Model Admission
Before opening a severe behavior program, it is important to delineate admission criteria, a general plan of care, discharge criteria, and procedures for continuation of care. Outlining these criteria will ensure you:
(a) admit appropriate patients (b) follow a general plan of care across patients (c) discharge patients at the appropriate time (d) maintain treatment effects post discharge
In this section, an overview of a model admission is presented.
Admission Criteria
Delineating specific admission criteria can ensure you admit patients who are most appropriate for and in need of your severe behavior program. Appendix A outlines a list of suggested admission criteria, some of which we describe below.
Severity of Destructive Behavior
It is recommended that a minimum admission criterion is that destructive behaviors are at a severity level that poses a clear and serious risk to self, others, or the environment, which is Severity Level 2 or above on the Severity Scale in Appendix C.
Failed Outpatient Therapy and Psychopharmacological Intervention
Requiring that a patient has failed a less-intensive level of service before admission to your severe behavior program ensures that the program serves patients most in need of intensive services. Admission to a severe behavior program also might be justified as an alternative to a more restrictive placement.
Exclusion Criteria
Outlining exclusion criteria for the program also is important. The program may not be able to maintain the safety of some patients, and some patients may be more appropriate for a different service provider. Ideally, patients should have stable medication regimens before and during admission such that the effects of the treatment program are not confounded with ongoing medication changes.
Plan of Care
You should have a general progression of procedures that you conduct when admitting patients to the severe behavior program. For example, admission often begins with a preference assessment followed by an observation with the patient and caregiver. Next, a functional analysis is conducted to identify the reinforcers for destructive behavior, which inform a function-based treatment.
Then, an empirically supported treatment is implemented, caregiver and stakeholder training is conducted, and testing for treatment generalization and maintenance across implementers and settings occurs.
Discharge Criteria
Outlining discharge criteria ensures that you do not discharge patients before you have established an effective treatment for destructive behavior and that you do not keep patients in the program who no longer need services or who are not progressing. Appendix A outlines potential discharge criteria for a severe behavior program.
Continuation of Care
A critical component of your severe behavior program is to ensure that treatment effects maintain over time and under changing conditions. Ensuring coordination of care increases the likelihood the patient's other service providers will implement the prescribed treatment program, and the results will maintain post-discharge. The program should offer follow-up services after the patient’s discharge from the severe behavior program.
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