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| Methods of Quantifying and Mitigating Severe Aggressive Outbursts in Inpatient and Emergency Department Settings |
| Sunday, May 26, 2019 |
| 6:00 PM–6:50 PM |
| Hyatt Regency West, Ballroom Level, Regency Ballroom D |
| Area: AUT/TBA; Domain: Applied Research |
| Chair: Seth B. Clark (Marcus Autism Center) |
| Discussant: Meagan K. Gregory (Kennedy Krieger Institute) |
| CE Instructor: Seth B. Clark, M.A. |
| Abstract: Behavioral inpatient units and hospital settings can often be associated with increased rates of severe aggressive behavior. Within these settings, it can also be difficult to manage aggressive outbursts and determine clinically significant reductions. This symposium will present the results of two studies that examined methods of quantifying and decreasing intense bursts of aggressive behavior. Bednar and Hausman examined the effectiveness of an individualized outburst severity score that quantified several unique dimensions of severe behavior (e.g., frequency of problem behavior, duration, number of staff required, staff rating of severity, and staff/patient injury). Clark, Call, Lomas Mevers, Scheithauer, and Muething sought to improve the quality of services provided to patients who are in behavior health care crisis and increase staff buy in by teaching emergency department (ED) staff basic strategies on how to prevent, identify, manage and de-escalate crisis behaviors. Together, these studies provide potential strategies of quantifying and improving the outcomes of individuals who engage in severe aggressive outbursts. Additionally, challenges associated with collecting data and training staff in these settings will be discussed. |
| Instruction Level: Basic |
| Keyword(s): aggressive outbursts, crisis management, measuring outcomes, staff training |
| Target Audience: Behavior Analysts and Clinicians |
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| A Method of Quantifying the Severity of Outbursts of High Intensity Problem Behavior |
| MOLLY K BEDNAR (Kennedy Krieger Institute), Nicole Lynn Hausman (Kennedy Krieger Institute; Johns Hopkins School of Medicine) |
| Abstract: Individuals with intellectual disabilities and autism spectrum disorder engage in severe problem behavior at rates disproportionately higher than their typically-developing peers (Newcomb and Hagopian, 2018). Some of these individuals engage in more episodic patterns of problem behavior which are infrequent, yet highly severe. The standard measure of clinical outcome is often percentage of reduction as compared to baseline levels. However, in a subset of the population who engage in episodic behavioral outbursts, relying on this measure may not be the most important indicator of treatment success. The purpose of the current study is to define and quantify relevant dimensions of problem behavior that occur in episodic outbursts to determine an effective clinical outcome measure. An individualized outburst severity score was used as a more appropriate outcome measure of treatment for these individuals. Data are collected across several dimensions including; frequency of problem behavior, duration, number of staff required, staff rating of severity, and staff/patient injury. Each dimension is scored on a scale of 1 (less intense) to 5 (more intense) in which each score is defined based what is clinically relevant for the individual patient. Results suggest a composite severity score could be an effective measure of clinical outcome. |
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| The Impact of Teaching Emergency Department Direct Care Staff Crisis Management Strategies |
| SETH B. CLARK (Marcus Autism Center), Nathan Call (Marcus Autism Center; Emory University School of Medicine), Joanna Lomas Mevers (Marcus Autism Center; Emory University School of Medicine), Mindy Christine Scheithauer (Marcus Autism Center; Emory University School of Medicine), Colin S. Muething (Marcus Autism Center; Emory University School of Medicine) |
| Abstract: Emergency departments (ED) and inpatient units can often be associated with stressors and triggers that may ultimately lead to increased agitation and crisis behaviors, such as aggression and disruption. EDs also frequently interact with patients who are currently in behavior health care crisis, further increasing the risk of agitation and aggression. This ultimately can result in difficulties providing medical care to these patients and ultimately an increased need for the use of restraint to safely manage behavior. The following study sought to examine if teaching ED staff basic strategies on how to prevent, identify, manage and de-escalate crisis behaviors can improve the quality of services provided to patients who are in behavior health care crisis, increase staff buy in, decrease the use of restraint, and decrease staff injuries. Over thirty ED staff completed behavioral skills training in these strategies and completed pre/post measures assessing their confidence in managing patients exhibiting aggressive behaviors, their overall feeling of safety and risk of injury, and their ability to communicate during crisis. Results demonstrated significant improvement on this measure following training. These outcomes are discussed in relation to next steps disseminating training on these topics to professionals outside of the field of behavior analysis. |
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