An examination of the implementation of setting-wide positive behaviour support in an adult disability residential setting

Abstract

Positive behaviour support, or PBS, is mandated in Ireland under the Health Act 2007 as an evidence-based framework of practice focused on enhancing quality of life for vulnerable adults living in residential settings. However, PBS is not uniformly available, nor is it implemented reliably across service providers. The most recent advancement in PBS practice, setting-wide or systemic PBS, which focuses on a multi-tiered systems of support, offers a promising solution to this predicament. The empirical study of this systemic framework with adult populations is still considered to be in very early stages, particularly in Ireland. The aim of this research programme was to use robust empirical methodologies to investigate the implementation of setting-wide PBS in a community-based residential setting for adults with ID. The research programme commenced with a systematic literature review of setting-wide PBS with adult populations, and results indicated that the incorporation of a workforce development programme was a common denominator in the included studies. The next phase focused on the development of a replicable workforce development manual in knowledge and skills for direct support personnel based on the findings of the systematic literature review and published training standards. Subsequently, a randomised control trial was conducted to examine the impact of the implementation of tier 1 setting-wide PBS on the quality of life and distressed behaviour of adults with ID, and the attitudes, knowledge, skills, and implementation fidelity of direct support staff. The results of the study were largely inconclusive, due to the significant methodological challenges faced, which were successively analysed in a process evaluation of the RCT, and a qualitative exploration of the barriers and enablers encountered by the direct support staff in the attempt to implement setting-wide PBS. This research programme contributes a comprehensive training manual, implementation roadmap and supplementary tools and resources to support enhanced future implementation of this important rights based proactive model of support at scale.