Search results

This purpose of this paper is to seek service users' opinions in order to assist the development of the challenging behaviour strategy (CBS) being developed by Worcestershire Mental Health Partnership Trust.

Potential focus group members were identified by local advocacy workers and clinical psychologists. All were known through their involvement in advocacy groups. During the focus group, opinions were sought on the draft CBS document to establish areas to be modified. Focus group members also spontaneously highlighted helpful and unhelpful service responses to challenging behaviour, their opinions of the term “challenging behaviour” and ideas about how such behaviour may develop.

Service responses were seen as important moderators of challenging behaviour. The proposed strategy was seen as mostly acceptable, but there were some important caveats raised. Participants thought that individuals should be involved as much as is possible in services (e.g. recruitment, inspections of services). Participants also discussed ideas of how to achieve their desired service, which was flexible and inclusive with well‐trained staff who understood the reasons for the individual's distress and how best to help with the resulting behaviours.

Service users with behaviour described as “challenging” are able to reflect upon the service they have received and provide helpful feedback and suggestions on improving it. Service users want staff to understand each individual and the triggers to their behaviour, as opposed to treating people the same way.

The purpose of this paper is to explore the place of medication in the management of challenging behaviour in people with intellectual disability by considering it in the context of the whole system around the person and by considering the challenges of implementing best practice guidance.

The paper identify factors that are barriers to implementing appropriate best clinical practice guidelines (such as “Challenging behaviour: a unified approach”) in relation to medication intervention. The paper explores current policy and recommendations on how to improve services for people with intellectual disability and challenging behaviour and make suggestions about how to ensure better compliance with existing guidelines and improve service delivery.

Better integration of services, access to specialist interventions including applied behavioural analysis and understanding communication are all essential to reducing the use of medication, as is the need for reactive, personalised and skilled social care provision.

The paper will help professionals and those involved in the provision of service to people with challenging behaviour to focus on areas of improvement and ensure that available resources are maximised to deliver the best outcome for them.

The aim of this paper is to provide an overview of the dominant approaches used to explain causes of challenging behaviour.

This paper is the second in a two‐part series. It presents the causes of challenging behaviour according to the three theoretical approaches that have dominated the literature: applied behaviour analysis; biological factors; and psychiatric disorders.

It is apparent that the causes of challenging behaviour are likely to be complex and involve multiple factors. The approaches that have dominated the literature focus on single causes and do not explore possible interactions between various causes. Given the shortcomings of existing approaches, a fourth approach, the biopsychosocial model, is proposed as an alternative model to explain the causes of challenging behaviour.

This paper is the most recent of only a few providing an overview of the various approaches that seek to explain the causes of challenging behaviour.

Challenging behaviours are defined in part by the risks of harm they present and the support of individuals who challenge would be improved with effective assessments of the risks posed by challenging behaviours. The purpose of this paper is to outline a model of risk assessment and review literature that provides relevant information.

Literature review.

Forensic risk assessment has a well worked-out and validated approach but tools used to assess challenging behaviours are not effective risk predictors. Applied Behaviour Assessment provides methods that can be more effectively used for risk assessment.

There is a need to develop valid risk assessment procedures for assessing the risks presented by challenging behaviours.

This is a fresh perspective on risk assessment in relation to challenging behaviours.

The purpose of this paper is to determine the extent to which mental health, physical health, communication, learned function of the behaviour(s), severity of disability, living arrangement, age, and gender, alone or in combination, predicted challenging behaviours in adults with intellectual disability.

In total, 74 adults with intellectual disability and their paid carers were recruited into the study from adult disability services in Victoria, Australia. Paid carers provided information about participants with intellectual disability on a range of measures targeting each variable of interest.

Based on principle components analyses of three challenging behaviour measures, two topographies of challenging behaviour emerged: contact and non-contact behaviours. Multiple regression analysis revealed that contact behaviours were predicted by anxiety scores and severity of disability. In addition to severity of disability and anxiety scores, non-contact behaviours were also predicted by sensory scores.

The results of the current study indicate that contact and non-contact behaviours were determined by multiple factors. Clinicians and others who work with people who display challenging behaviour may, therefore, find it helpful to utilise the biopsychosocial model in their formulations of possible reasons that motivate a person to engage in challenging behaviour.

These results contribute to the evidence base available to clinicians and researchers to guide future assessment for challenging behaviour. Expansion of functional assessment methods to explore factors not traditionally included, such as mental health and severity of intellectual disability, as causes of challenging behaviour, may prove helpful.

This article is the first in a two‐part series exploring challenging behaviour, its prevalence, risk factors and causes. The aim of this article is to provide an overview of prevalence studies and explore the various risk factors that have been associated with challenging behaviour. The authors also seek to explore methodological differences across studies that may contribute to the prevalence variations reported in the literature.

The article summarises the findings from frequently cited prevalence studies as well as more recent studies.

The prevalence of challenging behaviour reported in the literature has varied due to methodological differences across studies. Despite this, the best estimate is believed to be from 15 to 17.5 per cent. A range of factors have been associated with challenging behaviour and include gender, age, severity of disability and residential setting.

This article appears to represent the most current overview of research in this area.

Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”.

This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges.

It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again.

Standards in relation to care pathways are presented.

Nurses working in acute mental-health services are vulnerable to occupational stress. One stressor identified is the challenging behaviour of some service users (Jenkins and Elliott, 2004). The purpose of this paper is to discuss the discourses drawn on by nurses to understand challenging behaviour and talk about its management.

Nurses working on acute and psychiatric intensive care unit (PICU) wards were interviewed, and data were analysed using discourse analysis.

Biomedical and systemic discourses were found to be dominant. Alternative psychosocial and emotional discourses were drawn on by some participants but marginalised by the dominant biomedical construction of challenging behaviour.

Existing studies have not considered how discourses socially construct challenging behaviour and its management in inpatient mental-health services.

Challenging behaviour among school pupils has been the focus of extensive research in the UK and beyond; however, there has been a lack of recent comparable research on these issues in the further education (FE) sector. This paper aims to report the findings from a larger PhD research examining the introduction of interventions based on restorative justice implemented in colleges. This study focuses on the extent and nature of challenging student behaviour, as explained and understood by the students and staff.

The author used an interpretivist exploratory case study design and mixed qualitative research methods. The institute considered in the case study, Restorative College (pseudonymised), has education provisions for students aged 16+ years and enrols over 16,000 students annually. In the academic year 2017/2018, Restorative College committed itself to becoming a “restorative” institution. Data collection consisted of three stages (including semi-structured interviews, analyses of institutional policy documents and focus group discussions) and was conducted over 14 months.

The extent and nature of challenging student behaviours in the FE sector are significant and merit further research and analysis to support policy development.

Given the research methods adopted (single case study and qualitative research), the findings do not necessarily represent experiences across the FE sector.

This study emphasises the need to expand research on challenging behaviour in the FE sector, which has been limited thus far, also making a contribution in this direction.

People with challenging behaviour are commonly referred to the National Health Service for assistance and support. Good clinical practice would indicate that such interventions should be routinely monitored and evaluated in order to be maximally effective. Challenging behaviour has many impacts and, while monitoring frequency, duration and severity of behaviour is fundamental, equally key is attention to monitoring the impacts on the quality of life of the individual and those with whom they share their environments. Such outcomes are unlikely to be represented by one instrument, and a battery of measures currently holds most promise in relation to representation of what would be considered valid acceptable outcomes.