The St Andrew's Sexual Behaviour Assessment (SASBA): Development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment

Inappropriate sexual behaviour (ISB) as a sequela of neurological impairment is often overlooked in comparison to other challenging behaviours such as agitation and aggression, yet the impact on patients and carers can be equally significant and pervasive. Inconsistencies in terminology and lack of standardised measurement tools for ISB limit the degree to which such behaviour can be objectively and consistently identified, reported and managed within and between services. This paper proposes a new ISB scale, the St Andrew's Sexual Behaviour Assessment (SASBA) based on the Overt Aggression Scale - Modified for Neurorehabilitation (OAS-MNR: Alderman, Knight, Morgan, 1997). The validity and reliability of the SASBA for use with people who have both progressive neurological conditions and acquired brain injury admitted to in-patient services is explored. This scale allows continuous observations of four categories of ISB, each of which has four levels of severity, that were developed with reference to relevant literature (Johnson, Knight, Alderman, 2006). Statistical properties of the scale were obtained using written descriptions and video enactments of ISB generated by clinicians. Results indicate strong construct and content validity, and good inter-rater and test-retest reliability. Some preliminary field data are presented with 924 incidents of challenging behaviour captured by the OAS-MNR and SASBA over a 10-week period for 36 patients; 16.34% of incidents were sexual behaviour. Clinical uses of the scale and perceived concerns or benefits for staff are discussed.