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

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.