Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T05:27:13.331Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding Australian Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support

Published online by Cambridge University Press:  21 October 2019

Jai Jason Carmichael ,
Kate Rachel Gould ,
Amelia J. Hicks ,
Timothy J. Feeney  and
Jennie Louise Ponsford
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
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
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
Timothy J. Feeney
Affiliation:
Belvedere Health Services and the Mill School, Essex Junction, Vermont, USA
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

Objective:

Individuals with acquired brain injury (ABI) may experience persistent and distressing challenging behaviours (CB), and therefore, effective delivery of behaviour interventions is crucial. This study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions with a focus on Positive Behaviour Support (PBS).

Methods:

A sample of Australian community ABI therapists (n = 136) completed an online survey about their experiences with behaviour interventions, including PBS. Data from open-ended questions were analysed using content analysis. Frequency and descriptive statistics were computed, and a multiple regression was performed to determine factors predicting readiness to learn and implement new behaviour interventions. Rank-based non-parametric tests were conducted to investigate the influence of clinical role on experiences with behaviour interventions and training preferences.

Results:

Consistent with PBS, participants indicated that the following were important in addressing CB: teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. Despite a high level of desire and readiness, 80% of participants reported facing barriers to learning and implementing new behaviour interventions (e.g., lack of time). Participants’ confidence in using behaviour interventions (β = 0.31; p = 0.002) and the number of barriers faced (β = −0.30; p = 0.002) predicted their readiness to learn and implement new behaviour interventions. Confidence, duration of past training in behaviour interventions and preferred duration of future training did not differ based on clinical role.

Conclusion:

Implications for the development of training in behaviour interventions such as PBS and implementation into community practice are discussed.

Keywords

acquired brain injurychallenging behavioursPositive Behaviour Supporttrainingimplementation
Type
Articles
Information
Brain Impairment , Volume 21 , Issue 2 , September 2020 , pp. 191 - 207
Copyright
© Australasian Society for the Study of Brain Impairment 2019

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

Adams, A. S., Soumerai, S. B., Lomas, J., & Ross-Degnan, D. (1999). Evidence of self-report bias in assessing adherence to guidelines. International Journal for Quality in Health Care, 11(3), 187–192. doi: 10.1093/intqhc/11.3.187.CrossRefGoogle ScholarPubMed
Allen, D., Lowe, K., Baker, P., Dench, C., Hawkins, S., Jones, E., & James, W. (2011). Assessing the effectiveness of positive behavioural support: The P-CPO Project. International Journal of Positive Behavioural Support, 1(1), 14–23. Retrieved from http://www.bild.org.uk/our-services/journals/ijpbs/.Google Scholar
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.CrossRefGoogle 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.CrossRefGoogle Scholar
Australian Government Department of Human Services (2013). National framework for reducing and eliminating the use of restrictive practices in the disability service sector (the ‘National Framework’). Retrieved from https://www.dss.gov.au/sites/default/files/documents/04_2014/national_fraemwork_restricitive_practices_0.pdf.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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Berger, T. (2004). Computer-based technological applications in psychotherapy training. Journal of Clinical Psychology, 60(3), 301–315. doi: 10.1002/jclp.10265.CrossRefGoogle ScholarPubMed
Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of schoolwide positive behavioral interventions and supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12(3), 133–148. doi: 10.1177/1098300709334798.CrossRefGoogle Scholar
Braine, M. E. (2011). The experience of living with a family member with challenging behavior post acquired brain injury. Journal of Neuroscience Nursing, 43(4), 156–164. doi: 10.1097/JNN.0b013e3182135bb2.CrossRefGoogle ScholarPubMed
Carnevale, G. J. (1996). Natural-setting behaviour management for individuals with traumatic brain injury: Results from a three-year caregiver training program. Journal of Head Trauma Rehabilitation, 11(1), 27–38. doi: 10.1097/00001199-199602000-00005.CrossRefGoogle 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.CrossRefGoogle Scholar
Cashwell, T. H., & Dooley, K. (2001). The impact of supervision on counselor self-efficacy. The Clinical Supervisor, 20(1), 39–47. doi: 10.1300/J001v20n01_03.CrossRefGoogle Scholar
Cochrane, L. J., Olson, C. A., Murray, S., Dupuis, M., Tooman, T., & Hayes, S. (2007). Gaps between knowing and doing: Understanding and assessing barriers to optimal health care. Journal of Continuing Education in the Health Professions, 27(2), 94–102. doi: 10.1002/chp.106.CrossRefGoogle ScholarPubMed
Crabtree, B. F., & Miller, W. L. (1999). Doing qualitative research (2nd ed.). Newbury Park, CA: SAGE.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
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.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Feeney, T. J. (2010). 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Feeney, T. J., & Ylvisaker, M. (1995). Choice and routine: Antecedent behavioral interventions for adolescents with severe traumatic brain injury. Journal of Head Trauma Rehabilitation, 10(3), 67–86. doi: 10.1097/00001199-199506000-00007.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). London, UK: SAGE.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.CrossRefGoogle Scholar
Fleming, J., & Strong, J. (1995). Self-awareness of deficits following acquired brain injury: Considerations for rehabilitation. British Journal of Occupational Therapy, 58(2), 55–60. doi: 10.1177/030802269505800204.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Gardner, R. M., Bird, F. L., Maguire, H., Carreiro, R., & Abenaim, N. (2003). Intensive positive behaviour supports for adolescents with acquired brain injury: Long-term outcomes in community settings. Journal of Head Trauma Rehabilitation, 18(1), 52–74. Retrieved from https://journals.lww.com/headtraumarehab/pages/default.aspx.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Hall, K. M., Karzmark, P., Stevens, M., Englander, J., O’Hare, P., & Wright, J. (1994). Family stressors in traumatic brain injury: A two-year follow-up. Archives of Physical Medicine and Rehabilitation, 75(8), 876–884. doi: 10.1016/0003-9993(94)90112-0.CrossRefGoogle ScholarPubMed
Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I. S., Crabtree, J., … Cooper, V. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: Cluster randomised controlled trial. The British Journal of Psychiatry, 212(3), 161–168. doi: 10.1192/bjp.2017.34.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Holt, D. T., Armenakis, A. A., Harris, S. G., & Feild, H. S. (2008). Toward a comprehensive definition of readiness for change: A review of research and instrumentation. Research in Organizational Change and Development, 16, 289–336. doi: 10.1016/S0897-3016(06)16009-7.CrossRefGoogle Scholar
Holt, D. T., Helfrich, C. D., Hall, C. G., & Weiner, B. J. (2010). Are you ready? How health professionals can comprehensively conceptualize readiness for change. Journal of General Internal Medicine, 25(Suppl. 1), S50–S55. doi: 10.1007/s11606-009-1112-8.CrossRefGoogle ScholarPubMed
Hoofien, D., Gilboa, A., Vakil, E., & Donovick, P. J. (2001). Traumatic brain injury (TBI) 10-20 years later: A comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Injury, 15(3), 189–209. doi: 10.1080/026990501300005659.Google ScholarPubMed
IBM Corp. (2017). IBM SPSS statistics for Windows, version 25.0. Armonk, NY: Author.Google Scholar
Johnson, R., & Balleny, H. (1996). Behaviour problems after brain injury: Incidence and need for treatment. Clinical Rehabilitation, 10(2), 173–181. Retrieved from http://journals.sagepub.com/home/cre.CrossRefGoogle Scholar
Krippendorff, K. (2018). Content analysis: An introduction to its methodology (4th ed.). Thousand Oaks, CA: SAGE.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.CrossRefGoogle ScholarPubMed
Lowe, K., Allen, D., Brophy, S., & Moore, K. (2005). The management and treatment of challenging behaviours. Tizard Learning Disability Review, 10(2), 34–37. doi: 10.1108/13595474200500019.CrossRefGoogle Scholar
Neimeyer, G. J., Taylor, J. M., & Rozensky, R. H. (2012). The diminishing durability of knowledge in professional psychology: A Delphi Poll of specialties and proficiencies. Professional Psychology: Research and Practice, 43(4), 364–371. doi: 10.1037/a0028698.CrossRefGoogle Scholar
Ponsford, J., & 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
QSR International (2018). NVivo Version 12 [Computer software]. Melbourne, VIC: Author.Google Scholar
Qualtrics [Computer software]. (2018). Retrieved from https://www.qualtrics.com/au/.Google Scholar
Rahman, B., Oliver, C., & Alderman, N. (2010). Descriptive analysis of challenging behaviours shown by adults with acquired brain injury. Neuropsychological Rehabilitation, 20(2), 212–238. doi: 10.1080/09602010903021097.CrossRefGoogle ScholarPubMed
Sabaz, M., Simpson, G. K., Walker, A. J., Rogers, J. M., Gillis, I., & Strettles, B. (2014). Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: A multicenter study. Journal of Head Trauma Rehabilitation, 29(2), E19–E30. doi: 10.1097/HTR.0b013e31828dc590.CrossRefGoogle ScholarPubMed
Schlund, M. W. (2002a). Effects of acquired brain injury on adaptive choice and the role of reduced sensitivity to contingencies. Brain Injury, 16(6), 527–535. doi: 10.1080/02699050110113679.CrossRefGoogle ScholarPubMed
Schlund, M. W. (2002b). The effects of brain injury on choice and sensitivity to remote consequences: Deficits in discriminating response-consequence relations. Brain Injury, 16(4), 347–357. doi: 10.1080/02699050110103977.CrossRefGoogle ScholarPubMed
Schlund, M. W., & Pace, G. M. (2000). The experimental analysis of human operant behavior following traumatic brain injury. Behavioral Interventions, 15(3), 155–168. doi: 10.1002/1099-078X(200007/09)15:3<155:AID-BIN53>3.0.CO;2-F.3.0.CO;2-F>CrossRefGoogle Scholar
Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9(1), 7. doi: 10.1186/1748-5908-9-7.CrossRefGoogle ScholarPubMed
Stewart, R. E., Chambless, D. L., & Baron, J. (2011). Theoretical and practical barriers to practitioners’ willingness to seek training in empirically supported treatments. Journal of Clinical Psychology, 68(1), 8–23. doi: 10.1002/jclp.20832.CrossRefGoogle ScholarPubMed
Storkholm, M. H., Mazzocato, P., Tessma, M. K., & Savage, C. (2018). Assessing the reliability and validity of the Danish version of Organizational Readiness for Implementing Change (ORIC). Implementation Science, 13(1), 78. doi: 10.1186/s13012-018-0769-y.CrossRefGoogle Scholar
Tabachnick, B., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston, MA: Pearson Education.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.CrossRefGoogle ScholarPubMed
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 ScholarPubMed
Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4(1), 67. doi: 10.1186/1748-5908-4-67.CrossRefGoogle ScholarPubMed
Willis, T. J., & LaVigna, G. W. (2003). The safe management of physical aggression using multi-element positive practices in community settings. Journal of Head Trauma Rehabilitation, 18(1), 75–87. doi: 10.1097/00001199-200301000-00008.CrossRefGoogle ScholarPubMed
Wong, D., McKay, A., & Stolwyk, R. (2014). Delivery of psychological interventions by clinical neuropsychologists: Current practice in Australia and implications for training. Australian Psychologist, 49(4), 209–222. doi: 10.1111/ap.12061.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Supplementary material: File

Carmichael et al. supplementary material

Carmichael et al. supplementary material 1

Download Carmichael et al. supplementary material(File)
File 12.5 KB
Supplementary material: File

Carmichael et al. supplementary material

Carmichael et al. supplementary material 2

Download Carmichael et al. supplementary material(File)
File 14.3 KB