Challenging behaviour in community services

Abstract

The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty-eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self-injury as well as a range of behaviours of the 'hard to engage' type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty-five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out-of-borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.

A best practice in education and support services for independent living of intellectually disabled youth and adults in Mexico

“…[46][47][48][49] Therefore, long-term counseling and guidance for parents are needed to identify and deal with behaviors that interfere with healthy family interaction, socialization and opportunities for learning by the intellectually disabled child. [50][51][52][53][54][55] Behavioral problems are also observed due the lack of motor or impulse control.…”

“…19 In high-income countries, an estimated 25% of people with intellectual disability live with their families and 50% live independently in community residences. 20 However, in middle-or low-income countries, governmental programs promoting independent living among people with intellectual disability are virtually nonexistent and private services that provide training for autonomy in this population are rare.…”

Handbook of Intellectual and Developmental Disabilities

“…Nottestad and Linaker (1999) followed 109 people with ID from institutions to community living and found persistence of psychiatric problems and a significant increase in behavior problems (including disruptive and aggressive acts), as well as reduced access to psychological and psychiatric services. Joyce, Ditchfield, and Harris (2001) identified 482 people with ID and behavior problems in London and found that 24% had experienced a placement breakdown (moved from family or among community settings), 24% had come to the attention of the police, and 29% had been excluded from day services at least once. Tonge and Einfeld (2000) followed a sample of children with ID ages 4-19 years over 4 years and found that 40% had psychiatric disorders that persisted over this period, in all likelihood because less than 10% of those in need received specialist services (see also Kiernan & Alborz, 1996).…”

Diagnosis and Treatment of Aggression in Individuals with Developmental Disabilities

“…Aggression strains relationships between the individuals being supported and their caregivers, whether professionals or family members [6,7]. Risk for physical restraint [8,9], over-use of medication to treat behavior [10], exclusion from services [11], and becoming a victim of abuse [12] are all increased in individuals who exhibit aggressive behavior.…”