“Setting Events” as Determinants of Staff Behaviour: An Exploratory Study

Abstract

One of the major problems facing behaviour therapy has been the relative lack of success in bringing about lasting change in complex environments. The difficulty in assessing and understanding these failures may well be due to an unnecessarily narrow view of change in terms of small units of behaviour and short time-scales. In contrast, if one takes a “setting events” perspective, this might generate more explanatory hypotheses by focusing on larger behavioural units and longer time-scales. This exploratory study adopted such a perspective in order to consider staff opinions about the maintenance and generalization of an innovative behavioural programme in psychiatric rehabilitation. The results of a structured interview with a small group (n = 11) of multidisciplinary staff indicated the potential value of this perspective: factors traditionally regarded as obstructing innovation (such as not enough time, staff or facilities) were not in fact seen as problematic. On the contrary, factors which were more readily manipulable (such as feedback, nursing officer support and in-service training) were regarded as facilitating planned change. The implications of these findings and this perspective for sustained organizational development are discussed.

Behavioral knowledge among direct care staff in an inpatient psychiatric setting

“…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).…”

“…Several observational studies have noted that nursing and aide staff in public psychiatric hospitals are typically poor behavioral managers (Burdett and Milne, 1985;Niemeier, 1983;Gelfand et al, 1967) and most behavioral interventions require considerable staff effort at the lowest levels of the nursing hierarchy. These personnel are often not inclined to treat patients, but, rather, to keep them from acting out and being a problem (Gardner and Cole, 1987;Boudewyns et al, 1986).…”

“…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).…”

“…Efforts at individualized behavioral plans and ward token economy programming were impeded by the lack of consistency in application by staff who often seemed unaware of, or unable to, implement the programs (Virginia Department of Planning and Budget, 1986). Several studies have highlighted the need for more adequate training of residential direct care staff in the principles of behavior management (Knowles and Landesman, 1986;Virginia Department of Planning and Budget, 1986;Burdett and Milne, 1985).…”

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

“…In a small, older, exploratory study 121 of the opinions of staff of inpatient rehabilitation wards, the factor that most influenced staff use of behaviour therapy was attendance at the training course (100%), followed by nursing officer and peer support (91%). Marlowe et al's 116 case report compared the experiences of two mental health inpatient units in separate hospitals in Florida, USA, that underwent a staff training programme to implement psychosocial rehabilitation.…”