Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial

Abstract

BackgroundMany people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services.MethodThe study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS.DiscussionThe study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour.Trial registrationThis trial is registered with Clinical Trials.gov (Ref NCT01680276).Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0219-6) contains supplementary material, which is available to authorized users.

Evaluating the costs and cost-effectiveness of interventions for people with learning disabilities and behaviour that challenges: the need to improve the evidence base

“…An RCT currently in progress, evaluating the clinical and cost effectiveness of training staff in PBS versus usual care will also help to improve the evidence base further. The trial aims to recruit 246 adults to the trial with 12-months follow-up (Hassiotis et al 2014). In addition to providing information on a mechanism for implementing PBS in services it presents an opportunity to increase the evidence for the cost of challenging behaviour in learning disabilities.…”

Factors associated with reported challenging behavior in young people with epilepsy and neurodevelopmental problems: Data from a specialist epilepsy center

“…5 Challenging behavior is associated with increases in receipt of antipsychotic medication, service use, hospitalization, restrictive care practices, and deprivation. 6 In relation to potential contributors to challenging behavior in individuals with epilepsy, comorbid psychopathology was associated with violence in a meta-analysis of violence in epilepsy. 7 However, few studies examine reported incidents of challenging behavior in epilepsy or factors associated with such incidents.…”

Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT

“…The overall median level of challenging behaviour of the participants was higher than that reported in a trial of antipsychotic medication by Tyrer et al 61 In order to guard against the tendency for the impact of training to dissipate over time, we set up mentoring and peer support during the study period. 1,28,93 Our process evaluation indicated that training in PBS was well received by the therapists and the delivery of PBS was welcome and highly valued by the service managers of participating services, carers and participants with ID.…”