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BRTs & ABA IN THE HOSPITAL SETTING

  • Define what the Behavioral Response Team is & what its function is in the hospital setting.
  • Explore recent research on BRTs.
  • Introduce ABA therapy.
  • Complete an interactive simulation.
  • Provide ABA tips for working with patients that are on the autism spectrum or behaviorally complex.
  • Review 2 case studies.
  • Questions & Discussion

Objectives

BRT

Behavioral Response Team

Support hospital staff with behavioral "codes".

Prevent the use of security and restraints.

The Role of the BRT

Behavior Response Teams

Exist because hospital settings can trigger patients to become dysregulated.

Decrease stress, instill trust and maintain positive relationships between families and medical providers.

Research

An integrative Literature Review in the Journal of Nursing Administration reported that "[Response Teams] reduced security calls, restraint use, & staff injuries while improving staff knowledge and self-efficacy" (Choi et al, 2019).

A study in the Colorado Journal of Psychiatry and Psychology stated that through the use of BRTs "data demonstrated a reduction in the use of restraints over time" (Nicoli et al, 2019).

In the STT International Journal on Evidence-Based Nursing in 2017 Authors explored that "An evidence-based BERT (Behavioral Emergency Response Team) can improve patient and staff safety by decreasing assaults and injuries, restraint use, and security calls" (Zicko et al, 2017).

In a 2020 pilot study published in the Autism Research Journal, authors reported that "incorporating specialized ABA-based intervention during hospitalization may be feasible and well accepted by clinicians and families" (Sanders et al, 2020).

ABA (Applied Behavioral Analysis)

ABA

is a science that involves applying interventions to change socially significant behavior

How behavior works.

ABA

How behavior is affected by the environment.

Helps us to understand

Applies our understanding of how behavior works to real situations.

THE GOAL: Increase desired behavior and decreased behaviors that are harmful or affect learning.

How learning takes place.

Provided in different settings: home, school &

in the community.

The plan is unique and tailored to the patient.

Assess & Plan

The plan teaches skills that are useful in every day life.

Can involve 1-1 teaching or group instruction.

How does

it work?

A Board Certified Behavior Analyst assesses a patient, determines their needs and develops a plan for behavior modification.

Positive Reinforcement

https://www.youtube.com/watch?reload=9&v=JA96Fba-WHk&feature=emb_title

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat the behavior. Over time, this encourages positive behavior.

What strategy does ABA therapy use?

Reduce external stimuli.

First this, then that.

Be a thermostat, not a thermometer.

Behavior momentum:

Start with easy tasks that are doable and work up to harder tasks!

SIM & TIPS

Recruit the parents!

Learn basic sign language.

Use a visual story.

Finally, continue to learn...

https://www.youtube.com/watch?v=dKCdV20zLMs

Case Studies & Discussion

Case 1: A nurse's story

1. Impressions?

2. What was helpful? What was not?

3. What are opportunities for staff moving forward?

4. How might have this story turned out if a BRT was not available?

Lets discuss.

Case Study #2

A family's struggle

https://www.youtube.com/watch?v=-4drTQsSLXg

What challenges can you see for patient care?

What would you do as a nurse?

How do you think the parents feel?

How would you go about supporting this family during the admission process?

What would you do to make the patient's experience easier moving forward? (Think about report/ chart)

References

Applied Behavioral Analysis Program. (2020, September 10). 5 Job Settings for Applied Behavior Analysts. Applied Behavior Analysis Programs Guide. https://www.appliedbehavioranalysisprograms.com/lists/5-job-settings-for-applied-behavior-analysts/.

Autism Speaks. (2020). Autism Response Team (ART). Autism Speaks. https://www.autismspeaks.org/autism-response-team-art.

Choi, K. R., Omery, A. K., & Watkins, A. M. (2019). An Integrative Literature Review of Psychiatric Rapid Response Teams and Their Implementation for De-escalating Behavioral Crises in Nonpsychiatric Hospital Settings. JONA: The Journal of Nursing Administration, 49(6), 297–302. https://doi.org/10.1097/nna.0000000000000756

McNeil, C. B., Quetsch, L. B., & Anderson, C. M. (2019). Handbook of Parent-Child Interaction Therapy for Children on the Autism Spectrum. Springer International Publishing.

Nicoli, D., Carubia, B., & Penner, A. (2019). Behavioral Assistance Response Team Effectively Provides De-Escalation and Aggression Management at Large Tertiary Children’s Hospital. Colorado Journal of Psychiatry and Psychology, 3(1), 5–9.

Sanders, K., Staubitz, J., Juárez, A. P., Marler, S., Browning, W., Mcdonnell, E., … Warren, Z. (2020). Addressing Challenging Behavior During Hospitalizations for Children with Autism: A Pilot Applied Behavior Analysis Randomized Controlled Trial. Autism Research, 13(7), 1072–1078. https://doi.org/10.1002/aur.2308

Zicko, C. J. M., Schroeder, L. R. A., Byers, C. W. S., Taylor, L. A. M., & Spence, C. D. L. (2017). Behavioral Emergency Response Team: Implementation Improves Patient Safety, Staff Safety, and Staff Collaboration. Worldviews on Evidence-Based Nursing, 14(5), 377–384. https://doi.org/10.1111/wvn.12225

https://www.youtube.com/watch?reload=9&v=JA96Fba-WHk&feature=emb_title

https://www.youtube.com/watch?v=DgDR_gYk_a8

https://www.youtube.com/watch?v=dKCdV20zLMs

https://www.youtube.com/watch?v=-4drTQsSLXg

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