Responding to behaviour that challenges in community intellectual disability settings

People with intellectual disabilities who display behaviours that challenge may experience a range of staff management approaches, including restrictive practices (RP). While policy recommends non-pharmacological, person-centred approaches, there remains limited understanding of how behaviours that challenge are managed within community intellectual disability services and how RP is understood and experienced by staff. This thesis comprised a systematic review and an empirical mixed-methods study. The systematic review synthesised 37 studies examining non-pharmacological staff responses to behaviours that challenge in community intellectual disability settings. Three categories of management strategies were identified: function-based/Positive Behaviour Support approaches, relational and environmentaladaptations, and restrictive interventions. Implementation was influenced by staff skills, confidence and emotional regulation, alongside organisational support, while restrictive practices remained embedded within care. The empirical study examined staff understanding and use of RP and its relationship with staff wellbeing. Staff (n = 85) completed standardised questionnaires assessing RP use, attitudes towards aggression, workplace violence and wellbeing, and semi-structured interviews with 10 staff were analysed using Reflexive Thematic Analysis. Staff using RP experienced significantly more physical violence within their role and were more likely to endorse RP. Staff wellbeing was associated with attitudes towards aggression and experiences of workplace violence. Five qualitative themes were identified: RP as conceptually ‘grey’, moral complexity, systemic drivers, psychological burden, and relational approaches as pathways for change. Overall, findings highlight the interaction between individual, relational and systemic factors in shaping staff responses to behaviours that challenge. Clearer guidance, staff training, organisational support and relational, person-centred approaches may help reduce reliance on restrictive practices while supporting staff wellbeing.