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Who’s challenging who

Group of students with teacher holding notebook

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.


The study primarily addresses a recognised need for developing an effective workforce in adult social care, delivering effective leadership throughout the system, assessing models of co-production and their impact on social care outcomes, and providing best care and support for carers.

This study also aims to contribute to the evidence base for care homes and conceptualising and developing the evidence base for prevention in adult social care.

Previous research

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).

Recruitment targets

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

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.

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.

Research impact

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 learning disability and challenging behaviours in staff training to directly impact social care practice.

Funder: National Institute for Health Research (NIHR) School for Social Care Research

Chief investigator: Professor Richard Hastings