Who's Challenging Who?
‘Who's Challenging Who?’ is funded by the National Institute for Health Research (NIHR) School for Social Care Research, and is in collaboration with Cardiff University and Mencap. The primary objective is to determine the impact of the training programme on staff attitudes (empathy) towards people with learning disability and challenging behaviour. The secondary objectives are to determine the impact of the training on: staff confidence, attitudes and work-related wellbeing; incidence of challenging behaviour in residential homes, and use of restrictive practices.
Approximately one in six people with a learning disability (LD) engage in “challenging behaviours”. Challenging behaviours are defined by their negative impact on the person (e.g., injury, exclusion from the community) and others (e.g., physical harm, stress). The actions of staff members can make challenging behaviours more likely to occur, or make these behaviours worse. In particular, staff negative attitudes and lack of understanding about the reasons for challenging behaviours are contributory factors. To address lack of staff empathy and negative attitudes, we worked directly with people with LD to design a staff training course.
The training “Who’s Challenging Who?” (WCW) is designed to emphasise the role of staff as a challenge also to people with learning disabilities. WCW is a half day training course with follow on coaching to ensure implementation. WCW is delivered jointly by a trainer with LD who has been labelled as having challenging behaviours, along with a trainer without LD. We have conducted development work on WCW, written a manual, and completed a pilot evaluation the results of which were positive. Staff reported increased empathy for people with LD and challenging behaviours, increased confidence, and reductions in negative attitudes.
In the new research study, people with learning disabilities and challenging behaviours will co-deliver the WCW training. Two staff members from 118 LD residential services will participate. One half of group homes randomised to receive the WCW training. Following the research evaluation, group homes in the “training as usual” comparison group will also be offered the WCW training. The primary outcome will be changes in staff empathy towards people with CB. Secondary outcomes at the staff level will include confidence, attitudes, and work-related well-being. Secondary outcomes at the group home level will include recorded incidents of aggressive CB, and use of any restrictive practices.
If the results of this cluster randomised trial are positive, we will disseminate the findings widely and make all training manuals and materials freely available on the internet for anyone in LD services (and beyond) to use. Our training approach may have wider implications in other areas of social care (e.g., mental health, dementia, brain injury), and may also provide a generally applicable model for how to train people with LD to act as co-trainers in LD social care settings. People with LD and challenging behaviours have already been involved centrally with the design, development, and pilot evaluation of WCW, and will continue to be fully involved throughout this trial.