Staff perceptions of positive behavioural support in a secure forensic adult mental health setting
| DOI | https://doi.org/10.1108/JFP-10-2017-0044 |
| Date | 12 February 2018 |
| Pages | 42-53 |
| Published date | 12 February 2018 |
| Author | Graeme Karger,Bronwen Davies,Rosemary Jenkins,Victoria Samuel |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Staff perceptions of positive behavioural
support in a secure forensic adult mental
health setting
Graeme Karger, Bronwen Davies, Rosemary Jenkins and Victoria Samuel
Abstract
Purpose –Challenging behaviour has been a concern across forensic services. Traditionally these
have been managed reactively using medication, seclusion and restraint; however, there is growing
evidence that these approaches are ineffective and counter-therapeutic. A number of reports have
recommended the use of preventative approaches such as positive behavioural support (PBS). The
purpose of this paper is to iden tify “how staff within a secure forensic mental health setting perceived the
application of PBS?”
Design/methodology/approach –In total, 11 multi-disciplinary staff were interviewed and thematic
analysis was used to identify themes.
Findings –Five themes were identified: “The Functions”,“Appraising a new Approach”,“Collaborative
Challenges”,“Staff Variables”and “Organisational Issues”.
Practical implications –PBS enables staff to understand challenging or risky behaviour. It empowers
patients via collaboration, although there can be some challenges to this. Services need to invest in training,
support and leadership to ensure the model is embed and promote fidelity. Consideration needs to be given
to how quality of life can be improved within the limits of a forensic setting.
Originality/value –No previous studies asking staff about their experiences of PBS within a forensic mental
health context.
Keywords Thematic analysis, Challenging behaviour, Forensic mental health, Mentally ill offenders,
Positive behavioural support (PBS), Staff perceptions
Paper type Research paper
Introduction
Historically, staff working in inpatient settings have utilised “traditional methods”to manage
challenging behaviour which include restraint, seclusion and sedative medication (Kynoch et al., 2011;
Mason and Chandley, 1999). However, there has been growing evidence that questions
the effectiveness of such methods (see Duxbury, 2002) and even suggest that they may be
“counter-therapeutic”(Riahi et al., 2016). Various guidelines have been published which all advocate a
shift towards proactive and preventative models of managing challenging behaviour, such as positive
behavioural support (PBS) (Royal College of Nursing, 2008; MIND for Better Mental Health, 2013;
Ministry of Justice, National Offender Management Service and Youth Justice Board, 2012;
Department of Health, 2014; National Institute for Health and Care Excellence, 2015).
Gore et al. (2013) defined PB S as a “multicompone nt framework for (a ) developing an
understanding of t he challenging beha viour displayed b y an individual, bas ed on an
assessment of the s ocial and physical environm ent and broader context wit hin which it occurs;
(b) with the in clusion of stakeholder persp ectives and involvement; (c) u sing this understanding
to develop, implem ent and evaluate the effectiv eness of a personalised and en during system of
support; and (d) that enhances quality of life outcomes for the focal person and other
stakeholders”. Since its inception, PBS has been applied with efficacy within learning disability
(see Carr et al., 1999) and school-wide services (see Sugai et al., 2000). In forensic care, PBS
finds itself positioned within a context that has a greater potential to be inherently “aversive”;
Received 16 October 2017
Revised 18 November 2017
26 November 2017
Accepted 27 November 2017
The authors would like to thank all
the staff who participated in this
research, sometimes at a short
notice. The authors would also like
to thank the service for hosting the
research and enabling this project
to proceed.
Graeme Karger is based at
Community Child Psychology,
Children’s Centre, St David’s
Hospital, Cardiff, UK.
Bronwen Davies is a Clinical
Psychologist at Assessment
and Treatment Unit, Aneurin
Bevan University Health Board,
Llanfrechfa, Cwmbran, UK.
Rosemary Jenkins was
previously with the South Wales
School of Clinical Psychology,
Cardiff University, Cardiff, UK.
Victoria Samuel is a Senior
Research Tutor and a Clinical
Psychologist at the South
Wales School of Clinical
Psychology, Cardiff University,
Cardiff, UK.
PAG E 42
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 20 NO. 1 2018, pp. 42-53, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-10-2017-0044
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