Challenging Behaviors

Integrating new practices into local settings: Developing interdisciplinary treatment plans for challenging behaviorsJan Cavanaugh, PhDPsychologist, Home-Based Primary CareFayetteville VAMCSara Tepfer, MSW, LCSWSocial Worker, GRECCDurham VAMCBarbara Kamholz, MDGeropsychiatrist, DVAMC

Eleanor McConnell, PhD, RN, GCNS, BCClinical Nurse Specialist, GRECC, DVAMCJoined by Conference Faculty as facilitatorsAugust 23-24, 2010

Challenging Behaviors

• Case#1: “Lost in Space…”

• Case #2: “Not the man I married..”

• Case #3: I’m goin’ out of my #*!) mind!

• Case #4: “Gibberish, smibberish”

Four Scenarios

Challenging Behaviors

1. Team approach – make sure key disciplines represented at each table and have a voice

2. Facilitator – earliest birthday3. Note taker – latest birthday

Team analysis of behaviors& development of plan

Challenging Behaviors1. Dangerous or Disruptive?2. Odd or Annoying?

Challenging Behaviors

Tools1. Common language and framework to describe

behaviors2. Brainstorming based on systematic approach to

“assembling puzzle pieces” (handout)3. Template for sharing analysis & plans for 2 of

the 3 scenarios:• Decisions• Rationale

Challenging Behaviors

1. Describe the key behaviors that form the focus of your behavior management plan.

2. List the major “puzzle pieces” you have assembled to prioritize behaviors or develop the plan:

• History, life patterns & preferences• Type and level of cognitive function• Health Issues• Patterns & Routines• Environmental issues• Other people and caregivers?

3. How do you explain the behavior of this person?4. What have you decided to try and why?

• Who will be doing what?• How do you think it might help? • How will you know if it worked?

Assignment

Challenging Behaviors

Time management:

11:00-11:10 – Set up and instructions

11:10-11:20 – First case

11:20-11:30 – Next case

11:30-11:45 – Large group discussion with key insights regarding cases

Decisions

Debates

Insights

Questions

Challenging Behaviors

Collaborators – will provide additional information as needed, facilitate discussion at tables

1. Sara Tepfer, MSW, LCSW

2.Eleanor McConnell, PhD, RN

3.Jack Twersky, MD

4. Rebecca Fromme, PhD

5.Teepa Snow, MS, OTR, FAOTA

6. Barbara Kamholz, MD

7. Jorge Cortina, MD, DAPA

8.Francis Freeman, CNA