Coping with Challenging Behaviors

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Coping with Challenging Behaviors
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REALIZE

• It Takes TWO to Tango or tangle

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Learn to Dance with Your Partner
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When Something Is Not Working Well

• What Do We Tend to Do?

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Being right doesnt necessarily translate into
a good outcome for both OR either of you
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Deciding to change your approach and behavior
WILL REQUIRE you to stay alert and make
choices it is WORK
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Its the relationship that is MOST critical NOT
the outcome of one encounter
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Who Are YOUR Challenging People?

• Who Challenges YOU?

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What are the Challenging Behaviors that GET TO
YOU?
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By managing your own behavior, actions, words
reactions you can change the outcome of an
interaction.
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REALLY Ask Yourself

• Is this Behavior a Problem Behavior
• OR
• is this a So What Behavior
• An Annoying Behavior

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Is it REALLY a Problem?Is it a RISKY BEHAVIOR?

• Risk to that person (physical, emotional,
  physiological risk)?
• Risk to the caregiver?
• Risk to Others?
• Is the RISK REAL and IMMEDIATE?
• If NOT, it is a SO WHAT behavior

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If it is a SO WHAT Behavior

• Leave it ALONE!
• Figure out how to let go of it
• Let it go!

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If it is RISKY

• Describe the behavior OBJECTIVELY
• WHO?
• WHAT?
• WHERE?
• WHEN?
• WHAT helps WHAT makes it worse?
• Frequency Intensity?

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SIX Pieces to the Puzzle

• Personal history and preferences
• Level of cognitive function
• Other conditions sensory losses
• Environmental conditions
• Care partner approach and behaviors
• What happened full day all players

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Knowing the Person

• History
• Values and beliefs
• Habits and routines
• Personality and stress behaviors
• Work family history
• Leisure and spiritual history
• Hot buttons comforts

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Level of Cognitive Function

• What CAN the person do?
• What can the person NOT do?
• What CUES are effective? Ineffective?
• What are interests based on level?
• Consistency of Cognitive Level?

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Brain Failure
The persons brain is dying
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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 what is happening?

• Memory damage
• Cant learn new things
• Forgets immediate past
• Does time space travel
• Uses old memories like new
• May not ID self or others correctly
• CONFABULATES
• Follows visual cues
• Seeks out the familiar
• Can get stuck on an old emotional memory track

• Language damage
• Has very concrete understanding of words
• Misses 1 our of 4 words may miss Dont
• Word finding problems
• Word salad problems
• COVERS
• Follows your cues
• Gets very vague repeats
• Uses automatic responses
• Mis-speaks

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So what is happening?

• Impulse Control Problems
• Say whatever they are thinking
• Swear easily
• Use sex words or racial slurs when stressed
• Act impulsively
• Not think thru consequences
• Cant hold back on thoughts or actions
• Responds quickly strongly to perceived threats
• Flight, fight, fright

• Performance Problems
• Thinks they can do better than they can
• Can sometimes DO BETTER under pressure
  sometimes worse
• Uses old habits
• Attempts can be dangerous or fatal
• They will tell you one thing and then do another
• Families may over or under limit activities

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How do these losses relate to some risky
behaviors?

• Persistent going
• inability to terminate
• not able to anything else
• discomfort
• Eloping - escaping
• following cues
• wanting to leave
• going somewhere
• Constant talking or vocalizing
• Trying to communicate
• Self-stimulating
• Lack of Initiation
• Wont move or cooperate

• Lost and Looking
• cant find places
• looking for familiar
• Invading space
• automatic actions
• following interests habits
• no awareness of personal space
• Shadowing
• looking for help
• Comfort
• Resisting care
• Self-care
• Movement

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Level 5 - Routines RepeatsDiamonds

• Word finding problems
• Logic problems
• Place time confusion
• Very independent or seeking constant
  reassurance
• Resents take-over
• Self-awareness varies
• Fearful about what is wrong
• Typically resists outside helpers

• Becomes anxious and frustrated easily
• Has trouble with new routines and locations
• Tries to maintain control social behavior
• May try to escape/leave
• Can use signage cues
• Gets turned around
• Momentarily disoriented
• Does regular routines JUST FINE!

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Level 4 - Task OrientedEmeralds

• Has trouble sequencing thru tasks activities
• Often skips steps
• Looking for what to do and where to be
• Believes they can do it
• Dont need your help
• Has a mission in mind
• Goes back in time
• Gets lost in place

• Uses visual information to figure out what to do
• Follows samples demos
• Cant do an activity if visual prompt is not
  there
• Specifics and content in speech can be limited
• Gets stuck on stuff
• Needs to be involved
• Looks for stuff to do

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Level 3 - Hunting GatheringAmbers

• Imitates actions copies you
• Tool use is challenging
• Follows others
• Investigates the environment
• May taste or eat what they see
• Difficulty terminating
• Difficulty getting focused on care tasks
• Becomes easily distressed with unpleasant tasks
• Asks ?s mechanically

• Uses hands to touch, feel, handle, hold
• Explores what is visible and hidden
• Invade others space to explore
• Repeats actions over and over
• Sees in pieces not whole
• Impulsive or indecisive
• Understands few words

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Level 2 - Stuck on GORubies

• Gross motor only
• Poor finger use
• Limited visual processing
• Very limited communication skills
• Unable to do more complex motor actions
• Imitates those around
• Problems with chewing and swallowing

• Cant stop or sound asleep
• Copies your mood facial expressions
• Cant grade strength
• Better with rhythm and repetitive movements
• Loses weight
• On the move wanders forward no safety
  awareness

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Level 1 Reflexes RulePearls

• Bed bound or chair bound
• Unable to sit up for any length of time
• Unable to communicate verbally
• Lots of reflexes
• Breathing changes
• Moments of being present
• Can make eye contact some automatic responses

• Swallowing and eating problems
• Muscles shorten and contractures forms
• Pressure areas develop because of no movement
  limited intake
• Responds to touch, voice, movement, smells
• Startles easily
• Motor agitation indicates needs

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Health Illness

• Mobility problems?
• Pain?
• Sensory problems?
• Mental health issues?
• Other diagnoses of importance?

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Comparison of Fat Pads
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Environmental Factors Changes

• Physical Environment
• People
• Programming

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Environmental Aids

• Setting
• familiar
• friendly
• functional
• forgiving (safe)

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Environmental Aids

• Props
• visible invisible
• timely
• available
• matched to ability
• matched to interests

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Care Partner

• Approach
• Knowledge
• Skills

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Three Reasons to Communicate

• Get something DONE
• Have a conversation
• Help with distress

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Communication Getting the person to DO
Something

• Form a relationship FIRST
• Then Work on Task Attempt

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Connect

• 1st Visually
• 2nd Verbally
• 3rd Physically
• 4th Emotionally
• 5th Individually - Spiritually

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How you help

• Sight or Visual cues
• Verbal or Auditory cues
• Touch or Tactile cues

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To Connect

• Use the Positive Physical Approach

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Your Approach

• Use a consistent positive physical approach
• pause at edge of public space
• approach within visual range
• approach slowly
• offer your hand make eye contact
• call the person by name
• stand to the side to communicate
• respect intimate space
• wait for a response

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Hand-Under-Hand Position
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Your interaction

• Communicate with awareness
• look, listen, think!
• give your name
• make an empathetic observational statement
• You look busy...
• It looks like you are tired
• It sounds like you are upset
• wait for a response

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Give information

• Keep it short and simple
• Its lunch time
• Lets go this way
• Heres your socks
• Use familiar words and phrases
• Use gestures and props to help

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Encourage Engagement

• ask a person to try
• ask a person to help you
• give simple positive directions - 1 step at a
  time

• use props or objects
• gesture
• demonstrate
• guide
• distract
• redirect

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Daily Routines Client-Centered Programming

• Old habits and routines
• Patterns during the 24 hrs
• A time to rest, work, playsocialize
• Your needs my time

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To Cope with Challenging Behaviors

• Where will you start???
• An idea
• Care partner education
• Care partner skill building

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Then

• Observe document the risky behavior thoroughly
• what is the pattern
• when does it happen
• where does it happen
• who is involved
• what is said, done, attempted
• what makes it better worse

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Is it really a problem? A RISK

• If NO - leave it alone
• If YES - its time to problem solve
• call the team together
• put on the thinking caps

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REMEMBERExplore all of the following -

• Personal background information
• Level of cognitive function
• Health information
• Environmental issues
• Caregiver approach assistance
• Habits, schedules time of day

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Re-look at the problematic challenging behavior

• What does the person need?
• What is the meaning of the the behavior?
• Do you understand the risky behavior better?

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Make a PLAN!

• Who will do what
• When will it be done
• How will it work
• What environmental change is needed
• What props are needed - where will they be

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Implement your plan!

• Keep track of progress
• Document what is happening
• Communicate among the team members
• Rethink - if it isnt working.
• CELEBRATE - if it is!

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How can we help better?

• It all starts with
• your approach!

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How you help

• Sight or Visual cues
• Verbal or Auditory cues
• Touch or Tactile cues

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What Do They Do?

• Question
• Refuse
• Release verbal
• Intimidate physical
• Tension reduction

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What Should You Do?

• Be supportive
• Offer choices be directive
• Set realistic limits
• Act Take control
• Re-connect

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Believe -

• People
• Are doing
• The BEST they can!

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What shouldnt we do???

• Argue
• Make up stuff that is NOT true
• Ignore problem behaviors
• Try a possible solution only once
• Give up
• Let them do whatever they want to
• Force them to do it

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So WHAT should we do???

• Remember
• who
• has the healthy brain!