Behavioral Health Highlight from 2025 Annual Meeting Poster Session
This year’s 2026 CALTCM Annual Conference is just around the corner. Last year, I was impressed by the large number of submissions that had a significant impact on clinical practice. I wanted to highlight one of these posters through the Wave.
One of the most difficult challenges that occurs in the post-acute and long-term care (PALTC) settings is behavioral crisis involving verbal and physical altercations. Skilled nursing home administration and staff often panic and take on reactive responses, and nursing home attendings may be called rarely for emergency medications. Some altercations require mandatory reporting to CDPH followed by a CDPH investigation. As I’m often called as a medical director (and psychiatric consultant) to review such crises, I found this poster from the 2025 CALTCM annual meeting by Sabine Gysens, PhD, Shannon Bevett, RN and Lin Lin Sae, RN, particularly relevant and prescient. I thank Dr. Gysens for answering follow-up questions about her poster for this article.
Dr. Gysens is a Clinical Neuropsychologist at Laguna Honda Hospital and Rehabilitation Center (LHH). She and her colleagues outlined a proactive, holistic approach to managing behavioral challenges at LHH. They highlighted that behavioral challenges among LTC residents often led to crisis-driven interventions rather than a systematic, proactive approach. They established a “Therapeutic Care Team (TCT)” to implement early intervention, to collaborate with frontline caregivers, and to empower staff through education and guidance. The TCT team consists of RNs and CNAs trained by Dr. Gysens and her colleagues. The TCT members met weekly for a year-long series of meetings that included hands-on case reviews, taking into account principles of behavioral management and environmental control, focusing on de-escalation, and managing aggressive behaviors using the least restrictive methods. It focuses on safety and staff confidence.
TCT members focused on understanding their own and other staff's roles in perpetuating negative behavior. They often discussed how not to personalize (e.g., avoid verbal abuse) and to consider it in the context of the person’s life experience. TCT members participated in staff huddles and behavioral rounds and added patients for case reviews, either called by staff or flagged by monthly psych reviews (based on Certification and Survey Provider Enhanced Reporting (CASPER)). The team focused on identifying resident triggers, improving staff self-efficacy, and creating feedback loops to evaluate intervention efficacy.
The TCT team and frontline staff also complete a form as part of the care plan development. These include information gathering and proactive planning, as a team. Some questions include:
Gathering Information
1. What sensitivities/triggers are important to be aware of?
2. What approach is the resident most receptive to?
3. What happened? What was the event/behavior?
4. What may have contributed to this (triggers)?
5. Has this happened before?
6. Has anything helped?
7. Has anything made it worse?
8. What is working?
Proactive Planning
9. What are areas for improvement?
10. Recommendations for future approaches?
Initially, frontline staff viewed TCT nurses as surveillance figures, but over time they recognized their supportive, non-punitive role. Increased calls to TCT for guidance led to improved staff satisfaction and reduced physical and verbal aggression among residents. The study examined 48 residents and showed a 17% reduction in physical aggression and a 29% improvement in verbal aggression between 2024 and 2025. Overall, Dr. Gysens showed that using a systems-based, individualized approach to behavioral management improved both staff satisfaction and resident behavioral health outcomes.
I asked Dr. Gysens about the possibility of future educational events to disseminate her work. She highlighted some additional points for emphasis, which I thought were critical for clinician educators and medical directors as we attempt to collaborate with our frontline staff members:
- Learning behavioral interventions requires “hands-on” training and REPETITION
- One can learn about the theories of behavioral management, but applying them is a matter of PRACTICE.
- It’s often hard to avoid “personalizing” and taking a “meta level” perspective (or bird's eye view).
As a medical director, I know that behavioral health crises are not necessarily at the forefront of every facility. However, I believe the same approach can be used to address common clinical challenges, such as reducing readmissions, falls, and even patient/family satisfaction. First, we need to work as a team - that includes frontline staff and a coordinating team (such as the TCT). This group will work on gathering information, brainstorming, and planning out proactive interventions. The outcomes are then used to inform further information gathering and refine the interventions. This is the essence of the Plan-Do-Study-Act (PDSA) quality-improvement approach. Most importantly, REPETITION of this cycle is critical for success!