Clinical and cost effectiveness of staff training in Positive Behaviour Support (PBS) for treating challenging behaviour among people with learning disability: a multicentre cluster randomised controlled trial
Staff training in Positive Behaviour Support (PBS) is being tested against usual care in a trial involving 240 adults with learning disabilities whose challenging behaviour disrupts their daily lives and often leads to hospital stays or heavy medication. This matters because challenging behaviour—such as aggression or self-injury—affects roughly one in five people with learning disabilities, yet the evidence for how to reduce it in routine community settings is weak. Current care varies widely, and staff often lack structured, evidence-based techniques. The trial compares a seven-day accredited PBS training programme for community learning disability teams against standard multidisciplinary care, with ongoing supervision to keep skills sharp. If PBS proves effective, the impact would be direct and practical: fewer people would need long-term antipsychotic drugs or inpatient admissions, and more could live ordinary lives at home. The study also measures costs, so health commissioners would know whether the training saves money overall. A nested qualitative study will reveal what helps or hinders staff in applying PBS, making the results actionable for real-world services.
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Introduction: Many people with learning disability have challenging behaviour which often has serious consequences e.g. prescription of long term medication, in-patient admissions and disruption of normal daily activities. In this study we want to evaluate Positive Behaviour Support (PBS) delivered by staff in routine clinical practice. Interventions: Volunteer health staff working in each of the community learning disability teams (CLDT) will receive 7 days of accredited training in PBS. The professionals will be assigned acaseload of 5-10 cases each during the trial. Ongoing supervision will maintain staff skills and correct any errors in application. Usual care (for both arms) consists of routine multidiciplinary interventions (psychiatry, psychology, nursing, etc) available in CLDT. The sample size is based on the primary outcome (total ABC score). In order to detect a difference of 0.45 SD in our primary outcome with 90% power and 5% significance level inflating for clustering within the CLDT using an intracluster correlation of 0.062 and an average cluster size of 15, a total of 240 patients will be required. Analyses: We will use intention to treat. Primary analyses will be based on a three level multilevel regression model adjusting for baseline ABC measurements and the effects of clustering by services and repeated measures within participants. Costs will be compared using a bootstrapped regression model which allows analysis of actual costs and we will examine cost-effectiveness and cost-utility. The thematic analysis of the nested qualitative study will be guided by the framework approach. Finally we will explore the treatment fidelity of the intervention.
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