“They are in here for a reason but that doesn’t mean that they can’t have a decent quality of life or something to aim for” An Interpretative Phenomenological Analysis exploring staffs’ experiences of implementing the Positive Behaviour Support (PBS) pathway in a Forensic Learning Disability service

Student thesis: Doctoral Thesis


Background: National guidance has recommended Positive Behaviour Support (PBS) as a framework for understanding and managing behaviours that challenge (BTC). Forensic Learning Disability (FLD) services have adopted PBS as a framework to support their service provision, perhaps due to the link between the non-aversive principles of PBS and the promotion of least-restrictive practices in forensic services. Research examining the efficacy of PBS in Learning Disability (LD) services is in its infancy. Overall, there is a lack of research with regards to PBS in forensic services. Particularly in relation to how the unique aspects of forensic services may present as challenges to the implementation of PBS. Understanding factors that may present as barriers to the implementation of PBS would enable the organisation to implement change where needed. The overarching research question for this study is: ‘How do staff working in a FLD setting experience the implementation of PBS for BTC?”

Method: Nine participants, (three Clinical Leads, four LD Nurses and two Health Care Assistants) who work within a FLD service, each took part in semi-structured interviews. Interviews were transcribed and subsequently analysed using interpretative phenomenological analysis.

Results: Five superordinate themes emerged from the data, along with a number of subordinate themes. The first superordinate theme ‘the emotional impact of the role’ captures staff’s responses to the difficulties associated with working within a FLD service. ‘Coping mechanisms’ represents the different strategies staff utilise in an attempt to manage the distress they experience through their work. ‘The value of PBS’ reflects staff’s perspectives on how PBS has been useful within this service. Experiences appear to reflect the overall aims of PBS according to the literature. The superordinate theme ‘challenges to implementing PBS’ captures the difficulties staff experience when implementing PBS within this setting. Participants reflect on how these experiences have impacted upon their level of engagement and motivation. Lastly, ‘forensic culture’ illustrates how the unique and specialist nature of forensic services may in itself present as a barrier to the successful implementation of PBS.

Conclusion: This study has highlighted the challenges staff experience when implementing PBS within a FLD Service. Findings suggest that the underlying principles upon which PBS are based, may precipitate emotional conflict for staff within this setting. The forensic culture prevents staff from accessing support and processing this emotional conflict. This coupled with more specific barriers (limited resources, staff perceptions of PBS and prioritising risk over quality of life), creates challenges for staff implementing PBS within this service. Implications for clinical practice include the need for a system-wide commitment to address the specific issues highlighted through this research. As this study is relatively novel, further research within this domain is recommended to develop a clearer understanding of the complexities associated with implementing PBS within a FLD Service.
Date of Award2019
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorAsh Summers (Supervisor), Emma Phipps (Supervisor) & Michelle Small (Supervisor)

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