period. A range of measures were used at five time points (two baseline measures, one post-intervention measure and two follow-up measures) to evaluate the outcome of the intervention.

    Results: There were significant improvements at different time points on the General Health Questionnaire, the Maslach Burnout Inventory (Depersonalisation sub scale); a number of sub scales on the Staff Stress Questionnaire and the Dysfunctional Attitude Scale. However, there were no significant changes in measures on Acceptance (Acceptance and Action Questionnaire); not, and Values (Support Staff Values Questionnaire), which are key ACT concepts.

    Conclusions: The findings compare well to prior studies in the area, particularly when considered within the context of a train the trainers model. However, complete support for an ACT model was not demonstrated which provides opportunities for further research in the field.
  • Gore, N., Forrester-Jones, R. and Yong, R. (2012). Staff experiences of supported employment with SHIEC (Sustainable hub of innovative employment for people with complex needs). British Journal of Learning Disabilities.
  • Young, R., Gore, N. and McCarthy, M. (2012). Staff attitudes towards sexuality in relation to gender of people with intellectual disability: a qualitative study. Journal of Intellectual and Developmental Disability [Online] 37:343-347. Available at: https://doi.org/10.3109/13668250.2012.704983.
    Background Research has found staff attitudes regarding the sexuality of people with intellectual disability (ID) to be negative but influenced by several factors. The current study aimed to examine whether gender of people with ID affects such attitudes.

    Method Semistructured interviews were completed with 10 staff members and analysed using thematic analysis.

    Results Results indicated 3 themes: Women are perceived as sexually innocent, men as more sexually motivated, and motivations for sexual relationships are perceived to differ between men and women with ID.

    Conclusion The study indicates unfavourable attitudes towards sexuality in individuals with ID that correlate with traditional, restricted gender stereotypes. The identification of these themes highlights the importance of considering gender when supporting the sexuality of people with ID.
  • Gore, N. and Umizawa, H. (2011). Challenging Behaviour Training for Teaching Staff and Family Carers of Children with Intellectual Disabilities: A Preliminary Evaluation. Journal of Policy and Practice in Intellectual Disabilities [Online] 8:266-275. Available at: http://dx.doi.org/10.1111/j.1741-1130.2011.00315.x.
    Training programs on the topic of challenging behaviors have often been offered to teaching staff and family carers of children with intellectual disabilities (ID). These efforts have been found to be effective in bringing about positive changes for both children with ID and those who support them. Generally, such training has been offered to either staff or family carers but not at the same time. The authors conducted a study to evaluate the efficacy of a brief training program delivered at the same time to teaching staff and family carers (who were involved with the same child). The study also examined differences in outcomes between the two groups, which were drawn from local schools where some children exhibited challenging behaviors. Both teaching staff and family carers completed the Checklist of Challenging Behaviour, the Challenging Behaviour Attributions Scale, and the Emotional Reactions to Challenging Behaviour Scale prior to, and following, the training workshops. The workshops were divided into two segments. The content was the same, but in the first segment, one was held for teaching staff and one for parent carers. In the second segment, both groups met together. After the first segment, all participants completed a related homework task before joining each other for the second segment. Training used a functional model of challenging behavior and facilitated the production of individualized support plans for the target children. Significant positive changes were found regarding ratings of challenging behavior, participants causal attributions, and emotional reactions following the training. Some differences were found regarding outcomes for teaching staff vs. family carers. The study showed that teaching staff and family carers can benefit from receiving combined training to support challenging behavior in children with ID.
  • Forrester-Jones, R., Gore, N. and Melling, K. (2010). How many people with intellectual disability are employed in the UK?. Tizard Learning Disability Review [Online] 15:56-57. Available at: http://dx.doi.org/10.5042/tldr.2010.0031.
  • Gore, N., Barnes-Holmes, Y. and Murphy, G. (2010). The relationship between intellectual functioning and relational perspective-taking. International Journal of Psychology and Psychological Therapy 10:1-17.
    Several studies have employed an RFT-based test protocol as an assessment of perspective-taking with both typical and atypical samples of adults and children. In addition, other RFT protocols have found significant correlations between competencies on specific relations and outcomes on standardised IQ measures. However, there is no research to date that has examined correlations between relational perspective-taking and IQ. In the current study, 24 adults with varying levels of intellectual disability were exposed to standard measures of language ability and IQ, as well as an RFT-based test protocol for perspective-taking. In line with previous evidence, the results indicated significant differences across performances on different aspects of the perspective-taking protocol. Furthermore, the data indicated that perspective-taking correlated with verbal ability, full-scale IQ and performance IQ. These findings provide further evidence of the utility of the RFT-based protocol of deictic frames and highlight the role of intellectual functioning in perspective-taking.
  • Gore, N. and Dawson, D. (2009). Mental Disorder and Adverse Life Events in a Forensic Intellectual Disability Service. British Journal of Forensic Practice 11:8-13.
    The study investigated the frequency of adverse life events and prevalence of MD recorded for clients with intellectual disabilities (ID) in a medium secure unit, using data from an electronic patient record (EPR) system. Prevalence of MD was calculated on the basis of ICD-10 diagnoses and a 38-item checklist was developed to investigate adverse/traumatic life events for sub-samples with and without MD. High rates of MD were reported overall, particularly of schizotypal and delusional disorders and disorders of personality. Adverse life events including abuse, bereavement and relationship difficulties had been documented by clinicians. The overall number of recorded events was significantly higher for clients diagnosed with a MD. Associations between MD and life events have been reported previously, but not in a forensic ID population. The study contributes to a growing body of literature highlighting the relationship between life events and mental health in people with ID, offering further information for service development and clinical practice.
  • Dawson, D., Barnes-Holmes, D., Gresswell, D., Hart, A. and Gore, N. (2009). Assessing the Implicit Beliefs of Sexual Offenders Using the IRAP: A first Study. Sexual Abuse: A Journal of Research and Treatment [Online] 21:57-75. Available at: http://dx.doi.org/10.1177/1079063208326928.
    Researchers have proposed that the cognitive distortions of sexual offenders are underpinned by a number of implicit cognitive processes termed implicit theories. Until recently, however, the implicit theory hypothesis has received little empirical support due to broader limitations with standard forensic assessment procedures. The current research aimed to determine whether a new assessment methodology, the Implicit Relational Assessment Procedure (IRAP), could provide further evidence for Ward and Keenan's (1999) children as sexual beings implicit theory. The results indicated that the IRAP was significantly more effective at identifying core implicit differences between sexual offenders against children and nonoffenders than a cognitive distortion questionnaire. Furthermore, although both groups demonstrated an overall response bias towards adults as sexual and children as nonsexual, this bias was significantly impaired in the sexual offender group. The findings are discussed in relation to previous implicit theory research and recommendations for the development of implicit methodologies are made.

Book section

  • Gore, N. and Hastings, R. (2016). Mindfulness and acceptance-based therapies. In: Beail, N. ed. Psychological Therapies and People Who Have Intellectual Disabilities. Leicester: British Psychological Society, pp. 57-67.

Conference or workshop item

  • Murphy, G., Triantafyllopoulou, P., Chiu, P., Barnoux, M., Blake, E., Cooke, J., Forrester-Jones, R., Gore, N. and Beecham, J. (2016). Life after prison for ex-offenders with intellectual disabilities. In: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, p. 712.
  • Forrester-Jones, R., Gore, N. and Young, R. (2012). Supported employment for people with complex needs:no need to re-invent the wheel, just move it in a realistic direction!. In: Social Policy Association European & Asian Conference. pp. 127-128.
  • Forrester-Jones, R., Gore, N. and Young, R. (2012). Supported employment: not reinventing the wheel, just moving it in a realistic direction. In: Intellectual Association of the Scientific Study of Intellectual Disabilities World Congress. Wiley-Blackwell, pp. 7-8.

Internet publication

  • Beadle-Brown, J. and Murphy, B. (2016). With Learning Disabilities and/Or Autism [PDF on website]. Available at: https://www.unitedresponse.org.uk/what-does-good-look-like.
    This resource provides an overview of what good support looks like in services for people with learning disabilities and/or autism. The definition of “good” is based on both research and good practice and emphasises the nature and quality of the support needed to ensure good quality of life outcomes for people with learning disabilities and/or autism.

Monograph

  • Gore, N., Brady, S., Cormack, M., McGill, P., Shurlock, J., Jackson-Brown, F., Reid, C., Singh, R., Legge, A., Saville, M. and Wedge, S. (2015). Residential School Placements for Children and Young People With Intellectual Disabilities: Their Use and Implications for Adult Social Care. School of Social Care Reseach NIHR. Available at: http://sscr.nihr.ac.uk/PDF/ScopingReviews/SR10.pdf.
    Out of area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. In recent years there has been an increased drive to reduce such placements at as early a stage as possible. In this context the current review collates research and policy regarding use of residential schools for children and young people with intellectual disabilities and transition from these settings to adult services. The review highlights that relatively little is known about both use of, and transition from, residential schooling for children and young people with intellectual disabilities in the UK. Thirteen articles are identified: 7 examining the child or families’ experiences before placement, 4 examining outcomes during the placement, and 4 examining the process of transitioning from the placement and longer term outcomes. The methodological quality of articles was often limited. A lack of control groups, independent samples, or adequate sample sizes was particularly notable. Results are discussed in relation to factors that lead to a child’s placement in a residential school, children and families’ experiences of the placement, and outcomes following placement, including the transition process. A number of research priorities are highlighted based on gaps in the literature. Examples of alternative forms of support from clinical practice are provided, with recognition that a multi-element model is likely to be needed to provide high quality support to this group of young people.
  • Cooper, V., Emerson, E., Glover, G., Gore, N., Hassiotis, A., Hastings, R., Knapp, M., McGill, P., Oliver, C., Pinney, A., Richards, C., Iemmi, V. and Shurlock, J. (2014). Early Intervention for Children With Learning Disabilities Whose Behaviour Challenges. Briefing Paper. Challenging Behaviour Foundation.
  • Gore, N., Bernard, S., Shurlock, J. and Busk, M. (2014). Ensuring Quality Services for Children and Adults With Behaviour That Challenges. Local Government Association.
    Ensuring quality services: core principles for the commissioning of services for children, young people, adults and older people with learning disabilities and/or autism who display or are at risk of displaying behaviour that challenges' has been produced in response to Action 19 of Transforming Care: A national response to Winterbourne View Hospital; and restates a model of care which is known to represent best practice. Its aim is to support the commissioning of high quality and safe services which meet the needs of children, young people, adults and older people with learning disabilities and/or autism who display or are at risk of displaying behaviour that challenges, together with the needs of their families, throughout the life course.

Review

  • Gore, N. (2012). Review: Tales of Normansfield. The Langdon Down Legacy: Andy Merriman, Down’s Syndrome Association (2007). Tizard Learning Disability Review 17:151-152.
  • Gore, N. (2010). Thinking Globally Acting Locally: a personal journey by Peter Mittler. Tizard Learning Disability Review 18:104-105.
    Peter Mittler's narrative of his career to date offers a rich and inspiring account of some of the key developments that have driven better support and quality of life for people with intellectual disabilities over the past five decades. Whilst the coverage of these developments alone is highly informative, it is perhaps the detailed and frank, honest telling of the surrounding stories that offers the most useful insights.
    Whilst at times such reflections can feel uncomfortably intimate, they serve to contextualise actions and decision making in relation to individual motivations and social and historical frames of reference. We are reminded that the best research studies, service and policy developments do not occur in a vacuum but reflect a commitment to personal and shared values.
  • Gore, N. (2008). Financial Decision-Making: Guidance for Supporting Financial Decision-Making by People with Learning Disabilities. Journal of Intellectual Disability Research [Online] 52:273-274. Available at: http://dx.doi.org/10.1111/j.1365-2788.2007.01029.x.

Thesis

  • Hans, K. (2018). Positive Behaviour Support for Children With Intellectual and Developmental Disabilities in the United Kingdom.
    There is a large body of research indicating that when positive behaviour support is implemented within schools, there are decreases in school discipline referrals and challenging behaviour. There are only two studies that have used schoolwide positive behaviour support in a school where the majority of students have been diagnosed with intellectual disabilities. While these studies have shown the effectiveness of PBS, neither study has used validated measures or direct observations of student behaviour to determine if changes reported by teachers were seen in the students. This study attempted to find out the prevalence of students with intellectual and developmental; disabilities (IDD) and challenging behaviour in the southeast of England. Additionally, positive behaviour support was implemented schoolwide for a special school in England. Validated measures and direct observations were conducted for both school staff and students. Results indicated increases in positive feedback to students were achievable after five hours of training in positive behaviour support. Additionally, student incidents were lower for five of the six students observed in this study. While these changes were measured, due to the number of limitations, no generalizations can be made in regards to the effectiveness of the intervention. The study had a number of challenges however, not least being the drop out of children from the study and the difficulties of obtaining information on standardised questionnaires from parents and teachers.

Forthcoming

  • Gore, N. and Baker, P. (2019). We are all in this together: Supported staff. In: Baker, P. and Osgood, T. eds. Challenging Behaviour and People With Learning Disabilities: A Handbook. Brighton, UK: Pavilion.
    This chapter describes the link between the management of challenging behaviour presented by people with intellectual disabilities and the emotional impact of this on staff. A multi tiered model of staff support is described.
  • Gore, N., Chapman, M. and Mann, J. (2013). Division of Clinical Psychology Guidance on Mindfulness Approaches for People With Learning Disabilities. British Psychological Society.
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