Treatment and management of challenging behaviours in congregate and noncongregate community-based supported accommodation.
Community ID homes leaned on meds and restraint because no one drove real behavior plans.
01Research in Context
What this study did
Symons et al. (2005) watched adults with intellectual disability who lived in group homes or scattered apartments. They tracked challenging behavior for ten months to see if it dropped when services followed best practice.
The team also counted how often staff used pills, restraints, or behavioral plans. They wanted to know which tools workers actually picked.
What they found
Challenging behavior stayed flat. Nothing meaningful changed over the year.
Staff rarely used behavioral plans. Pills and holds stayed common even though they did not help.
How this fits with other research
Werner et al. (2025) flipped the script. Their OBM package cut mechanical restraint 80 percent and doubled behavior plans in similar homes. The same setting, opposite result.
Thillainathan et al. (2024) ran a full ABA program in a specialty house. Severe behavior dropped for most adults while staff kept 84 percent treatment integrity. Again, big change where J et al. saw none.
Nickerson et al. (2015) looks like a contradiction. They saw a small drop in aggression while pills stayed high. The gap is sample: they tracked clinic referrals, not everyday group homes.
Why it matters
This paper is a warning. Good behavior plans can sit on the shelf while restraint and meds fill the gap. Use the later studies as your playbook: add OBM tools, run full ABA, and measure weekly so staff see the payoff. When you walk into a home still stuck in 2005 mode, you now have proof that change is possible.
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02At a glance
03Original abstract
OBJECTIVES: To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour. SETTING: Community-based supported accommodation for people with ID and challenging behaviour. DESIGN: Longitudinal matched groups design. MAIN OUTCOME MEASURES: The nature and prevalence of use of procedures employed to treat and manage challenging behaviours. Observed and reported severity of challenging behaviours. RESULTS: Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than 15% of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (56%) and congregate (80%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff. DISCUSSION: Changes in reported and observed challenging behaviour over a 10-month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.
Journal of intellectual disability research : JIDR, 2005 · doi:10.1111/j.1365-2788.2005.00663.x