Positive Behavior Support Training Research Articles

Student challenging behavior with a positive behavior support training for teachers: A case study

<span lang="EN-US">Challenging behavior is repetitive behavior that risks interfering with learning or involvement in prosocial interactions. Challenging behaviors are often shown by students and difficult to manage, such as: defiance and noncompliance, destruction, disruption, physical aggression, self-injury, social withdrawal, socially inappropriate behavior, stereotypes, and verbal aggression. One of the ways of good classroom management is through Tier 1 Positive Behavior Support (PBS) training. It is very necessary for students and teachers when they are in the school environment because it can create a conducive classroom atmosphere. Therefore, the researcher designed a Tier 1 PBS training program that focuses on the teacher’s ability to manage the classroom using a proactive strategy as opposed to a reactive strategy. The subjects of this training were seven teachers of Islamic junior high school in Central Java, Indonesia. The experimental design was conducted without using a control group and using pre-test and post-test for evaluation. The findings indicated that Tier 1 PBS training is effective in increasing the ability of teachers to use proactive classroom management strategies and reducing the use of reactive classroom management strategies.</span>

Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial.

Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs). We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276). We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective. Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold. There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.

Study raises questions about how to deliver training in positive behaviour support

A major, multicentre, longitudinal English study has reported on the clinical outcomes achieved for 246 people with learning disabilities, across 23 specialist community services.

Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial.

Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability. Aims To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276). We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants. No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = -2.14, 95% CI: -8.79, 4.51) or secondary outcomes. Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour. Declaration of interest None.

Training clinical psychologists to be fit to deliver positive behavioural support

This article is based on a presentation given to the DCP Group of Trainers in Clinical Psychology (GTiCP) Annual Conference in Stratford-upon-Avon in November 2016. It sets out the background for training in Positive Behaviour Support (PBS) as part of clinical psychology training and examines current training practice as well as areas for development.

Commentary on “Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations”

Purpose – The purpose of this paper is to provide a commentary on Stocks and Slater’s paper, “Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations”. Design/methodology/approach – This is a narrative review of staff training in positive behaviour support (PBS) and challenging behaviour, drawing on Stocks and Slater’s paper and the core staff competencies outlined in the PBS Competence Framework (PBS Coalition, 2015). Findings – Taking into consideration multiple outcome measures, including staff outcomes such as self-efficacy, changes in staff behaviour, and the impact on quality of life for service users, may provide a broader insight into the effects of staff training. Supports and systems such as hands-on training, supervision, and practice leadership are also important factors that are likely to lead to positive service user and staff outcomes. Originality/value – This commentary reflects on Stocks and Slater’s paper in the broader context of staff training outcomes and factors that contribute to high-quality services for people with learning disabilities and challenging behaviour.

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.

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.

Guidance introduces training in positive behaviour support

Guidance introduces training in positive behaviour support

Outcomes of Staff Training in Positive Behaviour Support: A Systematic Review

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.

Increasing Teachers’ Use of Praise with a Response-to-Intervention Approach

A multiple baseline design across teachers was used to evaluate the effects of a systematic, response-to-intervention (RTI) approach on rates of desired teacher behavior. Specifically, teachers whose rates of specific, contingent praise were nonresponsive to typical schoolwide positive behavior support training (primary intervention tier) were provided with targeted training support (secondary tier), and, when necessary, more individualized assistance (tertiary tier). In addition, composite student behavior was examined to determine if concurrent changes in student problem behaviors occurred as teachers responded to differentiated training supports. Results indicate a relationship between an RTI approach to differential levels of performance feedback and teachers’ rates of praise.

Staff Training in Positive Behaviour Support: Impact on Attitudes and Knowledge

Background Positive behavioural support is increasingly viewed as the preferred service approach for people who challenge, but skills are insufficiently widespread. The need for effective staff training has been highlighted as a key factor in high quality service provision, with investigators recommending a multidimensional approach to increase effectiveness and produce changes in work performance.Method Attitudes and knowledge of registered (qualified nurses) and non‐registered (unqualified nursing assistants) staff in specialist health care services were assessed via self‐completion questionnaires before and after the delivery of a newly accredited taught course in PBS and at a 1‐year follow‐up.Results Significant increases in knowledge were evident immediately after the training for both groups, with further increases evident over time for the non‐registered staff who completed the qualification. Initial changes in attributions immediately after training reverted to baseline levels over time. Enduring change occurred in perceived confidence, which significantly increased both for registered and non‐registered staff.Conclusions The training had a positive effect on knowledge and perceived confidence but little enduring effect on attributions or emotional responses. The importance of training conducted in conjunction with allied changes in organizational systems to ensure ongoing management attention is discussed.

Impact of Extended Education/Training in Positive Behaviour Support on Staff Knowledge, Causal Attributions and Emotional Responses

Background This study sought to gather information about the impact of extended training in positive behaviour support on staff knowledge, causal attributions and emotional responses.Methods Students completed questionnaires at the beginning, middle and end of a University Diploma course to measure changes in their knowledge of challenging behaviour, their causal attributions and their emotional responses.Results Students’ knowledge significantly increased across the three data points. Students became less likely to attribute challenging behaviour to emotional causes. Changes in respect of making more behavioural attributions varied across different measures. Negative emotional responses reduced especially those related to depression/anger.Conclusions The training course presented here was associated with changes in student knowledge, attributions and emotional responses that are likely to be associated with better staff performance and better outcomes for people with intellectual disabilities.

Service User Outcomes of Staff Training in Positive Behaviour Support Using Person‐Focused Training: A Control Group Study

Background Effectively supporting individuals with intellectual disabilities who display challenging behaviours continues to be a priority for service providers. Person‐focused training (PFT) is a model of service delivery which provides staff with skills in functional assessment and intervention development. Existing longitudinal data from a study of 138 cases suggest that implementation of staff‐developed behaviour support plans through PFT is effective in reducing challenging behaviour in approximately 77% of cases [McClean et al.Journal of Intellectual Disability Research (2005) vol. 49, pp. 340–353]. However, no control group was used in this study.Method The current study involves the use of a control group of individuals with challenging behaviours matched against those selected for PFT over a 6‐month period. Groups were matched on type of challenging behaviour, duration of challenging behaviour, gender and level of disability. Information on the frequency, management difficulty and severity of challenging behaviour was collected pre‐ and post‐training using the Checklist of Challenging Behaviours (CCB) for both groups. Observational data were collected for the target group alone. Rates of psychotropic medication were tracked across the training period.Results Significant reductions in the frequency, management difficulty and severity of challenging behaviour were found for service users in the target group but not in the control group after 6 months. No significant changes were found in the use of psychotropic medication for either group over the 6‐month period.Conclusion Overall results suggest that PFT is an effective model for providing support to individuals with challenging behaviours.

Review of the Positive Behavior Support Training Curriculum

In the past several years, the values and practices of positive behavior support (PBS) have had a significant impact on services provided to adults and children with disabilities. Evidence of this impact can be seen in federal grants and laws such as the Individuals with Disabilities Education Act Amendments of 1997 (IDEA, 1997), a professional journal (the Journal of Positive Behavior Interventions), and an established organization (the Association for Positive Behavior Support). With this emergence comes a continued need for clearly defining PBS, identifying the skills evident in a competent practitioner, and effectively teaching those skills to supervisors, teachers, direct support staff, and other professionals. It is with these concerns in mind that we will review the training materials Positive Behavior Support Training Curriculum: Supervisory and Direct Support Editions (PBS-TC).

Staff Training in Positive Behaviour Support: Research into Practice

Staff Training in Positive Behaviour Support: Research into Practice