Developing behavioural services to meet defined standards within a national system of specialist education services

Community engagement around scrub typhus in northern Thailand: a pilot project

BACKGROUND

Scrub typhus is highly endemic in northern Thailand yet awareness and knowledge are low. We developed a community engagement project to improve awareness in communities at risk of contracting scrub typhus.

METHODS

We conducted a series of engagement sessions with healthcare workers and community health volunteers so they would, in turn, engage with their communities. We evaluated our activities by assessing the increase in scrub typhus knowledge, using a series of Likert-scale items and open-ended questions. Three to 6 months after the sessions, participants were followed up to collect their experiences training community members.

RESULTS

Of 134 participants who took part in eight sessions, 87.3% were community health volunteers. Disease knowledge increased substantially after the sessions and was well maintained for up to 5 mo. Satisfaction was high and, through participant feedback, engagement materials were improved to be more useful to the communities. People with higher education had higher scores and retention.

CONCLUSIONS

Community engagement was shown to be an effective tool to develop and carry out health-promoting activities in a culturally and context-appropriate manner.

Can the Behaviour Intervention Plan Quality Evaluation, Version 2, be simplified for use by stakeholders with limited experience of positive behaviour support?

BACKGROUND

Behaviour support plan (BSP) quality auditing tools like the Behaviour Intervention Plan Quality Evaluation, Version 2 (BIPQEII), assess the quality of a BSP from the perspective of technical compliance with behavioural principles. However, these principles may be inaccessible to interested stakeholders with limited experience and knowledge of positive behaviour support (PBS). The aim of this study was to test if a simplified version of the BIPQEII [the Behaviour Support Plan Audit Tool (BSPA-tool)] offers a reliable and valid assessment of a BSP's technical compliance with behavioural principles when used by professional stakeholders with varying levels of PBS experience and knowledge.

METHODS

Four scorers rated 50 de-identified BSPs using the BSPA-tool, with one scorer also rating the BSPs using the BIPQEII. Four weeks later, each scorer rated 25 of the 50 BSPs again using the BSPA-tool. Prior to BSP scoring, a group of PBS practitioners provided feedback on the BSPA-tool's content validity.

RESULTS

The BSPA-tool was found to have acceptable content and parallel-form validity; however, acceptable internal consistency and inter-rater and intra-rater reliability were dependent on PBS experience/knowledge, that is, scorers with more experience/knowledge achieved more acceptable levels of reliability.

CONCLUSIONS

This study confirms that even with simplification, BSP quality auditing tools based on technical compliance with behavioural principles are still only accessible to stakeholders with extensive experience/knowledge of PBS. To engage less-experienced stakeholders in BSP quality auditing processes, new audit tools need to be developed that focus on other aspects of BSP quality (e.g. readability and consultation).

Positive behaviour support: a systematic literature review of the effect of staff training and organisational behaviour management

Positive Behaviour Support is an applied behaviour analytic system of support that is utilised in schools and in residential care settings for children and adults with disabilities who engage in challenging behaviour. Implementation fidelity depends on appropriate staff training and organisational behaviour management. A systematic literature review is reported that evaluated the evidence in relation to change in staff and service user behaviour and the impact of organisational behaviour management systems on effectiveness, generalization, and maintenance of these outcomes. Nine relevant articles were identified and analysed according to (1) the demographics of staff and residents and methods of staff training; (2) organisational behaviour management systems; (3) staff and service-user behavioural outcome measures; and (4) the methodological quality of the study. A combination of antecedent and consequence-based training strategies was used in the studies. Eight studies reported on the organisational behaviour management systems that were used, with five reporting on the responsibility of trainees to transfer their training to their untrained teams (pyramidal training). Although the studies reported on staff behaviour change following the training, only one of the studies reported significant increases of service user quality of life as a result of staff training and only two studies provided adequate methodological strength.

Contribution of occupational therapists in positive behaviour support

AIM

Positive behaviour support employs specific strategies which aim to both reduce the incidence of behaviours of concern and enhance the quality of life of people with intellectual disabilities. This study aims to identify activities and experiences of occupational therapists working in behaviour support contexts to understand how they see their contributions in this area.

METHODS

Semi-structured interviews were undertaken with 10 occupational therapists who have provided behaviour support for people with intellectual disabilities. Audio recordings were transcribed verbatim and thematically analysed.

RESULTS

Three major themes emerged from the interview data: contextualising and understanding behaviour; occupational therapy - why and how?; and 'challenges, strengths and expanding horizons'.

CONCLUSIONS

Participants saw themselves as providing an occupational perspective in the delivery of behaviour support, to individuals with behaviour support needs. They highlighted that this was achieved utilising their skills and knowledge about positive behaviour support strategies. Their approaches were seen as drawing on: their understanding of neurological function and how it relates to a person's occupational engagement; combining occupationally focussed approaches with behavioural analysis methodology to guide practice; and advocating for person-centred interventions. These observations form the basis for exploring ways in which occupational therapists can advance their contributions in positive behaviour support settings.

A component analysis of positive behaviour support plans

BACKGROUND

Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness.

METHOD

Sixty-one staff working with individuals with intellectual disability and challenging behaviours completed longitudinal competency-based training in PBS. Each staff participant conducted a functional assessment and developed and implemented a PBS plan for one prioritised individual. A total of 1,272 interventions were available for analysis. Measures of challenging behaviour were taken at baseline, after 6 months, and at an average of 26 months follow-up.

RESULTS

There was a significant reduction in the frequency, management difficulty, and episodic severity of challenging behaviour over the duration of the study. Escape was identified by staff as the most common function, accounting for 77% of challenging behaviours. The most commonly implemented components of intervention were setting event changes and quality-of-life-based interventions.

CONCLUSION

Only treatment acceptability was found to be related to decreases in behavioural frequency. No single intervention component was found to have a greater association with reductions in challenging behaviour.

The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications

BACKGROUND

Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. Questions have been raised as to PBS effectiveness, costs, and accessibility.

METHOD

Outcome studies meeting specified criteria for PBS were selected for review. All told, 12 outcome studies encompassing 423 cases were included.

RESULTS

This review showed that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community.

CONCLUSIONS

The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment.

Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes

BACKGROUND

LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team was then trained to train other practitioners to meet the same professional standards. However, no client outcomes were reported in that study.

METHOD

This study replicates the NZ study within disability services in Tasmania, Australia. Further, this study examined the associated client outcomes and the impact of the training on severity ratings of subsequent referrals.

RESULTS

Tasmanian trainers trained participants to provide behavioural services that met the same professional standards. Client behavioural outcome data showed significant improvement. Referral data showed decreases in severity ratings.

CONCLUSIONS

The trainer of trainers process is effective in training staff to meet defined professional standards, including desired client outcomes, and to effectively make positive behaviour support accessible to a large number of people.