How best to support people with severe learning disabilities and challenging behaviour is a question that has been thrown into sharp relief by the Winterbourne View scandal and subsequent pronouncements by Government about improving care for vulnerable adults.
Clearly, managing risk and reducing harm are key components of the answer, but whilst necessary, will not be sufficient to enable people who are most challenging to us to live their lives in the way that they want.
In recent years, the evidence base for positive behaviour support (PBS) has been growing. We recently posted for example about how the reduction of the use of physical interventions associated with the systematic adoption of positive behavioural support across a service system was associated with reductions in physical interventions and also about the establishment of an ongoing database to for clinical practitioners to collate the impacts of PBS interventions and to address deficits in the literature.
The authors of this review sit out to look at whether this approach to applied behaviour analysis in support of people with challenging behaviour is clinically effective, cost effective and accessible.
The authors looked at a total of 12 outcome studies which met specified inclusion criteria for their review which encompassed 423 cases.
They found that the outcome studies suggested that positive behaviour support:
- Is effective in both severe and high-rate behaviour problems
- Is cost-effective in terms of outcomes
- Can be imparted through through training and widely disseminated to achieve outcomes
- Can work in institutional settings and community settings
They conclude that
practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment.
The efficacy of positive behavioural support with the most challenging behaviour: The evidence and its implications, LaVigna G and Willis T, in Journal of Intellectual and Developmental Disability, 37, 3 , 185-195