Who's Challenging Who?
‘Who's Challenging Who?’ was funded by the National Institute for Health Research (NIHR) School for Social Care Research, and was in collaboration with Cardiff University and Mencap. The primary objective was to determine the impact of the training programme on staff attitudes (empathy) towards people with learning disability and challenging behaviour. The secondary objectives were 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) was 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.
We published the protocol for this study in Trials:
Randell, E., Hastings, R. P., McNamara, R., Knight, R., Gillespie, D., & Taylor, Z. (2017). Effectiveness of the ‘Who’s Challenging Who’ support staff training intervention to improve attitudes and empathy towards adults with intellectual disability and challenging behaviours: study protocol for a cluster randomised controlled trial. Trials, 18(1), 460. doi: 10.1186/s13063-017-2175-1
And we worked with the WCW trainers to write and publish a paper about their experiences co-producing and delivering the training:
Richards, L., Williams, B., Przybylak, P., & Flynn, S. (2018). The experiences of people with learning disabilities in co-produced challenging behaviour training. Learning Disability Practice, 21(4), 28-35.
The findings from this study have been published:
- Flynn, S., Hastings, R. P., Gillespie, D., McNamara, R., Randell, E. (2019). Trainer and support staff experiences of engaging with the Who’s Challenging Who? challenging behaviour training course. Journal of Intellectual Disabilities, Online First. doi: 10.1177/1744629518821789
- Hastings, R.P., Gillespie, D., Flynn, S., McNamara, R., Taylor, Z., Knight, R., Randell, E., Richards, L., Moody, G., Mitchell, A., Przybylak, P., Williams, B., Hunt, P. (2018). Co-produced training to improve support staff attitudes and empathy towards adults with intellectual disability and behaviours that challenge: A cluster randomised controlled trial of the Who’s Challenging Who? intervention. Journal of Intellectual Disability Research, 62(9), 798-813. doi: 10.1111/jir.12536
- Flynn, S., Hastings, R. P., Gillespie, D., McNamara, R., & Randell, E. (2018). Is the amount of exposure to aggressive challenging behaviour related to staff work-related well-being in intellectual disability services? Evidence from a clustered research design. Research in Developmental Disabilities, 81, 155-161.