3 10 20

3/10/20 1 2 This presentation will: Review planning and - PDF document

3/10/20 1 2 This presentation will: Review planning and implementation of Tier 3 and 1 PBS Implementing a PBS continuum in a adaptations in a large public sector psychiatric hospital. large public psychiatric hospital Describe the

  1. 3/10/20 1 2 This presentation will: • Review planning and implementation of Tier 3 and 1 PBS Implementing a PBS continuum in a adaptations in a large public sector psychiatric hospital. large public psychiatric hospital • Describe the unique challenges of designing and implementing a positive practice model in a public sector psychiatric setting, particularly related to staff Meredith Ronan, Psy.D. engagement and promoting culture change. 17th International APBS Conference Miami, Florida March 13, 2020 • Assess empirical and qualitative outcome data to gauge utility and value of PBS programming (Tier 1 and 3) in inpatient psychiatric facilities. 1 2 3 4 Worcester Recovery Center and Hospital Worcester State Hospital (WRCH) 3 4 5 6 Patient Population Primary Components of Clinical Care • Multidisciplinary treatment teams include • 2 Court evaluation Units and 8 Continuing Care psychiatry, psychology, social work, units (26 patients per unit) occupational therapy, peer specialists, and • Length of stay- average 200 days nursing. • Demographics: ~25% Women, 75% Men • Medication administration and education. ▫ Diverse population • Opportunities for individual and group • Diagnostically: therapeutic interventions including a variety of ▫ Severe and persistent mental illnesses evidence-based treatments. ▫ Complex co-morbidities (physical/medical/cognitive) 5 6 1

  2. 3/10/20 7 8 Overview and Rationale PBS Consultation Service • Challenging behavior is a significant concern in • Introduced September 2015 through a inpatient settings. collaboration of Clinical/Hospital • Associated with a range of negative outcomes: Administration and Psychology and Nursing Patients: Staff: departments. • Restrictive practices • Injury • Aim to reduce rates of aggression/violence and • Prolonged hospitalization • High stress occurrence of restraint and seclusions • Poor quality of life • Burnout • Focus on patients with the most challenging • Low job satisfaction behaviors and intensive treatment needs in the state/DMH system. 7 8 9 10 Program Development PBS Program Initiation • Year 1 (September 2015-August 2016): ▫ Developed PBS consultation program and began individual case intervention. • Initial efforts were heavily focused on: ▫ Developed collaborations with four continuing care units ▫ Getting buy-in from staff (i.e., nursing) • Year 2 (September 2016-August 2017): ▫ Established a postdoc program and served two more continuing care units ▫ Collecting behavioral data to inform decision-making • Year 3 (September 2017-August 2018): and PBS planning ▫ Expanded individual consultation/intervention services to two more units ▫ Working directly with patients to engage and model ▫ Began planning for Hospital-Wide Tier 1 (Primary Prevention). specific intervention strategies. • Year 4 (September 2018-August 2019): • Significantly divergent from implicit models of care, ▫ Ongoing maintenance of individual PBS caseload, including increased beliefs about psychopathology, and challenging consultation capacity. behavior. ▫ Continued planning and began implementation of Hospital-Wide PBS implementation. • Shift from viewing problem as originating within the • Year 5 (September 2019-present) person and treated at the individual level à ▫ Reduced caseload capacity due to loss of postdoctoral position and part-time recognizing and emphasizing the role of funding for psychologist. environment and context. ▫ Ongoing planning and implementation of Hospital-Wide PBS, including intensive training and support with nursing department. 9 10 11 12 Medical Psychologists Psychiatrists Providers DMH – Dirty Words Clinical Social Occupational Treatment Workers Therapists • Behavior Problem Team Nurse 1 st Shift Managers • Behavioral Willful Nurses 1 st Shift 2 nd Shift (4) • Behavior Plan Coercion MHWs Nurses (8-12) Direct (3-4) Administration PBS • Reinforcement Reward Care Consultant Staff 3 rd Shift • Consequence Punishment 2 nd Shift Psychologist Nurses 3 rd Shift MHWs • Positive Good (2-3) Nurse (8-10) MHWs Supervisors • Attention Problematic (6) Guardians Human (Family or Rights Patients Legal) Officers 11 12 2

  3. 3/10/20 13 14 Patient Demographics Patient Demographics • Numerous lifetime psychiatric hospitalizations • 45 patients served throughout 4 ½ years of service (15+), and some have been continuously • Age range: 16-66 institutionalized for 10 or more years. • Diverse representation of gender, race/ethnicities, • Have displayed behaviors that posed a high risk to staff and were described as having been and primary/preferred languages unsuccessfully managed at other settings/facilities. • Primary psychiatric diagnoses: • Many are the highest users of specialized staffing ▫ schizophrenia spectrum disorder statuses (e.g., 3:1, 2:1, 1:1, Constant Observation ▫ autism spectrum disorder (CO)). ▫ post-traumatic stress disorder ▫ 20% require some special status daily or at all times, ▫ borderline personality disorder ▫ 40% have been on status at some point in time or for ▫ developmental/intellectual disability partial hours of the day ▫ 40% have not typically required special staffing ▫ neuro-cognitive disorders (other than 15” checks). ▫ obsessive compulsive disorder 13 14 15 ASSESSMENT • Record review • History • Collateral (staff) Challenging Behaviors • Antecedents/Consequences interviews • Ecological factors • Patient interview • Functional analysis • Data collection/analysis • Primarily include aggressive behaviors (i.e., INTERVENTION verbal and/or physical attempts or actual assaults). ◆ System ◆ ◆ Individual ◆ ◆ Environment ◆ PROACTIVE REACTIVE § Family • 75% of the cases in the program have physical § Response § Facility § Skill development § Physical factors strategies § Community aggression as the primary target behavior. → Individual therapy § Interpersonal (reduce severity § State → Communication § Programmatic of behavior) → Coping skills • Self-injurious behaviors and intrusive behaviors § Staff approach have also been targets for intervention. IMPLEMENTATION § What needs to be done and who is responsible? § Training & supporting staff § Shifting traditional perceptions and responses to challenging behavior OUTCOMES Data-based Decision Making 15 16 Proactive Strategies Ecological/Environmental Strategies • Interventions designed to reduce triggers or antecedents to problematic • Goals: behaviors by making changes environment to better fit the person’s characteristics and needs. ▫ Improve the person’s overall quality of life • Challenging behavior often occurs because there is a mismatch ▫ Give the person more control over his or her life between needs and environment: ▫ Teach the person skills (e.g., communication, • Physical Factors: coping/tolerating distressing experiences) ▫ Setting, light, noise, crowding • Interpersonal Factors: ▫ Reduce the need for restrictive/reactive strategies ▫ Communication/culture • Includes : ▫ Social interactions ▫ Ecological/Environmental Strategies ▫ Clear and consistent expectations • Programmatic Factors: ▫ Positive Programming ▫ Choice, predictability and control ▫ Focused Support Strategies ▫ Activity Scheduling ▫ Instructional methods ( LaVigna and Willis, 2009) ( LaVigna and Willis, 2009) 17 18 3

Download Presentation
Download Policy: The content available on the website is offered to you 'AS IS' for your personal information and use only. It cannot be commercialized, licensed, or distributed on other websites without prior consent from the author. To download a presentation, simply click this link. If you encounter any difficulties during the download process, it's possible that the publisher has removed the file from their server.


More recommend