Positive behaviour support in Dutch care settings: a multifaceted approach to managing challenging behaviours of adults with intellectual disabilities: Effectiveness, implementation and adherence requirements, and quality of life outcomes

This PhD project focuses on improving care for adults with intellectual disabilities and challenging behaviour in the Netherlands. Several studies were conducted within this project. First, a meta-analysis demonstrates that non-pharmacological interventions, particularly behavioural treatments combined with mindfulness, are effective in reducing challenging behaviour.

Subsequently, the effectiveness of a Dutch positive behaviour support (PBS) training for support staff was examined in a large-scale trial. Although PBS has proven effective internationally and is applied as standard care, it is barely available in the Netherlands. The trial results show that the training reduces lethargic behaviour and decreases irritable behaviour in clients with severe challenging behaviour or severe and profound intellectual disabilities. Additionally, the training improves clients' personal development and self-determination.

Interviews and focus groups with support staff and PBS trainers reveal that staff observe concrete improvements in clients' behaviour and experience more calmness, both in themselves and their clients. For successful implementation and sustainability of PBS, organisation-wide support is essential, as well as staff motivation, proper documentation, training of temporary staff, and regular evaluation.

Finally, research into staff and team characteristics shows that educational level, reflective skills, friendly behaviour, and self-confidence are associated with a better quality of life for clients. Notably, larger support teams are associated with reduced self-determination and social inclusion.