“The need is certainly there. This is the only
unit in Massachusetts that does what we do.”
Maureen Diana, RN Clinical Program Director

Arbour-Fuller Hospital’s Maureen Diana, RN, is the Clinical Program Director of the Intellectual Disabilities Unit and has been very involved with preparing for the unit’s expansion.

The intellectual disabilities program provides care for adults with permanent developmental disability who are experiencing an acute psychotic episode. The program originated in 1989 as a 4-bed unit that grew to 12 beds over the following 20 years. In December of 2015, the program moved to a larger unit and expanded to 20 beds.

One of the expected changes with the increase of patients is a greater variety of behaviors, some requiring a higher staff-to-patient ratio such as patients who are aggressive or exhibit self-injurious behavior. New staff were added related to the additional bed capacity and in anticipation of the increased needs in patient treatment, monitoring and administration of behavioral plans.

A large part of the intellectual disabilities treatment program involves many staff-led group activities. Groups run all day from 9:00 a.m. to 8:30 p.m. with a quiet hour from 3:00 p.m. to 4:00 p.m. during the shift change.

Diana says, “We start with ‘check-ins’ at the beginning of each shift. There is a community meeting where we review the schedule, do some exercises and open it up to the patients to discuss any communication issues. Then we have groups dealing with coping skills, processing, emotion management and social skills so they can work on different ways to deal with anger, hopelessness or depression.

“There are activity-based groups like art therapy, music therapy and sensory group. We also have groups called Medication Education and A Healthy Lifestyle, which include discussions on basics such as drinking plenty of water, eating protein, wearing a seatbelt, brushing teeth and washing hands. We make these discussions interesting and fun with games and prizes because everybody loves prizes!”

In order to monitor patients, the staff makes use of detailed grids. “A new grid is created daily to monitor and document each patient’s behaviors throughout the day—issues like aggression, medication non-compliance—whatever their external caregivers or internal clinicians want to address while the patient is on the unit. Also checked hourly on the grid are any medication changes and how the patient is responding to their medications.”

The other component of patient treatment is the highly individualized behavioral plans created for those who need to work on something specific. Small rewards are given for hard work on the patient’s part in making progress on their issues. This type of plan is tailored to the individual so staff may provide a special or meaningful prize for a patient who meets a behavioral goal.

“I spent Sunday making Spanish food for one of our Spanish guests.” Diana says, “The agreement was, if he achieved his goals, I would bring in Spanish food.”

“You either understand it and you get it or you don’t.
The people I work with get it. They have been here for
years and years and they still give 100% every day.”
Maureen Diana, RN

“Every one of our staff goes out of their way to reinforce patients who have made progress in the behavioral plan.” Diana says it makes a huge difference. “You connect with the patients and they trust you. When you get through to someone, it’s such a wonderful, rewarding thing.”

With the dedicated staff, Diana feels that the Intellectual Disabilities Unit is ready for 2016.

From AHS News, January/February 2016