The dilemmas of residential care staff working with the challenging behaviour of people with learning disabilities.

Objectives: To investigate residential care staff beliefs and feelings about the challenging behaviour of adults with learning disabilities in their care, and how they perceive these beliefs and feelings to have developed over time.

Design: A qualitative study using thematic analysis.

Methods: A group of 18 staff from 10 different residential services participated in indepth semi-structured interviews. Transcripts were analysed according to thematic analysis techniques drawn from interpretative phenomenological analysis (IPA) and grounded theory. The analysis was then subjected to scrutiny by participants using a respondent validation survey.

Results: Staff talked of dilemmas about whether challenging behaviour should be seen as a 'communication' of need or as a 'behaviour problem', how to balance a 'firm' response with 'kindness', and how to deal with unpleasant feelings evoked by the work, especially fear and frustration. Over time, staff reported overcoming initial fears of the client by 'getting to know them', or alternatively, avoiding the client, 'cutting off' emotionally, or protecting themselves with safety procedures.

Conclusions: The analysis suggests that staffs are troubled by the limitations of a narrow behavioural discourse. Staff development and training based on richer approaches that integrate behavioural ideas with a value-based philosophy, might allow staff to respond to needs expressed by behaviour without fear of reinforcing it. Services should attend to staff emotional reactions to their work, to help them maintain nonavoidant coping strategies.