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Challenging & complex behaviours: responsible thinking approach

Information Services
 
 

Behaviour

Challenging & complex behaviours: responsible thinking approach

Acquired brain injury can result in a wide variety of challenging behaviours that can impact negatively on partners, families, carers and the community.

 

Professionals have developed a wide range of responses including rewards/punishments, medication, seclusion, modelling, feedback and token economies. A disadvantage with some of these strategies may be that people who have previouslybeen high functioning independent adults may rebel against methods often associated with managing children's behaviour. Another approach is one that encourages personal responsibility.


THE RESPONSIBLE THINKING PROCESS (TM)

RTP is a set of questions, which when asked respectfully, encourage the person to reflect on their own behaviour and help them to make choices that will meet their goals without compromising the needs or rights of others. The person with a brain injury is encouraged in how to think through their goals and what they are doing in relation to the rules of the setting. Adapting the RTP for managing challenging difficult behaviours after an Acquired Brain Injury recognises that the person may have difficulty monitoring their own behaviour and that they may need prompts (use of the RTP questions) to reflect on their behaviour and to help make choices that are more socially acceptable and ultimately meet their goals.

 

KEY POINTS

You can't make anyone do anything. In the end people always make the ultimate decision on how they want to behave.


You can only control your own behaviour and create a supportive, helpful environment.


Do not tell others what to do. Instead, ask a question that encourages them to reflect on their behaviour.


A good rapport. With a calm non-judgmental interaction is vital when asking the RTP questions.

 

ARRIVING AT AN AGREEMENT

To assist with behaviour change motivational interviewing is done to help the person check if their behaviour is at odds with their goals. Then, a plan or agreement is made whereby expectations are specified and person comes up with ideas about what would be reasonable (logical consequences) should the plan be adhered to, or broken.

 

The idea is to develop an agreement as to what will happen when challenging behaviours are displayed, and what alternatives there are available (see case study).

 

Once the agreement has been made the RTP questions are used as the basis for encouraging the person to reflect on what they are doing and to be responsible for choosing what they will do next.


IF THE PERSON IS STICKING TO THE AGREEMENT

The person is asked "how have you been going with the agreement we made?" and "Has it been helpful?" Responses to their comments may include affirmations such as "Yes, I've noticed you are doing well".


WHEN THEY DON'T ADHERE TO THE AGREEMENT

Once again the approach is through questions, beginning with "How are you going with the agreement we made?" Further questions will help the person explore what is happening, such as "What did you decide would happen if you broke the agreement?" After careful listening to the response they person is again encouraged to self reflect by asking "Is that what you want to happen now?" "Okay, what will you choose to do now?"


IF THEY CONTINUE AGAINST THE AGREEMENT

The key here is to not back down. A typical response would be "Okay, I can see you have chosen to go with ____(the agreed consequences)." Again the focus in on questions such as "Do you want to work with me on this agreement?" If the answer is no then again their choice in the matter is confirmed. The best thing to do then is follow through on the logical consequence agreed upon and calmly remove yourself or the person from the situation, without argument and say "When you are ready to work on this we can talk about it again."

 
OPPORTUNITIES TO GAIN CONTROL

By just asking questions instead of telling someone what they should be doing, you are encouraging them to be more responsible for their own behaviour. By being neutral you will appear to have no investment in which behaviours they choose to exhibit. Ideally this creates an environment for them to gain more responsibility and control over their actions.

 

Case Study

David lives in a residential setting and enjoys spending time in the unit's social lounge. However, over the past six months David has learned that throwing objects around the room and yelling will get attention from the residential staff and visiting family members. He has learned to get what he wants (attention) with certain behaviours (that others find difficult).

It is explained to David that the unit staff and fellow residents find these behaviours difficult.

 

Negotiations with David seek a more appropriate way to gain attention from staff. Meanwhile the staff and family are encouraged to engage socially with David when he is demonstrating more appropriate behaviours.

 

David is respectfully asked, "What will happen if you throw things and yell at staff?" He is helped to arrive at some logical consequences, such as "You guys will ignore me, or I will need to leave". An agreement is arrived at which runs along the lines of "So, we are all agreed that it is ok for you to spend more time in the social lounge, but not when you throw things or yell at staff".

 

Of course, David has spent six months with this behaviour and it doesn't change overnight. But the staff are very consistent with the agreement. They regularly check with David how he is going with the agreement and if it has been helpful.

 

If he breaks the agreement staff use the RTP questions.

 

Staff: How are you going with the agreement we made?
David: Bugger it.
Staff: What did you decide would happen if you threw things at us?
David: That I couldn't stay in the social lounge.
Staff: Is that what you want to happen at the moment?
David: %^$# you all! (Throws a cushion at staff).
Staff: Okay I can see you are choosing not to stay in the lounge. David is calmly escorted away. Later, staff reassure David and help him problem solve any triggers so that he can be in the lounge so long as he is adhering to the agreement.

 

Over the next few weeks staff report a substantial reduction in yelling and items being thrown around the lounge as David begins to understand he is responsible for his behaviour and that he can choose actions with differing outcomes.


 

 

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