Everyday Behaviors: The ABC’s of Positive Interactions

LLU Behavioral Medicine Center is a unique mental health facility that serves a youth population with age ranges from five to 17 years old. The youth population creates a unique experience as many of these patients have not learned how to effectively communicate their needs or even identify the emotions that they are experiencing.

As the field of mental health is constantly changing and more interventions are being researched, Alan Kazdin, PhD research professor and Sterling professor emeritus of Psychology and Professor of Child Psychiatry (emeritus) created a parent management program, used by clinical therapists in the outpatient setting. This program was presented to the education department as a potential training for our youth services inpatient staff. After reviewing Alan Kazdin’s book and online course, it was decided that while the training in its entirety would not be beneficial to our inpatient behavioral care and RNs, the tenets of antecedents, behaviors and consequences as they impact positive interactions would be beneficial.

With feedback and constant review over four to five months from the patient care manager, nursing director, clinical therapists and doctors, the education department took the basic tenets presented in Kazdin’s Parent Management Training and created an education that would be specific to our inpatient youth services department which we titled Everyday Behavior: The ABC’s of Positive Interactions.

Monday, May 16, 2022, was the “Go Live” date for implementing the new program on the Child Unit (ages five to 12). The visible results from the program include patients who are more engaged in their treatment, to include attending groups, processing with staff and attending to basic hygiene needs. Staff are utilizing activities during program downtime to help patients effectively communicate and participate in group play. Staff are focused on positive interactions with patients, which has decreased the number and severity of restrictive interventions such as physical holds, mechanical restraints, and seclusion.

Children’s Hospital Patient and Family Advisory Council Star Program With Serena Oriero

Loma Linda University Children’s Hospital is dedicated to meeting the needs of patients, families and caregivers, and welcomes the feedback of those parties to improve its services.

LLU Children’s Hospital Patient and Family Advisory Council (PFAC) is a committee that allows for that feedback and is comprised of Children’s Hospital staff, as well as parents with children who have spent much time in and out of the hospital. As a charter, the committee meets once a month on the third Tuesday of each month, and works together on implementing goals that have been set for the year. Goals are set each January and are things that parents and staff feel will help to make the patient experience better.

In November 2021, the committee was able to roll out the STAR program. PFAC had been working on this program for approximately three years and were so excited to see it finally being used in the Children’s Hospital. The STAR program was initially presented to the Children’s Hospital PFAC as an idea of special needs moms that had spent a lot of time with their children in the inpatient setting. The program is designed to identify that the patient has a special need or disability early on so that staff can then cater their interaction to meet the patient’s needs. In practice, staff members interact with the patient in a manner that is helpful in de-escalating or even eliminating behaviors that can activate the triggers these children have.

The identifying factor is the placement of three stars: on the patient’s name band, outside of the patient’s room, and on the storyboard of the patient’s electronic chart. When the nurse wants to implement the program, there is a drop-down menu in the chart that triggers steps for the staff to take and enter in helpful information about the patient. The rollout of this program has been slow, but great reviews are being received about it from staff and parents.

There is a desire of many to see this program roll out systemwide as it would be beneficial to all special needs populations within the system. This program is not something that other hospitals have implemented, thus Children’s Hospital is excited to have led it and has seen the value in the extra care of special needs children when being cared for in the hospital.