Management of Challenging Behaviour Mike Holligan Nurse Manager Scottish Neurobehavioural Rehabilitation Service Robert Fergusson Unit
FACTS AND FIGURES • Opened in January 1992 • National Unit • Treatment of head injured adults with associated challenging behaviour • Multi disciplinary approach (51.60WTE Nurses, 3 psychologists, 1.5 SALT, 2.5 OT, Physio, Art Therapy, Associate Specialist, Dietitian, Neuropsychiatry, Socialwork)
FACTS AND FIGURES • 19 BEDDED UNIT (12&7) • TREATMENT APPROACH NON AVERSIVE • IABA LaVIGNA & WILLIS • TREATMENT PHILOSOPHY • RAID DAVIES APT
AIMS OF THE ROBERT FERGUSSON UNIT • TO PROVIDE A NATIONAL SERVICE FOR THE MULTI-DISCIPLINARY ASSESSMENT AND REHABILITATION OF PATIENTS WITH BEHAVIOURAL AND PSYCHIATRIC COMPLICATIONS OF ACQUIRED BRAIN INJURY • TO PROVIDE THERAPEUTIC PROGRAMMES WHICH PROMOTE MOBILITY, OPTIMUM PHYSICAL FUNCTIONING, INCREASE COGNITIVE AND SOCIAL SKILLS AND REDUCE PHYSICAL AND MENTAL DISABILITY. • TO PROVIDE OPPORTUNITIES FOR SOCIAL AND RECREATIONAL ACTIVITIES. • TO PROVIDE SUPPORT AND ADVICE TO RELATIVES, CARERS AND RELEVANT PROFESSIONALS.. • TO PROVIDE A HIGH QUALITY AND STANDARD OF TREATMENT, CARE AND THERAPY.
HOW MANY TREATED • 304 referrals (up to December 2002) • 114 patients admitted since January 1992 • Five patients have been re-admitted.
Define the Challenging Behaviour • Closely observe the behaviour • Define parameters • Agree what is challenging behaviour
Positive Programming Strategies • Teaching New Behaviour • Communication Strategies • Teaching more appropriate alternative behaviours • Assuming a meaning
Two philosophies are fatally flawed Punishment: whereby you spot the things the person does wrong, and ask yourself “What can I do so s/he doesn’t do that again?” Extinction: whereby you work out what the person “gets out of” their behaviour, and resolve that s/he won’t get it any more. E.g: not giving attention for ‘attention-seeking’ behaviour