Issues in the definition and implementation of “best practice” for staff delivery of interventions for challenging behaviour

Abstract

A focal sample of 103 intervention outcome studies was considered to confirm the evidence base for "best practice" for intervention for challenging behaviour in persons with intellectual disability and acquired brain injury and establish the service conditions associated with its effective implementation. Evidence supports the effectiveness of behavioural interventions with challenging behaviour, particularly those based upon prior functional analysis of behaviour. However, problems in formulating practice guidelines from such literature include: the limited evidence regarding clinical effectiveness in work with persons with acquired brain injury; the uncertain durability of change subsequent to intervention; and the heavy reliance upon research personnel external to services for assessment, analysis and programme design in reported studies. Subsequently, a further 42 papers which directly addressed the issue of the capacity of direct care for the delivery of interventions were reviewed. These suggest the importance of supervision processes, attitudinal change and establishment of formal review mechanisms as adjuncts to staff training in intervention methods.

Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: A cluster randomized controlled trial of setting-wide positive behaviour support

“…But many such professionals now adopt positive behaviour support (PBS) (Carr et al, 2002), an approach inevitably leading to a focus on the context in which challenging behaviour occurs -" the central independent variable in PBS is systems change" (Carr, 2007, p.4). Such change is not easily obtained with regular reports of difficulties implementing the proposed treatments both in social care (Ager & O'May 2001) and educational settings (Bambara, Nonnemacher, & Kern, 2009). The difficult behaviour presented in schools has been recognised as requiring a broader approach, more focused on prevention (Sugai & Horner, 2002).…”

The Use of Sensory Integration Therapy by Intervention Service Providers in Malaysia

“…Some examples of intervention for children with disabilities that are supported by empirical evidence are strategies that use the principles of applied behaviour analysis (Kavale & Forness, 1999;Matson, Benavidez, Compton, Paclawskyj, & Baglio, 1996;Rogers & Vismara, 2008) and functional assessment of challenging behaviours (Ager & O'May, 2001). Practices whose efficacy and usage are well supported by empirical research are highly recommended for use in educational intervention for children with disabilities (McWilliam, 1999;Rogers & Vismara, 2008;Worrall, 1990).…”

Increasing support staff fluency with the content of behaviour support plans: An application of precision teaching

“…Within developmental disability services a number of potential barriers to the uptake of behavioural interventions have been reported and include, poor staff knowledge about behavioural theory and techniques (Emerson & Emerson, 1987), poor management support for behavioural interventions (Ager & O'May, 2001), differences between support staff beliefs about the reason that challenging behaviours occurs, and behavioural hypotheses derived from functional assessment (Hastings, 1997;Hastings & Remington, 1994). More specifically in relation to BSPs, Albin et al (1996) further suggested that a lack of involvement of support staff in the development of the plan, inadequate training in its implementation, lack of belief in the efficacy of proposed strategies, and other systemic issues are also obstacles to effective implementation.…”