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

  • Angela Hassiotis (a1), Michaela Poppe (a2), Andre Strydom (a3), Victoria Vickerstaff (a4), Ian S. Hall (a5), Jason Crabtree (a5), Rumana Z. Omar (a6), Michael King (a2), Rachael Hunter (a4), Asit Biswas (a7), Viv Cooper (a8), William Howie (a9) and Michael J. Crawford (a10)...
Abstract
Background

Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.

Aims

To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).

Method

We 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.

Results

No 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.

Conclusions

Staff 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 interest

None.

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Copyright
Corresponding author
Correspondence: Angela Hassiotis, University College London Division of Psychiatry, 6th floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email: a.hassiotis@ucl.ac.uk
References
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Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

  • Angela Hassiotis (a1), Michaela Poppe (a2), Andre Strydom (a3), Victoria Vickerstaff (a4), Ian S. Hall (a5), Jason Crabtree (a5), Rumana Z. Omar (a6), Michael King (a2), Rachael Hunter (a4), Asit Biswas (a7), Viv Cooper (a8), William Howie (a9) and Michael J. Crawford (a10)...
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Response from UK Society of Behaviour Analysis - Positive Behaviour Support Special Interest Group

Joanne Coulson, Chair of Positive Behaviour Support Special Interest Group, UK SBA
12 June 2018

To the Editor,

We are writing in response to the article by Hassiotis et al. (2018) entitled Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial (BJP 212, 161–168). We respectfully request that you publish this letter in The British Journal of Psychiatry.

Hassiotis et al. stated that their aim was to evaluate the effects of training in Positive Behavioural Support (PBS) on challenging behaviour. While we welcome research in PBS, we have concerns about the conclusions that have been drawn from this study.

The authors describe how, after having received 6 days of training in PBS, NHS professionals – including speech and language therapists, nurses and occupational therapists – implemented PBS interventions in community services for people with intellectual disabilities. It was stated that in order to align with best practice, interventions were required to include 4 key components: functional assessment, observational data, a PBS plan, and a goodness-of-fit checklist. However, out of a possible total of 108 interventions,, no paperwork was submitted.

All PBS plans were rated by an independent assessor as being of poor quality, and, crucially, no information was gathered on whether or not they were actually implemented. In the absence of data concerning implementation, it is possible that the behaviour change strategies detailed in PBS plans were never actually used in services. The authors’ conclusion that PBS did not reduce challenging behavior is therefore unsupportable.

In view of the study’s limitations – and, in particular, the absence of evidence that the intervention it set out to assess (PBS) was actually implemented – the extent to which any meaningful conclusions can be drawn is questionable.

Yours faithfully,

Positive Behaviour Support Special Interest Group, UK Society for Behaviour Analysis
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Conflict of interest: None declared

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