1 - (SYM 22) Supporting Multidisciplinary Acute Care Staff on the Implementation and Maintenance of Positive Behavioral Interventions and Supports

Over the past two decades, there has been an increasing amount of research examining behavioral interventions within youth psychiatric inpatient setting. One such approach is Positive Behavioral Interventions & Supports (PBIS). PBIS was developed as a universal, school-wide prevention strategy (Bradshaw et al., 2008) that has been adapted for acute care settings (Reynolds et al., 2016). Within acute care settings, the implementation of PBIS has resulted in meaningful reductions in the use of restrictive interventions including the number of seclusion and restraint events, mean duration of events, percentage of patients placed in seclusion or restraint, the overall seclusion rate, and use of pro re nata (PRN) medications for agitation/aggression (Reynolds et al., 2016). One of the critical components for the success of PBIS is supporting staff. This talk will review key strategies to train staff and support fidelity over time including training; data monitoring and feedback loop; staff recognition; and an action committee comprising various unit staff members to monitor program fidelity and to resolve unit behavior management issues. The talk will focus on the development of an observation system to examine the ratio of positive to negative adult-to-child interactions and use of the reinforcement system as a key tool to assess impact of training and fidelity to approach. The ten-minute observations were conducted (N=335) at select times during the day (for example, at meals and community meetings) by doctoral-level psychologists. Post-intervention, staff members exceeded the goal of at least five positive interactions to one negative interaction with patients. During observations, staff provided on average 8.13±6.52 praising comments, .54±.97 corrective comments, and .22±.67 critical comments. Furthermore, staff members largely awarded stamps appropriately (on average 8.00±6.78 stamps given during the observation)—that is, contingent on behavior (6.62±5.97), with labeled praise (7.02±6.04), and within two seconds of identified behavior (7.12±6.16). Implementation of evidence-based practices in a pediatric inpatient psychiatric unit requires thoughtful engagement and ongoing support of staff. The described observation approach provides a means of producing evidence of intended behavior management skills and also provides an opportunity for feedback to staff about their strengths and identify potential areas of improvement.