Staff working directly with adults’ challenging behaviours in learning disability services need to be very good at what they do. They also need to want to do the job. A theory—practice gap exists, however, between what is known about effective, evidence-based approaches and whether and how these are used in person-centred community services. Many frontline staff working with people with the most serious challenging behaviours do not have the skills to implement programmes to change behaviour. This discussion article reviews workforce development in the context of clinical and service guidelines and asks whether the legitimate purview of frontline staff is treating challenging behaviour, managing it or simply coping with it on a daily basis, whilst maintaining the best quality of life possible for service users.
Ager, A. ( 1991) ‘Effecting Sustainable Change in Client Behaviour: The Role of the Behavioural Analysis of Service Environments’, in B. Remington (ed.), The Challenge of Severe Mental Handicap: A Behaviour Analytic Approach, pp. 343-68. Chichester : Wiley.
2.
Ager, A. & O’May, F. ( 2001) ‘Issues in the Definition and Implementation of "Best Practice" for Staff Delivery of Interventions for Challenging Behaviour’ , Journal of Intellectual and Developmental Disability, 26 (3): 243-56.
3.
Allen, D., James, W., Evans, J., Hawkins, S. & Jenkins, R. ( 2005) ‘Positive Behavioural Support: Definition, Current Status and Future Directions’, Tizard Review , 10 (2): 4-11.
4.
Bailey, B.A., Hare, D.J., Hatton, C. & Limb, K. ( 2006) ‘The Response to Challenging Behaviour by Care Staff: Emotional Responses, Attributions of Cause and Observations of Practice’ , Journal of Intellectual Disability Research , 50: 199-211.
5.
Baum, S. & Lyngaard, H. ( 2006) Intellectual Disabilities: A Systemic Approach . London: Karnac.
6.
Beadle-Brown, J., Mansell, J.L., Whelton, B., Hutchinson, A. & Skidmore, C. ( 2006) ‘People with Learning Disabilities in "Out-Of-Area" Residential Placements. 2: Reasons for and Effects of Placement’, Journal of Intellectual Disability Research, 50: 845-56.
7.
BPS (2004) Clinical Practice Guidelines: Psychological Interventions for Severely Challenging Behaviours Shown by People with Learning Disabilities. Leicester: British Psychological Society.
8.
BPS/RCP/RCSLT (2007) Challenging Behaviour: A Unified Approach. London: British Psychological Society/Royal College of Psychiatrists .
9.
Broks, P. ( 2003) Into the Silent Land. London : Atlantic.
10.
Campbell, M. ( 2007a) ‘Staff Training and Challenging Behaviour: Who Needs It?’, Journal of Intellectual Disabilities , 11 (2): 143-56.
11.
Campbell, M. ( 2007b) ‘Cognitive Representation of Challenging Behaviour among Staff Working with Adults with Learning Disabilities’ , Psychology, Health and Medicine, 12 (1): 1-14.
12.
Campbell, M. ( 2007c) ‘The Importance of Good Quality Services for the People with Complex Health Needs’, British Journal of Learning Disabilities, 36: 32-7.
13.
Campbell, M. ( 2008) ‘The Impact of Training on Cognitive Representation of Challenging Behaviour in Staff Working with Adults with Learning Disabilities’ , Journal of Applied Research in Intellectual Disabilities , 21 (6): 561-74.
14.
Carr, E.G., Horner, R.H., Turnbull, A.P., McLaughlin, D.M., McAtee, M.L., Smith, C.E., Ryan, K.A., Ruef, M.D. & Doolabh, A. ( 1999) Positive Behavior Support for People with Developmental Disabilities: A Research Synthesis. Washington, DC: American Association on Mental Retardation.
15.
Dagnan, D. & Cairns, M. ( 2005) ‘Staff Judgements of Responsibility for the Challenging Behaviour of Adults with Intellectual Disabilities’, Journal of Intellectual Disability Research, 49 (1): 95-101.
16.
Department of Health (1992) Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs (Mansell Report). Chair Professor Jim Mansell. London: HMSO.
17.
Department of Health (2001) ‘Chapter 8 - Quality Services’, in Valuing People: A New Strategy for Learning Disability for the 21st Century. London: Department of Health.
18.
Department of Health (2007) Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs: Report of a Project Group (rev. edn). Chair Professor J. L. Mansell. London: Department of Health.
19.
Dowey, A., Toogood, S., Hastings, R. & Nash, S. ( 2007) ‘Can Brief Workshop Interventions Change Care Staff Understanding of Challenging Behaviours?’, Journal of Applied Research in Intellectual Disabilities, 20: 52-7.
20.
Emerson, E. ( 1995) Challenging Behaviour: Analysis and Intervention for People with Intellectual Disabilities, 2nd edn. Cambridge: Cambridge University Press .
21.
Emerson, E. ( 1998) ‘Working with People with Challenging Behaviour’ , in E. Emerson, C. Hatton, J. Bromley & A. Caine (eds), Clinical Psychology in People with Intellectual Disabilities. Chichester: Wiley.
22.
Emerson, E. ( 2001) Challenging Behaviour: Analysis and Intervention in People with Learning Disabilities, 2nd edn. Cambridge: Cambridge University Press .
23.
Emerson, E., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., Kiernan, C. & Mason, L. ( 1997) The HARC Challenging Behaviour Project. Report II:The Prevalence of Challenging Behaviour. Hester Adrian Research Centre, University of Manchester.
24.
Emerson, E., Kiernan, C., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., Mason, L. & Hatton, C. ( 2001) ‘The Prevalence of Challenging Behaviours: A Total Population Study’, Research in Developmental Disabilities , 22 (1): 77-93.
25.
Grey, I.M., Hastings, R.P. & McClean, B. ( 2007) ‘Staff Training and Challenging Behaviour’, Journal of Applied Research in Intellectual Disabilities, Editorial, 20: 1-5.
26.
Forsyth, B. & Winterbottom, P. ( 2002) ‘Beds, Budgets and Burdens: Learning Disability Expenditure v. Workload across English Health Authorities’, The British Journal of Psychiatry, 181: 200-7.
27.
Foxx, R.M. ( 1996) ‘Twenty Years of Applied Behaviour Analysis in Treating the Most Severe Problem Behaviour: Lessons Learned’, Behaviour Analyst, 19: 225-35.
28.
Hastings, R.P. ( 1996) ‘Staff Training and Management in Services to People with Learning Disabilities: An Annotated Bibliography’, British Journal of Clinical Psychology, 35 (3): 480-2.
29.
Hastings, R. ( 1997) ‘Staff Beliefs about the Challenging Behaviours of Children and Adults with Mental Retardation’, Clinical Psychology Review, 17 (7): 775-90.
30.
Hastings, R.P. & Remington, B. ( 1993) ‘Is There Anything On . . . Why "Good" Behavioural Programmes Fail? A Brief Review’, Clinical Psychology Forum, 55: 9-11.
31.
Hastings, R.P., Remington, B. & Hopper, G.M. ( 1995) ‘Experienced and Inexperienced Health Care Workers’ Beliefs about Challenging Behaviours’, Journal of Intellectual Disability Research, 39: 474-83.
32.
Jones, E., Felce, D., Lowe, K., Bowley, C., Pagler, J., Strong, G., Gallagher, B., Roper, A. & Kurowska, K. ( 2001) ‘Evaluation of the Dissemination of Active Support Training and Training Trainers’, Journal of Applied Research in Intellectual Disabilities, 14 (2): 79-99.
33.
Koegel, L.K., Koegel, R.L. & Dunlap, G. ( 1996) Positive Behavioral Support: Including People with Difficult Behavior in the Community. Baltimore: Brookes.
34.
Lowe, K., Jones, E., Allen, D., Davies, D., James, W., Doyle, T., Andrew, J., Kaye, N., Jones, S., Brophy, S. & Moore, K. ( 2007) ‘Staff Training in Positive Behaviour Support: Impact on Attitudes and Knowledge’, Journal of Applied Research in Intellectual Disabilities, 20 (1): 30-40.
35.
Macleod, F.J., Morrison, F., Swanston, M. & Lindsay, W. ( 2002) ‘Effects of Relocation on the Communication and Challenging Behaviours of Four People with Severe Learning Disabilities’ , British Journal of Learning Disabilities, 30 (1): 32-7.
36.
Mansell, J. ( 1994) ‘The Prospect for Change: A Keynote Review. Introduction’ , British Journal of Learning Disabilities , 22: 2-5.
37.
Mansell, J. ( 1996) ‘Issues in Community Services in Britain’ , in J. Mansell & K. Ericsson (eds), Deinstitutionalization and Community Living: Intellectual Disability Services in Britain, Scandinavia and the USA, pp. 49-63. London: Chapman & Hall.
38.
Mansell, J. ( 2010) ‘Raising Our Sights: Services for Adults with Profound Intellectual and Multiple Disabilities’, Tizard Centre, University of Kent.
39.
Mansell, J.J., McGill, P. & Emerson, E. ( 2001) ‘Development and Evaluation of Innovative Residential Services for People with Severe Intellectual Disability and Serious Challenging Behaviour’, in L. M. Glidden (ed,), International Review of Research in Mental Retardation , pp. 245-98. New York: Academic.
40.
McGill, P., Bradshaw, J. & Hughes, A. ( 2007) ‘Impact of Extended Education/Training in Positive Behaviour Support on Staff Knowledge, Causal Attributions and Emotional Responses’ , Journal of Applied Research in Intellectual Disabilities , 20 (1): 41-51.
41.
McGrother, C., Thorp, C., Taub, N. & Machado, O. ( 2001) ‘Prevalence, Disability and Need in Adults with Severe Learning Disability’, Tizard Learning Disability Review, 6: 4-13.
42.
McLean, B., Dench, C., Grey, I., Shanahan, S., Fitzsimons, E., Hendler, J. & Corrigan, M. ( 2005) ‘Person Focused Training: A Model for Delivering Positive Behavioural Supports to People with Challenging Behaviours’ , Journal of Intellectual Disability Research, 49(5): 340-52.
43.
McVilly, K. ( 1997) ‘Residential Staff: How They View Their Training and Professional Support’, British Journal of Learning Disabilities, 25: 18-25.
44.
O’Brien, G. ( 2003) ‘The Classification of Problem Behaviour in Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation’, Journal of Intellectual Disability Research , 47 (suppl.1): 32-7.
45.
Oliver, C., Hall, S., Hales, J. & Head, D. ( 1996) ‘SIB and People with Intellectual Disabilities: Assessing the Behavioural, Knowledge and Causal Explanations of Care Staff’ , Journal of Research in Intellectual Disabilities, 9: 229-39
46.
Oliver, P.C., Piachaud, J., Tyrer, P., Regan, A., Dack, M., Alexander, R., Bakala, A., Cooray, S., Done, D.J. & Rao, B. ( 2005) ‘Randomized Controlled Trial of Assertive Community Treatment in Intellectual Disability: The TACTILD Study’, Journal of Intellectual Disability Research:49 (7): 507-15.
47.
Perera, C., Douds, F., Simpson, N. & Campbell, M.(2009) ‘Survey of LD Inpatient Services in Scotland’, Journal of Intellectual Disabilities, 13 (2): 161-71.
48.
Qureshi, H. ( 1994) ‘The Size of the Problem’, in E. Emerson, P. McGill & J. Mansell (eds), Severe Learning Disabilities and Challenging Behaviours: Designing High Quality Services, pp. 17-36. London: Chapman and Hall.
49.
Reid, D.H., Parsons, M.B. & Lattimore, L. ( 2005) ‘Improving Staff Performance through Clinician Application of Outcome Management’, Research in Developmental Disabilities , 26: 101-16.
50.
Robertson, J., Emerson, E., Pinkney, L., Caesar, E., Felce, D., Meek, A., Carr, D., Lowe, K., Knapp, M. & Hallam, A. ( 2005) ‘Treatment and Management of Challenging Behaviours in Congregate and Noncongregate Community-Based Supported Accommodation’ , Journal of Intellectual Disability Research, 49 (1): 63-72.
51.
Scotti, J.R., Evans, I.M., Meyer, L.H. & Walker, P. ( 1999) ‘A Meta-Analysis of Intervention Research with Problem Behaviour: Treatment Validity and Standards of Practice’ , American Journal on Mental Retardation, 93: 233-56.
52.
Scottish Executive (2000) The Same As You? A Review of Services for People with Learning Disabilities. Edinburgh: Scottish Executive.
53.
Scottish Executive (2006) Improving the Quality of Life for People with Learning Disabilities. Joint Improvement Team, Scottish Executive, Edinburgh .
54.
Shore, B.A., Iwata, B.A., Vollmer, T.R., Lerman, D.C. & Zarcone, J.R. ( 1995) ‘Pyramidal Staff Training in the Extension of Treatment for Severe Behavior Disorders’, Journal of Applied Behavior Analysis, 28: 323-32.
55.
Slevin, E., Truesdale-Kennedy, M., McConkey, R., Barr, O. & Taggart, L. ( 2008) ‘Community Learning Disability Teams: Developments, Composition and Good Practice. A Review of the Literature’, Journal of Intellectual Disabilities, 12 (1): 59-79.
56.
Thompson, C.L. & Reid, A. ( 2002) ‘Behavioural Symptoms among People with Severe and Profound Intellectual Disabilities: A 26-Year Follow-Up Study’, British Journal of Psychiatry, 181 (1): 67-71.
57.
Tierney, E., Quinlan, D. & Hastings, R. ( 2007) ‘Impact of a 3-Day Training Course on Challenging Behaviour on Staff Cognitive and Emotional Responses’, Journal of Applied Research in Intellectual Disabilities, 20: 58-63.
58.
Van Oorsouw, W.M.J., Embregts, P.J.C.M., Bosman, A.M.T. & Jahoda, A. ( 2010) ‘Training Staff to Manage Challenging Behaviour’ , Journal of Applied Research in Intellectual Disabilities , 23: 192-6.
59.
Whitaker, S. & Read, S. ( 2006) ‘The Prevalence of Psychiatric Disorders among People with Intellectual Disabilities: An Analysis of the Literature’ , Journal of Applied Research in Intellectual Disabilities , 19: 330-45.
