Response from UK Society of Behaviour Analysis – Positive Behaviour Support Special Interest Group

We are writing in response to the article by Hassiotis et al (2018)¹ entitled ‘Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial’. Hassiotis et al stated that their aim was to evaluate the effects of training in positive behavioural support on challenging behaviour. Although we welcome research in positive behavioural support, we have concerns about the conclusions that have been drawn from this study.

The authors describe how, after having received 6 days of training in positive behavioural support, National Health Service professionals – including speech and language therapists, nurses and occupational therapists – implemented positive behavioural support interventions in community services for people with intellectual disabilities. It was stated that in order to align with best practice, interventions were required to include four key components: functional assessment, observational data, a positive behavioural support plan and a goodness-of-fit checklist. However, out of a possible total of 108 interventions, no paperwork was submitted.

All positive behavioural support plans were rated by an independent assessor as being of poor quality, and, crucially, no information was gathered on whether or not they were actually implemented. In the absence of data concerning implementation, it is possible that the behaviour change strategies detailed in positive behavioural support plans were never actually used in services. The authors’ conclusion that positive behavioural support did not reduce challenging behaviour is therefore unsupportable.

In view of the study's limitations – and, in particular, the absence of evidence that the intervention it set out to assess (positive behavioural support) was actually implemented – the extent to which any meaningful conclusions can be drawn is questionable.