Challenging behaviour in people with learning disabilities: The goodness of fit of Positive Behavioural Support plans

Challenging behaviour in individuals with a learning disability can significantly impair the health/quality of life of the person themselves, those who care for them and those who live or work in close proximity (Emerson, 2002). Appropriate and ethical management of these behaviours is important for the well-being of both the individual and direct-care staff. Positive Behavioural Support (PBS) is a values-based behavioural technology that has been found to be effective in supporting people with learning disabilities and challenging behaviour and increasing their quality of life (e.g. Carr et al. 1999). However the application of PBS to real-world settings does not feature strongly in the research and therefore specific factors that contribute to the successful implementation of PBS have not been identified through research. Direct-care staff are crucial to implementing behavioural interventions with people with learning disabilities, yet their perspective is neglected in the literature. The main aim of the present study was to use qualitative methodology to explore the perspectives of direct-care staff working with PBS of what helps the successful implementation of PBS with people with learning disabilities and challenging behaviour. The perspectives of clinicians working with direct-care staff were also explored with the aim of identifying the extent of agreement between direct-care staff and clinicians. This study used semi-structured interviews with direct-care staff, and a focus group with clinicians. Verbatim transcripts were then analysed using a Grounded Theory approach. From the analysis, six core concepts emerged. These were, ‘Service delivery’, ‘External support’, ‘Internal Support’, ‘Mediators’ and ‘Delivery of PBS’, all of which combined to affect the ‘Goodness of Fit’ of PBS. Some factors were considered more important than others, such as the relationship between clinician and direct-care staff, the commitment of the organisation to PBS and the attitude of direct-care staff. The factors were diverse and highlighted the complexity of implementing PBS in community settings. The implications of the study for both services and clinical practice were discussed and recommendations made