Using positive behavioural support (PBS) for STOMP medication challenge

DOIhttps://doi.org/10.1108/AMHID-12-2018-0051
Published date12 June 2019
Date12 June 2019
Pages102-112
AuthorDavid Gerrard,Jennifer Rhodes,Ruth Lee,Jonathan Ling
Subject MatterHealth & social care,Learning & intellectual disabilities
Using positive behavioural support (PBS)
for STOMP medication challenge
David Gerrard, Jennifer Rhodes, Ruth Lee and Jonathan Ling
Abstract
Purpose The purpose of this paper is to investigate if positive behavioural support (PBS) can be an
effective alternative to medication, and can aid medication reduction in people with a learning disability,
autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP
is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic
medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental
health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge,
(NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.
Design/methodology/approach A two-group, experimental design was utilised. Both groups were
considered for medication reduction. The experimental group of 25 people received input from a specialist
PBS team, while the control group of 29 people underwent unsupported medication challenge.
Findings There was a significantly higher success rate for medication reduction and discontinuation when
PBS assessment and intervention was provided as an alternative to medication.
Practical implications This study indicates that providing PBS is associated with decreased medication
and if replicated should be become standard practice for specialist teams.
Originality/value This is the first study to investigate the effect of PBS on medicationreduction in patients
prescribed psychotropic medication for behaviour thought to be challenging.
Keywords Medication, Support, Positive, Reduction, STOMP, Behavioural
Paper type Research paper
1. Background
Stopping over-medication of people with a learning disability, autism or both (STOMP) is a
project supported by NHS England aimed at reducing the inappropriate prescribing of
psychotropic medication to manage behaviour that is deemed to be challenging in the absence
of a documented mental health diagnosis (Branford et al., 2018a, b; NHS England, 2016a, b).
The current project was launched in 2016 following the report into the Winterbourne View care
home which highlighted concerns related to the use of medication in this way (Department of
Health, 2012), in particular the off-label and poorly evidenced use of psychotropic medication.
Historically, little guidance has been available to guide the appropriate use of psychotropic
medication (Tyrer et al., 2008; Deb et al., 2007, 2009).
A report by Public Health England (2015) showed that 30,00035,000 prescriptions are issued
each day to people with a learning disability and/or autism for psychotropic medication to
manage behaviours, rather than as treatment for a serious mental illness. A UK population-based
cohort study identified that people with a learning disability who presented with challenging
behaviour were more than twice as likely to receive antipsychotic medication as those who did
not have any behavioural challenge (Sheehan et al., 2015).
NICE (2015) published a guidance document detailing how behaviours which challenge should
be more appropriately managed placing the reliance on non-pharmacological methods as the
first line intervention, with medication being considered only when other measures have not been
successful in keeping the person safe.
Received 21 December 2018
Revised 29 January 2019
Accepted 3 March 2019
Conflicts of interests: none
declared. David Gerrard and
Jonathan Ling received a grant
from the Academic Health Science
Network North East and Cumbria
to analyse the role of the
pharmacist within the community
treatment team. The AHSN is a
collaboration between NHS
Education and NHS Improvement
aimed at showcasing good
practice. It does not represent
commercial sponsorship.
David Gerrard, Jennifer Rhodes
and Ruth Lee are all basedat
NorthumberlandTyne and Wear
NHS Foundation Trust,
Newcastle upon Tyne,UK.
Jonathan Ling is based at
Faculty of Health Sciences and
Wellbeing, University of
Sunderland, Sunderland, UK.
PAGE102
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 13 NO. 3/4 2019, pp.102-112, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-12-2018-0051

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