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Systematic review of restraint interventions for challenging behaviour among persons with intellectual disabilities: focus on effectiveness in single-case experiments
- Authors:
- HEYVAERT Mieke, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 27(6), 2014, pp.493-510.
- Publisher:
- Wiley
Background: This article, the first in a two-part series, focuses on the effectiveness of restraint interventions (RIs) for reducing challenging behaviour (CB) among persons with intellectual disabilities. The second article focuses on experiences with RIs for CB among people with intellectual disabilities. Methods: A mixed-methods research synthesis involving statistical meta-analysis and qualitative meta-synthesis techniques was applied to synthesize 76 retrieved articles. This first article reports on the meta-analysis of 59 single-case experiments on effectiveness of RIs for CB among people with intellectual disabilities. Results and Conclusions: The RIs reported on in the single-case experiments were on average highly effective in reducing CB for people with intellectual disabilities, and this reduction in CB was statistically significant. However, the effects vary significantly over the included participants, and the published data and reported outcomes are rather unrepresentative of the everyday use of RIs among persons with intellectual disabilities. (Edited publisher abstract)
A preliminary investigation of the utility of the "Behavior Support Plan Quality Evaluation Guide II" for use in Australia
- Authors:
- WEBBER Lynne S., et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 36(4), December 2011, pp.273-277.
- Publisher:
- Taylor and Francis
In Victoria, Australia, the Disability Act 2006 specifies that all people receiving a government-funded disability service and who are subject to a restrictive intervention (such as a chemical or mechanical restraint) must have a behaviour support plan. The quality of behaviour support plans can be an important influence on the quality of the support provided to people with disability who show challenging behaviours. The Behavior Support Plan Quality Evaluation Guide II has been used to assess behaviour support plans to support children in schools in the United States. This study examined its usefulness for assessing behaviour support plans designed for adults with an intellectual disability in community support services in Australia. The researchers surveyed experienced practitioners about the relevance of the evaluation guide components, and an audit was conducted of randomly selected behaviour support plans submitted as a statutory requirement. The findings showed evidence of acceptable validity and reliability, and evidence of the need for substantial improvement in the quality of behaviour support plans. The authors conclude that the findings support the utility of the Behavior Support Plan Quality Evaluation Guide II to inform and evaluate service planning in supporting adults with intellectual disability who show challenging behaviour.
Meeting the challenge: some UK perspectives on community services for people with learning difficulties and challenging behaviour
- Editors:
- ALLEN David, BANKS Roger, STAITE Susan
- Publisher:
- King's Fund
- Publication year:
- 1992
- Pagination:
- 62p.,bibliog.
- Place of publication:
- London
Latest in the series An Ordinary Life. Gives practical examples of services around the country and in the context of these looks at key issues of: management and support; evaluation and monitoring; and progress, problems and priorities.
Evaluating the challenge: a guide to evaluating services for people with learning difficulties and challenging behaviour
- Authors:
- EMERSON Eric, CAMBRIDGE Paul, HARRIS Philip eds
- Publisher:
- King's Fund
- Publication year:
- 1991
- Pagination:
- 59p.,bibliog.
- Place of publication:
- London
Guidance for evaluators from health authorities, local authorities, the independent sector, university departments and elsewhere.
A quantitative evaluation of a regional Positive Behavioural Support workforce development approach
- Authors:
- MCKENZIE Karen, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 34(6), 2021, pp.1641-1654.
- Publisher:
- Wiley
Background: Research suggests that providing staff with input in relation to Positive Behavioural Support (PBS) can have beneficial outcomes. Much of this research, however, fails to take account of systemic issues and does not include a control group. Method: We used a non-randomised, controlled group design to evaluate accredited PBS programmes, delivered as part of a systemic, regional and workforce development approach. We compared outcomes of those attending the programmes (n = 240) with a control group (n = 54), pre- and post-intervention and at 3-months follow-up. Results: The programme and its wider impact were rated positively. Significant intervention effects were found for staff practice and retention, but not for staff knowledge and attributions, or behaviours that challenge and quality of life of those being supported. Conclusions: The results are discussed in the context of the study limitations and restrictions resulting from the Covid-19 pandemic. (Edited publisher abstract)
An evaluation of positive behavioural support implemented within an intensive community support service for people with learning disabilities who present with behaviours that challenge
- Authors:
- LEWIS Nicola, et al
- Journal article citation:
- Journal of Intellectual Disabilities, 25(3), 2021, pp.348-356.
- Publisher:
- Sage
- Place of publication:
- London
This article evaluates the effectiveness of a multidisciplinary intensive community support service, using positive behavioural support (PBS) as a core intervention model to reduce behaviours of concern and to improve the quality of life and occupational involvement of individuals with a learning disability who present with behaviours that challenge. The service used outcome measures to evaluate the effectiveness of the PBS model. The study looks at pre- and post-outcome measures which showed a significant improvement in behaviour, quality of life and occupational outcomes for individuals with a learning disability presenting with complex behaviours of concern. This study contributes to the growing evidence base for PBS being delivered by specialist community learning disability teams. (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)
Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: a cluster randomized controlled trial of setting-wide positive behaviour support
- Authors:
- McGILL Peter, et al
- Journal article citation:
- Research in Developmental Disabilities, 81, 2018, pp.143-154.
- Publisher:
- Elsevier
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. (Edited publisher abstract)
Less than the sum of the parts: lived experience of ATUs and mental health in-patient settings in the SELTCP region
- Authors:
- CLARE Jo, LOVE Alison, CEREZO Miren
- Publisher:
- Three Cs
- Publication year:
- 2020
- Pagination:
- 92
- Place of publication:
- London
A research into lived experience of Assessment and Treatment Units (ATUs) and other in-patients units for adults and children with learning disabilities and/or autism with ‘challenging behaviour’. Commissioned by South East London Transforming Care Partnership, the research involved a total of 11 people with lived experience, including three adults with autism and/or learning disabilities and eight family members. The study finds that with few exceptions, ATUs are not fit for purpose and actively harm those they are intended to treat. Only one children’s ward and one of eight ATU, PICU or in-patient services were described by witnesses as fully competent at assessment, treatment and resettlement of children and adults with learning disabilities and/or autism. The rest were mixed (in one case) or experienced as fundamentally incompetent and routinely breached the human and civil rights of patients with learning disabilities and/or autism (six cases). Whilst ATUs spend inordinate amounts of time seeking to diagnose or exclude specific mental illness, their primary modus operandi (detention, segregation, seclusion, restraint) deprive patients of the psychosocial aspects of existence (sleeping well, eating well, meaningful activity, exercising, time with friends and family) that are known to keep children and adults healthy and mentally well. While acknowledging that only a full closure programme will ‘fix’ the ATU system problem and stop the human rights abuses which are endemic to it, the authors make a series of recommendations to help improve human rights in ATUs in the interim. (Edited publisher abstract)
A pragmatic mixed-methods review of changing “case-complexity” of referrals to an intensive support service
- Authors:
- CLIFFORD Adam, KEMP Francesca Georgina
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 14(4), 2020, pp.111-124.
- Publisher:
- Emerald
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation. Design/methodology/approach: Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis. Findings: Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence. Research limitations/implications: Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources. Originality/value: The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population. (Edited publisher abstract)