Positive behavioral support planning in the inpatient treatment of severe disruptive behaviors: A description of service features.

Abstract

Positive behavior support (PBS) plans are increasingly used on inpatient units to assess and treat serious and dangerous behaviors displayed by patients with serious psychiatric impairment. A contemporary extension of traditional applied behavior analytic procedures, PBS plans integrate theories from several domains with perspectives on community psychology, positive psychology, and recovery-oriented care. Because there is little evidence to suggest that more invasive, punitive disciplinary strategies lead to long-term positive behavioral change (Parkes, 1996), PBS plans have emerged as an alternative to the use of seclusion and restraint or other forms of restrictive measures typically used on inpatient psychiatric units (Hammer et al., 2011). Moreover, PBS plans are a preferred method of intervention because more invasive interventions often cause more harm than good to all involved (Elliott et al., 2005). This article seeks to provide an integrated framework for the development of positive behavior support plans in inpatient psychiatric settings. In addition to explicating the philosophy and core elements of PBS plans, this work includes discussion of the didactic and pragmatic aspects of training clinical staff in inpatient mental health settings. A case vignette is included for illustration and to highlight the use of PBS plans as a mechanism for helping patients transition to less restrictive settings. This work will add to the scant literature examining the use of positive behavioral support plans in inpatient psychiatric settings. (PsycINFO Database Record

A pilot study: Positive behavioral support assessment and intervention for individuals with serious mental illness and criminal justice involvement.

“…Relatedly, the CJ system typically has coercive and punitive elements such as mandated treatment, probation, parole, rule violations, solitary confinement, etc. ; measures that are fundamentally at odds with every element of PBS (Hamlett et al, 2016). Additionally, such coercive interventions can trigger problematic behavior itself.…”

“…Though there has been a wealth of positive outcomes demonstrated in school settings (Farkas et al, 2012; Sugai & Simonsen, 2012), it is only more recently in which there is an increasing focus on the efficacy of using PBS with adults with SMI (Carr et al, 2021; Hamlett et al, 2016). Furthermore, there has been a dearth of literature focusing on using PBS for adults with SMI within an inpatient setting who interface with the CJ system.…”

“…PBS is an approach that is for use with individuals who engage in disruptive behaviors which in the PBS terminology are labelled behaviors of concern (BOC; as noted previously). These include verbal and physical aggression, suicidal or nonsuicidal self-injurious behaviors, personal hygiene concerns, safety issues, or other challenges related to self-care or grave disability (Hamlett et al, 2016). Though these behaviors may seem to fit in distinct categories, each of these concerns always must be evaluated in an individualized, person-centered manner.…”

Psychologists as educators: Creating change in community mental health.

“…Working in an outpatient wraparound setting, psychologists can play an important role in training social workers, psychiatrists, occupational therapists, residential staff members, and employment specialists on evidence-based trauma treatments. Additionally, psychologists can support mental health and residential staff members in understanding environmental factors that might be associated with increased behavioral difficulty, and how to modify environments to avoid dysregulation via interventions such as positive behavioral support implemented by the entire treatment team (Hamlett, Carr, & Hillbrand, 2016). Trauma informed care includes attention to developing an understanding of the impact of trauma on all staff members, both personally and in their work (Fallot & Harris, 2006).…”

Expanding traditional paradigms: An integrative approach to the psychotherapeutic treatment of psychosis.

“…Due to our own awareness of the value of integration, we now treat the experience of psychosis with an integrated psychodynamic and cognitive-behavioral approach, with a recovery-oriented care foundation (Hamlett, Carr, & Hillbrand, 2016). A CBT-P approach provides a focus on mitigating the impact of symptoms by providing interventions that can increase coping and provide tools to regain a grasp on reality, as well as increased competence and management of psychotic symptoms (Kingdon & Turkington, 2005).…”