title: A Positive Behavioral Approach for Aggression in Forensic Psychiatric Settings.
abstract: Aggression toward self and others by complex patients admitted to forensic psychiatric settings is a relatively common yet extremely difficult behavior to treat. Traditional interventions in forensic inpatient settings have historically emphasized control and management over treatment. Research over the past several years has demonstrated the value of behavioral and psychosocial treatment interventions to reduce aggression and to increase prosocial skill development in inpatient forensic population. Positive behavioral support (PBS) offers a comprehensive approach that incorporates the science of applied behavioral analysis (ABA) in support of patients with challenging behaviors, including aggression and violence. In this article, we describe a PBS model to treat aggression in forensic settings. PBS includes a comprehensive functional assessment, along with four basic elements: ecological strategies, positive programming, focused support strategies, and reactive strategies. Other key components are described, including data collection, staff training, fidelity checks to ensure correct implementation of the plan, and ongoing monitoring and revision of PBS strategies, according to treatment outcomes. Finally, a behavioral consultation team approach within the inpatient forensic setting is recommended, led by an assigned doctoral-level psychologist with specialized knowledge and training in behavioral methods. The behavioral consultation team works directly with the unit treatment team and the identified patient to develop, implement, and track a plan that may extend over several weeks to several months including transition into the community. PBS can offer a positive systemic impact in forensic inpatient settings, such as providing a nonpharmacologic means to address aggression, reducing the incidences of restraint and seclusion, enhancing staff proficiency in managing challenging patient presentations, and reducing recidivism when used as part of the bridge to community re-entry.
authors.affiliation: Dr. Tolisano is Director of Psychological Services, Connecticut Department of Developmental Services, Hartford, CT. Dr. Sondik is Director of the Behavioral Intervention Service, Connecticut Valley Hospital, Middletown, CT. Dr. Dike is Medical Director, Office of the Commissioner, Connecticut Department of Mental Health and Addiction Services, Hartford, CT and Assistant Professor of Psychiatry and Associate Program Director Law and Psychiatry Fellowship Program Yale University School of Medicine, New Haven, CT. peter.tolisano@ct.gov.
authors.forename: Peter
authors.initials: P
authors.lastname: Tolisano
authors.affiliation: Dr. Tolisano is Director of Psychological Services, Connecticut Department of Developmental Services, Hartford, CT. Dr. Sondik is Director of the Behavioral Intervention Service, Connecticut Valley Hospital, Middletown, CT. Dr. Dike is Medical Director, Office of the Commissioner, Connecticut Department of Mental Health and Addiction Services, Hartford, CT and Assistant Professor of Psychiatry and Associate Program Director Law and Psychiatry Fellowship Program Yale University School of Medicine, New Haven, CT.
authors.forename: Tracey M
authors.initials: TM
authors.lastname: Sondik
authors.affiliation: Dr. Tolisano is Director of Psychological Services, Connecticut Department of Developmental Services, Hartford, CT. Dr. Sondik is Director of the Behavioral Intervention Service, Connecticut Valley Hospital, Middletown, CT. Dr. Dike is Medical Director, Office of the Commissioner, Connecticut Department of Mental Health and Addiction Services, Hartford, CT and Assistant Professor of Psychiatry and Associate Program Director Law and Psychiatry Fellowship Program Yale University School of Medicine, New Haven, CT.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Dike
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D000072357:Applied Behavior Analysis / Q000331:legislation & jurisprudence / Q000379:methods; D001521:Behavior Therapy / Q000331:legislation & jurisprudence* / Q000379:methods*; D003131:Combined Modality Therapy; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D015897:Comorbidity; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011329:Prisoners / Q000331:legislation & jurisprudence* / Q000523:psychology*; D011594:Psychometrics; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy; D066107:Social Skills; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy; D014754:Violence / Q000331:legislation & jurisprudence* / Q000523:psychology*
chemical_list: D011619:Psychotropic Drugs