A Team Approach to Managing and Changing Challenging Behaviors

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A Team Approach to Managing and Changing
Challenging Behaviors
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ABCs to Change Behavior

• A Antecedents
• B Behavior
• C Consequences

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It Seems so SimpleABC

• So Why Are All of You HERE?
• Why Do We Struggle So with the Veterans who have
• Brain Changes or Impairments?

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Why Is ABC So Difficult for these Veterans?

• MANY abilities are affected
• Thoughts
• Words
• Actions
• Feelings
• It is variable
• Moment to moment
• Morning to night
• Day to day
• Person to person
• Place to place
• Some changes are predictable BUT complicated
• Specific brain parts
• Typical spread
• Some parts preserved

• If it is progressive
• More brain dies over time
• Different parts get hit
• Constant changing

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What Do We Notice First in the ABC Model?In
most cases B comes before A
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Start with BWhat behaviors are we talking
about?

• List BEHAVIORS you would consider for using the
  ABC approach

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My Examples

• No F PoA or HC PoA
• Losing Important Things
• Getting Lost
• Unsafe task performance
• Repeated calls contacts
• Refusing
• Bad mouthing you to others
• Making up stories
• Resisting/refusing care
• Swearing cursing
• Making 911 calls
• Mixing day night
• No solid sleep time
• Not following care/rx plans
• No initiation
• Perseveration

• Paranoid/delusional thinking
• Shadowing
• Eloping or Wandering
• Seeing things people
• Getting into things
• Threatening caregivers
• Undressing in public
• Pxs w/intimacy sexuality
• Being rude
• Feeling sick
• Use of drugs or alcohol to cope
• Striking out at others
• Falls injuries
• Contractures immobility
• Infections pneumonias
• Pxs w/ eating or drinking

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How Do Our Lists Compare?

• Match?
• Mis-Match?
• Why?

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What If We Categorize

• Annoying not a big issue, but wearing over time
  takes time away from other responsibilities
• Risky could cause harm to self or others, not
  always dangerous, but can be unpredictable as to
  when it will be serious
• Dangerous puts the person, the care provider,
  other people, or equipment in jeopardy or at
  immediate risk for injury

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We tend to ABC the Dangerous BehaviorsTry
to care plan or respond to the Risky Behaviors
when we see themExpect or put up with the
Annoying Behaviors until
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Then Go to the A

• Antecedents
• What is DRIVING the Behavior?

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What Makes BEHAVIORS Happen?

• SIX pieces
• The type level of cognitive impairment NOW
• The person who they have been
• Personality, preferences history
• Other medical conditions sensory status
• The environment setting, sound, sights
• The whole day how things fit together
• People - How the helper helps -
• Approach, behaviors, words, actions, reactions

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A Quick Example of Complexity

• One piece of one part of the puzzle called
  antecedents

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Normal Brain
Alzheimers Brain
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Positron Emission Tomography (PET) Alzheimers
Disease Progression vs. Normal Brains
Early Alzheimers
Late Alzheimers
Normal
Child
G. Small, UCLA School of Medicine.
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So A Quick Look at C

• Consequences What Happens?

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What Happens?

• Traditionally

• Non-Traditionally

• We wait till it gets dangerous or at least
  risky
• We blame
• We knee jerk react
• We treat the immediate
• We become parental
• We become judges
• We give up
• We go thru the motions
• We go to drugs 1
• anti-anxiety anti-psychotic

• ABC Annoying behaviors
• Become a detective
• Get EVERYONE involved early and often
• Re-look monitor - lots
• Change what is easiest first
• Change what can be controlled
• Celebrate all improvements
• Start by changing OURSELVES

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What Can YOU Control? OR NOT!

• CONTROL
• The environment setting, sound, sights
• The whole day how things fit together
• How the helper helps -
• Approach, behaviors, words, actions, reactions

• NOT CONTROL
• The person who they have been
• Personality, preferences history
• The type level of impairment NOW
• Other medical conditions sensory status

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For your persons with problem behaviorsREFRAME
Get interested and excitedbe challenged!
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Describe the Behavior

• Consider video to investigate
• Use objective language to describe THE BEHAVIOR
• Investigate NON-CHALLENGING BEHAVIOR -
  investigate what is going on when the behavior
  is NOT happening..
• Check it out from all perspectives 360

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Investigate Carefully!!!

• From Microscope to Telescope.
• Use a sensory approach
• look, listen, feel, smell, taste, movement
• Check out the environment
• Look at public, personal, intimate space issues
• Get in their shoes position
• Pay attention to cues and responses
• Look at timing, sequencing, responses

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Why a Team?

• Life happens 24/7
• These ABCs complicated multi-factorial
• The ABCs affect everyone
• Each person will decide to participate or not
• To optimize positive outcomes, it works best if
  we
• Have a common goal
• Start off in the same place
• Have a game plan
• Move in a planned, consistent direction
• Check in regularly
• Make adjustments as needed
• CELEBRATE the AH HA moments share the AH OHs

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What Makes BEHAVIORS Happen?

• SIX pieces
• The type level of cognitive impairment NOW
• The person who they have been
• Personality, preferences history
• Other medical conditions sensory status
• The environment setting, sound, sights
• The whole day how things fit together
• People - How the helper helps -
• Approach, behaviors, words, actions, reactions

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Lets get started

• Example Clip