The Brief Behavioural Assessment Tool (BBAT) Challenging Behaviour Community of Practice Ymddygiad Anhydrin Cymuned Ymarfer Impact Effeithio Change Newid Inform Rhoi Gwybod The Brief Behavioural Assessment Tool (BBAT)

Acknowledgements: The BBAT was developed by Dr Mark Smith Consultant Clinical Psychologist Dr Gill Nethell, Clinical Psychologist Professor Dave Allen, Associate Clinical Director With input from Dr Edwin Jones, Service Development Consultant Special Projects Team, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board

Local context- ABM Challenging behaviour care pathway- variation in assessments and interventions offered for CB Admissions to Acute Assessment and Treatment Units- no standard “product” on discharge Training needs identified at T2 and T3 Our overall agenda- improving competency and raising the bar of basic assessment skills

Brief functional analysis Comprehensive functional analysis should always be the “gold standard”, but may not always be needed or practical: ‘Low level’ CB Isolated behaviour that occurs in a specific context When comprehensive assessment already undertaken but needs to be reviewed When there is a need to put interim strategies in place due to risks Family settings Short admissions to AATU

Other brief assessment tools Some brief behavioural assessment tools already published, e.g. Functional Analysis Screening Tool (Iwata, 1995) But FAST is very brief (2 pages), and doesn’t include some key questions that we tend to ask So the BBAT was born!

What is the BBAT? Informant based assessment tool to use in functional analysis Explores key areas that are usually assessed using multiple tools such as FAI, MAS, CAI, RI etc

BBAT is designed to help you:  Clearly define behaviour(s) of concern  Identify key triggers- slow and fast  Identify possible maintaining consequences  Identify whether the person is able to use alternative responses, other than their challenging behaviour, so that you can build on these  Identify the person’s main preferences, so that you can use these to reinforce non-challenging behaviour  Identify the person’s basic communication skills

What it looks like 8 pages Takes approximately 1 hour-1hour 30 mins to complete 8 sections: Informant/service user relationship Defining and prioritising the behaviours of concern (over last 12 months) When is behaviour most likely to occur (slow and fast triggers) Early indicators Possible maintaining consequences Coping skills Basic communication skills Likes and preferences Summary tables

Limitations: Not a replacement for a comprehensive assessment Caution required when used in isolation Advisable to back up findings with some form of observational data as a minimum standard

ABMU ‘brief’ assessment process: Informant based assessment: BBAT Pre-post measures of change: ABC PAS-ADD HoNOS Direct observational data: Behaviour Monitoring Form (BMF)

Reliability and validity Comparing brief v comprehensive functional analysis in Specialist Residential Services Initial results suggest 75% + overlap in brief and comprehensive functional analysis when using BBAT

Factor analysis Factor analysis of the 20 items on maintaining functions Factor analysis of 126 BBATs indicates that at least 16 out of the 20 questions load solely onto the factors they were intended to with a loading greater than 0.4

Implementation: All ABMU -AATU staff trained in administration of BBAT, which is now used as part of all admissions Training planned for Tier 2 services in ABMU--BBAT will form part of “minimum standard” within the Care Pathway Trained small group of 3rd sector staff to successfully use BBAT Aneurin Bevan UHB training staff as above Betsi Cadwalladr UHB training staff Very positive feedback !!

BBAT training Training led by developers of BBAT Training on the whole brief assessment process Competency based approach: Learning how to use the tool Opportunity to practice Using the tool in situ Receiving feedback from a mentor Learning how to develop an intervention