Applying positive behaviour support with adolescents: a trauma-informed hospital discharge model

Purpose The hospital discharge service (HDS) supports children and young people (CYPs) aged 11–17 to return from hospital settings to their communities. The purpose of this study is to demonstrate that positive behaviour support (PBS), incorporating data-driven decision-making, functional assessment and multicomponent approaches, is effective and essential in care planning. Design/methodology/approach Using constructional and evidence-based approaches focused on individuals with learning disabilities (LDs) accessing PBS, HDS has generalised these methods to promote well-being, resilience and quality of life (QoL). This article reports on a model applying PBS approaches (Gore et al., 2022) for CYPs without LD who present in behavioural crisis, integrating trauma-informed care, co-production and family resilience strategies to support safer transitions. Findings Since inception, HDS has supported 32 CYPs, with preliminary outcomes suggesting high social validity (Table 1); an average 92% increase in the score of Experience of Service Questionnaire (ESQ); increases in mediator confidence scored by the Sheffield Learning Disabilities Outcome Measure (SLDOM) (Delahunty et al., 2018); (Table 2), an average increase of 45%; and goal score increases for all CYPs and mediators who set goals and attended the HDS five-stage model, with an average increase of 49% (Table 3). To date, 72% of CYPs have not re-presented for a non-medical need, i.e. when in a behavioural crisis. This model demonstrates the potential of extending PBS-informed interventions beyond the current UK literature regarding LD support and schoolwide PBS. Findings highlight the importance of PBS-informed discharge for marginalised adolescents who often fall between statutory provisions, contributing to the growing literature of PBS beyond LD populations in the UK. Research limitations/implications A limitation of the HDS model is that it is reactive, as it is supporting the CYPs once they have made contact with acute hospital settings. The authors would suggest a focus on community-based engagement to reduce the risk of escalating support needs and promote QoL for CYPs. A hospital for medically optimised CYPs does not serve well-being and can inadvertently compound trauma support needs. The authors would suggest further research on early identification during exam season of CYPs requiring additional support regarding emotional well-being and suicidal ideation. Originality/value PBS is recognised as an evidence-based practise for people with learning disabilities, however the evidence regarding its application in different contexts and for different populations is more limited. This paper examines a novel application of PBS in the context of a hospital discharge service supporting adolescents who are medically optimised to return to the community. To the best of the authors’ knowledge, this is the first research paper which considers such a cohort receiving PBS-focused intervention.