The impact of behavioural skills training on the knowledge, skills and well‐being of front line staff in the intellectual disability sector: a clustered randomised control trial (original) (raw)
Related papers
Staff Training in Intellectual and Developmental Disability Settings: a Scoping Review
Journal of Developmental and Physical Disabilities, 2019
Frontline staff are a valuable asset within an intellectual and developmental disability service. Their work dictates the overall standard of care delivered by the organization. However, there is evidence that the research relating to effective practice is having little impact on the competencies displayed by staff in the realworld setting. Therefore, a scoping review of published literature was conducted to investigate potential explanations for the inadequate dissemination of evidencebased practice in this sector. Systematic searches of relevant databases identified 156 papers for inclusion in the review. Practices in which staff were trained were categorized as either behavioral interventions or "other" interventions. The behavioral category was subdivided into: a) assessment; b) antecedent; c) consequence and, d) "mixed" practices. Although the studies reviewed provided staff training across a range of practices, many empirically supported interventions were not utilized. Despite rigorous scientific support for strategies such as functional communication training and noncontingent reinforcement, the literature did not robustly evaluate effective protocols to disseminate these practices to frontline staff. The review also highlighted a continued reliance on individualized training packages, rather than the implementation of empirically supported training models. Finally, results showed that a relatively small number of included studies examined the impact of staff training on service user outcomes and adult service users were underrepresented across all intervention categories. Findings provide a potential explanation for the apparent disconnect between theoretical advancements and practice in the applied setting and are discussed in relation to approaches to staff training.
Research and Practice in Intellectual and Developmental Disabilities, 2017
Problems have been identified in the provision of on-the-job training for people with disabilities. The aim of this study was to investigate staff knowledge and use of appropriate training strategies, and the perceptions of employees with intellectual disabilities of the on-the-job training. Three staff and four employees with intellectual disabilities working in one Australian Disability Enterprise participated in the study. Questionnaires, interviews, and examination of training documentation were used to examine the provision of on-the-job training to employees with intellectual disabilities. Staff reported on their knowledge and use of 15 empirically validated training and support strategies. Of these 15 strategies, only 2 were reported to have been used consistently by staff. Employees with intellectual disabilities reported that they were eager to learn new work skills but were not receiving the necessary training to assist them in learning such skills. The minimal utilisation of available training strategies to teach employees with intellectual disabilities workplace skills may indicate a lack of knowledge or confidence, or both, by staff in using the various training strategies. Further research is needed into the skills needed by staff whose job requires provision of on-the-job training to people with intellectual disabilities.
The British journal of psychiatry : the journal of mental science, 2018
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. Declar...
Research in Developmental Disabilities, 2009
The last decades have seen increased emphasis on the quality of training for direct-care staff serving people with intellectual disabilities. Nevertheless, it is unclear what the key aspects of effective training are. Therefore, the aim of the present metaanalysis was to establish the ingredients (i.e., goals, format, and techniques) for staff training that are related to improvements of staff behaviour. Our literature search concentrated on studies that were published in a period of 20 years. Fifty-five studies met the criteria, resulting in 502 single-subject designs and 13 n > 1 designs. Results revealed important information relevant to further improvement of clinical practice: (a) the combination of in-service with coaching-on-the-job is the most powerful format, (b) in in-service formats, one should use multiple techniques, and verbal feedback is particularly recommended, and (c) in coachingon-the-job formats, verbal feedback should be part of the program, as well as praise and correction. To maximize effectiveness, program developers should carefully prepare training goals, training format, and training techniques, which will yield a profit for clinical practice.
PLOS ONE
Background Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. Aims To conduct a process evaluation of a national clinical trial investigating the impact of PBSbased staff training on the level of challenging behaviour in adults with intellectual disability. Method The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Results Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention.
Health technology assessment (Winchester, England), 2018
Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. Community ID services in England. Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-C)]. Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. Carer-reported changes...
BJPsych Open
Background 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). Aims 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). Method 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. Results 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 ...
The risk factors for young people with intellectual disabilities developing a mental health disorder are higher than those found in the general population, yet training is very rarely available to frontline staff. A recent study in the United Kingdom cited prevalence rates of mental ill health among adults with intellectual disabilities ranging from 35.2 to 40.9%, depending upon the sensitivity of the diagnostic tool used . The ability to identify mental health problems is crucial to early intervention, but is particularly difficult when the symptoms of intellectual disability often mask emerging problems and confound differential diagnosis. The literature relating to mental health training focuses largely on changes in knowledge base and attitude, falling short of considering the primary focus of training-its impact upon practice and how this ultimately benefits people with intellectual disabilities. This study highlights the need for training, considers a training package provided to all frontline (direct care) staff in a residential school in the United Kingdom, catering to young people between the ages of 6 and 19 with severe intellectual disabilities, and investigates the impact of training upon practice and its influence upon the organization.
An integrated work skill analysis strategy for workers with significant intellectual disabilities
BACKGROUND: As the number of individuals with significant disabilities transitioning into competitive, integrated employment increases, so must the knowledge, experience, and expectations of vocational rehabilitation personnel. Evolving responsibilities require that employment specialists acquire the information, skills, attitudes and values necessary to realize integrated outcomes. OBJECTIVE: This is a follow-up to Brown & Kessler's 2014 JVR article on generating integrated worksites for individuals with significant disabilities. This article outlines an integrated work skill analysis strategy for individuals with significant disabilities. It is intended that the information presented here can be used to increase the number of individuals with significant intellectual disabilities who function effectively in integrated employment. CONCLUSION: It is important that individuals with significant disabilities are given the opportunities to succeed in employment. Following strategies to ensure the particular work environment will be safe and appropriate for a particular worker is just one step towards the chance to thrive in the workplace.