Social‐learning Programs Facilitate an Increase in Adaptive Behavior in a Forensic Mental Hospital

The Alternative to Restraint and Seclusion State Incentive Grant was a national initiative to reduce restraint and seclusion use in psychiatric hospitals and community based mental health settings sponsored by the National Association of State Mental Health Program Directors. This initiative was implemented in a large public sector psychiatric hospital. It involved the use of a restraint and seclusion prevention project team and a Patient-Staff Steering Committee collaborating on violence prevention. It also entailed systematic data collection and case reviews, staff-training on trauma-sensitive care and other relevant topics, employee recognition, as well as the use of specific restraint prevention tools including sensory modulation, positive behavioral support plans, comfort rooms, Wellness Recovery Action Plans, modified restraint orders, and new debriefing protocols. Compared with a 4-year baseline period, a 4-year implementation phase showed a reduction in annual restraints hours by 89%, annual staff injuries by 18%, and annual Workmen’s Compensation medical costs by 24%. The findings illustrate the value of implementing systemic evidence-based practices to reduce restraint use, enhance the quality of care in tertiary care settings, and promote a new, patient-centered and recovery-oriented institutional culture.

Section: Innovations and Preliminary Findingsmentioning

confidence: 99%

Implementing a program to reduce restraint and seclusion utilization in a public-sector hospital: Clinical innovations, preliminary findings, and lessons learned.

Dike

Lamb-Pagone

Howe

et al. 2021

“…Another study examining the efficacy of teaching clients with signs of polydipsia how to manage fluid consumption through the use of social-learning procedures revealed that five clients demonstrated fewer daily fluctuations in weight and improvements in biomedical markers of polydipsia (Baldwin et al, 1992). A third study found improvements in the functioning of clients in the SLP who were followed for 1, 2, 3, and 4 years, with results revealing that these clients had meaningful and significant gains in their rates of appropriate behavior over time (Newbill et al, 2011). Similarly, another study investigating the combined effects of the SLP and clozapine found improvements in observed rates of appropriate behavior and decreases in inappropriate behavior for two groups of SMI clients prior to the introduction of clozapine for one of the groups (Menditto et al, 1996).…”

mentioning

confidence: 99%

Examination of a social-learning program implemented in a maximum-security state hospital setting.

Menditto¹,

Pardee²,

Peterson³

2022

Self Cite

The present study examines the extent to which clients with serious mental illnesses (SMI) enrolled in a social-learning program (SLP) within a maximum-security state hospital were able to achieve discharge to less restrictive settings without requiring a return to maximum security. Retrospective analyses were undertaken to examine several time periods of the SLP's operation within maximum security. From 1988 to 2019, 248 clients were discharged from the SLP. Only 20 were readmitted to maximum security, primarily for violence in less restrictive facilities. The proportion of clients who were discharged from one 19-bed ward offering the SLP differed significantly from the proportion of clients who were discharged from an identical 19-bed ward offering treatment as usual within maximum security from 1988 to 1995. The rate of readmission to maximum security was also significantly lower for clients treated on the SLP than for clients treated on other long-term treatment programs within maximum security from 2010 to 2019. Violence in a less restrictive facility was the most common reason for readmission, which typically occurred more than 1 year after discharge. The results of the present study demonstrate the SLP's success in discharging clients with SMI from a maximum-security state hospital. Impact StatementIn a maximum-security state hospital, clients with serious mental illnesses were more likely to be discharged from and less likely to be readmitted to a social-learning program when compared to treatment as usual and other forms of treatment.

“…Menditto and colleagues (1996) were among the first to utilize an applied behavioral analytic approach in inpatient clinical settings. Among populations of incarcerated men, it has been shown that adaptive behaviors can develop with the use of social learning programs consequently facilitating significant improvement in functioning over 4 years of intervention (Newbill et al, 2011). Unfortunately, the empirical base focused demonstrating the effectiveness of PBS plan in inpatients settings is otherwise limited.…”

mentioning

confidence: 99%

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

Hamlett

Carr

Hillbrand

2016

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