Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Reynolds, Elizabeth K; Grados, Marco A; Praglowski, Nancy; Hankinson, Jessica C; Parrish, Carisa; Ostrander, Rick
• Is Part Of: Journal of patient safety and risk management. Volume 24:Issue 2(2019)
• Page Start: 64
• Page End: 70
• Publication Date: 2019-04
• Subjects: Seclusion -- restraint -- youth -- psychiatric -- positive behavior; Medical jurisprudence -- Great Britain -- Periodicals; Medical personnel -- Malpractice -- Great Britain -- Periodicals; Risk management -- Great Britain -- Periodicals
• DOI: 10.1177/2516043518811758
• Languages: English
• ISSNs: 2516-0435

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 = 1.94) to 0.48 ( SD = 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.