Chan, B. and Baker, P. (2020). An evaluation of the social validity of the Aberrant Behavior Checklist - Community. Tizard Learning Disability Review [Online]. Available at: https://doi.org/10.1108/TLDR-12-2019-0038.
Purpose – This paper aims to evaluate the social validity of the Aberrant Behavior Checklist - Communit y (ABC-C). Design/methodology/approach – Thirty-six participants completed a questionnaire in which they identified and commented on items of the ABC-C they saw as problematic. Thematic analysis was conducted on the comments made. Findings – All participants identified at least one item of the ABC-C as problematic with six items being so identified by over half the participants. A number of themes were identified in participant comments including ambiguity, judgemental language, child-focussed language, lack of attention to behavioural function and repetition. Research limitations/implications – More research is required using empirically based methodologies on measures used to assess people with learning disabilities. This should involve ascertaining the social validity of such measures by soliciting the views of both those being assessed and those assessing.
Originality/value – This study is the first of its kind to evaluate the social validity of one of the most widely used measures of challenging behaviour for people with learning disabilities.
Taylor-Roberts, L., Strohmaier, S., Jones, F. and Baker, P. (2019). A systematic review of community participation measures for people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 32:706-718. Available at: http://dx.doi.org/10.1111/jar.12565.
Background: Community participation is considered a fundamental aspect of quality of life and one of the essential goals of services for people with intellectual disabilities (ID), yet there is no agreed way of measuring community participation.
Method: Two systematic searches were performed across eight electronic databases to identify measures of community participation and identify validation studies for each measure. Measures were included if they were developed for adults with ID, measured extent of participation and had published information regarding content and psychometric properties. Each measure was evaluated on the basis of psychometric properties and in relation to coverage of nine domains of community participation from the International Classification of Functioning, Disability and Health (ICF).
Results: Eleven measures were selected with the quality rating scores varying substantially ranging from 2-11 of a possible 16.
Conclusions: The majority of measures were not sufficiently psychometrically tested. Findings suggest a need for the development of a psychometrically robust instrument.
McKendry, J. and Baker, P. (2018). Pica Behaviour and Positive Behavioural Support: Best Practice in assessment and intervention. International Journal of Positive Behavioural Support [Online] 8:33-41. Available at: https://www.ingentaconnect.com/contentone/bild/ijpbs/2018/00000008/00000002/art00005#expand/collapse.
Background: Pica (the ingestion of non-edible items) is a dangerous and relatively common behaviour presented by people with intellectual disabilities.
Method and materials: Non-systematic review of studies that are compatible with Positive Behavioural Support related to the definition, prevalence, assessment and intervention for PICA.
Results: PICA has a high prevalence in people with intellectual developmental disabilities and is potentially dangerous and multi-factorial in its causation. A range of suggested intervention strategies compatible with PBS were found with reported reductions in PICA ranging from 70-90% with a clear indication that multi-element interventions are likely to be the most effective.
Conclusions: Whilst the results reported in the studies reviewed are encouraging, there remain concerns regarding the feasibility of the implementation of these interventions and the extent to which the risk associated with PICA need to be managed even in the context of relatively effective interventions.
Carson, J. and Baker, P. (2018). What is being taught on Positive Behavioural Support Training: An audit of training provided in the UK. International Journal of Positive Behavioural Support [Online] 8:22-28. Available at: http://www.ingentaconnect.com/contentone/bild/ijpbs/2018/00000008/00000001/art00004#expand/collapse.
Background: Developing a workforce skilled in implementing PBS is a key aim for support services for people with intellectual disabilities who present challenging behaviour support services, and effective PBS training is a fundamental element in achieving this. There has been a substantial growth in the provision of training on PBS but little is known about the quality and content of that training.
Method and Materials: A audit methodology was employed using a bespoke audit tool to evaluate the content of eighteen PBS training courses in the UK found through internet searches of providers of PBS training.
Results: The findings showed considerable variability across training providers and across the essential elements of PBS practice in addition to complexity in informed commissioning of training.
Conclusions: The study concludes that currently the content of PBS training is worryingly inconsistent and variable leaving the process of commissioning subject to arbitrary influence. The argument for need for a formal accreditation process is made.
Baker, P., Appleton, P. and Williams, R. (2017). An examination of the addition of video informed reflective practice to the active support toolkit. British Journal of Learning Disabilities [Online] 45:180-189. Available at: http://dx.doi.org/10.1111/bld.12193.
This study evaluated a package of Active Support (AS), which included standard training with additional video informed reflective practice. The training package was implemented as part of a service improvement initiative in four residential intellectual disability homes, using a concurrent multiple baseline across environments design. Training consisted of a one-day workshop, and follow-up coaching. Momentary time sampling was used to measure engagement levels and staff assistance. A new observational tool was piloted to code the presence of positive and negative interactions between staff and the people with intellectual disabilities. Results showed that service user engagement levels and staff assistance increased significantly following the training. There was also a significant increase in positive interactions, and a significant decrease in negative interactions between staff and service users. The implications of these results are discussed.
Gore, N. and Baker, P. (2017). Mental health as motivational operation: Service-user and caregiver emotional states in the context of challenging behaviour. International Journal of Positive Behavioural Support [Online] 7:15-23. Available at: http://www.ingentaconnect.com/contentone/bild/ijpbs/2017/00000007/00000001/art00003.
This brief conceptual paper seeks to address the role of mental health and the experience of negative life events in the positive behavioural support framework in relation to the behaviour of both service users and caregivers and some of the implications this may suggest for intervention. It is argued that the conceptualisation of mental health related variables as motivating operations is parsimonious at a theoretical and practical level and may create one way of generating further synergies within the field of IDD.
Baker, P. (2017). Attending to debriefing as post-incident support of care staff in intellectual disability challenging behaviour services: An exploratory study. International Journal of Positive Behavioural Support [Online] 7:38-44. Available at: http://www.ingentaconnect.com.chain.kent.ac.uk/contentone/bild/ijpbs/2017/00000007/00000001/art00006.
Background: The psychological welfare of the workforce who support people with intellectual disabilities who present challenging behaviour is key in providing effective positive behavioural support. This workforce has consistently been identified as being vulnerable to experiencing poor psychological wellbeing. Debriefing after incidents is consistently recommended as good practice, despite the absence of clear guidance about the nature of the debrief and an adequate evidence base. Method and materials: A case study is presented in relation to a group debrief in which the critical incident stress management (CISM) model was carried out for six staff involved in a serious incident. Staff were assessed prior to the debrief and in a two-month follow up using the impact of events scale – revised (IES-R) (Weiss and Marmar, 1997). Results: Worryingly high IES-R scores for four of the staff were found prior to the debrief. At two-month follow up all staff scores had reduced to levels below the cut-off for clinical concern. Conclusions: Implications from the analysis of this case study are discussed in relation to general support and, specifically, post incident support offered to staff in intellectual disability services.
Davison, S., McGill, P., Baker, P. and Allen, D. (2015). A national UK survey of peripatetic support teams for children and adults with intellectual and developmental disability who display challenging behaviour. International Journal of Positive Behavioural Support [Online] 5:26-33. Available at: http://www.ingentaconnect.com.chain.kent.ac.uk/content/bild/ijpbs/2015/00000005/00000001/art00004.
Background: The service provision model of peripatetic support teams for people with intellectual disabilities who present challenging behaviour has been well established in the United Kingdom, with a small but growing evidence base. The current context in the UK would appear to indicate an ever-increasing role for such teams, in order to support people in their own communities and reduce the reliance on out-of-area placements. This study sought to establish the current position of such teams within the UK.
Method and materials: 46 teams were given the opportunity to complete an online questionnaire regarding the team's day to day functioning.
Results: 20 services responded to the survey providing a range of data. The results suggested that the services were mainly targeted towards adults, had a range of working practices and therapeutic orientations, with broadly successful outcomes (albeit self reported). The data would also suggest that this type of provision had diminished in recent years.
Conclusions: The implications of the survey are discussed within the context of the current policy in the UK. In particular, the lack of provision for children, the use of evidence based practice and what appears to be a diminishing resource just at the time when it is most needed are explored.
Daynes, S. and Baker, P. (2014). A pilot evaluation of positive behavioural support workshops for families of adults with intellectual disabilities who present challenging behaviour: ’It should have been offered years ago’. International Journal of Positive Behavioural Support [Online] 4:24-31. Available at: http://www.ingentaconnect.com.chain.kent.ac.uk/content/bild/ijpbs/2014/00000004/00000002/art00004.
Background: Positive behavioural support (PBS) workshops were designed for families supporting their adult son or daughter with an intellectual disability engaging in challenging behaviours. This was in recognition of the impact of their challenging behaviour, in particular the level of stress carers often experience and positive reports from other studies incorporating multi-family learning.
Method and materials: Two sets of pilot workshops were completed, incorporating modules in PBS and physical interventions. Workshops included presentations and self-directed/group learning tasks, recorded in a specifically designed workbook.
Results: Quantitative data was analysed using non-parametric tests. Positive results were found for changes in various areas including self-reported stress levels. Positive trends were also found in pre and post application of the Aberrant Behaviour Checklist (Aman and Singh, 1994).
Conclusions: This study showed very encouraging results in regard to the impact of this model of training for the carers involved. Further research is required to assess any longer term effects, and to explore the impact on larger numbers of participants.
Allen, D., McGill, P., Hastings, R., Toogood, S., Baker, P., Gore, N. and Hughes, J. (2013). Implementing positive behavioural support: changing social and organisational contexts. International Journal of Positive Behavioural Support [Online] 3:32-41. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00005?crawler=true.
Background: Social and organisational contexts have a major influence on both challenging behaviour and interventions designed to ameliorate such behaviour and improve quality of life.
Method and materials: A non-systematic review was conducted in order to identify social and organisational factors that impact upon positive behavioural support (PBS) intervention.
Results: A series of micro and macro influences on intervention effectiveness were identified. Possibilities for improving intervention effectiveness that extend the scope of traditional behavioural interventions were discussed.
Conclusions: Implications and opportunities for building capacity at an individual service user, organisational and cultural level are highlighted.
Denne, L., Noone, S., Gore, N., Toogood, S., Hughes, J., Hastings, R., Allen, D., Baker, P. and McGill, P. (2013). Developing a core competencies framework for positive behavioural support: issues and recommendations. International Journal of Positive Behavioural Support [Online] 3:24-31. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00004?crawler=true.
Background: Widespread adoption of positive behavioural support (PBS) will stand and fall on the extent to which we can develop a competent workforce. The case for the development of a competence framework for PBS is presented.
Method and materials: We review the role that competence frameworks play in evidence-based practice and outline some of the ways in which they have been defined and structured. We describe the process used to develop the UK Autism Education Competence Framework (ABACF) and discuss the particular issues that need to be considered when developing a competence framework specifically for PBS.
Results: We propose a conceptual model illustrating what a PBS competence framework might look like and suggest a process for its development.
Conclusions: Competence frameworks are one means of translating evidence into practice. To be effective they must be an integral part of all aspects of service provision and must be grounded in the defining components of the discipline they describe.
Hastings, R., Allen, D., Baker, P., Gore, N., Hughes, J., McGill, P., Noone, S. and Toogood, S. (2013). A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities. International Journal of Positive Behavioural Support [Online] 3:5-13. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00002?crawler=true.
Background: To be able to define positive behavioural support (PBS), describe PBS interventions and clarify the individual and organisational competencies needed to support PBS, a clear underlying conceptual framework is needed to identify why challenging behaviours occur.
Method and materials: Non-systematic review and discussion of the state of research and theoretical evidence focusing on vulnerability factors for challenging behaviours, maintaining processes, and the social impact of challenging behaviour.
Results: Understanding challenging behaviour is related most strongly to context. First, challenging behaviours are defined in terms of their social effects. Second, vulnerability factors for challenging behaviour include some biological factors, but mainly psycho-social risks relating to the life situation and inequalities experienced by people with developmental disabilities. Third, social contextual processes are primarily responsible for maintaining challenging behaviours.
Conclusions: PBS is a broad approach to understanding and intervention referring to multiple contributing factors and processes. To describe PBS without reference to an underlying theoretically grounded conceptual framework would lead to an impoverished version of the approach.
Gore, N., McGill, P., Toogood, S., Allen, D., Hughes, J., Baker, P., Hastings, R., Noone, S. and Denne, L. (2013). Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support [Online] 3:14-23. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2013/00000003/00000002/art00003.
Background: In light of forthcoming policy and guidance in the UK regarding services for people who display behaviour that challenges, we provide a refreshed definition and scope for positive behavioural support (PBS). Through doing this we aim to outline a framework for the delivery of PBS that is of practical and strategic value to a number of stakeholders.
Method and materials: We draw extensively on previous definitions of PBS, relevant research and our professional experience to create a multi-component framework of PBS, together with an overall definition and a breakdown of the key ways in which PBS may be utilised.
Results: The framework consists of ten core components, categorised in terms of values, theory and evidence-base and process. Each component is described in detail with reference to research literature and discussion regarding the interconnections and distinctions between these.
Conclusions: We suggest the framework captures what is known and understood about best practice for supporting people with behaviour that displays as challenging and may usefully inform the development of competences in PBS practice, service delivery, training and research.
Wills, S., Shephard, J. and Baker, P. (2013). Evaluating the impact of positive behaviour support training on staff knowledge, attributions, emotional responses and helping behaviour; capturing hearts and minds. International Journal of Positive Behavioural Support 3:31-39.
Background: Attention to the role of mediators has always been a key component of positive behavior support. This is evidenced by, amongst other things, the resources devoted to training front line care staff & families in the principles and practice of positive behaviour support (PBS). In order for this training to result in permanent changes in the behaviour of these mediators it is argued that, as well as acquiring knowledge, it is vital that training impacts on the beliefs and attributions of the participants.
Method and materials: The study involved 59 care staff working with individuals with intellectual disabilities and challenging behaviour who were trained in PBS. At pre- and post-training, staff completed self-report questionnaire packs in response to a case study depicting a service user with intellectual disabilities engaging in challenging behaviour.
Results: A series of paired samples t-tests were conducted to evaluate the training. Staff knowledge in positive behaviour support increased from pre- (5.05) to post- (6.82) training, t (37) = –4.45, p<0.001. Furthermore, at post-training, participants were less likely to attribute the causes of challenging behaviour as controllable by the service user with intellectual disabilities, more likely to engage in proactive strategies, less likely to engage in unhelpful behaviour, and reported higher levels of optimism in supporting a service user with challenging behaviour.
Conclusions: The findings indicate that the training course has potentially helpfully influenced the knowledge & attributions of the participants. The results are important in that they suggest that the course may indirectly lead to the enhancement of the quality of life of those service users supported by staff attending the training course.
Ravoux, P., Baker, P. and Brown, H. (2012). Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services. Journal of Applied Research in Intellectual Disabilities [Online] 25:189-202. Available at: https://doi.org/10.1111/j.1468-3148.2011.00653.x.
Background? A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members’ perspectives of managing clients with challenging behaviours in residential services.
Materials and Methods? Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members’ immediate responses to clients’ difficult behaviours and their decision-making processes.
Results? The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved.
Conclusions? Staff members’ responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future.
Baker, P. and Allen, D. (2012). Use of positive behaviour support to tackle challenging behaviour. Learning Disability Practice [Online] 15:18-20. Available at: http://dx.doi.org/10.7748/ldp2012.02.15.1.18.c8910.
The presentation of challenging behaviour by people with learning disabilities can be persistent and can have a huge effecton the individuals concerned and their carers. Applied behavioural analysis has offered much promise in this area, but concerns regarding the use of aversive procedures, such as punishment, along with recognition of the human rights of people with intellectual disabilities, has led to the development of positive behaviour support (PBS). This article argues that, as an emergingconcept, PBS is particularly vulnerable to corruption. To guardagainst this, PBS should always be based on data-based functional assessment and use empirically tested intervention strategies.
Baker, P., Wills, S., Smith, H., Kok, A. and Zakrewski, K. (2012). Combining pharmacological and positive behaviour support strategies in the treatment of self-injury. International Journal of Positive Behavioural Support 2:11-18.
Background: Positive behaviour support is increasingly using multiple perspectives to identify functional relationships and to examine and validate approaches for producing behavioural change. This would include gene-brain-behaviour relationships with the implication that pharmacological strategies could be incorporated in positive behaviour support plans.
Method and materials: A single-case methodology was used to examine the effects adding Naltrexone to the positive behaviour support plan of a woman with severe intellectual disability who presents self-injurious behaviour. Efficacy of the medication was examined across three functional analytic analogue conditions using a multi-element reversal design utilising blind ratings.
Results: Differential responding was observed across experimental conditions with tentative evidence of a positive treatment effect specifically and exclusively in the automatic reinforcement condition. Conclusions: Implications for prescribing practice of Naltrexone and other medications and the identification of behavioural markers correlated with positive treatment responses are highlighted.
Daynes, S., Wills, S. and Baker, P. (2011). Experiences of violence at work in community learning disability teams: "what should I do?". Advances in Mental Health and Intellectual Disabilities [Online] 5:6-14. Available at: http://dx.doi.org/10.1108/20441281111142576.
– Much of the research related to experiences of violence at work in intellectual disability services has focused on paid carers, with very little exploring the experiences of staff in community intellectual disability teams (CIDT). This study aims to address this issue.
– This study began with a brief survey sent to staff across six CIDTs in South East England. These experiences were further explored with in?depth interviews with a sub?sample of the respondents.
– The results of the survey indicated that 34 per cent of the respondents (n=105) had experienced some form of verbal or physical aggression at work during the previous six months. Emerging themes focused on the types of risks faced by this staff group; factors that helped with risk assessment and management (and why these things do not always happen); and how workers develop the skills in managing these risks.
– Implications are discussed in terms of gaps in current formal training and the role of more informal learning processes in addressing the specific needs of staff working with this client group.
Allen, D., Lowe, K., Baker, P., Dench, C., Hawkins, S., Jones, E. and James, W. (2011). Assessing the effectiveness of positive behavioural support: the P-COP Project. International Journal of Positive Behavioural Support 1:14-23.
ABSTRACT Background: Despite an emerging evidence base, the existing literature on positive behavioural support (PBS) has been criticised on a number of grounds. The P- CPO project was designed to establish a pragmatic, ongoing database that could be used within clinical services to routinely collate the impacts of PBS intervention and address deficits in the current literature. Materials & Methods: A variety of standardised and novel measures were employed to track the impact of PBS intervention on behaviour, quality of life and use of restrictive practices in three centres in the UK and Ireland. Results: Significant decreases in challenging behaviour were evident. These were accompanied by significant changes in community participation and adaptive behaviours, and significant reductions in the use of restrictive practices. Conclusions: The P- CPO database appears to be a practical tool for measuring the effects of PBS interventions.
Assessing the effectiveness of positive behavioural support: The P-CPO Project - ResearchGate. Available from: http://www.researchgate.net/publication/263217865_Assessing_the_effectiveness_of_positive_behavioural_support_The_P-CPO_Project [accessed Aug 19, 2015].
Davidson, T. and Baker, P. (2010). Learning disability classification: time for reappraisal. Learning Disability Review 15:42-45.
Baker, P. and Shephard, J. (2010). Reflections on the periodic service review as a practice leadership tool in services for people with intellectual disabilities in challenging behaviour. Tizard Learning Disability Review [Online] 15:29-32. Available at: http://dx.doi.org/10.5042/tldr.2010.0402.
Baker, P. (2007). Individual and service factors affecting deinstitutionalization and community use of people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 20:105-109. Available at: http://dx.doi.org/10.1111/j.1468-3148.2006.00313.x.
Background: The aim was to evaluate the effect of the closure of a small intellectual disability hospital on the community use of those people involved. In addition, the study sought to identify those factors that might influence the community use of people with intellectual disabilities.
Methods: The impact of resettlement was investigated using a mixed design in which changes in the dependent variable (The Guernsey Community Participation and Leisure Assessment, GCPLA scores) were measured within-subjects (before and after leaving hospital) and between-subjects (using a comparison group of people who lived in the community throughout the study). In addition, a standard multiple regression design was employed to explore the relative contribution of client and service variables to GCPLA scores.
Results: Resettlement from hospital corresponded with significant increase in the range and frequency of leisure and community contacts, although community use remained low in comparison with the general population and in relation to other people with intellectual disabilities. Community and leisure use was found to be related to the place of residence, adaptive behaviour and the robustness of community goals within the service user's individual plan.
Baker, P. (2000). Measurement of community participation and use of leisure by service users with intellectual disabilities: the Guernsey Community Participation and Leisure Assessment (GCPLA). Journal of Applied Research in Intellectual Disabilities [Online] 13:169-185. Available at: http://dx.doi.org/ 10.1046/j.1468-3148.2000.00015.x.
Community integration is now an important principle guiding service provision for people with intellectual disabilities. However, it has been argued that research has contributed little in the way of guidance and that this is mainly because of the lack of appropriate measures. The Guernsey Community Participation and Leisure Assessment (GCPLA) is described in the present paper. The GCPLA is a comprehensive assessment of community participation and the use of leisure that produces both quantitative and qualitative data. Data are presented which suggest that the instrument is potentially both valid and reliable. A study comparing use of their community by service users and a staff control group showed that the service users had a smaller range of activities, were less busy (i.e. took part in fewer frequent activities), and were more likely to access their communities in the presence of staff or carers, rather than alone or with friends. Suggestions for the use of the GCPLA are discussed including individual planning, service evaluation and training.
Baker, P. and Bissmire, D. (2000). A pilot study of the use of physical intervention in the crisis management of people with intellectual disabilities who present challenging behaviour. Journal of Applied Research in Intellectual Disabilities [Online] 13:38-45. Available at: http://dx.doi.org/10.1046/j.1468-3148.2000.00004.x.
The use of physical intervention in response to challenging behaviour in a nonspecialized intellectual disability service setting was found to be extremely high. In addition, staff confidence in their ability to prevent and respond to crisis situations involving challenging behaviour was extremely low. All staff within this setting received training in Strategies in Crisis Intervention and Prevention (SCIP). At three-month follow-up staff felt more confident in the management of crisis, and more supported by their organization. No significant effects on the number of incidents reported were found, although the data suggested an increased tendency to use a physical intervention relative to other methods following training. The implications of these findings for service design and further research are discussed.