Behavioral Contracting with Psychiatric Residents in Long-Term Care: An Exploratory Study

作者：Hartz Gary W^*; Brennan Penny L; Aulakh Jasdeep S; Estrin Maria Teresa

来源：Clinical Gerontologist, 2010, 33(4): 347-362.

DOI：10.1080/07317115.2010.502466

• behavioral contracting
• challenging behaviors
• Community Living Centers
• geropsychiatry
• geropsychology
• long-term care
• older adults
• psychiatric
• psychiatric nursing

Behavioral contracting has been widely used in medical and psychiatric settings, but not among residents with psychiatric problems in long-term care settings. We collected demographic, diagnostic, and behavioral contract information from treatment records of 51 long-term care residents (M = 59 years, 96% male, 59% Caucasian), most of whom had at least one psychiatric diagnosis. Noncompliant behaviors were a focus of 71% of behavioral contracts; disruptive behaviors a focus in 59%; and substance-related behaviors in 57% of the contracts. Targeted behaviors were tracked in a subsample (n = 27). In this subsample, disruptive behaviors were the most frequently repeated behaviors, followed by noncompliant and substance-related behaviors. More repetitions of behavior were associated with the presence of a cognitive disorder diagnosis and, marginally, with more medical conditions, and conserved legal status. The findings suggest that, despite having significant health, functioning, and social resource deficits, psychiatric long-term care residents may benefit from behavioral contracting. However, the effectiveness of this approach varies by behavior type, and the cognitive, medical, and social resource deficits of these residents may pose challenges to clinicians who use behavioral contracting with them.

• 出版日期2010