Program Evaluation of a Specialized Treatment Home for Adults with Severe Challenging Behaviour

Abstract

Individuals with intellectual and developmental disabilities who engage in severe challenging behaviour comprise 5-10% of the population and experience significant limitations in meaningfully participating in everyday activities due to associated risks (e.g., substantial injury to self and others, extreme property destruction, outward physical aggression targeting others). Unfortunately, research featuring adult participants who engage in severe challenging behaviour is relatively scare compared to child participants. Further, challenging behaviour literature tends to emphasize efficacy (e.g., Does the intervention work?) more often than effectiveness (e.g., Does the intervention work in real world settings?). The current project thus was a systematic program evaluation conducted to evaluate the effectiveness of a comprehensive behavioural treatment package at reducing severe challenging behaviour and generating adaptive skills in adults with intellectual and developmental disabilities. A hybrid nonexperimental consecutive case series design was employed featuring all participants (n = 8) who experienced the treatment package, regardless of their success. The results depicted primarily therapeutic outcomes with a substantial decrease in challenging behaviour from baseline to intervention for majority of participants (n = 5) and an increase in adaptive behaviour (i.e., number of mastered skills targets) for participants (n = 7) across the intervention condition. Treatment fidelity suggests frontline staff were largely implementing the interventions as intended (M = 84%, range 82-90%). Social validity surveys administered to participants, caregivers, and case managers provide support for the acceptability of treatment goals, procedures, and effects. Project limitations, clinical considerations, and future directions are discussed.