A Team Approach to Managing and Changing Challenging Behaviors
A Team Approach to Managing and Changing Challenging Behaviors ABCs to Change Behavior A = Antecedents B = Behavior C = Consequences 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? Why Is ABC So Difficult for these Veterans? MANY abilities are affected If it is progressive 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 More brain dies over time Different parts get hit Constant changing What Do We Notice First in the ABC Model?
In most cases B comes before A Start with B What behaviors are we talking about? List BEHAVIORS you would consider for using the ABC approach 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
How Do Our Lists Compare? Match? Mis-Match? Why? 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 We tend to ABC the Dangerous Behaviors Try to care plan or respond to the Risky Behaviors when we see them Expect or put up with the Annoying Behaviors until Then Go to the A Antecedents What is DRIVING the Behavior?
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
A Quick Example of Complexity One piece of one part of the puzzle called antecedents Normal Brain Alzheimers Brain Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains Normal Early
Alzheimers G. Small, UCLA School of Medicine. Late Alzheimers Child So A Quick Look at C Consequences What Happens? What Happens?
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
Non-Traditionally 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
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 For your persons with problem behaviors REFRAME Get interested and excited
be challenged! 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 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 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 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 Lets get started Example Clip
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