‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions

Abstract

Objectives: Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life. Methods: Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts. Findings: The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB. Conclusions: The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.

Behaviour support for people with acquired brain injury within the National Disability Insurance Scheme: an Australian survey of the provider market

“…Additionally, only a minority considered they would be approved by the Commission as a proficient or advanced behaviour support practitioner. This adds to recent findings of research with the broader ABI workforce in Australia, which highlighted clinicians' limited understanding of, and lower confidence in, provision of PBS (Carmichael et al, 2020;Carmichael et al, 2021).…”

“…Finally, this research has further demonstrated the specialised skills required in both service planning and provision in the area of behaviour support, and the need to ensure equity of access to the NDIS supports including behaviour support services (Carey et al, 2018; Carmichael et al, 2021; Gould et al, 2021). Meaningful behaviour change can take years after an ABI, and as such a life-span perspective is required for funding of behaviour supports within plans beyond just a one-off or single year of funding allocation.…”

“…In the field of ABI in Australia, Wong et al (2014) have identified a lack of training and experience of neuropsychologists in treating behaviours of concern for people with neurological conditions. Other barriers identified by Australian therapists include limited understanding of PBS, a lack of time to learn new behaviour interventions, and clinicians’ confidence (Carmichael, Gould, Hicks, Feeney & Ponsford, 2020; Carmichael et al, 2021). With the Commission seeking to build a skilled and capable workforce, a number of other issues have been highlighted as part of a parliamentary inquiry into NDIS behaviour support processes and regulations (NDIS Quality and Safeguards Commission, 2018).…”

Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions

“…[19][20][21] However, the implementation of such programs remains difficult. Stakeholders of Positive Behaviour Support programs raise potential issues such as lack of time, money, staff, or Positive Behaviour Support training in rehabilitation teams, 22 as well as the length or intensity of programs that may restrict the participation of family caregivers and individuals with TBI, 20 and hinder their engagement in those programs over the long-term. 23 Furthermore, challenging behaviours are context-specific and shaped or triggered by various internal (e.g., fatigue or stress levels) and external factors (e.g., punitive or avoidant responses from formal or informal caregivers, complex task demands), [24][25][26] and individuals vary in their ability to regulate behaviours from one situation to another.…”