A Thematic Analysis Investigating the Impact of Positive Behavioral Support Training on the Lives of Service Providers: "It Makes You Think Differently".

Positive behavioral support (PBS) employs applied behavioral analysis to enhance the quality of life of people who behave in challenging ways. PBS builds on the straightforward and intuitively appealing notion that if people know how to control their environments, they will have less need to behave in challenging ways. Accordingly, PBS focuses on the perspective of those who have behavioral issues, and assesses success via reduction in incidences of challenging behaviors. The qualitative research presented in this report approaches PBS from a different viewpoint and, using thematic analysis, considers the impact of PBS training on the lived experience of staff who deliver services. Thirteen support staff who work for a company supplying social care and supported living services for people with learning disabilities and complex needs in the northwest of England took part. Analysis of interviews identified five major themes. These were: (1) training: enjoyable and useful; (2) widening of perspective: different ways of thinking; (3) increased competence: better outcomes; (4) spill over into private lives: increased tolerance in relationships; and (5) reflecting on practice and moving to a holistic view: "I am aware that people…are not just being naughty." These themes evidenced personal growth on the part of service providers receiving training. Explicitly, they demonstrated that greater awareness of PBS equipped recipients with an appropriate set of values, and the technical knowledge required to realize them.

Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation.

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour.

BACKGROUND: Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period. METHOD: Functional assessments were conducted with 4 individuals with exceptionally severe challenging behaviours. Interventions were based on the multi-element model of behavioural support (LaVigna & Willis, 2005a). Dependent variables were behavioural ratings of (1) frequency, (2) episodic severity, (3) episodic management difficulty, and measures of (4) mental health status, and (5) quality of life. The intervention sequence was low arousal environment, rapport building, predictability, functionally equivalent skills teaching, and differential reinforcement strategies. RESULTS: Substantial reductions in target behaviours were observed, along with incremental improvement in mental health scores and quality-of-life scores. CONCLUSION: The study demonstrates the efficacy of positive behaviour support for people with exceptionally severe behaviour in individually designed services.

A component analysis of positive behaviour support plans.

BACKGROUND: Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness. METHOD: Sixty-one staff working with individuals with intellectual disability and challenging behaviours completed longitudinal competency-based training in PBS. Each staff participant conducted a functional assessment and developed and implemented a PBS plan for one prioritised individual. A total of 1,272 interventions were available for analysis. Measures of challenging behaviour were taken at baseline, after 6 months, and at an average of 26 months follow-up. RESULTS: There was a significant reduction in the frequency, management difficulty, and episodic severity of challenging behaviour over the duration of the study. Escape was identified by staff as the most common function, accounting for 77% of challenging behaviours. The most commonly implemented components of intervention were setting event changes and quality-of-life-based interventions. CONCLUSION: Only treatment acceptability was found to be related to decreases in behavioural frequency. No single intervention component was found to have a greater association with reductions in challenging behaviour.

An evaluation of positive behavioural support for people with very severe challenging behaviours in community-based settings.

This study employs a multiple baseline across individual design to describe positive behaviour support for five people in community settings. The individuals represent all people with intellectual disability residing in one county with long-standing challenging behaviour resulting in serious physical injury. Five types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology, quality of life and revenue costs. The systems of support required to maintain outcomes and develop real lifestyles include behaviour support planning, mental health review, on-call intensive support and emergency respite care. Behaviours reduced to near-zero levels following implementation of positive behaviour support and improvements were sustained over 24 months. The use of psychotropic medications reduced by 66 percent over the same period. Quality of Life Questionnaire scores improved significantly for three of the five participants. The results are discussed in the context of a framework for supporting people with severe challenging behaviours in the community.

Coping and positive perceptions in Irish mothers of children with intellectual disabilities.

Thirty-six mothers of children aged between 5 and 8 years with intellectual disabilities completed five self-report questionnaires measuring variables related to behavioural and emotional difficulties, levels of care demand, family supports, coping and positive perceptions. The relationships among these variables were investigated using a working model proposed by Hastings and Taunt (2002). Child behavioural and emotional problems in the non-clinical range predicted low levels of care demand. Formal social support was an effective form of support for mothers; helpfulness of formal social support predicted mobilizing the family to acquire and accept help in the community; and mobilizing the family predicted levels of strength and family closeness. The majority of respondents rated agreement with statements that their child was: a source of happiness or fulfilment; a source of strength and family closeness; and a source of personal growth and maturity. The theoretical and clinical implications of these results are discussed.

Evaluating the effectiveness of teacher training in Applied Behaviour Analysis.

Interventions for children with autism based upon Applied Behaviour Analysis (ABA) has been repeatedly shown to be related both to educational gains and to reductions in challenging behaviours. However, to date, comprehensive training in ABA for teachers and others have been limited. Over 7 months, 11 teachers undertook 90 hours of classroom instruction and supervision in ABA. Each teacher conducted a comprehensive functional assessment and designed a behaviour support plan targeting one behaviour for one child with an autistic disorder. Target behaviours included aggression, non-compliance and specific educational skills. Teachers recorded observational data for the target behaviour for both baseline and intervention sessions. Support plans produced an average 80 percent change in frequency of occurrence of target behaviours. Questionnaires completed by parents and teachers at the end of the course indicated a beneficial effect for the children and the educational environment. The potential benefits of teacher implemented behavioural intervention are discussed.

Combining psychiatric and psychological approaches in the inpatient assessment of aggression in a client with moderate intellectual disability.

The literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.