Issues in the definition and implementation of “best practice” for staff delivery of interventions for challenging behaviour

A focal sample of 103 intervention outcome studies was considered to confirm the evidence base for "best practice" for intervention for challenging behaviour in persons with intellectual disability and acquired brain injury and establish the service conditions associated with its effective implementation. Evidence supports the effectiveness of behavioural interventions with challenging behaviour, particularly those based upon prior functional analysis of behaviour. However, problems in formulating practice guidelines from such literature include: the limited evidence regarding clinical effectiveness in work with persons with acquired brain injury; the uncertain durability of change subsequent to intervention; and the heavy reliance upon research personnel external to services for assessment, analysis and programme design in reported studies. Subsequently, a further 42 papers which directly addressed the issue of the capacity of direct care for the delivery of interventions were reviewed. These suggest the importance of supervision processes, attitudinal change and establishment of formal review mechanisms as adjuncts to staff training in intervention methods.