Maladaptive behaviors, such as aggressive and disruptive behaviors, are a significant risk factor for maintaining community placement by individuals with intellectual disabilities. When experienced researchers provide training to individuals with intellectual disabilities on a mindfulness-based strategy, Meditation on the Soles of the Feet, the individuals are able to effectively self-manage their maladaptive behaviors. We investigated whether similar effectiveness would be found if community-based therapists provided the training to similar individuals living in the community. Three adults with mild intellectual disabilities and mental illness living in the community were taught by a community-based therapist to use this strategy to control maladaptive behaviors that included verbal aggression, disruptive behavior and physical aggression. They were taught to shift the focus of their attention from the negative emotions that triggered their maladaptive behavior to a neutral stimulus, the soles of their feet. All three individuals were able to reduce their maladaptive behaviors to near-zero levels and maintain their community placement that they had been at risk for losing, due to their maladaptive behavior. Subjective measures of various psychological symptoms showed a reduction in two of the individuals. Our study suggests that the demonstrated effectiveness of Meditation on the Soles of the Feet can be achieved by a community-based therapist.Keywords Maladaptive behavior Á Meditation on the soles of the feet Á Community placement Á Verbal and physical aggression Á Disruptive behavior Á Research to practice

Despite demonstrations of the utility and cost effectiveness of behavioral programming, such techniques are not commonly employed in psychiatric inpatient settings. Several explanations for this have been proposed, including inadequate levels of training and competence in behavioral programming among prevalent treatment staff. This study employed a multiple choice inventory to assess behavioral knowledge among subjects representing several direct care disciplines commonly found in inpatient psychiatric settings. The results support assertions of relatively low levels of behavioral knowledge among disciplines that are most prevalent in such settings. The implications of these results for initiatives to enhance behavioral knowledge and skills are discussed.The high level of demand for public services for chronic psychiatric patients has exerted pressure on public sector providers to devise treatments that are cost effective. Therapeutic approaches that are behavioral in orientation have been demonstrated to be cost effective for schizophrenics and other severely disturbed psychiatric populations, in both inpatient (Paul and Lentz, 1977) and outpatient (Liberman, et al., 1987) settings. Paul and Lentz (1977), for example, concluded that a behavioral token economy is the treatment of choice for chronic psychiatric inpatients when compared to active 'milieu' treatment programs or the medication/custodial care routine commonly provided to these patients.Despite demonstrations of the utility and cost effectiveness of behavioral programming in psychiatric settings, these techniques have not been widely adopted by practitioners in the field (Liberman et af., Bellack, 1986;Burdett and Milne, 1985;Moss, 1983). In a survey of 152 Veterans Administration Medical Centers, for example, only 20 reported having a behavioral training unit of any kind (Boudewyns et al., 1986). In a recent study of staff behavior in public inpatient psychiatric facilities within the State of Virginia, the observers concluded that ward environments reinforced passive institutionalized behavior, and, in some cases, actually promoted behavioral management problems. Treat-008&558 I /90/020095-09$05.00

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While behavioral methods have been demonstrated to be useful for treating problems associated with severe mental illness, they are seldom employed in inpatient psychiatric settings. This is partly due to a lack of knowledge and skill among direct care staff members. This manuscript outlines the development and evaluation of a training program to increase the knowledge and skill of direct care staff in the application of behavioral methods in a public psychiatric hospital. This project involved direct care staff members in program development, focused on the practical application of behavioral methods to ward situations, and employed pre-post measures to provide participants with performance feedback. Some evaluative data for this program are preseted.