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.
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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.
Allen, D. (1989). The effects of deinstitutionalisation on people with mental handicaps: a review. Mental Handicap Research, 2, 18–37.
Allen, D. (2009). Positive behavioural support as a service system for people with challenging behaviour. Psychiatry, 8(10), 408–411.
Allen, D., & Tynan, H. (2000). Responding to aggressive behaviour: impact of training on staff members’ knowledge and confidence. Mental Retardation, 38, 97–104.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Dench, C. (2005). A model for training staff in positive behaviour support. Learning Disability Review, 10, 2.
Department of Health. (1993). Services for people with learning disabilities and challenging behaviour or mental health needs (The Mansell Report). London: HMSO.
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.
Dunlap, G. (2004). Critical features of positive behavior support. Association of Positive Behavior Support Newsletter, 1(3), 1–3.
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.
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.
Emerson, E., McGill, P., & Mansell, J. (1994). Severe learning disabilities and challenging behaviours: designing high quality services. London: Chapman & Hall.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hastings, R. P. (1997). Measuring staff perceptions of challenging behaviour: the Challenging Behaviour Attributions Scale (CHABA). Journal of Intellectual Disability Research, 41, 495–501.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
McClean, B., & Grey, I. (2012). A component analysis of positive behavior support plans. Journal of Intellectual & Developmental Disability, 37(3), 221–231.
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.
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.
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.
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.
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.
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.
Rotholz, D. A., & Ford, M. E. (2003). Statewide system change in positive behavior support. Mental Retardation, 41(5), 354–364.
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.
Schalock, R. L., & Keith, K. D. (1993). Quality of life questionnaire: standardisation manual. Hastings: Mid Nebraska Mental Retardation Services.
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.
Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10(2), 349–367.
Thackery, M. (1987). Clinical confidence in coping with patient aggression: assessment and enhancement. Professional Psychology: Research and Practice, 18, 57–60.
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.
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.
Wacker, D. P., & Berg, W. K. (2002). PBS as a service delivery system. Journal of Positive Behavior Interventions, 4, 25–28.
Willis, T., & La Vigna, G. W. (1990). Behavioral assessment report and intervention plan. Los Angeles: Institute for Applied Behavior Analysis.
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MacDonald, A., McGill, P. Outcomes of Staff Training in Positive Behaviour Support: A Systematic Review. J Dev Phys Disabil 25, 17–33 (2013). https://doi.org/10.1007/s10882-012-9327-8
- Positive Behavior Support
- Challenging behavior
- Learning disability