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Challenging behaviour training may change carer attributions whether or not these are the focus of training

John Northfield

We have posted previously about the impact of carer attributions regarding the behaviour of people with learning disabilities and the impact these can have on carer responses. The authors of this systematic review were interested in the effects of carer training in challenging and complex behaviour.

The researchers searched the literature and included papers that reported outcomes for carer training on the behaviour of people with learning disabilities using measures of carer attribution of behaviour. They considered characteristics of scales content and length of training as possible factors affecting changes in attribution.

They found 11 papers that met the inclusion criteria. Most of the papers were studies using behavioural curricula for training. None explicitly set out to change attributions.

They found 8 of the 11 papers reporting changes in attribution, but it was not possible from the results presented to distinguish studies that reported such changes and those that did not.

The authors conclude that they found changes in beliefs and attributions occurring in the studies they reviewed, whether or not these were identified as a focus in the training. They suggest that the

formulation processes involved in behavioural training may play a key part in changing attributions as a consequence of this training.

They recommend more focused interventions that are specifically designed to change attributions and the development of measures of attribution change as a result of these interventions.

Changes in Attributions as a Consequence of Training for Challenging and Complex Behaviour for Carers of People with Learning Disabilities: A Systematic Review, Williams, S. et al,, in Journal of Applied Research in Intellectual Disabilities, 25: 203–216

Aggressive challenging behaviour requires personalised interventions, robust caregiver relationships, and sustained system-level support
Positive Behaviour Support: RCT finds no effect, but fidelity is poor
NICE learning disabilities and challenging behaviour guidance highlights need for stronger evidence
Written by

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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  • Jan

    Jan

    14 years ago
    The Challenging Behaviour Foundation provides training in Understanding Challenging Behaviour and Supporting Behaviour Change. (check out their newly updated website) In a recent study, evaluated by Nick Gore & Hiromi Umizawa, Tizard Centre, University of Kent, of CBF training delivered at five special needs schools in Kent, both family carers and school staff reported: - Frequency of challenging behaviour reduced - Severity of challenging behaviour reduced - Challenging behaviour easier to manage The full report can be read in the Journal of Policy and Practice in Intellectual Disabilities, Volume 8 Number 4 pp 266–275 December 2011 but most importantly: what was identified, but not evaluated, was that once context/reasons were better understood there was a reduction in challenging behaviour - i.e. carer attributions.
    • 2 replies
    • John Northfield
      John Northfield 14 years ago
      Hi Jan, thanks for your comment and for the mention regarding the work that Nick and Hiromi did. We actually picked this up when it was published and posted about it. If anybody wants to read the post, you can see it here http://www.thelearningdisabilitieself.net/2012/01/19/teaching-staff-and-family-carers-benefit-from-combined-training-around-children-with-learning-disabilities-and-challenging-behaviour/ john
    • Brodie Paterson
      Brodie Paterson 14 years ago
      We have know for a long time that what staff feel ( which in turn determines what they think) has a greater influence on their behaviour than what they know ( e.g. the principles of positive behavioural support). Consequently exploring and explicitly targeting staff attributions must be a core theme of training. However, its important we target in the context of a whole organisation public health based approach, the attributions of managers whose distance from the experience of challenging behaviour by the service user can result in an increased tendency to victim blame. This can result in unhelpful dynamic in which staff blame the client for wilfully choosing to exhibit the behaviour and managers blame staff for not preventing it. Sadly this is only too common in many services.
      • John Northfield
        John Northfield 14 years ago
        Hi Brodie, thanks for your comment. I think you are right to draw attention to the key role of management, and for me, equally impportant role of practice leadership when supporting people. I wonder if you are involved in training yourself? john