Employing behavioral methods to improve the context of care in a public psychiatric hospital: Reducing hospital reliance on seclusion/restraint and psychotropic PRN medication

Abstract

Many behaviorally trained scientist-practitioners have noted the poor utilization of behavioral interventions in psychiatric treatment settings. However, few have applied their behavior change skills to improve the organizational systems that are failing. This study first reviews the additive impact of a three-phase organizational change program, grounded in behavioral science, to reduce seclusion/restraint reliance in a public psychiatric hospital. It then describes a variation of the procedure that was subsequently applied to the problem of psychotropic prn medication reliance, both within the hospital and to a specific ward that evinces relatively high reliance. Significant reductions were realized in reliance on these procedures for the management of difficult cases. The results supplement previous evidence of the value of behavioral methods for individualized and ward-level program interventions by demonstrating that they also hold value for identifying relevant organizational problems and for instigating, strengthening, and maintaining organizational system changes to improve the quality of care. The advantages of a grounding in behavioral science and intervention methods for the provision of health care in management of public systems, as well as guidelines for behavioral clinicians who wish to enhance their impact on such systems, are discussed.