Staff ratings of challenging behaviour in an acquired brain injury population : evaluating the usefulness of screening measures

• Main Author: Gouick, Joanna
• Published: University of Edinburgh 2000
• Subjects: 616.89
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.651659

Current literature on sequelae of acquired brain injury reveals that behavioural disturbances such as physical and verbal aggression and disinhibited behaviour present a substantial barrier to community re-integration following severe brain injury. This study applies the concept of 'challenging behaviour', originally applied to people with learning disabilities, to behavioural disturbance following acquired brain injury. Definition of challenging behaviour, assessment, intervention, and impact on carers are discussed. Standardised measures of challenging behaviour are reviewed. The study has two aims. Firstly, to investigate the degree of shared understanding of the concept of challenging behaviour within a group of staff working in a specialist unit for people with behavioural disturbances following acquired brain injury. Twenty-eight members of staff (21 nurses and 7 other professional staff) completed questionnaires, consisting of four brief case vignettes. Each vignette was rated on 5-point scales for important defining aspects of challenging behaviour: overall management difficulty, threat to the physical safety of the patients and others, and impact on the patients' access to community facilities. Results are analysed for agreement between raters, taking consideration of demographic variables. Secondly, the usefulness of screening measures in application to challenging behaviour was evaluated within the same unit. The measures chosen were the Agitated Behaviour Scale (Corrigan 1989) and the Checklist of Challenging Behaviour (Harris et. al. 1994). Three members of staff (2 trained nurses and one other member of therapeutic staff) rated each patient's behaviour during the preceding week. A total of 22 patients were assessed, some on more than one occasion, and results examined for inter-rater reliability and concordance with clinical records. In addition, the behaviour profile of this clinical population is delineated. The application of standardised screening measures in general to challenging behaviour, methodological issues and future research implications are discussed.