Professor Peter McGill
Professor of Clinical Psychology of Learning Disability
Acting Director of Tizard Centre
About
Professor McGill joined the Tizard Centre in 1986 having previously worked with people with learning disabilities as an instructor, residential social worker and clinical psychologist. He is a registered clinical psychologist and board certified behaviour analyst.
Research interests
- Understanding the causes of challenging behaviour with particular reference to the role of motivating operations
- prevention of challenging behaviour through system-wide positive behaviour support
- transition of children and young people with intellectual and developmental disabilities from residential education
Teaching
Professor McGill teaches on the postgraduate programmes in applied behaviour analysis and positive behaviour support.
Supervision
Professor McGill currently supervises students on topics including early intervention in challenging behaviour, system-wide positive behaviours support, improving the fidelity of interventions with challenging behaviour and supporting life skills development in young people with autism.
Professional
- Trustee of the Challenging Behaviour Foundation 2005-2017
- member of the steering group for the Challenging Behaviour National Strategy Group
- co-editor of Tizard Learning Disability Review
Publications
Showing 50 of 114 total publications in the Kent Academic Repository. View all publications.
Article
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Gore, N. and McGill, P. (2019). Making it Meaningful: Caregiver Goal Selection in Positive Behavioral Support. Journal of Child and Familiy Studies [Online] 28:1703-1712. Available at: http://dx.doi.org/10.1007/s10826-019-01398-5.Objectives
Positive Behavioral Support (PBS) is considered the treatment framework of choice for children with intellectual and developmental disabilities (IDD) at risk of behavior that challenges. PBS demands stakeholder engagement, yet little research has explored goal formation in this context for caregivers of children with IDD.
Methods
We used Talking Mats and semi-structured interviews to support 12 caregivers of children with IDD who displayed behaviours that challenge, to develop goals for PBS. Interviews covered quality of life for caregivers and their child, adaptive and challenging aspects of child behavior, and aspects of caregiverâs own behavior.
Results
Caregivers were able to form individualised and meaningful goals in relation to all domains, demonstrating rich insight into personal needs and needs of their child. The process of forming goals was psychologically and emotionally complex given prior experiences and needs of participants but effectively supported by the interview method.
Conclusions
We conclude that goal formation in PBS requires careful consideration and structuring but has the potential to support effective working relationships and ensure assessment and intervention is aligned with the needs and aspirations of families. -
Brady, L., Padden, C. and McGill, P. (2019). Improving procedural fidelity of behavioural interventions for people with intellectual and developmental disabilities: A systematic review. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: http://dx.doi.org/10.1111/jar.12585.Background: Despite its importance within behavioural intervention, it remains unclear how best to achieve high procedural fidelity. This paper reviewed studies on improving procedural fidelity of behavioural interventions for individuals with intellectual and developmental disabilities (IDD).
Method: A systematic literature search was conducted, which identified 20 studies meeting inclusion criteria. Data were extracted on study design, participant characteristics, intervention, target behaviours, effect sizes, maintenance, generalisation, and social validity. A quality rating was also applied.
Results: A total of 100 participants took part in the included studies. Most participants were teachers working with children in school settings. There was a significant positive correlation between level of procedural fidelity and client outcomes. Feedback was the most commonly employed intervention to improve procedural fidelity.
Conclusions: More research should be conducted in environments with high levels of variability such as community homes to determine how to reach and maintain high levels of procedural fidelity. -
McGill, P. et al. (2018). Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: A cluster randomized controlled trial of setting-wide positive behaviour support. Research in Developmental Disabilities [Online]. Available at: https://doi.org/10.1016/j.ridd.2018.04.020.Background
Improving the quality of social care through the implementation of setting-wide positive behaviour support (SWPBS) may reduce and prevent challenging behaviour.
Method
Twenty-four supported accommodation settings were randomized to experimental or control conditions. Settings in both groups had access to individualized PBS either via the organisationâs Behaviour Support Team or from external professionals. Additionally, within the experimental group, social care practice was reviewed and improvement programmes set going. Progress was supported through coaching managers and staff to enhance their performance and draw more effectively on existing resources, and through monthly monitoring over 8â11 months. Quality of support, quality of life and challenging behaviour were measured at baseline and after intervention with challenging behaviour being additionally measured at long-term follow-up 12â18 months later.
Results
Following intervention there were significant changes to social care practice and quality of support in the experimental group. Ratings of challenging behaviour declined significantly more in the experimental group and the difference between groups was maintained at follow-up. There was no significant difference between the groups in measurement of quality of life. Staff, family members and professionals evaluated the intervention and its outcomes positively.
Conclusions
Some challenging behaviour in social care settings may be prevented by SWPBS that improves the quality of support provided to individuals. -
Hardiman, R. and McGill, P. (2018). How common are challenging behaviours amongst individuals with Fragile X Syndrome? A systematic review. Research in Developmental Disabilities [Online] 76:99-109. Available at: https://doi.org/10.1016/j.ridd.2018.02.020.Fragile X Syndrome (FXS) appears to be associated with an increased risk for engaging in challenging behavior, particularly self-injury, relative to those with mixed aetiology learning disabilities. Such behavioral issues are reported to be of high concern for those providing support. As such, this systematic review aimed to gain further epidemiological data regarding challenging behaviors in individuals with FXS, including: self-injurious behavior (SIB), hand-biting as a specific topography of SIB, aggression and property destruction. Twenty eight manuscripts were identified which reported the prevalence of a relevant topography of behavior, with widely varying prevalence estimates. Weighted averages of the prevalence of behaviors were calculated across studies. Comparison of proportions revealed significant gender differences and differences in the prevalence of types of behavior. It is hoped that this comprehensive overview of data on this clinically significant topic will help to inform and drive future investigation to understand and provide effective intervention for the benefit of those with FXS.
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MacDonald, A., McGill, P. and Murphy, G. (2018). An evaluation of staff training in positive behavioural support. Journal of Applied Research in Intellectual Disabilities [Online] 31:1046-1061. Available at: https://doi.org/10.1111/jar.12460.BACKGROUND: Positive Behavioural Support (PBS) has been shown to be effective in minimising
challenging behaviour, and improving the lives of people with intellectual disabilities. Training in
PBS is an important factor in achieving good coverage in the use of PBS. The aim of this study was to
evaluate the impact of training managers of social care services in PBS. METHOD: A year-long
training programme in PBS was delivered to 50 managers of community-based services for people
with challenging behaviour. Data were collected pre and post training, and at 6 month follow-up. A
non-randomised control group design was used. RESULTS: Data demonstrated significant reduction
in challenging behaviour. However, there was no change in quality of life for service users.
CONCLUSION: Training in PBS can reduce challenging behaviour in people with intellectual
disabilities; demonstrating any impact of PBS training on quality of life remains a challenge. -
Tomlinson, S., Gore, N. and McGill, P. (2018). Training Individuals to Implement Applied Behavior Analytic Procedures via Telehealth: A Systematic Review of the Literature. Journal of Behavioral Education [Online]. Available at: https://doi.org/10.1007/s10864-018-9292-0.The purpose of this article is to summarize literature relating to training individuals to implement applied behavior analytic procedures via telehealth and identify any gaps in the evidence base for this type of support. A systematic literature search revealed 20 articles focusing on training individuals to implement specific ABA techniques via telehealth. The Evaluative Method (Reichow et al. in J Austism Dev Disord 38:1311â1319, 2008; Reichow, in: Reichow, Doehring, Cicchetti, Volkmar (eds) Evidence-based practices and treatments for children with autism, Springer, New York, Reichow 2011) was used to assess the methodological quality of included articles. Results indicated that individuals were trained to implement a range of techniques, including assessments, targeted interventions, and specific teaching techniques. Socially significant outcomes were reported for clients in the form of reduced challenging behavior and increased skills. Trainee fidelity following training via telehealth was variable, and barriers related to the use of telehealth were highlighted. Where evaluated, cost and travel burdens were considerably lower than support provided in-person. The emerging literature is promising and suggests that telehealth may be an effective means of training individuals in ABA techniques; however, wider issues and practical implications related to the use of telehealth should be considered and are discussed as it relates to ABA providers.
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Tomlinson, S. et al. (2017). Trends in the provision of residential educational placements available for young people with learning disabilities/autism in England. Tizard Learning Disability Review [Online] 22:222-229. Available at: https://doi.org/10.1108/TLDR-07-2017-0028.Purpose â Little is known about the characteristics of residential educational settings for young people with
intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics
and experiences of the young people attending such settings rather than the setting itself; therefore,
an overview of national provision is needed. The paper aims to discuss these issues.
Design/methodology/approach â As part of a larger project, data were collected for all residential schools
and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for
30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of
the main project, settings offering placements only to young people aged under 16 were excluded.
Data were collected from a range of sources, including school/college websites, Ofsted and Department for
Education resources, and liaison directly with the setting.
Findings â In total, 342 residential educational settings were identified with 57 of these offering post-16
provisions only. A range of data is presented about these settings, including location, placement numbers and
types available, age range catered for, special educational needs categories registered for, governance
arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings.
Originality/value â These data provide a national overview of residential educational settings for young
people with IDD. This enables a clearer picture of the location and type of provision offered and allows
comparisons both within and between areas. -
McGill, P. (2016). Editorial. Tizard Learning Disability Review [Online] 21. Available at: http://www.emeraldinsight.com/doi/full/10.1108/TLDR-01-2016-0004.
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Hardiman, R. and McGill, P. (2016). The topographies and operant functions of challenging behaviours in Fragile X Syndrome: a systematic review and analysis of existing data. Journal of Intellectual & Developmental Disability [Online] 42:190-203. Available at: http://dx.doi.org/10.3109/13668250.2016.1225952.Background: Challenging behaviour, such as self-injury and physical aggression, is an issue of concern regarding a high proportion of individuals with fragile X syndrome. The aim of this review was to provide a comprehensive overview of the topographies and operant functions of challenging behaviours within the syndrome.
Method: Five electronic databases were searched, identifying 18 manuscripts. Overall proportions of individuals with particular topographies of behaviour, or behaviour serving different functions, were calculated.
Results: Across all participants, biting was the most common form of self-injury for males but not females. A pattern of behavioural function was observed, characterised by high levels of social-negative reinforcement, such as escape from demands.
Conclusion: The existence of within-syndrome biases in the manifestation of behavioural challenges is supported by our review -
Deveau, R. and McGill, P. (2016). Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour: a further examination and partial replication. Research in Developmental Disabilities [Online] 56:160-164. Available at: http://dx.doi.org/10.1016/j.ridd.2016.05.020.Background and Aims
Practice leadership (PL) style of frontline management has been shown to be associated
with better experiences for staff working with people who may exhibit challenging
behaviours (Anonymous, 2014). This study aimed to examine additional staff experience
factors with a different, larger sample and to partially replicate the findings of (Anonymous,
2014).
Methods
This study was a survey of staff self-reported data collected as part of a larger study.
Information was collected on PL and staff experiences of: stress, turnover, job satisfaction
and positive work experiences.
Results and Conclusions
The results broadly supported Deveau & McGill (2014) and demonstrated an association
between PL and greater job satisfaction and positive experiences for staff. Results on staff
turnover were inconsistent. The positive impact of PL on staff experience was further
supported by this study. Suggestions are made for further research.
Implications
These findings suggest further research is needed to examine the potential of interventions
in frontline management/leadership practice to improve staff experience of working in
challenging environments.
What this paper adds. Firstly, to the somewhat limited research literature on
management/leadership in intellectual and developmental disabilities. Secondly,
contributes additional evidence that a PL style of frontline management has beneficial
effects upon frontline staffâs experience of working in challenging environments i.e.
suggests a new intervention in an important area of policy and practice. Thirdly, suggests
that the IDD sector needs to place more emphasis upon frontline management
development and practice. -
McGill, P. and Bradshaw, J. (2015). Editorial. Tizard Learning Disability Review [Online] 21:1-1. Available at: http://dx.doi.org/10.1108/TLDR-10-2015-0041.
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Deveau, R. and McGill, P. (2015). Practice Leadership at the front line in supporting people with intellectual disabilities and challenging behaviour: a qualitative study of registered managers of community-based, staffed group homes. Journal of Applied Research in Intellectual Disabilities [Online] 29:266-277. Available at: http://dx.doi.org/10.1111/jar.12178.Background
The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour.
Method
Interviews, primarily focussed upon staff practice, were conducted with 19 managers of staffed group homes in SE England. Transcripts were analysed using interpretive phenomenological analysis.
Results
Five groups of themes emerged: monitoring staff performance, supporting new ways of working, shaping staff performance, influence of external and employing agencies, and importance of participants' personal values and experiences.
Conclusion
The themes identified contribute to a conceptual framework for thinking about front-line management/practice leadership. The limitations, and potential implications, of the findings are discussed. -
Davison, S. et al. (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. -
McGill, P. (2015). 'Count me in .. or out' Editorial. Tizard Learning Disability Review [Online] 20:1-2. Available at: http://dx.doi.org/10.1108/TLDR-10-2014-0036.
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Simó-Pinatella, D. et al. (2015). Efectos de las operaciones motivadores en una conducta autolesiva mediante las precesiones. Escritos de Psicologia [Online] 8:58-65. Available at: http://dx.doi.org/10.5231/psy.writ.2015.0107.Effects of motivating operations on self-harming behaviour through presessions (Article in Spanish)
This study explored the effects of motivating operations on the self-harming behaviour of a 42-year-old woman with intellectual disabilities. Functional analysis showed that her behaviour was maintained by positive social (attention and tangible) and automatic reinforcement. A multielement design was used to explore presession effects (access to attention and attention deprivation) on the frequency of the behaviour. The results showed that when access to attention was presented to the participant, the frequency of the behaviour decreased, suggesting the action of an abolishing operation. In conclusion, the use of preventive strategies to treat problem behaviours are emphasised, as well as the need for a functional assessment to understand the nature of these behaviours and to design intervention plans aimed at minimizing such behaviour. -
Bradshaw, J. and McGill, P. (2015). Commentary on "Why study the history of learning disability?". Tizard Learning Disability Review [Online] 20:11-14. Available at: http://dx.doi.org/10.1108/TLDR-10-2014-0035.Purpose
â The purpose of this paper is to introduce practitioners and practice-based academics to the relevance of historical study to learning disability research.
Design/methodology/approach
â States need to balance conceptual history against that of learning disabled individuals; reviews existing literature; offers guidelines for prospective historians; gives sample of findings from author's work elsewhere; draws conclusions.
Findings
â Research which is conceptually based and goes back before the rise of the long-stay institutions reveals the historical contingency of learning disability not only as a concept but as a supposed ânatural kindâ, and exposes the more durable historical permanence of the phobia that creates âextreme outgroupsâ.
Originality/value
â Of the very small amount of historical scholarship that engages with conceptual history before the modern era, none of it till now has sought to enquire about the relevance of its findings to current practice. -
McGill, P. (2015). Editorial. Tizard Learning Disability Review [Online] 20:177-178. Available at: http://dx.doi.org/10.1108/TLDR-08-2015-0032.
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McGill, P. (2015). Editorial TLDR (2). Tizard Learning Disability Review [Online] 20:109-110. Available at: http://dx.doi.org.chain.kent.ac.uk/10.1108/TLDR-05-2015-0023.
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McGill, P. (2015). Editorial. Tizard Learning Disability Review [Online] 20:53-53. Available at: http://dx.doi.org/10.1108/TLDR-02-2015-0004.
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Deveau, R., McGill, P. and Poynter, J. (2015). Characteristics of the most expensive residential placements for adults with learning disabilities in South East England: a follow-up survey. Tizard Learning Disability Review [Online] 20:97-102. Available at: http://dx.doi.org/10.1108/TLDR-01-2015-0003.Purpose
â The purpose of this paper is to investigate the characteristics of the highest cost residential placements provided for adults with learning disabilities in the South East of England, comparing findings with a previous survey.
Design/methodology/approach
â Lead commissioners for NHS and Local Authority teams in the South-East of England were asked to provide information on the five highest cost placements that they currently commissioned.
Findings
â The average placement cost was £200,000 per annum with a range from £81,000 to £430,000 per annum. Individual characteristics of people placed were broadly similar to those identified in previous studies.
Originality/value
â Significant resources are used to support relatively few individuals. These individualsâ needs and characteristics suggest areas for research and practice development. -
Langthorne, P., McGill, P. and Oliver, C. (2014). The motivating operation and negatively reinforced problem behavior. A systematic review. Behavior Modification [Online] 38:107-159. Available at: https://doi.org/10.1177/0145445513509649.The concept of motivational operations exerts an increasing influence on the understanding and assessment of problem behavior in people with intellectual and developmental disability. In this systematic review of 59 methodologically robust studies of the influence of motivational operations in negative reinforcement paradigms in this population, we identify themes related to situational and biological variables that have implications for assessment, intervention, and further research. There is now good evidence that motivational operations of differing origins influence negatively reinforced problem behavior, and that these might be subject to manipulation to facilitate favorable outcomes. There is also good evidence that some biological variables warrant consideration in assessment procedures as they predispose the person's behavior to be influenced by specific motivational operations. The implications for assessment and intervention are made explicit with reference to variables that are open to manipulation or that require further research and conceptualization within causal models.
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Deveau, R. and McGill, P. (2014). Leadership at the front line: impact of practice leadership management style on staff experience in services for people with intellectual disabilities and challenging behaviour. Journal of Intellectual and Developmental Disability [Online] 39:65-72. Available at: http://dx.doi.org/10.3109/13668250.2013.865718.Background The aim of this research was to explore the impact of a particular management style called practice leadership upon the experience of staff working in services for people with intellectual disability and challenging behaviour. Such staff have been shown to experience high stress and lack of job satisfaction. Support by the immediate manager may be an important ameliorating factor. However, style of manager support requires further exploration.
Method A single point-in-time survey of staff in adult residential services within the South East of England collected data on practice leadership, stress, and positive work experiences.
Results Practice leadership was positively associated with lower stress, greater positive work experiences for staff, and more strongly associated with âdevelopmentalâ than âsupportiveâ leadership. Effect sizes were small to medium.
Conclusions Staff experience of working in challenging environments may be improved by style of front-line leadership. However, further conceptualisation and research of staff experience and practice leadership is required. -
McGill, P. (2014). Tizard Learning Disability Review Editorial 19 (3). Tizard Disability Learning Review [Online] 19:0-0. Available at: http://dx.doi.org/10.1108/TLDR-04-2014-0010.
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McGill, P. (2014). Tizard Learning Disability Review Editorial 19 (4). Tizard Disability Learning Review [Online] 19:0-0. Available at: http://dx.doi.org/10.1108/TLDR-07-2014-0025.
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McGill, P. (2014). Tizard Learning Disability Review Editorial 19 (1). Tizard Disability Learning Review [Online] 19:0-0. Available at: http://dx.doi.org/10.1108/TLDR-10-2013-0044.
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McGill, P. (2014). Tizard Learning Disability Review 19 (2). Tizard Disability Learning Review [Online] 19:0-0. Available at: http://dx.doi.org/10.1108/TLDR-01-2014-0004.
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Allen, D. et al. (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.Abstract:
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. -
Gore, N. et al. (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. -
Simó-Pinatella, D. et al. (2013). Types of motivationg operations in interventions with problem behaviour: a systematic review. Behavior Modification [Online] 37:3-38. Available at: http://dx.doi.org/10.1177/0145445512448096.A motivating operation (MO) alters both the effectiveness of a stimulus as a reinforcer and the current frequency of all behavior that has been reinforced by that particular stimulus. This article reviews studies that have manipulated a MO during interventions with school-age participants with intellectual disabilities and problem behavior. A systematic review was conducted using the following major electronic databases: PsychInfo, Education Resources Information Center, Science Direct, Blackwell, SAGE, and Medline. A total of 31 published articles representing 55 participants was examined. Findings from this study suggest that the modification of a MO usually has an effect on the problem behavior by either establishing or abolishing its motivation. Furthermore, a relationship was found between the type of MO and the behavioral function identified. The theoretical and practical implications of these findings, limitations of this study and potential issues for future research are discussed.
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Hastings, R. et al. (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. -
Denne, L. et al. (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. -
MacDonald, A. and McGill, P. (2013). Outcomes of staff training in positive behaviour support: a systematic review. Journal of Developmental and Physical Disabilities [Online] 25:17-33. Available at: http://dx.doi.org/10.1007/s10882-012-9327-8.Positive Behavior Support has been shown to be effective in minimizing challenging behavior. Therefore training staff in Positive Behaviour Support would appear to be helpful in improving support to people with challenging behavior. The purpose of this review was to evaluate the research on the outcomes of Positive Behavior Support training. There are no other published reviews of Positive Behavior Support training outcomes. Searches were carried out using key words to identify studies which reported on Positive Behavior Support training. Following this, studies were evaluated against criteria for inclusion. 14 studies were identified by the review. Six studies focused on outcomes for staff. Four focused on outcomes for service users. Four studies reported outcomes for both staff and service users. Staff outcomes included changes in skills, confidence, knowledge, attributions and emotional responses. Service user outcomes demonstrated reduction in levels of challenging behaviour, but no evidence of change in quality of life was evident in the one study that evaluated this. Research demonstrates that Positive Behavior Support training has had a positive impact on knowledge, emotional responding, and attributions of staff. In addition, there is evidence of reductions in levels of challenging behaviour from service users. However, no evidence was found for Positive Behavior Support training having a positive impact on quality of life for service users.
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McGill, P. et al. (2012). Investigating naturally occurring variability in challenging behaviour - the Ecological interview. International Journal of Positive Behavioural Support [Online] 2:20-30. Available at: http://www.ingentaconnect.com.chain.kent.ac.uk/content/bild/ijpbs/2012/00000002/00000002/art00003.Background: This article presents the Ecological Interview (EI), a measure of variability in challenging behaviour, and includes some brief information on its development and research.
Method and materials: The EI was developed as part of a research project on naturally occurring variability in challenging behaviour. Drawing from previous measures, it gathers information from carers on the relative likelihood of challenging behaviour across a range of antecedent situations and events.
Results: Research carried out to date suggests the EI provides reliable, moderately valid and potentially generalisable data.
Conclusions: The EI may have a range of uses in clinical practice and research. Further study of its validity is warranted. -
Langthorne, P. and McGill, P. (2012). An indirect examination of the function of problem behaviour associated with Fragile X Syndrome and Smith-Magenis Syndrome. Journal of Autism and Developmental Disorders [Online] 42:201-209. Available at: http://dx.doi.org/10.1007/s10803-011-1229-6.Fragile X syndrome (FXS) and Smith-Magenis syndrome (SMS) are associated with a number of specific topographies of problem behavior. Very few studies have examined the function served by problem behavior in these groups. Using the Questions About Behavioral Function scale Matson and Vollmer (Userâs guide: questions about behavioral function (QABF). Scientific Publishers Inc., Baton Rouge, LA, 1995) the current study examined group differences in the function of problem behavior displayed by children with FXS and SMS, in comparison to a control group of children with non-specific intellectual and developmental disabilities. Between-group analyses showed children with SMS were more likely to display problem behavior related to physical discomfort. Both within- and between-group analyses showed children with FXS were less likely to display attention-maintained problem behavior. These findings hold implications for the assessment, treatment and prevention of problem behavior associated with both FXS and SMS.
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Barratt, N., McGill, P. and Hughes, C. (2012). Antecedent influences on challenging behaviour: a preliminary assessment of the reliability, generlisability and validity of the Ecological overview. International Journal of Positive Behavioural Support [Online] 2:31-41. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2012/00000002/00000002/art00004.Background: People with intellectual disabilities who display challenging behaviour are often exposed to a range of negative outcomes, including social and material deprivation, abusive practices and disruption to family life. Several studies have linked specific antecedent events to the occurrence of challenging behaviour.
Method and materials: The present study describes the further development of an indirect method of identifying antecedent influences on challenging behaviour by assessing the reliability, generalisability and validity of the Ecological Interview (EI). Twenty care workers providing direct support to individuals with intellectual disabilities and challenging behaviour were interviewed using the EI.
Results: The EI has good test-retest reliability and generalisability, and moderate validity.
Conclusions: The results of the study are discussed in terms of their implications for clinical practice and future research, and recommendations are made regarding alternative methods of assessing validity. -
Triantafyllopoulou, P., Murphy, G. and McGill, P. (2012). Carer's views of sleep disorders in adults with intellectual disabilities. Journal of Intellectual Disability Research [Online] 56:671-671. Available at: http://dx.doi.org/10.1111/j.1365-2788.2012.01583_3.x.
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McGill, P. and Poynter, J. (2012). High cost residential placements for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 25:584-587. Available at: http://dx.doi.org/10.1111/j.1468-3148.2012.00689.x.Background Concern has been expressed repeatedly
about the cost and quality of residential placements for
adults with learning disabilities and additional needs.
This study sought to identify characteristics of the highest cost placements in the South-East of England.
Method Lead learning disability commissioners in the
South-East of England were asked to provide information
about the ?ve highest cost residential placements that
they commissioned for adults with learning disabilities.
Results The average placement cost of £172k per annum
disguised wide variation. Individuals placed were
mainly young and male with high rates of challenging
behaviour and ? or autism spectrum disorder. Most
placements were in out-of-area residential care. The
highest costs were associated with hospital placements
and placements for people presenting challenging
behaviour.
Conclusions Young, male adults with learning disability,
challenging behaviour and ? or autism continue to receive
very high cost residential support, often in out-of-area
residential care. There remains limited evidence of plans
to redirect resources to more local service developments. -
Langthorne, P. et al. (2011). Examining the function of problem behavior in Fragile X Syndrome: preliminary experimental analysis. Examining the function of problem behavior in Fragile X Syndrome: preliminary experimental analysis [Online] 116:65-80. Available at: http://dx.doi.org/10.1352/1944-7558-116.1.65.Fragile X syndrome is the most common inherited cause of intellectual and developmental disability. The influence of environmental variables on behaviors associated with the syndrome has received only scant attention. The current study explored the function served by problem behavior in fragile X syndrome by using experimental functional analysis methodology with 8 children with fragile X. No child met criteria for attention-maintained problem behavior, 5 children met criteria for escape-maintained problem behavior, and 4 children met criteria for tangible-maintained problem behavior. Results are discussed and compared with previous findings on the function of problem behavior in fragile X syndrome, and implications for intervention are discussed. It is noted that the external validity of these findings is limited by the small sample size.
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McGill, P. and Poynter, J. (2011). How much will it cost? Characteristics of the most expensive residential placements for adults with learning disabilities. Tizard Learning Disability Review [Online] 16:54-57. Available at: http://dx.doi.org/10.5042/tldr.2011.0170.It is widely known that a relatively small number of very expensive, often out-of-area, placements consume a relatively large proportion of the social care budget. Valuing People Now (DH, 2009) acknowledged that too often people are sent to expensive out-of-area placements. There is, however, little research in this area and no routinely collected information. In this collaborative piece of work between the Valuing People Now Team, the Challenging Behaviour National Strategy Group and the Tizard Centre we aimed to identify the characteristics of the highest-cost placements in the South-East of England
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MacDonald, A., McGill, P. and Deveau, R. (2011). "You squeal and squeal but they just hold you down" Restrictive physical interventions and people with intellectual disabilities: service user views. International Journal of Positive Behavioural Support [Online] 1:45-52. Available at: http://www.ingentaconnect.com/content/bild/ijpbs/2011/00000001/00000001/art00006.Background: The experiences of service users who have been subject to restrictive physical interventions are largely unreported in the literature. Those studies that do exist report mainly negative emotions and responses.
Method: A qualitative method was used to analyse eight semi- structured interviews with service users who had either directly experienced or had witnessed restrictive physical interventions.
Results: The findings suggest that service users experience restrictive physical interventions as painful, emotionally distressing, and as indistinguishable from abuse, or from general violence in the environment. Service users attributed mixed motivations to staff and did not feel that restrictive physical interventions were justified; they also made practical suggestions for more positive alternatives.
Conclusions: This study adds to a growing literature pointing to the adverse effects of restrictive physical interventions. Practitioners should seek to reduce the need for the use of such interventions through the broader application of proactive approaches to positive behaviour support.
Book section
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McGill, P. (2015). Understanding of Challenging Behaviour and Positive Behaviour Support. in: Shimizu, N. and Gera., H. eds. Understanding of Challenging Behaviour and Positive Behaviour Support. Tokyo: The Earth Kyokushinsha, pp. 13-16.
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Allen, D., McGill, P. and Smith, M. (2015). The role of positive behaviour supports in reducing the use of restrictive practices. in: Liberman, R. P. and LaVigna, G. W. eds. New Directions in the Treatment of Aggressive Behavior for Persons with Mental and Developmental Disabilities. Nova Science Publishers, pp. 391-413. Available at: https://www.novapublishers.com/catalog/product_info.php?products_id=56150.
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McGill, P. (2015). Understanding Challenging Behaviour. in: Shimizu, N. and Gera, H. eds. Understanding of Challenging Behaviour and Positive Behaviour Support. Tokyo: The Earth Kyokushinsha, pp. 17-21.
Conference or workshop item
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Chantziara, S. et al. (2017). Investigating the need for life skills training among young people with autism and their carers. in: International Society for Autism Research.
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Chantziara, S. et al. (2017). Passport to life: Investigating the need for life skills training among young people with autism and their carers. in: European Association for Mental health in intellectual Disability.
Monograph
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Gore, N. et al. (2015). Residential school placements for children and young people with intellectual disabilities: their use and implications for adult social care. School of Social Care Reseach NIHR. Available at: http://sscr.nihr.ac.uk/PDF/ScopingReviews/SR10.pdf.Out of area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. In recent years there has been an increased drive to reduce such placements at as early a stage as possible. In this context the current review collates research and policy regarding use of residential schools for children and young people with intellectual disabilities and transition from these settings to adult services. The review highlights that relatively little is known about both use of, and transition from, residential schooling for children and young people with intellectual disabilities in the UK. Thirteen articles are identified: 7 examining the child or familiesâ experiences before placement, 4 examining outcomes during the placement, and 4 examining the process of transitioning from the placement and longer term outcomes. The methodological quality of articles was often limited. A lack of control groups, independent samples, or adequate sample sizes was particularly notable. Results are discussed in relation to factors that lead to a childâs placement in a residential school, children and familiesâ experiences of the placement, and outcomes following placement, including the transition process. A number of research priorities are highlighted based on gaps in the literature. Examples of alternative forms of support from clinical practice are provided, with recognition that a multi-element model is likely to be needed to provide high quality support to this group of young people.
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Emerson, E. et al. (2014). Estimating the number of children in England with learning disabilities and whose behaviours challenge. Challenging Behaviour Foundation.
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Cooper, V. et al. (2014). Early intervention for children with learning disabilities whose behaviour challenges. Briefing Paper. Challenging Behaviour Foundation.
Forthcoming
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Deveau, R. and McGill, P. (2019). Staff experiences working in community-based services for people with learning disabilities who show behaviour described as challenging: the role of management support. British Journal of Learning Disabilities [Online]. Available at: https://onlinelibrary.wiley.com/journal/14683156.Introduction: Research has shown a positive relationship between practice leadership (frontline management focused upon supporting staff to work better) and better staff experiences of working with people with learning disabilities who may show challenging behaviours. However, little is known regarding the impact of frequency and accessibility of frontline managerial support upon staff experiences, or upon the provision of practice leadership. Current policy and practice in England may lead to frontline managers being responsible for more fragmented services, thus influencing the accessibility of managerial support and practice leadership for staff. The current study investigated the impact on staff experiences of: frequency of contact with service manager and of practice leadership.
Methods: A single point in time survey of 144 staff measured: characteristics of service users, frequency of contact with manager, practice leadership and staff experiences e.g. burnout, teamwork and job satisfaction.
Results: Practice leadership was positively associated with more frequent contact with the manager. Better staff experiences were associated with more frequent contact with the manager and practice leadership and negatively with challenging behaviours.
Conclusion: The associations between practice leadership, manager contact and better staff experiences suggests further research and organisational action is needed to provide management support for staff. -
Chase, J. and McGill, P. (2019). The Sibling's Perspective: Experiences of Having a Brother or Sister with an Intellectual Disability and Behaviour Described as Challenging. Tizard Learning Disability Review [Online]. Available at: https://www.emeraldinsight.com/journal/tldr.
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