The Brief Behavioural Assessment Tool (BBAT)

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

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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

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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

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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 doesnt
  include some key questions that we tend to ask
• So the BBAT was born!

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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

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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 persons main preferences, so
  that you can use these to reinforce
  non-challenging behaviour
• ? Identify the persons basic communication
  skills

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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

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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

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ABMU brief assessment process

• Informant based assessment
• BBAT
• Pre-post measures of change
• ABC
• PAS-ADD
• HoNOS
• Direct observational data
• Behaviour Monitoring Form (BMF)

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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

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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

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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 !!

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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