Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

ABSTRACT

Challenging behaviours are a common and distressing consequence of acquired brain injury (ABI). There are no evidence-based guidelines for managing challenging behaviours after ABI, leaving clinicians with few resources to guide practice. Findings from case studies and single-subject experimental designs support the use of positive behaviour support (PBS) interventions for challenging behaviour post-ABI. This paper introduces PBS + PLUS: a multi-component and flexible PBS intervention using a person-driven collaborative approach to build a meaningful life and self-regulate behaviour after ABI. PBS + PLUS is currently being examined in a randomized controlled trial (RCT). Three detailed pilot case studies illustrate the highly individualized implementation of the programme, delivered to the individuals with ABI and carers over 12 months by a transdisciplinary team including neuropsychologists, occupational therapists, and psychiatrists. Objective behavioural outcomes are reported for participants using the Overt Behaviour Scale at baseline and four-monthly intervals for two years. Goal attainment scaling was used to measure personally meaningful goals. The qualitative appraisals of the intervention by participants, families and carers, and 12-month follow-up outcomes are described. The advantages and challenges of programme delivery are discussed. These case studies will assist clinicians and service providers to implement PBS + PLUS in anticipation of the results of the RCT.

KEYWORDS:

• Acquired brain injury
• Challenging behaviour
• Positive behaviour support
• Intervention
• Case study

Acknowledgements

The authors would like to acknowledge and gratefully thank the generosity, time and effort of the participants, therapists (Dr Kate Gould, Dr Belinda Renison, Dr Kim Trezise, Dr Diane Parcell, Nadine Holgate, Cathy Bucolo, Sally Peterson, and Dr Clare Kempnich), research staff at the Monash-Epworth Rehabilitation Research Centre; our independent expert for integrity monitoring, Melissa Capo, MS, CCC/SLP, The College of St. Rose, Albany, NY, USA; and Kat Orgallo, Graphic Designer, Medicine, Nursing & Health Sciences Teaching Resource Support Unit.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Transport Accident Commission through the Institute for Safety Compensation and Recovery Research [grant number 135].