COMPREHENSIVE, MULTIPHASED PROGRAM TO ADDRESS SELF-INJURIOUS BEHAVIOR By Dr Nadeem Ghayas

August 31, 2024

A comprehensive, multiphased approach to addressing self-injurious behavior (SIB) involves a series of interconnected strategies designed to gradually reduce the behavior while promoting positive alternatives. Here’s a more detailed and paraphrased breakdown of the program components:

1. Initial Use of Reinforcement and Physical Restraint: In the early stages, physical restraint is employed to manage self-injurious behavior. This tactic is intended to prevent immediate harm but is coupled with a system of reinforcement. Over time, the program seeks to extend the intervals during which the individual refrains from self-injury before restraint is applied. Additionally, if self-injury occurs, the program may incorporate a “timeout” approach from restraint to reinforce periods of non-injury.          Example: Consider Atif, who hits his head against the wall. Initially, whenever Atif exhibits self-injury, he is physically restrained for a set duration (e.g., 10 minutes). The program aims to lengthen the time Atif can go without self-injury before restraint is needed. If Atif manages to avoid self-injury for 5 minutes, he is not restrained; however, if self-injury occurs, he may receive a shorter duration of restraint (e.g., 5 minutes) as a timeout.
2. Gradual Reduction of Physical Restraint (Fading Restraint): This phase involves the systematic reduction of physical restraint as Atif demonstrates better control over his behavior. The duration and frequency of restraint interventions are progressively decreased, with the ultimate goal of phasing out physical restraint altogether while maintaining effective behavior management.  Example: In the initial phase, Atif is restrained for 10 minutes following each incident of self-injury. As improvement is noted, the restraint duration is reduced to 5 minutes, and Atif must display improved behavior for 10 minutes before restraint is applied. Eventually, the program aims to eliminate physical restraint, replacing it with verbal guidance or other non-restrictive interventions.
3. Introducing Less Restrictive Alternatives to Restraint: This strategy involves finding and implementing alternative methods to manage self-injurious behavior that are less restrictive than physical restraint. The goal is to replace physical restraint with supportive interventions that help Atif manage his behavior in a more constructive manner.              Example: Instead of physical restraint, Atif might be provided with calming alternatives, such as a quiet, comfortable space or a soft, weighted blanket, to manage his behavior. These methods are designed to offer comfort and support without the need for physical intervention.
4. Token Reinforcement for Positive Behavior: A token reinforcement system is used to reward Atif for engaging in adaptive and positive behaviors. Tokens or other rewards are given for displaying appropriate behavior, reinforcing desirable actions, and reducing the frequency of self-injurious behavior.  Example: Atif earns tokens for every 30 minutes he refrains from self-injury. These tokens can be redeemed for preferred items or activities, such as extra screen time or a favorite snack. As Atif progresses, the system may be adjusted to require longer periods of non-injury for token rewards, with the rewards becoming more significant or meaningful.
5. Training for Parents and Vocational Staff: Successful implementation of the program requires the active involvement of parents and vocational staff. Training these individuals ensures they understand and consistently apply the behavior management strategies both at home and in vocational settings. Consistent application of the program’s strategies across different environments is crucial for reinforcing positive behavior and reducing SIB.                      Example: Atif’s parents receive training on how to use the behavior management strategies, such as the token system and recognizing early signs of self-injury. Similarly, vocational staff are trained to manage Atif’s behavior in the workplace, including how to apply calming strategies and the token reinforcement system.

In summary, this multiphased program integrates behavior management techniques, positive reinforcement, and the involvement of caregivers to effectively address and mitigate self-injurious behavior. The approach focuses on gradually reducing restrictive measures, promoting positive behaviors through rewards, and ensuring consistent support across different environments.