1. The Brief Behavioural Assessment Tool (BBAT)
Challenging Behaviour
Community of Practice
Ymddygiad Anhydrin
Cymuned Ymarfer
Impact
Effeithio
Change
Newid
Inform
Rhoi Gwybod
The Brief Behavioural Assessment Tool (BBAT)

2. Acknowledgements: The BBAT was developed by
Dr Mark Smith Consultant Clinical Psychologist
Dr Gill Nethell, Clinical Psychologist
Professor Dave Allen, Associate Clinical Director
With input from
Dr Edwin Jones, Service Development Consultant
Special Projects Team,
Directorate of Learning Disability Services,
Abertawe Bro Morgannwg University Health Board

3. Local context- ABM
Challenging behaviour care pathway- variation in assessments and interventions offered for CB
Admissions to Acute Assessment and Treatment Units- no standard “product” on discharge
Training needs identified at T2 and T3
Our overall agenda- improving competency and raising the bar of basic assessment skills

4. Brief functional analysis
Comprehensive functional analysis should always be the “gold standard”, but may not always be needed or practical:
‘Low level’ CB
Isolated behaviour that occurs in a specific context
When comprehensive assessment already undertaken but needs to be reviewed
When there is a need to put interim strategies in place due to risks
Family settings
Short admissions to AATU

5. Other brief assessment tools
Some brief behavioural assessment tools already published, e.g. Functional Analysis Screening Tool (Iwata, 1995)
But FAST is very brief (2 pages), and doesn’t include some key questions that we tend to ask
So the BBAT was born!

6. What is the BBAT?
Informant based assessment tool to use in functional analysis
Explores key areas that are usually assessed using multiple tools such as FAI, MAS, CAI, RI etc

7. BBAT is designed to help you:
 Clearly define behaviour(s) of concern
 Identify key triggers- slow and fast
 Identify possible maintaining consequences
 Identify whether the person is able to use alternative responses, other than their challenging behaviour, so that you can build on these
 Identify the person’s main preferences, so that you can use these to reinforce non-challenging behaviour
 Identify the person’s basic communication skills

8. What it looks like 8 pages
Takes approximately 1 hour-1hour 30 mins to complete
8 sections:
Informant/service user relationship
Defining and prioritising the behaviours of concern (over last 12 months)
When is behaviour most likely to occur (slow and fast triggers)
Early indicators
Possible maintaining consequences
Coping skills
Basic communication skills
Likes and preferences
Summary tables

9. Limitations: Not a replacement for a comprehensive assessment
Caution required when used in isolation
Advisable to back up findings with some form of observational data as a minimum standard

10. ABMU ‘brief’ assessment process:
Informant based assessment:
BBAT
Pre-post measures of change:
ABC
PAS-ADD
HoNOS
Direct observational data:
Behaviour Monitoring Form (BMF)

11. Reliability and validity
Comparing brief v comprehensive functional analysis in Specialist Residential Services
Initial results suggest 75% + overlap in brief and comprehensive functional analysis when using BBAT

12. Factor analysis
Factor analysis of the 20 items on maintaining functions
Factor analysis of 126 BBATs indicates that at least 16 out of the 20 questions load solely onto the factors they were intended to with a loading greater than 0.4

13. Implementation:
All ABMU -AATU staff trained in administration of BBAT, which is now used as part of all admissions
Training planned for Tier 2 services in ABMU--BBAT will form part of “minimum standard” within the Care Pathway
Trained small group of 3rd sector staff to successfully use BBAT
Aneurin Bevan UHB training staff as above
Betsi Cadwalladr UHB training staff
Very positive feedback !!

14. BBAT training Training led by developers of BBAT
Training on the whole brief assessment process
Competency based approach:
Learning how to use the tool
Opportunity to practice
Using the tool in situ
Receiving feedback from a mentor
Learning how to develop an intervention