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

Angela Hassiotis,Michael King,Rachael Hunter,Vivien Cooper,Victoria Vickerstaff,William Howie,Jason Crabtree,Ian Hall,Andre Strydom,Rumana Omar,Mike Crawford,Asit Biswas

doi:10.1186/s12888-014-0219-6

Abstract

BackgroundMany people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services.MethodThe study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS.DiscussionThe study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour.Trial registrationThis trial is registered with Clinical Trials.gov (Ref NCT01680276).Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0219-6) contains supplementary material, which is available to authorized users.

Highlights

Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities
We argue that a rigorous evaluation of the clinical and cost effectiveness of Positive Behaviour Support (PBS) delivered by appropriately trained staff is long overdue
A reduction of 0.45 of a standard deviation on the Aberrant Behaviour Checklist (ABC) score in the ABC group compared to the Treatment as usual (TAU) group is considered to be clinically important

Summary

Introduction

Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services. There are few well conducted RCTs and the findings of those that have been carried out are inconclusive; most notably, a trial of antipsychotics showed that they were no more effective than placebo [13] in reducing challenging behaviour. A naturalistic follow-up for two years after randomisation showed a sustained positive effect of the intervention on challenging behaviour [12]. An additional qualitative exploration of the opinions of those involved in the trial (patients, carers and staff) revealed that there was strong support for clinical trials as a method of evaluating psychological therapies to treat challenging behaviour [14]

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