title: Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services.
abstract: BACKGROUND
  A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members' perspectives of managing clients with challenging behaviours in residential services.
  
  
  METHODS
  Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members' immediate responses to clients' difficult behaviours and their decision-making processes.
  
  
  RESULTS
  The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved.
  
  
  CONCLUSIONS
  Staff members' responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future.
authors.affiliation: South London and the Maudsley NHS Foundation Trust, London, UK. pravoux@lambeth.gov.uk
authors.forename: Peggy
authors.initials: P
authors.lastname: Ravoux
authors.forename: Peter
authors.initials: P
authors.lastname: Baker
authors.forename: Hilary
authors.initials: H
authors.lastname: Brown
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008607:Intellectual Disability / Q000451:nursing*; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D000078329:Workforce; D055815:Young Adult