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Bernstein AM, Clark SB, Pattishall AE, Morris CR, McCarter A, Muething CS, Pavlov AC, Chun T, Call NA. The Development and Acceptability of a Comprehensive Crisis Prevention Program for Implementation in Health Care Settings. J Am Psychiatr Nurses Assoc 2024; 30:424-433. [PMID: 35535388 DOI: 10.1177/10783903221093578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Behavioral crises are increasingly prevalent in health care settings. Existing programs, however, include procedures that lack adaptability, omit critical components, and deviate from clinical best-practice recommendations. Health care employees also continue to report lacking confidence for safely managing behavioral crises. AIMS We described the development and acceptability of a comprehensive crisis prevention program and its modification for a large pediatric health care system to help remediate the limitations of existing programs. METHOD Chi-square analyses evaluated the acceptability of the crisis prevention program pre- versus post-training and at 3- and 6-month follow-up times. For insignificant outcomes, logistical regressions identify whether responses differed between emergency-department and nonemergency-department employees. RESULTS Chi-square analyses were significant for 10 of 15 questions suggesting that employees were more confident in managing and communicating during behavioral crises post-training, and that this confidence was maintained. Logistic regressions found that emergency-department employees differed in some responses to the acceptability questionnaire than nonemergency-department employees over time. CONCLUSION The present crisis prevention program is adaptable to various settings and patients, and it is well received overall by employees. The safety of patients and employees is integral to the delivery of quality care and improving patient-provider relations.
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Affiliation(s)
- Alec M Bernstein
- Alec M. Bernstein, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Seth B Clark
- Seth B. Clark, MA, BCBA, Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Amy E Pattishall
- Amy E. Pattishall, MD, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R Morris
- Claudia R. Morris, MD, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrea McCarter
- Andrea McCarter, PhD, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Colin S Muething
- Colin S. Muething, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Alexis C Pavlov
- Alexis C. Pavlov, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Thomas Chun
- Thomas Chun, MPH, MD, Brown University, Providence, RI, USA
| | - Nathan A Call
- Nathan A. Call, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
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Romani PW, Schwien M, Boydstun D, Hays T, Lick J, Luehring MC, Richeson B. The Effect of Napping on the Function of Problem Behavior for One Child With an Acquired Brain Injury. Clin Case Stud 2022. [DOI: 10.1177/15346501221141491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many children experience sleep disruption in the form of difficulties falling asleep, staying asleep, or getting back to sleep. Children with acquired brain injuries (ABI) sometimes experience an exacerbation of these symptoms. Thus, researchers and practitioners alike need to identify creative assessment and treatment approaches to meet this population’s needs. The purpose of the current case study was to highlight one method for (a) determining a nap schedule and (b) evaluating the effect of fatigue on behavioral function for one child diagnosed with an ABI. We conducted a scatterplot analysis to identify periods in which problem behaviors occurred more or less often. These data informed when the child took naps. Afterward, the child participated in a functional analysis of problem behavior before a nap and again after a nap. Results showed both negative and positive reinforcement maintained problem behaviors before naps, while only positive reinforcement maintained problem behaviors after naps. Functional communication training (FCT) programs implemented to address escape, tangible, and attention functions before naps reduced problem behavior and increased communication. These data suggested that (a) motivating operations for problem behavior can differ depending on fatigue and (b) FCT is an effective intervention for problem behavior affected by fatigue. The current study provides an example of an assessment and treatment approach when biologic factors, like sleep, may influence problem behavior.
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Affiliation(s)
| | | | | | - Tara Hays
- Children’s Hospital Colorado, Aurora, CO, USA
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Ginsberg JS, Hoffmann RL, Lebet R, Gonzalez JZ. Behavioral Crisis Management: A Quality Improvement Pilot for Improving Teamwork in a Primary Care Pediatric Setting. J Pediatr Nurs 2021; 59:151-157. [PMID: 33892295 DOI: 10.1016/j.pedn.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Children with behavioral escalations in the primary care office may pose safety risks to themselves and others. Interprofessional teams utilizing crisis resource management (CRM) skills more successfully manage behavioral crises. The purpose of this quality improvement (QI) pilot project was to improve team performance during a behavioral crisis in pediatric primary care, as well as evaluate learner satisfaction with the curriculum. METHOD We implemented an evidence-based curriculum using simulation and didactic techniques in primary care offices within a pediatric network. Using a one group pre-post design, we evaluated roles, communication, and patient-centered care with the KidSIM Team Performance Scale. Utilizing a post intervention survey, learner feedback was elicited regarding learning environment, facilitators and barriers to learning, skill of facilitator, and usability and applicability of content. FINDINGS 101 interprofessional participants attended one of eight educational sessions. KidSIM Team Performance Scale results demonstrated statistically significant improved total team performance in a simulated behavioral crisis (Z = -2.52, p = 0.012). Post simulation evaluation demonstrated positive feedback about the program, content and facilitators. DISCUSSION This pilot QI project demonstrated that a curriculum using behavioral simulation scenarios and CRM principles can improve teamwork in an interprofessional primary care office. Additionally, participants overwhelmingly indicated satisfaction with the curriculum. APPLICATION TO PRACTICE Ensuring staff have the appropriate skills to manage behavioral health crises facilitates safer and more effective patient care, enhances patient-centered care and solidifies a positive staff approach in the pediatric ambulatory setting.
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Affiliation(s)
- Julie S Ginsberg
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Ruth Lebet
- Center for Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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