Positive Behaviour Support: Development and evaluation of an online staff training protocol

Positive behaviour support (PBS) is recognised as an evidenced based approach to addressing challenging behaviours exhibited by people with intellectual disabilities (IDD). The quality of staff performance is a crucial determinants of client outcomes but the comparative effectiveness of PBS training methods with regard to staff behaviour is rarely studied. The purpose of the current programme of research was to examine the effectiveness of behavioural training protocols in providing frontline care staff with the knowledge and skills required to deliver PBS. Firstly, a systematic review was conducted to expand on previous reviews of PBS training by including recent studies of PBS training and refining inclusion criteria to be more relevant to social care settings. Results indicated that training duration, skills practice and supervision were important determinants of positive training outcomes. The need for more comparision and control trials was also identified. Study 1 investigated the comparative effectiveness of behavioural skills training (BST) and workshop training on staff knowledge and competence, finding that there were no differences between groups in knowledge or competence at post-test. An analysis of interview data indicated that participants preferred BST and had a positive view of PBS. Participants believed that organisational factors, training individualisation and skills practice were important determinants of training success. In Study 2, a three-arm randomised controlled trial evaluated the comparative effectiveness of programmed instruction (PI), standard online instruction (SOI) and workshop training on participants attitudes, knowledge and application of knowledge related to PBS. It found that knowledge and application score increases were highest for those in the PI condition and lowest within the workshop condition. No changes to attitudes to challenging behaviour were observed following training. Study 3 utilised a within-subjects, pre-post-test design to evaluate the impact of PI training on the participants’ attitudes to challenging behaviour, knowledge of PBS, burnout and intervention design abilities. Results indicated that PI based PBS training was effective in increasing staff knowledge. While burnout was observed to have decreased following training, no changes in attitudes to challenging behaviour or intervention design ability were observed. The findings of the thesis indicate that in addition to previously identified features of PBS training, training methodology impacts significantly on training outcomes. They also suggest that online PI-based PBS training is an effective training methodology. Evidence from the thesis’ studies isuggest that PBS training can have positive impacts on outcomes with regard to PBS knowledge, performing behaviour analytic procedures, applying knowledge and staff burnout. Implications for future PBS training research and practice are discussed