Trauma-informed behavioral supports (TIBS) for inpatient treatment of individuals who experience BPD.

Trauma-Informed Behavioral Supports (TIBS) is a novel treatment approach targeting aggression against self or against others in individuals who experience borderline personality disorder (BPD). It is based on applied behavior analysis and uses a person-centered and trauma-informed framework. People with BPD hospitalized because of concerning behaviors, [aggression to others, verbal aggression (e.g., defined as aggression in the forms of verbal threats, etc.), physical aggression, and self-injury, etc.] may experience exacerbations of such behavior in the hospital. Individuals diagnosed with BPD were treated with TIBS to diminish the frequency of concerning behaviors in the context of a pilot study. Functioning during a three-month pre-treatment phase was compared with a six-month treatment phase. The TIBS intervention resulted in statistically significant and clinically meaningful decreases in physical and verbal aggression. The results of this pilot investigation approach suggests that TIBS can promote behavior change in the inpatient setting.

U.S. Department of Justice Investigation of a State Psychiatric Hospital.

The Department of Justice investigation of state psychiatric hospitals is nothing like investigation by more familiar regulatory agencies such as The Joint Commission or Centers for Medicare and Medicaid Services (CMS). For one, it comes with the threat of serious legal consequences for both the state psychiatric hospital under investigation and the state in general. Although little has been written about this topic, much of what has been written describes a negative, painful, and expansive experience affecting every aspect of the hospital system. Using an example of a state psychiatric hospital that has been investigated by the DOJ, this article examines this portrayal and explores whether there are positive aspects of such investigations that have been overlooked.

When Trauma Survivors with Psychosis Accuse Staff of Sexual Assault in Inpatient Psychiatric Care.

Inpatient psychiatric settings are now known settings in which sexual assault can occur. When a trauma survivor with psychosis makes an accusation of sexual assault within an inpatient setting, staff and the institution are frequently not well equipped in how to respond. While there is scant literature on how to proceed in such dilemmas there is even more of a dearth on how to effectively provide mental health services, trauma- and culturally informed care, and how to best engage with the individual so that safety can be maintained, and treatment continue. This article seeks to convey some basic supports for institutional response, theoretical frameworks to enhance understanding and clinical skill, and shifts in care so that trauma-informed and culturally informed care can take place within these complex dynamics. The goal of this paper is to support mental health services and interdisciplinary teams in becoming more effective in navigating these complex situations so that they can honor and respect the trauma survivor and continue to be effective at providing a healing environment.Public Significance Statement: This article offers enhanced understanding of managing risk and balancing trauma-informed care at an institutional and multi-systemic level when inpatients make allegations of sexual assault. Included in this is enhancing understanding from a theoretical framework of the traumatic experiences of clients, assessing needs and offering safety, treatment, and care, while also managing the complex dynamics and services of the organization.

A pilot study: Positive behavioral support assessment and intervention for individuals with serious mental illness and criminal justice involvement.

Individuals with serious mental illness (SMI) are consistently interfacing with the criminal justice (CJ) system. They are overrepresented in our nation's prisons and jails rather than being in appropriate treatment settings. They also exhibit behavioral challenges in such CJ settings that result in rule violations leading to punitive consequences, such as segregation and isolation, which have deleterious effects on their mental health and well-being. Individuals with SMI who are incarcerated also make up the majority of suicide attempts and stay longer than those without SMI. Positive Behavioral Support (PBS) is a form of assessment and intervention with demonstrated efficacy for mitigating disruptive behaviors in individuals with SMI. This article describes a pilot study aimed at evaluating the efficacy of implementing PBS to decrease behaviors of concern (BOC) by those who experience SMI and interface with the CJ system. Findings indicated that PBS has a positive impact on reducing the frequency and severity of challenging behaviors and consequentially reducing interactions with the CJ system. Implications of this intervention are explored as a mechanism to support recovery and build lives of meaning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Implementing a program to reduce restraint and seclusion utilization in a public-sector hospital: Clinical innovations, preliminary findings, and lessons learned.

The Alternative to Restraint and Seclusion State Incentive Grant was a national initiative to reduce restraint and seclusion use in psychiatric hospitals and community based mental health settings sponsored by the National Association of State Mental Health Program Directors. This initiative was implemented in a large public sector psychiatric hospital. It involved the use of a restraint and seclusion prevention project team and a Patient-Staff Steering Committee collaborating on violence prevention. It also entailed systematic data collection and case reviews, staff-training on trauma-sensitive care and other relevant topics, employee recognition, as well as the use of specific restraint prevention tools including sensory modulation, positive behavioral support plans, comfort rooms, Wellness Recovery Action Plans, modified restraint orders, and new debriefing protocols. Compared with a 4-year baseline period, a 4-year implementation phase showed a reduction in annual restraints hours by 89%, annual staff injuries by 18%, and annual Workmen's Compensation medical costs by 24%. The findings illustrate the value of implementing systemic evidence-based practices to reduce restraint use, enhance the quality of care in tertiary care settings, and promote a new, patient-centered and recovery-oriented institutional culture. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

When Sexual Trauma Survivors with Severe Psychiatric Disabilities Experience Institutional Care.

Individuals with severe psychiatric disabilities face many challenges from their experience of mental health problems, but also from disenfranchisement, marginalization, and stigmatization from a sociocultural experience. Those who are sexual trauma survivors also have unique challenges and intersecting experiences, which are not historically well understood, acknowledged, or treated in U.S. systems of care. Both in historic and modern mental health systems there have been methods thought of as interventions that have been or are currently reported as traumatizing to those who experience them. This article highlights the specific challenges, needs, and organizational shifts that U.S. systems of care need to be aware of and embark upon in order to provide treatment that is more efficacious with and cognizant of the experiences of those who are sexual trauma survivors. Furthermore, new paradigms for providing mental health treatment are offered in the context of providing trauma-informed as well as trauma treatment to those who are sexual trauma survivors and experience severe psychiatric disabilities.

Positive behavioral support planning in the inpatient treatment of severe disruptive behaviors: A description of service features.

Positive behavior support (PBS) plans are increasingly used on inpatient units to assess and treat serious and dangerous behaviors displayed by patients with serious psychiatric impairment. A contemporary extension of traditional applied behavior analytic procedures, PBS plans integrate theories from several domains with perspectives on community psychology, positive psychology, and recovery-oriented care. Because there is little evidence to suggest that more invasive, punitive disciplinary strategies lead to long-term positive behavioral change (Parkes, 1996), PBS plans have emerged as an alternative to the use of seclusion and restraint or other forms of restrictive measures typically used on inpatient psychiatric units (Hammer et al., 2011). Moreover, PBS plans are a preferred method of intervention because more invasive interventions often cause more harm than good to all involved (Elliott et al., 2005). This article seeks to provide an integrated framework for the development of positive behavior support plans in inpatient psychiatric settings. In addition to explicating the philosophy and core elements of PBS plans, this work includes discussion of the didactic and pragmatic aspects of training clinical staff in inpatient mental health settings. A case vignette is included for illustration and to highlight the use of PBS plans as a mechanism for helping patients transition to less restrictive settings. This work will add to the scant literature examining the use of positive behavioral support plans in inpatient psychiatric settings. (PsycINFO Database Record

Commentary: Treatment and violence risk mitigation in high-functioning autism spectrum individuals.

The article by Lerner and colleagues will allow forensic clinicians to gain more understanding of how the specific cognitive deficits in persons with high-functioning autism spectrum disorder (HFASD) relate to the propensity of these individuals to engage in cognitive distortions associated with violence. These deficits are relevant to a variety of forensic evaluations of matters such as criminal responsibility. We argue that they also have implications for the treatment and risk mitigation of individuals with HFASD who have engaged in violent behavior.

Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention.

Psychologist practitioners are not immune to some mental health problems, including suicidality, for which they provide services. In the aftermath of two recent psychologist suicides, the American Psychological Association's Advisory Committee on Colleague Assistance (ACCA) initiated the formation of a conjoint ad hoc committee consisting of members from ACCA, the American Psychological Association (APA) Practice Directorate, and the Section on Clinical Emergencies and Crises (Section VII of APA's Division 12) to investigate the incidence of psychologist suicide and its impact on colleagues, students or interns, patients or clients, and the profession. The committee reviewed the extant empirical literature on suicide rates for psychologists, evaluated unpublished data on psychologist suicide provided by the National Institute of Occupational Safety and Health (NIOSH), interviewed colleague survivors, reviewed published case reports of the impact of therapist suicides, and linked their findings to the literature on professional distress, impairment, and self-care. The committee concluded that there is evidence suggestive of an elevated risk of suicide for psychologists in past decades. It further concluded that there is a need for further research to confirm if there is a heightened risk of suicide for psychologists in the present day, and to determine factors that might contribute to such risk. Accounts from colleague-survivors suggest that the impact of a psychologist's suicide can affect many people including family, colleagues, students, and patients or clients. This article offers suggestions for possible preventive approaches, for intervention with potentially at-risk colleagues, and for postvention efforts in the wake of a colleague suicide.

Commentary: addressing suicidality in the treatment of parricidal offenders.

The high rate of suicides among parricidal offenders has important treatment implications. It suggests that the assessment and management of the risks of suicide and of interpersonal violence need to be conducted in an integrative fashion. It highlights the role of hopelessness and despair in parricidal acts and the need to target these for treatment, ideally by combining group and individual psychotherapy.

Instilling hope into forensic treatment: the antidote to despair and desperation.

The importance of hope in the treatment of physical ills is well documented. Less is known about its role in the treatment of mental illness. Hope, the expectation of achieving a goal, figures prominently among the curative influences that help forensic patients recover. The cognitive processes that fuel violence and bring patients into our care often result in the loss of hope. Successful treatment requires the restoration and fueling of hope as patients progress through the phases of recovery. We review the extant literature on hope as it relates to clinical concerns, including the genesis of violence, mood, adjustment to physical illness, spirituality, forensic assessment and treatment, staff morale, and patient-centered care.

Through the eyes of another: improving the skills of forensic providers using a consumer-informed role-play procedure.

OBJECTIVE: We describe an intervention aimed at improving the quality of care delivered by forensic clinicians and at exposing them to the principles of client-centered care. METHOD: Thirty-five forensic clinicians belonging to various professional disciplines participated in a day-long, multi-modal training developed with the help of former residents of a maximum-security forensic hospital. The main components of the training included a 1.5-hour simulation during which participants role-played being hospital residents, a video on discrimination, and a panel discussion with several of the former hospital residents. RESULTS: Participants rated the training as very relevant to their work, very worthy of being recommended to their peers, and as a profoundly positive and enriching experience. The benefits derived from the training included greater connectedness among the staff and better understanding of the patients' experiences. CONCLUSION: Factors that appear to have contributed to the success of the training sessions include administrative support, use of a multi-modal approach, and use of small groups.

Commentary: parricides unanswered questions, methodological obstacles, and legal considerations.

Unanswered questions about parricide abound. The scientific literature on parricide is modest and plagued by several methodological problems. In the present article, we seek to describe these problems, propose possible remedies, and review the legal considerations related to parricide. The rarity of the phenomenon creates significant barriers to the collecting of data about it. Moreover, generalization from any one study of parricide is also limited due to the low prevalence rate of the crime and ensuing difficulties with generating an unbiased sample of adequate size. The present article proposes strategies for accessing a statistically relevant sample size, in light of this low prevalence rate. Some of the remaining unanswered questions about parricide are also raised. Finally, legal questions surrounding criminal responsibility are explored.

Serum cholesterol concentrations and non-physical aggression in healthy adults.

Although physical aggression in humans and other primates appears to be negatively associated with total serum cholesterol (TSC) concentrations, the relationship between other forms of aggression and TSC is less clear. A plurality of studies have reported a positive association, some have reported no association, and a minority have reported a negative association. Some authors have speculated that the variability in findings is attributable to inconsistencies in the definitions and measurement of what has often been termed "verbal" aggression. Buss and Perry have developed the Aggression Questionnaire, a theoretically-derived and empirically validated self-report measure of aggression that breaks aggression into subcomponents. One hundred and seventy-one college students and university personnel were recruited to participate in a cholesterol screening health initiative and then invited to participate in a study of mood and cholesterol. They completed a Demographic Questionnaire, and the Aggression Questionnaire. Regression analyses with age and Body Mass Index (BMI) as covariates revealed that anger, hostility, and verbal aggression significantly predicted TSC. Physical aggression did not. This finding suggests that non-physical forms of aggression may constitute a risk factor for coronary artery disease and one that may be worthy of targeting through behavioral interventions such as anger management training.