Klatt, K., Bannerman Juracek, D., Norman, K., McAdam, D., Sherman, J., & Bowen Sheldon, J.,

2002,

Reviewed by Janet Robertson, Institute for Health Research,
Lancaster University

Methodology

This study looks at the influence of providing preferred activities, as identified through person centred planning, on the level of challenging behaviour shown by 3 people with severe or profound learning disabilities. Quality of Life Plans (QLP) were developed for the 3 participants. Quality of Life Planning is a person centred approach which was developed specifically for people with severe learning disabilities who have difficulty communicating preferences. Planning began with assessments of the person's needs and preferences, including where appropriate a medical evaluation of possible physical causes of challenging behaviour. Interviews with people involved in the person's life and observations were used to identify needs and preferences.

To implement the QLP, preferred activities were written into an individualised daily activity schedule. Several preferred activities and items were selected from each person's QLP that could be presented or not presented daily (for example, whilst favourite music could be presented daily, a preferred living accommodation could not). For between 83 and 111 days, support staff recorded the frequency of challenging behaviour and ongoing activity on data cards throughout the time from 3pm to 8pm for two participants and 3pm to 11pm for one participant. Support staff were instructed to help participants participate in as many preferred activities as possible. Inter-observer agreement was calculated for 3% of intervals for one participant, 2% of intervals for a second participant, and not at all for the third participant. Within person comparisons were made to analyse challenging behaviour in relation to preferred versus all other activities.

Critical appraisal

There are some methodological limitations to the study beyond the small number of participants. Only preferred activities that were amenable to being presented or not presented on a daily basis were included, thus missing other preferences that may have been more pertinent in relation to challenging behaviour (for example, living in a non preferred setting). Support staff had to collect data on top of carrying out their jobs which may had led to inaccuracies in the data. Further, the amount of interobserver reliability data collected is inadequate. Finally, as noted by the authors, the preferences employed in the study were identified in the QLP and these preferences were not confirmed by a data-based preference assessment to see if these were indeed high preferences.

Key findings

For the three participants, less time was spent doing preferred activities than other activities and on some days participants did not engage in any preferred activities. Preferred activity occurred for between 26% and 44% of observed intervals, with the daily range being from 0% of intervals to 90%. For two participants, the proportion of intervals during which challenging behaviour was observed was lower during preferred activities (4% and 15%) than during other activities (96% and 85%). There was little difference for the third participant (39% during preferred activities, 61% during other activities). The association between the number of preferred activities done in a day (1 to 5 different activities) differed across the three participants.

Social work practice/policy implications

Developing a preferred lifestyle through PCP may not be sufficient to reduce challenging behaviour for all people with severe learning disabilities. The authors suggest that PCP should be used to develop preferred lifestyles, these preferences should be continually assessed, and activity schedules implemented that are tailored to individualised preferences. They suggest that if challenging behaviours then continues to occur, functional analysis should be conducted to identify the functions of behaviour so that appropriate strategies can be implemented. However, it may be more appropriate to employ functional analysis at an earlier stage rather than waiting to see if the changes brought about by PCP have a positive effect on the challenging behaviour displayed by individuals.