1. Who Are We?
Universal Health Services (UHS), Inc. is one of the largest and most experienced hospital management companies in the nation. UHS has focused its efforts on managing acute care hospitals, behavioral health centers, and ambulatory surgery and radiation oncology centers. UHS owns and operates 70 such facilities around the country. UHS Neurobehavioral Systems is a new group within UHS that provides specialized assessment and treatment services for neuropsychiatric and neurobehavioral disorders. CNS units are located at psychiatric and medical-surgical hospitals, and in outpatient clinics. The primary focus of the UHS Neurobehavioral Systems units are the effective treatment of aggressive and/or impulsive juveniles.

When this UHS Neurobehavioral Systems' method of neuropsychiatric treatment is applied to long term residential treatment (of impulsively aggressive adolescents), outcome studies have demonstrated positive outcomes ranging from 86% to 90%. Positive outcome means that, after discharge (following residential neuropsychiatric treatment) the patient shows no further violent episodes, no re-hospitalization, no runaways, no incarceration, and has followed the aftercare plan with continuation of school (or work). Outcome studies are in progress for neuropsychiatric treatment in short term, acute UHS Neurobehavioral Systems treatment programs.

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2. What Is A Neurobehavioral Disorder?
"Neurobehavioral" refers to the type of behavioral problems that are associated with brain disorders. It is a term frequently used to describe the serious behavioral problems often seen after traumatic brain injury. For example, explosive rage behavior, impulse control problems, mood swings, and poor judgment are neurobehavioral problems. However, this term also applies to developmental brain problems that are the result of fetal exposure to drugs or alcohol (e.g.; fetal alcohol syndrome, crack babies, etc.), or other early brain impairments such as anoxia at birth or shaken child syndrome. When these brain impaired children become adolescents, they sometimes display the same neurobehavioral problems seen in traumatic brain injury cases, including violent temper and very poor impulse control. Unfortunately, traditional psychiatric treatment has been ineffective with these neurobehavioral disorders. The brain problem is a barrier to successful counseling, and typical psychiatric medicines are of limited benefit.

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3. How Is "Neurobehavioral" Treatment Different?
First of all, it is based on a thorough assessment of the brain function as well as psychosocial issues. Many of these children have language or memory disorders that prevent verbal psychotherapy from being effective. Some of these children have partial complex seizure disorders and other treatable brain conditions. By treating those correctable brain disorders and then using modified methods of therapy (e.g.; non-verbal therapy to bypass language and memory problems), it is possible to more effectively manage the violent behavior and allow for a re-socialization process to take place. If the individual’s actions present a danger to himself/herself and others, or if symptoms are severe, treatment in a CNS inpatient unit is recommended. Once stable and manageable, the juvenile is ready for discharge to a structured aftercare plan.

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4. How Long Does Neurobehavioral Treatment Take?
To stabilize violent behavior, complete a comprehensive assessment process, and develop an aftercare plan, UHS Neurobehavioral Systems Acute programs require 12 to 30 days assuming the patient is going to be placed in a structured and supervised community setting. Children and adolescents requiring a longer course of treatment may be referred for UHS Neurobehavioral Systems residential treatment.  The length of stay can range from 6 weeks to several months.  Completion of this extended treatment process allows the problem to be fixed permanently and to prevent repeat acute hospital admissions. Although aftercare is still required after discharge, this aftercare can be organized on an outpatient basis.

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5. Can Outpatient Assessments Be Accomplished?
In cases where the patient is impulsively aggressive but not highly dangerous, outpatient assessments are available at many of the UHS Neurobehavioral Systems program facilities. Outpatient assessments are possible for children from age 5 and up, and also for adults. At this time, inpatient services are only available for juveniles aged 5-17. Outpatient assessments are also available for attention, learning, language, and neurobehavioral disorders. Electrophysiological (EEG and evoked potentials) studies can also be accomplished on an outpatient basis.

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6. What About Staff Credentials?
UHS Neurobehavioral Systems programs are only placed in licensed hospitals and each program has a medical director who supervises all attending physicians. All staff, except technicians and clerical staff, are licensed or certified professionals. The staff includes a neuropsychologist, occupational therapist, speech pathologist, and master’s level therapists. The program director is usually a master’s prepared nurse, and each shift has an R.N. and trained technical staff.

The UHS Neurobehavioral Systems national team includes a group of professionals who organize, train, and facilitate the development of each UHS Neurobehavioral Systems unit. Dan Matthews, M.D. is the National Medical Director for all UHS Neurobehavioral Systems programs. Dr. Matthews has treated over 5,000 cases of violent juveniles. Larry Fisher, Ph.D. is the National Director of Neuropsychological Services. 

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7. What Other Services Are Included In UHS Neurobehavioral Systems Units?
Special education services, recreational services, speech and occupational therapy are available. Each unit has access to electrophysiological studies and most have EEG and evoked potential equipment, as well as neuropsychological testing equipment, on the premises. The UHS Neurobehavioral Systems staff at each unit, and the national staff as well, are available to conduct inservice educational sessions on the management of violent juveniles.

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The term "EEG" stands for Electroencephalogram. The EEG is a medical test that measures the electrical activity of the brain and, among other things, is used for the diagnosis of epilepsy. Electrodes are placed on the scalp to pick up the electrical activity that is occurring in the brain. It is a non-invasive test that is used when a doctor suspects that an episodic behavior is being caused by an electrical disorder in the brain. Episodic staring spells, shaking of the body, fainting spells or convulsive seizures are common behaviors that may be symptoms of electrical problems in the brain. However, there are other episodic behaviors that may lead a doctor to order an EEG for a patient. These may include some psychiatric symptoms such as poor emotional control or sudden onset of a loss of impulse control. For example, rapid mood swings or repetitive episodes of explosive aggression (against self, others or property) can sometimes be associated with brain electrical disorders. The doctor may order an EEG test.

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Two common types of evoked potentials are Auditory Evoked Responses (AER) and Visual Evoked Responses (VER). Evoked response measurement is similar to an EEG, using the same electrodes on the scalp, the same EEG machine, and a similar measurement of the electrical activity of the brain. However, whereas the EEG measures the ongoing electrical activity of the brain, the Evoked Response (as the name implies) measures the electrical response evoked in the brain by either auditory (AER) or visual (VER) stimulation. For example, for the AER, the patient is presented a "click" from an headphone (many times) and the EEG machine measures the brain’s electrical reaction evoked by that sound. For the VER, a flash of light is used instead of a sound. The advantage of this "evoked" response, for psychiatric conditions, is that it allows the doctor to see if there is any electrical abnormality deep inside the brain. Deep electrical disorders are important because the brain’s systems for controlling both emotions and impulses are located deep in the brain (in the Limbic region). Electrical disorders in this deep region can result in poor emotional control and/or poor impulse control. Abnormal findings indicate that medications to treat the source of the problem behavior can be prescribed.

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The most common conditions are listed below:

A. History of hyperactivity and/or developmental delays from early age (e.g.; preschool).

B. Substance abuse from an early age (before age 13).

C. Alcohol/drug exposure during pregnancy.

D. Head injury or physical abuse as a child.

E. Abnormal or "soft" neurological signs.

F. Learning disability or severe school problems.

G. Rage behavior (Intermittent Explosive Disorder).

H. Episodic loss of impulse control or emotional control.

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