An Interdisciplinary Approach to Treating Severe Behavior in a Juvenile Justice Facility: Teaching Behavioral Self-Management via Telehealth.

Adolescents living in residential juvenile justice facilities often receive mental health services during their stay to address committed offenses, yet some display challenging behavior during moments of conflict within the facility. These challenging behaviors could result in risk of harm to self or others, or the individual may experience punishment from facility staff. The purpose of this study was to explore the effects of an additive voluntary focused intervention for individuals who continued to display challenging behavior despite participation in "treatment as usual" in a juvenile justice facility. We implemented a self-management intervention, supported through interprofessional collaboration, via telehealth with four male adolescents. Using Behavior Skills Training, we taught participants to self-monitor precursors for challenging behavior and identify an alternative behavior to engage in to prevent overt challenging behavior events. Alternative behaviors were responses incompatible with the challenging behavior, or served as a rule to prompt self-management of further behavior. Results show all four participants increased their selection of alternative behaviors when presented with an evocative situation and a precursor for a severe behavior event during simulations. In addition, three participants stated they would use alternative behaviors across precursors not presented during teaching; however, two participants required booster sessions to maintain appropriate responding during simulations. Outside of simulated sessions, facility staff reported modest decreases in participants' challenging behavior during and after the intervention.