Authors: Jonathan Beebee (RNLD); Gillian Martin (BCBA); & Marianne Wooldridge (BCBA)
Post Winterbourne View there has been a flurry of government guidance documents advocating Positive Behaviour Support (PBS). This has led to a rise in commissioners looking for services that can offer PBS and a rise in services saying they offer this.
This has led to concern over when people say they are offering PBS how can we be sure what they are offering, and when practitioners say they use PBS as an intervention what competencies do they have. These concerns led to a special edition of the International Journal of PBS in Autumn 2013 aiming to clearly define PBS, and has led to some work on establishing PBS competencies which has recently been published by the PBS Coalition.
The authors were interested in mapping who Behaviour Practitioners are in the UK. This would give a baseline as to where services are now and thoughts on how they need to develop moving plans forward. Do they share similar training, roles, responsibilities, and accountability?
Similar research had been undertaken in Ireland (Martin, unpublished). We chose to adapt the questionnaire that had been developed for this research, pilot and adapt it. The questionnaire was published via Survey Monkey and shared via social media. It was also sent via a variety of email networks and forums. Social media users were also encouraged to copy the link and share it with their work colleagues and networks. We also advertised the research in some specific learning disability publications.
A research proposal was made to University of Hertfordshire School of Research Ethics Committee who granted ethical approval for the research.
Questions were able to be skipped to protect anonymity and no details were collected regarding the participants geographical location or employers name.
329 responses were received and 100% of respondents said their role met the definition we provided of behaviour practitioners. To our knowledge this is the largest research of this kind.
“for the purposes of this research, a behaviour practitioner is considered a person whose role primarily comprises of assessing, planning and delivering interventions to support people with intellectual disabilities and behaviours described as challenging”
71% of respondents were female (n=232) and 27% were male (n=89). 3 participants chose not to say. 48% of respondents reported working with people with learning disabilities for over 15 years indicating most people working in this arena are very experienced.
Information was asked about the age group of people that practitioners worked with and the answers are below.
Respondents worked in a wide variety of places as shown below, with 9 respondents preferring not to say.
The main profession of respondents were nurses and behaviour analysts who together made 55% of all responses. 11 people skipped this question, 2 preferred not to say and 17 respondents selected “other”.
Regulation of behaviour practitioners
The authors feel that professional regulation is important for behaviour practitioners. By being regulated/certified by a professional body practitioners need to meet set requirements of training, practice, and supervision. It also means that practitioners need to work to a set code of ethics/conduct. Not doing so could result in registration or certification being removed. This protects the vulnerable people who receive support and promotes the professionalism and standards of practice. For UK behaviour practice the authors recognise the Nursing & Midwifery Council, the Health Care Professionals Council, and the Behaviour Analysis Certification board as being the recognised authorities which registration or certification ensures competent practice.
It is concerning that the highest number of responses in this section was “none” with 41%. 11 people also chose to skip this question and 11 preferred not to say. In the comments there were a variety of comments of organisations people were signed up to. This included:
- BILD accredited
- Scottish Social Services Council
- BANT & CNHC
Whilst these bodies may require certain standards or training they do not regulate practice to the knowledge of the authors
An open question was asked regarding what training do people have relevant to their role. The answers were mixed and as we are unable to pair qualifications with training it is difficult to analyse the results accurately. It is therefore hard to draw any solid conclusions from this section. However, we will give some commentary here.
It is the opinion of the authors that, as PBS is an application of Applied Behaviour Analysis, in order to fully utilise PBS then practitioners or someone who supervises the practitioner should have an in depth knowledge of Applied Behaviour Analysis in order to correctly apply it. Professional qualifications, such as nursing and psychology may not automatically provide this competence.
Many respondents replied indicating they had studied ABA to MSc level. Others reported completing a 4 day course with IABA or a BTEC diploma. Whilst these short courses will increase skills and build awareness the authors would recommend that practice would still need to be supervised by someone who has studied in depth Applied Behaviour Analysis. There were also a variety of responses mentioning courses and qualifications that were not able to be verified regarding what level of PBS was covered within them.
Participants were asked if they reported to a clinical supervisor. 48 people skipped this question. Of those who responded 62% said that they did.
It was asked if their supervisors had specialist training in behaviour support. 152 people skipped this question (nearly half). 69% of those who responded said that they did, however we are unable to verify what this training was.
It was asked if participants receive external supervision. 49 people skipped this question, and of those who responded 53% said they had access to external supervision.
Participants were asked about informal supervision and this was reported to come from a variety of resources as can be seen in the table below
Due to the nature of this study the quality of the data is hard to verify. Firstly we do not know if all people who completed the survey do meet the definition of behaviour practitioner that we asked at the start. We cannot verify that people have undertook the training that they mention nor that this training does or does not give people competence in PBS.
Some of the questions may have been leading too, suggesting what answers we are hoping for, such as supervision. Most people would be aware this is something that should be in place and prompts may lead respondents to answer favourably. This may have been true for other questions also.
To the authors knowledge this is the largest mapping exercise that has been carried out to date to map who behaviour practitioners are in the UK. 329 responses is a very significant proportion and gives some clear indications of where the challenges are for people working with challenging behaviour.
It is our view that it is unacceptable that 41% of respondents are not regulated by a professional body. This reduces the professional protection that is available to young people and families and can result in practitioners not being accountable to a code of conduct, which could lead to de-registration if their practice is not effective or safe. It is a vital safeguard for people in receipt of health and social care services that appears to be very loosely applied to this area.
The level of training is unclear, but remains a concern. The BACB set out recommendations for what level of training is required to complete a functional assessment. It appears sporadic for vulnerable people and families whether the person they see for behaviour support will be trained to this level, and whether they will have access to a supervisor who has this training. We feel this research indicates more detailed research is required in this area.
Only 62% of respondents said they had regular supervision, and it appears numbers are low for how many of these will be equipped to give supervision in behavioural support. This may mean practice does not get appropriately questioned, and when issues could be identified and challenged they may go un-challenged and progress to bigger issues.
In summary, for vulnerable people in the UK who require behaviour support there appears to be a lack of consistency and quality in what people may receive. The authors feel that this warrants further investigation and that practice should have tighter regulation and clearer competencies in order to be able to say that a practitioner or a service offers behaviour support.