Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T15:56:02.941Z Has data issue: false hasContentIssue false
  • English
  • Français

‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions

Published online by Cambridge University Press:  04 June 2020

Jai Jason Carmichael Open the ORCID record for Jai Jason Carmichael [Opens in a new window] ,
Amelia J. Hicks Open the ORCID record for Amelia J. Hicks [Opens in a new window] ,
Kate Rachel Gould Open the ORCID record for Kate Rachel Gould [Opens in a new window] ,
Timothy J. Feeney ,
Penelope Analytis Open the ORCID record for Penelope Analytis [Opens in a new window]  and
Jennie Louise Ponsford Open the ORCID record for Jennie Louise Ponsford [Opens in a new window]
Jai Jason Carmichael*
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
Amelia J. Hicks
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
Kate Rachel Gould
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
Timothy J. Feeney
Affiliation:
Belvedere Health Services and the Mill School, Essex Junction, Vermont, USA
Penelope Analytis
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
Jennie Louise Ponsford
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
*
*Corresponding author. Email: [email protected]
Get access

Abstract

Objectives:

Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.

Methods:

Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.

Findings:

The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.

Conclusions:

The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.

Keywords

acquired brain injurychallenging behaviourstrainingimplementationPositive Behaviour Support
Type
Articles
Information
Brain Impairment , Volume 22 , Issue 1 , March 2021 , pp. 34 - 49
Copyright
© Australasian Society for the Study of Brain Impairment 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, M.I., Parmenter, T.R., & Mok, M. (2002). The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological wellbeing of the spouse/caregiver: Path model analysis. Brain Injury, 16(9), 743–757. doi: 10.1080/02699050210128906 Google Scholar
Arco, L., & Bishop, J. (2009). Single participant studies in positive behaviour support for parents of individuals with brain injuries. Brain Impairment, 10(3), 307–319. doi: 10.1375/brim.10.3.307 Google Scholar
Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., …Jäger, C. (2015). Tailored interventions to address determinants of practice. Cochrane Database of Systematic Reviews, 2015(4). doi: 10.1002/14651858.CD005470.pub3 Google Scholar
Barbour, R. S. (1998). Mixing qualitative methods: Quality assurance or qualitative quagmire? Qualitative Health Research, 8(3), 352–361. doi: 10.1177/104973239800800306 Google Scholar
Bearman, S. K., Weisz, J. R., Chorpita, B. F., Hoagwood, K., Ward, A., Ugueto, A. M., …Research Network on Youth Mental Health. (2013). More practice, less preach? The role of supervision processes and therapist characteristics in EBP implementation. Administration and Policy in Mental Health and Mental Health Services Research, 40(6), 518–529. doi: 10.1007/s10488-013-0485-5 CrossRefGoogle ScholarPubMed
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660–665. doi: 10.1176/appi.ps.201100401 Google Scholar
Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence‐based practice: A critical review of studies from a systems‐contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1–30. doi: 10.1111/j.1468-2850.2009.01187.x Google Scholar
Benedictus, M. R., Spikman, J. M., & van der Naalt, J. (2010). Cognitive and behavioral impairment in traumatic brain injury related to outcome and return to work. Archives of Physical Medicine and Rehabilitation, 91(9), 1436–1441. doi: 10.1016/j.apmr.2010.06.019 Google Scholar
Berger, T. (2004). Computer‐based technological applications in psychotherapy training. Journal of Clinical Psychology, 60(3), 301–315. doi: 10.1002/jclp.10265 Google Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi: 10.1191/1478088706qp063oa Google Scholar
Campbell, J. L., Quincy, C., Osserman, J., & Pedersen, O. K. (2013). Coding in-depth semistructured interviews: Problems of unitization and intercoder reliability and agreement. Sociological Methods & Research, 42(3), 294–320. doi: 10.1177/0049124113500475 Google Scholar
Carmichael, J. J., Gould, K. R., Hicks, A. J., Feeney, T. J., & Ponsford, J. L. (2019). Understanding Australian community ABI therapists’ preferences for training in and implementing behaviour interventions: A focus on Positive Behaviour Support. Brain Impairment. Advanced online publication. doi: 10.1017/BrImp.2019.32 Google Scholar
Carnevale, G. J., Anselmi, V., Johnston, M. V., Busichio, K., & Walsh, V. (2006). A natural setting behavior management program for persons with acquired brain injury: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87(10), 1289–1297. doi: 10.1016/j.apmr.2006.06.010 CrossRefGoogle ScholarPubMed
Carr, E. G., Dunlap, G., Koegel, R. L., Turnbull, A. P., Sailor, W., Anderson, J. L., …Fox, L. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4(1), 4–16. doi: 10.1177/109830070200400102 Google Scholar
Chew, E., & Zafonte, R. D. (2009). Pharmacological management of neurobehavioral disorders following traumatic brain injury – A state-of-the-art review. Journal of Rehabilitation Research and Development, 46(6), 851. doi: 10.1682/JRRD.2008.09.0120 CrossRefGoogle ScholarPubMed
Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K., White, A. M., & Caine, E. D. (2011). Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. The Journal of Primary Prevention, 32(3-4), 195–211. doi: 10.1007/s10935-011-0250-z Google Scholar
Curtin, M., & Fossey, E. (2007). Appraising the trustworthiness of qualitative studies: Guidelines for occupational therapists. Australian Occupational Therapy Journal, 54(2), 88–94. doi: 10.1111/j.1440-1630.2007.00661.x CrossRefGoogle Scholar
Decker, S. E., Jameson, M. T., & Naugle, A. E. (2011). Therapist training in empirically supported treatments: A review of evaluation methods for short-and long-term outcomes. Administration and Policy in Mental Health and Mental Health Services Research, 38(4), 254. doi: 10.1007/s10488-011-0360-1 Google Scholar
Doig, E., Fleming, J., & Kuipers, P. (2008). Achieving optimal functional outcomes in community-based rehabilitation following acquired brain injury: A qualitative investigation of therapists’ perspectives. British Journal of Occupational Therapy, 71(9), 360–370. doi: 10.1177/030802260807100902 Google Scholar
Dopson, S., Locock, L., Gabbay, J., Ferlie, E., & Fitzgerald, L. (2003). Evidence-based medicine and the implementation gap. Health, 7(3), 311–330. doi: 10.1177/1363459303007003004 Google Scholar
Fairburn, C. G., & Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49(6-7), 373–378. doi: 10.1016/j.brat.2011.03.005 Google Scholar
Feeney, T. J. (2010a). Structured flexibility: The use of context-sensitive self-regulatory scripts to support young persons with acquired brain injury and behavioral difficulties. Journal of Head Trauma Rehabilitation, 25(6), 416–425. doi: 10.1097/HTR.0b013e3181fbc0a2 Google Scholar
Feeney, T. J. (2010b). There’s always something that works: Principles and practices of positive support for individuals with traumatic brain injury and problem behaviors. Seminars in Speech and Language, 31(3), 145–161. doi: 10.1055/s-0030-1257531 Google Scholar
Feeney, T. J., & Achilich, J. (2014). Structured flexibility and context-sensitive behavioral support for the chronically cranky. NeuroRehabilitation, 34(4), 709–723. doi: 10.3233/NRE-141088 Google Scholar
Feeney, T. J., Ylvisaker, M., Rosen, B. H., & Greene, P. (2001). Community supports for individuals with challenging behavior after brain injury: An analysis of the New York State behavioral resource project. Journal of Head Trauma Rehabilitation, 16(1), 61–75. doi: 10.1097/00001199-200102000-00008 Google Scholar
Fisher, A., Bellon, M., Lawn, S., & Lennon, S. (2017). Identifying current practices and supports in behaviour management following ABI in South Australian community settings: A Delphi study. Brain Impairment, 18(2), 211–225. doi: 10.1017/BrImp.2016.36 Google Scholar
Fisher, A., Bellon, M., Lawn, S., & Lennon, S. (2019). Brain injury, behaviour support, and family involvement: Putting the pieces together and looking forward. Disability and Rehabilitation, 1–11. doi: 10.1080/09638288.2018.1522551 Google Scholar
Fisher, A., Bellon, M., Lawn, S., Lennon, S., & Sohlberg, M. (2019). Family-directed approach to brain injury (FAB) model: A preliminary framework to guide family-directed intervention for individuals with brain injury. Disability and Rehabilitation, 41(7), 854–860. doi: 10.1080/09638288.2017.1407966 Google Scholar
Foster, A. M., Armstrong, J., Buckley, A., Sherry, J., Young, T., Foliaki, S., …McPherson, K. M. (2012). Encouraging family engagement in the rehabilitation process: A rehabilitation provider’s development of support strategies for family members of people with traumatic brain injury. Disability and Rehabilitation, 34(22), 1855–1862. doi: 10.3109/09638288.2012.670028 Google Scholar
Gore, N. J., McGill, P., Toogood, S., Allen, D., Hughes, J. C., Baker, P., …Denne, L. D. (2013). Definition and scope for positive behavioural support. International Journal for Positive Behavioural Support, 3(2), 14–23. Retrieved from http://www.bild.org.uk/our-services/journals/ijpbs/ Google Scholar
Gould, K. R., Hicks, A. J., Hopwood, M., Kenardy, J., Krivonos, I., Warren, N., & Ponsford, J. L. (2019). The lived experience of behaviours of concern: A qualitative study of men with traumatic brain injury. Neuropsychological Rehabilitation, 29(3), 376–394. doi: 10.1080/09602011.2017.1307767 Google Scholar
Gould, K. R., Ponsford, J. L., Hicks, A. J., Hopwood, M., Renison, B., & Feeney, T. J. (2019). Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS+PLUS and three case studies. Neuropsychological Rehabilitation. Advanced online publication. doi: 10.1080/09602011.2019.1656647 CrossRefGoogle Scholar
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough?: An experiment with data saturation and variability. Field Methods, 18(1), 59–82. doi: 10.1177/1525822X05279903 Google Scholar
Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466. doi: 10.1016/j.cpr.2010.02.005 Google Scholar
Hicks, A. J., Gould, K. R., Hopwood, M., Kenardy, J., Krivonos, I., & Ponsford, J. L. (2017). Behaviours of concern following moderate to severe traumatic brain injury in individuals living in the community. Brain Injury, 31(10), 1312–1319. doi: 10.1080/02699052.2017.1317361 Google Scholar
Larson, M. J., Kelly, K. G., Stigge-Kaufman, D. A., Schmalfuss, I. M., & Perlstein, W. M. (2007). Reward context sensitivity impairment following severe TBI: An event-related potential investigation. Journal of the International Neuropsychological Society, 13(4), 615–625. doi: 10.1017/S1355617707070762 Google Scholar
LaVigna, G., & Willis, T. J. (2012). The efficacy of positive behavioural support with the most challenging behaviour: The evidence and its implications. Journal of Intellectual & Developmental Disability, 37(3), 185–195. doi: 10.3109/13668250.2012.696597 Google Scholar
Lyon, A. R., Stirman, S. W., Kerns, S. E., & Bruns, E. J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38(4), 238–253. doi: 10.1007/s10488-010-0331-y Google Scholar
Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050–1062. doi: 10.1037/0022-006X.72.6.1050 Google Scholar
Nadeem, E., Gleacher, A., & Beidas, R. S. (2013). Consultation as an implementation strategy for evidence-based practices across multiple contexts: Unpacking the black box. Administration and Policy in Mental Health and Mental Health Services Research, 40(6), 439–450. doi: 10.1007/s10488-013-0502-8 Google Scholar
Nott, M. T., Barden, H. L., Chapparo, C., & Ranka, J. L. (2019). Evidence based practice and knowledge translation: A survey of Australian occupational therapy practice with clients experiencing neurocognitive impairments. Australian Occupational Therapy Journal. Advanced online publication. doi: 10.1111/1440-1630.12625 Google Scholar
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). California, CA: Sage.Google Scholar
Ponsford, J. L., Downing, M. G., Olver, J., Ponsford, M., Acher, R., Carty, M., & Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: Outcome at two, five, and ten years post-injury. Journal of Neurotrauma, 31(1), 64–77. doi: 10.1089/neu.2013.2997 Google Scholar
Ponsford, J., Lee, N. K., Wong, D., McKay, A., Haines, K., Alway, Y., …O’Donnell, M. L. (2016). Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury. Psychological Medicine, 46(5), 1079–1090. doi: 10.1017/S0033291715002640 Google Scholar
Ponsford, J. L., & Schönberger, M. (2010). Family functioning and emotional state two and five years after traumatic brain injury. Journal of the International Neuropsychological Society, 16(2), 306–317. doi: 10.1017/S1355617709991342 Google Scholar
QSR International (2018). NVivo Version 12 [Computer software]. Melbourne, VIC: Author.Google Scholar
Srivastava, P., & Hopwood, N. (2009). A practical iterative framework for qualitative data analysis. International Journal of Qualitative Methods, 8(1), 76–84. doi: 10.1177/160940690900800107 Google Scholar
Tateno, A., Jorge, R. E., & Robinson, R. G. (2003). Clinical correlates of aggressive behavior after traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 15(2), 155–160. doi: 10.1176/appi.neuropsych.15.2.155 Google Scholar
Turkstra, L. S., McDonald, S., & DePompei, R. (2001). Social information processing in adolescents: Data from normally developing adolescents and preliminary data from their peers with traumatic brain injury. Journal of Head Trauma Rehabilitation, 16(5), 469–483. doi: 10.1097/00001199-200110000-00006 Google Scholar
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363. Retrieved from https://journals.stfm.org/familymedicine Google Scholar
Webster-Stratton, C. H., Reid, M. J., & Marsenich, L. (2014). Improving therapist fidelity during implementation of evidence-based practices: Incredible years program. Psychiatric Services, 65(6), 789–795. doi: 10.1176/appi.ps.201200177 Google Scholar
Ylvisaker, M., & Feeney, T. J. (Eds.) (1998). Positive everyday behavioural routines. In Collaborative brain injury intervention: Positive everyday routines (pp. 161–196). New York, NY: Cengage.Google Scholar
Ylvisaker, M., Jacobs, H. E., & Feeney, T. (2003). Positive supports for people who experience behavioral and cognitive disability after brain injury: A review. Journal of Head Trauma Rehabilitation, 18(1), 7–32. doi: 10.1097/00001199-200301000-00005 Google Scholar
Ylvisaker, M., Turkstra, L., Coehlo, C., Yorkston, K., Kennedy, M., Sohlberg, M. M., & Avery, J. (2007). Behavioural interventions for children and adults with behaviour disorders after TBI: A systematic review of the evidence. Brain Injury, 21(8), 769–805. doi: 10.1080/026990507014824 Google Scholar
Zoom Video Communications (2018). Zoom [Computer software]. Retrieved from https://zoom.us Google Scholar
Supplementary material: File

Carmichael et al. supplementary material

Carmichael et al. supplementary material

Download Carmichael et al. supplementary material(File)
File 18.5 KB