The Challenging Behaviour Foundation

Children with intellectual disability are at a higher risk of presenting with behaviours that challenge. Video Interaction Guidance (VIG) is a brief, personalised, strengths-based therapy that focuses on improving the parent-child relationship and interactions. A strong parent-child relationship may reduce the risk of behaviours that challenge. Access to support is difficult for families of children with intellectual disability. Remotely delivered support may enhance access to therapy for those who might otherwise struggle to access support. To date, no definitive effectiveness trial of VIG, or remotely delivered VIG, has been conducted, including in intellectual disability. A feasibility randomised controlled trial (RCT) aimed to recruit 50 parents of a child with intellectual disability (aged 6-12) referred to specialist mental health services. Participants were randomised on a 1:1 basis to VIG plus treatment as usual (TAU) or just TAU. Measures were collected remotely at baseline, 3-month, and 6-month follow-up. A parallel economic study explored the feasibility of a future economic evaluation, while an embedded process evaluation explored feasibility and acceptability through qualitative interviews. A survey investigated TAU in specialist mental health services. A Parent Carer Advisory Group of 10 parents of children with intellectual disability worked with the research team on design, recruitment, data analysis and interpretation. Forty-four parents consented to participate in the study and 40 were randomised to the RCT. Of those, 75% remained in the study at 6-month follow-up, and 70% of the VIG-arm participants completed at least 3 cycles of VIG. At 6-month follow-up, between 83.3% and 100% of parent-completed questionnaires were completed, including the Developmental Behaviour Checklist (DBC2 at 86.7% completion rate). The acceptability of VIG was high among parents and practitioners. Parents identified few barriers to participation when VIG was delivered remotely. The cost of VIG was calculated at £153.35 per session and £306.70 per cycle. Video-feedback interventions are not typically part of TAU: just 15% of 66 specialist mental health services reported offering any video-feedback intervention to parents of children with intellectual disability. Findings supported the feasibility and acceptability of a definitive trial of remotely delivered VIG to parents of children with intellectual disability referred for support to specialist mental health services. Adaptations will be needed to enhance recruitment and align some of the study outcomes and processes more closely to parent preferences. ISCTRN 13171328, Registration date 28 December 2022.

PurposeCare pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”.Design/methodology/approachThis paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges.FindingsIt is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again.Originality/valueStandards in relation to care pathways are presented.

Haim Dotan - Haim Dotain Ltd. (ISR) Sven Plieninger - Schlaich Bergermann Partner (DE) Agnes Koltay - Koltay Facades (UAE) Willem Jan Neutelings - Neutelings Riedijk Architects (NL) Gijs Rikken - MVRDV (NL) Faidra Oikonomopoulou - TU Delft (NL)

Abstract Training programs on the topic of challenging behaviors have often been offered to teaching staff and family carers of children with intellectual disabilities (ID). These efforts have been found to be effective in bringing about positive changes for both children with ID and those who support them. Generally, such training has been offered to either staff or family carers but not at the same time. The authors conducted a study to evaluate the efficacy of a brief training program delivered at the same time to teaching staff and family carers (who were involved with the same child). The study also examined differences in outcomes between the two groups, which were drawn from local schools where some children exhibited challenging behaviors. Both teaching staff and family carers completed the Checklist of Challenging Behaviour, the Challenging Behaviour Attributions Scale, and the Emotional Reactions to Challenging Behaviour Scale prior to, and following, the training workshops. The workshops were divided into two segments. The content was the same, but in the first segment, one was held for teaching staff and one for parent carers. In the second segment, both groups met together. After the first segment, all participants completed a related homework task before joining each other for the second segment. Training used a functional model of challenging behavior and facilitated the production of individualized support plans for the target children. Significant positive changes were found regarding ratings of challenging behavior, participants' causal attributions, and emotional reactions following the training. Some differences were found regarding outcomes for teaching staff vs. family carers. The study showed that teaching staff and family carers can benefit from receiving combined training to support challenging behavior in children with ID.

This article explores innovative and interactive ways of working with people who have severe learning disabilities, special needs and/or challenging behaviour who, despite the efforts of those who support them, are not able to respond to attempts to interact with them. It examines the possibilities of communicating by using people's own behaviours and outlines how these methods of interaction can be developed into a 'language' which people with these disabilities recognize and find motivating. Entering into a person's world in a way that is not confusing or threatening may allow him/her to move from solitary self-stimulation to shared activity. People with these disabilities will then become aware of a world outside their own (sometimes they are aware of this but are unable to make a connection between what they perceive and themselves), and begin to understand their relationship to it. Surprise is an important element as it shifts attention from the inner space to the source of the intervention. A number of examples illustrate a range of person-centred approaches and the variety of disabilities that may be assisted.