Behavior Support Plans Research Articles

Training school psychologists to conduct culturally informed Functional Behavior Assessment interviews.

Exclusionary discipline is a racialized mechanism through which schools systematically remove racially and ethnically minoritized youth from the learning environment. Although the development of Functional Behavior Assessments (FBAs) and linked behavior support plans have been identified as an alternative practice, school psychologists often do not ask questions about the cultural and contextual factors that may influence students' behavior during FBA interviews. Therefore, training is warranted. Unfortunately, staff often have limited time and resources to devote to professional development; therefore, it is critical to ensure that training procedures that require more time offer better outcomes than those that require fewer resources. The present study compared the effectiveness of high intensity training (e.g., behavioral skills training) versus a low intensity training procedure (e.g., self-training) procedures on school psychologists' ability to facilitate simulated FBA interviews grounded in cultural humility with caregivers before and after exposure to one of two training conditions. Findings from regression analyses indicated that self-training adequately prepared school psychologists to adhere to the questions on the protocol, however, behavioral skills training improved the quality of interview delivery. Implications for future research and training are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementing culturally responsive and trauma‐informed practices with checklists and goal setting

AbstractWe discuss the use of two empirically validated behavior‐change methods—checklists and goal setting—and designed a checklist to assist behavior analysts in improving their behavioral services to be more culturally responsive and trauma informed. We also present pilot data evaluating the use of the checklist and goal setting on the inclusion of culturally responsive and trauma‐informed practices in behavior support plans designed for students in a public school. The training package was effective for both participants, and the participants' weekly goals corresponded to the observed changes in their behavior plans. Moreover, both participants strongly agreed that the checklist was valuable and easy to use and reported increases in their perceived abilities to implement culturally responsive and trauma‐informed practices posttraining.

Integrating behavioral, psychodynamic, recovery-oriented, and trauma-informed principles to decrease aggressive behavior in inpatient care.

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Ikigai framework: Supporting meaning in life

AbstractThis article describes the elements of a support framework based on the Japanese concept Ikigai, “that which gives your life meaning and purpose.” The basic assumption is that understanding and attaining life meaning and purpose are both the main goal and the main pathway to achieving optimal quality of life. The Ikigai framework recognizes the characteristics of people with disabilities—both their capabilities and their limitations—and contends that these need to match expectations for autonomy and choice making, but always supported and enhanced by lifelong learning. The three main pillars of the framework (environment, skills, and approaches) offer an outline for effective support planning that reduces the need for behavior support plans and enhances opportunities to develop life meaning and thus optimal quality of life.

Exploring The Impact of Positive Behaviour Support Plans on Adult Acute Mental Health Staff Practice

IntroductionThere is a national movement to reduce restrictive interventions due to the harm and distress they can cause which has been reflected in NHS trust policies and practices. NHS trust policies state that all in-patients who may require restrictive interventions must have a Positive Behaviour Support Plan (PBSP) based on a functional analysis of what drives and triggers their behaviour. A PBSP is intended to facilitate understanding and help manage behaviours that challenge by teaching new skills and ways to communicate a person’s needs. Previous research on the use of PBSPs on adult acute mental health wards is limited but research on PICU wards has shown PBSPs have not been implemented into mental health care as intended.Objectives Trust policies identify that PBSPs should be implemented to reduce the use of restrictive interventions. However, it is unknown whether PBSPs are being used as part of routine practice on the acute mental health ward. The degree to which staff are aware of patients PBSPs and how they use them to guide their practice is unclear. The service evaluation aims to understand the perspectives, attitudes, and experiences of staff who are responsible for using and implementing PBSPs on the ward. The evaluation aims to investigate how PBSP informs practice and to identify the barriers and facilitators to implementing PBSPs on the ward.MethodsA volunteer sample of clinical staff members (including Doctors, Nurses, Psychotherapists, Occupational Therapists, and Clinical Support Workers) who are responsible for implementing PBSPs on an acute mental health ward in the East of England took part in a focus group which lasted up to an hour. There were four focus groups with between two and four participants per group. A total of thirteen staff members participated in the focus groups. The focus groups lasted up to one hour and were guided by a topic guide. Two members of the project team facilitated the group. Focus groups were audio recorded.ResultsThematic synthesis will be the overarching approach used to synthesise the qualitative data from the focus groups. The audio recordings will be transcribed. Analysis will be conducted on a within-case basis prior to cross-case analysis aimed to identify common themes. Two evaluators will work together to code, analyse, and synthesise the extracted data.ConclusionsBased on the results, training may be developed to improve the understanding and implementation of the PBSPs on the ward. The findings may also result in changes to the way PBSPs are used. The results will be presented to the trust chief executives and used to inform how to best support individuals who may be at risk of requiring restrictive interventions.Disclosure of InterestNone Declared

Non-pharmacological prescribing for behaviour that challenges in dementia: An evaluation of 12 months of outcome data

BackgroundNon-pharmacological interventions are recommended as a first line treatment for the management of Behaviour that Challenges in Dementia (BtC). For the past decade, The Durham and Darlington Care Home Liaison (CHL) Hub have developed Behaviour Support Plans (BSPs), providing guidance on staff approaches and recommending specific, individualised, non-pharmacological interventions. Until recently, it was left to residents’ families to pay for and provide any items recommended. Clinicians knew what interventions could help, but they could not prescribe them. The CHL Hub was awarded non-recurrent funding in 2021 to prescribe a range of non-pharmacological interventions. This evaluation presents 12 months of routine outcome data for residents receiving such interventions.MethodProxy-rated measures of behaviour that challenges (Challenging Behaviour Scale, CBS, Moniz-Cook et al., 2001) and Quality of Life in Dementia Scale (QUALID, Weiner et al., 2000) were completed as part of routine care pre and post non-pharmacological intervention. Qualitative feedback .from care home staff and families of residents receiving non-pharmacological interventions was collected via telephone interview.ResultsResults show a significant difference between pre and post intervention CBS (z=1.28, p<.01) and QUALID scores (z=1.03, p<.01), with large effect sizes (r=.82, CI [.74-.87] and r=.67, CI [.5-.81], respectively).ConclusionCare home residents showed reduced BtC and improved quality of life following the introduction of non-pharmacological interventions as part of BSPs. Recommendations are discussed.

Restrictive practices in community services for people with intellectual disabilities at risk of behaviours that challenge: insights and omissions of the Disability Royal Commission

People with intellectual disabilities commonly experience violent, abusive, and restrictive contexts, particularly those who are at risk of behaviours that challenge, behaviours that often are a sign of trauma, fear, pain, and loss of power. For example, the use of physical restraint and psychotropic medication to manage behaviours labelled as challenging is prevalent in services for people with intellectual disabilities, and has a negative impact on their wellbeing and quality of life. The Australian Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability has recommended a reduction in the use of restrictive practices, and that they only be used as a last resort. However, there is a risk that a narrow focus on behaviours labelled as challenging and their management through legislation, procedures, and authorisation by writing behavioural support plans fails to properly address the concerns of people with intellectual disabilities at risk of behaviours that challenge. There might not be enough incentive for the system-wide change required to properly meet the needs of this specific group. The closure of group homes, as recommended by the Commission, is appealing, given that abusive and restrictive practices are repeatedly uncovered in these settings. However, this might add to the precarious situation unless significant social change is made. Instead, perhaps more feasible, a plan to enable group homes become truly a home, safe and with highly skilled support available, should be developed. A framework based on the concept of capable environments might aid in this endeavour.

Examining treatment integrity in conjoint behavioral consultation in middle schools: A mixed methods study.

Family-school partnership interventions can effectively address behavioral concerns in students (T. E. Smith et al., 2020). However, little is known about factors impacting the successful delivery of behavioral strategies by parents and teachers in the context of such interventions, particularly for adolescent populations. This study used a mixed methods design to examine the treatment integrity of behavior support plans (BSPs) for adolescents in middle school. Parents and teachers of eight middle school students at risk for emotional or behavioral difficulties engaged in conjoint behavioral consultation to develop and implement BSPs. Participants completed measures of stress and student behavioral severity prior to implementing BSPs, and treatment integrity was monitored during implementation. Open-ended survey questions gathered qualitative implementation information from parents and teachers at the conclusion of the intervention. Quantitative findings indicated negative correlations between parenting stress and days of implementation (r = -.93) and between teacher perceptions of student behavioral severity and adherence to the BSP (r = -.81). Qualitative findings identified barriers to implementation (e.g., time and scheduling, intensity of student behavior); facilitators of implementation (e.g., alignment with values and practices, collaboration across participants); and parent endorsement of changes to parenting practices. Quantitative and qualitative results were in partial agreement regarding the relationship between student behavioral severity and implementation, and the triangulated results expanded our understanding of barriers and facilitators to implementing BSPs. Limitations and implications for science and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Creating effective teaching and learning environments: Building a positive behavioural support (PBS) model for UK special schools

AbstractThe importance of reducing restraint and restrictive interventions in special schools has been recognised across the four nations of the UK. Government guidance for England and Wales, and recommendations produced by Restraint Reduction Scotland, both reference Positive behavioural support (PBS) as an evidence‐based approach that can be used to proactively support pupils with, or at risk of, behaviours that challenge. The Department of Education of Northern Ireland recommends the development of behaviour support plans to support children with special education needs and disabilities. Special schools, however, also have a responsibility to set high expectations for every pupil, to provide access to the respective national curricula and to meet individual needs. School‐wide positive behavioural support (SW‐PBS), originated in the USA in the 1990s in response to a body of evidence that showed improved social and academic outcomes when behavioural interventions were implemented across whole school settings. It is increasingly being adopted in the UK. Drawing upon examples from schools in England and Wales with which the authors are familiar, this paper outlines the rationale for a special schools' model of SW‐PBS and illustrates the ways in which this can be adjusted to meet the specific needs of each setting. Key Points Reducing restraint and restrictive interventions in schools is a high priority across all four nations of the UK. Special schools also have a responsibility to provide children with special education needs and disabilities positive learning environments that maximise learning opportunities and meet individual needs. School‐wide positive behaviour support (SW‐PBS) provides a useful framework to help special schools meet these expectations.

An argumentation analysis of testimony about positive behaviour support and chemical restraint in Australia’s Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

Introduction Australia’s Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (2019–2023) is examining, amongst many issues, how positive behaviour support (PBS) can address challenging behaviour and reduce the use of restrictive practices, particularly chemical restraint. This study explores the basis of the claims made about this during testimony. Materials and methods Applying existing recommendations for the study of Royal Commissions, this study uses argumentation analysis of testimony. Results Three central claims about PBS were identified: practitioners, behaviour support plans, and chemical restraint. Comparison with Australian research shows preparation of behaviour support practitioners is poor, behaviour support plans do not show a clear benefit to people with disability, and chemical restraint remains a persisting issue with no viable way forward. Discussion The analysis highlights the difference between perceptions of PBS and the current Australian evidence underlying it. The barriers to the promotion of PBS to address restrictive practices in Australian disability services prompts reconsideration of the policy expansion to address restrictive practices in other sectors.

학교 차원 긍정적 행동지원의 중요성과 실행 가능성에 대한 유아교사와 유아특수교사의 인식

Purpose: This study purposed to examine the perceptions of early childhood teachers and early childhood special education teachers regarding the importance and feasibility of school-wide positive behavior support at the school level. Method: To achieve this, a survey was developed based on an analysis of previous studies on the perception of school-wide positive behavior support, and it was administered to early childhood teachers and early childhood special education teachers. Results: First, both early childhood teachers and early childhood special education teachers highly recognized the importance of school-wide positive behavior support in all items. However, early childhood teachers preschool teachers rated 'Organized and predictable daily routine' in the universal level, 'Implementing teacher training' and 'Group guidance for teaching social skills' in the targeted level, and 'Establishing and implementing positive behavior support plans based on functional assessment' in the individual level higher than early childhood special education teachers. Second, both early childhood teachers and early childhood special education teachers highly recognized the feasibility of implementing school-wide positive behavior support as above average in all items. However, early childhood teachers perceived a higher feasibility of implementing five items in the universal level and three items in the targeted level than early childhood special education teachers. In the individual level, there was no perceptual difference between the two groups of teachers. Third, both groups perceived the feasibility of the items much lower than their importance, and recognized factors such as time constraints, lack of collaboration, and insufficient administrative and financial support as obstacles to implementation. Conclusion: Based on the findings, recommendations for further discussions and directions for future research on the implementation of school-wide positive behavior support in early childhood education settings were suggested.

A service evaluation measuring the effectiveness of ABC training on staff confidence in reporting ABCs and their understanding of the framework rationale

The Antecedent-Behaviour-Consequence (ABC) model is commonly used to document and analyse challenging behaviours within brain injury rehabilitation services. Data from these recordings can be utilised to implement Positive Behavioural Support (PBS) plans and inform effective support strategies to manage challenging behaviour. Therefore, it is pivotal that staff within these settings are adequately trained in recognising and reporting challenging behaviours and feel confident in their ability to do so. Currently, there is no existing literature that evidences the effect of ABC framework training on staff confidence in recognising and reporting challenging behaviours. In this service improvement project, nineteen staff members from a neurorehabilitation service completed one training session focusing on challenging behaviours and the ABC framework. Participants completed an eight item Likert scale questionnaire pre-training (immediately before training), post-training (immediately after training) and at a four-week follow-up to assess their self-perceived confidence in their knowledge around the ABC model, the rationale behind this framework and their ability to effectively complete an ABC report. Descriptive statistics and a repeated measures ANOVA were conducted to examine whether training had an effect on self-reported confidence scores. Findings revealed a significant effect of training on staff confidence, Wilks Lambda = 0.35, F (1,18) = 1252.42, p = .000, with an effect size of np2 = .98, with an increase in confidence post-training. This effect was also maintained at follow-up indicating that staff confidence was retained after a 4-week period.

Intellectual disability and autism in adults influence psychological treatments for mental health comorbidities

PurposeThe purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services.Design/methodology/approachA cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.FindingsThere was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses.Research limitations/implicationsNot having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism.Originality/valueThis large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

Quality Improvement Project - Initial survey of a new Mental Health of Intellectual Disabilities Service established in Ireland in January 2022

Introduction A new mental health service specialising in intellectual disabilities in Ireland was set up in January 2022. Its current compliment of staff includes is a Consultant Psychiatrist, Trainee Psychiatrist, Social Worker and Administrator. The current National Directive in Ireland is to prioritize Mental Health of Intellectual Disabilities services. Objectives The aim of the project is to establish the current baseline level of diagnostics and interventions within the new service. Our aim is to develop this service by implementing and following the gold standard guidelines and determine what extra resources does the service need. Methods The first fifty case notes of patients assessed by the new service were inspected. The reviewer looked for evidence of the following clinical descriptions:Diagnosis of Intellectual Disabilities and its severity; Mental Capacity; Psychiatric Diagnoses; Physical health diagnoses; Medications and evidence of a Positive Behavioural Support Plan to manage complex challenging behaviours. Results The fifty patient audit contained 38 (76%) men and 12 (24% women) . One patient had Mild Intellectual Disabilities (ID), 39 (78%) had Moderate ID and 10 (20%) had Severe ID. All patents were very vulnerable and had limited or lacking Mental Capacity. Common diagnoses of the following were recorded in the following numbers and percentages; - Autism diagnosis 30 ( 60% ); Epilepsy 19 (38%); & Down Syndrome 9 (18%). A Formal Psychiatric diagnosis was identified in 26 (52%) of patients. Challenging Behaviour (severe and complex) was identified for 41 ( 82%) of the patients. The full breakdown of psychiatric diagnoses was ‘Psychotic illness’ – 9 (18%); Anxiety – 7(14%); Bipolar Affective Disorder 5 (10%): Depression – 4(8%); Attention Deficit Hyperactivity Disorder (ADHD) 3 (6%); Obsessive Compulsive Disorder (OCD) – 2(4%); Dementia – 2(4%): Post Traumatic Stress Disorder (PTSD) – 1 (2%); & Schizoaffective Disorder 1(2%). A Positive Behavioural Support plan (PBS) was available to support 33 (66%) of patients. 42 (84%) of patients were prescribed antipsychotic medication. 12 (24%) were prescribed more than one antipsychotic. 20 (40%) were prescribed an antipsychotic without a formally documented diagnosis of a psychotic disorder. 12 (24%). Conclusions The results of this first survey highlight areas in which the service can be improved. The service has requested funding for a Community Nurse and a Psychologist. Psychological evaluations and Positive Behavioural Support plans are essential for people with complex challenging behaviours. A Community Nurse should assist with Health Promotion and help supervise patients requiring Depot Antipsychotic medication or Clozapine. We also plan to set up a joint clinic with the Consultant Neurologist on a regular basis. Disclosure of Interest None Declared

Can the Behaviour Intervention Plan Quality Evaluation, Version 2, be simplified for use by stakeholders with limited experience of positive behaviour support?

Behaviour support plan (BSP) quality auditing tools like the Behaviour Intervention Plan Quality Evaluation, Version 2 (BIPQEII), assess the quality of a BSP from the perspective of technical compliance with behavioural principles. However, these principles may be inaccessible to interested stakeholders with limited experience and knowledge of positive behaviour support (PBS). The aim of this study was to test if a simplified version of the BIPQEII [the Behaviour Support Plan Audit Tool (BSPA-tool)] offers a reliable and valid assessment of a BSP's technical compliance with behavioural principles when used by professional stakeholders with varying levels of PBS experience and knowledge. Four scorers rated 50 de-identified BSPs using the BSPA-tool, with one scorer also rating the BSPs using the BIPQEII. Four weeks later, each scorer rated 25 of the 50 BSPs again using the BSPA-tool. Prior to BSP scoring, a group of PBS practitioners provided feedback on the BSPA-tool's content validity. The BSPA-tool was found to have acceptable content and parallel-form validity; however, acceptable internal consistency and inter-rater and intra-rater reliability were dependent on PBS experience/knowledge, that is, scorers with more experience/knowledge achieved more acceptable levels of reliability. This study confirms that even with simplification, BSP quality auditing tools based on technical compliance with behavioural principles are still only accessible to stakeholders with extensive experience/knowledge of PBS. To engage less-experienced stakeholders in BSP quality auditing processes, new audit tools need to be developed that focus on other aspects of BSP quality (e.g. readability and consultation).

‘Stakeholders are almost always resistant’: Australian behaviour support practitioners’ perceptions of the barriers and enablers to reducing restrictive practices

A restrictive practice (RP) is defined as a practice or intervention that has the effect of restricting the rights or freedom of movement of a person, and includes physical, mechanical, and chemical restraint, and seclusion. If misused or overused, RPs may present serious human rights infringements. In Australia, behaviour support practitioners who deliver behaviour support funded by the National Disability Insurance Scheme are responsible for developing positive behaviour support plans that aim to reduce and eliminate the use of RPs. At present, little is known about the barriers that behaviour support practitioners experience when attempting to reduce and eliminate the use of RPs and, conversely, what helps (or enables) them to reduce and eliminate RPs. To learn more, we conducted an online survey consisting of two open-ended questions with 109 Australian behaviour support practitioners to identify barriers and enablers. We found that fear and reluctance on the part of stakeholders were often barriers to reducing the use of RPs. However, we found that having time, funding, and resources for training, supervision, other implementation activities, care team collaboration, and data-based decision-making helped overcome barriers. We provide specific recommendations for addressing identified barriers for individual behaviour support practitioners, service provider organisations, and government and regulatory agencies.

Implementation of Behavior Support Plan Introduced to Mothers: A Case Study

Upon learning that their child has a neurodevelopmental disorder, families enter a different process and can experience problems related to their child’s behavior management. This study was designed in response to a request from mothers with children diagnosed with various neurodevelopmental disorders. The study used a multi-level case study, one of the qualitative research designs. A behavior support plan (BSP) was created to address the three mothers' needs concerning the negative behaviors they observed in their children. The BSP is a 12-session program based on applied behavior analysis (ABA). This program was shaped by collecting data through semi-structured interviews, field notes, and the researcher’s diary before the family education. It was determined whether the program was effective by continuing to collect data through the data collection tools in the middle and end of the BSP implementation. The results of the inductive analysis revealed that BSP reduced the problem behaviors in the children and ended the punishments given by the mothers and that they felt better via this education. In general, it is recommended to train applied behavior analysts who are going to provide individual family education based on ABA, to make family education a country policy, and to increase such education provided to families both at schools and individually.

Antipodean Perspectives-Aged Care Nursing and the Multifaceted Role of the Aged Care Nurse.

Healthy ageing refers to the development and maintenance of the functional ability of ageing individuals. Aged care nurses provide nursing care to elderly individuals and usually work in aged care residential facilities, nursing homes, home care services, and/or hospital departments. The registered nurse working in the aged care sector has several important roles. Key roles cover both therapeutic and preventative paradigms, as discussed in this paper. The aged care nurse is also “tasked with” holistic patient-centred care and the promotion of healthy ageing via advocacy and sociocultural roles. This paper examined, described, and analysed the multifaceted role of an aged care nurse from an Australian perspective. We conducted meticulous searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to aged care nursing in Australia. This paper relied upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. Multiple aspects of healthy ageing and holistic aged care nursing are discussed. The key roles of the aged care nurse are enumerated next, in accordance with the code of conduct from the Nursing and Midwifery Board of Australia (NMBA). The NMBA promotes evidence-based, culturally sensitive, consultative, holistic aged care clinical practice that includes input from care recipients, their decision makers, and/or their health care providers. The difficult issue of loneliness is discussed with strategies to ameliorate aspects of this. Good social networks, community interactions, meaningful friendships, and participation in personalised spiritual/religious practices improve the quality of aged care. The key topic of elder abuse and its forms are discussed apropos of aged care nursing. Healthy ageing is promoted by identifying and reporting elder abuse at the earliest. Current Australian law and recent federal legislation changes pertaining to aged care nursing are discussed next. As a result of these legislation changes, several new quality control imperatives (for aged care organisations/facilities) under the Aged Care Quality and Safety Commission (ACQSC) have been implemented. Residential and flexible aged care providers should now have robust ongoing documentation and a well-developed behaviour support plan (BSP) for each care recipient who currently requires or may require restrictive practices, which must be reported under the new serious incident reporting scheme (SIRS). Various strategies to promote healthy ageing and approaches to communicate effectively with aged care recipients are also discussed. Healthy ageing is promoted when age care recipients are empowered with making their own autonomous choices in “major and minor” aspects of life. Finally, approaches to optimise quality aged care nursing care are discussed. The Roper–Logan–Tierney model is one of the models used to assess and optimise nursing care. This is premised on the capability of an ageing individual to accomplish 12 basic activities of daily living.

Caring for behaviorally challenging patients in nonpsychiatric settings.

This article discusses a pilot study on the use of a behavior support plan to safely address patients who exhibit disruptive behaviors in the ED and nonpsychiatric medical settings while respecting their autonomy.

Special Educator Burnout and Fidelity in Implementing Behavior Support Plans: A Call to Action

Special education teachers have one of the most challenging and stressful jobs in public education, which often leads to increased burnout. High levels of burnout have, in turn, been related to lower levels of fidelity of implementation in delivery of evidence-based behavior interventions. The purpose of this position paper is to (a) propose exploration of several potential malleable factors related to burnout of special educators serving students with and at risk for emotional and behavioral disorders, (b) link those suggestions to theoretical frameworks, (c) discuss the relation between burnout and fidelity, and (d) suggest measures that may be used to pursue this research, with the ultimate goal of helping the field discover means of intervention to remediate and prevent burnout.