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    • Outcome Measures for Challenging Behaviour Interventions

    A commitment was made in April 2009 for the Faculty to develop a ‘menu’ of recommended measures for use by psychologists and the wider services that support adults with learning disabilities whose behaviour challenges services.

    Project participants from ten services across England used one or more of a selection of outcome measures before and after challenging behaviour interventions. Project participants also completed a 'Utility of Measures' questionnaire to provide a perception of how useful and valid each measure had been.

    From the project data, four outcome measures are recommended for use for challenging behaviour interventions:

    • The Behavior Problems Inventory-01 (Rojahn et al., 2001). 
    • The Challenging Behaviour Interview (Oliver et al., 2002). 
    • The Health of the Nation Outcome Scales - Learning Disability version (Roy et al., 2002). 
    • The Maslow Assessment of Needs Scales - Learning Disability (Skirrow & Perry, 2009).

    A summary table of other outcome measures reported as being in use during the project was also collated from available data.

    Download the full project report

    Measure Information

    The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behaviour rating instrument for self-injurious, stereotypic, and aggressive / destructive behaviour. Items are rated on a frequency scale and a severity scale. Instructions for use are provided on the measure.

    Rojahn et al. (2001) report the BPI-01 to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) instrument for assessing challenging behaviour in people with a learning disability. Further information is also provided in Rojahn et. al (2012).

    Project Results: The results from the 'Utility of Measures' sheets for the BPI-01 suggest it was perceived by project participants as being clear and easy to use, and relatively short to administer. It was seen as being able to detect change for nearly all people on whom it was administered, and this change was thought to be consistent with clinical opinion. The key limit to the measure was highlighted as being its use of terminology that is outdated in the UK and may therefore be deemed disrespectful (i.e. 'mental retardation').

    There was a significant difference (p=0.0002) between the totalised BPI-01 scores for the pre- and post-intervention groups. This suggests that the BPI-01 is able to differentiate between the two populations, and may therefore be useful for reporting outcomes at a service level as well as for individual clinical interventions.

    Based on the results of this project, the BPI-01 is recommended for use as an outcome measure for challenging behaviour interventions in adult learning disability services.

    The BPI-S is a shorter, 30-item version of the BPI. It was recently introduced in two articles in the Journal of Intllectual Disability Reserach (Rojahn et al., 2012a and 2012b).

    As the BPI-S was not included in the LD Faculty project we have no further data on which to base a recommendation for its use. The referenced article does, however, include information on test development, reliability and validity.

    Download the Behavior Problems Inventory (BPI)

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    • Behavior Problems Inventory (BPI)
    • Behavior Problems Inventory - Short Version (BPI-S)

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    References
    • Rojahn, J., Matson, J.L., Lott, D., Esbensen, A.J. & Small, Y.(2001). The Behavior Problems Inventory: An Instrument for the Assessment of Self-Injury, Stereotyped Behavior, and Aggression /Destruction in Individuals With Developmental Disabilities. Journal of Autism and Developmental Disorders, 31 (6), 577-588.
    • Rojahn, J., Rowe, E. W., Sharber, A. C., Hastings, R., Matson, J. L., Didden, R., Kroes, D. B. H. and Dumont, E. L. M. (2012a). The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: Part I: development and provisional clinical reference data. Journal of Intellectual Disability Research, 56 (5), 527-545
    • Rojahn, J., Rowe, E. W., Sharber, A. C., Hastings, R., Matson, J. L., Didden, R., Kroes, D. B. H. and Dumont, E. L. M. (2012b). The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: Part II: reliability and validity. Journal of Intellectual Disability Research, 56 (5), 546-565.

    Measure Information

    The Maslow Assessment of Needs Scales - Learning Disabilities (MANS-LD) is a 19 item questionnaire designed for use with a person with a learning disability. Response is via a 5 point scale with symbols to help the person decide their response. Questions are focussed on how happy the person is with the way some of their basic needs are being met. The MANS-LD is supplemented by an 8 item questionnaire adapted from the World Health Organisation Quality of Life Scale (WHOQOL-8; Power,2003), which also has a 5 point scale to help the person decide their response. Instructions for use of the MANS-LD and WHOQOL-8 are provided on the measure.

    The MANS-LD was developed by Paul Skirrow and Ewan Perry (© 2009 to Mersey Care NHS Trust). The authors describe the measure as having good face validity, applicability to a range of settings and consistency with national policy such as Valuing People and the Human Rights Act. The authors have piloted the scale to refine standardisation, but no validation or reliability studies have been completed.

    Project Results

    Issues in some of the services participating in the project meant that the amount of final data for the MANS-LD was limited. This should be considered when evaluating the project results.

    The results from the 'Utility of Measures' sheets for the MANS-LD suggest it was perceived by project participants as reasonably short to administer. The fact that it is designed for use with people with a learning disability appears to have contributed to a general perception that it is very respectful in its design. There were some qualitative comments by project participants highlighting that some of the questions could be difficult for people with a learning disability to understand, which could contribute to the scale being lengthy to answer. This may indicate that further validation and standardisation would be helpful. On balance, however, the MANS-LD was perceived as a good measure for use with people with a learning disability with the ability to answer the questions. It was seen as being able to detect change for most people on whom it was administered, and this change was thought to be mostly consistent with clinical opinion.

    There was a significant difference (p=0.0121) between the totalised MANS-LD scores for the pre- and post-intervention groups. This suggests that the MANS-LD is able to differentiate between the two populations, and may therefore be useful for reporting outcomes at a service level as well as for individual clinical interventions.

    Based on the results of this project, the MANS-LD is recommended for use as a self-report outcome measure that reflects the service user's perception of their quality of life before and after a challenging behaviour intervention. There are, however, some additional considerations for services, as discussed above.

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    MANS-LD Easy Read Retrospective- compressed (N.B. - this version of the prospective MANS-LD has been compressed to meet the BPS website requirements. This has left a 'watermark' advertising the compression software.