Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial.
BACKGROUND
Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services.


METHODS
The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS.


CONCLUSIONS
The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour.


BACKGROUND
This trial is registered with Clinical Trials.gov (Ref NCT01680276 ). Clinical Trials Unit: PRIMENT https://www.ucl.ac.uk/priment/ .
UCL Division of Psychiatry, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK. a.hassiotis@ucl.ac.uk.
Angela
A
Hassiotis
UCL Division of Psychiatry, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK. a.strydom@ucl.ac.uk.
Andre
A
Strydom
Imperial College of Medicine, Claybrook Centre, Charing Cross Campus, 37 Claybrook Road, London, W6 8LN, UK. m.crawford@imperial.ac.uk.
Mike
M
Crawford
East London Foundation Trust, Community Learning Disability Service, Mile End Hospital, Bancroft Road, London, UK. Ian.Hall2@bartshealth.nhs.uk.
Ian
I
Hall
Medical Statistics, Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK. r.omar@ucl.ac.uk.
Rumana
R
Omar
The Research Department of Primary Care and Population Sciences, University College, Rowland Hill Street, London, NW3 2PF, UK. v.vickerstaff@ucl.ac.uk.
Victoria
V
Vickerstaff
University College London, Primary Care & Population Health, Royal Free Hospital, Rowland Street, London, NW3 2PF, UK. r.hunter@ucl.ac.uk.
Rachael
R
Hunter
Department of Clinical Psychology, University College London, 119 Torrington Place, London, WC1E 7HB, UK. j.crabtree@ucl.ac.uk.
Jason
J
Crabtree
Challenging Behaviour Foundation, The Old Courthouse, New Road Avenue, Chatham, ME4 6BE, UK. vivien@thecbf.org.uk.
Vivien
V
Cooper
Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Groby Road, Leicester, LE3 9QF, UK. asit.biswas@leicspart.nhs.uk.
Asit
A
Biswas
South West London and St George's Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Joan Bicknell Centre, Springfield Hospital, London, SW17 7DJ, UK. William.Howie@swlstgtr.nhs.uk.
William
W
Howie
UCL Division of Psychiatry, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK. michael.king@ucl.ac.uk.
Michael
M
King
D000328:Adult; D001521:Behavior Therapy / Q000191:economics* / Q000193:education* / Q000379:methods; D017028:Caregivers / Q000523:psychology; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis / Q000379:methods; D004739:England / Q000453:epidemiology; D005260:Female; D006282:Health Personnel / Q000191:economics* / Q000193:education*; D006801:Humans; D008607:Intellectual Disability / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome