A Team Approach to Managing and Changing Challenging Behaviors

1. A Team Approach to Managing and Changing Challenging Behaviors

2. ABCs to Change Behavior A = Antecedents B = Behavior C = Consequences

3. It Seems so Simple…ABC So Why Are All of You HERE? Why Do We Struggle So with the Veterans who have Brain Changes or Impairments?

4. 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 Why Is ABC So Difficult for these Veterans?

5. What Do We Notice First in the ABC Model?In most cases ‘B’ comes before ‘A’

6. Start with ‘B’What behaviors are we talking about? List BEHAVIORS you would consider for using the ABC approach

7. 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 My Examples

8. How Do Our Lists Compare? Match? Mis-Match? Why?

9. 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

10. 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…

11. Then Go to the ‘A’ Antecedents What is DRIVING the Behavior?

12. 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

13. A Quick Example of Complexity… One piece of one part of the puzzle called ‘antecedents’

14. Normal Brain Alzheimers Brain

15. Positron Emission Tomography (PET) Alzheimer’s Disease Progression vs. Normal Brains Early Alzheimer’s Late Alzheimer’s Normal Child G. Small, UCLA School of Medicine.

17. So – A Quick Look at ‘C’ Consequences – What Happens?

18. What Happens? Traditionally 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 • 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

19. 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 What Can YOU Control? OR NOT!

20. For your persons with problem behaviors…REFRAME…Get interested and excitedbe challenged!

21. 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

22. 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

23. 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

24. 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

25. Let’s get started Example Clip