A systematic review of training methods to increase staff's knowledge and implementation of positive behaviour support in residential and day settings for individuals with intellectual and developmental disabilities

Behaviour support plans (BSPs), if accurately implemented, have been found to increase skills and decrease challenging behaviour of individuals with intellectual and developmental disabilities. Training is essential for staff to acquire the skills necessary for accurate implementation. The aim of this systematic literature review was to evaluate procedures used to train staff in Positive Behaviour Support (PBS), on both knowledge of PBS and implementation of BSPs. Systematic searches of 4 databases identified 18 studies as meeting criteria. Findings indicate that description alone was not consistently effective in increasing knowledge and should be used in combination with other training strategies. Staff's implementation of BSPs were increased by different combinations of the following training components: description, feedback, modelling, role-play, monitory incentive, and escape contingency. To identify evidenced based practice when training staff on BSPs, it is necessary to evaluate active and feasible training components from current training models.

Relabelling behaviour. The effects of psycho-education on the perceived severity and causes of challenging behaviour in people with profound intellectual and multiple disabilities

BACKGROUND

Prevalence rates of challenging behaviour are high in children and adults with profound intellectual and multiple disabilities (PIMD). Moreover, many of these behaviours are observed daily. Direct support staff report that most challenging behaviour identified has little impact on the person with PIMD and attribute challenging behaviour in children and adults with PIMD mainly to a biomedical model. The purpose of this study was to evaluate whether an intervention (psycho-education) had any effect on direct support staff's assessment of challenging behaviour in terms of its severity and their biomedical causal explanations (attributions) for this behaviour.

METHOD

A stepped wedge study design was used to evaluate the effects of a psycho-education intervention on the perceived severity and the attributions offered for challenging behaviour of people with PIMD by 198 direct support staff. We used questionnaires assessing the perceived severity of challenging behaviour and staff views of its causes. Data on the dependent variables were collected at four 1-month intervals.

RESULTS

The intervention was found to have an effect on the perceived severity of challenging behaviour identified in people with PIMD in the sense that staff generally scored challenging behaviour as more severe in its consequences after the intervention. However, this effect was very small. No significant effects were found in terms of reduction in the biomedical scale scores.

CONCLUSION

No evidence for the effectiveness of a psycho-educational approach on the assessment of challenging behaviour in terms of severity and the biomedical attributions for behaviour was found. More research is required to explore further the effects of more elaborate training using methods to enable direct support staff to reflect on the behaviour of people with PIMD and on their own behaviour.

Staff attributions of the causes of challenging behaviour in children and adults with profound intellectual and multiple disabilities

A study has shown that staff do not generally perceive challenging behaviour in people with profound intellectual and multiple disabilities (PIMD) as being of serious consequence. In this study we aimed to gain a better understanding of the causal explanations that direct care and support staff give for challenging behaviour in this group. The purpose of this study was twofold: (1) to determine the way staff attribute challenging behaviour in children and adults with PIMD; and (2) to analyse whether more experienced staff attribute challenging behaviour in children and adults with PIMD differently than less experienced staff. In total, 195 direct support staff and an equal number of children and adults with PIMD participated in the study. Direct support staff filled out the Challenging behaviour Attribution Scale (five causal explanatory models of challenging behaviour) to explain challenging behaviour in one individual that they supported. The results show that direct support staff as a whole report the biomedical model as the most plausible explanation for challenging behaviour in children and adults with PIMD. However, in the present study the mean scores on all models are low. This might indicate that a large number of staff found none of the models particularly useful as possible explanations of challenging behaviour in people with PIMD. This could mean that staff have difficulties stating the cause of challenging behaviour in this group. Another possible explanation could be that there is little scientific knowledge about causing and maintaining factors of challenging behaviour in people with PIMD. It could also mean that staff have additional explanations for challenging behaviour in this target group that are not mentioned in the instrument used. Future research should address these issues. No differences were found between more experienced and less experienced direct support staff.

Exposure to aggressive behaviour and burnout in direct support providers: The role of positive work factors

Many direct support providers (DSPs) are exposed to aggressive behaviour in their work supporting adults with developmental disabilities service recipients. This is a work environment factor that has been linked to job burnout. The objective of this study was to examine the impact of positive work factors on emotional exhaustion (EE) among DSPs who are exposed to aggressive behaviour. Survey responses from 671 DSPs who were working in community service settings for adults with developmental disabilities, and were exposed to aggressive behaviour at least monthly were examined. Hierarchical linear regression examined the direct contribution and moderating role of positive work factors (self-efficacy for dealing with aggression and work contributions) on EE measured with the Maslach Burnout Inventory-Human Services Survey, after controlling for demographics, occupational variables, exposure to aggression and negative emotional reactions to aggression. Results showed that younger age, more experience, more depression/anger emotions in response to aggression, lower self-efficacy and low positive work contributions were significantly associated with EE. Positive work motivation was a moderator of exposure to aggression and EE. When work motivations were low, DSPs were more negatively affected by higher exposure to aggression. These findings suggest that in addition to addressing the negative emotional reactions to the aggressive behaviour encountered at work, it is also important to foster positive work factors which may be protective against EE.

Self-injurious behaviour, non-interventionism and practitioners' needs: Implications for training and managerial support

The aim of the present article is to critically analyse the literature concerning the factors that lead to non-interventionism towards self-injurious behaviour (SIB) in the field of intellectual disability and to make recommendations for the development of practice. It emerges that the limited behaviour analytic skills of practitioners impede the implementation of behavioural interventions and allow SIB to persist. The implications for the development of in-service training and managerial support that would disseminate the implementation of behavioural interventions are briefly discussed.

Adolescents׳ perceptions of peers with depression: an attributional analysis

Understanding adolescents׳ perceptions of peers with depression is vital in order to tackle peer exclusion and lessen stigmatization. To examine adolescents׳ perceptions of a hypothetical peer with depression, we test an attributional model: that stigma towards persons with mental disorders is influenced by attributions about the causes of their disorders and inferences of personal responsibility. Participants were 401 adolescents from 4th year/10th grade with an age range of 14.75-17.08 years (M=15.90 years; S.D.=0.403 years). Structural Equation Modeling was employed to assess the relationships among causal attributions (personal control), perceived responsibility, and emotional reactions, in predicting social acceptance/exclusion of a peer with depression. Results indicated that (a) if the peer with depression is perceived as having little control over the cause of depression, responsibility is not inferred, participants feel sympathy and pity, and are likely to socially accept the peer (b) gender of vignette character and participant influence these responses. This study builds on our theoretical understanding of why adolescents with depression may face social exclusion from peers by applying a well-established theory in social psychology. Findings should be incorporated into the design of interventions aimed at reducing peer exclusion and stigmatization of adolescents with depression.

Who's challenging who? Changing attitudes towards those whose behaviour challenges

BACKGROUND

Although staff attitudes towards individuals with intellectual disability (ID) whose behaviour challenges may be an important part of a positive support culture, very little research has focused on the development of training specifically designed to change staff attitudes. Positive contact is hypothesised to be an effective way to change attitudes towards stigmatised groups.

METHODS

We designed and developed a half day training package about the experiences of individuals whose behaviour challenges - Who's Challenging Who (WCW). The WCW package was delivered according to a manual by a trainer with ID and a professional without disability. Seventy-six staff from a variety of organisations participated in one of 10 WCW training sessions and provided data on their attitudes and empathy towards individuals whose behaviour challenges prior to the WCW training and immediately at the end of training. Staff also completed a post-training evaluation questionnaire.

RESULTS

A training package was successfully developed collaboratively with individuals whose behaviour challenges, and received very positive evaluations from staff participants. Short-term positive change was shown for empowerment and similarity attitudes, and staff empathy and self-efficacy. These outcomes were associated with small to moderate effect sizes.

CONCLUSIONS

Meaningful short-term positive staff attitude changes were found and the WCW training model was shown to be feasible. More robust research designs are needed for future evaluation. In addition, the function of an attitude change intervention such as WCW within organisations' training strategies requires further development.

Evaluating staff training: taking account of interactions between staff and clients with intellectual disability and challenging behaviour

BACKGROUND

Hastings (2010) has recently emphasised 3 aspects in the training of staff who serve clients with mild to moderate intellectual disability and challenging behaviour (CB): Staff attitudes, self-awareness, and clients' perspectives. This study investigates whether programs include these aspects.

METHOD

A systematic search yielded 11 relevant articles.

RESULTS

Generally, all programs aimed to improve staff knowledge and skills. Client variables concerned frequencies and severities of CB. None of the studies included clients' perspectives or staff attitudes and self-awareness.

CONCLUSIONS

The fact that staff attitudes and awareness or clients' perspectives were not among the main goals of the training studies suggests that recent views of effective treatment of CB are not yet the object of scientific study. Given the acknowledgment of these aspects, it is warranted that future research focuses upon these recent insights.

The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review

A number of studies have used mindfulness-based interventions to influence the behavior of people with intellectual disabilities, to improve their quality of life, and to reduce challenging behavior. The present review critically evaluates 18 studies and assesses the clinical and academic impact of their findings. Strengths identified included replicable methodological approaches, use of multiple baseline designs, strong construct and criterion validity, and consideration of the mechanisms by which mindfulness influences behavior change. Limitations included a lack of randomized controlled trials, inclusion of qualitative data without structured analysis, limited use of statistical analyses, and problems with sampling leading to difficulties generalizing findings. There was also a paucity of research investigating the impact of "Dialectical Behavior Therapy" and "Acceptance and Commitment Therapy" and the role of mindfulness within these approaches. Further research is warranted in this regard.

Coping with challenging behaviours of children with autism: effectiveness of brief training workshop for frontline staff in special education settings

BACKGROUND

The present study examined the effectiveness of three staff training elements: psychoeducation (PE) on autism, introduction of functional behavioural analysis (FBA) and emotional management (EM), on the reaction of challenging behaviours for frontline staff towards children with autism in Hong Kong special education settings.

METHODS

A sample of 311 frontline staff in educational settings was recruited to one of the three conditions: control, PE-FBA and PE-FBA-EM groups. A total of 175 participants completed all three sets of questionnaires during pre-training, immediate post-training and 1-month follow-up.

RESULTS

Findings showed that the one-session staff training workshop increased staff knowledge of autism and perceived efficacy but decrease helping behavioural intention.

CONCLUSIONS

In spite of the limited effectiveness of a one-session staff training workshop, continued staff training is still necessary for the improvement of service quality. Further exploration on how to change emotion response of staff is important.

Workforce development and challenging behaviour: training staff to treat, to manage or to cope?

Staff working directly with adults' challenging behaviours in learning disability services need to be very good at what they do. They also need to want to do the job. A theory-practice gap exists, however, between what is known about effective, evidence-based approaches and whether and how these are used in person-centred community services. Many frontline staff working with people with the most serious challenging behaviours do not have the skills to implement programmes to change behaviour. This discussion article reviews workforce development in the context of clinical and service guidelines and asks whether the legitimate purview of frontline staff is treating challenging behaviour, managing it or simply coping with it on a daily basis, whilst maintaining the best quality of life possible for service users.