Transforming Care: the use of Positive Behaviour Support to enable children and young people to remain in their local communities

Project title:

Transforming Care: the use of Positive Behaviour Support to enable children and young people to remain in their local communities


The Transforming Care agenda results from the Winterbourne View Hospital scandal in 2011. The scandal highlighted the vulnerability of people with learning (intellectual) disabilities and/or autism and ‘challenging behaviour’ placed away from their families and their local communities.

Dr Roland Casson (Clinical Psychologist) undertook a CLAHRC EoE Fellowship project in 2015 (as part of a programme of research carried out by the Enduring Disabilities and/or Disadvantage Theme of the CLAHRC East of England) to understand how local services might better support the inclusion of people whose behaviour ‘challenges’. He focused on a significant component of the ‘Transforming Care’ agenda: the exclusion from school of children and young people (CYP) with learning (intellectual) disabilities and/or autism and behaviour that is perceived as ‘challenging’. Exclusion from school often results in the placement of CYP in specialist provision, such as 52 week residential educational provision or hospital units, that frequently far from their families and others who are able to monitor their progress and well-being. It can be very difficult for them to return to their local communities and many specialist placements last well into adulthood. Specialist placements are, however, hugely costly (approx. £300,000 per annum) and use money that could be more effectively invested in local services.

The starting point:

During his Fellowship, Dr Casson sought to (a) gather data about the CYP in 52 week residential schools and (b) understand how decisions were made to exclude CYP with learning disabilities and/or autism and ‘challenging behaviour’ from schools and other local provisions, and the processes leading to specialist, out of area placements. Through interviews with health and social care practitioners, managers and commissioners of services, and an examination of individuals’ trajectories to specialist placements, he established that there was limited systematic support to enable these children to remain in local provision, close to their families.

From research to implementation:

Following Dr Casson’s Fellowship project, two years’ funding was secured through Cambridgeshire County Council Social Care) to establish a small multi-disciplinary intensive support team. The team used an evidence-based approach, Positive Behaviour Support (PBS). Eight CYP were referred to the service, all of whom are now in, or remain in, local school provision with access to short breaks. There was evidence of other positive outcomes, including reductions in ‘challenging behaviour’, improved mood and well-being, improvements in family quality of life, and parental satisfaction with the team’s approach. Strikingly, the average cost of local provision (around £100,000 p.a.) is significantly less than a full time residential school or in-patient Cambridgeshire County Council recently committed further funding until 2021 in order to improve outcomes for the individuals referred to the project and their families and contribute to broader changes in services for CYP with learning disabilities and/or autism and ‘challenging behaviour’.

Aims of the new project:

For the CLAHRC EoE to work with practitioners and others to support the development of the intensive support team in a different local context, that of Peterborough, and refine the evaluation of outcomes.

Dr Isabel Clare (Enduring Disabilities and/or Disadvantage Theme, CLAHRC) and Professors Andree LeMay and John Gabbay (Implementation, CLAHRC) are supporting these next steps, working with the local children’s Transforming Care Lead (Karen Chopping).

Further material will be added to this website as the project progresses.


For further information on this project, please contact Roland Casson

For a ‘BITE’ sized summary of the research, please see:

Share this article
Tweet about this on Twitter