Positive Behaviour Study - Evaluating Positive Behavioural Supports Intervention for Individuals with Acquired Brain Injury

INTERVENTION: The program will offer a 12 month behavior intervention using a Positive Behaviour Support (PBS) framework. The intervention will be delivered by one or more of the following health professionals: neuropsychologist, occupational therapist, speech therapist and/or psychiatrist. As the intervention is individualised, therapists relevant to each individual's goals will be included. Therapists will be a mix of clinicians with varied degrees of experience, All therapists will receive supervision from an international expert in PBS provision through group and individual supervision. Positive Behaviour Support aims to decrease problem behaviour by increasing quality of life. The aim of this approach is to make meaningful changes in the environment working with natural supports and help individuals to learn new skills and competencies so that problem behaviours become unnecessary. Essential to these strategies are i) the identification of valued outcomes by the individual and other stakeholders, ii) identification of the people in the individual's life who can assist them in attaining those outcomes, iii) identify the barriers to attaining those outcomes and iv) put in place strategies or environmental changes designed to improve the quality of life for the individual receiving support. Structured flexibility: This intervention is invidualised and context‐sensitive. It utilises a hypothesis‐testing approach, and requires ongoing input. This framework is used flexibly rather than prescriptively. Clinicians are welcome and encouraged to draw from other evidence‐based paradigms to enrich their intervention approach. For example, motivational interviewing, CBT, acceptance and commitment therapy, and others. Successful achievement of goals will be measured using Goal Attainment Scaling. Review of goal attainment will occur on completion of intervention. The number and frequency of sessions will be individualised. It is anticipated that participants will receive a session frequency of between 1 and 8 sessions per month, and an intervention duration of between 3 and 12 months, depending on the level of support required and number of therapists involved. Sessions will be provided to participants in their own homes or at our consulting suits in Hawthorn (Melbourne, Victoria). For participants who reside more than one hour from Melbourne, telehealth options will also be made available (e.g. Skype, phone calls). Any materials provided to participants as part of the intervention will be individualised and developed as part of the intervention process. Therefore, there are no pre‐specified materials to be reported. As part of the trial we are developing training materials based on the supervision sessions and drawing together existing PBS materials. In regards to treatment fidelity, adherence to the framework will be monitored via a range of methods including: audio and video taping of 10‐20% of sessions for review by a PBS expert. Regular supervision meetings with a PBS expert including feedback from the session reviews. After every clinical session, therapists will complete a treatment integrity checklist to identify which PBS approaches were used within each session, Therapists will self‐rate the quality of their sessions. These checklists and ratings will be used to identify areas clinician's require additional supervision in. CONDITION: Acquired Brain Injury PRIMARY OUTCOME: Overt Behaviour Scale SECONDARY OUTCOME: A one item QoL scale developed by the researchers (rate your QoL from 0 (worst) to 10 (best)). ; Alcohol Use Disorders Identification Test (AUDIT) ; Behaviour Recording sheet ; ; Carer Information Questionnaire (hours and cost of paid care, hours of unpaid care). ; ; ; Challenging Behaviour Self Efficacy Scale ; Close other participants (family member/ carer) will be asked to record each time a behaviour occurs each day for 14 days. The types of behaviour included are verbal and physical aggression, socially and sexually inappropriate behaviour, repetitive behaviour, wandering/ absconding and lack of initiation. Care And Needs Scale (CANS) ; ; Community Integration Questionnaire Revised (CIQ‐R) ; Drug Abuse Screening Test (DAST) ; ; Family Assessment Device (FAD) General Functioning (GF) Scale ; Frontal Systems Behavior scale (FrSBe) ; ; Goal Attainment Scaling ‐ individualised method for setting and reviewing goals. Healthcare Utilisation Diary ; Hospital anxiety and Depression Scale (HADS) ; ; Medication questionnaire ‐ name of medication, dose and frequency ; ; Mini International Neuropsychiatric Interview (MINI) ; ; Quality of Life on the Comprehensive Quality of Life Scale ‐ Adult (ComQol‐a5) ; ; Satisfaction with Intervention ; ; A customised interview schedule has been developed with a range of questions to understand participants perceptions of the program, provide specific feedback on the overall program, the strategies, programs and people engaged with during the program and the impact it has had on the participants. Ratings include ‘not at all’, ‘a little’ and ‘a lot’. There are also 10‐point Likert scales used for each individual therapy session (as rated separately by the therapist and the participants). Working Alliance Measure ; ; Several meta analyses of a broad variety of helping contexts, kinds of clients, and problems have reported a consistent positive relation between the quality of the alliance and the results of the helping process. Broadly, The Working Alliance Measure measures (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. ; INCLUSION CRITERIA: TBI (any severity, any number) and/or ABI (stroke, hypoxic injury) Aged 18‐65 years Any time post‐injury Displays behaviours of concern as defined by the Overt Behaviour Scale Significant other available to participate (family member, house manager, attendant carer, treating staff)