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OSH takes a proactive approach to behavioral issues

BPS staff
James Clay, Psy.D. (middle) leads a discussion with psychology intern Meghan Rowland, Matt Sturgeon, Psy.D. and Amy Smith, Ph.D. during a behavioral psychology meeting in Harbors. BPS staff work with the hospital's most behaviorally challenged patients to identify the triggers for their behavior, and help staff learn to recognize these triggers and redirect the patient toward more constructive behavior.

A team of Oregon State Hospital psychologists and mental health specialists, assigned to work with the hospital's most challenging patients, is helping unit staff learn to address behavioral issues before, rather than after, they occur.


"Our program is all about being proactive," said psychologist Dr. Amy Smith. "This leads to fewer crises and reactivity, which frees up staffs' time and creates a safer, more therapeutic environment."


The Behavioral Psychology Program (BPS), which was started in 2008 to address behavior-related issues in the hospital's geriatric units, is made up of three psychologists, including Smith, and 12 mental health specialists. Rather than being assigned to a specific unit or patient population, BPS staff receive consultation requests for individual patients on a case-by-case basis. While most of their time is devoted to the hospital's recently admitted patients, BPS is a valuable resource available to every unit.


The goal of the BPS team is to identify the root causes of a certain behavior — why the patient is acting out in a specific way — what sets off that behavior and what types of alternative behaviors can replace it.


"Old, negative behaviors can be replaced with equivalent, positive behaviors and doing so changes your entire life," said psychologist Dr. James Clay. "If you've used violence all your life to get what you need, then you tend to wind up in some pretty negative places. But if you find another way to express whatever is driving that violence, it can have an incredibly positive impact."


Clay said when a person acts out in a negative manner, those who observed the behavior often believe it came out of nowhere. In most instances though, a definable, although sometimes unnoticed, chain of events led to the behavior.


"We want to find a spot in that chain where staff can intervene and head off the negative behavior before it becomes a problem," Clay said.


One of the cornerstones of behavioral interventions is recognizing that each patient is unique, with distinct needs that require a personalized behavioral support plan.


"It's very individualized, and a lot of work goes into identifying what causes that person to engage in that behavior," Smith explained.


Interventions come in a variety of forms. Some patients may need to learn a new skill, while others may respond well to a change in environment. Smith added that if reasonable accommodations can be made for a patient who, for example, has a light-sensitivity or chronic-pain issue, these changes can sometimes make all the difference in the world.


"It's really about identifying the triggers, so the interventions we use for some people might not necessarily look like they're linked to a certain behavior, but in the global picture for that person, they really are," Smith said.


While each patient's intervention is unique, the consistency in which it's applied is not.


"Behavioral interventions tend to work the same way as psychotropic meds — you have to give it everyday at the same dosage, and it may be several weeks before you see the benefits," Clay said. "Although it can be much more difficult than just giving a pill, research shows it leads to some pretty good outcomes."


Having seen so many positive results during the past three years, Clay, Smith and the rest of their team strongly believe in the interventions, and are more than happy to provide training to any hospital staff on behavioral intervention practices and techniques.


"One of our missions is to disseminate as much information as possible," Clay said. "If everybody — doctors, psychologist, line staff — have a familiarity with behavioral interventions, then those interventions will be tried earlier and be more effective."