Effects of Organisational and Managerial Interventions in Formal Care Settings on Aggressive Behaviour in Adults With Intellectual Disability or Autistic Adults. A Systematic Scoping Review.

BACKGROUND: Aggressive behaviour in formal care settings for persons with intellectual disability or autistic adults poses significant challenges. Individual-level interventions have shown limited efficacy, highlighting the need to explore organisational and systemic approaches. However, research remains scarce on how organisational and managerial practices affect aggressive behaviours in care settings. OBJECTIVES: This project aimed to review service organisation and managerial practices affecting aggression towards others and objects in adults with intellectual disability or autism in formal care settings. METHODS: A systematic scoping review was conducted, focusing on the concepts of "Intellectual Disability/Autism Spectrum Disorder," "Aggressive Behaviour," and "Care Organisation". Academic databases (CINAHL, EMBASE, PsycINFO and Medline) and grey literature sources (Google Scholar, government sites) were searched for studies published between 1994 and 2023 in English and French. Selected articles were categorised by intervention type and a narrative synthesis was conducted for each category. FINDINGS: Of 4426 references, 12 publications were selected for narrative synthesis. The following interventions demonstrated positive effects on the frequency and severity of aggressive behaviour in formal care settings: enhanced services and revised care pathways, improved provider accountability, staff support and more livable, homelike physical environments. No effect was found for case grouping. CONCLUSION: Interventions addressing organisational and managerial practices may help reduce aggressive behaviour in formal care settings. Ecological models of health may guide the efforts of decision-makers and practitioners in this endeavour.