Complex Behaviour Service: enhanced model for challenging behaviour
| Date | 02 July 2014 |
| Pages | 219-227 |
| DOI | https://doi.org/10.1108/AMHID-08-2013-0056 |
| Published date | 02 July 2014 |
| Author | Sophie Inchley-Mort,Khadija Rantell,Charlotte Wahlich,Angela Hassiotis |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Accounting education |
Complex Behaviour Service: enhanced
model for challenging behaviour
Sophie Inchley-Mort, Khadija Rantell, Charlotte Wahlich and Angela Hassiotis
Sophie Inchley-Mort is a
Researcher, based at Camden
Learning Disabilities Service,
Camden & Islington NHS
Foundation Trust, London, UK.
Dr Khadija Rantell is an
Honorary Research Fellow,
based at JRO
Communications, Joint
Research Office (Part of the
Research Support Centre),
University College London,
London, UK.
Charlotte Wahlich is a
Research Assistant, based at
Camden Learning Disabilities
Service, Camden & Islington
NHS Foundation Trust,
London, UK.
Dr Angela Hassiotis is based at
Mental Health Sciences Unit,
University College London,
London, UK.
Abstract
Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people
with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to
explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour
Service (CBS).
Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team
were assessed at baseline, six and 12 months and compared with those of 22 peers who received
usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant
Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and
social care supports.
Findings – At six months improvements were seen across all ABC domains in both groups, with greater
improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group
differences were maintained only for stereotypy at 12 months. No other differences were found.
Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide
clinical benefits to individuals with challenging behaviours. However,there are issues around integration into
existing services that need to be addressed in order to maximise efficiency.
Keywords Challenging behaviour, Adults, Complex behaviour, Pilot, Service model
Paper type Research paper
Introduction
The social construct of “challenging behaviour” refers to “culturally abnormal” actions deemed
by others to be “dangerous, frightening, distressing, or annoying” (Emerson, 2001; The Royal
College of Psychiatrists, 2007), e.g. verbal and physical aggression, self-injury, stereotypy
and destruction of property. Point prevalence varies between studies but is estimated at
22.5 per cent (95 per cent CI 20.0-25.5 per cent) with a two year incidence of 4.6 per cent
(Smiley et al., 2007).
In the UK, approximately 33 per cent of those presenting with challenging behaviours are placed
out of their geographical area of origin due to a lack of appropriate services in their local
community (Department of Health, 2004; Crossland et al., 2005). These placements, however,
tend to be costly and vary in quality or, in some cases, perpetrate abusive practices
(Department of Health (DoH), 2012) and decrease likelihood of community integration
(SCIE, 2004; Barron et al., 2011; Chinn et al., 2011). UK data demonstrate that challenging
behaviours are a major predictor of costs (Knapp et al., 2005) with one study reporting that
relocation of ten service users with challenging behaviour into community living not only
improved quality of life but saved around £900,000 per year (Association of Supported Living,
2011). Various reports (Mansell, 1993, 2007) have advocated community based person-tailored
approach to challenging behaviour (Department of Health, 2001, 2009). Specialist behaviour
services, in the past termed peripatetic community services (Hassiotis, 2002), have long
been seen as a model of good practice though no specific evaluation of the model has ever
The study was funded by the
North Central London Research
Consortium (NoCLoR; grant
reference 2C10). The funder has
had no role or other influence in
the study process.
DOI 10.1108/AMHID-08-2013-0056 VOL. 8 NO. 4 2014, pp. 219-227, CEmeraldGroup Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 219
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