Interdisciplinary program treats challenging behavior

Department news | October 31, 2023

As part of the new model of care launched this past March, the Psychiatry and Behavioral Medicine Unit at Seattle Children’s reorganized itself into three programs. These programs consist of the Child Inpatient Program, the Adolescent Inpatient Program, and the Biobehavioral Inpatient Program (BBIP). BBIP is an interdisciplinary program that specializes in the assessment and treatment of children and adolescents with intellectual and developmental disabilities, including autism, who engage in severe challenging behavior such as aggression, non-suicidal self-injury and property destruction. The team consists of a psychiatrist, psychologist, behavior analysts, social worker, case manager and direct care staff that includes nurses and behavior technicians. BBIP is the only inpatient program of its kind in the WWAMI region and one of nine in the country.

There are two levels of programming in BBIP. The first level is a social environment based on Positive Behavioral Interventions and Supports. This milieu provides many forms of visual prompts and schedules to help the patients understand the structure and expectations of the program and positive reinforcement systems to help them be successful in following those expectations.

In the second level of programming, patients participate in Applied Behavior Analysis (ABA) sessions led by behavior analysts. These are focused on assessing the variables that maintain challenging behaviors and evaluating treatment components that effectively decrease those targeted behaviors. The team tracks medication and environmental effects on the behaviors and identifies trends across days. Once effective treatments are identified in the focused ABA sessions, they are generalized back out into the first level of programming and evaluated for effectiveness.

Overall, the two levels of interventions allow the clinical team to better understand the interplay between medical, pharmacological and behavioral variables and how those variables contribute to the occurrence and maintenance of challenging behaviors. Because BBIP produces a large amount of behavioral data as part of standard clinical practice, the clinical team will have the ability to produce clinical research for dissemination. In addition to research, the program will be a hub of training for psychiatry fellows, psychology interns and behavior analysts thus increasing the workforce of providers that have experience working with this population.