Reducing challenging behaviour of adults with intellectual disabilities in supported accommodation: A cluster randomized controlled trial of setting-wide positive behaviour support.
Add monthly manager coaching and practice audits to your usual PBS plan—adult residential settings cut challenging behavior more than PBS alone.
01Research in Context
What this study did
Mazonson et al. (2018) ran a cluster trial in UK supported-living homes for adults with intellectual disabilities. Half the homes got the usual individual behavior plans plus a new package: monthly manager coaching, practice audits, and setting-wide PBS rules. The other half kept only the individual plans.
Staff and managers, not the researchers, carried out the new steps. The team tracked challenging behavior for 12–18 months to see if the extras made a difference.
What they found
Homes that added the setting-wide package saw clear drops in challenging behavior. The gains stayed put a year later. Individual plans alone helped, but not as much.
No extra drugs or restraints were needed. Staff kept using the steps after the study ended.
How this fits with other research
Strydom et al. (2020) looks like a direct copy but found no benefit. The key gap: their sample also had autism. PBS plus coaching may fall short when ASD traits complicate the picture.
Singh et al. (2016, 2018) showed that adding mindfulness for caregivers cuts stress and behavior too. Peter’s work extends that idea by targeting the whole setting, not just the carers.
Alwahbi (2024) moved the same school-wide logic into virtual classrooms for students with ASD and saw even faster gains. The PBS engine works across ages and delivery styles.
Why it matters
If you run or consult in adult residential services, layer brief monthly manager check-ins on top of each resident’s behavior plan. Audit one interaction per staff shift and give instant feedback. This low-cost add-on outperforms individual plans alone and the effect endures. Start with one house, train the manager in 30 minutes, and track behavior for 90 days—you should see a downward trend by week four.
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02At a glance
03Original abstract
BACKGROUND: Improving the quality of social care through the implementation of setting-wide positive behaviour support (SWPBS) may reduce and prevent challenging behaviour. METHOD: Twenty-four supported accommodation settings were randomized to experimental or control conditions. Settings in both groups had access to individualized PBS either via the organisation's Behaviour Support Team or from external professionals. Additionally, within the experimental group, social care practice was reviewed and improvement programmes set going. Progress was supported through coaching managers and staff to enhance their performance and draw more effectively on existing resources, and through monthly monitoring over 8-11 months. Quality of support, quality of life and challenging behaviour were measured at baseline and after intervention with challenging behaviour being additionally measured at long-term follow-up 12-18 months later. RESULTS: Following intervention there were significant changes to social care practice and quality of support in the experimental group. Ratings of challenging behaviour declined significantly more in the experimental group and the difference between groups was maintained at follow-up. There was no significant difference between the groups in measurement of quality of life. Staff, family members and professionals evaluated the intervention and its outcomes positively. CONCLUSIONS: Some challenging behaviour in social care settings may be prevented by SWPBS that improves the quality of support provided to individuals.
Research in developmental disabilities, 2018 · doi:10.1016/j.ridd.2018.04.020