Process evaluation of a randomised controlled trial of PBS-based staff training for challenging behaviour in adults with intellectual disability

Abstract

Background Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. Aims To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. Method The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Results Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8–32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. Conclusions PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care.

“Look, all our hard work is paying off”: A qualitative evaluation of a system‐wide, workforce development model to promote positive behavioural support

“…Such practice leadership and work‐based coaching have been identified as important components of both PBS and Active Support (e.g. Bigby, Bould, Iacono, & Beadle‐Brown, 2019; Bosco et al., 2019). The latter, which identifies the strengths and needs of the person and uses targeted support to enable the person to engage in meaningful activities and relationships with others, is argued by some researchers to be both complementary to, and a crucial component of, PBS in terms of supporting proactive approaches (e.g.…”

Protocol for the process evaluation of the Promoting Activity, Independence and Stability in Early Dementia (PrAISED), following changes required by the COVID-19 pandemic

“…It has been reported in previous process evaluations that adding travelling times on top of the existing workload might thwart job satisfaction. 39 The use of remote support might rectify some of these negative experiences.…”

Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

“…PBS plan, goodness -of fit checklist, functional assessment and observational data) that was submitted by the therapists were assessed by an independent reviewer by means of the Behaviour Intervention Plan Quality Evaluation Scoring Guide II. The quality tool enabled the assessment and classification of the intervention plans as weak, underdeveloped, good or superior [46].…”