Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Kwong WY (1), Tang TL (1)
Affiliation :
(1) Child and Adolescent Psychiatry, Castle Peak Hospital
Introduction :
Refractory Autism Spectrum Disorder (ASD) cases are prone to exhibit more challenging behaviour, including aggression, self-harm and destructive behaviour. In Child and Adolescent Psychiatry, Castle Peak Hospital, the refractory ASD cases have prolonged hospitalisation with an average length of stay of 2.2 years due to their persistent behaviour problems. Its impact reflected on the issues of placement problem, congested ward environment, carer stress, application of restrictive measures, staff and patients’ incidents and service quality as well as the team morale. In view of this, staff applied the Evidence-based practice for managing the behaviour problems since March 2023 including 1. TEACCH (Treatment and Education of Autistic and Communication Handicapped Children) Model with environment modification supplemented of physical structure, scheduling, work system, routine and visual structure 2. Applied Behaviour Analysis for Behavior Modification
Objectives :
(1) to promote and apply the evidence-based practice (2) to reduce the severity of challenging behaviour; (3) to reduce the frequency of application of physical restraint; (4) to improve staff and relatives’ satisfaction in caring refractory ASD cases; (5) to improve the quality of life: domains including able to attend Red Cross School teaching, training by Occupational Therapist, Ground Parole during visiting hour, Day Leave, join leisure activities in day room.
Methodology :
A ‘Pre-test’ vs ‘Post-test’ design was adopted and collected data in 2/2023 and 11/2023 respectively. Subjects were (1) refractory ASD cases; (2) staff; (3) relatives. Outcome measures were categorised as: (1) severity of challenging behaviour by using Challenging Behaviour Index (CBI); (2) frequency of application of physical restraint; (3) satisfaction survey among relatives and staff; (4) quality of life.
Result & Outcome :
CBI results showed that the severity of challenging behaviour reduced 72.3% in 9 months. Frequency of application of restraint reduced 89.95% within the period from 2 to 11/2023. Staff mean satisfaction score increased from 3.5/10 to 8/10, and relative mean satisfaction score increased from 3.25/10 to 7/10. Cases’ quality of life were also improved by being able to attend different social activities in day time, such as able to attend Red cross School teaching sessions, have plans for placement, ground parole with relatives during visiting. Therefore, EBP should be promoted and applied in child and adolescent psychiatry.
