From Dangerous to Discharged: An Application of Social-Learning-Based Procedures in an Acute Hospital Setting

Abstract

Psychiatric inpatients who demonstrate persistent aggressive behavior present unique treatment planning and placement challenges. This article presents the case of a severely Veteran who demonstrated high levels of aggressive behavior as well as persistent adaptive behavior deficits. A comprehensive Treatment Recovery and Rehabilitation Plan (TRRP) based on Social-Learning Program procedures resulted in rapid improvements in recovery-related outcomes and discharge within 31 days of TRRP initiation. This intervention significantly reduced maladaptive behavior and increased treatment participation.These improvements were unrelated to pharmacotherapy changes during the hospitalization. Following discharge, a re-emergence of problematic behaviors in a community placement resulted in a more restrictive rehospitalization. The absence of TRRP implementation at this placement likely contributed to the re-emergence of problem behavior. This case illustrates the importance of implementing evidence-based psychosocial interventions in acute settings, engaging in recovery-oriented treatment planning, and maintaining continuity of care across settings.