A Team Approach to
Managing and Changing
Challenging Behaviors
ABCs to Change Behavior
A = Antecedents
B = Behavior
C = Consequences
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?
Why Is ABC So Difficult for these Veterans?
• MANY abilities are affected • If it is progressive…
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Thoughts
Words
Actions
Feelings
• It is variable
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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
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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
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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)
Alzheimer’s Disease Progression vs. Normal Brains
Normal
G. Small, UCLA School of Medicine.
Early
Alzheimer’s
Late
Alzheimer’s
Child
So – A Quick Look at ‘C’
Consequences – What Happens?
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
• 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
–anti-anxiety & anti-psychotic
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?
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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
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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
Let’s get started
Example Clip