Professionals' perceptions of psychotropic medication in residential facilities for individuals with mental retardation.
State-home staff want more say and more training on psychotropic meds, yet physicians still make nearly every decision alone.
01Research in Context
What this study did
The authors mailed a survey to every state-run home for people with intellectual disability. They asked nurses, aides, and house managers who really decides to start or stop psychotropic meds. They also asked what training staff already had and what training they still wanted.
What they found
Physicians call almost every medication shot. Staff see behavior plans as a good way to handle aggression, yet four out of five say they need more teaching about meds versus behavior tools. In short, doctors drive the bus, but the crew feels lost at the wheel.
How this fits with other research
Johnson et al. (2025) looked at 30 years of similar surveys and found the same gap: training raises knowledge, but no one knows if it changes prescribing. Fahmie et al. (2013) later counted pills and showed 58 % of adults with ID still take psychotropics, so the 1996 wish for behavior options did not slow the trend.
Branford (1997) followed the same residents into community homes and saw pill counts stay flat or rise, even after official drug reviews. That seems to clash with the 1996 staff hope for fewer meds, but the follow-up tracked actual prescriptions while the 1996 paper captured feelings, not pharmacy data.
Bird et al. (2022) finally gave staff what they asked for: an interdisciplinary team that mixes med review with behavior data. In five kids, doses dropped or stopped safely. Their case series extends the 1996 survey by showing the training-plus-team model staff wanted can work.
Why it matters
If you work in a facility, bring this survey to your next team meeting. Ask the doctor to walk through one medication sheet with behavior data in hand. Offer to graph target behaviors before and after any dose tweak. One shared review can turn the 1996 wish for more training into the 2022 reality of safer, lower dosing.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one resident on psychotropics, collect one week of behavior data, and email the chart to the prescriber before the next review.
02At a glance
03Original abstract
Professional staff in four state facilities for individuals with mental retardation were surveyed to determine their perceptions, knowledge and opinions regarding the use of psychotropic medication. A large majority of the 377 respondents indicated that the physicians in their facilities were primarily responsible for medication-related decisions. Under ideal conditions, however, all professional staff and parents were seen as having a greater influence in the decision-making process. Aggression, delusions and hallucinations, self-injury, other psychiatric disorders, and anxiety were rated as disorders most likely to result in medication therapy. Behaviour modification was viewed as a suitable alternative to drug treatment for acting out and aggression. The professionals indicated that behavioural observation was the most influential assessment technique in current usage, followed by global impressions and informal diaries. Over 80% of the respondents perceived their preservice and inservice training on issues related to the use of psychotropic medication to treat behaviour problems as inadequate, with 96% of them desiring continuing education. These findings were compared to data from similar studies of populations with other disabilities, and suggestions for modifications in the current decision-making processes related to the use of psychotropic medication in institutionalized individuals with mental retardation are discussed.
Journal of intellectual disability research : JIDR, 1996 · doi:10.1111/j.1365-2788.1996.tb00596.x