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Background
This paper has a long history, like some of the other articles in this issue. Following the BBC Panorama expose of Winterbourne View in 2011, the English Department of Health’s Transforming Care report (Department of Health, 2012) identified a number of key actions including a “refresh” of the document Challenging Behaviour: A Unified Approach (Royal College of Psychiatrists, British Psychological Society, & Royal College of Speech and Language Therapists, 2007). In 2013, the current authors were asked to update the chapter on “Capable environments” that had been part of the 2007 document. That chapter had provided an analysis of why community placements break down and institutional, out-of-area placements persist, drawing on the updated Mansell Report produced around the same time (Department of Health, 2007). We decided that the analysis in that chapter remained largely valid and that, rather than simply update it, we should write something different that attempted to more directly map some of the characteristics of capable environments. In particular, we decided to start from the closing section of the original chapter which argued that, rather than treat people whose behaviour is challenging by moving them to specialist settings, we should support people to live good lives (despite any continuing challenging behaviour) in their local communities. It was noted that this would require that support in such settings focussed on “good preventative practice” (p. 52), incorporating active support and positive behavioural support.
We thought it would be worth elaborating such preventative practice in a way that might be useful for a range of stakeholders. It could provide the basis of a “curriculum” for social care of use to provider organisations. It could clarify the required competencies of staff and managers working in such organisations. It could identify the training needs of such staff. It could form the basis for a service specification that could be used by service commissioners. And it could form the first tier of preventative support around challenging behaviour enabling and allowing more treatment focussed approaches where these were necessary. Accordingly, the first draft of what has become the current article was produced in early 2013 and (especially with Winterbourne View in mind) started from the same analysis of the breakdown of community placements and their replacement by institutional,...