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Increase the sensitivity of healthcare professionals to behavior problems

Behaviorally Skilled Healthcare Professionals

Accessing quality healthcare is imperative for every individual’s health status, quality of life and even life expectancy. Providers strive to achieve quality of care for every individual they treat. However, there are substantial barriers to care such as cost, and lack of insurance, uncooperative patient behaviors, and the unavailability of professional with skills for addressing common behavioral problems associated with an IDD. Current use of restrictive procedures such as restraint potentially contributes to the aversiveness of healthcare appointments perpetuating the concerns.  

 

Several procedures employed in behavior analytic practice could be incorporated into health care settings to improve quality of care and appointment outcome success. Examples include teaching client skill sets such as tolerance of novel stimuli, compliance with novel demands, and tolerance of wearing hearing aids or glasses.  The use of high-probability (high-p) request sequence, non-contingent escape, and dental desensitization illustrate that behavior analytic approaches embedded within healthcare systems can increase compliance during medical examinations, potentially alleviating client/provider stress and improving appointment outcomes.  

 

Additional strategies include (a) the use of a pre-visit questionnaire that identifies obstacles that might arise during the appointment and addresses patient learning history along with patient/caregiver concerns, (b) exposure approaches such that patients are systematically exposed in therapy sessions to aspects of appointments that might elicit anxiety until a comfort level is achieved to encourage more successful appointments,  and (c) and environmental arrangement such as addressing duration of appointments and minimizing triggers in consultative areas.  Beyond preventative and treatment strategies, behavior analysts can provide critical information to providers such as a detailed client history, (e.g., ABC, frequency, duration data) along with comprehensive information on medication side effects. While there appears to be increased investigation of these topics, further research is needed to evaluate these procedures in practice. 

 

Obstacles that contribute to deficiencies in quality care include competing administrative obligations (e.g., allocation of staff resources, time, funding, and billing requirements). Moreover, evidence-based strategies addressing complex behavioral needs are not often included in medical training programs with many medical providers still unfamiliar with the field of behavior analysis.  Having access to billable hours and expertise in behavior analytic procedures with the additional benefit of collaboration of care would benefit medical providers, their clients, and client support systems as a whole.  

 

We believe that the current state of behavioral health services for persons with IDD merits an analysis the delineates how and why behavioral services can be better integrated into the healthcare system.  

Here is what this Action Circle is up to: 

  • Collaborating with members of the behavior analytic community to identify examples of successful integration of behavior analytic services within health care settings.  

  • Systematically searching the literature for (a) strategies or services that have proven benefit in addressing common problems that healthcare providers and persons with IDDs have described, (b) efforts to improve behavioral health services for people diagnosed with an IDD, (c) policies adopted to support improved healthcare for people with IDDs.

  • Producing a draft product that includes:

    • A review of the evidence on the efficacy of behavioral health services delivered to persons with IDDs. 

    • Recommendations for increasing availability of effective behavioral health services embedded within healthcare systems for people with IDDs. 

    • Policies that would require the reimbursement for evidence-based services for persons with IDDs. 

    • Identification of next steps and call for research. 

  • Interviewing 10 experts who could give feedback about our draft review and recommendations.

  • Publishing recommendations

  • Developing a plan for how local action circles could implement some of the recommendations.