England’s National Institute for Health and Clinical Excellence (NICE) has issued a new Quality Standard (QS101) covering the care of children, young people and adults with a learning disability and ‘behaviour that challenges’
The definition of ‘behaviour that challenges’ used by NICE is ‘Culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities.’
NICE stresses that, ‘behaviour that challenges’ is not a diagnosis and that while such behaviour is a challenge to services, family members and carers, it may serve a purpose for the person with a learning disability, for example by producing sensory stimulation, attracting attention, avoiding demands and communicating with other people.
The new standard seeks to address concerns highlighted in Out of sight, a 2013 report by Mencap and the Challenging Behaviour Foundation, which called for an end to the neglect and abuse of people with a learning disability.
NICE provides national guidance and advice to improve health and social care. Its quality standards describe high-priority areas for quality improvement in a defined care or service area.
Each standard consists of a prioritised set of specific, concise and measurable statements. QS101 includes eight of these:
- Statement 1 – People with a learning disability have a comprehensive annual health assessment from their GP.
- Statement 2 – People with a learning disability and behaviour that challenges have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.
- Statement 3 – People with a learning disability and behaviour that challenges have a designated person responsible for coordinating the behaviour support plan and ensuring that it is reviewed.
- Statement 4 – People with a learning disability and behaviour that challenges take part in personalised daily activities.
- Statement 5 – People with a learning disability and behaviour that challenges have a documented review every time a restrictive intervention is used.
- Statement 6 – People with a learning disability and behaviour that challenges only receive antipsychotic medication as part of treatment that includes psychosocial interventions.
- Statement 7 – People with a learning disability and behaviour that challenges have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.
- Statement 8 – Parents or carers of children aged under 12 years with a learning disability and behaviour that challenges are offered a parent‑training programme.