Overview:
What is the cause of a behavior? Why do we do the things we do? We can ponder on questions like this for our own personal interest, but for those responsible for the care of patients with serious mental disorders and behavioral challenges, the question becomes much more pertinent. When dealing with challenging behaviors in a psychiatric facility (or other settings), we as clinicians are tasked with finding a way to: 1) identify the problem behavior; 2) have a hypothesis of the function of the behavior; 3) implement a plan that will reinforce a replacement behavior that will serve as incompatible or as an alternative to the identified problem.
Each of these three steps can be a challenge and an opportunity to make progress in a patient's care. To add to the complexity of this situation, the inpatient hospital setting adds its own set of circumstances that may impede progress in behavioral management of a patient.
As a behavior clinician in a state hospital system, for over thirteen years, I have seen the process of behavior planning in the state hospital fail and succeed in spectacular, and often surprising, ways. The function of a behavior can be identified using several different methods.
A process can be put in place to identify a function by observation and other assessments. Once the function is determined, then the behavior plan is to be based on that function. In one case, a patient in a state hospital refused to leave his living area. He would only venture a few feet beyond his door. If, in this case, the function of the behavior was hypothesized to be escape (from a stimulus), then the behavior plan could develop a replacement behavior that is not conducive with this refusal to leave his living area.
The patient is enticed with a snack for attending so much time in a group just down the hall. After that, the requirements are increased, but with each time the patient may leave the group setting after a certain time has elapsed and receive his treat. To refuse to attend and attend are diametrically opposed. You cannot do both. By reinforcing the opposite response, this patient was learning to tolerate this uncomfortable environment.
In another case, one patient could not get through a competency to stand trial restoration class without interrupting others or being a general disruption. In that case, an egg timer, fake money and the earning of time to look at family pictures and spend time with staff become beneficial to developing a plan so he could stay in a group and ultimately be found competent and leave the hospital.
I have worked in the community as well. In a small "waiver" home one young lady was able to earn hair appointments and special events out of the house by completing household chores and other daily routines. Her behavioral improvement, and those of other patients, could be graphed in simple ways to display to treatment teams and guardians to explain what changes are occurring with the patient.
In each of these cases, the function led to the development of a plan tailored for that patient. Once the target has been identified, and the behavior plan developed, then what is put in place is a system of making sure each part of the plan is implemented and done correctly. Treatment fidelity is used to establish how each part of the plan has been successfully completed.
If you have challenging behaviors in your inpatient, or community, setting I recommend attending this webinar. One does not change his or her life and then change behavior. The behavior changes come first to make a changed life. To treat those patients who need the most care, we use a process made to suit the person we are trying to assist.
Why should you Attend: Throughout the country the inpatient hospital setting has changed over the many years. After deinstitutionalization movements and funding cuts for large institutions, many of the state hospitals which once housed two-thousand or more patients have had a significant reduction in size. The remaining patient population remained as there were not services available to meet their needs and their own diagnoses and behavioral problems made them difficult to place.
The forensic and high security psychiatric patients have been found to be especially difficult to transition on from inpatient care, and the result has been greater concentrations of such patient populations in the remaining state facilities.
The state hospitals may have been in place for many years, but the patient populations have changed over time. These changes have created new challenges that may not be amenable to calming environments, routine activities, sets or standard rules or medication adjustments. It is true that such methods may have their place and can be put to good use for many individuals, but some of the more challenging patient situations may receive benefit from quality behavior support plans based on functional assessment.
If the client/patient population you work with require behavior management, and previous methods have not proven successful, an examination of the patient's behavior (not just their diagnosis) and the proper determination of a behavior's function (not simply "cause") may be what is needed for the safety and well-being of those in the hospital setting.
This webinar will focus on identifying the function of severe problems behaviors and the development of an appropriate plan. In addition, this discussion will address the pitfalls of working in an inpatient environment where there may be procedural impediments to behavior interventions or resistance to attempting methods not well received by co-workers and/or administrators of a hospital setting
Areas Covered in the Session:
What is function in terms of understanding behavior?
Why is function so important in the development of a behavior support plan?
How is behavior support plan development in an inpatient facility different from other settings?
Components of the Behavior Support Plan
Behavioral Definition
Behavioral Measurement
Functional Behavioral Assessment
Reliability
Intervention
Experimental Design
Maintenance and Generalization
Individual Cases
Interruptions in the Classroom
Origami Artwork for Reading a Joke
Aggression Everyday
Other Scenarios
What is the cause of a behavior? Why do we do the things we do? We can ponder on questions like this for our own personal interest, but for those responsible for the care of patients with serious mental disorders and behavioral challenges, the question becomes much more pertinent. When dealing with challenging behaviors in a psychiatric facility (or other settings), we as clinicians are tasked with finding a way to: 1) identify the problem behavior; 2) have a hypothesis of the function of the behavior; 3) implement a plan that will reinforce a replacement behavior that will serve as incompatible or as an alternative to the identified problem.
Each of these three steps can be a challenge and an opportunity to make progress in a patient's care. To add to the complexity of this situation, the inpatient hospital setting adds its own set of circumstances that may impede progress in behavioral management of a patient.
As a behavior clinician in a state hospital system, for over thirteen years, I have seen the process of behavior planning in the state hospital fail and succeed in spectacular, and often surprising, ways. The function of a behavior can be identified using several different methods.
A process can be put in place to identify a function by observation and other assessments. Once the function is determined, then the behavior plan is to be based on that function. In one case, a patient in a state hospital refused to leave his living area. He would only venture a few feet beyond his door. If, in this case, the function of the behavior was hypothesized to be escape (from a stimulus), then the behavior plan could develop a replacement behavior that is not conducive with this refusal to leave his living area.
The patient is enticed with a snack for attending so much time in a group just down the hall. After that, the requirements are increased, but with each time the patient may leave the group setting after a certain time has elapsed and receive his treat. To refuse to attend and attend are diametrically opposed. You cannot do both. By reinforcing the opposite response, this patient was learning to tolerate this uncomfortable environment.
In another case, one patient could not get through a competency to stand trial restoration class without interrupting others or being a general disruption. In that case, an egg timer, fake money and the earning of time to look at family pictures and spend time with staff become beneficial to developing a plan so he could stay in a group and ultimately be found competent and leave the hospital.
I have worked in the community as well. In a small "waiver" home one young lady was able to earn hair appointments and special events out of the house by completing household chores and other daily routines. Her behavioral improvement, and those of other patients, could be graphed in simple ways to display to treatment teams and guardians to explain what changes are occurring with the patient.
In each of these cases, the function led to the development of a plan tailored for that patient. Once the target has been identified, and the behavior plan developed, then what is put in place is a system of making sure each part of the plan is implemented and done correctly. Treatment fidelity is used to establish how each part of the plan has been successfully completed.
If you have challenging behaviors in your inpatient, or community, setting I recommend attending this webinar. One does not change his or her life and then change behavior. The behavior changes come first to make a changed life. To treat those patients who need the most care, we use a process made to suit the person we are trying to assist.
Why should you Attend: Throughout the country the inpatient hospital setting has changed over the many years. After deinstitutionalization movements and funding cuts for large institutions, many of the state hospitals which once housed two-thousand or more patients have had a significant reduction in size. The remaining patient population remained as there were not services available to meet their needs and their own diagnoses and behavioral problems made them difficult to place.
The forensic and high security psychiatric patients have been found to be especially difficult to transition on from inpatient care, and the result has been greater concentrations of such patient populations in the remaining state facilities.
The state hospitals may have been in place for many years, but the patient populations have changed over time. These changes have created new challenges that may not be amenable to calming environments, routine activities, sets or standard rules or medication adjustments. It is true that such methods may have their place and can be put to good use for many individuals, but some of the more challenging patient situations may receive benefit from quality behavior support plans based on functional assessment.
If the client/patient population you work with require behavior management, and previous methods have not proven successful, an examination of the patient's behavior (not just their diagnosis) and the proper determination of a behavior's function (not simply "cause") may be what is needed for the safety and well-being of those in the hospital setting.
This webinar will focus on identifying the function of severe problems behaviors and the development of an appropriate plan. In addition, this discussion will address the pitfalls of working in an inpatient environment where there may be procedural impediments to behavior interventions or resistance to attempting methods not well received by co-workers and/or administrators of a hospital setting
Areas Covered in the Session:
What is function in terms of understanding behavior?
Why is function so important in the development of a behavior support plan?
How is behavior support plan development in an inpatient facility different from other settings?
Components of the Behavior Support Plan
Behavioral Definition
Behavioral Measurement
Functional Behavioral Assessment
Reliability
Intervention
Experimental Design
Maintenance and Generalization
Individual Cases
Interruptions in the Classroom
Origami Artwork for Reading a Joke
Aggression Everyday
Other Scenarios
Speakers
Timothy J. Templin,
Who Should Attend
- BAs
- MA
- PHDs
- JDs
- Others who are Interested in Psychology, Sociology and other Fields will Benefit from the Information Provided
