Joumal of Intellectual Disability Research495

VOLUME 41 PART 6 pp 495-5OI DECEMBER 1997

Measuring staff perceptions of challenging behaviour: theChallenging Behaviour Attributions Scale (CHABA)

R. P. Hastings

Behavioural Sciences Unit, Institute of Child Health, University College London, London, England

Abstract

Causal attributions may interact with other variables to

determine staff responses to challenging behaviour.

Furthermore, staff perceptions of the causes of

challenging behaviour are likely to change as a result of

theoretical and practical training. However, there is no

established simple method for measuring staff

attributions that could facilitate research in these areas.

The present paper describes the development and

preliminary psychometric analysis of the Challenging

Behaviour Attributions Scale (CHABA).

Keywords challenging behaviour, ChallengingBehaviour Attributions Scale (CHABA), staffperceptions

Introduction

Staff beliefs about the causes of challengingbehaviours (i.e. their causal attributions) arereceiving increased interest in the intellectualdisability literature (e.g. Berryman et al. 1994;Bromley & Emerson 1995; Hastings et at. 1995b).There are at least two reasons why clinicians andresearchers have begun to focus on staff attributions.

First, there is an implicit assumption that stafiF ideas

Correspondence: Richard P. Hastings Ph.D., Department ofPsychology, University of Southampton, Highfield, Southampton,SO17 iBJ, England.

about the causes of challenging behaviour willinfluence their responses to it. Although there is nodirect information about how and when attributionsmay be related to stafif intervention behaviour, it hasbeen suggested that attributions interact with a numberof other factors to determine stafiF behaviour (Hastings& Remington 1994; Hastings et al. 1995a). Thesefactors iticlude stafiF emotional responses to challengingbehaviour, stafiF beliefs about efiFective interventionstrategies, formal aspects of service cultures (e.g.behavioural programmes and policy documents) andinformal aspects of service cultures (e.g. 'unwrittenrules' developed by staff working together).

The second reason for an interest in stafiFattributions relates to the need to evaluate stafiftraining on challenging behaviour. Influentialcontemporary training approaches are based, tovarying degrees, on behavioural analyses andintervention strategies (e.g. LaVigna & Donnellan1986; Zarkowska & Clements 1988; Carr et al.1994). If such training is successful, we might expectStafiF to place more of an emphasis on causalhypotheses related to positive and negativereinforcement processes, and environmental settingevents (including lack of stimulation). Furthermore,we might expect there to be less use of biomedicaland psychodynamically derived models. Suchgeneral changes have been reported (Berryman et al.1994; Noone & Iceton 1995). In contrast, anti-behavioural traiping models may expect changes in

1997 Blackwell Science Ltd

496Joumal of Intellectual Disability Research VOLUME 41 PART 6 DECEMBER 1997

R. P. Hastings • Staff attributions about challenging behaviour

the reverse direction. Whichever is the case, changesin staff attributions may occur after training aboutchallenging behaviour.

There have been a variety of difiFerent methodsused to access stafiF attributions about challengingbehaviours: direct interviews with care stafiF(Hastings 1995), open-ended questions requiringwritten responses (Berryman et al. 1994),questionnaire rating scales (Hastings et al. 1995b)and multiple-choice questions (Oliver et al. 1996).However, no method has yet become establishedand there is a need for a flexible measure that can beused both in research on stafiF behaviour and in theevaluation of stafiF training (Hastings 1997).

One scale has been developed that measures,among other things, caregiver attributions about self-injurious behaviour (the Self-Injury BehaviouralUnderstanding Questionnaire, SIBUQ; Oliver et al.1996). The SIBUQ incorporates a number of shortvignettes describing self-injurious behaviour.Respondents are asked to choose one of four causalhypotheses from those given with each of thevignettes. These alternatives represent a 'correct'behavioural hypothesis, a behavioural hypothesis thatis 'incorrect', an internal organic hypothesis and ahypothesis related to emotional processes. Separatescores can be derived from the SIBUQ representingthe proportion of vignettes for which a respondentchooses each of the four types of hypothesis.Although the SIBUQ has a wide range of potentialuses, it focuses only on self-injurious behaviour andit is not designed to distinguish between differenttypes of behavioural hypothesis (e.g. positive versusnegative reinforcement processes).

The present paper describes a self-completion ratingscale that measures stafiF causal models of challengingbehaviour, the Challenging Behaviour AttributionsScale (CHABA). In addition, preliminarypsychometric data are presented. The CHABA isdesigned for use in research on staff behaviour and forinclusion with other measures in the evaluation of stafiFtraining on challenging behaviour.

Method

Participants

Ninety care stafif working in services for people withintellectual disabilities participated in research to

develop the CHABA. All of the stafiF worked incommunity-based services that incorporated grouphomes and some small specialized units incommunity settings (mean number of service usersin each home/unit, based on stafiF reports = 9.84).Twenty-seven stafiF had professional qualifications orwere in managerial positions. This group includedtrained nurses, various managers andphysiotherapists. Out of the remaining stafiF, 61 hadno professional qualifications related to the care ofpeople with intellectual disabilities. Information wasnot available on two staff members. The stafiF had amean age of 37.88 years (SD = 12.05) and had amean length of experience working with people withintellectual disabilities of 7.65 years (SD = 5.74).Sixty-eight staff were female and 20 male (two staffdid not record their sex).

The Challenging Behaviour Attributions Scale

The CHABA was developed by the addition of itemsto a questionnaire used in previous research on stafiFattributions about challenging behaviour (fordescriptions of this questionnaire, see Hastings et al.1995b; Hastings et al. 1997). The originalquestionnaire consisted of 25 causal explanations forchallenging behaviour reflecting the range of modelsfound in the research literature. Participants in theprevious research studies were given a briefdescription of a challenging behaviour and wereasked to rate the likelihood that each of the 25 causalstatements applied to the described behaviour on aseven-point scale.

This questionnaire was expanded into a 39-itemscale with statements relating to five causal models:learned behaviour (eight items); medical/biologicalfactors (nine items); emotional factors (eight items);aspects of the physical environment (eight items);and self-stimulation (six items). The questionnaire isnot designed to be a measure of stafiF 'attributionalstyle' as such, but is concerned with stafiF applicationof causal models of challenging behaviour inparticular circumstances. These circumstances aredescribed within case examples or 'vignettes' aboutchallenging behaviour.

Participants in the present study completed aquestionnaire containing the expanded scale. First,they were asked to read one of two vignenesdescribing either aggressive or stereotyped

© 1997 Blackwell Science Ltd, Joumal of Intellectual Disability Research 41, 495-501

497Journal of Intellectual Disability Research VOLUME 41 PART 6 DECEMBER 1997

R. P. Hastings • Staff attributions about challenging behaviour

behaviour. Each stafiF member read one vignetteonly. Secondly, they were asked to consider the 39items and rate the likelihood that each was a reasonfor the occurrence of the described behaviour.Ratings were made on a five-point scale rangingfrom 'very unlikely' to 'very likely'. Five points werechosen in preference to the original seven-pointformat because pervious samples rarely used theextreme categories. The instructions for theCHABA, the two vignettes used and an example ofthe rating scale are shown in Appendix i.

In the final section of the questionnaire, staff wereasked for information about their sex, their age, theircurrent job, their length of experience working withpeople with intellectual disabilities, and the numberof service users cared for in their group home orunit. They were also asked to indicate the extent oftheir training on challenging behaviours.'Challenging behaviour' was defined using examplebehaviours rather than a complex definition ofchallenging behaviour. Staff ratings of their trainingon challenging behaviour were achieved through theselection of one of the following five responses:

(1) no formal training on challenging behaviour;(2) limited training (one or two short courses only);(3) a fair amount of training (several courses);(4) detailed training (many courses, or coverage on

a professional course); and(5) extensive training (specialism in the

management of challenging behaviours or asimilar level of training)

Procedure

Questionnaires, accompanied by a covering letterexplaining the purpose of the study, were sent tomanagers of all group homes and units for peoplewith intellectual disabilities in a community-basedservice in the south of England. The two versions ofthe questionnaire (aggression/stereotypy) wereallocated randomly to the homes/units, except thatstaff working together did not receive differentquestionnaires. Ninety staff returned questionnaires(a response rate of 60%). No information is availableabout the characteristics of those staff who did notcomplete and return a questionnaire. However,previous research with staff fi-om this service suggeststhat the present sample was representative of theservices sampled.

Results and discussion

Scoring the CHABA

Five main sub-scale scores are calculated fi-om ratingsof the CHABA items. Each rating is assigned a valueof: (-2) very unlikely; (-1) unlikely; (o) equally likely/unlikely; (i) likely; or (2) very likely. A total score foreach sub-scale is derived by summing the ratings on allof the items associated with the five casual models (seeTable i) and dividing this score by the number of itemsin the sub-scale. A sub-scale score below zero suggeststhat the respondent considers the particular causalmodel is unlikely to apply to the rated behaviour. Atotal score above zero suggests that the particularcausal model is viewed as applicable to the ratedbehaviour. Scores on individual sub-scales can also becompared directly. For example, a more positive scalescore for emotional factors than biomedical factorsindicates that the person views the former causal modelas more applicable in a given situation.

After elimination of an ambiguous item from theLearned Behaviour sub-scale ('Because she wants tocommunicate something', see below for itemanalysis procedure), scores for this causal modelwere represented as an overall Learned Behaviourscore and as two shorter sub-scales. This wasachieved by scoring separately items suggestive ofpositive and negative reinforcement processes. Theuse of separate Learned Positive and LearnedNegative sub-scales scores is optional.

Item analysis

The final version of the CHABA scale was decidedupon after an item analysis. Items that correlatedwith the total score for the relevant sub-scale atr < 0.30 were removed from the CHABA. This left a33-item scale: Learned Behaviour (six items, threeitems each for Learned Positive and LearnedNegative); Biomedical (six items); Emotional (sevenitems); Stimulation (six items); and PhysicalEnvironment (eight items). The items for the finalscale, in their order of presentation, and theirassociated sub-scales are shown in Table i.

CHABA scores

Scores for the 33-item CHABA were calculated forall the participating staff. Mean scores for each sub-

I 1997 Blackwell Science Ltd, Journal of Intellectual Disability Research 41, 495-501

498Journal of Intellectual Disability Research VOLUME 41 PART 6 DECEMBER I997

R. P. Hastings • Staff attributions about chaiienging behaviour

Table I The Challenging Behaviour Attributions Scale items and

sub-scales*

Item and number Sub-Scale

1. Because she/he is given things to do that aretoo difficult for her/him L/LN

2. Because she/he is physically ill BM3. Because she/he does not like bright lights PE

4. Because she/he is t ired BM

5. Because she/he cannot cope wi th high levelsof stress EM

6. Because her/his house is too crowded wi thpeople PE

7. Because she/he is bored ST8. Because of the medication that she/he is given BM

9. Because she/he is unhappy EM10. Because she/he has not got something that

she/he wanted L/LPI I. Because she/he lives in unpleasant surroundings PE12. Because she/he enjoys it ST13. Because she/he is in a bad mood EM14. Because high humidity makes her/him

uncomfortable PE15. Because she/he is worr ied about something EM16. Because of some biological process in her/

his body BM17. Because her/his surroundings are too warm/cold PE18. Because she/he wants something L/LP19. Because she/he is angry EM20. Because there is nothing else for her/him to do ST21. Because she/he lives in a noisy place PE22. Because she/he feels let down by somebody EM23. Because she/he is physically disabled BM24. Because there is not very much space in her/

his house to move around in PE25. Because she/he gets left on her/his own ST26. Because she/he is hungry or thirsty BM27. Because she/he is frightened EM28. Because somebody she/he dislikes is nearby L/LN29. Because people do not talk to her/him very

much ST30. Because she/he wants to avoid uninteresting

tasks L/LN31. Because she/he does not go outdoors very

much PE32. Because she/he is rarely given activities t o do ST33. Because she/he wants attention f rom other

people L/LP

*(L) learned behaviour; (LP) learned positive; (LN) learned negative;

(BM) biomedical; (EM) emotional; (PE) physical environment; (ST)

stimulation.

scale for the whole sample, and sub-divided byqualification status and type of behaviour, are shownin Table 2. Overall, these data suggest thatbehavioural processes (in particular, positivereinforcement processes), emotional factors andstimulatory hypotheses were viewed by the presentsample as most relevant to understanding the causesof challenging behaviour.

Correlations between the sub-scales are shown inTable 3.' Clearly, there is a strong relationshipbetween the Learned Behaviour, and both theLearned Positive and Learned Negative sub-scales.However, the relationship between the LearnedPositive and Learned Negative sub-scales is relativelyweak. Together with the near zero mean score onthe Learned Negative sub-scale for this sample, thissuggests that staff do not believe negativereinforcement processes are important inunderstanding challenging behaviours. It has beensuggested elsewhere that this may be because stafffind it more difficult to understand the concept ofnegative reinforcement (Hastings 1997).

Apart from the associations with the stimulationsub-scale, correlations between sub-scales weregenerally moderate. This suggests that staff viewchallenging behaviour as determined by a range ofsocial, emotional, biomedical and environmentalfactors. Complex interactions between such factorsin the determination of challenging behaviour havealso been proposed in the research literature (e.g.Oliver et al. 1993). The stimulation sub-scale did nothave any strong associations with the other sub-scales, although the association with the PhysicalEnvironment sub-scale was moderate. This suggeststhat stimulatory causal models are viewed by staff asrelatively independent of other variables. Theassociation with the Physical Environment sub-scalecan be explained by the fact that the Stimulationitems describe a barren, unstimulating environment.

Reliability

Reliability of the CHABA was assessed by theinternal consistency method using Cronbach's alphacoefficient for each of the sub-scales. These alpha

'Parametric correlations were used because the data were

reasonably normally distributed. The sub-scale correlations were

repeated with non-parametric tests, but the coefficients obtained

were almost identical to those in Table 3.

I 1997 Blackwell Science Ltd, Journal of Intellectual Disability Research 41, 495-501

Journal of Intellectual Disability Research VOLUME 41 PART 6 DECEMBER I997

499R. P. Hastings • Staff attributions about challenging behaviour

Table 2 Staff mean scores for the Challenging Behaviour Attributions Scale sub-scales sub-divided by qualification status and type of chal-lenging behaviour

Sub-scale

BiomedicalPhysical environmentLearned Behaviour:

Learned Positive

Learned NegativeStimulation

Emotional

Whole sample(n = 90)M(SD)

-0.09 (0.60)0.08 (0.70)0.S3 (0.63)0.84 (0.72)0.22 (0.76)0.52 (0.60)0.60 (0.59)

Qualified(n = 27)M(SD)

-0,10(0.60)0.01 (0.53)0.48 (0.62)0.80 (0.78)0.16(0.67)0.69 (0.57)0.63 (0.58)

Unqualified

(n = 6 l )M(SD)

-0.06 (0.60)0.12(0.74)0.55 (0.66)0.85 (0.71)0.24 (0.80)0.45(0.61)0.57 (0.60)

Aggression(n = 49)M{SD)

0.19(0.52)0.38 (0.54)0.81 (0.54)1.15 (0.62)0.47 (0.67)0.44 (0.55)0.80 (0.49)

Stereotypy(n = 39)M(SD)

-0.43 (0.53)-0.31 (0.70)

0.18(0.57)0.45 (0.66)

-0.09 (0.75)0.63 (0.65)0.35 (0.60)

Table 3 Correlations between the Challenging Behaviour Attribu-tions Scale sub-scales scores*

Table 4 Cronbach's alpha values for the Challenging Behaviour At-

tributions Scale sub-scales (n = 90)

Sub-scale EM

Sub-scale

LN LP BM PE ST

EmotionalLearned:

learned negativelearned positive

Biomedical

Physical environmentStimulation

0.65 0.50 0.61 0.56 0.56 0.220.86 0.85 0.60 0.54 0.21

0.47 0.51 0.41 0.140.51 0.53 0.22

0.63 0.10

0.35

*(L) learned behaviour; (LP) learned positive; (LN) learned negative;

(BM) biomedical; (EM) emotional; (PE) physical environment; (ST)

stimulation.

values show a moderate to good level of reliabilityfor all of the CHABA sub-scales (see Table 4).

Conclusions

The preliminary psychometric data presented inthis paper suggest that the CHABA has acceptablelevels of reliability. Estimates of internalconsistency for the sub-scales, based onCronbach's alpha coefficient, were moderate togood in size. Anecdotal data suggest that stafffound the CHABA easy to understand and tocomplete. Therefore, it is reported here as aflexible practical tool for measuring staffattributions about challenging behaviours in

Sub-scale

BiomedicalPhysical environmentLearned behaviourLearned positiveLearned negativeEmotionalStimulation

Cronbach's alpha

0.650.870.760.730.650.750.69

research and practical contexts (i.e. as a part of theevaluation of staff training).

Validity for a measure of staff attributions isdifficult to establish given the lack of objectiveexternal validation criteria. At present, there are novalidity data available for the CHABA. One possiblestrategy would be to use the CHABA to monitorattributions of staff going through extensive trainingon understanding and treating challenging behaviour(e.g. a diploma or Masters course in BehaviouralApproaches to Challenging Behaviour) where wemight expect there to be some clear change in staffperceptions over time. If the CHABA were sensitiveto change in such a context, it would then beworthwhile to use it to measure change as a result ofless intensive courses typical of much training forstaff working v*dth people with intellectualdisabilities.

Further research is also warranted on otherproperties of the scale (in particular, its

) 1997 Blackwell Science Ltd, Journal of Intellectual Disability Research 41, 495-501

500Journal of Intellectual Disability Research VOLUME 41 PART 6 DECEMBER I997

R. P. Hastings • Staff attributions about chaiienging behaviour

stability—probably within a test-retest paradigm)and its utility in other contexts (e.g. with specialeducation staff and parents).

Acknowledgements

The author would like to thank the managers andstaff of Loddon NHS Trust for their help with thisresearch. The Challenging Behaviour AttributionsScale is available for use free of charge for thepurposes of research and the evaluation of stafftraining. The latest version of the CHABA, and up-to-date information on the use of the scale, can beobtained by writing to the author.

References

Berryman J., Evans I. M. & Kalbag A. (1994) The effectsof training in nonaversive behavior management on theattitudes and understanding of direct care staff. Journal ofBehavior Therapy and Experimental Psychiatry 25, 241-50.

Bromley J. & Emerson E. (1995) Beliefs and emotionalreactions of care staff working with people withchallenging behaviour. Journal of Intellectual DisabilityResearch 39, 341-52.

Carr E. G., Levin L., McConnachie G., Carlson J. I.,Kemp D. C. & Smith C. E. (1994) Communication-BasedIntervention for Problem Behavior: A User's Guide forProducing Positive Change. Paul H. Brookes Publishing,Baltimore, MD.

Hastings R. P. (1995) Understanding factors that influencestaff responses to challenging behaviours: an exploratoryinterview study. Mental Handicap Research 8, 296-320.

Hastings R. P. (1997) Staff beliefs about the challengingbehaviours of children and adults with mentalretardation. Clinical Psychology Review, in press.

Hastings R. P., Reed T. S. & Watts M. W. (1997)Community staff causal attributions about challengingbehaviours in people with intellectual disabilities. Journalof Applied Research in Intellectual Disabilities, in press.

Hastings R. P. & Remington B. (1994) Rules ofengagement: towards an analysis of staff responses tochallenging behavior. Research in DevelopmentalDisabilities 15, 279-98.

Hastings R. P., Remington B. & Hatton C. (1995a) Futuredirections for research on staff performance in servicesfor people with learning disabilities. Mental HandicapResearch 8, 333-9.

Hastings R. P., Remington B. & Hopper G. M. (1995b)Experienced and inexperienced health care workers'beliefs about challenging behaviours. Journal of IntellectualDisability Research 39, 474-83.

LaVigna G. W. & Donnellan A. M. (1986) Alternatives toPunishment: Solving Behavior Problems with Non-AversiveStrategies. Irvington, New York, NY.

Noone S. & Iceton J. (1995) Do staff change the way inwhich they attribute causality and blame about clientswith challenging behaviours after staff training? Paperpresented at the British Institute of Learning DisabilitiesIntemational Conference on Challenging Behaviour,Oxford, September 1995.

Oliver C , Hall S., Hales J. & Head D. (1996) Self-injurious behaviour and people with intellectualdisabilities: assessing the behavioural knowledge andcausal explanations of care staff. Journal of AppliedResearch in Intellectual Disabilities 9, 229-39.

Oliver C , Murphy G., Crayton L. & Corbett J. (1993) Self-injurious behavior in Rett syndrome—interactionsbetween features of Rett syndrome and operantconditioning. Journal of Autism and DevelopmentalDisorders 23, 91-109.

Zarkowska E. & Clements J. (1988) Problem Behaviour inPeople with Severe Learning Disabilities: A Practical Guideto a Constructional Approach. Croom Helm, London.

Received 7 February 1997; revised 23 May 1997

Appendix I

The Challenging Behaviour Attributions Scale(CHABA)

Instructions

Please read the following brief description:

Sophie is a young woman who has severelearning disabilities (mental handicap).Sometimes, Sophie is aggressive towardthe people who care for her and live withher. She will kick and punch people, pulltheir hair, and physically push them(sometimes so forcefully that people fallto the ground).

Sophie is a young woman who has severelearning disabilities (mental handicap).Sometimes, Sophie engages in stereotypedbehaviours. She will rock from one foot tothe other whilst standing in one place, waveher hands in front of her face or repeatedlyroll things between her fingers.

Consider how likely it is that the followingstatements are reasons for Sophie behaving in theway described above. You have been given very littleinformation compared to that you might have if you

© 1997 Blackwell Science Ltd, Journal of Intellectual Disability Research 41, 495-501

Journal of Intellectual Disability Research VOLt;ME4i PART 6 DECEMBER 1997501 - —

R. P. Hastings • StafT attributions about challenging behaviour

worked with Sophie. Therefore, simply think about E = equally likely/unlikelythe most likely reasons for someone like Sophie L — likelybehaving in this way. VL = very likely

Please give your response to each of the possible Please indicate your response by placing a circlereasons and use the scales below each reason to around the appropriate point on the scale.indicate your opinion. The key shows what thepoints on the scales mean: 1. Because she is given things to do that are

VUL = very unlikely too difiBcult for herUL = unlikely VUL UL E L VL

1997 Blackwell Science Ltd, Journal of Intellectual Disability Research 41, 495-501