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| Current Research on Staff and Patient Behavior at the Kennedy Krieger Institute's Neurobehavioral Unit |
| Tuesday, October 8, 2013 |
| 11:00 AM–12:20 PM |
| Salon Celestun (Fiesta Americana) |
| Area: DDA/CSE; Domain: Applied Behavior Analysis |
| Chair: Ethan S. Long (Virginia Institute of Autism) |
| CE Instructor: Jennifer R. Zarcone, Ph.D. |
| Abstract: The Neurobehavioral Unit is conducting a variety of research projects on program evaluation, standards of clinical care, as well as the assessment and treatment of severe behavior disorders in children with a variety of disabilities. In this symposium we will provide an overview of the program as well as current research on staff behavior interventions, functional analysis and ethical considerations, medication and behavioral intervention plans. |
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| The Inpatient Neurobehavioral Unit |
| PATRICIA F. KURTZ (Kennedy Krieger Institute), Lynn G. Bowman (Kennedy Krieger Institute), Jennifer R. Zarcone (Kennedy Krieger Institute), Louis P. Hagopian (Kennedy Krieger Institute) |
| Abstract: The Neurobehavioral Unit Programs at Kennedy Krieger Institute specialize in the treatment of severe problem behavior displayed by individuals with intellectual and developmental disabilities. The inpatient Neurobehavioral Unit has been in existence for 30 years, and has served individuals from over 30 states. This presentation will describe the neurobehavioral continuum of care, and the interdisciplinary assessment and treatment approach of the Inpatient Neurobehavioral Unit. The behavior analytic approach to assessment and treatment of severe problem behavior will be described, and case examples will be presented. Finally, parent training, generalization of treatment gains, and treatment outcomes will be discussed. |
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| Increasing Staff Hand Washing in a Hospital Setting |
| LYNN G. BOWMAN (Kennedy Krieger Institute), Samantha Hardesty (Kennedy Krieger Institute), Melissa M. McIvor Shulleeta (Behavior Change, Inc), Louis P. Hagopian (Kennedy Krieger Institute), Sigurdur Oli Sigurdsson (University of Maryland, Baltimore County) |
| Abstract: Hand washing is the most important preventative measure for the reduction of contagious diseases; however, less than 40% of health care workers wash their hands prior to interacting with a patient (CDC, 2007). Staff training has been somewhat successful at increasing glove and hand sanitizer use within hospital settings, but no study has demonstrated maintenance of these skills (Stephens & Ludwig, 2005). The purpose of the current study was to increase compliance with hand washing and hand sanitizing in an inpatient hospital setting. Participants were 125 direct contact staff caring for children who engage in severe problem behavior. Annual in-services and standard hospital hygiene practices (e.g., signs) were present prior to the study. A critical antecedent analysis was conducted to identify stimulus conditions in which hand washing was likely to occur. Data were collected on the stimulus condition, sanitizer use and hand washing. During baseline, hand washing averaged 10.1% of opportunities. An antecedent-based intervention was ineffective in changing staff behavior; however the introduction of a reinforcement-based procedure was successful at increasing compliance for over 2 years, but only when data collectors associated with the lottery were present. Reliability data were collected on 22% of observations and averaged 97.2%. |
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| The Safety of Functional Analyses of Self-Injurious Behavior |
| SUNGWOO KAHNG (Kennedy Krieger Institute), Nicole Lynn Hausman (Kennedy Krieger Institute), Alyssa Fisher (Kennedy Krieger Institute), Jeanne M. Donaldson (Kennedy Krieger Institute), Jessica Cox (Kennedy Krieger Institute), Monica Lugo (Kennedy Krieger Institute), Katie Wiskow (The Kennedy Krieger Institute) |
| Abstract: Functional analysis is the most precise method of identifying the variables that maintain SIB, and its use may lead to more effective treatment. One criticism of the functional analysis of SIB is that it may unnecessarily expose individuals to a higher risk of injury. The purpose of this study was to determine if there were higher levels and severity of injury during the functional analysis versus outside of the functional analysis. A retrospective records review was conducted with 101 participants admitted to a specialized inpatient unit for the treatment of their SIB. The results showed that the injury rates were relatively low across all situations and that when injuries occurred, they were generally not severe. These findings suggest that the functional analysis of SIB is relatively safe. Given the treatment benefits of knowing the precise function SIB, functional analyses should be a standard part of a comprehensive treatment plan. |
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| Measuring the Complexity of Treatment using the Treatment Intensity Rating Form |
| JENNIFER R. ZARCONE (Kennedy Krieger Institute), Nicole Lynn Hausman (Kennedy Krieger Institute), Cara L. Phillips (The Kennedy Krieger Institute/Johns Hopkins School of Medicine), Louis P. Hagopian (Kennedy Krieger Institute) |
| Abstract: The purpose of the study was to develop a method for characterizing the complexity of behavioral and medical treatment plans for patients receiving services from the Neurobehavioral Unit. The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three subcategories: pharmacological interventions, behavior supports, and protective equipment. The TIRF could be use to characterize: 1) the intensity of our treatment plans for program evaluation purposes and 2) the level of supports and training caregivers will need when a child is discharged from the unit. Preliminary data with 26 randomly selected inpatient files, indicated that at discharge, these patients were taking more than 3 psychotropic medications and that even though they were at moderate dosages and had minor side effects the medications often required monitoring of therapeutic levels to evaluate efficacy. The most commonly prescribed medications were Ativan and Risperdal. Regarding behavior supports, the 26 patients often had over 6 proactive and reactive components in their behavior plans, and for many individuals with SIB, mechanical restraints were needed at least intermittently. For 31% of participants, we had a second rater independently score the same behavior plans and medical discharge summaries and found interrater reliability to be at 83%. |
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