View in EDS HTML Full Text PDF Full Text

The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability

Saved in:
Bibliographic Details
Title: The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability
Language: English
Authors: McVilly, K., Webber, L., Sharp, G., Paris, M.
Source: Journal of Intellectual Disability Research. Aug 2013 57(8):703-715.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 13
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Descriptors: Behavior Problems, Test Validity, Planning, Adults, Mental Retardation, Delphi Technique, Day Programs, Intervention, Program Effectiveness, Foreign Countries, Individual Characteristics, Reinforcement, Rewards, Predictor Variables, Environmental Influences, Responses, Goal Orientation, Teamwork, Interpersonal Communication, Philosophy
Geographic Terms: Australia
DOI: 10.1111/j.1365-2788.2012.01602.x
ISSN: 0964-2633
Abstract: Background: The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability. Method: A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners ("n" = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics. Results: The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. Conclusions: The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes. (Contains 4 tables.)
Abstractor: As Provided
Number of References: 29
Entry Date: 2014
Accession Number: EJ1014799
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHB_yRkqOlhsvbdh0Zbv0wrAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDLcbED1tB6xl_IhQBQIBEICBmuCXdFELGW0J5LG_ULs4WtsWlYQiWxES6Xch0AiPrj8QFDLfKECe_mZ2QxluJT51BV2vVxTf7610gE-3rD1b0WUQVNYh_3EeYxD89VFuo_Pu4ImVPCW3tE159eVhm3Anm2gw6lI87pPVRyz7dqrfGP2fdIxkZtzP17SVSjTF_oj04TZhVK7j5Ix51SJBWF1fEN3ALQIrwanJdvM=
Text:
  Availability: 1
  Value: <anid>AN0088263553;eul01aug.13;2018Jul09.14:14;v2.2.500</anid> <title id="AN0088263553-1">The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability. </title> <p>Background  The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP‐QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day‐support services for adults with intellectual disability. Method  A three‐round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8‐week period. The analyses included deductive content analysis and descriptive statistics. Results  The 12 quality domains of the BSP‐QEII were affirmed as valid for application in adult accommodation and day‐support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. Conclusions  The BSP‐QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.</p> <p>behaviour support plan; challenging behaviour; validity; assessment</p> <p>The quality of support provided to people with intellectual disabilities (ID) has long been debated in the scientific literature, and many attempts have been made at both policy and clinical levels to measure this allusive construct (Borthwick‐Duffy 1996; Brown 1997; Stancliffe & Lakin 2005; Mansell 2006). For people with ID who also exhibit challenging behaviours, measures of service quality have now moved beyond administrative criteria focusing on the extent to which services bring about changes in the frequency and duration of behaviour, or clinical criteria addressing changes in the form of behaviour, and the acquisition of alternative behaviours. The contemporary service quality agenda is now focused on the extent to which services act ethically, recognise and uphold people's human rights and, importantly, minimise practices which infringe on people's human rights (Allen 2008; French et al. 2010; Emerson & Einfeld 2011).</p> <p>People whose behaviours give rise to their referral for behaviour intervention, or behaviour support, are particularly at risk of infringements of their human rights (Webber et al. 2010). Such infringements can take the form of restrictive practices such as chemical restraint, physical or mechanical restraint, and seclusion (McVilly 2009), and can have long‐term adverse effects (Bird & Luiselli 2000). To minimise the misuse of these practices and promote quality in both service provision and service outcomes for this group, the principles and practices of Positive Behaviour Support (PBS) are now widely accepted and promoted (Carr et al. 1999; Sugai et al. 2000; Allen et al. 2005; Lowe et al. 2005; McVilly 2007). PBS builds on the science of applied behaviour analysis and seeks to address both deficient skill sets and coping abilities inherent in the individual, and at the same time address deficiencies in the environment that have contributed to the person's initial need to use challenging behaviours, and their continued use of these behaviours (Carr et al. 2002; Johnston et al. 2006).</p> <p>Clinical assessment and evidence‐based formulation informed by PBS, together with the education of those providing primary support are important systemic elements for ensuring quality in service provision and service outcomes. However, given the complexity that often characterises the provision of support, and the multiplicity of people involved, the quality of the documentation associated with the process, namely the behaviour support plan (BSP), could be critical to success (Webber et al. 2011a).</p> <p>When considering the quality of BSPs, six concepts have been identified, and are empirically supported, as important for effective behavioural support planning (Horner et al. 2000). These include: having an objective definition of the behaviour and its hypothesised function – what are the behaviours of concern and what functions does each serve; situational specificity – when and where do the behaviours occur, or not occur; strategies to support behavioural change – including both environmental change strategies and skills teaching; reinforcement of adaptive behaviours and the non‐use of the behaviour; reactive strategies to use when behaviours emerge – along a continuum from the least restrictive first; and team co‐ordination and communication. Horner et al. (2000) assert that if these guidelines for the formulation of BSPs are followed, staff will develop an effective, evidence‐based plan which should result in a better quality of service being provided to the client, and a service which promotes their health, well‐being and quality of life and, importantly, supports their human rights.</p> <p>Phillips et al. (2010) developed a tool to assess the extent to which BSPs for people with ID were inclusive of best practice criteria, such as those proposed by Horner et al. Their study included a comparison of plans prepared prior to and following the introduction new legislation (Disability Act [Victoria], 2006) governing the support of people with disability, including explicit provisions for the planning, implementation and review of behaviour support programmes designed to safeguard people's civil and human rights. The study concluded that there exists a lack of best practice criteria in BSPs and direct support staff are ill equipped to execute behaviour support strategies, despite a legislative framework to support these interventions. However, to date there is limited evidence of the validity and reliability of their tool, given the study was based on a relatively small sample, and drawn from a single community service provider agency. Further work in this direction holds promise to better inform policy and clinical developments.</p> <p>In a similar attempt to construct a best practice framework to both inform the education of staff and evaluate the formulation of BSPs, the Behaviour Support Plan Quality Evaluation Guide II (BSP‐QEII) was developed (Browning‐Wright et al. 2003). The BSP‐QEII includes 12 rating items assessing various substantive aspects of plans (e.g. quality of behaviour definition, specification of antecedents, identification of behaviour function). It has mainly been used and evaluated in the USA, in educational settings to support children with challenging behaviour, where it has been found to be a reliable evaluation tool (Cook et al. 2012). For example, one study examined plans written by educators (Cook et al. 2007). The study found only 11% of the plans developed by typical school teams were rated as ‘Adequate’ compared to 65% of the plans from teams with more experienced and skilled staff members involved, and who had received specific instruction in the principles of PBS. In another school setting for children with autism, the BSP‐QEII was used to assess the effect of a specific brief training delivered to improve BSPs (Kraemer et al. 2008). The study used the BSP‐QEII to evaluate plans both pre and post training. Results revealed that training improved the quality of BSPs. However, the findings indicated the majority of BSPs developed were still inadequate and potentially legally invalid due to substantive and procedural violations.</p> <p>Based on these findings, it is possible that the BSP‐QEII could offer a potentially useful measure of the quality of behaviour support documentation in adult settings too. McVilly et al. (2012) and Webber et al. (2011b) report evidence of acceptable levels of inter‐rater agreement for the majority of the individual items, when used by people who have undertaken some minimal training and practice. With the exception of the above studies, to date the BSP‐QEII has generally been applied in the USA to the assessment of BSPs developed by teachers in school settings to support children with disability. The extent to which these findings can be generalised to the support of adults in community‐based accommodation and day‐support organisations supported by psychologists and allied health professionals requires further investigation.</p> <p>As part of a programme of research examining the potential application of the BSP‐QEII in community‐based services for adults with ID, including the reliability of the tool (see McVilly et al. 2012), the current study investigated the validity of the BSP‐QEII in the context of its use by psychologists and allied health professionals in community based services for adults with ID. The validity of an assessment refers to its true capacity to measure what it purports to measure (Groth‐Marnat 2009); in this instance, the quality of BSPs. There are different ways of assessing validity. At its most basic is face validity, which asks the question would those with expertise recognise the tool as measuring what it claims to measure. However, face validity remains relatively subjective. A related, but more rigorous approach is that of establishing content validity. While still relying on practitioner judgement, content validity typically involves a series of practitioners selected for their expertise rating various items or domains of the assessment, according to an objective scale. After the content validity has been established, further modelling can be conducted to establish the construct validity of the items (i.e. do individual items in the instrument measure‐related issues, or do different results emerge as might be predicted when the instrument is used in different situations, and can the instrument satisfactorily distinguish between plans developed in different situations or circumstances). Where similar tools already exist, it would be possible to evaluate the tool's concurrent validity. Finally, it might be important to establish the tool's predictive validity, with respect to certain clinical criterion. For example, high scores on a tool such as the BSP‐QEII might predict high‐quality service outcomes for people with a disability.</p> <p>The current study was designed to assess the content validity of the BSP‐QEII. This was undertaken with reference to the opinion of clinical experts working with adults with ID in community based accommodation and day‐support settings. It was predicted that given the criteria of the BSP‐QEII is based on best practice as derived from the research literature there would be high endorsement of these concepts by experienced practitioners.</p> <hd id="AN0088263553-2">Method</hd> <hd id="AN0088263553-3">Ethics</hd> <p>Ethics approval for this study was provided by the Deakin University Human Research Ethics Committee.</p> <hd id="AN0088263553-4">Procedure</hd> <p>Consistent with the focus on establishing the content validity of the BSP‐QEII, within the context of service provision to adults with ID in community‐based services, the investigation was conducted as a three‐round Delphi study (Mullen 2003). Delphi studies are designed to source the opinion of persons who are expert in a particular area, and to devise a consensus of opinion among such an expert group. They typically involve multiple rounds of data collection, where by participants proposes the key constructs for consideration and then over a series of contributions provide ratings and evaluation of each other's opinions. The current Delphi study was conducted over a period of approximately 8 weeks, with each round active for up to 2 weeks at a time.</p> <p>Round One asked participants to list in dot‐point form, in their expert opinion, key indicators of a quality BSP. Deductive content analysis (Krippendorff 2004) was then used to group the comments according to the existing 12 quality criteria of the BSP‐QEII, with provision made for the development of additional thematic groups as might be suggested by the data. Deductive content analysis was used given that one aim of the study was to evaluate the a priori theoretical framework of BSP‐QEII. To address the potential for bias in the analysis, members of the research team first individually considered the grouping of the items, and the final Round One grouping was then facilitated though a consensus coding process among the research team as a whole, in which each of the responses were discussed and the rationale for their allocation to a category debated among the researchers. Here it should be noted that we intentionally chose not to simply ask the expert practitioners to make direct ratings on the 12 BSP‐QEII items in Round One, to avoid tautological endorsement of items that already had face validity in the research literature.</p> <p>Round Two included three tasks. Participants reviewed the researchers' allocation of their comments (provided in Round One) to the various categories. Participants indicated if they believed the allocation of each comment was appropriate, and if not they had the option to suggest a re‐allocation. This process was devised to further address any potential bias in the researchers' original allocation of items, and to address issues of trustworthiness in the data (i.e. the qualitative equivalent of validity). Participants then indicated if they considered each individual comment as being essential to a quality BSP. Participants were then asked to rate each of the 12 BSP‐QEII quality categories, and the two additional categories that had emerged from the analysis of the Round One data, according to how essential these general overarching categories were as quality indicators for BSPs. For these 14 overarching categories, participants responded using a 10‐point Likert scale: 0 = not required; 1–3 = not important; 4–6 = important; 7–9 = very important; 10 = essential for inclusion.</p> <p>Round Three asked the participants to rate the individual comments, originally generated in Round One and then identified as a sub‐set in Round Two as being among the most frequently endorsed as essential to a quality BSP. To provide these ratings, participants recorded responses on the same 10‐point scale used in Round Two to rate the 14 general overarching categories.</p> <hd id="AN0088263553-5">Participants</hd> <p>Purposive sampling was undertaken. This is the recommended approach for Delphi studies, which by design seek to recruit persons with specific experience and expertise. Subsequently, the inclusion criteria sought to recruit persons with experience and professional responsibility for the development of BSPs in adult disability services. Primarily these people were employed in government‐run specialist behaviour intervention teams. However, some professionals with similar responsibility in community service organisations were also included in the recruitment process. The recruitment process involved service managers circulating an approved Plain Language Statement inviting staff who met the inclusion criteria to volunteer for the study.</p> <p>In total there were 80 eligible participants, of which 30 agreed to participate (representing a 37.5% response rate). There were 10 men and 20 women. They ranged in age from 23 to 57 years (M = 37.8; SD = 10.11). Their experience in disability services ranged from 6 months to 33 years (M = 12.58; SD = 8.73). They reported a variety of qualifications (and combination of qualifications), including graduate level qualifications in psychology, speech pathology and occupational therapy, as well as qualifications in nursing and as psycho‐educational trainers. Overall, this group was typical of those involved in the provision of assessment and behaviour programme development for adults with ID in this jurisdiction. All fulfilled very similar roles, dedicated full time to developing and reviewing BSPs for adults with ID in community‐based accommodation and day‐support services.</p> <hd id="AN0088263553-6">Results</hd> <hd id="AN0088263553-7">Delphi Round One</hd> <p>Participants in Round One provided 273 individual comments. Each of the participants' comments were allocated to one of the 12 BSP‐QEII categories, by means of deductive content analysis and consensus coding. Taking into account duplications and similar comments made by individual participants, a total of 97 different comments were distributed across the 12 BSP‐QEII categories. In addition, two additional categories emerged as a result of the content analysis (background on the person with disability, and details reflecting contemporary philosophy of service provision). The distribution of comments to the BSP‐QEII categories and the two additional categories is given in Table 1.</p> <p>1 The allocation of 97 comments to the 12 BSP‐QEII categories and the two additional categories</p> <p> <ephtml> <table><tr><th>BSP‐QEII categories</th><th>Number of comments allocated (% of 97)</th></tr><tr><td>A. Behaviour of concern stated in a way that is observable and measurable</td><td>6.20</td></tr><tr><td>B. Predictors/triggers of behaviour are described in detail</td><td>9.28</td></tr><tr><td>C. Analysis (explanation) of what supports the problem behaviour is logically related to the identified predictors/triggers</td><td>10.30</td></tr><tr><td>D. Environmental changes (strategies) are logically related to what supports the problem behaviour</td><td>5.15</td></tr><tr><td>E. Function of behaviour is explained in terms of what the person needs or gets; rejects or escapes; protests or avoids</td><td>3.10</td></tr><tr><td>F. Replacement behaviour (a positive alternative to the BoC which serves the same function) is identified for teaching</td><td>3.10</td></tr><tr><td>G. Teaching strategies for replacement behaviours are outlined in detail; i.e. how replacement behaviours will be taught</td><td>7.22</td></tr><tr><td>H. Reinforcers are described to encourage the use of replacement behaviours and reward the non‐use of BoC</td><td>3.10</td></tr><tr><td>I. Reactive strategies for managing BoC safely are described</td><td>6.20</td></tr><tr><td>J. Goals and objectives for behaviour change are described; i.e. increase in use of replacement behaviours (positive alternatives to BoC)</td><td>5.15</td></tr><tr><td>K. Team co‐ordination is described in terms of what roles people perform, who is responsible for particular tasks and by when</td><td>10.30</td></tr><tr><td>L. Communication about what information is to be recorded and how it is to be circulated</td><td>5.15</td></tr></table> </ephtml> </p> <p></p> <p> <ephtml> <table><tr><th>Additional categories</th><th /></tr><tr><td>M. Background to the person including their personal history, strengths, preferences, support needs and diagnoses etc.</td><td>9.30</td></tr><tr><td>N. Contemporary Philosophy of service provision to people with disabilities is reflected in the plan in terms of language used; issues addressed and lay out adopted</td><td>16.50</td></tr></table> </ephtml> </p> <p>1 BoC, behaviour of concern; BSP‐QEII, Behaviour Support Plan Quality Evaluation Guide II.</p> <hd id="AN0088263553-8">Delphi Round Two</hd> <p>For the 97 individual comments extracted from Round One and allocated across the 14 categories for Round Two, 49 individual suggestions were made for the reallocation of comments to other categories. However, there were no consistent suggestions across participants (i.e. all suggestions for re‐allocation were unique to individual participants). Overall, these results were interpreted as affirming the research team's original consensus allocation of the items to the 12 BSP‐QEII categories plus the additional two categories which emerged from the coding process. Consequently, the items as allocated following Round One were retained in their respective groupings for Round Three.</p> <p>All 97 items presented to participants in Round Two were rated as essential to a quality BSP. These are presented in Table 2. However, the extent to which they were endorsed ranged between 20% of respondents and 80% of respondents. Overall, items were endorsed as being essential by 47% of participants.</p> <p>2 Individual comments endorsed by respondents in round two as being essential to a quality behaviour support plan</p> <p> <ephtml> <table><tr><th>Participant comments</th><th>% of participants providing endorsement</th></tr><tr><td>Behaviour of concern</td><td /></tr><tr><td> Description of problem behaviour (observable and measurable)</td><td>80.00</td></tr><tr><td> High rate times of occurrence</td><td>33.33</td></tr><tr><td> Clear description of behaviours to be increased and decreased</td><td>60.00</td></tr><tr><td> The impact of BoC on the person and others and how these affect QoL</td><td>40.00</td></tr><tr><td> Data around frequency, intensity and duration not just anecdotal</td><td>46.70</td></tr><tr><td> Any warning of build‐up</td><td>40.00</td></tr><tr><td>Predictors</td><td /></tr><tr><td> Clear definition of predictors of behaviour (key indicators)</td><td>60.00</td></tr><tr><td> History of BoC</td><td>33.33</td></tr><tr><td> Things staff should avoid/not do when around the client</td><td>40.00</td></tr><tr><td> Health/medical/psychiatric concerns</td><td>40.00</td></tr><tr><td> Side effects of medications</td><td>40.00</td></tr><tr><td> Current skills (what is client good at and what they have difficulty with)</td><td>40.00</td></tr><tr><td> Communication skills</td><td>46.70</td></tr><tr><td> Sensory stimulation</td><td>46.70</td></tr><tr><td> Antecedents and functions of BoC</td><td>46.70</td></tr><tr><td>Analysis of what supports behaviour</td><td /></tr><tr><td> Behaviour recordings (settings, triggers, results)</td><td>40.00</td></tr><tr><td> Observation (where appropriate and feasible)</td><td>20.00</td></tr><tr><td> Motivational analysis (likes and dislikes, preferred activities)</td><td>26.70</td></tr><tr><td> Functional behavioural analysis</td><td>53.33</td></tr><tr><td> Understanding of why BoC occurs</td><td>60.00</td></tr><tr><td> Concise inclusion of historical factors relating to BoC, i.e. trauma engagement style that works/exacerbates, any schemas relating to BoC</td><td>26.70</td></tr><tr><td> Understand why BoC – what are the reasons?</td><td>46.70</td></tr><tr><td> Medical status</td><td>33.33</td></tr><tr><td> Medications and side effects</td><td>33.33</td></tr><tr><td> Hypothesis on function of BoC</td><td>53.33</td></tr><tr><td>Environmental structure</td><td /></tr><tr><td> Shorts term change strategies</td><td>40.00</td></tr><tr><td> Environmental factors that can be changed to decease BoC (long term)</td><td>60.00</td></tr><tr><td> Change environment to increase choice making</td><td>60.00</td></tr><tr><td> Prevention of BoC</td><td>60.00</td></tr><tr><td> Details persons programme</td><td>40.00</td></tr><tr><td>Function of behaviour</td><td /></tr><tr><td> Purpose and function of the behaviour</td><td>66.70</td></tr><tr><td> Why the behaviours are occurring in terms of what the person needs or gets; rejects or escapes; protests or avoids</td><td>46.70</td></tr><tr><td> Understanding the needs and behaviours of the person</td><td>46.70</td></tr><tr><td>Replacement behaviours</td><td /></tr><tr><td> Attempt and teach functionally equivalent behaviour</td><td>40.00</td></tr><tr><td> Clear links between function of behaviour and strategy that meets the need</td><td>46.70</td></tr><tr><td> What supports can be used so client will not have to use BoC and can use positive alternatives</td><td>46.70</td></tr><tr><td>Teaching strategies</td><td /></tr><tr><td> Language understood by the client</td><td>53.33</td></tr><tr><td> Positive programming</td><td>46.70</td></tr><tr><td> Things the staff can do to increase the clients support</td><td>40.00</td></tr><tr><td> Skills development (e.g. relaxation, communication, identify/monitor emotion)</td><td>53.33</td></tr><tr><td> What the plan is to decrease restrictive procedures</td><td>33.33</td></tr><tr><td> Include teaching strategies</td><td>40.00</td></tr><tr><td> Clear succinct management and ideas to teach other ways to communicate</td><td>40.00</td></tr><tr><td>Reinforcers</td><td /></tr><tr><td> Short term strategies (rewards)</td><td>40.00</td></tr><tr><td> Engage client in an activity that they enjoy</td><td>46.70</td></tr><tr><td> Incentive programmes</td><td>33.33</td></tr><tr><td>Reactive strategies</td><td /></tr><tr><td> Reactive strategies on a continuum from least restrictive to most restrictive</td><td>60.00</td></tr><tr><td> Consideration of persons human rights in utilising restrictive practice</td><td>60.00</td></tr><tr><td> Clearly listing any restrictive practices and interventions and why these are necessary</td><td>53.33</td></tr><tr><td> Evaluation of proactive and restrictive intervention included</td><td>53.33</td></tr><tr><td> Clear‐concise info about restrictive interventions</td><td>46.70</td></tr><tr><td> Safety of person and other</td><td>53.33</td></tr><tr><td>Goals and objectives</td><td /></tr><tr><td> Person goals/what the person want to achieve in their life</td><td>40.00</td></tr><tr><td> Evidence the plan works</td><td>46.70</td></tr><tr><td> Realistic goals within achievable time and resources</td><td>46.70</td></tr><tr><td> Demonstration that ultimate goal in reduction of BoC and increase in QoL or person and their support</td><td>53.33</td></tr><tr><td> What the plan is to decrease restrictive procedures</td><td>46.70</td></tr><tr><td>Team co‐ordination</td><td /></tr><tr><td> Ongoing monitoring of BoC</td><td>60.00</td></tr><tr><td> Monitoring of implementation of strategy or access to enjoyed activity</td><td>46.70</td></tr><tr><td> Consultation with all involved parties (stakeholders) and multiple perspectives</td><td>66.70</td></tr><tr><td> Maintained and updated appropriately</td><td>66.70</td></tr><tr><td> Client/resident should have input into strategies so they feel some responsibility and want to take some ownership</td><td>46.70</td></tr><tr><td> Evidence of collaborative approach to development</td><td>40.00</td></tr><tr><td> Endorsed by experienced practitioner (signed off)</td><td>33.33</td></tr><tr><td> Action plan (who does what, when etc)</td><td>60.00</td></tr><tr><td> Authorisation, e.g. Authorised Programme Officer</td><td>66.70</td></tr><tr><td> Consent, e.g. client or guardian</td><td>60.00</td></tr><tr><td>Communication</td><td /></tr><tr><td> Recommendations/referrals to other relevant professional such as OT, speech etc.</td><td>46.70</td></tr><tr><td> Evidence of review dates</td><td>60.00</td></tr><tr><td> Monitoring progress and communication between stakeholders</td><td>40.00</td></tr><tr><td> Information sources, e.g. people consulted, reports used to inform plan</td><td>46.70</td></tr><tr><td> List of service providers/agencies</td><td>40.00</td></tr><tr><td>Contemporary philosophy</td><td /></tr><tr><td> Clear to understand/plain English/no jargon</td><td>60.00</td></tr><tr><td> Ease of implementation</td><td>40.00</td></tr><tr><td> Concise – not too wordy – one/two page summary</td><td>33.33</td></tr><tr><td> Gives a good balanced, non judgemental view of the client</td><td>40.00</td></tr><tr><td> Person centred</td><td>60.00</td></tr><tr><td> Clients likes and dislikes</td><td>40.00</td></tr><tr><td> Politically correct language, e.g. not labelling or judging</td><td>60.00</td></tr><tr><td> Positively focused not just a reactive strategy</td><td>60.00</td></tr><tr><td> Useable strategies for staff/practical that work; social validity</td><td>46.70</td></tr><tr><td> Demonstrating understanding of what constitutes a BoC and how this may differ from an ‘annoying’, challenging or age typical behaviour</td><td>46.70</td></tr><tr><td> Evidence based</td><td>53.33</td></tr><tr><td> Supports system change</td><td>33.33</td></tr><tr><td> Flexibility</td><td>26.70</td></tr><tr><td> Office of the Senior Practitioner related pages of behaviour support plan should be omitted from working document in unit as it only serves as a distracter to staff</td><td>46.70</td></tr><tr><td> Short sharp direct procedure to mange BoC</td><td>20.00</td></tr><tr><td> Sympathetic</td><td>20.00</td></tr><tr><td>Background</td><td /></tr><tr><td> Personal history</td><td>46.70</td></tr><tr><td> Family background</td><td>40.00</td></tr><tr><td> Person's disability/diagnosis</td><td>46.70</td></tr><tr><td> Medical history</td><td>40.00</td></tr><tr><td> Skills (strengths) and support needs</td><td>60.00</td></tr><tr><td> Cognitive ability and limitations</td><td>46.70</td></tr><tr><td> Communication ability & support needs</td><td>60.00</td></tr><tr><td> Sensory ability and support needs</td><td>46.70</td></tr><tr><td> Personality (preferences, style, likes, dislikes, long/short fuse, etc.)</td><td>40.00</td></tr></table> </ephtml> </p> <p>2 BoC, behaviour of concern; QoL, quality of life.</p> <p>From these items the researchers extracted those that had endorsement by at least 60% of respondents. Subsequently 26 items were identified. These items formed the basis of Round Three (described later).</p> <p>In Round Two, participants also rated the 14 overarching categories (12 from the BSP‐QEII and the additional two to emerge from the analysis of the Round One data) on a scale of 0 (not required in a BSP) to10 (essential for inclusion in a BSP). The results of these ratings are shown in Table 3. Overall, there was a high level of endorsement for all of the categories, with the mean scores indicating respondents to consider each of the categories to be very important to essential to a quality BSP. The only category not to attain a mean rating within the range indicating it to be at least very important was ‘Reinforcers are described to encourage the use of replacement behaviours and reward the non‐use of BoC’. This item received a mean rating of 6.93 (i.e. important).</p> <p>3 Round Two: average ratings of importance for the quality criteria, as given by expert participants</p> <p> <ephtml> <table><tr><th>Categories</th><th>Mean</th><th>SD</th><th>Median</th></tr><tr><td>BSP‐QEII categories</td><td /><td /><td /></tr><tr><td> A. Behaviour of concern stated in a way that is observable and measurable</td><td>9.71</td><td>0.61</td><td>10</td></tr><tr><td> B. Predictors/triggers of behaviour are described in detail</td><td>9.64</td><td>0.63</td><td>10</td></tr><tr><td> C. Analysis (explanation) of what supports the problem behaviour is logically related to the identified predictors/triggers</td><td>9.57</td><td>0.76</td><td>10</td></tr><tr><td> D. Environmental changes (strategies) are logically related to what supports the problem behaviour</td><td>8.71</td><td>2.67</td><td>10</td></tr><tr><td> E. Function of behaviour is explained in terms of what the person needs or gets; rejects or escapes; protests or avoids</td><td>9.57</td><td>0.65</td><td>10</td></tr><tr><td> F. Replacement behaviour (a positive alternative to the BoC which serves the same function) is identified for teaching</td><td>8.21</td><td>2.64</td><td>8.5</td></tr><tr><td> G. Teaching strategies for replacement behaviours are outlined in detail; i.e. how replacement behaviours will be taught</td><td>8.00</td><td>3.00</td><td>9</td></tr><tr><td> H. Reinforcers are described to encourage the use of replacement behaviours and reward the non‐use of BoC</td><td>6.93</td><td>3.05</td><td>7.5</td></tr><tr><td> I. Reactive strategies for managing BoC safely are described</td><td>7.93</td><td>2.70</td><td>8.5</td></tr><tr><td> J. Goals and objectives for behaviour change are described; i.e. increase in use of replacement behaviours (positive alternatives to BoC)</td><td>8.71</td><td>1.54</td><td>9</td></tr><tr><td> K. Team co‐ordination is described in terms of what roles people perform, who is responsible for particular tasks and by when</td><td>8.14</td><td>2.07</td><td>9</td></tr><tr><td> L. Communication about what information is to be recorded and how it is to be circulated</td><td>7.46</td><td>2.27</td><td>8</td></tr><tr><td>Additional categories</td><td /><td /><td /></tr><tr><td> M. Background to the person including their personal history, strengths, preferences, support needs and diagnoses etc.</td><td>8.07</td><td>2.13</td><td>8.5</td></tr><tr><td> N. Contemporary Philosophy of service provision to people with disabilities is reflected in the plan in terms of language used; issues addressed and lay out adopted</td><td>8.00</td><td>1.84</td><td>8</td></tr></table> </ephtml> </p> <p>3 BoC, behaviour of concern; BSP‐QEII, Behaviour Support Plan Quality Evaluation Guide II.</p> <hd id="AN0088263553-9">Delphi Round Three</hd> <p>Table 4 displays the mean item ratings from Round Three for each of the 26 statements, which had previously achieved endorsement as essential to a quality BSP by at least 60% of participants in Round Two. All items were rated by participants within the range indicating them to be very important (M = 9.40). The item with the highest level of endorsement (M = 10.00) was ‘Purpose and function of the behaviour’. The least endorsed item was ‘Authorisation’ (M = 8.88). Here it should be noted that only 10 of the 14 quality domains were represented by way of comments that were among those endorsed by at least 60% of participants. The quality domains not represented in the final round by comments from Round Two were: replacement or alternative behaviours to be taught, teaching strategies, reinforcers, and goals and objectives for the intervention programme.</p> <p>4 Round Three: mean, median and standard deviation of participant responses</p> <p> <ephtml> <table><tr><th>Quality domain</th><th>Participant comments</th><th>Mean</th><th>SD</th><th>Median</th></tr><tr><td>Behaviour of concern</td><td>Description of problem behaviour (observable and measurable)</td><td>9.85</td><td>0.37</td><td>10</td></tr><tr><td>Clear description of behaviours to be increased and decreased</td><td>9.62</td><td>1.02</td><td>10</td></tr><tr><td>Predictors</td><td>Clear definition of predictors of behaviour (key indicator)</td><td>9.69</td><td>0.62</td><td>10</td></tr><tr><td>Analysis of what supports behaviour</td><td>Understanding of why BoC occurs</td><td>9.73</td><td>0.60</td><td>10</td></tr><tr><td>Environmental structure</td><td>Environmental factors that can be changed to decease BoC (long term)</td><td>9.58</td><td>1.10</td><td>10</td></tr><tr><td>Change environment to increase choice making</td><td>9.12</td><td>2.43</td><td>10</td></tr><tr><td>Prevention of behaviour of concern</td><td>9.60</td><td>0.74</td><td>10</td></tr><tr><td>Function of behaviour</td><td>Purpose and function of the behaviour</td><td>10.00</td><td>0</td><td>10</td></tr><tr><td>Reactive strategies</td><td>Reactive strategies on a continuum from least restrictive to most restrictive</td><td>8.96</td><td>1.70</td><td>10</td></tr><tr><td>Consideration of persons human rights in utilising restrictive practice</td><td>9.69</td><td>0.62</td><td>10</td></tr><tr><td>Team co‐ordination</td><td>Ongoing monitoring of BoC</td><td>9.27</td><td>1.31</td><td>10</td></tr><tr><td>Consultation with all involved parties (stakeholders) and multiple perspectives</td><td>9.19</td><td>1.50</td><td>10</td></tr><tr><td>Maintained and updated appropriately</td><td>9.08</td><td>1.60</td><td>10</td></tr><tr><td>Action plan (who does what, when etc.)</td><td>9.20</td><td>1.61</td><td>10</td></tr><tr><td>Authorisation</td><td>8.88</td><td>1.75</td><td>10</td></tr><tr><td>Consent, e.g. client or guardian</td><td>9.00</td><td>2.30</td><td>10</td></tr><tr><td>Communication</td><td>Evidence of review dates</td><td>9.04</td><td>2.00</td><td>10</td></tr><tr><td>Contemporary practice</td><td>Clear to understand/plain English/no jargon</td><td>9.19</td><td>1.70</td><td>10</td></tr><tr><td>Person centred</td><td>9.46</td><td>1.14</td><td>10</td></tr><tr><td>Politically correct language, e.g. not labelling or judging</td><td>9.00</td><td>1.41</td><td>9.5</td></tr><tr><td>Positively focused not just a reactive strategy</td><td>9.73</td><td>1.80</td><td>10</td></tr><tr><td>Background</td><td>Skills (strengths) and support needs</td><td>9.60</td><td>0.63</td><td>10</td></tr><tr><td>Communication ability & support needs</td><td>9.60</td><td>0.63</td><td>10</td></tr></table> </ephtml> </p> <p>4 BoC, behaviour of concern.</p> <hd id="AN0088263553-10">Discussion</hd> <p>This study utilised a three‐round Delphi method with a purposive sample of experienced behaviour support practitioners to assess the content validity of the BSP‐QEII. Validation was sought with specific reference to the use of the BSP‐QEII to assess the quality of BSPs for adults with ID in community based accommodation and day‐support settings. Based on work in the USA (Cook et al. 2007; Kraemer et al. 2008), and preliminary evidence from a pilot study in Australia (Webber et al. 2011b), it was predicted that given the criteria of the BSP‐QEII is based upon best practice as derived from the research literature (i.e. it has established face validity) there would be high endorsement of these concepts by experienced practitioners.</p> <p>Round One of the study revealed that participants' responses concerning possible quality indicators for BSPs could generally be referenced within the 12 categories of the BSP‐QEII. Here it should be noted that we intentionally chose not to simply ask the expert practitioners to make direct ratings on the 12 BSP‐QEII items at Round One, to avoid tautological endorsement of items that already had face validity in the research literature. However, the deductive content analysis revealed two additional categories that could be considered as important for evaluating a quality BSP: background information (on the client) and contemporary philosophy (of service provision). Generally, the comments made by participants were consistent with the principles and practices associated with PBS (Carr et al. 1999, 2002). Among those items that were most frequently commented on as important for inclusion in a quality plan were the need to objectively define the problem behaviour and to conduct a systematic analysis of what supports the continuation of the identified problem behaviour.</p> <p>The issues that, while raised by participants, were subject to relatively few comments were the use of reinforcers, understanding the function of behaviour, environmental changes and teaching replacement behaviours. Consistent with the research literature, each of these issues could be considered vital to the successful implementation of a BSP. The fact that experienced practitioners did not highlight these aspects of behaviour support to a greater extent is surprising, and warrants further investigation. Failure to include, or at least consider such issues in a BSP could jeopardise the effectiveness of that plan. The current data cannot explain why these issues were not more highly endorsed. However, in contrast to the practitioners involved in the development of the original BSP‐QEII items, practitioners in the current study were not by profession educators. Although experienced behaviour support practitioners for adults, it could be that their training had neither emphasised the importance of, nor equipped them to teach replacement behaviours, or to take into account and control the antecedents to problem behaviour. These findings suggest the need for further research into the congruence between the training curriculum used to prepare practitioners for adultservices and what research has demonstrated to be the essential components of effective practice.</p> <p>Round Two affirmed the allocation by the researchers of the participants' comments from Round One to the 14 categories. While some suggestions were made for re‐allocation, there was no clear consensus that would have warranted any re‐allocation. On average, participants ranked all BSP‐QEII items as being very important for inclusion in a BSP. They also affirmed the two additional categories which had emerged from the analysis of the Round One data. These results suggest the BSP‐QEII (with the possible addition of the two additional items) to be a valid measure of quality when reviewing BSPs developed for adults with ID supported in community‐based housing and day‐support settings. This is an important finding because, apart from preliminary work by Webber et al. (2011b), previous research has only considered the application of the BSP‐QEII to plans developed for children in school settings.</p> <p>The results from Round Three affirmed the results from Round Two, that the items that were endorsed by at least 60% of respondents as essential to a quality BSP were again rated on average as very important. The item with the highest level of endorsement related to the need for plans to clearly identify the ‘purpose and function of the behaviour’. The item with the lowest average level of endorsement, although still within the range indicating it was very important, was the need for plans to document the ‘authorisation’ of procedures. However, not all of the quality domains were represented by way of comments in Round Three. The quality domains not represented in the final round by comments from Round Two were: replacement or alternative behaviours to be taught; teaching strategies, reinforcers, and goals and objectives for the intervention programme. These areas are not well covered in either certificate level disability courses or undergraduate psychology courses offered in Australia. It could be that these areas are not given sufficient emphasis in policy and professional development activities. It is also possible that practitioners do not view these areas as appropriate for or well understood by disability support workers, and therefore do not include them in plans that they expect this workforce to implement. Given their potential importance to successful outcomes for client programmes, why these issues might not be of such concern to practitioners warrants further investigation.</p> <p>The Delphi method proved both useful and effective for the current study in determining the content validity of the BSP‐QEII in a jurisdiction outside of the USA, and for its application in settings outside of schools. It affirmed the preliminary findings of Webber et al. (2011b). Furthermore, it enabled new data to be generated concerning what comprises a quality BSP, and for practitioner opinions to be compared with an existing theoretical framework purported to represent best practice in behaviour support planning.</p> <p>The samples of practitioners who responded were representative of those persons involved in the development and review of BSPs for adults with ID in community‐based accommodation and day‐support services. The analyses at Round One suggested that data saturation within this sample had been reached, based on the number of duplicate and parallel comments reported (amounting to approximately 65% of all comments). Furthermore, all three rounds provided consistent results, whereby each round supported the previous findings.</p> <p>Policy makers and practitioners regularly seek advice on what constitutes good practice and how services, such as the provision of behaviour support could be evaluated. The current findings add to the literature by making explicit those factors valued by practitioners working in adult settings. A particular feature of this study is that it used expert opinion to establish generic best practice criteria and then used these comments to garner validity of the BSP‐QEII criteria. This approach was in contrast to that of Horner et al. (2000) which provided respondents with a list of what the authors believed to best practice criteria in the first instance. The approach adopted in the current study recognised the participants to be experts in their own right, and commenced the investigative process without presenting any a priori assertions about what constituted good practice. These, in the form of the BSP‐QEII domains, were not introduced until Round Two.</p> <p>There were however, some limitations to the current research. The participants were generally professional staff working mainly in government services (government services comprise approximately 50% of disability staff working in Victoria). Future research could include a broader expert group, incorporating private practitioners and direct support staff. The opinions of direct support staff could be very useful, especially given the fact that the majority of BSPs are designed by these staff. The findings from such a study would potentially show what direct support staff value, know and need to know in order to successfully implement a BSP, both in terms of the content and structure of these plans. At the time of conducting the study, the BSP‐QEII was restricted in its use to a small group of staff in the central office of the Department of Human Services. However, a small number of practitioners involved in the current study might have had some limited prior exposure to the BSP‐QEII. Here though it is unlikely that any such exposure would have contributed any significant bias to the overall results. Finally, the initial allocation of participant comments to the various categories was undertaken by the research team, and this could conceivably have incorporated some unintended bias. However, accepted procedures for deductive content analysis and consensus coding were employed, and further independent validation of the allocation was sought from participants in Round Two (i.e. recognised member checking procedures). Here though, future studies could be strengthened if an independent panel were used for the content analysis and coding.</p> <p>Overall, this study lends support to the use of the BSP‐QEII as an acceptable best‐practice framework for the education and training of practitioners responsible for the development and implementation of BSPs. Furthermore, it affirms its validity as a tool for use in programme review and quality assurance. Importantly, these findings suggest that the principles underpinning the BSP‐QEII and the criteria comprising the tool, although originally developed to support teachers planning supports for children in schools, are potentially equally applicable for use by practitioners in community‐based services for adults with ID. This study also raises questions as to why some practitioners seem not so concerned about a number of issues, already established in the research literature as important to effecting behaviour change, and which have potential to influence the quality of their BSPs and outcomes in clinical practice.</p> <p>With established validity for use in the assessment of BSPs devised for adults with ID, future research needs to investigate the use of the BSP‐QEII for both the auditing of service quality and as an educational framework in adult services. Furthermore, research could investigate different client outcomes that might arise from BSPs of varying quality, and which emphasise different facets of quality. It would also be feasible to use the BSP‐QEII to investigate the effects of different service policies, administrative protocols and educational strategies on the quality of BSPs and their associated client outcomes. Such studies could be conducted as cross‐sectional designs, incorporating comparisons between services and jurisdictions at particular points in time, as well as longitudinal designs evaluating the impact of changes in policy and procedures over time on the quality of BSPs and, importantly, associated client outcomes.</p> <ref id="AN0088263553-11"> <title>References</title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext>Allen D. (ed.) ( 2008 ) Ethical Approaches to Physical Interventions, Vol. II. BILD, Kidderminister. </bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext>Allen D., James W., Evans J., Hawkins S. & Jenkins R. ( 2005 ) Positive behavioural support: definition, current status and future directions. Tizard Learning Disability Review 10, 4 – 11. </bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext>Bird F. L. & Luiselli J. K. ( 2000 ) Positive behavioral support of adults with developmental disabilities: assessment of long‐term adjustment and habilitation following restrictive treatment histories. Journal of Behavior Therapy and Experimental Psychiatry 31, 5 – 19. </bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext>Borthwick‐Duffy S. ( 1996 ) Evaluation and measurement of quality of life: special considerations for persons with mental retardation. In: Quality of Life, Vol. 1 (ed. R. Schalock ), pp. 89 – 100. American Association on Mental Retardation, Washington, DC. </bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext>Brown R. ( 1997 ) Quality of Life for People with Disabilities: Models, Research and Practice. Stanley Thornes, Cheltenham. </bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext>Browning‐Wright D., Saren D. & Mayer G. R. ( 2003 ) The behaviour support plan‐quality evaluation guide. Available at: <ulink href="http://www.pent.ca.gov">http://www.pent.ca.gov</ulink> (retrieved 1 December 2011). </bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext>Carr E., Dunlap G., Horner R., Koegel R., Turnbull A., Sailor W. et al. ( 2002 ) Positive behavior support: evolution of an applied science. Journal of Positive Behavior Interventions 4, 4. </bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext>Carr E. G., Horner R. H., Turnball A. P., Marquis J. G., McLaughlin D. M., McAtee M. L. et al. ( 1999 ) Positive Behavior Support for People with Developmental Disabilities: A Research Synthesis. American Association on Mental Retardation, Washington, DC. </bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext>Cook C., Crews S., Wright D., Mayer G., Gale B., Kraemer B. et al. ( 2007 ) Establishing and evaluating the substantive adequacy of positive behavioral support plans. Journal of Behavioral Education 16, 191 – 206. </bibtext> </blist> <blist> <bibl id="bib10" type="bt">10</bibl> <bibtext>Cook C. R., Mayer G. R., Browning‐Wright D., Kraemer B., Wallace M. D., Dart E. et al. ( 2012 ) Exploring the link among behavior intervention plans, treatment integrity, and student outcomes under natural educational conditions. The Journal of Special Education 46, 3 – 16. </bibtext> </blist> <blist> <bibl id="bib11" type="bt">11</bibl> <bibtext>Emerson E. & Einfeld S. ( 2011 ) Challenging Behaviour, 3rd edn. Cambridge University Press, Cambridge. </bibtext> </blist> <blist> <bibl id="bib12" type="bt">12</bibl> <bibtext>French P., Chan J. & Carracher R. ( 2010 ) Realising human rights in clinical practice and service delivery to persons with cognitive impairment who engage in behaviours of concern. Psychiatry, Psychology & Law 17, 245 – 72. </bibtext> </blist> <blist> <bibl id="bib13" type="bt">13</bibl> <bibtext>Groth‐Marnat G. ( 2009 ) Handbook of Psychological Assessment, 5th edn. Wiley, Hoboken, NJ. </bibtext> </blist> <blist> <bibl id="bib14" type="bt">14</bibl> <bibtext>Horner R. H., Sugai G., Todd A. W. & Lewis‐Palmer T. ( 2000 ) Elements of behavior support plans: a technical brief. Exceptionality: A Special Education Journal 8, 205 – 15. </bibtext> </blist> <blist> <bibl id="bib15" type="bt">15</bibl> <bibtext>Johnston J., Foxx R., Jacobson J., Green G. & Mulick J. ( 2006 ) Positive behavior support and applied behavior analysis. The Behavior Analyst 29, 51. </bibtext> </blist> <blist> <bibl id="bib16" type="bt">16</bibl> <bibtext>Kraemer B. R., Cook C. R., Browning‐Wright D., Mayer G. R. & Wallace M. D. ( 2008 ) Effects of training on the use of the behavior support plan quality evalution guide with autism educators. Journal of Positive Behavior Interventions 10, 179 – 89. </bibtext> </blist> <blist> <bibl id="bib17" type="bt">17</bibl> <bibtext>Krippendorff K. ( 2004 ) Content Analysis: An Introduction to Its Methodology, 2nd edn. Sage Publications, Inc, Thousand Oaks, CA. </bibtext> </blist> <blist> <bibl id="bib18" type="bt">18</bibl> <bibtext>Lowe K., Allen D., Brophy S. & Moore K. ( 2005 ) The management and treatment of challenging behaviours. Tizard Learning Disability Review 10, 34. </bibtext> </blist> <blist> <bibl id="bib19" type="bt">19</bibl> <bibtext>McVilly K. ( 2007 ) Positive Behaviour Support for People with Intelelctual Disabilities: Evidence‐Based Practice Promoting Quality of Life. Australasian Society for the Study of Intellectual Disability, Melbourne. </bibtext> </blist> <blist> <bibl id="bib20" type="bt">20</bibl> <bibtext>McVilly K. ( 2009 ) Physical Restraint in Disability Services: Current Practices, Contemporary Concerns, and Future Directions. Department of Human Services, Melbourne, Vic. </bibtext> </blist> <blist> <bibl id="bib21" type="bt">21</bibl> <bibtext>McVilly K., Webber L., Paris M. & Sharp G. ( 2012 ) Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP‐QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour. Journal of Intellectual Disability Research (in press). </bibtext> </blist> <blist> <bibl id="bib22" type="bt">22</bibl> <bibtext>Mansell J. ( 2006 ) Deinstitutionalisation and community living: progress, problems and priorities. Journal of Intellectual and Developmental Disability 31, 65 – 76. </bibtext> </blist> <blist> <bibl id="bib23" type="bt">23</bibl> <bibtext>Mullen P. ( 2003 ) Delphi: myths and reality. Journal of Health Organization and Management 17, 37 – 52. </bibtext> </blist> <blist> <bibl id="bib24" type="bt">24</bibl> <bibtext>Phillips L., Wilson L. & Wilson E. ( 2010 ) Assessing behaviour support plans for people with intellectual disability before and after the Victorian Disability Act 2006. Journal of Intellectual and Developmental Disability 35, 9 – 13. </bibtext> </blist> <blist> <bibl id="bib25" type="bt">25</bibl> <bibtext>Stancliffe R. & Lakin C. ( 2005 ) Costs and Outcomes of Community Services for People with Intellectual Disabilities. Brookes Publishing, Baltimore, MD. </bibtext> </blist> <blist> <bibl id="bib26" type="bt">26</bibl> <bibtext>Sugai G., Horner R., Dunlap G., Hieneman M., Lewis T., Nelson C. et al. ( 2000 ) Applying positive behavior support and functional behavioral assessment in schools. Journal of Positive Behavior Interventions 2, 131. </bibtext> </blist> <blist> <bibl id="bib27" type="bt">27</bibl> <bibtext>Webber L., McVilly K., Stevenson E. & Chan J. ( 2010 ) The use of restrictive interventions in Victoria, Australia: population data for 2007–2008. Journal of Intellectual and Developmental Disability 35, 199 – 206. </bibtext> </blist> <blist> <bibl id="bib28" type="bt">28</bibl> <bibtext>Webber L., McVilly K., Fester T. & Chan J. ( 2011a ) Factors influencing quality of behaviour support plans and the impact of plan quality of on restrictive intervention use. International Journal of Positive Behavioural Support 1, 24 – 31. </bibtext> </blist> <blist> <bibl id="bib29" type="bt">29</bibl> <bibtext>Webber L. S., McVilly K., Fester T. & Zazelis T. ( 2011b ) Assessing behaviour support plans for Australian adults with intellectual disability using the ‘Behavior Support Plan Quality Evaluation II’ (BSP‐QE II). Journal of Intellectual and Developmental Disability 36, 1 – 5. </bibtext> </blist> </ref> <aug> <p>By K. McVilly; L. Webber; G. Sharp and M. Paris</p> </aug>
Header DbId: eric
DbLabel: ERIC
An: EJ1014799
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22McVilly%2C+K%2E%22">McVilly, K.</searchLink><br /><searchLink fieldCode="AR" term="%22Webber%2C+L%2E%22">Webber, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Sharp%2C+G%2E%22">Sharp, G.</searchLink><br /><searchLink fieldCode="AR" term="%22Paris%2C+M%2E%22">Paris, M.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Aug 2013 57(8):703-715.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2013
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Validity%22">Test Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Planning%22">Planning</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Delphi+Technique%22">Delphi Technique</searchLink><br /><searchLink fieldCode="DE" term="%22Day+Programs%22">Day Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Reinforcement%22">Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Rewards%22">Rewards</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Responses%22">Responses</searchLink><br /><searchLink fieldCode="DE" term="%22Goal+Orientation%22">Goal Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Teamwork%22">Teamwork</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Philosophy%22">Philosophy</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Australia%22">Australia</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1365-2788.2012.01602.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0964-2633
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability. Method: A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners ("n" = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics. Results: The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. Conclusions: The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes. (Contains 4 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 29
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2014
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1014799
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1014799
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1365-2788.2012.01602.x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 703
    Subjects:
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Test Validity
        Type: general
      – SubjectFull: Planning
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Delphi Technique
        Type: general
      – SubjectFull: Day Programs
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Individual Characteristics
        Type: general
      – SubjectFull: Reinforcement
        Type: general
      – SubjectFull: Rewards
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Environmental Influences
        Type: general
      – SubjectFull: Responses
        Type: general
      – SubjectFull: Goal Orientation
        Type: general
      – SubjectFull: Teamwork
        Type: general
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Philosophy
        Type: general
      – SubjectFull: Australia
        Type: general
    Titles:
      – TitleFull: The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: McVilly, K.
      – PersonEntity:
          Name:
            NameFull: Webber, L.
      – PersonEntity:
          Name:
            NameFull: Sharp, G.
      – PersonEntity:
          Name:
            NameFull: Paris, M.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 08
              Type: published
              Y: 2013
          Identifiers:
            – Type: issn-print
              Value: 0964-2633
          Numbering:
            – Type: volume
              Value: 57
            – Type: issue
              Value: 8
          Titles:
            – TitleFull: Journal of Intellectual Disability Research
              Type: main
ResultId 1