Behavior Management Plans Decrease Inmate Self-Injury
Barboza, Sharen, Wilson, John S., Corrections Today
Recurrent self-injurious behavior among inmates is one of the most pressing and frequent challenges currently being faced in corrections. The costs are high; self-injurious inmates are at increased risk for loss of limb and life; staff who intervene to restore safety are at increased risk for injury, trauma and burnout; and the additional supervision and care necessary for these inmates, including emergency medical interventions and correctional officer overtime, add another set of costs. Collectively, these costs can quickly exhaust available resources and budgets. The use of behavior management plans (BMPs) to decrease inmate self-injury has been touted in recent publications as successful. To date, much of this success has been anecdotal or limited to single case studies.
BMPs are individualized, systematic programs that combine structured incentive plans with skills training and risk management. They are designed to decrease inmate self-injury that is not driven by suicidal intent or by serious psychiatric symptoms. Self-injurious behavior driven by suicidal intent or serious mental illness requires treatment that addresses these underlying conditions. BMPs are used with inmates who engage in self-injurious behavior in efforts to change their feelings or the environment. For these inmates, self-injury is the targeted problem.
Understanding the Behavior
Developing a BMP begins with an assessment of the behavior's function. This is called a functional assessment. In a functional assessment, mental health staff identify inmate-specific antecedents and consequences that make self-injury more likely to occur. Antecedents are the events, thoughts and feelings that precede the self-injurious behavior; consequences are the events, thoughts and feelings that follow the self-injurious behavior. Self-injurious behavior occurs either because it is triggered by antecedents or because it is reinforced by consequences. It is often produced by some combination of these two. Once the antecedents and consequences are identified, the function of the self-injury can be clarified.
Recurrent self-injury occurs because it "works" for the inmate. It works either by reducing the likelihood of an undesirable experience or by increasing the likelihood of a desired experience. As long as the self-injury continues to provide one of these positive outcomes, it is functional for the inmate and unlikely to decrease. The positive outcomes strengthen the behavior, making it more likely to recur. Bear in mind that what is positive in terms of outcome is subjective and defined by the inmate, not by what observers might deem pleasant or desirable.
The function of recurrent self-injury falls into two broad categories: Self-injury that is primarily triggered by antecedents can be thought of as reactive or emotional; self-injury that is intended to change the consequences can be considered instrumental. It is behavior that is used as an instrument or means to an end. Figure 1 outlines these concepts.
Figure 1. Types of Self-Injurious Behavior Emotional Instrumental * Unplanned * Strategic * Reactive * Means to an end * "Hot blooded" * "Cold blooded" * Focused on prior existing injuries * Focused on future rewards * Driven by antecedents * Driven by eon sequences
Because the same behavior can be emotional, instrumental or a combination of the two, assessment of antecedents and consequences is critical to understanding why the behavior works for the inmate. The same self-injurious behavior (e.g., swallowing foreign objects) can have different functions for different individuals.
To illustrate such differences, consider two self-injurious inmates living on a mental health housing unit at a large city jail. Inmate A has been engaging in self-injury for years. …