MERRC Current project

Reducing Behaviours or Concern following Brain Injury – Positive Behavioural Supports Intervention and Evaluation

Project lead Professor Jennie Ponsford, AO
Project deputy lead/s Dr Kate Gould
Ms Amelia Hicks
Dr Tim Feeney
Associate Professor Malcolm Hopwood
Project partner/s Associate Professor Malcolm Hopwood, School of Psychiatry, University of Melbourne and Albert Road Clinic
Dr Tim Feeney, Belvedere Health Services and the Mill School, Essex Junction, Vermont, USA
Transport Accident Commission
Brain Injury Australia (Steering Committee)
Project dates01/07/2015 – 30/04/2020

Project overview:

This project is addressing a key mental health issue in individuals with brain injury. In developing and evaluating a PBS intervention for use by clinicians, and providing training and supervision in its implementation the project will translate the research findings into clinical practice to enhance quality of life for individuals with brain injury and their families.

Behaviours of concern (BoC) following acquired brain injury (ABI) – including aggression, difficulty starting (initiating) everyday tasks, and sexual inappropriateness – present significant challenges for the person with ABI, the people who support them, service organisations and wider society. These behaviours contribute to social isolation, relationship and family breakdown, dislocation from accommodation, and often impede an individual’s ability to return to valued life roles. BoC cause considerable stress for the person with ABI, their relatives and other carers; reducing quality of life and contributing to the development of mental illness. These behaviours are often chronic, continuing for decades post injury (Ponsford & Schönberger, 2010). Despite the far-reaching impact of BoC there is limited evidence supporting effective interventions.

Positive Behaviour Support (PBS) is an approach that aims to reduce BoC and improve quality of life. PBS involves collaboratively setting goals with the individual and the important people in their life, and identifying barriers to achieving those goals (Feeney 2010). As part of this process, the individual is supported to identify the function served by the BoC and the possible factors contributing to the behaviour, including factors related to the brain injury, the person and the environment.

The goal is to minimise BoC by modifying antecedent contributing factors, providing training and/or environmental supports/restructuring to the person, family, support workers and others as necessary; that is, to structure the environment, adjust tasks and expectations to ensure success and provision of meaningful and well understood daily routines. It aims to teach and/or shape adaptive and co-operative social behaviours in the individual and promote independence and self-management, utilising natural supports as far as possible.

This study is the first randomised controlled trial of a PBS intervention for BoC in adults with ABI. Participants with ABI and the people in their support network receive up to 12 months of PBS from skilled clinicians (e.g. neuropsychologists, speech therapists, and/or occupational therapists). Participants are randomly allocated to receive the intervention upon entering the study, or after waiting one year (and receiving treatment as usual). Participants with ABI and a Close Other (e.g. family member, carer support staff) complete research measures at baseline, 4 monthly intervals and throughout a 12-month follow-up. It is hypothesised the intervention will reduce the frequency and severity of BoC as assessed on the Overt Behaviour Scale. Other outcomes measured include individualised goals, community participation, quality of life, care needs, paid attendant care work hours, medication use, drug and alcohol use, mood, and family functioning.

Key actions to date:

Pilot case studies and qualitative studies documenting the experience of the intervention by individuals with brain injury, their close others and clinicians delivering the interventions have been completed and preparations made for the development of translational materials.

Research translation:

A major aspect of the translation phase will include comprehensive, evidence-based training of neurorehabilitation therapists. Findings will also be communicated through international conferences and journals, education and information for people with behaviours of concern and their families.

Expected impact:

There is international interest in the findings of this world-first study, which will have local, national and global reach into communities where people with acquired brain injury and their families have ineffective or unmet therapeutic needs.

Further information:

Jennie Ponsford, AO

Professor of Neuropsychology
MICCN
Monash University, Clayton Vic 3800

Director
Monash-Epworth Rehabilitation Research Centre
Epworth Healthcare, 89 Bridge Road, Richmond Vic 3121

Tel: 61 3 9905 1552
Fax: 61 3 9905 3948
Mobile: 0419 320 671

Email: Jennie.Ponsford@monash.edu