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Who's Challenging Who

A cluster randomised controlled trial to test the effectiveness of a staff training intervention to improve support staff attitudes and empathy towards adults with learning disability and challenging behaviours.

Study background

Individuals with a learning disability (LD) often engage in behaviours that are labelled as “challenging” (challenging behaviours – CB) which are, by definition, a significant challenge for services and impact negatively on the quality of life of people with LD. CBs are also related to risk of abusive practices (cf. Winterbourne View scandal exposed by BBC Panorama), increased carer stress (Hastings, 2002a, 2002b), and high cost of support services (Knapp et al., 2005). High quality epidemiological research suggests that 18.7% of adults with LD known to services engage in CB that has significant impact on their lives (Jones et al., 2008).

The study primarily addresses NIHR SSCR theme iv – People (developing an effective workforce in adult social care; delivering effective leadership throughout the system; models of co-production and their impact on social care outcomes; providing best care and support for carers). It is also relevant to the following themes:

  • I. Provision of care and support (Research to help develop the evidence base for care homes)
  • Iii. Prevention (conceptualising and developing the evidence base for prevention in adult social care)

Study design

We developed the Who’s Challenging Who (WCW) training course for support staff to address an identified need for training. The WCW training course is a half-day in length and involves a co-trainer with LD and CB working with a co-trainer without disability.

A pilot study was completed to establish the content of the training programme which is now being evaluated in this large scale robust research trial.


We aim to recruit 118 residential settings into the trial with 2 members of staff from each: 236 participants in total.

Involving the public and patients

Involving the public has led to detailed feedback on the content of the training programme and the delivery of the course.

As well as being grounded in longer-term research and theoretical development, Who’s Challenging Who offers a practical solution to the inclusion of the perspectives of users with LD and CB in staff training to directly impact social care practice.