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A logic model of the implementation of a regional workforce strategy in positive behavioural support
- Authors:
- NOONE Steve, BRANCH Alison, SHERRING Melissa
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.185-193.
- Publisher:
- Emerald
Purpose: Positive behavioural support (PBS) as a framework for delivering quality services is recognised in important policy documents (CQC, 2020; NICE, 2018), yet there is an absence in the literature on how this could be implemented on a large scale. The purpose of this paper is to describe a recent implementation of a workforce strategy to develop PBS across social care and health staff and family carers, within the footprint of a large integrated care system. Design/methodology/approach: A logic model describes how an initial scoping exercise led to the production of a regional workforce strategy based on the PBS Competence Framework (2015). It shows how the creation of a regional steering group was able to coordinate important developmental stages and integrate multiple agencies into a single strategy to implement teaching and education in PBS. It describes the number of people who received teaching and education in PBS and the regional impact of the project in promoting cultural change within services. Findings: This paper demonstrates a proof of concept that it is possible to translate the PBS Competency Framework (2015) into accredited courses. Initial scoping work highlighted the ineffectiveness of traditional training in PBS. Using blended learning and competency-based supervision and assessment, it was possible to create a new way to promote large-scale service developments in PBS supported by the governance of a new organisational structure. This also included family training delivered by family trainers. This builds on the ideas by Denne et al. (2020) that many of the necessary building blocks of implementation already exist within a system. Social implications: A co-ordinated teaching and education strategy in PBS may help a wide range of carers to become more effective in supporting the people they care for. Originality/value: This is the first attempt to describe the implementation of a framework for PBS within a defined geographical location. It describes the collaboration of health and social care planners and a local university to create a suite of courses built around the PBS coalition competency framework. (Edited publisher abstract)
Commentary on “a logic model for the implementation of a regional workforce strategy in positive behavioural support”",
- Author:
- TOMLINSON Serena Rose Louisa
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.194-198.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on “A logic model for the implementation of a regional workforce strategy in Positive Behavioural Support”. Design/methodology/approach: This commentary provides a discussion of the importance of evaluating positive behaviour support (PBS) training and key issues relating to this. This provides a springboard from which researchers/practitioners may consider these issues when designing and evaluating PBS training courses. Findings: Three main issues are explored: the necessary diversity and breadth of PBS training approaches, the outcome domains to be evaluated and wider systemic issues that may influence PBS training and evaluation of its effectiveness. Originality/value: Effective PBS implementation requires robust training. To achieve this, it will be important for the field to overcome issues relating to the evaluation of training approaches. (Edited publisher abstract)
Including people with intellectual disabilities in the development of their own positive behaviour support plans
- Author:
- BREEZE James
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.199-205.
- Publisher:
- Emerald
Purpose: People with intellectual disabilities are not routinely involved in the assessment of their behaviours that challenge, as this is often completed by a proxy respondent and the health-care professional. This is contrary to guidance stating that everyone should be involved in the planning of their care. This paper aims to show how health-care professionals can support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the subsequent development of their own positive behaviour support (PBS) plans. Design/methodology/approach: A non-systematic review of the existing literature on improving the engagement of people with learning disabilities in health-care planning, and specifically PBS planning, was undertaken. Appropriate papers were included in this paper. Findings: There are several evidence-based methods to improve people’s engagement in the assessment of their own behaviours that challenge and then the development of their PBS plans. These methods are discussed in terms of their application to supporting people to communicate and involving them in the process of developing a valid and meaningful PBS plan. This is a relatively new focus within the literature, and further research should focus on increasing engagement in the process, as well as monitoring how co-production affects PBS outcomes. Originality/value: This paper summarises some of the approaches used to support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the development of their own PBS plans. This should encourage health-care professionals to consider how to use alternative and augmentative communication strategies to facilitate co-production in their own clinical practice. (Edited publisher abstract)
"Commentary on “Including people with intellectual disabilities in the development of their own positive behaviour support plans”
- Authors:
- LEE Steven, STEWART Kitty
- Journal article citation:
- Tizard Learning Disability Review, 26(4), 2021, pp.206-211.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to broaden the discussion on some of the barriers and solutions for co-production in positive behaviour support (PBS) planning as identified in the paper “Including people with intellectual disabilities in the development of their own Positive Behaviour Support Plans”. Design/methodology/approach: Drawing on the literature associated with co-production in PBS planning, this commentary will reflect on the wider systems and culture needed to enable successful implementation of this way of working. Findings: Co-production in PBS planning is recommended as part of best practice guidelines. However, there is limited research in the area of co-production with regards to PBS and use of augmentative and alternative communication methods. Collaboration among speech and language therapy and PBS practitioners is an important factor for co-production to achieve the best outcomes for people with learning disabilities who display behaviours of concern. Along with identifying a range of communication tools/strategies needed for PBS assessment/planning, it also requires a whole systems approach and culture shift to ensure the necessary foundations are in place. Originality/value: Co-production in PBS planning remains an under practiced way of working. This commentary builds on the barriers and solutions identified for co-production and provides further insight into what might be needed to achieve this in health and social care settings. (Edited publisher abstract)
Commentary on “A reflective evaluation of the Bradford positive behaviour support – in reach service
- Author:
- SHOLL Catherine Sarah
- Journal article citation:
- Tizard Learning Disability Review, 25(4), 2020, pp.193-196.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”. Design/methodology/approach: The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings: The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value: The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed. (Edited publisher abstract)
A reflective evaluation of the Bradford positive behaviour support – in reach service
- Authors:
- HODDER Matthew, et al
- Journal article citation:
- Tizard Learning Disability Review, 25(4), 2020, pp.185-192.
- Publisher:
- Emerald
Purpose: Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach: A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings: When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value: This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas. (Edited publisher abstract)
Adapted dialectical behaviour therapy skills group service evaluation
- Authors:
- SEARLE Robert John, BORSETI Ianiv
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(1), 2021, pp.1-7.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to determine the effectiveness of an adapted dialectical behaviour therapy (DBT) treatment programme for individuals with an intellectual disability, via completion of a service evaluation. Design/methodology/approach: Outcome measurements were competed at pre-, post- and 12 months follow-up, and the effectiveness of the intervention was assessed using a Friedman analysis. Findings: Findings demonstrated that the treatment group showed significant differences in their “psychological distress” scores, but no significant differences were found in their “psychological well-being”, “anxiety” or “quality of life” (WHO-QOL) scores over time. Originality/value: Overall, the current study adds to the small but growing literature that supports using the skills training group part of DBT as a stand-alone psychological intervention when working with people with an intellectual disability. (Edited publisher abstract)
Assessing the effectiveness of the “I Can Feel Good” programme mindfulness module for a group of detained intellectually disabled patients
- Authors:
- CRAVEN Rachel, SHELTON Lyn
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 14(6), 2020, pp.299-310.
- Publisher:
- Emerald
Purpose: This study aims to evaluate the clinical effectiveness of the Mindfulness module of the “I Can Feel Good” programme, an adapted dialectical behaviour therapy (DBT) informed skills programme for a group of intellectually disabled offenders (IDOs). Design/methodology/approach: The programme module was delivered to a group of five male IDOs detained under the Mental Health Act 1983 (Revised 2007) at an intellectual disability (ID) rehabilitation hospital based in the UK. The mindfulness module was 12 sessions in length, and it was evaluated using the emotional problems scale (EPS) and the cognitive and affective mindfulness scale-revised (CAMS-R) self-assessment and observational scale. These measures were administered pre- and post-module and used the staff report scales as a primary source of evaluation. Findings: Non-parametric testing revealed that there was a reduction in scores post module on the externalising behaviour problem scale of the EPS and increased scores on the CAMS-R observational scale, which would indicate clinical improvement in the IDO’s behavioural presentation, although it was not statistically significant. The internalising behaviour problem scale showed increased signs of anxiety post module, this could be related to increased self-awareness. The CAMS-R self-reported measure indicated reduced mindfulness qualities following the module. Originality/value: The results indicate that following the mindfulness module, there was a reduced level of challenging behaviour displayed by the patients with increased signs of emotional regulation. There was also an observed reduction in symptoms of depression and low self-esteem post module. (Edited publisher abstract)
Commentary on a “unified approach to behaviours that challenge”: a social care provider perspective
- Author:
- OCKENDEN John
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.159-162.
- Publisher:
- Emerald
Purpose: This paper aims to consider the extent to which academic research, as described by the papers in this journal, has helped the large-scale use of positive behaviour support (PBS) with people with learning disabilities whose behaviour may be challenging. Design/methodology/approach: The author explores the issue from the perspective of a social care provider seeking to implement PBS successfully across the organisation’s services. Findings: The author concludes that research needs to refocus its efforts if it is to make a real contribution and argues that future emphasis should be on implementation. Originality/value: This commentary articulates the concerns and experiences of a service provider that has striven to implement effective, evidence-based support, informed by relevant research, for many years. Such a perspective is rarely heard in academic PBS research literature. (Edited publisher abstract)
Commentary on a “unified approach to behaviours that challenge”: implementing evidence-based practice – a clinician’s perspective
- Author:
- CARNABY Steven
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.163-167.
- Publisher:
- Emerald
Purpose: This paper aims to provide a commentary on papers in this special edition concerning the implementation of evidence-based practice from a clinician’s perspective. Design/methodology/approach: The commentary makes a number of points drawing on both recent literature and the author’s own experience working as a clinician with children and adults with learning disabilities including those who are autistic whose behaviours can challenge themselves, their parents, carers and support networks. Findings: Effective implementation requires clinical expertise to operate within a context of collaboration and partnership working, where co-production with those who have lived experience ensures that what clinicians offer resonates and contributes to improvements in quality of life for all. Originality/value: The paper will be of value to clinicians working alongside children and adults with learning disabilities and their families, particularly clinical psychologists and behaviour specialists, and to other stakeholders wanting to enable and facilitate the development of high-quality support. (Edited publisher abstract)