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There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation.

This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built.

This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process.

In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

The Behavior Problems Inventory-Short Form (BPI-S) is a shorter version of the Behavior Problems Inventory-01. In this paper, BPI-S population norms are reported from a total administrative population of adults with intellectual disability (ID). To facilitate the use of the BPI-S in clinical services to assess behavior change, the purpose of this paper is to describe how to use BPI-S clinically significant and reliable change (RC) scores.

Data were gathered on 265 adults with ID known to services. Proxy informants completed the BPI-S on challenging behaviors over the previous six months. Clinically significant cut-off values and RC scores were calculated using the Jacobson and Truax’s (1991) method.

BPI-S clinical reference data are presented to provide benchmarks for individual and group comparisons regarding challenging behavior. Examples demonstrate how to use clinical norms to determine change.

Behavior change is a major goal of researchers and practitioners. Data from the present study can make the BPI-S a valuable tool for determining change in challenging behavior following service input or intervention.

Whilst well used in research, the BPI-S may be less extensively used in practice. This present study provides data to enable researchers and practitioners to use the BPI-S more widely in assessing clinical outcomes, such as intervention research and service evaluation.

The purpose of this paper is to provide a commentary on Patterson and Berry’s paper “Reflections on culture, structure and function of an intensive support service centred on positive behavioural support”.

This paper reviews key ideas presented in Patterson and Berry’s article relative to the recent history of service delivery in the UK and the growing interest being shown in positive behaviour support.

Patterson and Berry’s article adds to a modest literature on specialist support services and should stimulate further descriptions of service models and the concepts underpinning them.

The literature on specialist support service models is limited and this addition should be relevant to a wide range of clinicians, consumers and commissioners.

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.

Client engagement increases substantially when staff teams implement active support. The impact of active support on challenging behaviour is less clear. There are grounds for believing that active support procedures could in some cases neutralise environmental conditions known to evoke challenging behaviour. We implemented a three‐phase clinical intervention to increase engagement and reduce passive and challenging behaviour. In phase 1 we trained staff to deliver inviting activity‐based instruction at eye level. In phase 2 we introduced activity support plans to increase client choice and control. In phase 3 staff used peer‐monitoring procedures to consolidate implementation. We measured staff behaviour and client outcome across the three phases of intervention and at follow‐up. Staff provided warm and inviting activity‐based instruction at eye level more frequently after participating in phase 1 on‐site training. The proportion of activity‐based interactions with choice increased when activity plans were introduced in phase 2. Engagement replaced passive and challenging behaviour. Staff observations suggested changes were maintained over the short run. Our own observations indicated decay at 22 months. Our data suggest that active support procedures can make challenging behaviour less likely by altering antecedent conditions that reliably evoke such behaviour. Without sustained effort, interventions are susceptible to decay.

The purpose of this paper is to provide a commentary on Rhodes and Toogood’s article on the possible relationship between Active Support training and staff job satisfaction.

Rhodes and Toogood unusually and importantly include outcomes for both frontline staff and service users following an Active Support intervention. This commentary builds upon this approach by drawing on ideas recently raised by Deveau and McGill (2015).

A number of important themes are identified including the mutuality of direct support staff (DSS) and service user experience, the significance of considering both the formal and informal aspects of organisational culture and the value of employing a complexity theory perspective.

Effective public services require an understanding of the factors influencing the behaviour of public service staff. In intellectual disability services, positive outcomes can only be obtained through a broader appreciation of the drivers of DSS behaviour, especially the roles played by culture and leadership.

Active support (AS) influences the way staff support people with intellectual disabilities to take part in everyday activities. Changes in work practices may affect job satisfaction. The impact of AS on job satisfaction has not, however, been widely studied. Job satisfaction is linked with levels of staff turnover and the overall quality of services provided to people with intellectual disabilities (Coomber & Barriball, 2007; Hatton et al., 2001). The purpose of this paper is to describe an evaluation of job satisfaction amongst 38 direct care staff working in intellectual disability services before and after AS was implemented.

A single group, repeated-measures design was used. In total, 38 members of direct care staff received AS training. Data on job satisfaction were collected before, and after, AS was implemented. In total, 19 members of staff took part in a follow-up 12 weeks later.

There was a significant increase in reported job satisfaction following the implementation of AS. Subscale analysis revealed that the most significant increases in job satisfaction were related to areas directly targeted by AS, including satisfaction with skill level and satisfaction with amount of time spent with service users.

Implementing AS may provide an added benefit for direct care staff, who feel more satisfied at work. While a significant number of papers have been published focusing on the benefits of AS, no papers have specifically looked at the impact that the intervention can have on job satisfaction.

This article describes the development of a specialist peripatetic support service for people with learning disabilities whose behaviour is challenging. It addresses service goals, working methods and development objectives, reviews selected aspects of service process and client outcome, and comments on the impact of changing demand on the service environment.