Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: A cluster randomized controlled trial of setting-wide positive behaviour support

Abstract

Background: Improving the quality of social care through the implementation of setting-wide positive behaviour support (SWPBS) may reduce and prevent challenging behaviour. Method: Twenty-four supported accommodation settings were randomized to experimental or control conditions. Settings in both groups had access to individualized PBS either via the organisation's Behaviour Support Team or from external professionals. Additionally, within the experimental group, social care practice was reviewed and improvement programmes set going. Progress was supported through coaching managers and staff to enhance their performance and draw more effectively on existing resources, and through monthly monitoring over 8-11 months. Quality of support, quality of life and challenging behaviour were measured at baseline and after intervention with challenging behaviour being additionally measured at long-term follow-up 12-18 months later. Results: Following intervention there were significant changes to social care practice and quality of support in the experimental group. Ratings of challenging behaviour declined significantly more in the experimental group and the difference between groups was maintained at follow-up. There was no significant difference between the groups in measurement of quality of life. Staff, family members and professionals evaluated the intervention and its outcomes positively. Conclusions: Some challenging behaviour in social care settings may be prevented by SWPBS that improves the quality of support provided to individuals.

Influence of the organizational environment on challenging behaviour in people with intellectual disabilities: Professionals’ views

“…The reciprocal interactional patterns between all personnel and residents are part of the organizational culture, which directly affects the behaviour (Bigby, Knox, Beadle‐Brown, & Clement, ) and quality of life (Bigby & Beadle‐Brown, ) of people with intellectual disabilities. Interventions that focus on the environmental context, instead of the individual, may therefore reduce challenging behaviour among residents more successfully (McGill et al, ).…”

“…On the other hand, the use of a more detailed concept, such as positive behaviour support (PBS), might also have facilitated data analysis. This concept has shown the importance of a focus on the challenging context in which residents receive support, and not on the challenging behaviour they display (Carr, ; Grey & McClean, ; McGill et al, ). In addition, PBS studies aim to integrate evidence from organizational management, ecological, cultural and positive psychology aspects with biomedical science, which might have provided more structured insight (Carr, ).…”

Factors that predict good Active Support in services for people with intellectual disabilities: A multilevel model

“…The Active Support Measure (ASM) (Mansell et al, ) indicated the quality of Active Support, and, hence, was the predicted variable. It has been used in multiple studies of Active Support and its use ensured comparability of results (see Mansell & Beadle‐Brown, ).…”

An evaluation of staff training in positive behavioural support

“…The Aberrant Behavior Checklist (ABC) (Aman et al., ) is an informant‐based scale designed to assess challenging behaviour in people with intellectual disabilities. It has demonstrated reliability and validity and is well‐used within the literature, including other studies in relation to PBS, (Allen et al., ; Hassiotis et al., ; McGill et al., under review).…”