1. Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial.
- Author
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Strydom, Andre, Bosco, Alessandro, Vickerstaff, Victoria, Hunter, Rachael, the PBS study group, Poppe, Michaela, Ratti, Victoria, Hall, Ian, Crabtree, Jason, Omar, Rumana Z., Biswas, Asit, Blickwedel, Jessica, Cooper, Vivien, Crawford, Mike, and Hassiotis, Angela
- Subjects
AUTISM spectrum disorders ,AUTISTIC people ,INTELLECTUAL disabilities ,MEDICAL personnel ,CHILDREN with autism spectrum disorders ,COST effectiveness ,BEHAVIOR disorders - Abstract
Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = − 2.10, 95% CI: − 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI − 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. Trial registration: ClinicalTrials.gov: NCT01680276. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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