Cognitive representation of challenging behaviour among staff working with adults with learning disabilities : an evaluation of the impact of an open learning training course

Abstract

This was an investigation into the relationship between quality of care and staff views of, and responses to, challenging behaviour in adults with learning disabilities. Cognitive representations have been identified as a determinant of therapeutic outcomes in a variety of health care settings. There were two main aims of this study. First, to describe and measure the cognitive representations of challenging behaviour among staff working with adults with learning disabilities and second, to evaluate the effects of training on these views held by staff. Existing literature was reviewed. A Likert type questionnaire, the Challenging Behaviour Representation Questionnaire (CBRQ) was developed to record staff views. The CBRQ draws on two existing measures: the Illness Perception Questionnaire (IPQ) and the Challenging Behaviour Attributions Scale (CHABA). The CBRQ will give a new method of evaluating the staff views most often associated with evidence-based practice, helping behaviours and positive outcomes. Questionnaire items were generated from responses by 300 staff, to assess the applicability of Leventhal's Self Regulatory model in the context of challenging behaviour. The rating scales in the questionnaire were theoretically derived, based on the dimensions of Leventhal's model (identity, cause, consequences, treatment/control, time-line). An 'emotional-reaction' dimension was added, suggested by more recent research. The use of the Leventhal model was supported, with the exception of the 'time line' component. The questionnaire was tested for reliability and validity then administered before and after training to staff in three different groups. Targeted training changed cognitive representation of challenging behaviour overall, as measured by the CBRQ, and this change was statistically significantly in two of the five dimensions for the experimental group. Other results suggest that dimensions of cognitive representation are affected in different and complex ways by training. The statistical and the practical significance of the results are discussed in relation to staff training and therapeutic outcomes for people with learning disabilities. A 'staff-regulatory' model of cognitive representation is proposed linking cognitive representation and challenging behaviour.