Establishing a context to reduce challenging behaviour using procedures from active support: a clinical case example

Client engagement increases substantially when staff teams implement active support. The impact of active support on challenging behaviour is less clear. There are grounds for believing that active support procedures could in some cases neutralise environmental conditions known to evoke challenging behaviour. We implemented a three‐phase clinical intervention to increase engagement and reduce passive and challenging behaviour. In phase 1 we trained staff to deliver inviting activity‐based instruction at eye level. In phase 2 we introduced activity support plans to increase client choice and control. In phase 3 staff used peer‐monitoring procedures to consolidate implementation. We measured staff behaviour and client outcome across the three phases of intervention and at follow‐up. Staff provided warm and inviting activity‐based instruction at eye level more frequently after participating in phase 1 on‐site training. The proportion of activity‐based interactions with choice increased when activity plans were introduced in phase 2. Engagement replaced passive and challenging behaviour. Staff observations suggested changes were maintained over the short run. Our own observations indicated decay at 22 months. Our data suggest that active support procedures can make challenging behaviour less likely by altering antecedent conditions that reliably evoke such behaviour. Without sustained effort, interventions are susceptible to decay.