Portrait of Professor Peter McGill

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.  

See Peter's profile on Youtube

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 121 total publications in the Kent Academic Repository. View all publications.

Article

  • Deveau, R., Gore, N. and McGill, P. (2019). Senior manager decision‐making and interactions with frontline staff in intellectual disability organisations: A Delphi study. Health and Social Care in the Community [Online]. Available at: https://doi.org/10.1111/hsc.12842.
  • 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] 32:762-778. 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.
  • 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] 24:138-146. Available at: https://doi.org/10.1108/TLDR-11-2018-0032.
    Purpose

    Siblings of individuals with disabilities provide the most long-term care for an individual with disabilities, yet research on their experiences is limited. A majority of previous research focuses on young siblings from a parent’s viewpoint. The purpose of this paper is to investigate the effects of having a sibling with a disability and behaviour described as challenging from adult siblings’ perspectives.
    Design/methodology/approach

    Six adult siblings of individuals with intellectual disabilities and behaviour described as challenging were interviewed about their responsibilities pertaining to their sibling, family relationships and the support that had been provided. The study used semi-structured interview methodology based on interview questions from previous research.
    Findings

    Siblings described a multifaceted impact on their lives. They attributed aspects of their career choices, personal characteristics and family dynamics to having a sibling with a disability and behaviour that challenges. Siblings stressed the inadequate support that they have received throughout their lives. They are, in a sense, the invisible carers for their sibling but they are perceived by society as just a sibling. Siblings described an optimistic perspective on their lives, even though they expressed the difficulties that they have faced.
    Research limitations/implications

    Due to the recruitment process and limited demographic of the participants, the findings may not be generalisable to the general population of siblings of individuals with disabilities. Further research should focus on a broader population.
    Practical implications

    This study reinforces the need for more support for siblings of individuals with disabilities in childhood and in adulthood.
    Originality/value

    This paper provides perspectives of individuals that have not been fully represented in previous research.
  • 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://doi.org/10.1111/bld.12280.
    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.
  • 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 caregiver’s 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.
  • 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] 27:172-222. 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 38:1311–1319, 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.
  • 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://dx.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.
  • McGill, P., Vanono, L., Clover, W., Smyth, E., Cooper, V., Hopkins, L., Barratt, N., Joyce, C., Henderson, K., Sekasi, S., Davis, S. and Deveau, R. (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] 81:143-154. Available at: https://dx.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 organisation’s 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 8–11 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 12–18 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.
  • Tomlinson, S., McGill, P., Gore, N. and Humphreys, J. (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: 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: 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 – 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 – 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.
  • 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 staff’s 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.
  • 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
  • McGill, P. (2016). Editorial. Tizard Learning Disability Review [Online] 21. Available at: http://www.emeraldinsight.com/doi/full/10.1108/TLDR-01-2016-0004.
  • 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.
  • Simó-Pinatella, D., Alomar-Kurz, E., Font-Roura, J., Gine Gine, C. and McGill, P. (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.
  • 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.
  • 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
    – 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
    – 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
    – 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
    – Significant resources are used to support relatively few individuals. These individuals’ needs and characteristics suggest areas for research and practice development.
  • 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
    – 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
    – 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
    – 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 “natural kind”, and exposes the more durable historical permanence of the phobia that creates “extreme outgroups”.

    Originality/value
    – 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.
  • 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.
  • 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.
  • McGill, P. (2015). Editorial. Tizard Learning Disability Review [Online] 20:53-53. Available at: http://dx.doi.org/10.1108/TLDR-02-2015-0004.
  • 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.
  • McGill, P. (2015). Editorial. Tizard Learning Disability Review [Online] 20:177-178. Available at: http://dx.doi.org/10.1108/TLDR-08-2015-0032.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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 “developmental” than “supportive” 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.
  • 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.
  • Simó-Pinatella, D., Font-Roura, J., Planella-Morató, J., McGill, P., Alomar-Kurz, E. and Giné, C. (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.
  • 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.
    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.
  • 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.
  • 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.
  • 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.

Book section

  • Murphy, G. and McGill, P. (2020). Challenging Behaviours in People with Intellectual Disabilities. In: Bhaumik, S. and Alexander, R. eds. Oxford Textbook of the Psychiatry of Intellectual Disability. Oxford University Press. Available at: https://global.oup.com/academic/product/oxford-textbook-of-the-psychiatry-of-intellectual-disability-9780198794585?cc=gb&lang=en&#.
    This chapter provides definitions of challenging behaviour and reviews the evidence on prevalence and long term risk factors in challenging behaviour. The chapter then considers behavioural assessment and interventions for those with severe and profound disabilities, delineating a practical method for analysing and intervening with referrals.
  • 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.
  • 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.
  • 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.

Conference or workshop item

  • Chantziara, S., Krska, J., McGill, P. and Bratt, A. (2017). Investigating the need for life skills training among young people with autism and their carers. In: International Society for Autism Research.
  • Chantziara, S., Krska, J., McGill, P. and Bratt, A. (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

  • Gore, N., Brady, S., Cormack, M., McGill, P., Shurlock, J., Jackson-Brown, F., Reid, C., Singh, R., Legge, A., Saville, M. and Wedge, S. (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 families’ 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 child’s placement in a residential school, children and families’ 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.
  • Cooper, V., Emerson, E., Glover, G., Gore, N., Hassiotis, A., Hastings, R., Knapp, M., McGill, P., Oliver, C., Pinney, A., Richards, C., Iemmi, V. and Shurlock, J. (2014). Early Intervention for Children With Learning Disabilities Whose Behaviour Challenges. Briefing Paper. Challenging Behaviour Foundation.
  • Emerson, E., Hastings, R., McGill, P., Pinney, A. and Shurlock, J. (2014). Estimating the Number of Children in England With Learning Disabilities and Whose Behaviours Challenge. Challenging Behaviour Foundation.

Thesis

  • Oliver, D. (2020). The Development of Palliative Care for People With Progressive Neurological Disease.
    The role of palliative care for people with neurological disease has been developing for over 50 years, and was described from the early days of the modern hospice movement. This thesis considers my papers and studies which have helped in establishing the need for palliative care, the involvement of specialist palliative care services, the effectiveness of palliative care for neurological patients, the importance of complex decision making for this patient group and the development of guidelines, to enable care to be more widely established for patients and families. These papers have developed from the evidence from earlier research and the experience of hospices and specialist palliative care teams and helped to encourage further research. They have been important in providing an evidence-base for neurological palliative care and support-ed a wider recognition of the role of palliative care for people with neurological disease. The re-search reported here demonstrates how the increasing collaboration between specialist palliative care services and neurology can result in improved care of patients with neurological dis-ease, together with their families.
  • Chantziara, S. (2019). Life Skills Provision in the UK for Young People With Autism Spectrum Disorders: An Investigation of the Views and Needs of Parents, Young People and Education Providers.
    The aim of the thesis was to investigate life skills provision for high functioning young people with ASDs and to contribute to the development of future school-based interventions. A mixed methods design including two qualitative and one quantitative study was employed. Semi-structured interviews were conducted with young people with ASDs and their parents to obtain their views and experiences in relation to life skill training they have received, their aspirations for adulthood and needs for future training. Interviews were followed by focus groups with education providers to explore their views with regards to life skills training they offer and their recommendations for improvements. Findings from these two studies provided the basis for the design of two questionnaires aiming to further investigate and compare the views and experiences among parents and education providers. Parents and young people expressed a strong need for individualization of life skills support. Parents voiced a request for mentoring/befriending while young people asked for assistance with peer-relationships. There were also signs of parental conflict regarding their involvement in the support. Schools appeared to be corresponding to this need for individualization. They exerted great efforts to meet the specific needs of their pupils, and tried to incorporate life skills training into daily activities. However, support was applied in an informal, impromptu way, at the expense of more structured and effective programs. Furthermore, the involvement of neurotypical peers and parents in the support encountered obstacles, thus limiting the opportunities for generalization of the learned skills. Improving co-operation between schools and parents could be the first step in advancing school provisions. Emphasis should be placed on individualized support while also making use of evidence-based practices. Schools could also provide more hands-on support with peer-relationships and make use of "natural" opportunities available for practising life skills. Future interventions, should further investigate the involvement of neurotypical peers in life skills training and the effectiveness and applicability of mentoring /befriending, particularly within a school setting. The role of parents in the support should also be negotiated in each case as they may not always perceive their involvement as desirable or beneficial.
  • Hurman, M. (2017). Exploring the Relationships of People With an Intellectual Disability and Their Support Staff: To What Extent Is Rapport a Useful and Measurable Concept?.
    Background Research interest in exploring the quality of relationships 'rapport' between people with an intellectual disability (ID) and those that support them is slowly expanding. People with ID, particularly those that present a challenge to others, are more likely to experience abuse; consequently they have been the subject of many service scandals. People with little or no verbal language are likely to struggle to tell others that relationships with staff or family carers have deteriorated to the point of becoming abusive.
    The limited research available indicates that rapport with staff is associated with reductions in behaviour described as challenging, particularly when the behaviour serves a demand avoidance function.
    Despite some suggestions of how people with ID and limited language, may show that the relationship with carers is of a good quality there was no observational method of obtaining this information.

    Method A systematic review was conducted and literature used to design an observational method of rapport measurement, the IRM. Participants with ID were filmed in the presence of SP. Alongside the filmed observations staff completed the Staff Rating of Other Staff, Staff Self- Rating of Rapport and took part in Preference Testing Sessions (McLaughlin and Carr, 2005). Filmed material was analysed using the IRM. The IRM was subsequently developed into the easier to use Rapport Rating Scale (RRS). The RRS and measures used in the original IRM study were piloted by clinicians and reviewed in focus groups over an 8 month period.

    Results Literature searches found that there is very little research that has directly examined rapport between people with intellectual disabilities and staff or unpaid carers. Consequently concepts similar to rapport were examined and identified some material useful to the development of the IRM. Most concepts asserted that it is possible to see observable changes in participants with ID when rapport with staff or unpaid carers is developed.
    The IRM study showed, higher average IRM scores for the SP in the good rapport groups when compared to each of the McLaughlin and Carr (2005) measures. Analysis of the easier to use RRS indicated that professionals and trainees, were able to use the RRS to discriminate between good, neutral or poor rapport towards carers

    Conclusions Using rapport measures in clinical practice, suggests that clinicians supporting people with ID were able to use rapport measurement tools successfully. For a number of clinicians the content of the Positive Behaviour Support plan was altered or enhanced through the rapport information collected during assessment. There are implications of understanding and the ability to measure rapport between people with ID and staff, on, clinical practice, staff training, service development and the wider policy agenda.
  • MacDonald, A. (2016). An Evaluation of Staff Training in Positive Behaviour Support.
    AIMS: Challenging behaviour is common for many people with learning disabilities and has a negative impact on the lives of these individuals. It is linked to decreased levels of support from staff, reduced opportunities for inclusion in the community, use of restrictive interven-tions, and placement breakdown. Equipping staff with the necessary knowledge, skills and experience to support people with challenging behaviour in a positive, respectful and effec-tive way has proved a challenge for care agencies. Positive Behaviour Support (PBS) has been shown to be effective in minimising challenging behaviour. The aim of this study was to evaluate the impact of training managers of social care services in PBS. METHOD: A longitudinal training programme in PBS was delivered to 50 managers of community-based services for people with learning disabilities and challenging behaviour. The training pro-gramme lasted a year; 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 which was sustained over time. However, there was no change in quality of life for service users, and very limited changes in staff support to ser-vice users. CONCLUSION: This study has demonstrated that training managers in PBS can have a positive impact on challenging behaviour in people with learning disabilities. There are a number of aspects to the results which are unexpected and these are discussed with ref-erence to the relevant literature.
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