Introduction: Healthcare professionals, nationally and internationally, experience that exposure to persons withintellectual disabilities (ID) during education is often insufficient. Professionals within the sector urge enhancedtraining that will better prepare them for working with their clients. Providing care and support to persons with IDis complex and places high demands on the professionals such as knowledge about ID and cha llenging behaviors(CB) as well as communication and interaction. Earlier studies have shown that knowledge deficiencies in theseareas may prevent healthcare professionals from understanding their clients and their behaviors, particularly thosebehaviors considered to be challenging.However, staff working with persons with ID reported CB as a problem they could not always address in thedesired manner while performing their work duties. This predicament was shown to often generate stress, angerand powerlessness among staff, increasing the likelihood of burnout. Helping staff to better understand and bebetter prepared prior to meeting, communicating and interacting with persons with ID, especially concerningaddressing CB, could therefore help to establish and maintain a healthy work environment and sustainable workinglife.In this study, we investigated the impact of web-based training on the staff´s perception of the frequency andmanagement difficulties of CB among persons with ID in residential settings in Sweden. The training addressedthe topics ID and CB as well as communication and interaction and was offered to the staff working in theresidences. Since the basic assumption was that CB is a consequence of interrupted communication and interactionbetween staff and persons with ID, we hypothesized that by introducing web-based training focusing on ID andCB as well as communication and interaction, the frequency of CB and degree of management difficulty of CB indaily care would be reduced.Aim: To explore staff’s perceptions about CB among clients with ID in residential settings before and after a web -based training program, specifically addressing ID and CB as well as communication and interaction.Research questions1. Do staff report a lower frequency of CB among clients with ID in residential settings after the web -basedtraining?2. Do staff report a lower degree of management difficulty of CB among clients with ID in residential settings afterthe web-based training?

Methods: A within-subjects study design was applied in which the participants were exposed to the treatment –in this case, web-based training – and measurements were made using the survey instrument “Checklist ofChallenging Behavior” (CCB) before and after exposure to examine any potential changes that occurred.Cluster sampling was conducted whereby 20 residential facilities were included. All staff in those residences wereoffered web-based training and invited to participate in this study.A total of 212 participants accepted the invitation to the survey by filling in CCB and accordingly systematicallyrate the frequency of CB among the clients and the own difficulty in managing these behaviors as perceived byparticipating staff. The CCB includes 41 items related to topographies of aggressive and other CB divided alongthe dimensions of physical violence/aggressive behavior, property destruction, miscellaneous behavior and mentalillness. The CCB was developed by Harris and Humphreys, who assessed the instrument’s content validity andinter-rater reliability. The researchers concluded that the instrument was a reliable indicator of the presence orabsence of CB. All measurements were based on five-point scale.43First, descriptive analysis was performed to summarize the characteristics of the sample. Central measurementswere presented as the mean and dispersion by standard deviation. As the data were represented on an ordinal scale,the Wilcoxon signed-rank test was used to determine whether a lterations existed between the responses before andafter training concerning the frequency of CB and management difficulty of these behaviors.Considering the number of calculations performed, a significance value of p < 0.05 was established. In addition,p-values < 0.1 were interpreted as tendencies. In order to contribute to indications of practical significance, acorrelation coefficient r was calculated by converting the z-values, as described by Pautz and Olivier, of those subitems with significant values. According to the rule of thumb for interpretation of Cohen’s r: 0.1 = small effectsize, 0.3 = medium effect size and 0.5 = large effect size.

Results: The demographic description revealed that, of those who provided information about their job ty pe andlevel of education, approximately 87% worked as support assistants in the facilities, and most had completedsecondary education. The analysis showed that, after training, staff self-reported a significantly lower degree offrequency on the dimension of property destruction, on the sub-item “damaging others’ clothes, furniture, or otherobjects”. Similarly, a significant difference was revealed in the dimension of mental illness. In addition, regardingthe management difficulty of CB, the analysis revealed that, after training, staff self-reported a significantly lowerdegree of management difficulty on all sub-items on the dimension of property destruction. However, the effectsizes were considered small. Apart from that, the calculations also showed tendencies towards significance on anumbers of sub-items e.g biting, throwing things at people, breaking windows and absconding.

Discussions: The observed reduction in the frequency of CB after the web-based training may have been due toenhanced knowledge and understanding by staff of CB among their clients, which could have consequently ledthem to no longer consider these behaviors as challenging. In earlier research, it was found that the amount ofknowledge possessed by staff could act as a significa nt predictor of their behavioral responses to CB. Accordingly,it is reasonable to suspect that the reduced management difficulty of CB as perceived by staff may have been dueto their enhanced knowledge of such behaviors, which impacted their views and behavioral responses to CB.Considering the formal education the majority of the staff have and the complexity of the job within this sector, itwould be unreasonable to expect all of the staff to have the capability to perform all job duties without sufficientopportunities to expand their knowledge and improve their skills with the support of the relevant healthcareorganization. This aspect has been equally emphasized to promote a healthy and sustainable workplace from theview of Work-Integrated Learning.

Conclusion: Considering the complexity of meeting the needs of persons with ID, in addition to job -specificknowledge, collaboration with multi-professional teams is also recommended. As such, routinely training tosupport Work-Integrated Learning should be offered to all professionals involved in caring for individuals withintellectual disabilities to reinforce social sustainability in the sector.