[State of knowledge: Challenging behaviours - best practices in prevention, assessment and Intervention for people with an intellectual disability, physical disability or autism spectrum disorder]

Boisvert I, Mercier M
Record ID 32018001248
Original Title: État des connaissances: Troubles graves du comportement : meilleures pratiques en prévention, en évaluation et en intervention auprès des personnes qui présentent une déficience intellectuelle, une déficience physique ou un trouble du spectre de l’autisme
Authors' objectives: In Québec, interventions for people with ID or ASD who present challenging behaviours are based on a clinical practice guideline entitled Le service d’adaptation et de réadaptation auprès des personnes ayant des troubles graves du comportement [Rehabilitation services for people with challenging behaviours], developed in 2010 by experts working with the Service québécois d’expertise en troubles graves du comportement (SQETGC) and published by the Fédération québécoise des centres de réadaptation en déficience intellectuelle et en troubles envahissants du développement (FQCRDITED). While this clinical practice guideline for challenging behaviours has the advantage of being operational and detailed, it is not, however, based on a systematic review of the scientific literature. It also focuses on individuals with ID or ASD but does not consider brain-damaged people being treated in the physical disability service program—individuals who are also likely to present challenging behaviour. In addition, a number of documents related to this practice have been published over the past 10 years by reputable scientific bodies, such as the National Institute for Care Excellence in the United Kingdom (NICE) and the Haute Autorité de Santé (HAS) in France—hence the relevance of reviewing the existing clinical practice guideline to ensure that practices are up to date. It is in this context that the SQETGC directors requested that INESSS produce a state-of-knowledge report to document best practices in prevention, assessment and intervention for people who have ID, PD or ASD and who present challenging behaviours.
Authors' results and conclusions: RESULTS: In general, the values and intervention principles encouraged in the documents consulted reflect the importance of establishing a close partnership with people with challenging behaviours and their families, and respecting their rights, including the right to be treated with dignity at all times and to receive support tailored to their needs and preferences. Involving people with challenging behaviours in decision-making, encouraging their independence, improving their quality of life and maintaining a respectful relationship of trust with them are also among the values and intervention principles put forward in the documents reviewed. The following eight key themes of best practices in intervention were identified in the documents consulted: 1. Psychosocial interventions; 2. Interventions focused on environmental adaptation; 3. Rewarding daytime activities; 4. Behavioural crisis interventions; 5. Post-crisis support; 6. Use of medication when required; 7. Control measures; 8. Behavioural support plans. In terms of best practices related to service implementation, the literature consulted indicates the importance of establishing a provincial governance responsible for ensuring quality of practice, judicious use of allocated funds and accessibility of services. All of the documents consider training for staff working with individuals with challenging behaviours as one of the determining factors of service quality. It is therefore recommended that facility managers ensure that care providers are adequately prepared by providing them evidence-driven and practice-based training that is regularly updated. In addition, the literature reviewed emphasizes that individual or group supervision is an essential component of the support that should be available to staff. CONCLUSION: Implementing the best practices documented in this state-of-knowledge report certainly represents a challenge for stakeholders working with people who present challenging behaviours. Although many of these best practices are already known and applied in Québec, additional efforts could be made to put them into place, since they are likely to improve the well-being and quality of life of the persons concerned and their families and, ultimately, to promote greater social inclusion.
Authors' methods: A systematic review of the scientific and grey literature was carried out in accordance with INESSS’s production standards [2013]. A total of 52 documents were identified, including 18 from the grey literature on practices and 34 systematic reviews or meta-analyses. The methodological quality of the retained documents was determined using recognized assessment scales. Data from these publications were extracted, and the findings are presented as a narrative synthesis.
Project Status: Completed
Year Published: 2021
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Intellectual Disability
  • Self-Injurious Behavior
  • Social Behavior Disorders
  • Child Behavior Disorders
  • Adult
  • Child
  • Autism Spectrum Disorder
  • Behavioral Symptoms
  • Persons with Mental Disabilities
  • Intellectual disability
  • Physical disability
  • Autism Spectrum Disorder
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.