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Support for people with intellectual disabilities and challenging behaviour in the United Kingdom is currently under much scrutiny. Positive behaviour support has been put forward as the key approach for improving services for this group of people. Drawing on both the literature and on the practice experience of organisations, arguments are made that implementing active support can reduce the need for positive behaviour support and also support the implementation of positive behaviour support where this is needed. Key features of both active support and positive behaviour support are outlined and the fit between the two explained at both a general level and for the different stages of developing and implementing positive behaviour support interventions. It is suggested that implementing active support not only provides conditions in which challenging behaviour is likely to decrease, thereby reducing the need for the implementation of positive behaviour support, but, where such implementation is necessary,...

Background We hypothesised that a key factor determining the quality of active support was ‘practice leadership’ – provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support. Method Relevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons. Results There was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support. Conclusions A number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities.

Following earlier findings that people with intellectual disability and challenging behaviour received poorer care when they lived in a grouped setting (75% or more residents also having challenging behaviour), this study aimed to investigate whether people without challenging behaviour also experienced different care or lower engagement in meaningful activity when living with people with severe or potentially severe challenging behaviour. Kruskal-Wallis analysis revealed no effect of living in homes where residents had challenging behaviour, either on care practices or on engagement in meaningful activity. This was also true for sub-groups selected because they might be more vulnerable. Further Mann-Whitney analyses revealed no differences between those living in homes where no-one had severe or potentially severe challenging behaviour compared to those living in homes where anyone had challenging behaviour, and no differences between those people living in homes where less than 75% of the residents had challenging behaviour compared to those where 75% or more had challenging behaviour. Using a narrower definition of challenging behaviour, as severe and frequent aggression, also produced no significant effects. Possible explanations for these somewhat surprising results are discussed and suggestions for future research are presented.

Forty-nine adults with learning disabilities living in 13 small staffed homes in England were studied as part of larger projects in 1997 and again in 2000. A pre-test/post-test comparison group design was used to assess differences in staff implementation of "active support," service user engagement in meaningful activities and adaptive behaviour. Homes which adopted active support showed significantly increased engagement in meaningful activity and adaptive behaviour between 1997 and 2000. A comparison group showed no significant change.

The effects of functional grouping of people with intellectual disabilities on care practices in small residential homes in the community were investigated. A group comparison and a matched-pairs comparison were carried out in settings where less than or more than 75% residents were non-verbal, non-ambulant, had severe challenging behaviour, severe social impairment or were verbal and ambulant. Further analysis, focused on those with challenging behaviour was carried out using ordinal regression. In the group-comparison study, no significant differences were found for three of the five groups. Residents who were non-ambulant were rated as receiving care with less interpersonal warmth in grouped settings; residents with severe challenging behaviour were rated as receiving less good care practices in four respects (interpersonal warmth, assistance from staff, level of speech and staff teamwork) in grouped settings. The matched-pairs comparison found significant differences only for people with challenging behaviour, where grouped settings achieved less good results in terms of interpersonal warmth and staff teamwork. Higher adaptive behaviour and mixed settings were predictive of better care practices on 13 of 14 items of the Active Support Measure (ASM), with some setting variables also predictive for some items. Care practices only appear to vary for people with challenging behaviour, where grouped settings appear to offer less good results in some respects.

Background The pattern of residential services for people with intellectual disability in England has changed dramatically since 1971, with many more places being made available in residential homes in the community. The aim of the present study was to assess the needs and characteristics of residents and features of all the residential homes provided by a national charity. Method Assessments of adaptive behaviour, problem behaviour and social impairment were completed by staff who knew residents well; information about costs and staffing was provided from central records. Results A significant proportion of residents have important care needs relating to their skills, their behaviour and their social abilities. Residents with these needs are dispersed throughout services, so that a large majority of services include one or more residents with relatively complex needs. Conclusions Compared with services in the late 1980s, these services care for a much more disabled client group. Since individuals with high levels of particular needs are typically distributed throughout services, a very high proportion of services require staff who have relatively advanced skills. Current national plans do not adequately address this need and case management arrangements may encourage the re-creation of more institutional services. Declaration of interest The first author is a Trustee of the charity.