Advertisement

Outcomes of Staff Training in Positive Behaviour Support: A Systematic Review

  • Anne MacDonaldEmail author
  • Peter McGill
ORIGINAL ARTICLE

Abstract

Positive Behavior Support has been shown to be effective in minimizing challenging behavior. Therefore training staff in Positive Behaviour Support would appear to be helpful in improving support to people with challenging behavior. The purpose of this review was to evaluate the research on the outcomes of Positive Behavior Support training. There are no other published reviews of Positive Behavior Support training outcomes. Searches were carried out using key words to identify studies which reported on Positive Behavior Support training. Following this, studies were evaluated against criteria for inclusion. 14 studies were identified by the review. Six studies focused on outcomes for staff. Four focused on outcomes for service users. Four studies reported outcomes for both staff and service users. Staff outcomes included changes in skills, confidence, knowledge, attributions and emotional responses. Service user outcomes demonstrated reduction in levels of challenging behaviour, but no evidence of change in quality of life was evident in the one study that evaluated this. Research demonstrates that Positive Behavior Support training has had a positive impact on knowledge, emotional responding, and attributions of staff. In addition, there is evidence of reductions in levels of challenging behaviour from service users. However, no evidence was found for Positive Behavior Support training having a positive impact on quality of life for service users.

Keywords

Positive Behavior Support Training Challenging behavior Learning disability Outcomes 

References

  1. Albin, R. W., Lucyshyn, J. M., Horner, R. H., & Flannery, K. B. (1996). Contextual fit for behavior support plans. A model for ‘goodness of fit’. In L. K. Koegel, R. L. Koegel, & G. Dunlap (Eds.), Positive Behavioural Support. Including people with difficult behavior in the community. Baltimore: Paul H Brookes.Google Scholar
  2. Allen, D. (1989). The effects of deinstitutionalisation on people with mental handicaps: a review. Mental Handicap Research, 2, 18–37.CrossRefGoogle Scholar
  3. Allen, D. (2009). Positive behavioural support as a service system for people with challenging behaviour. Psychiatry, 8(10), 408–411.CrossRefGoogle Scholar
  4. Allen, D., & Tynan, H. (2000). Responding to aggressive behaviour: impact of training on staff members’ knowledge and confidence. Mental Retardation, 38, 97–104.PubMedCrossRefGoogle Scholar
  5. Allen, D., McDonald, L., Dunn, C., & Doyle, T. (1997). Changing care staff approaches to the prevention and management of aggressive behaviour in a residential treatment unit for persons with mental retardation and challenging behaviour. Research in Developmental Disabilities, 18, 101–102.PubMedCrossRefGoogle Scholar
  6. Allen, D., James, W., Evans, J., Hawkins, S., & Jenkins, R. (2005). Positive behavioural support: definition, current status and future directions. Learning Disability Review, 10, 4–10.CrossRefGoogle Scholar
  7. Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). The Aberrant Behavior Checklist: a behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.PubMedGoogle Scholar
  8. Baker, D. J. (1998). Outcomes of behaviour support training to an agency providing residential and vocational support to persons with developmental disabilities. Journal of the Association for Persons with Severe Handicaps, 23, 144–148.CrossRefGoogle Scholar
  9. Browning-Wright, D., Mayer, G. R., Saren, D. (2003) Behaviour Support Plan Quality Evaluation Scoring Guide. Updated version accessed 30th August 2012 at http://www.pent.ca.gov/beh/qe/bspscoringrubric.pdf.
  10. Browning-Wright, D., Mayer, G. R., Cook, C. R., Crews, S. D., Kraemer, B. R., & Gale, B. (2007). A preliminary study on the effects of training using Behavior Support Plan Quality Evaluation Guide (BSP-QE) to improve positive behavioral support plans. Education and Treatment of Children, 30(3), 89–106.CrossRefGoogle Scholar
  11. Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., et al. (2002). Positive behavior support: evolution of an applied science. Journal of Positive Behavior Interventions, 4(1), 4–16.Google Scholar
  12. Carr, E. G., Horner, R. H., Turnbull, A. P., Marquis, J., Magito-McLaughlin, D., McAtee, M. L., et al. (1999). Positive behavioral support for people with developmental disabilities: a research synthesis. Washington: American Association on Mental Retardation.Google Scholar
  13. Crates, N., & Spicer, M. (2012). Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes. Journal of Intellectual & Developmental Disability, 37(3), 196–208.CrossRefGoogle Scholar
  14. Dench, C. (2005). A model for training staff in positive behaviour support. Learning Disability Review, 10, 2.Google Scholar
  15. Department of Health. (1993). Services for people with learning disabilities and challenging behaviour or mental health needs (The Mansell Report). London: HMSO.Google Scholar
  16. Deveau, R., & McGill, P. (2009). Physical interventions for adults with intellectual disabilities: survey of use, policy, training and monitoring. Journal of Applied Research in Intellectual Disabilities, 22, 145–151.CrossRefGoogle Scholar
  17. Dunlap, G. (2004). Critical features of positive behavior support. Association of Positive Behavior Support Newsletter, 1(3), 1–3.Google Scholar
  18. Dunlap, G., & Carr, E. G. (2009). Positive behavior support and developmental disabilities: a summary and analysis of research. In S. L. Odom, R. H. Horner, M. E. Snell, & J. Blacher (Eds.), Handbook of developmental disabilities (pp. 469–482). London: Guilford Press.Google Scholar
  19. Dunlap, G., Hieneman, M., Knoster, T., Fox, L., Anderson, J., & Albin, R. W. (2000). Essential elements of inservice training in positive behavior support. Journal of Positive Behavior Interventions, 2, 22–32.CrossRefGoogle Scholar
  20. Emerson, E., McGill, P., & Mansell, J. (1994). Severe learning disabilities and challenging behaviours: designing high quality services. London: Chapman & Hall.Google Scholar
  21. Emerson, E., Robertson, J., Gregory, N., Hatton, C., Kessissoglou, S., Hallam, A., et al. (2000). Treatment and management of challenging behaviour in residential settings. Journal of Applied Research in Intellectual Disabilities, 13, 197–215.CrossRefGoogle Scholar
  22. Emerson, E., Kiernan, C., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., et al. (2001). The prevalence of challenging behaviours: a total population study. Research in Developmental Disabilities, 22, 77–93.PubMedCrossRefGoogle Scholar
  23. Felce, D., Lowe, K., & Beswick, J. (1993). Staff turnover in ordinary housing services for people with severe or profound mental handicaps. Journal of Intellectual Disability Research, 37(2), 13–152.Google Scholar
  24. Freeman, R., Smith, C., Zarcone, J., Kimbrough, P., Tieghi-Benet, M., Wickham, D., et al. (2005). Building a state-wide plan for embedding positive behaviour support in human services organisations. Journal of Positive Behaviour Interventions, 7, 109–119.CrossRefGoogle Scholar
  25. Gore, N., & Umizawa, H. (2011). Challenging behavior training for teaching staff and family carers of children with intellectual disabilities: a preliminary evaluation. Journal of Policy & Practice in Intellectual Disabilities, 8(4), 266–275.CrossRefGoogle Scholar
  26. Grey, I. M., & McClean, B. (2007). Service user outcomes of staff training in positive behaviour support using person-focused training: a control group study. Journal of Applied Research in Intellectual Disabilities, 20, 6–15.CrossRefGoogle Scholar
  27. Grey, I. M., McClean, B., & Barnes-Holmes, D. (2002). Staff attributions about the causes of challenging behaviours: effects of longitudinal training in multi-element behaviour support. Journal of Learning Disabilities, 6, 297–312.Google Scholar
  28. Harris, P., Humphreys, J., & Thomson, G. (1994). A checklist of challenging behaviour: the development of a survey instrument. Mental Handicap Research, 7(2), 97–176.Google Scholar
  29. Hassiotis, A., Robotham, D., Canagasabey, A., Romeo, R., Langridge, D., Blizard, R., et al. (2009). Randomized, single-blind controlled trial of a specialist behavior therapy team for challenging behavior in adults with intellectual disabilities. The American Journal of Psychiatry, 166(11), 1278–1285.PubMedCrossRefGoogle Scholar
  30. Hastings, R. P. (1997). Measuring staff perceptions of challenging behaviour: the Challenging Behaviour Attributions Scale (CHABA). Journal of Intellectual Disability Research, 41, 495–501.PubMedCrossRefGoogle Scholar
  31. Hastings, R. P., & Brown, T. (2002). Behaviour problems of children with autism, parental self-efficacy and mental health. American Journal on Mental Retardation, 107, 222–232.PubMedCrossRefGoogle Scholar
  32. Horner, R. H., Dunlap, G., Koegel, R. L., Carr, E. G., Sailor, W., Anderson, J., et al. (1990). Toward a technology of “non-aversive” behavioral support. Journal of the Association for Persons with Severe Handicaps, 15, 125–132.Google Scholar
  33. Horner, R. H., Sugai, G., Todd, A. W., & Lewis-Palmer, T. (2000). Elements of behavior support plans. Journal of Positive Behavior Interventions, 6, 3–12.CrossRefGoogle Scholar
  34. Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., & Mulick, J. A. (2006). Positive behavior support and applied behavior analysis. Behavior Analyst, 29, 51–74.PubMedGoogle Scholar
  35. Jones, E., Perry, J., Lowe, K., Felce, D., Toogood, S., Dunstan, F., et al. (1999). Opportunity and the promotion of activity among adults with severe mental retardation living in community residences: The impact of training staff in Active Support. Journal of Intellectual Disability Research, 43, 164–178.PubMedCrossRefGoogle Scholar
  36. Jones, E., Felce, D., Lowe, K., Bowley, C., Pagler, J., Gallagher, B., et al. (2001). Evaluation of the dissemination of active support training in staffed community residences. American Journal on Mental Retardation, 106(4), 344–358.PubMedCrossRefGoogle Scholar
  37. Kincaid, D., George, H. P., & Childs, K. (2006). Review of the positive behavior support training curriculum: supervisory and direct support editions. Journal of Positive Behavior Interventions, 8(3), 183–188.CrossRefGoogle Scholar
  38. Kraemer, B. R., Cook, C. R., Browning-Wright, D., Mayer, G. R., & Wallace, M. D. (2008). Effects of training on the use of the Behavior Support Plan Quality Evaluation Guide with autism educators: a preliminary investigation examining positive behavior support plans. Journal of Positive Behavior Interventions, 10(3), 179–189.CrossRefGoogle Scholar
  39. La Vigna, G. W., & Willis, T. J. (2005). Episodic severity: an overlooked dependent variable in the application of behavior analysis to challenging behavior. Journal of Positive Behavior Interventions, 7, 47–54.CrossRefGoogle Scholar
  40. La Vigna, G. W., & Willis, T. J. (2012). The efficacy of positive behavioral support with the most challenging behavior: the evidence and its implications. Journal of Intellectual & Developmental Disability, 34(3), 185–195.Google Scholar
  41. La Vigna, G. W., Willis T. J., & Donnellan A. M. (1989). The role of positive programming in behavioral treatment. In E Cipani (Ed.), The Treatment of Severe Behavior Disorders. Monographs of the American Association on Mental Retardation 12:59–83.Google Scholar
  42. La Vigna, G. W., Willis, T. J., Shaull, J., Abedi, M., & Sweitzet, M. (1994). The periodic service review: a total quality assurance system for human services and education. Baltimore: Paul H. Brookes.Google Scholar
  43. La Vigna, G. W., Christian, L., Liberman, R. P., Camacho, E., & Willis, T. J. (2002). Training professionals in the use of positive methods for community integration of persons with developmental disabilities. Psychiatric Services, 53, 16–18.CrossRefGoogle Scholar
  44. La Vigna, G. W., Christian, L., & Willis, T. J. (2005). Developing behavioral services to meet defined standards within a national system of specialist educational services. Pediatric Rehabilitation, 8(2), 144–155.Google Scholar
  45. Leadbetter, D. (2002). Good practice in physical intervention. In D. Allen (Ed.), Ethical approaches to physical interventions. Responding to challenging behaviour in people with intellectual disabilities. Kidderminster: BILD.Google Scholar
  46. Lowe, K., Jones, E., Allen, D., Davies, D., James, W., Doyle, T., et al. (2007). Staff training in positive behaviour support: impact on attitudes and knowledge. Journal of Applied Research in Intellectual Disabilities, 20, 30–40.CrossRefGoogle Scholar
  47. Lucyshyn, J. M., Horner, R. H., Dunlap, G., Albin, R. W., & Ben, K. R. (2002). Positive behavior support with families. In J. M. Lucyshyn, G. Dunlap, & R. W. Albin (Eds.), Families and positive behavior support: addressing problem behavior in family contexts (pp. 3–43). Baltimore: Paul H. Brookes.Google Scholar
  48. Macurik, K. M., O’Kane, N. P., Malanga, P., & Reid, D. H. (2008). Video training of support staff in intervention plans for challenging behavior: comparison with live training. Behavioral Interventions, 23, 143–163.CrossRefGoogle Scholar
  49. McClean, B., & Grey, I. (2012). A component analysis of positive behavior support plans. Journal of Intellectual & Developmental Disability, 37(3), 221–231.CrossRefGoogle Scholar
  50. McClean, B., Dench, C., Grey, I., Shanahan, S., Fitzsimmons, E., Hendler, J., et al. (2005). Person focused training: a model for delivering positive behavioural supports to people with challenging behaviours. Journal of Intellectual Disability Research, 49, 340–352.PubMedCrossRefGoogle Scholar
  51. McGill, P., Bradshaw, J., & Huges, A. (2007). Impact of extended education/training in positive behaviour support on staff knowledge, causal attributions and emotional responses. Journal of Applied Research in Intellectual Disabilities, 20, 41–51.CrossRefGoogle Scholar
  52. Mitchell, G., & Hastings, R. P. (1998). Learning disability care staff’s emotional reactions to aggressive challenging behaviours: development of a measurement tool. British Journal of Clinical Psychology, 37, 441–449.PubMedCrossRefGoogle Scholar
  53. Oliver, C., Hall, S., Hales, J., & Head, D. (1996). Self-injurious behaviour and people with intellectual disabilities: assessing the behavioural knowledge and causal explanations of care staff. Journal of Applied Research in Intellectual Disabilities, 9, 229–239.CrossRefGoogle Scholar
  54. Reid, D., Rotholz, D. A., Parsons, M. B., Morris, L., Braswell, B. A., Green, C. W., et al. (2003). Training human service supervisors in aspects of PBS: evaluation of a state-wide, performance-based program. Journal of Positive Behavior Interventions, 5(1), 35–46.CrossRefGoogle Scholar
  55. Reynolds, S., Lynch, S., & Litman, S. (2011). Training care teams of children with autism spectrum disorders in positive behaviour support: an innovative approach. Healthcare Quarterly, 14, 95–99.PubMedGoogle Scholar
  56. Rotholz, D. A., & Ford, M. E. (2003). Statewide system change in positive behavior support. Mental Retardation, 41(5), 354–364.PubMedCrossRefGoogle Scholar
  57. Sailor, W., Freeman, R., Britten, J., McCart, A., & Smith, C. (2000). Using information technology to prepare personnel to implement functional behavioral assessment and positive behavioral support. Exceptionality, 8(3), 217–230.CrossRefGoogle Scholar
  58. Schalock, R. L., & Keith, K. D. (1993). Quality of life questionnaire: standardisation manual. Hastings: Mid Nebraska Mental Retardation Services.Google Scholar
  59. Sprague, J. R., Flannery, B., O’Neill, R., & Baker, D. J. (1996). Effective behavioural consultation: supporting the implementation of positive behaviour support plans for persons with severe challenging behaviours. Eugene: Specialised Training Program.Google Scholar
  60. Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10(2), 349–367.PubMedCrossRefGoogle Scholar
  61. Thackery, M. (1987). Clinical confidence in coping with patient aggression: assessment and enhancement. Professional Psychology: Research and Practice, 18, 57–60.CrossRefGoogle Scholar
  62. Tierney, E., Quinlan, D., & Hastings, R. P. (2007). Impact of a 3-day training course on challenging behaviour on staff cognitive and emotional responses. Journal of Applied Research in Intellectual Disabilities, 20, 58–63.CrossRefGoogle Scholar
  63. Tyrer, P., Oliver-Africano, P. C., Ahmed, Z., Bouras, N., Cooray, S., Deb, S., et al. (2008). Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. The Lancet, 371, 57–63.CrossRefGoogle Scholar
  64. Wacker, D. P., & Berg, W. K. (2002). PBS as a service delivery system. Journal of Positive Behavior Interventions, 4, 25–28.CrossRefGoogle Scholar
  65. Willis, T., & La Vigna, G. W. (1990). Behavioral assessment report and intervention plan. Los Angeles: Institute for Applied Behavior Analysis.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.The Richmond Fellowship ScotlandGlasgowUK
  2. 2.Tizard CentreUniversity of KentCanterburyUK

Personalised recommendations