Date of Conferral







Cheryl T. Balkcom


Researchers have demonstrated the effectiveness of positive behavior support (PBS) services in the in-home (IH) setting but few studies examined its use with traumatic brain injury (TBI) clients, and most of these were small sample cases. Additional research on IH PBS services for TBI clients was recommended, in particular using larger samples. The purpose of this study was to address that need by examining the effectiveness of IH PBS services in treating TBI-related challenging behaviors on a larger sample. The theoretical foundations for PBS, behaviorism, cognitive constructivism, social learning theory, and the biopsychosocial model of behavior, are described. The research questions asked whether there was an association between TBI clients receiving IH PBS services and the frequency of physical aggression, verbal aggression, and noncompliance they displayed. An ex post facto quantitative study was conducted using archival data from clinicians from an IH TBI services agency that provided supports to 62 clients for these 3 maladaptive behaviors. Chi square analysis of the aggregate categorical data examined the association between PBS services and the frequencies of those behaviors for those clients. Findings showed that PBS-based IH TBI services led to a reduction in physical aggression, verbal aggression, and noncompliance. Given the growing desire for IH services on the part of individuals with TBI, ensuring effective IH behavior supports is an important social change to how the healthcare system treats TBI. This study contributes to the literature on best practices for IH TBI behavior services and can help inform agencies and state oversight bodies about the use of PBS-based IH supports for TBI clients.