Process evaluation of a randomised controlled trial of PBS-based staff training for challenging behaviour in adults with intellectual disability

Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. To conduct a process evaluation of a national clinical trial investigating the impact...

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Bibliographic Details
Published in:PloS one Vol. 14; no. 8; p. e0221507
Main Authors: Bosco, Alessandro, Paulauskaite, Laura, Hall, Ian, Crabtree, Jason, Soni, Sujata, Biswas, Asit, Cooper, Vivien, Poppe, Michaela, King, Michael, Strydom, Andre, Crawford, Michael J., Hassiotis, Angela
Format: Journal Article
Language:English
Published: United States Public Library of Science 22.08.2019
Public Library of Science (PLoS)
Subjects:
Adult
Adults
Analysis
Behavior
Behavior disorders
Behavior therapists
Behavior therapy
Biology and Life Sciences
Caregivers
Clinical trials
Computer and Information Sciences
Databases as Topic
Design
Disabled children
Employee training
Evaluation
Health Personnel - education
Humans
Intellectual disabilities
Intellectual Disability - psychology
Internet
Intervention
Learning disabilities
Medical care quality
Medical personnel
Medical research
Medicine and Health Sciences
Mental disorders
Online databases
People and Places
Psychiatry
Psychological aspects
Psychology
Public health
Research and Analysis Methods
Social Sciences
Technical education
Training
United Kingdom > UK
England
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0221507