ABSTRACT
A major advance in the behavioural approach to 'severe challenging behaviours' has been the shift towards a behavioural analytic approach in which interventions are based upon an understanding of the functions of challenging behaviours. This chapter addresses how the advances can be supported in the work of people undertaking frontline care responsibilities in a range of settings: parents at home, day centre staff and teachers in social service, health and educational settings. It describes an experiential exercise 'The Birthday Exercise' that introduces the basic ideas of cognitive therapy to carers working with people with learning disabilities and severe challenging behaviour. It is particularly relevant for managers of these services who are responsible for providing and maintaining high-quality environments for users and those who work with them. To make things work and attain a high-quality life for carers and clients, staff had better recognise that some of the things they are doing as part of their current practice are not working.
