Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

Abstract

BackgroundStaff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.AimsTo evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).MethodWe carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.ResultsNo treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.ConclusionsStaff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.Declaration of interestNone.

Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

“…The present analysis using data from a cluster randomised trial of staff training in delivering PBS suggests that the intervention did not reduce challenging behaviour in ASD+ participants. These findings are in keeping with the main trial findings, which showed no effect of staff training in PBS on reducing challenging behaviour [40]. In line with other studies [48][49][50][51][52], ASD+ participants displayed a high level of challenging behaviour.…”

“…The current study aims to investigate whether staff training in PBS delivery is clinically and cost effective compared to treatment as usual in adults with ASD+, in a trial described previously [40]. In summary, this was a multicentre, two-arm cluster randomised controlled trial in which 246 adults with ID (with and without ASD) were recruited from 23 community intellectual disability services across England.…”

“…They were further supported through monthly teleconferences with peers, the Chief Investigator, the trial manager and the trainers. Further details can be found in the full trial report [40].…”

“…The costing perspective is health and social care costs only and over 12 months. Units costs for care are reported in a previous publication by the authors [40]. Given the 12-month time horizon no discounting of costs and QALYs is included.…”

“…The present analysis reports on the clinical and cost effectiveness of training health professionals working in community teams to deliver positive behaviour support for challenging behaviour in a subsample of adult ASD+ participants, testing a planned subsidiary hypothesis in a multicentre cluster randomised controlled trial in England [39,40]. The trial was the first large-scale systematic evaluation examining the impact of the delivery of PBS by trained staff in secondary community health and social care ID services in the UK.…”