The Effects of a Staff-Training Program in Behavior Management and Social-Learning Principles on Staff-Patient Interactions Within a Psychiatric Rehabilitation Inpatient Unit

• Published in: American journal of orthopsychiatry 2020, Vol.90 (4), p.419-431
• Main Authors: Schenkel, Lindsay S, Wilkniss, Sandra M, Savitz, Adam, Spaulding, William D, Silverstein, Steven M
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Behavior Therapy; Chronic illnesses; Educational Measurement - statistics & numerical data; Female; Health behavior; Health Personnel - education; Hospital Programs; Hospitalization; Hospitals; Human; Humans; Inpatient; Inpatients; Inservice Training; Intervention; Male; Medicine; Mental disorders; Mental health services; Nurses; Patients; Physician-Patient Relations; Predictions; Psychiatric Hospital Staff; Psychiatric Rehabilitation; Psychiatric Training; Psychiatric Units; Psychiatrists; Psychologists; Rehabilitation; Schizophrenia; Social Learning; Social workers; Test Construction; Training
• ISSN: 0002-9432; 1939-0025
• DOI: 10.1037/ort0000443

Despite the existence of effective behavioral interventions for people diagnosed with serious mental illness (SMI), these continue to be underutilized. Barriers to implementation include a low frequency of staff-patient interactions, as well as a lack of knowledge about, and negative attitudes toward, behavioral interventions. Therefore, we examined the effects of a mandatory behavioral staff-training program on staff-patient interactions on a long-term psychiatric inpatient program for individuals with SMI. Staff-training consisted of two-phases: didactic training followed by a written exam, and in vivo training and assessment. From pre- to posttraining, all staff demonstrated increased positive and therapeutic behaviors and decreased negative behaviors when interacting with patients. Additionally, at baseline, nonmedical staff (psychologists, social workers) displayed significantly more therapeutic and fewer negative behaviors compared with medical staff (psychiatrists, nurses, mental health workers), and this pattern persisted at posttraining despite improvements in both groups. Importantly, completion of the staff-training program was associated with improvements in patient behavior. Although both written and in vivo test scores significantly predicted change in negative staff behaviors toward patients, the in vivo test performance increased predictive ability over and above that of written test performance. Staff who disagreed with behavioral management principles displayed less improvement in negative behaviors from pre- to postassessment. These data have implications for clarifying staff training needs in programs for chronically ill people with SMI. Public Policy Relevance Statement Effective behavioral interventions for people diagnosed with serious mental illness (SMI) continue to be underutilized in inpatient hospital settings. To date, there have been very few published investigations of behaviorally based staff-training initiatives for mental health professionals who work with SMI populations. As such, empirically supported guidelines for training mental health staff are lacking. This investigation reports on the results of a comprehensive staff-training program in behavioral techniques, consisting of didactic, interactive, and in vivo components, along with written and in vivo assessments of mastery.