Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

Kate Rachel Gould, Jennie Louise Ponsford, Amelia J. Hicks, Malcolm Hopwood, Belinda Renison, Timothy J. Feeney

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)


Challenging behaviours are a common and distressing consequence of acquired brain injury (ABI). There are no evidence-based guidelines for managing challenging behaviours after ABI, leaving clinicians with few resources to guide practice. Findings from case studies and single-subject experimental designs support the use of positive behaviour support (PBS) interventions for challenging behaviour post-ABI. This paper introduces PBS + PLUS: a multi-component and flexible PBS intervention using a person-driven collaborative approach to build a meaningful life and self-regulate behaviour after ABI. PBS + PLUS is currently being examined in a randomized controlled trial (RCT). Three detailed pilot case studies illustrate the highly individualized implementation of the programme, delivered to the individuals with ABI and carers over 12 months by a transdisciplinary team including neuropsychologists, occupational therapists, and psychiatrists. Objective behavioural outcomes are reported for participants using the Overt Behaviour Scale at baseline and four-monthly intervals for two years. Goal attainment scaling was used to measure personally meaningful goals. The qualitative appraisals of the intervention by participants, families and carers, and 12-month follow-up outcomes are described. The advantages and challenges of programme delivery are discussed. These case studies will assist clinicians and service providers to implement PBS + PLUS in anticipation of the results of the RCT.

Original languageEnglish
Pages (from-to)57-91
Number of pages35
JournalNeuropsychological Rehabilitation
Issue number1
Publication statusPublished - Jan 2021


  • Acquired brain injury
  • Case study
  • Challenging behaviour
  • Intervention
  • Positive behaviour support

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