Enhancing participation outcomes for people with acquired brain injury, high and complex daily support needs and challenging behaviour: a qualitative study of Australian allied health practitioners

Sue Sloan; Em Bould; Libby Callaway

doi:10.1080/09638288.2026.2650821

Enhancing participation outcomes for people with acquired brain injury, high and complex daily support needs and challenging behaviour: a qualitative study of Australian allied health practitioners

Disabil Rehabil. 2026 Mar 31:1-22. doi: 10.1080/09638288.2026.2650821. Online ahead of print.

Authors

Sue Sloan¹, Em Bould^{1

2}, Libby Callaway^{1

2}

Affiliations

¹ Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
² Occupational Therapy Department, School of Primary and Allied Health Care, Faculty of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

PMID: 41914781
DOI: 10.1080/09638288.2026.2650821

Abstract

Purpose: To investigate how experienced allied health practitioners (AHPs) enhance participation outcomes for community-dwelling adults with high disability support needs and challenging behaviour following extremely severe acquired brain injury (ABI).

Materials and methods: Participants were 23 AHPs experienced in adult ABI rehabilitation who participated in semi-structured interviews. Responses were illustrated with a single de-identified case example. Qualitative data analysis was conducted using NVivo and followed the six steps of Reflexive Thematic Analysis.

Results: Eight themes to enhance participation outcomes were identified: (1) "building a good relationship," (2) "it takes a team", (3) "I just need to find something he can do", (4) "behaviour, activity and participation are inseparable", (5) "behaviour is everybody's business", (6) "environments that match the person's needs", (7) "work with the disability support workers, team leader, and the person above them", and (8) "there's a direct correlation between behaviour and participation".

Conclusions: This study supports a bidirectional relationship between behaviour and participation that can be harnessed to shape successful AHP interventions. Implications for future clinical research include the importance of integrating behaviour support plans into structured routines focused on meaningful activity and role participation following ABI, and concurrently measuring behaviour and participation outcomes.

Keywords: Profound brain injury; challenging behaviour; community living; disability; participation; positive behaviour support; support worker.

Plain language summary

Interventions developed by AHPs and implemented by disability support workers can assist people with ABI who have high daily support needs and challenging behaviour to achieve meaningful participation goals.Disability workers require training and ongoing support from AHPs to manage complex disability support needs and challenging behaviour.Challenging behaviour and participation are related bidirectionally, and need to be measured and addressed together.