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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.

Policies exist to regulate the use of restraint and seclusion so that they are only implemented when necessary and following appropriate standards and procedures. These policies often focus on students with disability. This qualitative study explored school leaders’ understanding, use and perspectives of the Restraint and Seclusion Policy mandated for Victorian government schools, in relation to primary school-aged children with disability. Reflexive thematic analysis was undertaken on interviews conducted with eight leaders from six Victorian government schools. Five themes were developed: (i) Perceptions about behaviours of concern; (ii) Complex policy complicates implementation; (iii) Many factors determine policy implementation; (iv) Reporting is required but stressful; and (v) Support is important and includes, but is not limited to, professional development. Results indicate the Policy was valued but complex. School ethos, educator ideologies and understanding of behaviour, and the physical environment impacted policy implementation. Leaders felt the most effective approach to reducing restraint and seclusion use was preventing challenging behaviour through proactive and holistic approaches. Reporting was necessary but the process often felt arduous and judgmental for educators. The Restraint and Seclusion Policy was valued but needs to be user friendly and supported with professional development about understanding the policy, behaviour and disability.

This study evaluates the effectiveness of a brief functional analysis and functional communication training conducted via telehealth. Three interventionist-child dyads took part in the study including one speech and language pathologist and two school teaching assistants, each working with one child with autism spectrum disorder. Interventionists were trained using didactic training to implement a brief functional analysis as well as synchronous coaching from a BCBA® to implement functional communication training. A multiple baseline across participants design was utilised to evaluate if interventionists could implement functional communication training to decrease challenging behaviours that included aggression, elopement and disruption. Sessions concluded earlier than planned due to school closures mandated by the COVID-19 outbreak for two of the three participants; however, existing data provide evidence that telehealth is a valid model for enabling clinicians to work in collaboration with school personnel to effectively deliver assessment and intervention procedures remotely via telehealth.

This qualitative research study is a narrative cross multi-case analysis. The purpose of this study is to understand how the practice of the Collaborative Problem Solving method (CPS) has impacted the parenting relational experience and their perception of their child's teachers. The CPS method is a problem-solving strategy that is based on the premise that children and people do well if they have the cognitive skills to do well; and, that their behaviour reflects their cognitive skills. The CPS method provides an alternative perspective on human behaviour enabling the CPS practitioner to consider that challenging behaviour is not the will to be challenging, rather it is the inability, at that moment, not to be challenging. This method also provides a sequence of interpersonal engagement that provides the opportunity to regulate (to calm), to relate (to connect), and to reason (to problem-solve) while promoting the experience of co-regulation that strengthens the relational experience. The research question is "What are parents' experiences with their practice of the CPS method and how has their practice impacted their perception and experience of their child's school teacher?" There are two concepts that guide this study: the differential impact of experience and anti-ableism. The foundation and concepts behind the CPS method are also a philosophical framework that guides this study. This study revealed that parents who practice the CPS method have a strong connection to the philosophy behind the method and discovers that the practice of the CPS method can impact a parent's perception and experience of their children's teacher, however, that process can be disrupted by the parent's experience of trauma should the teacher be involved in the traumatic event.

Contains fulltext : 251950.pdf (Publisher’s version ) (Open Access) Background: Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors). Method: Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results. Results: Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home. Conclusions: Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start. 12 p.

Interactions between staff and individuals with intellectual disability have been shown to influence the development or maintenance of challenging behaviours among the latter. Given the implications of these observations, the present study sought to describe special education teachers’ responses to challenging behaviours displayed by their pupils. Eight teachers and 12 children with intellectual disability who manifested challenging behaviours were observed over the course of 6 months. Teachers completed questionnaires regarding their emotional reactions to, and understanding of, challenging behaviours. They also reported their behavioural and emotional responses to challenging behaviours described in vignettes. The combination of observation and questionnaires provided a more comprehensive understanding of teacher’s attitudes towards challenging behaviours. Results indicated a discrepancy between reported and observed behaviours. Teachers preferred verbal interventions or not responding to challenging behaviours. The analysis of interactions between teachers and their pupils highlighted relationships between emotions, attributions and several behaviours., Les études ont démontré que les interactions entre les intervenants et les personnes ayant une déficience intellectuelle peuvent avoir un effet sur le développement ou le maintien des troubles du comportement chez ces dernières. Considérant la portée de ce constat, la présente étude propose une analyse descriptive des réactions des enseignants travaillant dans des classes spéciales face aux comportements problématiques de leurs élèves. Huit enseignants et 12 enfants ayant une déficience intellectuelle et présentant des troubles du comportement ont été observés pendant une période de 6 mois. Des questionnaires ont été administrés aux enseignants afin de recueillir de l’information concernant leurs émotions face aux troubles du comportement et la compréhension qu’ils en avaient. Des mises en situation portant sur le type d’intervention utilisée en réponse aux comportements problématiques et les émotions ressenties dans cette situation ont également été administrées. L’observation associée aux questionnaires a permis une compréhension plus globale des attitudes des enseignants envers les troubles du comportement. Les résultats démontrent que les comportements observés diffèrent des comportements rapportés. Il apparaît que les enseignants favorisent les interventions verbales ou n’interviennent pas face aux troubles du comportement. L’analyse des interactions entre les enseignants et leurs élèves met en évidence le lien existant entre les émotions, les attributions et plusieurs comportements.

To ascertain whether young people with dystonia are more likely than the general population to have mental health and/or behavioural difficulties, and to explore factors that may contribute to these difficulties.Using a quasi-experimental design, 50 young people with dystonia aged 7-17 and their carers were recruited from the Evelina London Children's Hospital. Young people completed the Beck Youth Inventories and the Strengths and Difficulties Questionnaire. Carers completed the Strengths and Difficulties Questionnaire-Parent version and the Paediatric Pain Profile. Important medical factors, such as age of onset, motor severity and manual function were obtained from medical records.One sample z tests showed young people with dystonia self-reported significantly higher levels of anxiety (p .001) and prosocial difficulties (p .01), with 48% experiencing clinically significant anxiety levels. They experienced significantly lower levels of anger, disruptive behaviour and conduct problems (all p ≤ .01). Carers reported significantly higher rates of emotional problems, hyperactivity and peer problems, and significantly lower prosocial behaviours (all p ≤ .01). Pearson's correlation coefficients showed lower levels of self-esteem were related to higher levels of anxiety (p = .015). High levels of pain were related to parent-rated conduct problems (p = .004). Age of dystonia onset and motor severity did not correlate with any of the psychological or behavioural measures.Our study suggests high rates of anxiety and behaviours that challenge in children with dystonia. Screening in movement clinics would be helpful in early identification and signposting for support.

Differences in perceived emotional support in family networks of people with mild intellectual disability with and without challenging behaviour were explored by using a self-report measure. One hundred and thirty-eight participants (78 men and 60 women, average age 28.2 years old) with mild intellectual disability were interviewed using the Family Network Method – Intellectual Disability to assess their emotionally supportive family relationships. The instrument maps the perceived emotional support among all the family members in the family networks of people with mild intellectual disability, with and without challenging behaviour. The results suggest that challenging behaviour may not be strongly associated with the family network characteristics and emotional support in family networks of people with mild intellectual disability. A few, and generally small, differences were found between the family networks of people with or without challenging behaviour. However, one moderate sized group difference was found: those with challenging behaviour reported less mutual support in their whole family network.

Differences in perceived emotional support in family networks of people with mild intellectual disability with and without challenging behaviour were explored by using a self-report measure. One hundred and thirty-eight participants (78 men and 60 women, average age 28.2 years old) with mild intellectual disability were interviewed using the Family Network Method – Intellectual Disability to assess their emotionally supportive family relationships. The instrument maps the perceived emotional support among all the family members in the family networks of people with mild intellectual disability, with and without challenging behaviour. The results suggest that challenging behaviour may not be strongly associated with the family network characteristics and emotional support in family networks of people with mild intellectual disability. A few, and generally small, differences were found between the family networks of people with or without challenging behaviour. However, one moderate sized group difference was found: those with challenging behaviour reported less mutual support in their whole family network.

Einleitung: Das Verhalten von psychisch kranken Menschen beeinflusst, wie sie von ihren Mitmenschen wahrgenommen werden. Somit wird auch die Beziehung zwischen Pflegepersonen und psychiatrischen Patient*innen verändert. In dieser Arbeit werden diese Veränderungen und ihre Ursachen erforscht. Methodik: Zur Beantwortung der Forschungsfrage wurde in den Datenbanken CINAHL und PubMed systematisch recherchiert. Der zeitliche Rahmen umfasste zehn Jahre (2013-2023), um die Aktualität der eingeschlossenen Studien zu gewährleisten. Insgesamt wurden zwölf Studien für die Beantwortung der Forschungsfrage ausgewählt und behandelt. Die Bewertung der Qualität der einzelnen Studien richtete sich nach den Kriterien von Brandenburg, Panfil und Mayer (2007). Ergebnisse: Die Veränderung der Pflegebeziehung wurde anhand vier Aspekten, der persönlichen Grundhaltung von Pflegepersonen, dem Fachwissen, der Teamarbeit und der Emotionalität, beschrieben. Des Weiteren wurden Lösungsansätze zu einer Besserung der Pflegebeziehung und zwischenmenschlicher Zusammenarbeit geliefert. Schlussfolgerung: Erlebnisse aus vergangenen Pflegesituationen prägen die Einstellung von Pflegepersonen maßgeblich und beeinflussen somit zukünftige Pflegebeziehungen. Ein adäquates Wissen im Fachbereich der Psychiatrie trägt zu einem Verständnis der Verhaltensweisen psychisch Erkrankter bei und fördert so den Beziehungsaufbau sowie den -erhalt. Grundvoraussetzung für den funktionierenden Pflegeprozess und Beziehungsaufbau ist ein gut geplantes Zeitmanagement, das durch Teamarbeit möglich wird. Die Emotionalität der Pflegepersonen sowie der Patient*innen bestimmt über den Erfolg der Pflege-Patient*innenbeziehung. Schlüsselbegriffe: Pflege-Patient*innenbeziehung, psychische Krankheit, Verhaltensauffälligkeiten Introduction: Challenging behaviours of mental ill patients have an impact on the perceptions of their fellow men. This also changes the relationship between nurses and patients. This work aims to describe the contributing factors of this change and points out ways to reduce its sources of friction. Methodology: The systematic search to answer the research question was done in the databanks of CINAHL and PubMed. The time frame of the search was determined for ten years (2013-2023) to secure the relevance of the studies. In total twelve studies were chosen to answer the research topics question. Quality criteria of Brandenburg, Panfil and Mayer (2007) was chosen to judge the studies quality. Results: Changes in the relationship between nurses and psychiatric patients were defined on four sub-categories, nurses attitudes, psychiatric expertise, teamwork and emotional reactions. Furthermore, solutions and improvements for a better therapeutic/nursing bond were listed. Conclusion: The studies have shown that nurses´ experiences with mental ill patients impact their attitudes and future nursing relationships. With psychiatric expertise comes the understanding of behavioural differences that can be seen in mental ill people, which leads to improve the build of an healthy relationship between the two parties. Keywords: therapeutic relationship, mental illness, challenging behaviour

The diploma thesis deals with challenging behaviour in pupils with intellectual disability and autism. The aim of the thesis is to map the current reality of education of these pupils through the statements of pedagogical staff from pre-schools and elementary schools established in accordance with section 16, paragraph 9 of the Education Act. The occurrence, frequency, intensity and specific manifestations of challenging behaviour are examined, as well as the underlying causes influencing challenging behaviour, prevention and preventative approaches, solutions to the occurrence and escalation. The theoretical part provides a comprehensive overview of the problem and challenging behaviour in our country and in the Anglo-Saxon world and it deals with approaches to challenging behaviour. It also focuses on autism, neurodiversity and intellectual disability. The research part defines the aim of the thesis, research questions and methodology. The research is carried qualitatively using semi-structured interviews. The results of the research draw on substantial statements of fourteen members of pedagogical staff. The conclusions of the work present a comprehensive picture of the challenging behaviour problematics. It is indicative of good practice, but also of lack of information and lack of support...

Differences in perceived emotional support in family networks of people with mild intellectual disability with and without challenging behaviour were explored by using a self-report measure. One hundred and thirty-eight participants (78 men and 60 women, average age 28.2 years old) with mild intellectual disability were interviewed using the Family Network Method – Intellectual Disability to assess their emotionally supportive family relationships. The instrument maps the perceived emotional support among all the family members in the family networks of people with mild intellectual disability, with and without challenging behaviour. The results suggest that challenging behaviour may not be strongly associated with the family network characteristics and emotional support in family networks of people with mild intellectual disability. A few, and generally small, differences were found between the family networks of people with or without challenging behaviour. However, one moderate sized group difference was found: those with challenging behaviour reported less mutual support in their whole family network.

People with intellectual and developmental disabilities (IDD) and autism are often marginalized and further traumatized because of behaviours that are difficult (challenging) for care providers and services to manage. These behaviours are similar in many ways to responses of our autonomic nervous system when triggered by danger and life threat – namely fight-flight-freeze (FFF) and shutdown survival responses. This discussion paper, drawing on polyvagal theory understanding, explores these similarities further from Outside-In (i.e., as observed and reported by others such as carers and clinicians) and Inside-Out perspectives (i.e., as described by people with IDD and autism engaging in these behaviours). Polyvagal theory, developed by Dr. Stephen Porges, explains how the sympathetic nervous system and the dorsal branches of the vagus nerve are involved in FFF and shutdown survival responses; the ventral branches of the vagus nerve are involved in the capacity for social engagement and in the experience of feeling safe. In our paper, the experience of feeling safe is investigated and triggers that alert the nervous system to danger and threat are identified. Being safe and feeling safe diminishes autonomic nervous system reactivity and automatic survival responses. We conclude that imbuing a safe experience for people with IDD and autism (from their perspective), through optimal health and supportive emotional and physical environments adapted to unique needs, will diminish autonomic nervous system reactivity and dysregulation, which in turn will diminish consequent distress behaviours that services and care providers find difficult. Being safe and feeling safe, are key to both treatment and prevention of emotional and behavioural distress and difficult behaviours.

Purpose This paper aims to provide a commentary on the article “Teaching behavioural expectations to secondary age students with intellectual disabilities attending a special school”. Design/methodology/approach The impact on teachers who deal with high levels of behaviours that challenge is explored. Findings The article highlights the importance of proactive, preventative strategies for behaviour management and the need for staff training and support. Originality/value Teachers working with pupils who engage in high levels of behaviours that challenge need training and support.

Purpose School-wide positive behaviour support (SWPBS) is a proactive behavioural support system that fosters behaviour change in individuals in a school setting. This article aims to present a case example of teaching and reinforcing behavioural expectations in a special school. Design/methodology/approach This case study reflects different steps and materials used before and during the intervention in a special education school with 61 secondary students with intellectual disabilities. An AB design (A – baseline; B – intervention) was used to collect and analyze data. Findings Results suggest that teaching behavioural expectations as a universal measure may be feasible and positively impact school climate. Suggestions and recommendations for implementing SWPBS within a school are provided. Originality/value This case study provides a step-by-step guide illustrating the process of teaching and reinforcing behavioural playground expectations to young adults with intellectual disabilities attending a special school.

The new Dutch Care and Coercion Act aims to better regulate the use of psychotropic drugs for challenging behaviour in people with an intellectual disability. This study explores experiences of intellectual disability physicians (IDPs) in prescribing psychotropic drugs and investigates how the Act and the new multidisciplinary guideline on challenging behaviour affects their practice. A qualitative study was conducted, consisting of nine semi-structured in-depth interviews with IDPs, followed by a thematic analysis. It was found that IDPs experienced the new Act and guideline as supportive of their work as guardians of the appropriate use of psychotropic drugs. The multidisciplinary character of the guideline was experienced positively. However, IDPs are faced with organisational barriers and time constraints, as such, they question the feasibility of implementing the Act. Based on these findings, it can be concluded that the Care and Coercion Act may support the existing shift towards the appropriate use of psychotropic drugs if required conditions can be met.

Purpose A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events. Design/methodology/approach Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis. Findings The key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”. Originality/value Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development.

The Pyramid Model (PM) is an evidence-based, early educational framework designed to promote all young children’s social-emotional-behavioural (SEB) learning. The tiered PM early education practice framework, developed in North America, embeds strategies for children with exceptional needs naturally and coherently integrates apparently divergent approaches to promoting young children’s SEB skills. Responsive teaching, which is fundamental to early education practice, is shown to link with positive behaviour support practices by means of incidental and planned intentional teaching. These early education PM practices are intended to promote children’s SEB skills when used together purposefully, consistently, and intensively. The PM’s potential application in Australia was investigated with 4–5-year-olds in 4 Victorian preschools. Quantitative data from the study suggested that after training and subsequent coaching in the PM, there was significant change in intervention educators’ behaviour, which was independently observed and rated using the Teaching Pyramid Observation Tool. Concurrently, the SEB skills of the children in the intervention groups were shown to have developed at a significantly greater rate than the children in the contrast groups as assessed using the Social Skills Improvement System Rating Scales.

Purpose Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

A pilot feasibility study which aims to determine the feasibility and acceptability of a clinical behaviour checklist. The checklist identifies a number of potential causes of behaviours that challenge; namely pain/discomfort, sensory problems/sensitivity, anxiety, low mood, sleep, emotional outbursts, impulsivity, insistence on sameness, social differences. The aim is that the checklist will ensure that these factors are routinely considered.

Recognition of the level of emotional development (ED) is essential in adults with an intellectual disability to align treatment and support accordingly. The empirical-based Scale of Emotional Development – Short (SED-S) assesses the level of ED in 5 reference age groups from 0 - 12 years in eight different domains. The scale is assessed by an expert in developmental psychology in a semistructured interview with close caregivers. It consists of eight domains: ‘Relating to his/her Own Body’, ‘Relating to Significant Others’, ‘Dealing with Change/Object Permanence’, ‘Differentiating Emotions’, ‘Relating to Peers’, ‘Engaging with the Material World’, ‘Communicating with Others’, and ‘Regulating Affect’ (Sappok et al., 2018). Each domain is evaluated on a stage level: adaptation (SED-S 1; emotional reference age: 0–6 months), socialisation (SED-S 2; emotional reference age: 7–18 months), first individuation (SED-S 3; emotional reference age: 19–36 months), identification (SED-S 4; emotional reference age: 4–7 years) and reality awareness (SED-S 5; emotional reference age: 8–12 years). For each domain and level of ED, the overall 200 individual items describe age-specific behaviours. The overall level of ED is determined by the fourth lowest ranking domain (Sappok et al. 2016; Sappok et al. 2018). This study aims to: Analyse the psychometric qualities on item level of each item of the Scale of Emotional Development—Short (SED-S; Sappok et al., 2018).

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.

Schools present a unique context for the generation and resolution of conflicts of human rights. While the conflicts that arise are many and various, a default response appears to be the prioritisation of the rights of the majority. Hence the rights of the many then trump the rights of the few. However, the intersection of multiple stakeholders, and multiple interests and rights, requires decision-makers to identify the rights at stake for all and address conflicts in ways that are both principled and transparent. Drawing on an established body of human rights theory, and using the example of children whose behaviour is causing disruption as a case, this paper offers a rights-informed approach to consider responses to some of the tensions and conflicts that can arise between students in schools. While acknowledging that (a) the resolution of these disputes will turn on individual facts and contexts and rarely be clear-cut and (b) that human rights theory and law on this issue is also complex and contested, we suggest that a rights-informed response should, and would usefully, be applied in situations when the interests of one child appear to conflict with the interests of others in the context of schools.

Purpose Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar. Design/methodology/approach This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured. Findings This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices. Originality/value This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

L’échelle d’impact des problèmes actuels de comportement (IMPAC) est un outil visant à mesurer l’impact des comportements problématiques chez les personnes ayant subi une lésion cérébrale acquise. Cette mesure évalue l’impact des comportements sur la personne cérébrolésée et son entourage selon cinq dimensions : les relations significatives, l’intégrité psychologique, l’accès aux services, l’intégrité physique et les interventions dispensées. Mis au point par des intervenants spécialisés en trouble du comportement chez la clientèle cérébrolésée, cet outil a fait l’objet d’une série de trois études de validation de contenu. Celles-ci ont été menées auprès d’experts et de professionnels du réseau de la réadaptation en déficience physique. Les résultats ont démontré que l’échelle IMPAC possède une validité de contenu satisfaisante, c’est-à-dire que les dimensions ciblées et les niveaux d’impact décrits pour chacune d’elles reposent sur des critères clairement définis et reconnus comme tels par les experts. L’échelle IMPAC constitue donc un instrument potentiellement utile pour les cliniciens qui souhaitent évaluer de manière objective l’impact des comportements problématiques d’un usager, et ainsi contribuer à guider les interventions prioritaires et à éclairer les décisions d’orientation vers des ressources d’hébergement ou des services spécialisés., The IMPAC Scale (Impact des problèmes actuels de comportement) is an instrument designed to evaluate the impact of challenging behaviour in people with acquired brain injury. This scale measures the impact of such behaviour on the brain-injured person and their social network based on five areas: significant relationships, psychological integrity, access to services, physical integrity and received interventions. The instrument was initially developed by specialized practitioners working with brain-injured persons exhibiting severe challenging behaviour. A series of three validation studies were conducted in which experts and practitioners in fields such as acquired brain injury rehabilitation were consulted. The results showed that the IMPAC Scale has satisfactory content validity — i.e. targeted impact areas and described impact levels are based on clearly defined criteria recognized as such by experts and practitioners. Therefore, the IMPAC Scale can be a useful tool for clinicians who need to objectively assess the impact of a user’s challenging behaviour, which can help prioritize interventions and recommend appropriate residential facilities or specialized services.

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

Autism Spectrum Disorder (ASD) is associated with complex distress and challenging behaviours that have a negative impact on the everyday life of those with ASD, as well as their parents and carers. These challenging behaviours include negative emotional behaviours, motor behaviours, and changes in routines. Even though challenging behaviours occur in most subjects with ASD, the cause of these largely remains unknown. It has been implicated that these challenging behaviours are associated with a change in the health of those with ASD. More research needs to be conducted that can establish a direct association. Towards this goal, the present study aimed to explore whether health status had an impact on the distressing behaviour in the subjects diagnosed with ASD. We analysed the response from the parents/carers in a Macedonian population of those with ASD, to determine which challenging behaviours were most likely to be observed during a change in health. Based on a scoring system, the manifestation of challenging behaviour was evaluated and compared with the changes in health. Changes in appetite or dietary preferences, irritability and low mood, and loss of previously acquired skills had the greatest association with a change in health. These findings provide early insight into types of challenging behaviours that are directly associated with a change in health. Our results demonstrate a relationship between health status and challenging behaviour in the subject with autism, suggesting that caregivers may need to consider this when choosing strategies for managing challenging behaviour.

Challenging behaviour is a problematic issue for students with intellectual disability, including those in special education settings. While there is a need to address challenging behaviour in thes...

Inclusion regarding challenging behaviour is one of the most demanding challenges for teachers. How schools succeed with inclusion regarding challenging behaviour can therefore be a good indicator ...

Background Nearly 60,000 people applied for asylum in the Netherland in 2015, confronting the governmental structures and services with great administrative, logistical and service provision challenges. Refugee children’s psychosocial needs and wellbeing are often overlooked, and post-migration support is of pivotal importance. Methods An easy accessible movement–based psychosocial intervention, called TeamUp, was developed for children aged 6–17 living in refugee reception centres. A mixed-method process evaluation was conducted of (1) implementation process, assessing attendance (n = 2183 children, and n = 209 children); (2) implementation quality, using structured observations at two time points to evaluate facilitator’s (2a) individual-level fidelity (n = 81 facilitators); (2b) team-level fidelity (n = 22 teams); (2c) facilitators’ competencies (n = 81); (2d) trainee perceived self-efficacy pre-post training (n = 73); and (3) perceptions on implementation and outcomes, employing a survey (n = 99), focus group discussions and key informant interviews with children (n = 94), facilitators (n = 24) and reception centre staff (n = 10). Results Attendance lists showed a mean of 8.5 children per session, and children attending 31.3% of sessions. Structured observations demonstrated 49.2% and 58.2% individual-level fidelity, 72.5% and 73.0% team-level fidelity, and 82.9% and 88.4% adequacy in competencies, each at T1 and T2 respectively. The main reported challenges included managing children’s energy regulation (e.g. offering settling moments) and challenging behaviour. Training participation significantly improved perceived self-efficacy for trainees. The facilitator survey demonstrated on average, high satisfaction and self-efficacy, low experienced burden, and high perceived capacity-building support. Qualitatively, TeamUp was positively perceived by all stakeholders and was regarded as contributing to children’s psychosocial outcomes. Conclusion (1) Attendance and group size were lower than expected. (2) The intervention’s facilitator fidelity ranged from moderate to adequate—exhibiting a need for specific fidelity and capacity strengthening—while facilitator competencies were high. Trainee’s perceived self-efficacy improved significantly following a 2-day training. (3) Facilitators expressed high levels of satisfaction, self-efficacy and support, and low burden. The intervention was positively perceived by all stakeholders and to have a positive impact on children’s psychosocial learning and wellbeing.

Purpose The purpose of this paper is to outline the development and piloting of a training intervention for social care staff that uses a capable environments framework to improve the quality of staff support. Design/methodology/approach A single case study was used to evaluate changes in the quality of staff support and in levels of engagement and challenging behaviour for one of the individuals supported. Findings The case study demonstrates the usefulness of the capable environments framework as a model for training and development of support planning. Staff provided more positive interaction and support to the individual, who displayed increased participation in activities and reductions in the occurrence and episodic severity of challenging behaviour. Originality/value Capable environments is a systematic, theoretically-driven approach, which is focussed on the quality of support design and provision for people with intellectual disability. The use of such a framework as an intervention assists staff in the provision of effective personalised supports, a foundation for positive behaviour support.

Purpose This paper aims to present a conceptual viewpoint highlighting the utility of active support in implementing capable environments and to extend this by presenting a three-tiered preventative model of positive behavioural support (PBS) in UK health and social care. Design/methodology/approach Provision of a commentary on “Building capable environments using practice leadership” by Linda Hume, Nadia Khan and Martin Reilly. Findings Capable environments and active support should be key, universal and essential PBS tier one supports in UK health and social care. Training staff in Active Support and developing practice leadership help implement capable environments. Originality/value The three-tiered PBS model was recently proposed by Leitch et al. (2020) and is worthy of further debate and refinement with the involvement of stakeholders. It has several practical implications including refocussing efforts on early intervention to get tier one supports implemented effectively in recognition that PBS is much wider than intense tier three supports. It could reinforce and motivate existing providers of quality support and indicate where and how other providers can commence the process of implementing PBS. Future research could consider the effectiveness of applying implementation science to the field of learning disabilities and PBS in particular.

Background: Behaviours that challenge might prevent intellectually impaired individuals from experiencing a good quality of life (QoL). These behaviours arise in interaction with the environment and can be positively or negatively affected by architecture. Aim: This scoping review explores how architecture contributes to the QoL of individuals engaging in such behaviours. It aims to identify possible gaps in the existing literature and map areas of future research. Method: Four databases were searched using four concepts: architecture, QoL, challenging behaviour, and intellectual impairment. Since only one source covered all concepts, the search criteria were widened to include sources integrating only two or three concepts, nonpeer-reviewed sources, and autism.18 papers, were analysed in terms of their contribution to relations between QoL, behaviours that challenge, and architecture. Results: This review shows that architecture, QoL, intellectual impairment, and behaviours that challenge have not yet been studied jointly. Conclusions: The contribution of architecture to the QoL of these individuals should be subject of future research, together with the similarities and differences between their needs and those of individuals with autism. ispartof: Research In Developmental Disabilities vol:127 ispartof: location:United States status: published

The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of ‘restrictive practices’ across all sectors of health care, including the difference between ‘restrictive practices’ (such as attitudes of control, limit setting and unnecessary ward rules) and ‘restrictive interventions’ (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.

Purpose This paper aims to improve community care for people with intellectual disabilities (ID) and/or autism. Lack of coordination between agencies leads to children and young people with the most complex needs falling between services. The North West Operational Delivery Network (ODN) for learning disability and autism set out to develop a model of care for mental health services for children and young people with ID and/or autism in North West England that would improve coordination between services and lead to better community care. Design/methodology/approach The ODN held a series of good practice events and consultations with stakeholders in North West England to look at gaps in service provision, national guidelines and agree on a pathway for services. Findings The ODN decided to use the THRIVE framework as the basis for a specific model of care. Interventions were mapped against the THRIVE groupings, including pathways and team specifications for assessment and support for children with autism, and models for child and adolescent mental health service support for ID and/or autism, for keeping children and young people with behaviour that challenges in the community and transition. Originality/value This model aims to provide the North West England region with a clear multi-agency approach for supporting the needs of this population and supports multi-agency commissioning, gap analysis, earlier intervention and improving health outcomes for this population.

Positive behaviour support is used by staff to help people with different disabilities, but we do not know what helps staff to keep using positive behaviour support. We looked at all the reports that people have written about using positive behaviour support to find out what helps staff to keep using it. We used a special way of putting everything together and found groups of important things to do with positive behaviour support, the people who use it, and things happening around them. These things can help staff use positive behaviour support better and for longer. Abstract: Background It is necessary to understand which variables successfully contribute to the adoption of positive behaviour support (PBS) in disability services if people with disability are to experience meaningful outcomes. Methods A systematic review of the disability support literature was undertaken, and meta-aggregation was used to synthesise the findings. The study applies ENTREQ statement criteria, and diffusion of innovations theory was used to analyse and interpret the results. Results Twenty-seven papers were included in the analysis, from which over 300 findings were extracted. Forty-one aggregated findings generated a final set of 26 principles which informed the development of a conceptual framework for the adoption of PBS in disability services. Conclusion The conceptual framework and supporting principles will assist those interested in introducing PBS into disability services for successful adoption and are applicable to researchers, managers, and practitioners alike. Recommendations are made to expand research on the application of PBS in specific disability contexts and to broaden the application of PBS beyond challenging behaviour.

Background: Challenging Behaviour (CB) occurs in up to 80% of nursing home residents with dementia. Identifying stressors causing CB is difficult (as residents themselves cannot indicate what is experienced as stressful), thereby hampering the psychosocial approach. Nowadays, stress-related biomedical variables, such as (aberrant) physical activity, skin temperature, heart activity, and skin conductance, can be measured continuously and relatively easily using wearable sensors. Next to validation of algorithms (i.e. the relationship between wearable data and CB), it is of utmost importance to consider the different values, attitudes, and needs of all stakeholders involved to successfully develop, apply and implement this technology. Objective: To identify the values, needs, and attitudes of multiple stakeholders regarding wearables in the care of people with dementia and CB. Method: A qualitative study was conducted, in which a real-life context was created in a Dutch nursing home. Two residents with CB wore the Empatica E4 wristband for three half-days. Multiple stakeholders (i.e., eight involved nurses and eight informal caregivers) were interviewed. Subsequently, results were used for designing two focus groups. The first focus group included formal (n=6) and informal (n=6) caregivers. The second focus group consisted of community-dwelling people with dementia (n=7) and their informal caregivers (n=5) and case managers (n=2). Results: Stakeholders accepted the wearable as a supportive technology in the care of people with dementia and CB. Expected value, user comfort, need for information, and design (including customizability and stigmatization) were important themes. During the focus groups, explicit recommendations were given by the participants with respect to the wearables’ design. Conclusion: In order to enhance the adoption of wearable sensors in CB and dementia on an individual level, information about the technology and the design of the wearable deserves more explicit attention in clinical practice and future research.

Background: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]). Method: This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data. Results: The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work. Conclusion: Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.

Neurodevelopmental impairments have been recognised as a major association of paediatric kidney disease and bladder dysfunction, presenting challenges to clinicians and families to provide reasonable adjustments in order to allow access to investigations and treatments. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterised by impairments in social interaction/communication and repetitive sensory-motor behaviours. Mental health, learning and physical co-morbidities are common. There is emerging evidence that ASD and kidney disease have some overlaps with genetic copy number variants and environmental factors contributing to shared pathogenesis. Prevalence rates of ASD in kidney disease are currently not known. A high index of suspicion of underlying ASD is required when a young person presents with communication difficulties, anxiety or behaviour that challenges, which should then trigger referral for a neurodevelopmental and behavioural assessment. We discuss practical approaches for providing care, which include understanding methods of communication and sensory, behavioural and environmental adaptations. Supplementary Information The online version contains supplementary material available at 10.1007/s00467-020-04875-y.

Children and adults with severe intellectual disability and complex needs often show behaviours and distress that carers and professionals find difficult to identify causes for, manage and decrease. The prevailing view is that these behaviours and distress are learned and consequently interventions focus on behavioural techniques. In this article we summarise the findings of research that indicate that behaviour and distress in this population are influenced by transient and stable characteristics or conditions that can interact with aspects of learning, be independent of learning, and interact with each other. These transient and stable characteristics or conditions are: pain and discomfort, sensory sensitivity, anxiety and low mood, sleep problems, atypical emotional regulation, specific cognitive difference, and differences in social behaviour. To aid carers and professionals, we present a checklist of the elements of an assessment process that covers these transient and stable characteristics or conditions and other relevant influences on behaviour and distress such as seizures, medication, learning and communication. We also draw attention to the benefit of identifying the cause of intellectual disability to inform the assessment process.

Purpose This paper challenges the value of consensus within the field of learning disability. In this commentary, the author argues that consensus threatens to silence multiple viewpoints, hides how power operates and stifles creativity. Design/methodology/approach The author focuses on two articles within this special issue to suggest that the consensus celebrated is more about a set of shared values, rather than a set of shared practices. This should make us question the depth of the field’s consensus. Findings The presumption that multiple paradigms can be “unified” actually hides how power operates to resolve disagreements among positive behaviour support, active support and human rights approaches. A similar erasure occurs in the language of “capable environments,” which the author argues obscures the role of individuals, relationships and organizational cultures in impacting quality of life. Research limitations/implications We need to create and build a new interdisciplinary field of challenging behaviour studies that is willing to embrace conflict and disagreement in research, policy and practice. Practical implications The author believes that this approach is more likely to empower people, including people with learning disabilities whose behaviour challenges, family members, and direct support workers because it is more likely to recognize their experiences and expertise. Originality/value A new multidisciplinary field of challenging behaviour studies may encourage more theoretical diversity that makes us challenge the value of consensus and embrace creativity.

Purpose The purpose of this paper is to explore three main areas in relation to the interface between challenging behaviour and offending. Design/methodology/approach The first aim is to explore the labelling of behaviours as challenging or offending behaviour in the light of legal definitions, staff knowledge and beliefs and the mental capacity and mental health acts. The second is to explore challenging behaviour as a risk factor for offending in people with Intellectual Disability (ID).The third aim is to discuss the challenging behaviour as a barrier to discharge from secure services. Findings There is limited research suggesting that challenging behaviour such as physical aggression can lead to longer stay in forensic services, and this warrants further research. Originality/value This paper aims to promote discussion about the interface of offending and challenging behaviour in people with IDs and to promote best practice.

Purpose The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”. Design/methodology/approach The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed.

Purpose Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas.

PurposeThe purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like.Design/methodology/approachThis paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance.FindingsPeople admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital.Originality/valueService providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGillet al.(this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld.

Contains fulltext : 227106.pdf (Publisher’s version ) (Open Access) Background: Interactions with professional caregivers affect the quality of support and life of people with intellectual disabilities and contribute to the occurrence of challenging behaviour. The present literature review provides an overview of factors facilitating or hindering meaningful staff-client interactions in people with borderline to profound intellectual disabilities and challenging behaviour. Method: Database searches, reference list and citation screening, and expert consultations were undertaken. A thematic synthesis of 28 studies was performed. Results: Factors were identified at the client (i.e. behaviour, emotions and (dis)abilities), staff (i.e. interactive principles, knowledge, psychological resources, attributions, attitudes and (coping with) emotions) and context levels (i.e. group size, team and organization). Conclusions: The present overview provides insights into factors that facilitate or hinder meaningful staff-client interactions with people with intellectual disabilities and challenging behaviour. The results support the need to combine client, staff and contextual factors when considering staff-client interactions in research and practice. 13 p.

Purpose There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

Purpose The purpose of this paper is to provide an individual family-carer perspective on navigating the complex child, adult, education, health and social care systems focussing on what might be needed to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges. Design/methodology/approach This is a conceptual analysis, drawing on lived experience, policy and practice. Findings Policy and best practice advocate a holistic, person-centred, outcome-focussed approach to supporting individuals with learning disabilities whose behaviour challenges, but the existing complex multiple organisational structures are not conducive to delivering this. Making the system work for people requires focussed leadership across all levels to co-ordinate and align the component parts. It is certainly possible to achieve, but it is currently unclear who will take responsibility for making this happen. Originality/value Families are often the only constant in the lives of people with disabilities. This commentary highlights what is important to and for families when attempts are made to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges.

Purpose This paper aims to consider the extent to which academic research, as described by the papers in this journal, has helped the large-scale use of positive behaviour support (PBS) with people with learning disabilities whose behaviour may be challenging. Design/methodology/approach The author explores the issue from the perspective of a social care provider seeking to implement PBS successfully across the organisation’s services. Findings The author concludes that research needs to refocus its efforts if it is to make a real contribution and argues that future emphasis should be on implementation. Originality/value This commentary articulates the concerns and experiences of a service provider that has striven to implement effective, evidence-based support, informed by relevant research, for many years. Such a perspective is rarely heard in academic PBS research literature.

Purpose This paper aims to provide a commentary on papers in this special edition concerning the implementation of evidence-based practice from a clinician’s perspective. Design/methodology/approach The commentary makes a number of points drawing on both recent literature and the author’s own experience working as a clinician with children and adults with learning disabilities including those who are autistic whose behaviours can challenge themselves, their parents, carers and support networks. Findings Effective implementation requires clinical expertise to operate within a context of collaboration and partnership working, where co-production with those who have lived experience ensures that what clinicians offer resonates and contributes to improvements in quality of life for all. Originality/value The paper will be of value to clinicians working alongside children and adults with learning disabilities and their families, particularly clinical psychologists and behaviour specialists, and to other stakeholders wanting to enable and facilitate the development of high-quality support.