In this age of managed care and the pressure for shorter length of stays, acute care inpatient settings have had to adjust to an altered landscape in clinical care. This presents unique challenges to the psychologist who is typically the behavioral consultant on the clinical team. Formal assessments start at admission so that behaviors, particularly difficult and at times unsafe behaviors, can be identified, understood, and addressed quickly. Behavior plans that are concise, targeted and emphasize adaptive coping strategies are the most helpful for patients and staff to maximize clinical care while also addressing the urgent need for stabilization during these brief inpatient stays.

In our inpatient adult psychiatric setting, we use the ERASE model as a foundation for our positive behavioral supports and specifically to develop the behavior plans. We find ERASE to be very helpful in doing the “detective work” that is required to understand and modify patients’ behavior. ERASE is also used as a communication tool and a means of assessing treatment progress. In this chapter, we will discuss how the psychologist as a behavioral consultant can assist the multidisciplinary team, the family, and the patient to view the patient’s behavior as a form of communication and to find ways to meet the needs underlying the patient’s behavior. We will discuss how securing staff interest in being “behavior detectives” helps foster their confidence in working with patients’ difficult or unsafe behaviors. ERASE also serves as a therapeutic tool for the patient and family because the ultimate goal is to help patients understand their behavior and to engage patients collaboratively in their treatment.