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1 – 10 of 404
Article
Publication date: 3 June 2019

David Gerrard, Jennifer Rhodes, Ruth Lee and Jonathan Ling

The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a…

Abstract

Purpose

The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.

Design/methodology/approach

A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge.

Findings

There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication.

Practical implications

This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams.

Originality/value

This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 3/4
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 1 April 2005

David Allen, Wendy James, Jayne Evans, Sarah Hawkins and Rosemary Jenkins

This article summarises the historical development of positive behavioural support. The main features of this approach are described, and the evidence for its effectiveness…

2769

Abstract

This article summarises the historical development of positive behavioural support. The main features of this approach are described, and the evidence for its effectiveness outlined. Despite clear empirical support for its use, relatively few people with learning disabilities and challenging behaviour appear to have access to this form of therapeutic intervention. Reasons for this are discussed, along with recommendations for future development.

Details

Tizard Learning Disability Review, vol. 10 no. 2
Type: Research Article
ISSN: 1359-5474

Article
Publication date: 13 July 2018

Suzi J. Scott, Louise D. Denne and Richard P. Hastings

Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry…

Abstract

Purpose

Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry and is not commonly directly researched within the learning disabilities field. The purpose of this paper is to describe the process of developing a logic model for the UK Positive Behavioural Support (PBS) Academy as part of an evaluation and impact study of its work to date.

Design/methodology/approach

Logic models are a visual representation of the relationship between a project’s resources, activities and outputs and identified outcomes, in relation to key stakeholder groups. This representation allows for key impact measures to be identified and can be a useful tool for evaluation purposes. The authors used the process outlined by McLaughlin and Jordan (1998) to develop a bespoke logic model for the PBS Academy.

Findings

The model was particularly helpful in making clear the distinction between output and impact, identifying impact criteria differentiated by stakeholder group and across time scales, and highlighting areas of activity that are needed to increase the impact of the work of the PBS Academy in the longer term.

Originality/value

In the absence of any generalised impact evaluation frameworks in the learning disabilities field, the authors suggest that logic models may provide a useful framework for evaluating the impact of policy, practice, and research interventions.

Details

Tizard Learning Disability Review, vol. 23 no. 3
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 18 January 2018

Graeme Karger, Bronwen Davies, Rosemary Jenkins and Victoria Samuel

Challenging behaviour has been a concern across forensic services. Traditionally these have been managed reactively using medication, seclusion and restraint; however, there is…

Abstract

Purpose

Challenging behaviour has been a concern across forensic services. Traditionally these have been managed reactively using medication, seclusion and restraint; however, there is growing evidence that these approaches are ineffective and counter-therapeutic. A number of reports have recommended the use of preventative approaches such as positive behavioural support (PBS). The purpose of this paper is to identify “how staff within a secure forensic mental health setting perceived the application of PBS?”

Design/methodology/approach

In total, 11 multi-disciplinary staff were interviewed and thematic analysis was used to identify themes.

Findings

Five themes were identified: “The Functions”, “Appraising a new Approach”, “Collaborative Challenges”, “Staff Variables” and “Organisational Issues”.

Practical implications

PBS enables staff to understand challenging or risky behaviour. It empowers patients via collaboration, although there can be some challenges to this. Services need to invest in training, support and leadership to ensure the model is embed and promote fidelity. Consideration needs to be given to how quality of life can be improved within the limits of a forensic setting.

Originality/value

No previous studies asking staff about their experiences of PBS within a forensic mental health context.

Article
Publication date: 2 October 2021

Steve Noone, Alison Branch and Melissa Sherring

Positive behavioural support (PBS) as a framework for delivering quality services is recognised in important policy documents (CQC, 2020; NICE, 2018), yet there is an absence in…

Abstract

Purpose

Positive behavioural support (PBS) as a framework for delivering quality services is recognised in important policy documents (CQC, 2020; NICE, 2018), yet there is an absence in the literature on how this could be implemented on a large scale. The purpose of this paper is to describe a recent implementation of a workforce strategy to develop PBS across social care and health staff and family carers, within the footprint of a large integrated care system.

Design/methodology/approach

A logic model describes how an initial scoping exercise led to the production of a regional workforce strategy based on the PBS Competence Framework (2015). It shows how the creation of a regional steering group was able to coordinate important developmental stages and integrate multiple agencies into a single strategy to implement teaching and education in PBS. It describes the number of people who received teaching and education in PBS and the regional impact of the project in promoting cultural change within services.

Findings

This paper demonstrates a proof of concept that it is possible to translate the PBS Competency Framework (2015) into accredited courses. Initial scoping work highlighted the ineffectiveness of traditional training in PBS. Using blended learning and competency-based supervision and assessment, it was possible to create a new way to promote large-scale service developments in PBS supported by the governance of a new organisational structure. This also included family training delivered by family trainers. This builds on the ideas by Denne et al. (2020) that many of the necessary building blocks of implementation already exist within a system.

Social implications

A co-ordinated teaching and education strategy in PBS may help a wide range of carers to become more effective in supporting the people they care for.

Originality/value

This is the first attempt to describe the implementation of a framework for PBS within a defined geographical location. It describes the collaboration of health and social care planners and a local university to create a suite of courses built around the PBS coalition competency framework.

Details

Tizard Learning Disability Review, vol. 26 no. 4
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 19 July 2018

Anne MacDonald

The purpose of this paper is to provide a commentary on some of the issues raised in the paper “Developing a logic model to guide evaluation of impact for learning disability…

Abstract

Purpose

The purpose of this paper is to provide a commentary on some of the issues raised in the paper “Developing a logic model to guide evaluation of impact for learning disability projects: the case of the Positive Behavioural Support (PBS) Academy”.

Design/methodology/approach

Drawing on the PBS literature and with reference to the Scott et al. paper, the use of a logic model as a framework for implementing PBS within social care organisations is described.

Findings

A logic model may be a useful framework for the implementation of PBS within social care organisations and could be used to help organisations develop a strategic approach to whole-system implementation of PBS.

Originality/value

This commentary adds to the discussion by considering the use of a logic model as a framework for implementing PBS within social care organisations.

Details

Tizard Learning Disability Review, vol. 23 no. 3
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 28 December 2018

Ruth M. Lee, Jennifer A. Rhodes and David Gerrard

The purpose of this paper is to demonstrate how Positive Behavioural Support (PBS) can be used as an alternative to psychotropic medication to improve the quality of life of an…

1177

Abstract

Purpose

The purpose of this paper is to demonstrate how Positive Behavioural Support (PBS) can be used as an alternative to psychotropic medication to improve the quality of life of an individual with a learning disability and behaviour described as challenging.

Design/methodology/approach

A single case design was utilised. A unique PBS stopping over medication of people with a learning disability, autism or both (STOMP) clinic model was developed and PBS was used in line with National Institute for Health and Care Excellence (NICE) guidance. This included functional behavioural assessment, to support understanding of the reasons behind behaviour described as challenging, and a gradual medication reduction.

Findings

This case study found that antipsychotic medication used to manage behaviour that challenges could be safely reduced and individual quality of life increased when PBS was used as an alternative.

Originality/value

STOMP is a project supported by NHS England aimed at reducing the inappropriate prescribing of psychotropic medication to manage behaviour that challenges. NICE guidance recommends that behaviour should be more appropriately understood through PBS. More research is needed to demonstrate how the two work together for safe medication reduction and improved quality of life.

Details

Tizard Learning Disability Review, vol. 24 no. 1
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 2 February 2021

Edwin Jones

This paper aims to present a conceptual viewpoint highlighting the utility of active support in implementing capable environments and to extend this by presenting a three-tiered…

Abstract

Purpose

This paper aims to present a conceptual viewpoint highlighting the utility of active support in implementing capable environments and to extend this by presenting a three-tiered preventative model of positive behavioural support (PBS) in UK health and social care.

Design/methodology/approach

Provision of a commentary on “Building capable environments using practice leadership” by Linda Hume, Nadia Khan and Martin Reilly.

Findings

Capable environments and active support should be key, universal and essential PBS tier one supports in UK health and social care. Training staff in Active Support and developing practice leadership help implement capable environments.

Originality/value

The three-tiered PBS model was recently proposed by Leitch et al. (2020) and is worthy of further debate and refinement with the involvement of stakeholders. It has several practical implications including refocussing efforts on early intervention to get tier one supports implemented effectively in recognition that PBS is much wider than intense tier three supports. It could reinforce and motivate existing providers of quality support and indicate where and how other providers can commence the process of implementing PBS. Future research could consider the effectiveness of applying implementation science to the field of learning disabilities and PBS in particular.

Details

Tizard Learning Disability Review, vol. 26 no. 1
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 3 October 2016

Lawrence A. Patterson and Samuel Berry

The purpose of this paper is to explore experiences of team culture, structure and function of an intensive support service (ISS) within the context of the recent service guidance…

Abstract

Purpose

The purpose of this paper is to explore experiences of team culture, structure and function of an intensive support service (ISS) within the context of the recent service guidance “Building the Right Support” (NHS England, Local Government Association and Association of Directors of Adult Social Services, 2015). Reflections on the Hampshire and Southampton ISS set up in 2010 are discussed with a view to informing a debate about frameworks for ISS services nationally.

Design/methodology/approach

A reflective piece, drawing on experience and case examples.

Findings

This paper describes that a key function of an ISS is making individuals safe and this is significantly assisted by using shared team formulation, which can enable information and perspectives to be shared between and within teams as rapidly as possible. Further, a case is made for recognising the importance of inter-disciplinary practice, as the Southampton and Hampshire ISS has removed the “old fashioned” demarcations that led to individuals seeing a “procession” of different professionals from different disciplines. This relates to team structure, but importantly is about a culture of holding a shared identity based on positive behavioural support values, rather than a traditional uni-disciplinary perspective.

Practical implications

ISS models are being proposed by NHS England and this paper suggests some important practical aspects.

Originality/value

Limited literature exists examining the team culture within ISSs, which contributes to desired outcomes for service users. This paper opens a debate about structural and functional aspects of service delivery in this service model.

Details

Tizard Learning Disability Review, vol. 21 no. 4
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 11 January 2013

Edwin Jones

The purpose of this paper is to provide a viewpoint on what needs to be done to develop competent residential services for people with intellectual disabilities and challenging…

Abstract

Purpose

The purpose of this paper is to provide a viewpoint on what needs to be done to develop competent residential services for people with intellectual disabilities and challenging behaviour.

Design/methodology/approach

This article draws on previous accounts of the actions required. Whilst these have been available for decades and are still valid, they have not been fully implemented, hence the theme of “Back to the future”.

Findings

The need to continue developing small‐scale, community‐based services that have a clear value base and are committed to taking person‐centred action is highlighted. The paper focuses on the need to enhance service quality through the dissemination and implementation of Positive Behavioural Support and discusses some key issues regarding this with reference to recent work in Wales.

Originality/value

This paper makes a timely contribution to the current debate and highlights some practical actions and tools developed in Wales that may be of wider interest.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 7 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

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