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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.

Grouping people with learning disabilities and challenging behaviour in residential care has been the focus of several recent research studies. This paper describes these studies and what they found. In general, they show negative effects of grouping people with challenging behaviour together in terms of the quality of staff interaction with them and the outcomes they experience.

The purpose of this article is to explore the current evidence base in understanding the relationship between mental health and challenging behaviour in people with intellectual disabilities.

The article discusses how challenging behaviour is associated with psychiatric disorders. Common aetiological factors between challenging behaviour and psychiatric disorders and diagnostic issues are considered. The article ends with a review of the assessment and management of challenging behaviour within the context of mental health.

Several studies have highlighted common aetiological factors that are responsible for challenging behaviour and psychiatric disorders in people with intellectual disabilities, and although there is an overlap in the symptoms, both are thought to be different phenomena. Treatment of the psychiatric disorder should ameliorate the challenging behaviour, although a functional analysis of the behaviour may still be required in order to understand the purpose of the behaviour. There is evidence for a range of different treatment approaches.

The article will assist professionals working with people with intellectual disabilities to understand the complex relationship between mental health and challenging behaviour. It also gives guidance on principles of management of people with complex mental health and behavioural needs.

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.

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.

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 purpose of this paper is to give an overview of studies that focused on variables likely to affect staff ability to carry out behavioural strategies for challenging behaviours in individuals with intellectual disabilities.

Literature review: studies that were published in a peer reviewed journal, between 1999 and 2016, were selected for this review.

In total, 29 articles were selected. Several factors likely affect staff ability to appropriately carry out behavioural interventions were identified: staff assumptions, distressing emotions elicited by challenging behaviours, reciprocal reinforcement systems, service characteristics and cultural systems.

These findings raise the question what staff need in order to be able to change their naturally occurring behaviours in response to challenging behaviours and to carry out behavioural interventions. Future research may identify barriers and facilitators underlying the provision of effective interventions, taking into account the possible role of staff beliefs, their emotions, service characteristics and cultural systems.

Securing better health and better care outcomes for people by effective use of public resources is at the heart of the commissioning agenda. Commissioning should ensure that the needs and wishes of people are well understood, and the market managed, so there are a range of local supports and provision available at a reasonable price. This is particularly important for people with intellectual disability whose behaviour is challenging, where effective clinically informed leadership is essential. Although models of good practice have been demonstrated for more than 20 years, making this happen on a wider scale remains the real challenge. Common wisdom about positive practice is not common practice in meeting identified needs. This paper aims to demystify the ‘commissioning’ role, and highlights the case for change in current practice, exploring some of the key barriers that must be addressed and suggesting ways to achieve better outcomes.

In 1997 Tom was a 32‐year‐old man with a diagnosis of severe intellectual disability and autism who engaged in high‐rate challenging behaviour. Tom's out‐of‐area placement was about to break down and he needed help urgently. For 16 months specialist challenging behaviour services supported Tom directly in a single‐occupancy service. They conducted functional assessment and delivered multi‐level intervention, including medication withdrawal, environmental enrichment, skills teaching, augmented communication and targeted behavioural intervention. Support was then transferred to mainstream learning disability services. Following intervention, the rate of challenging behaviour shown by Tom fell significantly from more than 200 instances per day to almost none. Community involvement and engagement increased. Tom moved into shared accommodation with support from mainstream learning disability services at no additional cost. Improvement at intervention was still apparent 10 years later. Tom's story adds to a growing number of articles showing how focused intervention can deliver lasting improvement in quality of life. Four aspects of Tom's story are discussed in the light of the Mansell Report.

Research highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.

Two interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.

There was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.

Based on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.