Clinical Peer Review: Description of a Comprehensive Model in Behavioral Healthcare
ABSTRACT This article describes a comprehensive model of clinical peer review that was established at a large behavioral healthcare organization serving children, adolescents, and adults with developmental disabilities. The purpose of peer review is to provide routine evaluation of practice standards that will produce the highest quality of habilitative care. The major components of peer review address (a) clinical support and administration, (b) intervention policies and procedures, (c) case consultation, (d) utilization of extraordinary procedures, (e) performance improvement projects, and (f) communication at all levels of the organization. This article discusses implementation of the model, including examples and illustrations, and factors that contribute to positive outcome. This approach to peer review represents a systems methodology that can be adopted by behavioral healthcare and human service organizations to build an in-house program of clinical quality improvement. It is a necessary first step in the large-scale implementation of behavioral services.
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ABSTRACT: Increasing demands for accountability in behavioral services have required data-based and reliable clinical decisions. The importance of reliable data is magnified in settings where restrictive procedures (e.g., therapeutic restraints) and challenging antecedent behaviors (e.g., aggression) are part of the typical treatment day. While reliable data contribute to valid decision making, a number of challenges exist to obtaining these data including, but not limited to, program wide logistics and uncertainty about the independence of observers. The present study acquired interobserver agreement (IOA) data for therapeutic restraints across an entire program day. Data revealed that staff compliance with the recording protocol was high and that a large proportion of therapeutic restraints were captured for IOA purposes. High levels of IOA were also recorded for a number of dimensions of therapeutic restraint implementation. Implications for future research as well as clinical applications are discussed.Journal of Developmental and Physical Disabilities 12/2009; 21(6):473-483. DOI:10.1007/s10882-009-9157-5 · 1.56 Impact Factor
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ABSTRACT: The present study evaluates a training program with paraprofessional service providers at a community-based habilitation setting. Four staff were taught to implement alternative and augmentative communication instruction with an adult who had autism and mental retardation through a combination of instruction, demonstration, behavior rehearsal, and performance feedback. Training was conducted under natural conditions at the adult's group home residence. Three of the four staff were able to maintain near-100% instructional accuracy following initial training. The results add to the limited research literature concerning community-based training of direct-care personnel.Behavior Modification 12/2007; 31(6):847-55. DOI:10.1177/0145445507302893 · 1.70 Impact Factor
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ABSTRACT: Background This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by establishing a fixed-time release (FTR) criterion.Methods Research supporting these approaches within community-based service settings are presented.Results Physical restraint can be effectively reduced and eliminated using antecedent intervention procedures and FTR contingencies.Conclusions Future research on physical restraint reduction and elimination should be conducted among people with intellectual disability. Intervention should include explicit therapeutic goals and methods that are acceptable to service providers. Outcome evaluation should focus on long-term follow-up over months and years. Finally, organizations serving people who have intellectual disability should approach physical restraint reduction and elimination by dedicating sufficient resources and adopting evidence-based practices.Journal of Applied Research in Intellectual Disabilities 02/2009; 22(2):126 - 134. DOI:10.1111/j.1468-3148.2008.00479.x · 1.38 Impact Factor