Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial

BMC Psychiatry

Michael King¹  William Howie^1,10  Asit Biswas²  Vivien Cooper³  Jason Crabtree⁷  Rachael Hunter⁴  Victoria Vickerstaff⁵  Rumana Omar⁶  Ian Hall⁸  Mike Crawford⁹  Andre Strydom¹  Angela Hassiotis¹ 

[1] UCL Division of Psychiatry, Charles Bell House, 67-73 Riding House Street, London W1W 7EY, UK;Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Groby Road, Leicester LE3 9QF, UK;Challenging Behaviour Foundation, The Old Courthouse, New Road Avenue, Chatham ME4 6BE, UK;University College London, Primary Care & Population Health, Royal Free Hospital, Rowland Street, London NW3 2PF, UK;The Research Department of Primary Care and Population Sciences, University College, Rowland Hill Street, London NW3 2PF, UK;Medical Statistics, Department of Statistical Science, University College London, Gower Street, London WC1E 6BT, UK;Department of Clinical Psychology, University College London, 119 Torrington Place, London WC1E 7HB, UK;East London Foundation Trust, Community Learning Disability Service, Mile End Hospital, Bancroft Road, London, UK;Imperial College of Medicine, Claybrook Centre, Charing Cross Campus, 37 Claybrook Road, London W6 8LN, UK;South West London and St George’s Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Joan Bicknell Centre, Springfield Hospital, London SW17 7DJ, UK

关键词: Behavioural intervention;    Complex intervention;    Intellectual disability;    Positive Behaviour Support;    Cluster RCT;    Challenging behaviour;   

Others  :  1123428
DOI  :  10.1186/s12888-014-0219-6

 received in 2014-06-17, accepted in 2014-07-22,  发布年份 2014

【 摘 要 】

Background

Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services.

Method

The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS.

Discussion

The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour.

Trial registration

This trial is registered with Clinical Trials.gov (Ref NCT01680276 webcite).

Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/ webcite.

【 授权许可】

   
2014 Hassiotis et al., licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Diagnostic and Statistical Manual version 5 (DSM V).Intellectual DisabilityAm Psychiatr Assoc 2013.
• [2]Emerson E, Hatton C: Estimating Future Need/Demand for Support for Adults with Intellectual Disability in England. Institute for Health Research, Lancaster University, Lancaster; 2004.
• [3]Cooper S-A, Smiley E, Jackson A, Finlayson J, Allan L, Mantry D, Morrison J: Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. J Intellect Disabil Res 2009, 53:217-232.
• [4]Hassiotis A, Hall I: Behavioural and cognitive-behavioural interventions in the treatment of outwardly directed aggression in people with an intellectual disability.Cochrane Library 2008, 3:.
• [5]Matson JL, Neal D, Kozlowski AM: Treatments for the challenging behaviours of adults with intellectual disabilities. Can J Psychiatr 2012, 57:587-592.
• [6]Bhaumik S, Gangadharan S, Hiremath A, Russell PSS: Psychological treatments in intellectual disability: the challenges of building a good evidence base. Br J Psychiatry 2011, 198:428-430.
• [7]Scotti JR, Evans IM, Meyer LH, Walker P: A meta-analysis of intervention research with problem behavior: treatment validity and standards of practice. Am Assoc Ment Retard 1991, 96:233-256.
• [8]Didden R, Duker PC, Korzilius H: Meta-analytic study on treatment effectiveness for problem behaviours with individuals who have mental retardation. Am J Ment Retard 1997, 101:387-399.
• [9]Didden R, Korzilius H, Van Oorsouw W, Sturmey P: Behavioral treatment of challenging behaviors in individuals with mild mental retardation: meta-analysis of single-subject research. Am J Ment Retard 2006, 111:290-298.
• [10]Heyvaert M, Maes B, Onghena P: A meta-analysis of intervention effects on challenging behaviour among persons with intellectual disability. J Intellect Disabil Res 2010, 54:634-649. 1291
• [11]Hassiotis A, Robotham D, Canagasabey A, Blizard R, Murad S, King M: Randomized, Single-Blind, Controlled Trial of a Specialist Behavior Therapy Team for Challenging Behavior in Adults With Intellectual Disability. Am J Psychiatr 2009, 166:1278-1285.
• [12]Hassiotis A, Canagasabey A, Robotham D, Marston L, Romeo R, King M: Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes. Br J Psychiatry 2011, 198:490-491.
• [13]Grey I, Hastings R: Evidence based practice in the treatment of behaviour disorders in intellectual disability. Curr Opin Psychiatry 2005, 18:469-475.
• [14]Robotham D, King M, Canagasabey A, Inchley-Mort S, Hassiotis A: Social validity of randomised controlled trials in health services research and intellectual disability: a qualitative exploration of stakeholder views. Trials 2011, 12:144.
• [15]Gustavsson A, Svensson M, Jacobi F, Allgulander J, Alonso E, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jönsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J, et al.: Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011, 21:718-779.
• [16]Hassiotis A, Parkes C, Jones L, Fitzgerald B, Romeo R: Individual Characteristics and Service Expenditure on Challenging Behaviour for Adults with Intellectual Disability. J Applied Res Intellect Disabil 2008, 21:438-445.
• [17]Knapp M, Comas-Herrera A, Astin J, Beecham J, Pendaries C: Intellectual disability, challenging behaviour and cost in care accommodation: what are the links? Health Soc Care Community 2005, 13:297-306.
• [18]Allen D, Lowe K, Moore K, Brophy S: Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour. J Intellect Disabil Res 2007, 51:409-416.
• [19]Felce D, Jones E, Lowe K, Perry J: Rational resourcing and productivity: Relationship among staff input, resident characteristics and group home quality. Am J Ment Retard 2003, 108:161-172.
• [20]Dunlap G, Carr EG, Horner RH, Zarcone J, Schwartz I: Positive behavior support and applied behavior analysis: A familial alliance. Behav Modif 2008, 32:682-698.
• [21]Baer D, Wolf M, Risley R: Some still-current dimensions of applied behavior analysis. J Appl Behav Anal 1987, 20:313-327.
• [22]Carr E, Dunlap G, Homer RH, Koegel AP, Turnbull AP, Sailor W, Anderson J, Albin RW, Koegel LK, Fox L: Positive Behaviour Support: evolution of an applied science. J Positive Behaviour Interventions 2002, 4:4-16.
• [23]Emerson E: Challenging Behaviour: Analysis and Intervention in People with Intellectual Difficulties. Cambridge University Press, Cambridge; 1995.
• [24]McClean B, Dench C, Grey I, Shanahan S, Fitzsimons E, Hendler J, Corrigan M: Person Focused Training: a model for delivering positive behaviour supports to people with challenging behaviours. J Intellect Disabil Res 2005, 49:340-352.
• [25]Lowe K, Jones E, Allen D, Davies D, James W, Doyle T, Andrew J, Kaye N, Jones S, Brophy S, Moore K: Staff training in Positive Behaviour Support: impact on attitudes and knowledge. J Applied Res Intellect Disabil 2007, 20:30-40.
• [26]Beadle-Brown J, Mansell J, Whelton B, Hutchinson A: People with intellectual disability in ‘out-of-area’ residential placements: 2. Reasons for and effects of placement. J Intellect Disabil Res 2006, 50:845-856.
• [27]Grey IM, McClean B: Service user outcomes of staff training in positive behaviour support using person-focused training: a control group study. J Applied Res Intellect Disabil 2007, 20:6-15.
• [28]Transforming Care: A National response to Winterbourne View Hospital: Department of Health Review Final Report. 2012.
• [29]Services for People with Intellectual Disability and Challenging Behaviour and/or Mental Health Needs (Revised Edition). 2007.
• [30]Keogh-Brown M, Bachmann M, Shepstone L, Hewitt C, Howe A, Ramsay C, Song F, Miles J, Torgerson D, Miles S, Torgerson DJ, Miles S, Elbourne D, Harvey I, Campbell MJ: Contamination in trials of educational interventions. Health Technol Asses 2007, 11(43):1.
• [31]Eldridge SM, Ashby D, Kerry S: Sample size for cluster randomized trials: effect of coefficient of variation of cluster size and analysis method. Int J Epidemiol 2006, 35:1292-1300.
• [32]Challenging Behaviour: A Unified Approach. College Report 144. 2007.
• [33][http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf] webcite Department of Constitutional Affairs: Mental Capacity Act 2005..
• [34][http:/ / www.pearsonclinical.com/ psychology/ products/ 100000593/ wechsler-abbreviated-scale-of-intel ligence-wasi.html?Pid=015-8981-502] webcite Wechsler Abbreviated Scale of Intelligence (WASI)..
• [35]Hatton C, Emerson E, Robertson J, Gregory N, Kessissoglou S, Perry J, Felce D, Lowe K, Walsh PN, Linehan C, Hillery J: The adaptive behavior scale-residential and community (part I): towards the development of a short form. Res Devl Disability 2001, 22:273-288.
• [36]Aman MG, Singh NN, Stewart AW, Field CJ: The Aberrant Behavior Checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic 1985, 89:485-491.
• [37]Oliver PC, Crawford MJ, Rao B, Reece B, Tyrer P: Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behaviour: a reliability study. J Applied Res Intellectual Disability 2007, 20:368-372.
• [38]Prosser H, Moss S, Costello H, Simpson N, Patel P, Rowe S: Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability. J Intellect Disabil Res 1998, 42:264-272.
• [39]Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, Devlin N, Egmar AC, Greiner W, Gusi N, Herdman M, Jelsma J, Kind P, Scalone L, Ravens-Sieberer U: Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res 2010, 19:875-886.
• [40]Baker PA: Measurement of community participation and use of leisure by service users with Intellectual disability: the Guernsey community participation and leisure assessment. J Applied Res Intellect Disabil 2000, 13:169-185.
• [41]Pruchno R: The effects of help patterns on the mental health of spouse caregivers. Res Ageing 1990, 12:57-71.
• [42][http://www.gl-assessment.co.uk/products/general-health-questionnaire-0] webcite General Health Questionnaire 12.. .
• [43]McCarron M, Gill M, Lawlor B, Begley C: A pilot study of the reliability and validity of the Caregiver Activity Survey—Intellectual Disability (CAS-ID). J Intellect Disabil Res 2002, 46:605-612.
• [44]Strydom A, Romeo R, Perez-Achiaga N, Livingston G, King M, Knapp M, Hassiotis A: Service use and cost of mental disorders in older adults with intellectual disability. Br J Psychiatry 2010, 196:133-138.
• [45]Wood AM, White IR, Thomson SG: Are missing outcome data adequately handled? A review of published randomized controlled trials in major medical journals. Clinical Trials 2004, 1:368-376.
• [46]Carpenter J, Goldstein H: Multiple imputation in MLwiN. Multilevel modelling newsletter 2005, 16:9-18.
• [47][https://www.esrc.ac.uk/…/764c27a0-ff0c-46ae-bc9a-89247b691475] webcite Carpenter JR, Kenward MG: Instructions for MLwiN multiple imputation macros. accessed April 2014.
• [48]Nevalainen J, Kenward MG, Virtanen SM: Missing values in longitudinal dietary data: A multiple imputation approach based on a fully conditional specification. Stat Med 2009, 28:3657-3669.
• [49]Guide to the Methods of Technology Appraisal. National Institute for Health and Care Excellence, London; 2008.
• [50]Dolan P: Modeling valuations for EuroQol health states. Med Care 1997, 35:1095-1108.
• [51]Briggs AH, Wonderling DE, Mooney CZ: Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997, 6:327-340.
• [52][http://www.qsrinternational.com/products_previous-products_n6.aspx] webcite QSR International-NVIVO9.. accessed June 2014.
• [53]Brawn V, Clarke V: Using thematic analysis in Psychology. Qual Res Psychol 2006, 3:77-101.