Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program

Abstract

Objective: Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method: This naturalistic, prospective study covered a 26-month period and utilized a pre-post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results: With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 (SD ¼ 1.94) to 0.48 (SD ¼ 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/ aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions: This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.

Reducing aggression in psychiatric wards using Safewards—A Polish study

“…Recently, researchers found a similar reduction in aggressive behavior among patients in a program for youth in psychiatric treatment when using positive, proactive strategies. 28 Other researchers have also suggested more patient/ nurse interaction as a viable strategy for reducing violence on the ward. 29 Despite the frequency of mechanical restraints decreasing, the length of time in restraints did not change.…”

“…In previous research in Australia, patients reported feeling “more connected” with the staff after Safewards was implemented, 27 and that appeared to be the case here. Recently, researchers found a similar reduction in aggressive behavior among patients in a program for youth in psychiatric treatment when using positive, proactive strategies 28 . Other researchers have also suggested more patient/nurse interaction as a viable strategy for reducing violence on the ward 29 …”

Child inpatient treatment: Moving it out of the shadows

“…There continues to be a good deal of focus on restraint reduction in child treatment, which is, of course, an important topic. And from these efforts come interesting interventions, such as a recent report on the use of Positive Behavior and Interventions Supports to reduce aggression and acting out (Reynolds et al, ). But in addition to translational work, there needs to be continued recognition and research into how the structure of care reduces aggressive incidents and nurses' roles in implementing the systems that build safe milieus (Magnowski & Cleveland, ).…”

Bridging the evidence-implementation gap: The 4th Global Ministerial Patient Safety Summit 2019, Jeddah

“…Although the study design used a prepost design, a strength of the paper was a detailed description of the intervention. 11 Smith and colleagues describe lessons learned in implementing Communication and Optimal Resolution (CANDOR), a comprehensive approach to disclosure of adverse events that includes resolution with patients and families. Their description of barriers encountered and steps taken to overcome those barriers is exemplary.…”

“…Although the study design used a pre–post design, a strength of the paper was a detailed description of the intervention. 11…”